Liver Ultrasound E-Book
91,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Liver Ultrasound An up-to-date discussion of modern liver ultrasound techniques, combining hepatological and radiological perspectives into one stand-alone resource. In Liver Ultrasound: From Basics to Advanced Applications, a team of distinguished experts delivers an in-depth textbook on how to perform liver ultrasound and interpret common and uncommon clinical findings. The authors also walk readers through the nuances of ultrasonic and parametric features, from both a radiological and hepatological perspective, in differentiating the multitude of liver conditions. They also discuss clinical evaluations and how to use more advanced and currently evolving techniques. Readers will experience well-illustrated and clear ultrasound images while also getting access to a complimentary website that features numerous videos which integrate the book's modern and multidisciplinary approach. The book also includes: * A thorough introduction to the basics of ultrasound, as well as ultrasound scanners and knobology * Comprehensive explanations on how to perform a liver ultrasound, including routine practicalities, discussions of normal liver anatomy, normal variants and advanced Doppler techniques * Practical discussions of focal liver lesions, including their characterization and detection and how contrast enhanced ultrasound plays a pivotal role * A clinical overview on the use of point of care ultrasound in liver disease as well as the use of ultrasound in liver related infectious diseases, biliary disorders and pediatric liver disease * An extensive overview on the use of ultrasound and specific findings in liver transplantation * The role of ultrasound in chronic liver disease, vascular liver diseases and interventional procedures, as well as discussions on advancing technologies namely shearwave elastography, attenuation imaging and fusion Perfect for all who perform liver sonography namely, hepatologists, radiologists, internal and emergency medicine physicians and sonographers. Liver Ultrasound: From Basics to Advanced Applications will also benefit trainees from all these specialties.
Sie lesen das E-Book in den Legimi-Apps auf:
Seitenzahl: 637
Veröffentlichungsjahr: 2024
Ähnliche
Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
List of Contributors
Forewords
Preface
About the Companion Website
1 Getting Started
What Is Ultrasound?
Ultrasound Waves
Physical Processes That Affect Ultrasound Waves
Ultrasound Transducers
Ultrasound Image Formation
References
2 Knobology and Terminology
Getting Started
Image Optimisation
Useful Tools
Advanced Applications
Useful Terminology
Further Reading
3 Normal Liver Anatomy
Anatomy of the Liver and Ultrasound Appearance
Normal Variants of Liver Anatomy
Practical Approach for How to Scan the Liver
Liver Ultrasound Report
Videos
References
4 An Introduction to Contrast‐Enhanced Ultrasound
Ultrasound Contrast Agents
Pharmacokinetics
Interaction with Ultrasound Waves
Scanning Modes
Injecting Ultrasound Contrast Agents (Microbubbles)
Safety
State of the Art
References
5 Focal Liver Lesions – Characterisation and Detection
Liver Contrast‐Enhanced Ultrasound Protocol and Image Optimisation
Benign Focal Liver Lesions
Malignant Focal Liver Lesions
Contrast‐Enhanced Ultrasound and Intervention
Liver Imaging Reporting and Data System
Conclusion
Videos
References
6 Ultrasound of the Biliary System
Anatomy and Topography of the Gallbladder and Biliary Tree
Gallbladder Pathology
Gallbladder Wall Pathology
Biliary Duct Dilatation
Congenital Pathologies of the Biliary Tree
Cholangitis
Contrast‐Enhanced Ultrasound in Biliary Disorders
Videos
References
7 Tropical Infections of the Liver
Parasitic Infections of the Liver
Bacterial Infections of the Liver
Fungal Infections of the Liver
Viral Infections Affecting the Liver
References
8 Ultrasound in Chronic Liver Disease
General Ultrasonic Features of Chronic Liver Disease
Sonographic Differences among Various Liver Disease Aetiologies
Mimics of Cirrhosis
Pitfalls
Conclusion
References
9.1 Shear Wave Elastography for Liver Disease: Part 1
Introduction to Liver Elastography and Different Elastographic Techniques
Physical Principles of Shear Wave Elastography
Confounding Factors and Current Limitations
Practical Advice
References
9.2 Shear Wave Elastography for Liver Disease: Part 2
Clinical Use and Interpretation of Shear Wave Elastography in Liver Disease
Elastography in Different Liver Disease Aetiologies
Practical Advice
Videos
References
10 Liver Ultrasound in the Paediatric Population
Diffuse Liver Disease: Congenital
Diffuse Liver Disease: Acquired
Focal Liver Lesions
Key Checkpoints for Emergency/On‐Call Scans
References
11 Ultrasound in Vascular Liver Diseases
Portal Vein Thrombosis and Extrahepatic Portal Vein Obstruction
Intrahepatic Non‐cirrhotic Portal Hypertension
Budd–Chiari Syndrome
Vascular Malformations
Acknowledgement
References
12 Point‐of‐Care Ultrasound in Liver Disease
Basics of POCUS and Training Requirements
POCUS Examination Technique
Confounding Factors and Co‐existing Pathologies
POCUS in Acute Presentation of Liver Dysfunction
Post‐procedural Interventional Complications
POCUS in Liver Trauma
POCUS in Cirrhosis
POCUS in Cirrhosis and Worsening Liver Function
Basic Principles of POCUS in Liver Disease
Videos
References
13 Liver Transplantation
Indications for Transplant
Surgical Techniques in Liver Transplantation
Post–Liver Transplant Imaging
Vascular Complications
Hepatic Artery
Hepatic Artery Thrombosis
Hepatic Artery Stenosis
Pseudoaneurysm
Portal Vein Complications
Inferior Vena Cava Complications
Biliary Complications
Neoplastic Disease
Parenchymal Abnormalities
Perihepatic Complications
Contrast‐Enhanced Ultrasound in Liver Transplant
Conclusion
References
14 Ultrasound in Hepatobiliary Intervention
Patient Preparation
Liver Biopsies
Ultrasound‐Guided Drainage (Liver and Gallbladder)
Thermal Ablation
Biliary, Portal Venous Access
Use of Ultrasound to Aid Transjugular Intrahepatic Portosystemic Shunt Creation
References
15 Advancing Ultrasound Technologies
Ultrasound B‐Mode/Greyscale Imaging
Doppler Technologies
Contrast‐Enhanced Ultrasound
Shear Wave Elastography
Viscosity
Attenuation Imaging/Parameter
Fusion
Conclusion
References
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Ultrasound properties of common materials and tissue.
Table 1.2 Reflection coefficients at some common interfaces.
Chapter 5
Table 5.1 Time windows for the three phases of liver enhancement on contrast...
Table 5.2 A summary of the typical enhancement characteristics of benign liv...
Table 5.3 A summary of the typical enhancement characteristics of malignant ...
Chapter 7
Table 7.1 Ultrasound appearance of HIV‐associated liver disease.
Chapter 10
Table 10.1 Todani classification of bile duct cysts.
Chapter 11
Table 11.1 Main vascular liver disorders and role of ultrasound and elastogr...
Table 11.2 Ultrasound stages of hepatic involvement in hereditary haemorrhag...
Chapter 12
Table 12.1 Different causes of respiratory failure with lung sonographic pat...
Table 12.2 Ultrasound signs of cirrhosis and clinically significant portal h...
Table 12.3 Hepatic and extrahepatic causes that should be excluded with poin...
Chapter 14
Table 14.1 Guidance on coagulation threshold and pausing anticoagulants base...
List of Illustrations
Chapter 1
Figure 1.1 (a–e) Longitudinal wave propagation using a simplified physical m...
Figure 1.2 Specular (left) and diffuse (right) reflection.
Figure 1.3 (a) Reflected, refracted, and (b) scattered waves.
Figure 1.4 Changes in voltage across both sides of the piezoelectric materia...
Figure 1.5 Resonance behaviour of piezoelectric ultrasound transducers.
Figure 1.6 Response of a highly resonant transducer and damped transducer to...
Figure 1.7 An ultrasound transducer's internal architecture.
Figure 1.8 Schematic of an array transducer.
Figure 1.9 The line‐by‐line scanning approach is illustrated for different t...
Figure 1.10 The typical time gain compensation (TGC) slide controls for diff...
Figure 1.11 The delay‐and‐sum receive beamforming method for obtaining the i...
Figure 1.12 A pulsed ultrasound beam to image two point sources along one sc...
Figure 1.13 Computed harmonic beam profiles in the focal plane of a 2.25 MHz...
Figure 1.14 The conventional coordinate system in an ultrasound imaging syst...
Figure 1.15 Doppler effect occurring due to blood cell motion.
Figure 1.16 Continuous wave Doppler system.
Figure 1.17 A sonogram of continuous wave Doppler and pulsed wave spectral D...
Figure 1.18 Pulsed wave spectral Doppler system.
Figure 1.19 B‐mode, spectral Doppler, and colour Doppler in a triplex mode a...
Figure 1.20 A typical colour‐coded box estimated from power Doppler superimp...
Figure 1.21 Microbubble contrast agents. Left: bright‐field micrograph of a ...
Figure 1.22 The pulse inversion and amplitude modulation methods for harmoni...
Figure 1.23 Clinical examples of a time–intensity curve for (a) a bolus inje...
Figure 1.24 Principle of elastography: the blue spring, which simulates soft...
Figure 1.25 Principle of shear wave elasticity estimation: the two curves sh...
Figure 1.26 (a) The ultrasound B‐mode speckle pattern of scatterers within a...
Figure 1.27 (a) Illustration of double reflection artefact. (b) A, ascites; ...
Figure 1.28 The pulse repetition frequency is not high enough and the aliasi...
Figure 1.29 The pulse repetition frequency is not high enough and the aliasi...
Figure 1.30 The inverted mirror sonogram is observed in pulse wave spectral ...
Chapter 2
Figure 2.1 This outlines the essential buttons on a typical ultrasound conso...
Figure 2.2 A typical console for a high‐performing ultrasound scanner. Most ...
Figure 2.3 The measurement callipers outlining a hepatocellular carcinoma (w...
Figure 2.4 Time gain compensation (TGC; arrow) and automated TGC (arrowhead)...
Figure 2.5 (a) No time gain compensation (TGC) adjustment – note that the ne...
Figure 2.6 Note functional buttons when choosing advanced presets and two ti...
Chapter 3
Figure 3.1 The liver is located below the diaphragm, extending from the righ...
Figure 3.2 The liver has a smooth, dome‐shaped diaphragmatic surface and a m...
Figure 3.3 Examples of liver size compared to the right kidney. (a) Normal s...
Figure 3.4 The Glisson's capsule can barely be seen surrounding the liver, s...
Figure 3.5 Ligamentum teres (LT) or round ligament takes direct contact with...
Figure 3.6 The boundaries of the caudate lobe (asterisk) are defined by the ...
Figure 3.7 (a, b) The gallbladder (GB) is a pear‐shaped structure located in...
Figure 3.8 The common bile duct (CBD) can be seen as a thin tubular structur...
Figure 3.9 In the majority of cases the portal vein (white arrow) lies poste...
Figure 3.10 In this sequence of images, the dilated bile ducts help to clear...
Figure 3.11 Pictorial view of the portal venous system draining blood from t...
Figure 3.12 The portal venous system can be recognised on ultrasound as a tu...
Figure 3.13 (a–c) The hepatic veins originate from the periphery of the live...
Figure 3.14 Liver segmentation following Couinaud classification. IVC, infer...
Figure 3.15 (a–d) This sequence of images shows how the ultrasound beam tran...
Figure 3.16 Diaphragmatic slips (arrows) represent incomplete accessory fiss...
Figure 3.17 An anatomical variant known as beaver tail liver or a sliver of ...
Figure 3.18 A Riedel's lobe is represented by a downward projection of the l...
Figure 3.19 The papillary process (arrow) is an anterior and medial extensio...
Figure 3.20 Anatomical variant of the hepatic artery (HA) running anteriorly...
Figure 3.21 (a) Longitudinal scan view at the epigastric level, showing segm...
Figure 3.22 (a) Epigastric transverse scan view showing cranial segments IVA...
Figure 3.23 (a–c) Different images of segment IV obtained by sweeping from r...
Figure 3.24 Transverse subcostal (TS) epigastric view. The higher TS view wi...
Figure 3.25 By further angling the probe downwards the portal vein (PV) appe...
Figure 3.26 The most lateral segments of the liver are visualised by scannin...
Figure 3.27 The gallbladder (GB) ultrasound assessment starts with a subcost...
Figure 3.28 The probe is obliquely positioned in the epigastrium and it is m...
Figure 3.29 A subcostal epigastric view of the hepatic hilum and porta hepat...
Figure 3.30 Intercostal longitudinal scan showing the hepatic hilum and the ...
Figure 3.31 An intercostal longitudinal scan view (a) usually provides a goo...
Figure 3.32 The portal vein can be assessed by using (a) an intercostal long...
Figure 3.33 (a) To assess the portal venous system, start by using an epigas...
Figure 3.34 The portal vein (PV) calibre is measured at the hepatic hilum at...
Figure 3.35 The hepatic veins (HV) have a thin wall that is barely visible, ...
Figure 3.36 Measurement of portal venous flow at the level of the main porta...
Figure 3.37 (a) Colour Doppler of the hepatic veins. (b) Spectral analysis o...
Figure 3.38 The hepatic artery is visualised using a longitudinal intercosta...
Figure 3.39 (a, b) The spleen is best visualised in a longitudinal oblique l...
Chapter 4
Figure 4.1 The preferred split‐screen mode where the microbubble‐specific mo...
Figure 4.2 (a, b) The measurement callipers can be a useful aid when trying ...
Figure 4.3 (a, b) The typical packaged items provided to constitute microbub...
Chapter 5
Figure 5.1 Simple cyst seen as a well‐defined thin‐walled anechoic lesion (a...
Figure 5.2 Complex liver cyst (arrow) shows complex internal structure on th...
Figure 5.3 Haemangioma. (a) Baseline B‐mode ultrasound shows an echopoor ava...
Figure 5.4 Haemangioma with incomplete ‘fill‐in’. (a) Solid predominantly ec...
Figure 5.5 Focal nodular hyperplasia. (a–d) Dual‐display contrast‐enhanced u...
Figure 5.6 Adenoma. (a) Dual‐display contrast‐enhanced ultrasound showing en...
Figure 5.7 (a) Large hyperechoic focal lesion seen on B‐mode that on contras...
Figure 5.8 Focal fatty change. Echogenic focal liver lesion adjacent to the ...
Figure 5.9 Multiple focal fatty sparing. Patient with colon cancer who was r...
Figure 5.10 Regenerative nodule. (a) Pedunculated lesion in a cirrhotic live...
Figure 5.11 Liver abscess. Dual‐display contrast‐enhanced ultrasound shows e...
Figure 5.12 B‐mode ultrasound shows a hypo/anechoic liver lesion with signs ...
Figure 5.13 (a) An ill‐defined heterogeneic focal lesion was identified in s...
Figure 5.14 Dual display contrast enhanced ultrasound (CEUS) showing a large...
Figure 5.15 Dual display contrast enhanced ultrasound (CEUS) of a segment VI...
Figure 5.16 (a) Sub‐centimetric hypoechoic focal lesions with hyperechoic ou...
Figure 5.17 (a) A liver laceration following a stabbing. On B‐mode it has a ...
Figure 5.18 Hypervascular metastasis from a primary parathyroid cancer. (a) ...
Figure 5.19 Hypovascular metastasis from colorectal cancer. (a) Dual‐display...
Figure 5.20 Hepatocellular carcinoma. (a) Dual‐display contrast‐enhanced ult...
Figure 5.21 (a) A large hypoechoic focal lesion in a patient with recurrent ...
Figure 5.22 (a) On B‐mode ultrasound a large right liver lobe heterogeneous ...
Figure 5.23 (a) Ill‐defined heterogeneous area (arrows) adjacent to the gall...
Figure 5.24 (a) A segment VI hyperechoic focal lesion with a subtle echopoor...
Figure 5.25 (a) A large hypoechoic and heterogeneous right liver lobe focal ...
Figure 5.26 Dual‐display contrast‐enhanced ultrasound of two slightly hypere...
Figure 5.27 (a) Echogenic material fills and stretches the portal vein (PV)....
Figure 5.28 Klatskin cholangiocarcinoma. Dual‐display contrast‐enhanced ultr...
Figure 5.29 Gallbladder (GB) carcinoma. Dual‐display contrast‐enhanced ultra...
Figure 5.30 (a) Multiple liver target‐like lesions with a hyperechoic spicul...
Figure 5.31 Local recurrence in a treated hepatocellular carcinoma (HCC). Du...
Figure 5.32 Contrast‐enhanced ultrasound follow‐up in a hepatocellular carci...
Chapter 6
Figure 6.1 The gallbladder is composed of a fundus, body, infundibulum, and ...
Figure 6.2 Examples of a ‘phrygian cap’ of the gallbladder, which is charact...
Figure 6.3 Septated gallbladder.
Figure 6.4 Septated thickened gallbladder containing sludge and stones (arro...
Figure 6.5 (a–c) Different examples of gallstones with typical posterior aco...
Figure 6.6 (a) The gallbladder (GB) is filled with cholesterol stones with n...
Figure 6.7 (a) Porcelain gallbladder (GB). (b–d) Two examples of the wall‐ec...
Figure 6.8 (a, b) The gallbladder (GB) is filled with sludge. (c) Sludge‐fil...
Figure 6.9 The gallbladder (GB) lumen is filled with heterogeneous material ...
Figure 6.10 (a, b) A patient was admitted with right upper quadrant pain and...
Figure 6.11 (a–c) Ultrasound reveals detachment of the gallbladder walls, vi...
Figure 6.12 (a) Acute cholecystitis in a septic patient presenting with righ...
Figure 6.13 (a–c) The gallbladder (GB) wall is thickened and the lumen is fi...
Figure 6.14 Gangrenous cholecystitis. (a) The gallbladder (GB) lumen is repl...
Figure 6.15 There is thickening of the gallbladder (GB) wall and evidence of...
Figure 6.16 (a) Multiple small stones accumulate in the gallbladder (GB) nec...
Figure 6.17 Mimics of cholecystitis. (a) Stratified thickening of the gallbl...
Figure 6.18 (a) Diffuse adenomyomatosis in a thick‐walled gallbladder (GB) a...
Figure 6.19 Different examples of gallbladder (GB) polyps. (a) Multiple poly...
Figure 6.20 (a) The gallbladder (GB) has a contracted appearance with thicke...
Figure 6.21 (a, b) The gallbladder (GB) is completely substituted by an ill‐...
Figure 6.22 (a) Pronounced biliary duct dilatation with a double barrel shot...
Figure 6.23 Cholecystolithiasis (a, white arrow) with gallstones migration i...
Figure 6.24 Diffuse intrahepatic biliary dilatation with multiple intrahepat...
Figure 6.25 (a) On B‐mode ultrasound there is evidence of an ill‐defined hyp...
Figure 6.26 Large pseudocyst of the head of the pancreas causing compression...
Figure 6.27 Common bile duct dilatation (white arrow) secondary to compressi...
Figure 6.28 The galldbladder has been substituted by an ill‐defined echogeni...
Figure 6.29 (a, b) Pronounced intrahepatic biliary dilatation. The gallbladd...
Figure 6.30 Biliary hamartomas (von Meyenburg complexes; arrows) appear as s...
Figure 6.31 Diffuse thickening of the biliary tree in a patient with cholecy...
Figure 6.32 (a, b) Two cases of acute cholangitis highlighted by diffuse thi...
Figure 6.33 Aerobilia after endoscopic retrograde cholangiopancreatography (...
Figure 6.34 Primary sclerosing cholangitis. (a) Pronounced thickening of the...
Figure 6.35 (a, b) Diffuse thickening of both proximal and more distal bilia...
Figure 6.36 Primary sclerosing cholangitis. There is marked thickening of th...
Chapter 7
Figure 7.1 CE cyst stages and suggested stage‐specific clinical management o...
Figure 7.2 Sonographic patterns of E. multilocularis (a) ‘Hailstorm’, (b) ‘p...
Figure 7.3 Round hypoechoic amoebic liver abscess without significant wall i...
Figure 7.4 (a) Thickening of the peripheral portal branches (arrows), (b) ec...
Figure 7.5 Criss‐cross fibrotic septae of the tortoise‐back pattern in a Fil...
Figure 7.6 Confluent, hypoechoic small lesions (upper arrow) and periportal ...
Figure 7.7 A patient with acute epigastric pain, common bile duct (CBD) show...
Figure 7.8 Pyogenic liver abscesses. (a) Abscess in the left liver lobe with...
Figure 7.9 Disseminated tuberculosis in an HIV patient. (a) Hypoechoic focal...
Figure 7.10 Multiple clustered hypoechoic lesions in diabetic patients from ...
Figure 7.11 Hypoechoic liver lesion due to syphilis in an HIV‐positive patie...
Figure 7.12 Brucellar liver abscess with a characteristic central calcificat...
Figure 7.13 Oedematous, thickened gallbladder wall (arrow) in a patient with...
Figure 7.14 Small fungal liver abscess in an HIV‐positive patient showing a ...
Figure 7.15 Echogenic focal lesions in an HIV‐positive patient with dissemin...
Figure 7.16 HIV cholangiopathy with (a) thickened wall of the common bile du...
Figure 7.17 Thickened wall of the gallbladder in a patient with dengue fever...
Chapter 8
Figure 8.1 At a glance the morphological appearance of the liver shows hyper...
Figure 8.2 Examples of heterogenic echotexture of liver parenchyma of differ...
Figure 8.3 (a, b) In advanced liver disease the outline of the liver is irre...
Figure 8.4 (a, b) Parenchymal retraction and nodularities are also highlight...
Figure 8.5 (a, b) Parenchymal micronodularities and irregular outline are hi...
Figure 8.6 Steatosis is graded according to parenchymal brightness and the d...
Figure 8.7 (a, b) Diffuse ill‐defined hepatic steatosis with a geographical ...
Figure 8.8 (a, b) A more focal but ill‐defined distribution of hepatic steat...
Figure 8.9 Different examples of focal fatty sparing (arrows) adjacent to th...
Figure 8.10 Dilated portal vein (calibre 14.9 mm) in a patient with advanced...
Figure 8.11 Two examples of patients with advanced chronic liver disease hig...
Figure 8.12 (a–c) Gallbladder (GB) thickening secondary to portal hypertensi...
Figure 8.13 (a) An example of homogeneous splenomegaly with a cranio‐caudal ...
Figure 8.14 Patient with cirrhosis and severe portal hypertension. (a) The s...
Figure 8.15 Examples of small‐volume ascites surrounding the liver (a, b, ar...
Figure 8.16 Two cases of advanced chronic liver disease with severe portal h...
Figure 8.17 (a, b) Two examples of portal blood flow inversion as an express...
Figure 8.18 (a) Increased hepatic resistive index (RI) in a patient with adv...
Figure 8.19 (a) Normal portal flow velocity, splenomegaly, and normal spleni...
Figure 8.20 Patient with cirrhosis and clinically significant portal hyperte...
Figure 8.21 Anechoic tubular structures (left side) posterior to the left lo...
Figure 8.22 (a, b) Two examples of large tubular convoluted vascular collate...
Figure 8.23 Large retroperitoneal shunt in patient with hepatitis C virus/al...
Figure 8.24 Patient with cirrhosis and severe portal hypertension. (a, b) Th...
Figure 8.25 An example of hepatitis C virus–related cirrhosis: the liver is ...
Figure 8.26 Steatotic‐looking liver with homogeneous echotexture and almost ...
Figure 8.27 There is a clear discrepancy between an almost homogeneous echot...
Figure 8.28 Patient with alcohol related liver disease cirrhosis. Note is ma...
Figure 8.29 (a) Patient with florid autoimmune hepatitis and related severe ...
Figure 8.30 (a–c) Severe liver injury with uneven distribution of the necroi...
Figure 8.31 Cirrhosis secondary to metabolic dysfunction‐associated steatoti...
Figure 8.32 (a, b) Two cases of different patients with primary biliary chol...
Figure 8.33 (a) Extensive thickening of the left lobe distal biliary ducts i...
Figure 8.34 Patient with primary sclerosing cholangitis with dissociation of...
Figure 8.35 Patient with primary sclerosing cholangitis. (a) The distal port...
Figure 8.36 (a, b) Two different patients with primary sclerosing cholangiti...
Figure 8.37 Pronounced fibrotic changes extending from the right biliary duc...
Figure 8.38 Two cases of Wilson’s disease characterised (a) by slightly hete...
Figure 8.39 (a) Patient with grossly distended IVC and hepatic veins as a si...
Figure 8.40 Hepatosplenic sarcoidosis: the liver has a slightly heterogeneic...
Figure 8.41 Common variable immunodeficiency–related chronic granulomatous l...
Figure 8.42 Heterogeneic appearance of hepatic parenchyma where multiple ill...
Figure 8.43 Heterogeneic echotexture and irregular outline (a–c) were detect...
Figure 8.44 sinusoidal obstruction syndrome (SOS) in a patient who underwent...
Figure 8.45 The ultrasound appearance of a liver with advanced cirrhosis (a)...
Figure 8.46 (a) Hepatomegaly with heterogeneous echotexture and extensive fi...
Figure 8.47 A case of porto‐sinusoidal vascular disorder diagnosed on liver ...
Figure 8.48 Sonographic appearance of biopsy‐proven nodular regenerative hyp...
Chapter 9_1
Figure 9.1.1 Transient elastography readings (FibroScan 502 Touch
®
, Ech...
Figure 9.1.2 Point shear wave elastography (ElastPQ
®
, EPIQ Elite ultras...
Figure 9.1.3 Point shear wave elastography (SWM
®
, Arietta 850 ultrasoun...
Figure 9.1.4 Point shear wave elastography (VTQ
®
, Sequoia ultrasound sy...
Figure 9.1.5 Point shear wave elastography (S‐Shearwave
®
, RS80A ultraso...
Figure 9.1.6 Point shear wave elastography (QElaXto
®
, MyLab™9 ultrasoun...
Figure 9.1.7 Two‐dimensional shear wave elastography (EQI
®
, EPIQ Elite ...
Figure 9.1.8 Two‐dimensional shear wave elastography (STE
®
, Resona 7 ul...
Figure 9.1.9 Two‐dimensional shear wave elastography (Aplio i800 series ultr...
Figure 9.1.10 Two‐dimensional shear wave elastography (SSI, Aixplorer
®
ultra...
Figure 9.1.11 Two‐dimensional shear wave elastography (LOGIQ
®
E9 ultrasound ...
Figure 9.1.12 Two‐dimensional shear wave elastography (Acuson Sequoia™ ultra...
Chapter 9_2
Figure 9.2.1 Elastography is considered accurate in detecting minimal or abs...
Figure 9.2.2 The presence of confounding factors such as cholestasis, inflam...
Figure 9.2.3 (a) B‐mode ultrasound shows features in keeping with chronic li...
Figure 9.2.5 A patient admitted to hospital with clinical and biochemical fe...
Figure 9.2.6 Two schematic diagrams that summarise the trend of (a) liver st...
Figure 9.2.7 Two cases of primary biliary cholangitis–related chronic liver ...
Figure 9.2.8 Patient with primary biliary cholangitis with a heterogeneous l...
Figure 9.2.9 (a) Heterogeneous liver echotexture with irregular outline and ...
Figure 9.2.10 Patient with chronic liver disease (CLD) secondary to hepatiti...
Figure 9.2.12 40 year‐old patient with autoimmune hepatitis. (a) The liver h...
Figure 9.2.14 A 60 year‐old woman with primary biliary cholangitis (PBC). (a...
Figure 9.2.16 Patient with (a) pronounced hepatic parenchymal heterogeneicit...
Figure 9.2.17 Increased liver siffness values are not reliable because of in...
Figure 9.2.18 (a) A large right liver lobe lesion surely interferes with ela...
Figure 9.2.19 Two different elastography techniques are used in different pa...
Figure 9.2.20 A 66‐year‐old patient with chronic hepatitis C and slightly el...
Figure 9.2.21 Two different cases of patients with severe steatosis. Elastog...
Figure 9.2.22 Autoimmune hepatitis–related cirrhosis. Both liver (a) and spl...
Figure 9.2.23 A 48‐year‐old woman with a history of acute severe onset of au...
Figure 9.2.24 Severe autoimmune hepatitis in a patient who underwent magneti...
Figure 9.2.25 Primary sclerosing cholangitis might be characterised by bilia...
Figure 9.2.26 Primary sclerosing cholangitis is typically characterised by i...
Figure 9.2.27 Two cases of primary sclerosing cholangitis (PSC) show pronoun...
Figure 9.2.28 Patient with acute cellular rejection after two months from li...
Chapter 10
Figure 10.1 A 9‐month‐old infant with biliary atresia and splenic malformati...
Figure 10.2 A 3‐year‐old with Caroli syndrome. (a) B‐mode image of the liver...
Figure 10.3 Cystic fibrosis–associated liver disease. (a) B‐mode image showi...
Figure 10.4 B‐mode images of sclerosing cholangitis. (a) Extrahepatic bile d...
Figure 10.5 Focal nodular hyperplasia in B‐mode ultrasound shows a well‐defi...
Figure 10.6 Haemangioendothelioma. Conventional ultrasound showing a mixed e...
Figure 10.7 (a) B‐mode image of a haemangioendothelioma in the left liver lo...
Figure 10.8 B‐mode image of a mesenchymal hamartoma showing a large multisep...
Figure 10.9 (a) B‐mode image of a hepatic adenoma shows a well‐demarcated hy...
Figure 10.10 (a) B‐mode image of a hepatoblastoma showing a heterogeneous so...
Figure 10.11 (a–e) Post‐surgical follow‐up in a different patient demonstrat...
Figure 10.12 (a) B‐mode ultrasound shows a large heterorgeneous focal lesion...
Figure 10.13 (a) B‐mode image of a solitary embryonal sarcoma, showing a wel...
Figure 10.14 (a, b) B‐mode ultrasound of a patient with rhabdomyosarcoma, de...
Figure 10.15 (a) B‐mode image demonstrates multiple hyperechoic focal lesion...
Figure 10.16 Ill‐defined hypoechoic mass in the right liver lobe (a, arrow),...
Figure 10.17 (a) B‐mode image shows a thick‐walled liver abscess (arrow) in ...
Chapter 11
Figure 11.1 Partial portal vein thrombosis in a patient without cirrhosis. (...
Figure 11.2 Cavernous transformation of the portal vein. (a) The right intra...
Figure 11.3 These images focus on the vascular changes occuring in the acute...
Figure 11.4 Neoplastic complete invasion of the left branch of the portal ve...
Figure 11.5 Porto‐sinusoidal vascular disorder in an advanced stage. (a) The...
Figure 11.6 Acute Budd–Chiari syndrome (BCS). (a, b) The left hepatic vein i...
Figure 11.7 There is a large lesion originating from the right adrenal gland...
Figure 11.8 Intrahepatic collateral veins in a patient with chronic Budd‐Chi...
Figure 11.9 (a) Focal nodular hyperplasia–like liver nodule in a patient wit...
Figure 11.10 (a) Tortuous dilatation of the hepatic artery with (b) intrahep...
Figure 11.11 Haemorrhagic hereditary telangiectasia grade 3. (a, b) Multiple...
Figure 11.12 Large congenital intrahepatic porto‐systemic shunt. Note (a) th...
Figure 11.13 (a) Transverse image of a congenital shunt of the right branch ...
Chapter 12
Figure 12.1 The ultrasound beam is able to penetrate by ‘looking through’ th...
Figure 12.2 The retrohepatic inferior vena cava (IVC) crosses the liver, rec...
Figure 12.3 Although constitutional variability has been described, in norma...
Figure 12.4 During inspiration the diaphragm lowers, allowing lung expansion...
Figure 12.5 (a) Right pleural effusion (arrow) with complete atelectasis of ...
Figure 12.6 (a) Oblique transverse subcostal view showing a large right pleu...
Figure 12.7 Subcostal transverse view revealing large echogenic right pleura...
Figure 12.8 Patient with respiratory failure and sepsis. Point‐of‐care ultra...
Figure 12.9 (a) Bilateral B‐lines and sub‐pleuric lung consolidation (arrow)...
Figure 12.10 A mixed alveolar‐interstitial pattern in a patient with severe ...
Figure 12.11 (a) Patient with a large right pleural effusion (asterisk) and ...
Figure 12.12 An example of the interference of confounding factors and the u...
Figure 12.13 Coronal view with M‐mode evaluation of the inferior vena cava (...
Figure 12.14 (a) Patient with periportal fibrosis and non‐cirrhotic portal h...
Figure 12.15 A large hypoechoic lesion known to be a hepatic abscess (asteri...
Figure 12.16 Three cases of cholecystitis are described. (a) Acute lithiasic...
Figure 12.17 Patient admitted with painless jaundice. Point‐of‐care ultrasou...
Figure 12.18 (a) Patient with rapid onset of malaise, jaundice, and abdomina...
Figure 12.19 A case of acute liver failure secondary to autoimmune hepatitis...
Figure 12.20 Patient with acute hepatitis B presenting with jaundice, malais...
Figure 12.21 Liver point‐of‐care ultrasound in a patient with a five‐day his...
Figure 12.22 Liver point‐of‐care ultrasound in a septic patient with abdomin...
Figure 12.23 A 34‐year‐old woman who presented after three months of abdomin...
Figure 12.24 (a) Large focal liver lesion with satellite lesions in an 80‐ye...
Figure 12.25 A patient admitted with abdominal pain and shortness of breath....
Figure 12.26 A patient with hepatitis C–related cirrhosis was admitted with ...
Figure 12.27 A large right lobe isoechoic lesion with a central ill‐defined ...
Figure 12.28 Two examples of complicated cysts. In (a) an example of intrale...
Figure 12.29 A 30‐year‐old man with abdominal distension and right upper qua...
Figure 12.30 A patient with hepatitis B–related cirrhosis who complained of ...
Figure 12.31 (a) Perihepatic fluid (arrow) seen shortly after a percutaneous...
Figure 12.32 Post‐surgical follow up in a patient who underwent laparotomy f...
Figure 12.33 Post‐cholecystectomy large haemorrhagic collection. Contrast‐en...
Figure 12.34 Liver point‐of‐care ultrasound in a patient who developed sever...
Figure 12.35 (a) Large intraparenchymal haematoma. (b) Liver contusion with ...
Figure 12.36 (a) On B‐mode ultrasound an ill‐defined heterogenic area is com...
Figure 12.37 Patient with blunt abdominal trauma. Point‐of‐care‐ultrasound d...
Figure 12.38 Contrast‐enhanced ultrasound is repeated after embolisation of ...
Figure 12.39 Obvious ultrasound features of cirrhosis complicated by clinica...
Figure 12.40 A 71‐year‐old man with advanced liver disease was admitted beca...
Figure 12.41 A patient with cirrhosis and multiorgan failure secondary to se...
Figure 12.42 Rapidly progressive liver failure in a patient with known hepat...
Figure 12.43 (a) Patient with sepsis, and respiratory and liver failure. Poi...
Figure 12.44 A hyperechoic wedge‐shaped cortical area of the left kidney (ar...
Figure 12.45 Diffuse intestinal and portal pneumatosis as a consequence of s...
Figure 12.46 (a, b) Extreme inferior vena cava and hepatic veins distension ...
Figure 12.47 (a) Pronounced distension of inferior vena cava (IVC) and hepat...
Chapter 13
Figure 13.1 (a) The normal post‐liver transplantation colour and spectral ul...
Figure 13.2 A contrast‐enhanced ultrasound examination of a ‘difficult’ hepa...
Figure 13.3 A 34‐year‐old male patient with a day 5 ultrasound examination o...
Figure 13.4 A split‐liver transplantation in a 21‐year‐old male patient, wit...
Figure 13.5 A 34‐year‐old male patient with a hepatic artery pseudoaneurysm....
Figure 13.6 A 52‐year‐old male patient with a recent liver transplantation. ...
Figure 13.7 A 52‐year‐old man with a second liver transplantation and an occ...
Figure 13.8 A 46‐year‐old male patient with a liver transplantation of one y...
Figure 13.9 A 48‐year‐old woman post liver transplantation with a known hepa...
Figure 13.10 A 55‐year‐old male patient following liver transplantation. (a)...
Chapter 14
Figure 14.1 (a, b) Pre‐procedure ultrasound with and without annotations dem...
Figure 14.2 (a) Semi‐automatic Tru‐Cut–style biopsy needle. (b) Biopsy needl...
Figure 14.3 (a) Contrast‐enhanced computed tomography demonstrating portal v...
Figure 14.4 (a) Axial computed tomography demonstrating a thick‐walled liver...
Figure 14.5 (a) Access kit including Chiba needle, Mandril wire, and introdu...
Figure 14.6 (a) Ultrasound demonstrating a hyperaemic, thick gallbladder wal...
Figure 14.7 (a) T1‐weighted gadolinium‐enhanced magnetic resonance imaging (...
Figure 14.8 Step‐by‐step biliary access. (a) Illustration of the relevant li...
Figure 14.9 (a, b) Ultrasound images with and without annotations demonstrat...
Chapter 15
Figure 15.1 (Video 15.1) This shows a thrombosed portal vein with numerous c...
Figure 15.2 (Video 15.2) There is an exophytic focal lesion on a background ...
Figure 15.3 (Video 15.3) This was an incidental finding in a young female pa...
Figure 15.4 The quad view function on the Aplio i‐series (Canon Medical Syst...
Figure 15.5 (a) A map showing attenuation imaging (ATI) from Canon Medical S...
Figure 15.6 The typical set‐up for ultrasound fusion, with the box (arrow) s...
Figure 15.7 (Video 15.4) (a) The left‐hand image shows the subtle low‐densit...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
List of Contributors
Forewords
Preface
About the Companion Website
Begin Reading
Index
Wiley End User License Agreement
Pages
i
ii
v
vii
vii
ix
x
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
Liver Ultrasound
From Basics to Advanced Applications
Edited by
Adrian K.P. Lim, MD, FRCP, FRCR
Professor and Consultant Radiologist
Department of Imaging, Imperial College Healthcare NHS Trust, London, UK;
Department of Metabolism, Digestion and Reproduction,
Imperial College London, UK
Matteo Rosselli, MD, PhD, FRCP
Consultant in Internal Medicine and Honorary Associate Professor
Department of Internal Medicine, San Giuseppe Hospital, USL Toscana Centro, Empoli, Italy;
Division of Medicine, Institute for Liver and Digestive Health, University College London,Royal Free Hospital, London, UK
This edition first published 2024© 2024 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Adrian K.P. Lim and Matteo Rosselli to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
Registered OfficesJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.
Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication DataNames: Lim, Adrian, editor. | Rosselli, Matteo, editor.Title: Liver ultrasound : from basics to advanced applications / edited by Adrian K.P. Lim, Matteo Rosselli.Description: First edition. | Hoboken, NJ : Wiley‐Blackwell, 2024. | Includes bibliographical references and index.Identifiers: LCCN 2022017515 (print) | LCCN 2022017516 (ebook) | ISBN 9781119612599 (cloth) | ISBN 9781119612605 (adobe pdf) | ISBN 9781119612636 (epub)Subjects: MESH: Liver Diseases–diagnostic imaging | Liver–diagnostic imaging | UltrasonographyClassification: LCC RC847.5.I42 (print) | LCC RC847.5.I42 (ebook) | NLM WI 710 | DDC 616.3/620754–dc23/eng/20220610LC record available at https://lccn.loc.gov/2022017515LC ebook record available at https://lccn.loc.gov/2022017516
Cover Design by WileyCover Image: Courtesy of Matteo Rosselli
List of Contributors
Ali AlsafiDepartment of ImagingImperial College Healthcare NHS TrustLondon, UK
Annalisa BerzigottiDepartment of Visceral Surgery and Medicine,Inselspital, Bern University HospitalUniversity of BernBern, Switzerland
James P.F. BurnDepartment of ImagingImperial College Healthcare NHS TrustLondon, UK
Annamaria DeganelloDepartment of Radiology, King’s College Hospital;Division of Imaging Sciences, King’s College LondonLondon, UK
Caroline EwertsenDepartment of RadiologyRigshospitaletCopenhagen, Denmark
Giovanna FerraioliDepartment of Clinical, Surgical, Diagnostic andPediatric Sciences, University of PaviaPavia, Italy
M. Ángeles García‐CriadoRadiology Department, Hospital Clínic i ProvincialUniversity of BarcelonaBarcelona, Spain
Ivica GrgurevicUniversity Hospital DubravaDepartment of Gastroenterology, Hepatology and ClinicalNutrition,University of Zagreb School of Medicine and Faculty ofPharmacy and BiochemistryZagreb, Croatia
Sevan HarputDivision of Electrical and Electronic EngineeringLondon South Bank UniversityLondon, UK
Chris J. HarveyDepartment of ImagingImperial College NHS Healthcare TrustLondon, UK
Tom HellerLighthouse Trust, Lilongwe, Malawi;International Training and Education Center for Health,University of Washington, Seattle, WA, United States
Michaëla A.M. HusonRadboud University Medical Center, Department ofInternal Medicine and Radboud Center of InfectiousDiseases (RCI), Nijmegen, The Netherlands
Robert de KnegtDepartment of Gastroenterology and HepatologyErasmus MC University Medical CentreRotterdam, The Netherlands
Adrian K.P. LimDepartment of Imaging, Imperial College Healthcare NHSTrust, London, UK;Department of Metabolism, Digestion and Reproduction,Imperial College London, UK
Andreas PanayiotouDepartment of RadiologyKing’s College HospitalLondon, UK
Neeral R. PatelDepartment of ImagingImperial College Healthcare NHS TrustLondon, UK
Thomas PuttickDepartment of RadiologyKing’s College HospitalLondon, UK
Maija RadzinaRadiology Research laboratory, Riga Stradins University;Diagnostic Radiology Institute, Paula Stradins UniversityHospital; Medical Faculty, University of Latvia,Riga, Latvia
Matteo RosselliDepartment of Internal Medicine, San Giuseppe Hospital,USL Toscana Centro, Empoli, Italy;Division of Medicine, Institute for Liver and DigestiveHealth, University College London, Royal Free Hospital,London, UK
Davide RoccarinaDepartment of Internal Medicine and Hepatology,Azienda Ospedaliero‐Universitaria di Careggi,Florence, Italy;Division of Medicine, Institute for Liver and DigestiveHealth, University College London, Royal Free Hospital,London, UK
Maria E. SellarsDepartment of RadiologyKing’s College HospitalLondon, UK
Paul S. SidhuDepartment of RadiologyKing’s College HospitalLondon, UK
Ioan SporeaDepartment of Gastroenterology and HepatologyVictor Babes University of Medicine and PharmacyTimisoara, Romania
Francesca TamarozziDepartment of Infectious Tropical Diseases andMicrobiology, WHO Collaborating Centre onStrongyloidiasis and other Neglected Tropical Diseases,IRCCS Sacro Cuore Don Calabria Hospital,Negrar di Valpolicella, Verona, Italy
Meng‐Xing TangDepartment of BioengineeringImperial College LondonUK
Xiaowei ZhouState Key Laboratory of Ultrasound Engineering inMedicine, College of Biomedical Engineering, ChongqingMedical University, Chongqing, China
Forewords
It gives me great pleasure to write the foreword for this very exciting book. Every practical aspect of the discipline has been covered by an energetic team of experts, providing an easily accessible manual for a branch of medical imaging that for some non‐experts has been seen as highly specialised and difficult to unlock.
Professor Adrian K.P. Lim is a Professor of Medical Imaging at Imperial College London who, over the years, has majored on new ultrasound techniques, improving visualisation and discrimination of malignant from non‐malignant lesions. Dr Matteo Rosselli has worked at the Institute for Liver and Digestive Health at University College London for many years. Together with Professor Adrian K.P. Lim, he has organised the International Hepatology Ultrasound Course at the Royal Free Hospital in London with an active opportunity for ‘hands‐on’ experience for each delegate.
It was this practical approach to teaching and problem solving that has informed this easily digestible book. As a hepatologist who has relied on the expertise of Professor Adrian K.P. Lim and Dr Matteo Rosselli for important diagnostic advice on a tidal wave of patients over the years, it is gratifying to see their knowledge opened up to a wider audience.
Professor Simon Taylor‐RobinsonProfessor of Translational MedicineImperial College London
Undoubtedly, Adrian K.P. Lim and Matteo Rosselli are genuine experts in the field of liver ultrasonography. Together they combine the skills and knowledge of the clinical radiologist with the domain expertise of the practicing hepatologist to address an aspect of patient care which is crucial in the day‐to‐day management of patients with liver disease. Not only are they experts in the art and science of liver ultrasound but, as illustrated in this book, they are also world class teachers of liver ultrasound.
As a clinical hepatologist at St Marys Hospital London for over 30 years and a professor of hepatology at Imperial College, I have witnessed and appreciated the evolution of liver ultrasound and the increasing dependence on this diagnostic technology in hepatology. Whilst most hepatologists, usually with a gastroenterology training, understand the strengths and limitations of endoscopy, the same cannot be said of ultrasonography. Unfortunately, relatively few hepatologists have mastered ultrasound and consequently fail to fully comprehend the full versatility of this crucial diagnostic tool. Within this book lies an opportunity to correct this deficiency.
Whilst no one can be expected to master a sophisticated skill such as ultrasound without the guidance and training provided by an expert, Adrian K.P. Lim and Matteo Rosselli’s ‘Liver Ultrasound’ goes a long way in providing the information required to get started in this field. The first few chapters provide the novice with the essentials of ultrasound physics, liver anatomy and indeed the anatomy of the ultrasound machine, appropriately termed ‘knobology’. Subsequent chapters deal with the common and, in some cases less common, causes of liver disease with focus on focal liver lesions, biliary tract disease, vascular disease and ultrasound in chronic liver disease. This book also deals with relatively new developments in ultrasound including the use of shearwave elastography for assessment of liver fibrosis and microbubble ultrasound for characterisation of space‐occupying lesions. The practical nature of this book is illustrated by the chapter on interventional radiology techniques which includes a guide to managing patients with coagulopathy requiring invasive procedures ‐ frequently a source of tension between radiologist and hepatologist.
This is a book which I would strongly recommend to all trainee hepatologists and gastroenterologists. It really should be considered as essential reading for those hepatologists planning to undertake training in liver ultrasound and should definitely be included in the induction pack for radiology trainees. I would like to see an era when all hepatologists undertook their own liver ultrasounds. This book may be one of the catalysts which help to make this happen.
Professor Mark ThurszProfessor of Hepatology and Head of DepartmentFaculty of Medicine, Department of MetabolismDigestion and ReproductionImperial College London, UK
It is with great pleasure that I introduce to you this book on Liver Ultrasound conceived and led by Adrian K.P. Lim and Matteo Rosselli. The book includes chapters ranging from very basic physical concepts of medical ultrasound to the most updated guidelines for the use of ultrasonography in the clinical management of patients with liver diseases. Since my early training as a clinical hepatologist, I have witnessed the progressive technical development of this field and how ultrasonography has become an essential instrument in everyday clinical practice. The latest developments, including the use of elastography for the assessment of liver tissue fibrosis and contrast agents for the characterization of liver lesions, have made ultrasonography a solid omni‐comprehensive asset in Hepatology.
The concept of the book derives from the success of the series of International Liver Ultrasound workshops organized at the Royal Free Hospital in London in the past ten years and is directed at providing a written and illustrated basis to everybody who is interested in developing skills in liver ultrasonography and relative clinical applications. The book is obviously directed to radiologists and sonographers but, most importantly, to trainees in Hepatology and hepatologists, who will have the highest professional advantage by becoming independent users of ultrasonography.
In conclusion, I am truly enthusiastic about this book, and I wish huge success to all those who wish to become expert users of this technology.
Professor Massimo PinzaniMD, PhD, FRCP, FAASLD, MAESheila Sherlock Chair of HepatologyUniversity College London, Royal Free Hospital
Preface
The origins of this book stemmed from a series of workshops that we put together and the realisation that there was an appetite for most clinicians and allied health professionals to learn how to scan a liver. While most of us learn via mentors and on the job, rarely are the basics, the ‘tips and tricks’, put into words. Instead, these nuggets of information tend to be passed on from generation to generation by word of mouth.
With ultrasound becoming the modern‐day ‘stethoscope’, the initial aim of this book was to provide an ‘all you need to know’ about liver ultrasound, from the basics to advanced practice. As the chapters developed, it progressed from a relatively basic to intermediate‐level book into one that encompasses a wide range of diseases. Our esteemed co‐authors also provided in‐depth knowledge on the multifaceted aspects of liver pathology, its clinical background, and how to apply the latest and advancing technologies.
Overall, it has turned into a book for the beginner to take with them through their journey and medical career, offering a pictorial review of both common and uncommon diseases. We hope this will serve the current and future generations of multidisciplinary liver ultrasound imagers well.
To our past, present, and future colleagues and students – thank you for teaching, helping, and inspiring us to write this book!
Adrian K.P. Lim and Matteo Rosselli
About the Companion Website
This book is accompanied by a companion website.
www.wiley.com/go/LiverUltrasound
This website includes:
Video clips
1Getting StartedUltrasound Physics and Image Formation
Sevan Harput1, Xiaowei Zhou2, and Meng‐Xing Tang3
1 Division of Electrical and Electronic Engineering, London South Bank University, London, UK
2 State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
3 Department of Bioengineering, Imperial College London, UK
What Is Ultrasound?
Ultrasound refers to an acoustic wave whose frequency is greater than the upper limit of human hearing, which is usually considered to be 20 kHz. Medical ultrasound operates at a much higher frequency range (generally 1–15 MHz) and it is inaudible. Medical ultrasound images are produced based on the interaction between the ultrasound waves with the human body. For this reason, producing and interpreting an ultrasound image require an understanding of the ultrasound waves, their transmission and reception by sensors, and the mechanisms by which they interact with biological tissues.
Ultrasound Waves
Unlike electromagnetic waves used in optical imaging, X‐ray, and computed tomography (CT), ultrasound waves are mechanical waves that require a physical medium to propagate through. For example, ultrasound waves can travel in water or human tissue, but not in a vacuum. Ultrasound waves transport mechanical energy through the local vibration of particles. In other terms, an ultrasound wave propagates by the backwards and forwards movement of the particles in the medium. It is important to note that while the wave travels, the particles themselves are merely displaced locally, with no net transport of the particles themselves. For example, if a lighted candle is placed in front of a loudspeaker, the flame may flicker due to local vibrations, but the flame would not be extinguished since there is no net flow of air, even though the sound can travel far away from the speaker [1]. While propagating in a medium, both the physical characteristics of the ultrasound wave and the medium are important for understanding the wave behaviour. Therefore, this section will first introduce the relevant physical processes and parameters that affect ultrasound wave propagation.
Ultrasound Wave Propagation
There are many types of acoustic waves, such as longitudinal, shear, torsional, and surface waves. The mechanical energy contained in one form of an acoustic wave can be converted to another, so most of the time these waves do not exist in isolation. However, for the sake of simplicity we will only describe the longitudinal or compressional waves, which are most commonly used in B‐mode and Doppler imaging.
The propagation of longitudinal ultrasound waves is illustrated in Figure 1.1 using discrete particles. As we know, human tissue is not made up of discrete particles, but rather a continuous medium with a more complicated structure. This is merely a simplified physical model to explain wave propagation. During the wave propagation, particles are displaced due to the acoustic pressure in parallel to the direction of motion of the longitudinal wave, as illustrated in Figure 1.1a–c. When the pressure of the medium is increased by the wave, which is called the compression phase, particles in adjacent regions move towards each other. During the reduced pressure phase (rarefaction), particles move apart from each other. During these two phases, the change in the concentration of particles changes the local density, shown in Figure 1.1d as the higher‐density regions with darker colours. This change in local density can be related to the change in acoustic pressure, which is also proportional to the velocity of the particles, Figure 1.1e. Particle velocity should not be confused with the speed of sound. The ultrasound wave travels, while the particles oscillate around their original position. The particle velocity is relatively small in comparison to the speed of sound in the medium.
Figure 1.1 (a–e) Longitudinal wave propagation using a simplified physical model depicted graphically. A detailed explanation is in the text above.
Speed of Sound, Frequency, and Wavelength
A propagating ultrasound wave can be characterised by its speed, frequency, and wavelength. Similar to other types of waves, the speed of propagation of an ultrasound wave is determined by the medium it is travelling in. Propagation speed is usually referred to as the speed of sound, denoted by ‘c', and it is a function of the density, ‘ρ', and stiffness, ‘k', of the medium, as shown in Equation 1.1:
Tissue with low density and high stiffness has a high speed of sound, whereas high density and low stiffness lead to low speed of sound. See Table 1.1 for speed of sound values in different tissue types and materials [2, 3].
In addition to speed of sound, the frequency, ‘f', and the wavelength, ‘λ', of the ultrasound wave are crucial parameters for medical ultrasound imaging. The frequency of a wave is the reciprocal of the time duration of a single oscillation cycle of the wave and carries a unit of Hz. The wavelength is the length of a single cycle of the wave and is linked to frequency and speed of sound, as in Equation 1.2:
In short, frequency has the timing information about the wave for a given space, and wavelength has the spatial (relating to physical space) information about the wave at a given time. Ultrasound image resolution is related to frequency/wavelength and is usually better at higher frequencies and shorter wavelengths. At a given ultrasound imaging frequency, the wavelength changes proportionally with the speed of sound. For medical ultrasound imaging, the speed of sound is usually assumed to be constant for the tissue and in order to change the image resolution, one needs to change the imaging frequency. For example, for an average speed of sound in soft tissues of 1540 m/s, the wavelength is 0.77 mm at 2 MHz and 0.154 mm at 10 MHz.
Table 1.1 Ultrasound properties of common materials and tissue.
Material
Speed of sound
c
(m/s)
Acoustic impedance
Z
(MRayl)
Density,
ρ
(10
3
kg/m
3
)
Attenuation coefficient at 1 MHz (dB/cm)
Air
330
0.0004
0.0012
1.2
Blood
1570
1.61
1.026
0.2
Lung
697
0.31
0.45
1.6–4.8
Fat
1450
1.38
0.95
0.6
Liver
1550
1.65
1.06
0.9
Muscle
1590
1.70
1.07
1.5–3.5
Bone
4000
7.80
1.95
13
Soft tissue (mean)
1540
1.63
–
0.6
Water
1480
1.48
1
0.002
Acoustic Impedance
Acoustic impedance is the effective resistance of a medium to the applied acoustic pressure. For example, the particle velocity in soft tissue will be higher than the particle velocity in bone for the same applied pressure due to the difference in their acoustic impedance (see Table 1.1). The acoustic impedance, ‘Z', of a material is determined by its density and stiffness values, as shown in Equation 1.3:
Physical Processes That Affect Ultrasound Waves
Reflection
When an ultrasound wave travelling through a medium reaches an interface of another medium with a different acoustic impedance, some portion of the ultrasound wave is reflected, as shown in Figures 1.2 and 1.3. The amplitudes of the transmitted and reflected ultrasound waves depend on the difference between the acoustic impedances of both media, see Figure 1.3. This can be formulated as the reflection coefficient, shown in Equation 1.4:
The interfaces with higher reflection coefficients appear brighter on an ultrasound B‐mode image, since a large portion of the ultrasound wave is reflected back. Reflection coefficients at some common interfaces are shown in Table 1.2.
It should be remembered that the underlying model for the equation of the reflection coefficient is based on specular reflection, which means a reflection from a perfectly flat surface or an interface.
In reality, the reflection of ultrasound waves can be considered either specular or diffuse (https://radiologykey.com/physics‐of‐ultrasound‐2). When the ultrasound waves encounter a large smooth surface such as bone, the reflected echoes have relatively uniform direction. This is a type of specular reflection, as shown on the left of Figure 1.2. When the ultrasound waves reflect from a soft tissue interface, such as fat–liver, the reflected echoes can propagate towards different directions. This is a type of diffuse reflection, as shown on the right of Figure 1.2.
Refraction
Refraction is the bending of a wave when it enters a medium with a different speed. It is commonly observed with all types of waves. For example, when looked from above, a spoon appears to be bent in a glass full of water. The reason for this is that the light emerging from the water is refracted away from the normal, causing the apparent position of the spoon to be displaced from its real position, due to the difference in the speed of light in water and in air.
Figure 1.2 Specular (left) and diffuse (right) reflection.
Refraction of ultrasound waves occurs at boundaries between different types of tissue (different speeds of sound), as shown in Figure 1.3. In ultrasound imaging, this can cause displacement of the target from its true relative position. If the speed of sound is the same in both media, then the transmitted ultrasound wave carries on in the same direction as the incident wave.
Scattering
Human tissue has inhomogeneities. When these inhomogeneities are much smaller than the wavelength, then the ultrasound wave is scattered in many directions, as shown in Figure 1.3. Most of the ultrasound wave travels forward and a certain portion of the wave's energy is redirected in a direction other than the principal direction of propagation. Scattering reduces the amplitude of the initial propagating ultrasound wave, but the lost energy due to scattering is not converted to heat.
Table 1.2 Reflection coefficients at some common interfaces.
Interface
R
Liver–air
0.9995
Liver–lung
0.684
Liver–bone
0.651
Liver–fat
0.089
Liver–muscle
0.0149
Liver–blood
0.0123
Figure 1.3 (a) Reflected, refracted, and (b) scattered waves.
Scattering plays an important role in blood velocity estimation. Blood cells (e.g. erythrocytes are 6–8 μm) are usually much smaller than ultrasound imaging wavelengths (>100 μm). Therefore, blood does not reflect but scatter the ultrasound waves.
Absorption
Ultrasound waves are pressure waves. They change the local density by compression and rarefaction, where not all adjacent particles move together. When particles are moving towards each other they experience friction. In medical imaging, this friction is caused by the viscoelastic behaviour of human soft tissue, which is effectively the resistance against the motion.
When the local compression generated by the ultrasound waves are resisted by the friction of the soft tissue, heat is generated. In other words, there will be tiny differences in temperature between regions of compression and rarefaction. Tissue will conduct heat from the higher‐temperature region to the lower. This overall process will result in a bulk rise in temperature of the tissue due to viscous losses. Consequently, the energy of the travelling ultrasound waves will be lost after propagation.
