Invasive and non-invasive diagnosis of cirrhosis and portal hypertension

Figure 1 Heterogeneity of cirrhosis in histology. All pictures are histological finding of cirrhosis however, they show different feature in thickness of sepata and the size of nodules. A: Shows mild cirrhosis with thin septa (MTC stain, × 100); B: Shows moderate cirrhosis with at least two broad septa; C: Shows severe cirrhosis with at least one very broad septa (MTC stain, respectively, × 200). A, B, C are correspond to subclass of Laennec fibrosis scoring system F4A, F4B and F4C respectively, The widths between two arrows show the significant difference among subclass of cirrhosis. n: Regenerating nodule; MTC: Masson trichrome stain[8].

Figure 2 Doppler ultrasonography showing change in the hepatic vein waveform and damping index (A) before and (B) 3 mo after propranolol treatment in a patient with liver cirrhosis. Hepatic vein waveform changed from biphasic to near triphasic, quantitative measurement of damping index (DI) decreased from 0.61 to 0.33 in association with a hepatic venous pressure gradient (HVPG) decrease from 18 to 11 mmHg[92]. HVPG: Hepatic venous pressure gradient.

Figure 3 Hepatic vein enhancement with microbubble contrast-enhanced ultrasound and measurement of Hepatic vein arrival time and the correlation between Hepatic Venous Pressure Gradient and Hepatic vein arrival time. A: Ultrasound images showing the HV (white arrows) before the contrast injection; B: Arrival of microbubble contrast agent in the HV after contrast enhancement; HVAT was calculated as the time (in seconds) from injection to a sustained increase in signal in the TIC to more than 10% above baseline; C: Recorded TIC profile shows early HVAT (11.0 s; the 10-s lead time was subtracted from 21.0 s) in a patient with cirrhosis with HVPG of 20 mmHg; D: Recorded TIC profile shows an HVAT of 27.0 s (37.0 min 10 s) in a healthy control; E: HVAT was significantly linearly correlated with HVPG in the patients with compensated cirrhosis (r² = 0.545; P < 0.001). HV: Hepatic vein; CEUS: Contrast-enhanced ultrasonography; HVAT: Hepatic vein arrival time; HVPG: Hepatic venous pressure gradient; TIC: Time intensity curve[102].