(Ultrasound Review) For children with cystic fibrosis, CT and ultrasound correlation enabled improved diagnosis of fat infiltration and periportal fibrosis and increased diagnostic accuracy. The finding, reported in the January issue of European Journal of Radiology, suggested that although ultrasound is the most commonly used diagnostic tool for hepatobiliary manifestations in cystic fibrosis, the improved diagnostic capabilities of CT and ultrasound in combination enabled enhanced patient management and follow-up.
Dr Deniz Akata and colleagues from Hacettepe University School of Medicine, Ankara, Turkey, performed ultrasound and CT in 48 children, and compared the results. Thirty children had at least one abnormal liver finding on either CT or ultrasound. While ultrasound showed increased liver echogenicity in 24 patients, only 12% of these were confirmed as steatosis using CT attenuation criteria.
"Liver echogenicity was considered increased if it was significantly greater than that of the right kidney. Fat infiltration, fibrosis and microcalcifications all manifest as increased echogenicity on ultrasound and are therefore difficult to differentiate. Ultrasound showed increased periportal echogenicity in 37% of patients that CT failed to identify," they said.
Other findings detected by both modalities were cirrhosis, lymph nodes at the hepatico-duodenal ligament (37%), and gallbladder abnormalities (24%). Liver enlargement, contour irregularity and heterogeneous parenchyma characterized parenchymal disease. None of the children with cirrhosis showed any collateral venous dilation usually associated with portal hypertension.
"The most common radiological finding was increased echogenicity of the liver, found in 24 (50%) of the patients which was heterogeneously increased in seven and homogeneously increased in 17 patients," the authors said.
Akata and colleagues concluded, "none of the imaging methods were superior, but supplementary of each other." Improved management of lung disease affords cystic fibrosis patients extended survival rates, which in turn requires refined diagnosis of hepatobiliary disease. This should enable better determination of patient prognosis, they said.
"Hepatobiliary manifestations of cystic fibrosis in children: correlation of CT and US findings"D Akata et al
Department of Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
European Journal of Radiology 2002(January); 41:26-31
By Ultrasound Review
January 3, 2002
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