Maitray Patel
SRU Fellow
Mayo Clinic Arizona
Posts: 646
Institution: Mayo Clinic Arizona
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Post by Maitray Patel on Apr 19, 2018 14:24:38 GMT -8
It seems to me that my sonographers label about 50% of our cases as "echogenic liver". Sometimes it's florid and obvious, but in other cases it seems fairly equivocal...and I end up blowing these off. Is hepatic steatosis that common now? Have others found this overcalling of echogenic liver by their sonographers?
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Nirvi Dahiya
Executive Board
Mayo Clinic Arizona
Enjoying the SRU Forum - Great Potential for networking
Posts: 37
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Post by Nirvi Dahiya on Apr 19, 2018 14:26:19 GMT -8
Yes - seems to be so
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Maitray Patel
SRU Fellow
Mayo Clinic Arizona
Posts: 646
Institution: Mayo Clinic Arizona
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Post by Maitray Patel on Apr 19, 2018 14:29:07 GMT -8
Problem is that it translates to overcalling by residents/fellows. They are disinclined to "disagree" with the sonographer. One thing I rely on more and more is whether there is good sound transmission--I definitely blow off the equivocal cases when there is no reduction in acoustic transmission to the deeper parts of the liver. How do others fine tune this in their practice?
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Post by Aya Kamaya on Apr 23, 2018 10:35:32 GMT -8
Maybe your sonographers should not be the ones to make this decision? This is a diagnosis that should be made by a radiologist, not a sonographer IMO.
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Maitray Patel
SRU Fellow
Mayo Clinic Arizona
Posts: 646
Institution: Mayo Clinic Arizona
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Post by Maitray Patel on Apr 23, 2018 10:46:56 GMT -8
Aya, absolutely. We ask our sonographers to jot down notes in our electronic jot pad for the case, especially if they aren't checking out the case directly (as happens since we are remotely covering 2 sites). That also helps when we are reviewing cases on call since we can see what the sonographer said and what the trainee dictated.
Do you find your sonographers often feeling that the liver is echogenic?
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Bill Middleton
SRU Fellow
Mallinckrodt Institute of Radiology
Posts: 143
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Post by Bill Middleton on Apr 25, 2018 4:07:07 GMT -8
I look for sparing near GB and portal vein. Sometimes that helps me when I am not sure otherwise.
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Maitray Patel
SRU Fellow
Mayo Clinic Arizona
Posts: 646
Institution: Mayo Clinic Arizona
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Post by Maitray Patel on Apr 25, 2018 6:59:56 GMT -8
Yes, it's very helpful when there is "sparing" as that nails the diagnosis, in my mind. There are a number of cases in which we don't see sparing. I'm attaching an example of a recent case in which my sonographer indicated "echogenic liver". I think part of the issue here was that the patient had somewhat limited windows and intercostal scanning led to edges of the images showing relatively poor signal due to effects of the ribs. This makes one think there is liver heterogeneity and areas of acoustic signal drop. In this case, I dictated "equivocally increased liver echogenicity could reflect hepatic steatosis or be a normal variant", because to me the echogenicity difference between the liver and kidney was "equivocally abnormal". Anyway, I find the sonographers commonly telling me in their notes that the liver was echogenic, and I back off that conclusion about 10-15% of the time that they say it (meaning I only agree in about 5 of 6 cases). Attachments:
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Maitray Patel
SRU Fellow
Mayo Clinic Arizona
Posts: 646
Institution: Mayo Clinic Arizona
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Post by Maitray Patel on Apr 25, 2018 7:09:52 GMT -8
Does anyone routinely use the hepatorenal index that the folks at Oschner have promoted? See attachment. Frankly, I've never used it but maybe it would be a simple thing to implement for the equivocal cases? In the remote past, we used to throw around the diagnosis of "fatty liver" with impunity, but I think it has more clinical significance now. |
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Post by Stefanie Lee (McMaster) on May 8, 2018 18:11:08 GMT -8
I have the opposite experience - perhaps I am the one overcalling fatty liver... Thanks for sharing the hepatorenal index (and setting up this forum as a useful resource!). I will try it out and see how it goes.
Conversely, our sonographers frequently comment on echogenic pancreas, which I tend not to report. But perhaps I should start doing so, given the recent Radiology article on increased pancreatic echogenicity and diabetes? Any advice appreciated.
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Maitray Patel
SRU Fellow
Mayo Clinic Arizona
Posts: 646
Institution: Mayo Clinic Arizona
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Post by Maitray Patel on May 9, 2018 5:49:58 GMT -8
Thanks for bringing my attention to the pancreas echogenicity article. To be honest, I had not seen it yet. I've practically never been concerned with the degree of pancreas echogenicity on US. I rarely mention it as a finding, and have never made any "impressions" regarding it even if I have rarely said something about it in the findings. I'm posting the article here for others to see, since I it had not yet registered for me. I'm not impressed that this has any meaning for me on first glance of the article though. In the study, it seems that 13.7% of all patients (regardless of pancreas echogenicity) ended up with "incident diabetes" (odds 1:7.2) with a hazards ratio of 1.49 if there was IPE. Applying that odds ratio to the cohort, the implication is that if you see IPE, you would then have a 20% chance of developing incident diabetes later (odds 1:4.9) instead of the baseline risk of 13.7%. Thus, 80% of patients with IPE will NOT get incident diabetes. I'm not sure I would be adding much value to patient care by making the finding. That's my preliminary take, though it would be interesting to understand the thoughts of others. |
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Post by Stefanie Lee (McMaster) on May 12, 2018 16:50:23 GMT -8
Thanks for the insight - although I don't encourage our residents to follow suit, I do see fatty pancreas being reported on ultrasound from time to time, so this is helpful to know.
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Maitray Patel
SRU Fellow
Mayo Clinic Arizona
Posts: 646
Institution: Mayo Clinic Arizona
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Post by Maitray Patel on Jun 27, 2018 6:28:00 GMT -8
This thread was placed in the "Sample" area so that non-members can see the types of discussions that can take place in the Forum. I'm closing further replies here--the topic is moved to the "Practice of US" category, in the Abdomen/Renal board. Please continue the discussion thereConsider joining SRU to get access to this type of content in the SRU Forum. |
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