Iver cirrhosis The accuracy of ultrasound in the correct diagnosis of "liver cirrhosis"in patients with complications(ascites, splenomegaly, collaterals)is high(> 90 %) In the initial stages and in micronodular cirrhosis, it may be overlooked in up to 30 %[(32)1 Sonographic signs of liver cirrhosis include inhomogenous echotexture and irregular-nodular liver surface delineation and a variety of other possible findings including destroyed vascular architecture also dependent on the etiology of diseases IFigure 9]. Dysproportional segment atrophy (and also hypertrophy has been observed [Figure 10] Figure 9 Liver cirrhosis. Typical signs of liver cirrhosis include inhomogenous echotexture and irregular liver surface delineation(a, arrow). In addition distinctive nodules are suggestive(b). Sometimes it might be difficult to identify the liver parenchyma, therefore the organ is indicated as well: Leber: liver Nodular liver surface(especially using high frequency transducers) has an excellent positive predictive value close to 100 for cirrhosis. A disproportional volume enlargement of the caudate lobe in relation to the right and left lobe may be indicative of liver cirrhosis but this sign is of limited value in daily clinical practice Coarse liver parenchyma and a disturbed or destroyed vascular architecture as a sig of portal hypertension- such as reversed portal flow and collateral vessels- are other signs of liver cirrhosis. In Doppler studies, a raise in the arterioportal peak velocity ratio(maximum velocity of the hepatic artery divided through the maximum velocity of the vena portae)of more than 3.5 is predictive for cirrhosis. The positive predictive value of the detection of signs of portal hypertension is excellent such as reversed portal flow and the detection of collateral vessels. The negative predictive value is worse. Overall, the accuracy is about 60 % An enlarged portal vein diameter greater than 1.25 cm or a reduced portal vein flow velocity indicates cirrhosis with a sensitivity and specificity of about 80 % All mentioned parameters, however, are of limited val Figure 10 Liver lobes and segments may behave different during the course of a disease, as shown in this patient with systemic scleroderm with gradually shrinkage of the right liver lobe(in between markers). The changes of the liver evolved gradually over the last ten yearsLiver cirrhosis The accuracy of ultrasound in the correct diagnosis of “liver cirrhosis” in patients with complications (ascites, splenomegaly, collaterals) is high (> 90 %). In the initial stages and in micronodular cirrhosis, it may be overlooked in up to 30 % [(32)]. Sonographic signs of liver cirrhosis include inhomogenous echotexture and irregular-nodular liver surface delineation and a variety of other possible findings including destroyed vascular architecture also dependent on the etiology of diseases [Figure 9]. Dysproportional segment atrophy (and also hypertrophy) has been observed [Figure 10]. Figure 9 Liver cirrhosis. Typical signs of liver cirrhosis include inhomogenous echotexture and irregular liversurface delineation (a, arrow). In addition distinctive nodules are suggestive (b). Sometimes it might be difficult to identify the liver parenchyma, therefore the organ is indicated as well: Leber: liver. a b Nodular liver surface (especially using high frequency transducers) has an excellent positive predictive value close to 100 % for cirrhosis. A disproportional volume enlargement of the caudate lobe in relation to the right and left lobe may be indicative of liver cirrhosis but this sign is of limited value in daily clinical practice. Coarse liver parenchyma and a disturbed or destroyed vascular architecture as a sign of portal hypertension - such as reversed portal flow and collateral vessels - are other signs of liver cirrhosis. In Doppler studies, a raise in the arterioportal peak velocity ratio (maximum velocity of the hepatic artery divided through the maximum velocity of the vena portae) of more than 3.5 is predictive for cirrhosis. The positive predictive value of the detection of signs of portal hypertension is excellent such as reversed portal flow and the detection of collateral vessels. The negative predictive value is worse. Overall, the accuracy is about 60 %. An enlarged portal vein diameter greater than 1.25 cm or a reduced portal vein flow velocity indicates cirrhosis with a sensitivity and specificity of about 80 %. All mentioned parameters, however, are of limited value. Figure 10 Liver lobes and segments may behave different during the course of a disease, as shown in this patient with systemic sclerodermy with gradually shrinkeage of the right liver lobe (in between markers). The changes of the liver evolved gradually over the last ten years