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Lucius C, Flückiger A, Meier J, Möller K, Jenssen C, Braden B, Kallenbach M, Misselwitz B, Nolsøe C, Sienz M, Zervides C, Dietrich CF. Ultrasound of Bile Ducts-An Update on Measurements, Reference Values, and Their Influencing Factors. Diagnostics (Basel) 2025; 15:919. [PMID: 40218269 PMCID: PMC11988351 DOI: 10.3390/diagnostics15070919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 03/24/2025] [Accepted: 03/27/2025] [Indexed: 04/14/2025] Open
Abstract
Objective: To provide an overview of the technique and normal values of ultrasound studies of the bile system based on the published literature. Methods: A literature search for ultrasound studies with measurements of the bile ducts in healthy subjects was performed. Relevant data published between 1975 and end of 2024 were extracted, discussed, and complemented with the own experiences of the authors. The clinical implications are presented and discussed. Results: For the diameter of the common bile duct, reference values between 5 and 9 mm have been published. The main influencing factors are age and history of cholecystectomy, and other factors to be considered are discussed here. The cut-off for the common bile duct wall is set at 1.5 mm. The literature on measurements of intrahepatic bile ducts is scarce. A diameter of <2-3 mm can be considered normal. The method of ultrasound examination is presented here, as well as a comparison with other imaging methods and their clinical implications. Conclusions: Standardized measurement techniques and normal values in the context of influencing factors are crucial for the ultrasound examination of the bile system.
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Affiliation(s)
- Claudia Lucius
- Outpatient Department of Gastroenterology, IBD Centre Helios Hospital Berlin Buch, 13125 Berlin, Germany;
| | - Anja Flückiger
- Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, 3013 Bern, Switzerland;
| | - Jennifer Meier
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, 3013 Bern, Switzerland;
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christian Jenssen
- Department for Internal Medicine, Krankenhaus Märkisch Oderland, 15344 Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Brandenburg Medical University, 16816 Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, UK;
- Medical Department B, University Muenster, 48149 Muenster, Germany
| | - Michael Kallenbach
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, 40225 Dusseldorf, Germany
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Medizinische Klinik und Poliklinik II, LMU München, 80539 München, Germany
| | - Christian Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, 4600 Køge, Denmark
- Institute for Clinical Medicine, Denmark University of Copenhagen, 1172 Kobenhavn, Denmark
| | - Michael Sienz
- Benedictine Congregation of St. Ottilien, St. Benedict Hospital Ndanda, Ndanda, Mtwara Region, Tanzania
| | | | - Christoph Frank Dietrich
- Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, 3013 Bern, Switzerland;
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Cekuolis A, Schreiber-Dietrich D, Augustinienė R, Taut H, Squires J, Chaves EL, Dong Y, Dietrich CF. Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients. Cancers (Basel) 2023; 15:cancers15082360. [PMID: 37190288 DOI: 10.3390/cancers15082360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental imaging findings-the role of ultrasound". IFs in the liver of newborns and children are rare and much less commonly encountered than in adults; as a result, they are relatively much more frequently malignant and life-threatening, even when they are of benign histology. Conventional B-mode ultrasound is the well-established first line imaging modality for the assessment of liver pathology in pediatric patients. US technological advances, resulting in image quality improvement, contrast-enhanced ultrasound (CEUS), liver elastography and quantification tools for steatosis have expanded the use of ultrasound technology in daily practice. The following overview is intended to illustrate incidentally detected liver pathology covering all pediatric ages. It aims to aid the examiner in establishing the final diagnosis. Management of incidentally detected focal liver lesions (FLL) needs to take into account the diagnostic accuracy of each imaging modality, the patient's safety issues (including ionizing radiation and nephrotoxic contrast agents), the delay in diagnosis, the psychological burden on the patient and the cost for the healthcare system. Moreover, this paper should help the pediatric clinician and ultrasound practitioner to decide which pathologies need no further investigation, which ones require interval imaging and which cases require further and immediate diagnostic procedures.
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Affiliation(s)
- Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | | | - Rasa Augustinienė
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01062 Dresden, Germany
| | - Judy Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Edda L Chaves
- Radiology Department, Hospital Regional Nicolas Solano, La Chorrera 1007, Panama
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland
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Blank V, Heni M, Karlas T. Quantification of Portal Vein Vascularization Using an Automated Post-Processing Video Analysis Tool. Ultrasound Int Open 2023; 9:E2-E10. [PMID: 36950090 PMCID: PMC10027440 DOI: 10.1055/a-1999-7818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/03/2022] [Indexed: 03/22/2023] Open
Abstract
Purpose Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler patterns can be performed using an innovative ultrasound-based algorithm (pixel flow analysis, PFA). This tool already shows promising results in obstetrics, but the technique has not yet been evaluated for portal venous blood flow assessment. Methods This prospective exploratory research study evaluated the applicability of PFA in the portal venous system. Measurements of portal venous flow using PFA and PW-Doppler were compared in healthy volunteers (n=20) and in patients with hepatic steatosis (n=10) and liver cirrhosis (n=10). Results In healthy volunteers (60% female, mean age 23 years, BMI 21.5 kg/m 2 [20.4-23.8]), PFA and PW-Doppler showed a strong positive correlation in fasting conditions (r=0.69; 95% CI 0.36-0.87), recording a median blood flow of 834 ml/min (624-1066) and 718 ml/min (620-811), respectively. PFA was also applicable in patients with chronic liver diseases (55% female, age 65 years (55-72); BMI 27.8 kg/m 2 (25.4-30.8)), but the correlation between PFA and PW-Doppler was poor (r=- 0.09) in the subgroup with steatosis. A better correlation (r=0.61) was observed in patients with liver cirrhosis. Conclusion PFA and PW-Doppler assessment of portal venous vascularization showed high agreement in healthy volunteers and patients with liver cirrhosis. Therefore, PFA represents a possible alternative to conventional PW-Doppler sonography for visceral blood flow diagnostics and merits further evaluation.
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Affiliation(s)
- Valentin Blank
- Division of Gastroenterology, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
- Department of Gastroenterology and Division of Interdisciplinary Ultrasound, University Hospital Halle, Halle (Saale), Germany
| | - Maria Heni
- Division of Gastroenterology, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
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Stockdale AJ, Kreuels B, Shawa IT, Meiring JE, Thindwa D, Silungwe NM, Chetcuti K, Joekes E, Mbewe M, Mbale B, Patel P, Kachala R, Patel PD, Malewa J, Finch P, Davis C, Shah R, Tong L, da Silva Filipe A, Thomson EC, Geretti AM, Gordon MA. A clinical and molecular epidemiological survey of hepatitis C in Blantyre, Malawi, suggests a historic mechanism of transmission. J Viral Hepat 2022; 29:252-262. [PMID: 35075742 PMCID: PMC9305194 DOI: 10.1111/jvh.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) is a leading cause of liver disease worldwide. There are no previous representative community HCV prevalence studies from Southern Africa, and limited genotypic data. Epidemiological data are required to inform an effective public health response. We conducted a household census-based random sampling serological survey, and a prospective hospital-based study of patients with cirrhosis and hepatocellular carcinoma (HCC) in Blantyre, Malawi. We tested participants with an HCV antigen/antibody ELISA (Monolisa, Bio-Rad), confirmed with PCR (GeneXpert, Cepheid) and used line immunoassay (Inno-LIA, Fujiribio) for RNA-negative participants. We did target-enrichment whole-genome HCV sequencing (NextSeq, Illumina). Among 96,386 censused individuals, we randomly selected 1661 people aged ≥16 years. Population-standardized HCV RNA prevalence was 0.2% (95% CI 0.1-0.5). Among 236 patients with cirrhosis and HCC, HCV RNA prevalence was 1.9% and 5.0%, respectively. Mapping showed that HCV RNA+ patients were from peri-urban areas surrounding Blantyre. Community and hospital HCV RNA+ participants were older than comparator HCV RNA-negative populations (median 53 vs 30 years for community, p = 0.01 and 68 vs 40 years for cirrhosis/HCC, p < 0.001). Endemic HCV genotypes (n = 10) were 4v (50%), 4r (30%) and 4w (10%). In this first census-based community serological study in Southern Africa, HCV was uncommon in the general population, was centred on peri-urban regions and was attributable for <5% of liver disease. HCV infection was observed only among older people, suggesting a historic mechanism of transmission. Genotype 4r, which has been associated with treatment failure with ledipasvir and daclatasvir, is endemic.
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Affiliation(s)
- Alexander J Stockdale
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Benno Kreuels
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and 1st Department of Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany.,Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Isaac T Shawa
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Kamuzu University of Health Sciences, Blantyre, Malawi
| | - James E Meiring
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Deus Thindwa
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Karen Chetcuti
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Maurice Mbewe
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi
| | | | | | - Rabson Kachala
- Malawi Ministry of Health, Capitol Hill, Lilongwe, Malawi
| | | | - Jane Malewa
- Kamuzu University of Health Sciences, Blantyre, Malawi.,Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Peter Finch
- Kamuzu University of Health Sciences, Blantyre, Malawi.,Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chris Davis
- MRC - University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Rajiv Shah
- MRC - University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Lily Tong
- MRC - University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Ana da Silva Filipe
- MRC - University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Emma C Thomson
- MRC - University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Anna Maria Geretti
- Department of Infectious Diseases, Fondazione PTV, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Trust Programme, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Kamuzu University of Health Sciences, Blantyre, Malawi
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Dietrich CF, Fraser AG, Dong Y, Guth S, Hari R, Hoffmann B, Prosch H, Walter R, Abramowicz JS, Nolsøe CP, Blaivas M. Managing Incidental Findings Reported by Medical, Sonography and Other Students Performing Educational Ultrasound Examinations. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:180-187. [PMID: 34756465 DOI: 10.1016/j.ultrasmedbio.2021.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
The evolution of ultrasound imaging into a key technology for diagnostic practice has resulted in its incorporation into the education of medical students worldwide. Although the introduction of ultrasound into medical schools' curricula is relatively recent, training of sonographers and other ultrasound users is mature. Ultrasound is being used in a variety of learning environments and clinical settings, from courses in anatomy and physiology to clinical rotations where medical and other students may scan healthy volunteers or patients, sometimes with little to no supervision. Educators may be apprehensive about a perceived high likelihood that students will encounter unexpected findings during these sessions, which could distress the patient or ultrasound model as well as the student, and result in problems that would be more pronounced if such incidental findings are complex. Policies are needed to address how to manage incidental ultrasound findings that are identified during educational activities. This article summarizes the background and provides a framework for establishing and implementing a well-designed and thoughtful approach for dealing with incidental findings observed in volunteer subjects by medical students during training courses in ultrasound diagnostic scanning. Subject confidentiality should be respected, and review of incidental findings should be transparent without provoking unnecessary anxiety. It is the responsibility of the instructor or supervisor to ensure adequate clinical follow-up if indicated.
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Affiliation(s)
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sabine Guth
- Conradia Medical Prevention Hamburg, Hamburg, Germany
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Robin Walter
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Copenhavn, Denmark
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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Trenker C, Görg C, Freeman S, Jenssen C, Dong Y, Caraiani C, Ioanițescu ES, Dietrich CF. WFUMB Position Paper-Incidental Findings, How to Manage: Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2017-2032. [PMID: 34052061 DOI: 10.1016/j.ultrasmedbio.2021.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Department of gastroenterology, Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse Marburg, Germany
| | - Simon Freeman
- University Hospitals Plymouth, Imaging Directorate, Derriford Hospital, Plymouth, United Kingdom
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH Strausberg/Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg "Theodor Fontane", Germany; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Simona Ioanițescu
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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7
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Dietrich CF, Shi L, Löwe A, Dong Y, Potthoff A, Sparchez Z, Teufel A, Guth S, Koch J, Barr RG, Cui XW. Conventional ultrasound for diagnosis of hepatic steatosis is better than believed. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1235-1248. [PMID: 34171931 DOI: 10.1055/a-1491-1771] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hepatic steatosis is a condition frequently encountered in clinical practice, with potential progression towards fibrosis, cirrhosis, and hepatocellular carcinoma. Detection and staging of hepatic steatosis are of most importance in nonalcoholic fatty liver disease (NAFLD), a disease with a high prevalence of more than 1 billion individuals affected. Ultrasound (US) is one of the most used noninvasive imaging techniques used in the diagnosis of hepatic steatosis. Detection of hepatic steatosis with US relies on several conventional US parameters, which will be described. US is the first-choice imaging in adults at risk for hepatic steatosis. The use of some scoring systems may add additional accuracy especially in assessing the severity of hepatic steatosis. SUMMARY In the presented paper, we discuss screening and risk stratification, ultrasound features for diagnosing hepatic steatosis, B-mode criteria, focal fatty patterns and Doppler features of the hepatic vessels, and the value of the different US signs for the diagnosis of liver steatosis including classifying the severity of steatosis using different US scores. Limitations of conventional B-mode and Doppler features in the evaluation of hepatic steatosis are also discussed, including those in grading and assessing the complications of steatosis, namely fibrosis and nonalcoholic steatohepatitis. KEY MESSAGES Ultrasound is the first-line imaging examination for the screening and follow-up of patients with liver steatosis. The use of some scoring systems may add additional accuracy in assessing the severity of steatosis. Conventional B-mode and Doppler ultrasound have limitations in grading and assessing the complications of steatosis.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Long Shi
- Department of Ultrasound, Jingmen No. 2 People's Hospital, Jingmen, Hubei, China
| | - Axel Löwe
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Yi Dong
- Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Andrej Potthoff
- Gastroenterology and Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreas Teufel
- Division of Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Guth
- Conradia Medical Prevention Hamburg, Hamburg, Deutschland
| | - Jonas Koch
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Richard G Barr
- Northeastern Ohio Medical University, Southwoods Imaging, Youngstown, OH, USA
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Karlas T, Blank V, Böhlig A. Diagnostic Value of Ultrasound in Fatty Liver Disease. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:128-153. [PMID: 33622003 DOI: 10.1055/a-1352-4313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hepatic steatosis is a commonly seen phenomenon in clinical practice and is the result of the accumulation of lipids in the hepatocytes. In most cases steatosis refers to nonalcoholic fatty liver disease (NAFLD), but it also occurs in other diseases of the liver parenchyma of a different etiology and is the result of the dysregulation of metabolic processes. Consequently, inflammatory processes can induce progressive fibrosis. Due to the high prevalence of fatty liver disease, a further increase in metabolic liver cirrhosis with corresponding complications can be expected in the near future. Due to its broad availability, ultrasound is particularly important, especially for the management of NAFLD. In addition to diagnosis and risk stratification, the monitoring of high-risk patients in NAFLD is becoming increasingly clinically important. Multimodality ultrasound includes B-mode and duplex methods, analysis of tissue stiffness (elastography), contrast-enhanced imaging (CEUS), and steatosis quantification. When using ultrasound in fatty liver disease, a standardized approach that takes into account the limitations of the method is essential.
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Affiliation(s)
- Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Albrecht Böhlig
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
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9
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Khammas ASA, Mahmud R. Ultrasonographic Measurements of the Liver, Gallbladder Wall Thickness, Inferior Vena Cava, Portal Vein and Pancreas in an Urban Region, Malaysia. J Med Ultrasound 2020; 29:26-31. [PMID: 34084713 PMCID: PMC8081096 DOI: 10.4103/jmu.jmu_53_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Ultrasonographic (USG) measurements of the liver length, gallbladder wall thickness (GBWT), diameters of the inferior vena cava (IVC), portal vein (PV), and pancreas are valuable and reliable in diagnosis hepatobiliary and pancreas conditions. This study is aimed to determine the normal values of liver length, GBWT, AP diameters of the IVC and PV, AP diameter of the head and body of the pancreas. Methods: A prospective cross–sectional study was carried out in this study. A total of the 408 participants were randomly recruited using a systematic method. According to the USG reports, the subjects who had normal USG report for liver, biliary system, and pancreas were described as normals, whereas the subjects who had hepatobiliary diseases such as fatty liver, liver cysts, hemangioma, cirrhosis, gallbladder wall thickening, acute cholecystitis, gallstones, and polyps were recorded as abnormal subjects. Results: Of the 408 participants with a mean of 52.6 ± 8.4 years old. Of those, 294 (72.1%) participants were normal and 114 (27.9%) subjects were reported as abnormal. More than half of the study population was males, 52.9% versus 47.1% of females. There was a significant difference of liver length, head, and body of the pancreas between genders (P = 0.004, 0.002, and P < 0.001, respectively). Moreover, the pancreatic body only was significantly correlated with age (P = 0.026). There also was a significant difference of the liver length, head, and body of the pancreas between normal and abnormal subjects (P < 0.001, P = 0.007, and P < 0.001). Conclusion: Liver length, diameter of the head, and body of the pancreas were significantly associated with gender and hepatobiliary diseases. In addition, only the diameter of the body of the pancreas was significantly correlated with age.
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Affiliation(s)
- Abdul Sattar Arif Khammas
- Department of Radiological Techniques, College of Health and Medical Technology/Baghdad, Middle Technical University, Baghdad, Iraq
| | - Rozi Mahmud
- Department of Imaging, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
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10
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Dietrich CF, Westerway S, Nolsøe C, Kim S, Jenssen C. Commentary on the World Federation for Ultrasound in Medicine and Biology Project "Incidental Findings". ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1815-1820. [PMID: 32409233 DOI: 10.1016/j.ultrasmedbio.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Hirslanden Klinik Beau-Site, Salem und Permanence, Bern, Switzerland; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sue Westerway
- Centre for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge Asc Prof, Copenhagen Academy for Medical Education and Simulation (CAMES) University of Copenhagen Denmark
| | - Christian Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Seung Kim
- Seoul National University, Seoul, South Korea
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
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Pasolini MP, Spinella G, Del Prete C, Valentini S, Coluccia P, Auletta L, Greco M, Meomartino L. Ultrasonographic assessment of normal jugular veins in Standardbred horses. BMC Vet Res 2019; 15:343. [PMID: 31619232 PMCID: PMC6794831 DOI: 10.1186/s12917-019-2104-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background Ultrasonography (US) is the recommended imaging technique to evaluate jugular veins. This prospective randomized clinical study was designed to collect a series of B-mode US measurements of manually distended jugular veins in healthy Italian Standardbreds and to find possible correlations between ultrasound measurements and animal morphometric characteristics. Forty-two horses, eight males and 34 females (range 3–22 years; bodyweight 494.4 ± 41.7 kg), were included in the study. The diameters and wall thicknesses of both jugular veins were measured at three different sites of the neck. The differences in ultrasound measurements based on scans, age, gender, side, and site of the neck were evaluated by ANOVA or by the Kruskal-Wallis test. The effects of the morphometric measures on each ultrasound parameter were evaluated by MANOVA (P < 0.05). Results The ultrasound measurements did not differ significantly between the three different sites or between genders; hence, they were pooled together in the results. On the transverse scan, the mean dorsoventral and lateromedial diameters were 1.58 ± 0.23 and 2.20 ± 0.25 cm, respectively; the mean superficial and deep wall thicknesses (SWT and DWT) were 0.07 ± 0.01 and 0.08 ± 0.01 cm, respectively. On the longitudinal scan, the mean dorsoventral diameter was 1.59 ± 0.26 cm, and the SWT and DWT were both 0.08 ± 0.01 cm. Neck length, from the caudal edge of the mandible to the thoracic inlet, was related to the dorsoventral diameter in both longitudinal and transverse scan and to the SWT and DWT in transverse scan, whereas height at the withers (measured with tape) and estimated weight were related to the wall thickness. Dividing the subjects into groups by age in years (“young” 3–7, “mature” 8–14, “old” > 14), differences were found for the lateromedial diameter in the transverse scan and the SWT on the longitudinal scan. The main limitation of this study was that only one operator performed the measurements. Conclusion The US measurements of the jugular veins and their relationship with morphometric measures reported in this manuscript might be considered as guidelines both for early diagnosis and monitoring jugular vein abnormalities in healthy Italian Standardbred horses.
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Affiliation(s)
- Maria Pia Pasolini
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via a Federico Delpino, 1, 80137, Naples, Italy
| | - Giuseppe Spinella
- Department of Veterinary Medical Sciences, University Alma Mater of Bologna, via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, BO, Italy
| | - Chiara Del Prete
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via a Federico Delpino, 1, 80137, Naples, Italy.
| | - Simona Valentini
- Department of Veterinary Medical Sciences, University Alma Mater of Bologna, via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, BO, Italy
| | - Pierpaolo Coluccia
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via a Federico Delpino, 1, 80137, Naples, Italy
| | - Luigi Auletta
- IRCCS SDN, via E. Gianturco 113, 80143, Naples, Italy
| | - Michele Greco
- Clevedale Veterinary Practice, Home Farm, Redcar, UK
| | - Leonardo Meomartino
- Interdepartmental Radiology Centre, University of Naples Federico II, Via Federico Delpino 1, 80137, Naples, Italy
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12
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Evaluation of a novel tomographic ultrasound device for abdominal examinations. PLoS One 2019; 14:e0218754. [PMID: 31242250 PMCID: PMC6594674 DOI: 10.1371/journal.pone.0218754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
Conventional ultrasound (US) is the first-line imaging method for abdominal pathologies, but its diagnostic accuracy is operator-dependent, and data storage is usually limited to two-dimensional images. A novel tomographic US system (Curefab CS, Munich, Germany) processes imaging data combined with three-dimensional spatial information using a magnetic field tracking. This enables standardized image presentation in axial planes and a review of the entire examination. The applicability and diagnostic performance of this tomographic US approach was analyzed in an abdominal setting using conventional US as reference. Tomographic US data were successfully compiled in all subjects of a training cohort (20 healthy volunteers) and in 50 patients with abdominal lesions. Image quality (35% and 79% for training and patient cohort respectively) and completeness of organ visualization (45% and 44%) were frequently impaired in tomographic US compared to conventional US. Conventional and tomographic US showed good agreement for measurement of organ sizes in the training cohort (right liver lobe and both kidneys with a median deviation of 5%). In the patient cohort, tomographic US identified 57 of 74 hepatic or renal lesions detected by conventional ultrasound (sensitivity 77%). In conclusion, this study illustrates the diagnostic potential of abdominal tomographic US, but current significant limitations of the tomographic ultrasound device demand further technical improvements before this and comparable approaches can be implemented in clinical practice.
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Shen YN, Zheng ML, Guo CX, Bai XL, Pan Y, Yao WY, Liang TB. The role of imaging in prediction of post-hepatectomy liver failure. Clin Imaging 2018; 52:137-145. [PMID: 30059953 DOI: 10.1016/j.clinimag.2018.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/11/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
Abstract
Post-hepatectomy liver failure (PHLF) is not only a leading cause of mortality but also a leading cause of life-threatening complications in patients undergoing liver resection. The ability to accurately detect the emergence of PHLF represents a crucially important step. Currently, PHLF can be predicted by a comprehensive evaluation of biological, clinical, and anatomical parameters. With the development of new technologies, imaging methods including elastography, diffusion-weighted magnetic resonance imaging, and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid-enhanced MRI play a more significant role in the pre-operative prediction and assessment of PHLF. In this review, we summarize the mainstream studies, with the aim of evaluating the role of imaging and improving the clinical value of existing scoring systems for predicting PHLF.
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Affiliation(s)
- Yi-Nan Shen
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Meng-Lin Zheng
- Department of Ultrasound, Huashan Hospital of Fudan University, Shanghai, China
| | - Cheng-Xiang Guo
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Yao Pan
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Yun Yao
- Department of General Surgery, The People's Hospital of Changxing County, Huzhou, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.
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Berzigotti A, Ferraioli G, Bota S, Gilja OH, Dietrich CF. Novel ultrasound-based methods to assess liver disease: The game has just begun. Dig Liver Dis 2018; 50:107-112. [PMID: 29258813 DOI: 10.1016/j.dld.2017.11.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/08/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
Abstract
In the last 10 years the availability of ultrasound elastography allowed to diagnose and stage liver fibrosis in a non-invasive way and changed the clinical practice of hepatology. Newer ultrasound-based techniques to evaluate properties of the liver tissue other than fibrosis are emerging and will lead to a more complete characterization of the full spectrum of diffuse and focal liver disease. Since these methods are currently undergoing validation and go beyond elastography for liver tissue evaluation, they were not included in the recent guidelines regarding elastography issued by the European Federation of Societies in Ultrasound in Medicine and Biology. In this review paper, we outline the major advances in the field of ultrasound for liver applications, with special emphasis on techniques that could soon be part of the future armamentarium of ultrasound specialists devoted to the assessment of liver disease. Specifically, we discuss current and future ultrasound assessment of steatosis, spleen stiffness for portal hypertension, and elastography for the evaluation of focal liver lesions; we also provide a short glimpse into the next generation of ultrasound diagnostic methods.
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Affiliation(s)
- Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Berne, Switzerland.
| | - Giovanna Ferraioli
- Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Simona Bota
- Department of Gastroenterology, Hepatology, Nephrology and Endocrinology, Klinikum Klagenfurt, Klagenfurt am Wörthersee, Austria.
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway.
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany.
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Arora S, Cheung AC, Tarique U, Agarwal A, Firdouse M, Ailon J. First-year medical students use of ultrasound or physical examination to diagnose hepatomegaly and ascites: a randomized controlled trial. J Ultrasound 2017; 20:199-204. [PMID: 28900520 DOI: 10.1007/s40477-017-0261-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 07/05/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare point-of-care ultrasound and physical examination (PEx), each performed by first-year medical students after brief teaching, for assessing ascites and hepatomegaly. Ultrasound and PEx were compared on: (1) reliability, validity and performance, (2) diagnostic confidence, ease of use, utility, and applicability. METHODS A single-center, randomized controlled trial was performed at a tertiary centre. First-year medical students were randomized to use ultrasound or PEx to assess for ascites and hepatomegaly. Cohen's kappa and interclass coefficient (ICC) were used to measure interrater reliability between trainee assessments and the reference standard (a same day ultrasound by a radiologist). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were compared. A ten-point Likert scale was used to assess trainee diagnostic confidence and perceptions of utility. RESULTS There were no significant differences in interobserver reliability, sensitivity, specificity, accuracy, PPV, or NPV between the ultrasound and PEx groups. However, students in the ultrasound group provided higher scores for perceived utility (ascites 8.38 ± 1.35 vs 7.08 ± 1.86, p = 0.008; hepatomegaly 7.68 ± 1.52 vs 5.36 ± 2.48, p < 0.001) and likelihood of adoption (ascites 8.67 ± 1.61 vs 7.46 ± 1.79, p = 0.02; hepatomegaly 8.12 ± 1.90 vs 5.92 ± 2.32, p = 0.001). CONCLUSIONS When performed by first-year medical students, the validity and reliability of ultrasound is comparable to PEx, but with greater perceived utility and likelihood of adoption. With similarly brief instruction, point-of-care ultrasonography can be as effectively learned and performed as PEx, with a high degree of interest from trainees.
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Affiliation(s)
- Samantha Arora
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Angela C Cheung
- Division of Gastroenterology, Department of Medicine, Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, ON Canada
| | - Usman Tarique
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Arnav Agarwal
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | | | - Jonathan Ailon
- Faculty of Medicine, University of Toronto, Toronto, ON Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada.,Saint Michael's Hospital, 30 Bond Street, 4-146 Cardinal Carter Wing, Toronto, ON M5B1W8 Canada
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Patzak M, Porzner M, Oeztuerk S, Mason RA, Wilhelm M, Graeter T, Kratzer W, Haenle MM, Akinli AS. Assessment of liver size by ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:399-404. [PMID: 24638913 DOI: 10.1002/jcu.22151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/08/2013] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND To determine liver span sonographically in a randomly selected population sample and identify factors that affect liver size. METHODS A total of 1,789 subjects (963 females, 826 males; mean age 41.8 ± 12.8 years) underwent sonographic examination of the liver in the midclavicular line to determine liver span. Subjects underwent physical examination and blood tests and completed a standardized interview questionnaire. RESULTS The average liver span in the midclavicular line for the overall collective was 15.0 ± 1.5 cm; the average for females was 14.9 ± 1.6 cm and 15.1 ± 1.5 cm for males. Liver span exceeded 16 cm in 24.3% of subjects. Results of the multivariate analysis showed that, of the factors potentially influencing liver span, gender, age, body mass index, body height, fatty liver (p < 0.0001), waist-to-hip ratio (p = 0.015), and metabolic syndrome (p = 0.032) are significant. By contrast, diabetes mellitus, alcohol consumption, tobacco consumption, physical activity, and laboratory findings showed no influence. CONCLUSIONS Sonographic measurement of liver span in the midclavicular line is a simple method for routine clinical use. Gender, age, body mass index, waist-to-hip ratio, body height, hepatic steatosis, and metabolic syndrome are factors associated with liver span.
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Affiliation(s)
- Monika Patzak
- Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Dietrich C, Schreiber-Dietrich D, Nürnberg D. Abdominelle Sonographie. DER GASTROENTEROLOGE 2013; 8:341-356. [DOI: 10.1007/s11377-013-0766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19:3173-3188. [PMID: 23745019 PMCID: PMC3671069 DOI: 10.3748/wjg.v19.i21.3173] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast-enhanced ultrasound (CEUS), computed tomography and magnetic resonance imaging, as well as image-guided biopsy. CEUS techniques have proved to be the most pertinent method; these techniques became part of the clinical routine about 10 years ago in Europe and Asia and are used for a variety of indications in daily clinical practice. CEUS is in many cases the first and also decisive technical intervention for detecting and characterizing liver tumors. This development is reflected in many CEUS guidelines, e.g., in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 as well as the recently published World Federation for Ultrasound in Medicine and Biology-EFSUMB guidelines 2012. This article sets out considerations for making a structured work-up of incidental liver tumors feasible.
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Organ Volume by Computed Tomography Correlates With Longitudinal Axis on Ultrasound in Patients With Gaucher Disease. Ultrasound Q 2011; 27:225-8. [DOI: 10.1097/ruq.0b013e318239c5eb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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