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This study aims to evaluate the clinic value of ultrasound, computed tomography (CT) and serological testing in the differentiation between hepatic Cystic Echinococcosis (CE) types 1 and simple hepatic cysts.Totally 50 patients with CE Types 1 and 50 patients with simple hepatic cysts were included. All patients examined by ultrasound, CT and serological testing respectively. The receiver operating characteristic (ROC) curve of diagnosis methods was drawn and their sensitivity, specificity, Youden index, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value were compared. Pathology result was used as golden standard.The area under ROC curve of ultrasound was 0.97 and of CT and serological testing was 0.79 and 0.71 respectively. The sensitivity of ultrasound in the diagnosis of CE Types 1 was 96.00%, specificity was 98.00%, the positive likelihood ratio was 48.00, and negative likelihood ratio was 0.04. Disease prevalence was 50%, positive predictive value was 97.96%, and negative predictive value was 96.08%. The sensitivity of CT was 80.00%, specificity was 62.00%, positive likelihood ratio was 2.11, and negative likelihood ratio was 0.32. Disease prevalence was 50%, positive predictive value was 67.80%, and negative predictive value was 75.61%. The sensitivity of immunological test was 86.00%, specificity was 72.00%, positive likelihood ratio was 3.07, and negative likelihood ratio was 0.19. Disease prevalence was 50%, positive predictive value was 75.44%, and negative predictive value was 83.72%. Combined ultrasound and immunological test, the sensitivity and the specificity was 82% and 100% respectively. Combined CT and immunological test, the sensitivity the specificity was 70% and 82% respectively.In the differentiate diagnosis of CE Types 1 and simple hepatic cyst, ultrasound is better than CT with high sensitivity and specificity, therefore recommended. Immunological examination is an important complement to the imaging examination.

Agenesis of the right liver is a rare congenital anomaly which can be associated with an ectopic gallbladder. Hereby, it is presented the case of a 39-year-old man investigated for right upper quadrant abdominal pain and diagnosed at computed tomography with a cystic liver mass initially considered as hydatid cyst. At laparotomy, it was discovered agenesis of the right liver and the presumed hydatid cyst was a retrohepatic gallbladder with lithiasis. Cholecystectomy was performed with an uneventful outcome. Reassessment of the computed tomography images by an experienced radiologist confirmed the intraoperative diagnosis. Although agenesis of the right liver with retrohepatic gallbladder is an exceptional appearance, surgeons should be aware of this anomaly because it can raise challenging issues of diagnosis and surgical planning during cholecystectomy., (Celsius.)

Introduction: The present study indicates that simple and hydatid cysts in liver are a common health problem in Turkey. The aim of the study is to differentiate different types of hydatid cysts from simple cysts by using diffusion-weighted images., Materials and Methods: In total, 37 hydatid cysts and 36 simple cysts in the liver were diagnosed. We retrospectively reviewed the medical records of the patients who had both ultrasonography and magnetic resonance imaging. We measured apparent diffusion coefficient (ADC) values of all the cysts and then compared the findings., Results: There was no statistically meaningful difference between the ADC values of simple cysts and type 1 hydatid cysts. However, for the other types of hydatid cysts, it is possible to differentiate hydatid cysts from simple cysts using the ADC values., Conclusion: Although in our study we cannot differentiate between type I hydatid cysts and simple cysts in the liver, diffusion-weighted images are very useful to differentiate different types of hydatid cysts from simple cysts using the ADC values., Competing Interests: There are no conflicts of interest.

Purpose: The purpose of our study is to evaluate results of percutaneous aspiration with alcohol sclerotherapy in symptomatic patients with simple hepatic cysts by employing single-session techniques either by a needle or a catheter., Materials and Methods: We retrospectively included 39 simple hepatic cysts in 35 patients treated via percutaneous aspiration and single-session alcohol sclerotherapy between years 1993 and 2012. Indications were pain (n = 28) or ruling out cystic echinococcus (CE) disease (n = 7). 29 cysts in 26 patients were treated by needle technique (Group A) and ten cysts in nine patients were treated by single-session catheter technique (Group B). Patients were followed for 4-173 months (median: 38 months)., Results: All patients were successfully treated. Before procedure, cyst volumes were 21-676 cc (median: 94 cc). Post-procedure cyst volumes at last follow-up were 0-40 cc (median: 1 cc). The mean decrease in cyst volume was 95.92 ± 2.86 % in all patients (95.96 ± 3.26 % in Group A and 95.80 ± 6.20 % in Group B). There was no statistically significant difference between the volume reduction rates of Group A and Group B. Only one patient, in Group B, developed a major complication, an abscess. Hospitalization period was 1 day for all patients., Conclusions: For patients with symptomatic simple hepatic cysts smaller than 500 cc in volume by using puncture, aspiration, injection, and reaspiration (PAIR) technique with only needle, single-session alcohol sclerotherapy of 10 min is a safe and effective procedure with high success rate.

Cystic formations within the liver are a frequent finding among populations. Besides the common cystic lesions, like simple liver cysts, rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential diagnosis. Thorough knowledge of each entity's nature and course are key elements to successful treatment. Detailed search in PubMed, Cochrane Database, and international published literature regarding rare cystic liver lesions was carried out. In our research are included not only primary rare lesions like cystadenoma, hydatid cyst, and polycystic liver disease, but also secondary ones like metastasis from gastrointestinal stromal tumors lesions. Up-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided. A diagnostic and therapeutic algorithm is also proposed. The need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities, diagnostic tools, and treatment modalities is stressed. Patients with cystic liver lesions must be carefully evaluated by a multidisciplinary team, in order to receive the most appropriate treatment, since many cystic liver lesions have a malignant potential and evolution.

Hepatic cysts are increasingly found as a mere coincidence on abdominal imaging techniques, such as ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI). These cysts often present a diagnostic challenge. Therefore, we performed a review of the recent literature and developed an evidence-based diagnostic algorithm to guide clinicians in characterising these lesions. Simple cysts are the most common cystic liver disease, and diagnosis is based on typical USG characteristics. Serodiagnostic tests and microbubble contrast-enhanced ultrasound (CEUS) are invaluable in differentiating complicated cysts, echinococcosis and cystadenoma/cystadenocarcinoma when USG, CT and MRI show ambiguous findings. Therefore, serodiagnostic tests and CEUS reduce the need for invasive procedures. Polycystic liver disease (PLD) is arbitrarily defined as the presence of > 20 liver cysts and can present as two distinct genetic disorders: autosomal dominant polycystic kidney disease (ADPKD) and autosomal dominant polycystic liver disease (PCLD). Although genetic testing for ADPKD and PCLD is possible, it is rarely performed because it does not affect the therapeutic management of PLD. USG screening of the liver and both kidneys combined with extensive family history taking are the cornerstone of diagnostic decision making in PLD. In conclusion, an amalgamation of these recent advances results in a diagnostic algorithm that facilitates evidence-based clinical decision making.

Objectives: To present a case of primary hepatic actinomycosis., Clinical Presentation: A-40-year-old man was admitted to the general surgery clinic with a 1-month history of abdominal pain and weight loss. Liver transaminase, bilirubin levels and white blood cell counts were increased. Abdominal ultrasound and CT revealed cystic lesions with necrotic debris involving the posterior segment of the right lobe of the liver and the medial segment of the left lobe., Intervention: The patient underwent surgery under general anesthesia. On exploration, three cavities were found within the liver containing necrotic material. Surgical debridement and drainage was performed. Histopathological examination revealed actinomycotic colonies with a surrounding suppurative granulomatous reaction. The patient was treated with penicillin for 3 months., Conclusion: This case showed that histological examination of biopsy or surgical material or anaerobic cultures was needed for definitive diagnosis and that hepatic actinomycosis should be included in the differential diagnosis of solitary or multiple hypodense liver lesions., (Copyright (c) 2010 S. Karger AG, Basel.)

Purpose: Many human blood proteins are synthesised in the liver. Their serum levels may decrease or increase due to liver disorders and some of them serve as useful biomarkers. Determination of serum concentration of different biomarkers has important role in diagnosis of liver diseases and in monitoring the course of disease. In this work 3 serum markers associated with liver disorders were compared. The aim was to assess whether these biomarkers exhibit specific distribution pattern in different types of liver disease: liver neoplasia (primary hepatocellular carcinoma [HC] or metastatic liver disease [MLD] from colon cancer), viral hepatitis C (HCV) and the parasitic infection echinococcosis., Methods: Serum concentrations of alpha-fetoprotein (AFP), ferritin and insulin-like growth factor I (IGF-I) were determined in patients with liver disease and compared between patient groups and with healthy persons., Results: Serum AFP and ferritin levels exhibited similar pattern of change in patients with liver neoplasia or HCV, and concentrations of these 2 markers were significantly increased compared to the control group (p < 0.01 in each case). On the other hand, the concentration of IGF-I was significantly decreased in patients with liver neoplasia or echinococcosis compared to the control group (p < 0.05 for both). The concentration of IGF-I was significantly lower and the concentration of ferritin significantly higher in patients with HC than in patients with MLD from colorectal cancer (p < 0.01 for both)., Conclusion: The results have shown that each hepatic pathology studied exhibited specific profile of the analysed set of biomarkers. Therefore, the simultaneous determination of the 3 mentioned biomarkers may help in differential diagnosis of liver diseases.

Alveolar echinococcosis (AE) is a rare but potentially serious zoonosis for which an early diagnosis is of primary importance. We report the first observation of AE in a cardiac transplant patient infected by hepatitis C virus. He first presented with a single asymptomatic hepatic nodule. The liver biopsy showed an epithelioid granuloma with necrosis. We review the clinical features, diagnosis and outcome of this disease in immunocompromised hosts. In immunocompromised patients living in areas endemic for Echinococcus multilocularis, AE should be included in the differential diagnosis of tumor like lesions of the liver.

Introduction: Cysts are a common radiological finding in the liver. Many affected patients do no require treatment. However a minority require further investigation and treatment for symptoms or risk of underlying malignancy., Methods: A computerised database of patients presenting to Auckland Hospital for the management of liver lesions was established in 2000. Details of demographics, presentation, investigations, management, and follow-up are entered prospectively., Results: Forty-seven patients (36 female, median age 61, range 37-86 years) requiring surgical treatment of cystic liver lesions were identified from a total of over 800 patients enrolled in the database. Twenty-five patients presented with simple cysts, of whom 12 had radiological evidence of polycystic liver and kidney disease. All 25 patients were symptomatic and all were managed successfully with laparoscopic fenestration. Nine patients presented with complex cysts which were treated with liver resection. Of these patients, four had benign cysts, three had underlying biliary cystadenomas, and two had biliary cystadenocarcinomas. One patient with a biliary cystadenocarcinoma is dead of disease. The median follow-up for all 47 patients was 26 months., Conclusions: Cystic liver lesions can represent a spectrum of underlying conditions. All cysts require investigation and complex cysts or symptomatic simple cysts require further treatment.

Of 74 patients, treated in 2000-2007 yrs in the clinic for nonparasitic hepatic cyst, in 18 hepatic polycystosis was revealed. The applied examination algorhythm was two-staged and included the clinico-laboratory investigations results analysis, as well as serological tests for echinococcus, two-dimensional ultrasonographic investigation data, CT in necessity, the cyst puncture--on the first stage and laparoscopy with histologic investigation of the cyst wall--on the second. The proposed differential diagnostic criteria application had permitted to differ the hepatic cyst of parasitic and nonparasitic origin in 98% of observations.

The high frequency of benign and asymptomatic liver cysts must not underevaluate the potential diagnostic difficulties of liver cystic diseases. Complicated liver cyst or cystic mass of various origin, such as developmental, neoplastic or inflammatory, are important to be recognized by the radiologist. The diagnostic approach is depending on the number of lesions and their dissemination. The presence of a wall, the internal structure of the lesion, particularly the MR signal and the proximity of the biliary tree are the main diagnostic criteria. Some less frequent but characteristic unusual features need to be memorized.

A 72-year-old woman with multilocular liver cysts was admitted. This lesions seemed to be an alveolar hydatid disease. Two methods of Western blotting were used for serologic diagnosis. One method recognizes antigens of crude extracts of Echinococcus multilocularis (EM). The other method recognizes a purified antigen (Em18) of EM. Her serum only reacted with the former method and never reacted with Em18 antigen. Eighteen months after first admission, she had an operation. The resected specimen was diagnosed with simple cysts. Western blotting using Em18 antigen could greatly facilitate the differential diagnosis of simple liver cyst and alveolar hydatid disease.

Problems of diagnostic and treatment policy in hepatic lesions are considered. Based on analysis of 511 cases, the authors demonstrate that among hepatic lesions as well as widespread diseases (hemangioma, cancers, parasitic and non-parasitic cysts) rare diseases can be also found. Diseases of different organs may simulate hepatic lesions.

Background: Laparoscopic fenestration is considered the best treatment for symptomatic simple liver cysts. Conversely, the laparoscopic approach for the management of hydatid simple liver cysts is not widely accepted because of the risk for severe complications. Despite improvement in imaging techniques, the probability of preoperatively mistaking a hydatid liver cyst for a simple liver cyst remains about 5%. Therefore, laparoscopic fenestration, planned for a liver cyst could be performed unintentionally for an undiagnosed hydatid liver cyst., Methods: From January 2000 to January 2001, 15 patients with a diagnosis of liver cyst underwent laparoscopy for fenestration. In all cases preoperative serologic and imaging assessment had excluded hydatid liver cyst. To further exclude hydatid liver cyst, preliminary aspiration of the cyst with assessment of cystic fluid characteristics was performed., Results: In two patients with presumedly simple liver cyst, hydatid liver cyst was diagnosed instead at laparoscopy by aspiration of cystic fluid. The procedure was converted to laparotomy with subtotal pericystectomy., Conclusions: The risk of misdiagnosing a hydatid liver cyst for a simple liver cyst, especially in the presence of a solitary cyst, should be considered before laparoscopic fenestration is performed. Intraoperative aspiration of cyst fluid before fenestration can minimize this risk, thus avoiding severe intraoperative and late complications.

This article discusses MR imaging of infective liver lesions including pyogenic liver abscesses, amebic liver abscesses, echinococcal disease, hepatic fungal abscesses, granulomatous hepatic infections, schistosomiasis, and fascioliasis.

A 20-year-old woman underwent alcohol sclerotherapy for a symptomatic liver cyst, initially diagnosed as simple liver cyst. Five months later, she presented with expulsion of the cyst from the puncture site. The cyst was proved to be due to hydatid disease. Spontaneous expulsion is a rare complication of sclerotherapy.

Cystic lesions of the liver in the adult can be classified as developmental, neoplastic, inflammatory, or miscellaneous. Although in some cases it is difficult to distinguish these entities with imaging criteria alone, certain cystic focal liver lesions have classic computed tomographic (CT) and magnetic resonance (MR) imaging features, which are important for the radiologist to understand and recognize. Lesions with such features include simple (bile duct) cyst, autosomal dominant polycystic liver disease, biliary hamartoma, Caroli disease, undifferentiated (embryonal) sarcoma, biliary cystadenoma and cystadenocarcinoma, cystic subtypes of primary liver neoplasms, cystic metastases, pyogenic and amebic abscesses, intrahepatic hydatid cyst, extrapancreatic pseudocyst, and intrahepatic hematoma and biloma. Specific CT and MR imaging findings that are important to recognize are the size of the lesion; the presence and thickness of a wall; the presence of septa, calcifications, or internal nodules; the enhancement pattern; the MR cholangiographic appearance; and the signal intensity spectrum. In addition, access to critical clinical information remains extremely important. The most important clinical parameters defined include age and gender, clinical history, and symptoms. An understanding of the classic CT and MR imaging appearances of cystic focal liver lesions will allow more definitive diagnosis and shorten the diagnostic work-up.

We present the case of a 42-year-old male patient with a large hepatic cyst, simulating a hydatid cyst. Subtotal cystectomy was performed. Thirteen months after this procedure the patient relapsed and a second laparotomy and total cystectomy were performed. A histopathological diagnosis of epidermoid cyst of the liver was made. The differential diagnosis of epidermoid cysts of the liver is broad and definitive diagnosis is usually only obtained after pathological examination of the surgical specimen. For this reason, and because of the potential for neoplasia, complete resection of the hepatic lesion should be attempted.

Intrabiliary rupture leading to biliary obstruction is a rare but serious presentation of hepatic echinococcosis. Four such cases are presented. Imaging studies including sonography, computed tomography and/or cholangiography, done in all patients led to a definite preoperative diagnosis which was later confirmed at surgery. Biliary tree dilatation was detected in three out of four patients, hydatid contents were seen in three patients and definite cysto-biliary communication was documented in two.

Objective: To evaluate the treatment of symptomatic benign non-parasitic cysts of the liver by percutaneous drainage and sclerotherapy with alcohol or surgery., Design: Descriptive, prospective., Setting: The study was conducted at the University Hospital of Catania (Italy), which serves as a general community hospital., Summary Background Data: Solitary biliary cysts are among the most frequent cystic lesions of the liver and have a prevalence of 1 to 2 percent. They are almost always asymptomatic and do not require treatment. Ultrasonography shows a regular, round or oval, entirely liquid and trans-sonic image sufficient to make the diagnosis. Complications are exceptional., Patients: Eight out of 40 patients who presented with symptomatic benign non-parasitic cysts of the liver during the period 1987-1994 and in whom percutaneous drainage was not contraindicated. INTERVENT: Drainage sclerotherapy with absolute alcohol was carried out, after which suction was applied until oozing stopped., Results: Eight patients were treated, all women, 49-61 years old. In 7 patients, the cyst did not recur during the follow-up period which ranged from 8 to 60 months. Only one patient needed another percutaneous drainage. No complications of the drainage were encountered., Conclusion: Percutaneous drainage followed by alcohol sclerotherapy and suction is the treatment of choice in patients with symptomatic benign non-parasitic cysts of the liver. Surgical treatment should be reserved for patients who fail to respond to repeated percutaneous drainage and cases in which the location of the cyst makes it technically difficult to use a percutaneous route.

Objectives: Differential diagnosis between a benign cystic hepatic lesion, biliary cyst, and a potentially malignant lesion or biliary cystadenoma, is difficult. The aim of this study was to evaluate imaging features of atypical cystic liver lesions and the role of imaging techniques in determining a specific diagnosis., Methods: Twenty-six patients with atypical cystic hepatic lesions were included in this study. All patients underwent surgery and pathological diagnosis was atypical hepatic cyst (n = 18), biliary cystadenoma (n = 4), hydatic cyst (n = 3), and ciliated hepatic foregut cyst (n = 1). We systematically reviewed US (n = 24), CT (n = 24), and MRI (n = 8) examinations., Results: Septum were seen in both cystadenomas (US: n = 4, CT: n = 1) and hepatic cysts (US: n = 11, CT: n = 6). No mural nodules were seen. A thin wall was noted in both hepatic cysts (n = 2) and cystadenomas (n = 3). The intrahepatic biliary tract was dilated in 3 patients with hepatic cysts, 1 patient with cystadenoma, and 2 patients with hydatic cysts. Calcifications were noted in 1 patient with hepatic cyst, 3 patients with hydatic cysts, and in the case of ciliated hepatic foregut cyst. We found an associated typical hepatic cyst in 77% of cases (14/18) with atypical hepatic cysts; this was never found in other atypical cystic lesions (P < 0.01)., Conclusion: In this series, no imaging features provided a differential diagnosis of atypical hepatic cysts and cystadenomas. The presence of associated typical hepatic cysts is helpful in suggesting the diagnosis of hepatic cyst.

A prospective study in 88 consecutive patients with solid hepatic mass was performed to determine the value of ultrasound in the diagnosis of pseudo-tumoral hydatid cyst. Ultrasonography systematically searched 5 evocative signs: hypoechoic spiral, peripheric hypoechoic rim surrounded by an echoic border, daughter cysts, hyperechoic areas with shadowing and/or enhancement of back-wall echos. Diagnosis of pseudo-tumoral hydatid cyst was based upon the association of, at least, 2 signs. The sensitivity of echography was 92.3% and the specificity was 98.3%. Furthermore this study allow us to propose a new, more accurate, definition of the hydatid spiral. However, serologic tests were found to be of little interest.

The radioimmunological method was used to determine the content of tumor markers APP, REA, CA 19-9, and CA 72-4 in 53 patients with nonmalignant three-dimensional structures in the liver (hemangioma, nonparasitic cysts, alveococcosis, hydatid cysts), in 9 patients with primary carcinoma of the liver, and in 24 healthy individuals. The significance of APP determination and complex study of tumor markers in the recognition and differential diagnosis of benign and malignant structures in the liver is shown. It allowed the percentage of disparity between the laboratory and the verified diagnosis to be reduced to 4.8%.

The authors performed 69 puncture biopsies (in 12 cases--under guidance of laparoscopy, in 57--ultrasound investigation) in 63 patients with indeterminate diagnosis of focal hepatic lesion. A positive result was noted in 59 (96.9%) patients. Of them, 43 had a malignant tumour been diagnosed, 16--non-tumour process. In 2 cases, a false negative result was obtained, in 1--a false positive one.

Cystic liver lesions are being increasingly detected by ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). These lesions produce a wide spectrum of radiological features. Unfortunately their appearance is not always specific and they may resemble and be mistaken for other lesions. Cystic lesions can be classified into congenital, inflammatory, neoplastic and miscellaneous groups. In this pictorial essay a number of unusual cystic lesions are illustrated with a brief analysis of morphological features of the individual lesion and a diagnostic approach for cystic liver lesions is suggested.

The results of clinical observations of 60 patients with polycystosis of the liver who had been treated or examined by the authors in the period from 1964 to 1989 were summarized. The clinical course of the disease was featured by scanty clinical signs: pains in the upper half of the belly and hepatomegaly were most frequent. The combination of diagnostic techniques for verification of surgical intervention necessity was established. Besides, it was stated that the diagnosis of polycystosis of the liver should be complex and based on anamnestic data and the results of clinical, laboratory and instrumental investigations. Preference should be given to ultrasonography and computed tomography. Cysts with diameter of 5 cm and more, complicated polycystosis of the liver (bleeding, suppuration, malignancy) and cystic compression of the extrahepatic bile ducts and vessels (portal and cava inferior veins) were found to be indicative signs for surgical treatment of hepatic polycystosis. A total of 41 patients were subjected to surgical treatment with 49 operational procedures employed. Fenestration of hepatic cysts (42), that were organosparing operations, predominated. Resection of the liver was performed in 2 patients who had total cyst substitution for the whole of the left lobe. The improvement registered in 85.7% of operated on patients evidenced the favorable results of surgical treatment.

The authors analyse 60 cases of polycystic disease of the liver; 41 patients underwent operation, 19 were kept under dynamic follow-up. The diagnosis of polycystic disease of the liver is based on the results of ultrasonic examination and computed tomography; serological tests are conducted for differential diagnosis with hydatid disease. Twenty (33.3%) patients had affection of the kidneys, pancreas, ovaries, and brain. As the result of surgery the condition improved in 30 (85.7%) and became worse in 5 (14.3%) patients in follow-up periods of 6 months to 23 years. Complications occurred in the postoperative period in 10 patients, the mortality rate was 4%. Fenestration of the cysts is the main type of intervention, which allows maximum preservation of the functioning hepatic parenchyma. The left hepatic lobe was resected in only 2 patients with its complete cystic degeneration. Defocused laser beam and bipolar rotor electrocoagulator were used for ++de-epithelialization of the cystic walls. Experience shows the expediency of surgical treatment for decompression of the maintained hepatic parenchyma.

Ultrasonography of the liver as a non-invasive examination technique has been integrated within the recent years amongst the methods in routine use for the clinical diagnosis of liver diseases. The reliability of this technique is comparable to scintigraphy and computer-tomography. Side-effects are practically non-existent, whilst cost and time expenditure are markedly lower than with these other techniques. Sonography is indicated in any suspected diffuse or circumscribed pathological lesion of the liver. Furthermore, sonography is performed for the detection of ascites, perihepatic abscesses to evaluate the mobility of the diaphragm and in any case of jaundice of unknown aetiology. In the following study the referral diagnosis, ultrasonic diagnosis and final diagnosis were compared in 26 patients referred for ultrasonic diagnosis. In 22 out of the 26 patients full agreement was obtained between ultrasonic diagnosis and the final diagnosis. In 2 cases liver disease was suspected on ultrasonic examination, but the specific diagnosis was missed. A lack of agreement occurred in only 2 patients with respect to ultrasonic and final diagnosis. This study demonstrates the high accuracy of ultrasonic diagnosis in liver diseases. Ultrasonography, scintigraphy and computer tomography give similar results. In some cases, however, clinical diagnosis may be optimized by a combination of all available methods.

The effectiveness of scintigraphy, sonography and angiography is compared in a material of 140 cases of circumscribed disease of the liver. Typical clinical starting points are defined as points of reference of the diagnostic techniques. Clinical diagnosis is very safe in cases of secondary blastoma and hepatocellular carcinoma of the liver. Since the great majority of these conditions cause space-occupying lesions of the liver, problems of radiologic diagnosis are confined to the smaller number of clinically ill-defined lesions. For the diagnosis of secondary blastomas and cystic process of all kinds, scintigraphy and sonography are not improved by angiography. Solid space-occupying lesions of unknown origin, however, can only be recognized with angiography. Histology of both benign and malignant processes will be correct in more than 90% of cases.

Five cases demonstrate the reliability of sonography in identifying cysts and calcifications within the liver. This method is shown to be capable, often without detailed clinical information, of detecting the underlying disease and of monitoring its development.

The diagnostic value of sonography and CT was studied in 259 patients. In the diagnosis of solid tumours, CT is superior to sonography, whereas ultrasound is more useful in the investigation of cystic lesions. In estimating the extent of intrahepatic tumours, the falciform ligament is more useful than a line from the cava to the gall bladder, both for CT and ultrasound, although in this case CT shows the extent of tumours more accurately. 3.7% of the ultrasound and 2.3% of the CT examinations were of limited value because of unavoidable technical problems.

The metabolic activity of the hepatic cytochrome P450 system was studied in 53 ambulatory subjects. 18 of these were cirrhotics and 23 had non-cirrhotic liver disease, documented by biopsy, serologic, ultrasound or computerized tomography findings, and characterized by quantitative liver function tests, such as galactose elimination capacity and indocyanine green fractional clearance. For comparison, 12 normal control subjects were also included. All subjects were given 10 mg/kg body weight antipyrine and saliva concentrations determined with an HPLC-method at 24 and 48 hours after dosing. Antipyrine saliva clearance (ASC) was calculated according to a two-point method (Cl1), and compared with a one-point method (Cl2) using the 24 h sample only. These subjects also underwent an aminopyrine breath test (ABT), breath samples being collected at regular intervals during 60 minutes following injection of a tracer dose of 1.5 muCi (14C-dimethylamino)antipyrine. Cl1 and Cl2 correlated strongly (r = 0.93). On the basis of smaller variations (particularly in control subjects), better definition of disease severity and convenience and time saving, Cl2 is to be preferred. Comparison of Cl2 with ABT showed that both procedures apparently quantify overlapping enzymatic activities. However, the relationship between Cl2 and ABT values, albeit highly significant (r = 0.72), suggests that only about half of the variables are subject to the same determinant. In addition, a positive intercept of the regression line extrapolated to the Cl2 axis points to quantitatively important extrahepatic breakdown of antipyrine. The results suggest that, in view of the wide variation in normal values (presumably in part influenced by exogenous pollutants), ASC only provides an approximation of hepatic metabolic activity.(ABSTRACT TRUNCATED AT 250 WORDS)