Ultrasound evaluation of hepatic vein morphology: a promising simple diagnostic tool?

Considerable advances have been made in the noninvasive assessment of diffuse liver disease. Much of the focus has been on attempts at staging fibrosis without resorting to liver biopsy with its accompanying morbidity. Quantifying the extent or stage of fibrosis is important prognostically, in deciding on treatment, assessing response to treatment and in deciding when to commence surveillance for hepatocellular carcinoma. Much of the recent interest and research activity has been in the use of techniques using imaging-related technology. The main area has been in measurement of liver elasticity using ultrasound [1] or MRI [2]. As liver fibrosis increases the liver becomes less elastic and this change in elasticity can be measured with some degree of accuracy and reproducibility. A second and, to date, less convenient and robust approach, has been the measurement of transit time of microbubble ultrasound contrast agents through the liver [3]. Microbubble transit time tends to decrease with development of more severe fibrosis and cirrhosis, most likely as a result of intrahepatic shunting.