Objective Ultrasonographic Findings for Diagnosis of Liver Cirrhosis: A Comparison between Images Obtained with Low Frequency and High Frequency Probes on a PACS

PURPOSE: We aimed to evaluate objective ultrasonography (US) findings for diagnosis of liver cirrhosis and to correlate the utility between the use of the low frequency and high frequency probes for images analyzed on the picture archiving and communications system (PACS). MATERIALS AND METHODS: A total of 87 patients participated in the study; 19 patients that had a clinically proven normal liver and 68 patients that had biopsy-proven chronic liver disease were evaluated with the use of US for the status of the liver. Multiple variables such as a 'smooth surface,' 'irregular nodular surface,' 'homogeneous echotexture,' 'heterogeneous appearance mixed with hypoechoic and hyperechoic echotexture' and 'hypoechoic honeycomb like echotexture' were evaluated based on images obtained with the use of both low frequency and high frequency probes by two observers. The diagnoses obtained after US were correlated with the histological results using assess agreement as statistical method. The concordance rate was calculated to correlate the utility between the use of the low frequency and high frequency probes. RESULTS: An 'irregular nodular surface' showed high interobserver agreement for the diagnosis of liver cirrhosis on images obtained with the low frequency probe (kappa= 0.61). In addition, 'hypoechoic honeycomb' showed high interobserver agreement on images obtained with the high frequency probe (kappa= 0.60). The use of the low frequency probe was associated with more accuracy for the diagnosis of liver cirrhosis (73%). CONCLUSION: Objective US findings for the diagnosis of liver cirrhosis are an 'irregular nodular surface' on images obtained with use of a low frequency probe and a 'hypoechoic honeycomb' on images with use of a high frequency probe.

The Four Primitive Reflexes in the Normal Elderly People

BACKGROUND: The primitive reflexes such as palmomental, glabella, snout, nuchocephalic reflexes may appear in a variety of diseases of the central nervous system. In this study, we investigated the frequencies of these primitive reflexes in the healthy elderly Korean population that have never been studied before. METHODS: Randomly selected 103 vol-unteers aged older than 60 years were examined by neurologists with a systemic neurological examination which included primitive reflexes and by radiologists with neuroimaging. Seven subjects were excluded from the study due to abnormal findings in the MRI of one subject and unusual neurological signs in 6 subjects. RESULTS: The overall mean age of the subjects was 66.5 years. One or more of the primitive reflexes were seen in 26 (24.9%) subjects. Eighteen (17.2%) subjects showed the palmomental reflex; eleven (10.5%) subjects showed the glabella reflex; five (4.8%) sub-jects showed the snout reflex; and one (1.0%) subject showed the nuchocephalic reflex. One subject had palmomental, glabella as well as snout reflexes, and five subjects had two primitive reflexes at the same time. CONCLUSIONS: Despite the normal findings from the neurological examinations and neuroimaging, 24.9% of healthy aged people had one or more primitive reflexes. The presence of these primitive reflexes as an isolated phenomenon may not imply brain lesions. (J Korean Neurol Assoc 19(4):380~383, 2001)