GASTROENTEROLOGY 1966;94:157-62 zyxwvutsrqpo A New Quantitative Ultrasonic Method for Diagnosis of Chronic Parenchymal Liver Disease AHMED MEDHAT, FRANK L. IBER, and MORGAN DUNNE Departments of Medicine and Radiology, Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, Maryland zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJI The degree of echogenicity of the hepatic paren- chyma was measured by an objective method com- paring patient’s sonograms with a tissue-mimicking phantom obtained with available real-time ultra- sound machines. A single sonographic image of the liver and the phantom was taken using identical settings in each case. The ratio of the mean density of the phantom to that of the liver was obtained. The mean of the ratio in 30 normal subjects was 1.04 * 0.01, in 26 patients with early alcoholic liver dis- ease 1.23& 0.04, and in 74 cirrhotic subjects 1.54+ 0.03, with a significant difference among the three groups (p < 0.05). A significant correlation was also obtained between the ratio and a modified Child’s classification (r = 0.553, p < 0.05) in cirrhotic sub- jects. Follow-up studies were available in a limited number of patients with early alcoholic liver dis- ease showing progression or improvement parallel- ing alcohol use. Using this method, ultrasound may have considerable potential in the diagnosis and follow-up of alcoholic liver disease. A lcoholism is the leading cause of liver cirrhosis in the United States and the eighth leading cause of death (1). Alcoholic liver disease manifests itself clinically as three distinct, but interrelated and overlapping, entities: fatty liver, alcoholic hepatitis, and cirrhosis (2). The latter two are progressive and clearly shorten survival, whereas the former is re- versible with abstinence. Liver biopsy currently is required to establish the precise diagnosis, but its cost, slight risk, and time lost from work usually limit its use to advanced liver disease. Technical advances in ultrasonography have made it valuable in the noninvasive investigation of he- patic diseases, and its usefulness in the diagnosis of biliary obstruction (3) and focal diseases of the liver (4) is well established. On the other hand, the place of abdominal ultrasound in the diagnosis of diffuse hepatic disease is less clear (4,5). This is largely due to the subjective nature of ultrasonographic criteria for the diagnosis of diffuse liver disease, which depends heavily on the skill and experience of the interpreter and on variable technical factors. Stan- dardization of abdominal sonography and its inter- pretation would make it more useful in the diagnosis of liver disease (5). In this paper, we present an objective and simple method of quantitating liver echoes using standard ultrasonographic machines. We have evaluated its utility in the diagnosis of alcoholic liver diseases. Materials and Methods All patients were studied at the Baltimore Veterans Administration Medical Center. Nearly all had been well characterized during a previous hospital stay before the study and all provided written informed consent. The studies were approved by the Institutional Review Boards of the Baltimore Veterans Administration Medical Center and the University of Maryland School of Medicine. Pa- tients were selected because of a clear diagnosis. No effort was made to study all possible patients. Normal Subjects Thirty healthy male subjects were selected from among the staff and patients in the Veterans Administra- tion environment. None had a history of alcohol abuse (>50 g of alcohol weekly on a regular basis], and none had a history of liver disease or its complications. Liver tests in the normal range were available for 27 of these subjects, but only 1 subject underwent liver biopsy. Early Alcoholic Liver Disease Twenty-six alcoholic male patients admitted for alcohol detoxification and found to have prominent hep- atomegaly (> 15 cm liver span) by physical examination or abnormal liver tests (two or more abnormal results from 0 1966 by the American Gastroenterological Association 0016-5065/66/$3.50