From the Guidelines
A parenchymatous liver detected by ultrasound indicates abnormal liver tissue with increased echogenicity, often suggesting fatty liver disease, which requires further evaluation to determine the underlying cause and appropriate management. This finding is typically characterized by a diffuse increase in liver echogenicity, which can be graded as mild, moderate, or severe based on the degree of fatty infiltration 1. The diagnosis of hepatic steatosis using ultrasound has been shown to have a sensitivity of 84.8% and a specificity of 93.6% in moderate and severe cases 1. However, the accuracy of ultrasound in detecting mild steatosis is lower, with sensitivity and specificity ranging from 53.3% to 65% and 77% to 81.2%, respectively 1.
Some key points to consider in the evaluation of a parenchymatous liver include:
- The importance of lifestyle modifications, such as reducing alcohol intake, losing weight, and improving diet, in managing fatty liver disease
- The need for further testing, such as liver function tests or additional imaging studies, to determine the severity and cause of the liver abnormality
- The potential for progression to more serious liver conditions, such as steatohepatitis, fibrosis, or cirrhosis, if the underlying causes are not addressed
- The use of quantitative grading, such as the hepatorenal index, to obtain a more accurate assessment of liver steatosis, which has been shown to have an excellent correlation with fat fraction on MR spectroscopy and liver biopsy 1
In terms of management, lifestyle modifications are recommended as the initial approach, with medication or other interventions considered on a case-by-case basis. It is essential to work with a healthcare provider to determine the best course of action and to monitor the progression of the disease. By addressing the underlying causes of fatty liver disease and making lifestyle changes, it is possible to reverse early changes and prevent the development of more serious liver conditions 1.
From the Research
Definition of Parenchymatous Liver
A parenchymatous liver refers to a liver with disease or damage affecting the parenchyma, which is the functional tissue of the liver 2.
Detection by Ultrasound
Ultrasound can be used to detect parenchymal liver disease, including granulomatous liver disease 3. The ultrasound scan may show multiple echogenic lesions surrounded by a hypoechoic halo.
Characteristics of Parenchymal Liver Disease
Parenchymal liver disease can be diffuse, affecting the entire liver, and may progress to fibrosis and eventually hepatocellular carcinoma 2. The disease can be caused by various factors, including hepatic steatosis, fibrosis, metabolic diseases, and hepatitis.
Diagnosis and Evaluation
Liver biopsy is considered the gold standard for evaluating parenchymal liver disease [(4,5)]. However, non-invasive methods, including serum biomarkers and imaging techniques such as ultrasound, computed tomography scan, and magnetic resonance imaging, are also used 2. Imaging-guided parenchymal liver biopsy, particularly with ultrasound guidance, is a safe and effective way to diagnose and evaluate parenchymal liver disease 6.
Key Points
- Parenchymatous liver refers to a liver with disease or damage affecting the parenchyma.
- Ultrasound can detect parenchymal liver disease, including granulomatous liver disease.
- Parenchymal liver disease can be diffuse and may progress to fibrosis and hepatocellular carcinoma.
- Liver biopsy is the gold standard for evaluating parenchymal liver disease, but non-invasive methods are also used.
- Imaging-guided parenchymal liver biopsy, particularly with ultrasound guidance, is a safe and effective way to diagnose and evaluate parenchymal liver disease.