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Coarse Nodular US Pattern in Hepatic Cirrhosis: Risk for Hepatocellular Carcinoma¹

¹ From the Department of Anatomy and Histopathology, Gastroenterology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.C., S.F., G.A.N., A.A.); and Department of Internal Medicine and Gastroenterology, II Università, Naples, Italy (L.C., B.P., C.d.V.B., I.d.S.). Received October 24, 2001; revision requested January 14, 2002; final revision received July 8; accepted July 31. Address correspondence to E.C., Gastroenterology Unit, Ospedale Belcolle, Strada Sammartinese, 01100 Viterbo, Italy (e-mail: e.caturelli@tiscalinet.it).

View larger version (148K): [in a new window]   Figure 1. Oblique US scan of the right subcostal area of the liver. Normal homogeneous pattern is observed in a patient with PBC.

View larger version (135K): [in a new window]   Figure 2. Oblique US scan of the right subcostal area of the liver. Typical bright liver pattern characterized by the presence of numerous, fine, tightly packed echoes of high signal intensity uniformly distributed throughout the liver parenchyma is observed in a patient with HBV-related cirrhosis.

View larger version (133K): [in a new window]   Figure 3. Oblique US scan of the right intercostal area of the liver. Typical coarse echo pattern with nonhomogeneous, thick, uneven echo spots without any distinct hypoechoic nodules is observed in a patient with HCV-related cirrhosis.

View larger version (130K): [in a new window]   Figure 4. Oblique US scan of the right intercostal area of the liver. Typical coarse nodular pattern with multiple small (<6-mm) weakly hypoechoic nodules (arrowheads) scattered over background pattern of coarse echoes is observed in a patient with HBV- and HDV-related cirrhosis.

View larger version (20K): [in a new window]   Figure 5. Graph shows cumulative risks of HCC associated with the coarse nodular US pattern in etiologic subgroups of cirrhosis. In HDV-related disease, the risk is 11.5% ± 8.3 (standard error); in HBV-related disease, 100.9% ± 54.8 (standard error); in HCV-related disease, 156.9% ± 88.5 (standard error); in ALC, 87.5% ± 73 (standard error). A log-rank test of the four curves indicated a significant difference (P = .012).

View larger version (20K): [in a new window]   Figure 6. Graph shows cumulative risk of HCC associated with the coarse echo pattern in etiologic subgroups of cirrhosis. In HDV-related disease, the risk is 7.1% ± 5 (standard error); in HBV-related disease, 33.6% ± 11.9 (standard error); in HCV-related disease, 52.8% ± 20.8 (standard error); in ALC-related disease, 13.8% ± 8.5 (standard error). A log-rank test of the four curves did not indicate a significant difference (P = .98).