{"id":7856,"date":"2024-01-18T06:26:24","date_gmt":"2024-01-18T09:26:24","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=7856"},"modified":"2024-02-13T09:52:54","modified_gmt":"2024-02-13T12:52:54","slug":"ultrassonografia-multiparametrica-hepatica-em-cirrose","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/ultrassonografia-multiparametrica-hepatica-em-cirrose\/","title":{"rendered":"Ultrassonografia Multiparam\u00e9trica Hep\u00e1tica em Cirrose"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/7856?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/7856?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\r\n<h2 id=\"h-introducao\" class=\"wp-block-heading\"><strong>Introdu\u00e7\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>A avalia\u00e7\u00e3o multiparam\u00e9trica hep\u00e1tica por ultrassom (AMH-US) em pacientes cirr\u00f3ticos consiste na pesquisa minuciosa e peri\u00f3dica de achados ultrassonogr\u00e1ficos que cuja detec\u00e7\u00e3o impactem diretamente na sobrevida do paciente. Tais achados podem e devem ser investigados ao longo do exame de maneira customizada, a depender da etiologia da cirrose e de suas principais complica\u00e7\u00f5es, o CHC e a Hipertens\u00e3o Portal Clinicamente Significativa (HPCS). Via de regra, faz-se uma avalia\u00e7\u00e3o detalhada no modo B e avalia\u00e7\u00e3o vascular Doppler, ainda que tamb\u00e9m possa contemplar, a depender da etiologia da cirrose, a elastograf\u00eda ARFI (Pointer ou 2D SWE), quantifica\u00e7\u00e3o gordurosa e inflamat\u00f3ria hep\u00e1tica, bem como no uso do contraste de microbolhas.<\/p>\r\n\r\n\r\n\r\n<p>O <strong>CHC<\/strong> \u00e9 a complica\u00e7\u00e3o de maior impacto na sobrevida de pacientes com doen\u00e7a hep\u00e1tica cr\u00f4nica avan\u00e7ada (HCAc\/Cirrose)<sup>1<\/sup>. Assim, a sua detec\u00e7\u00e3o precoce (Estadio BCLC 0 ou A) \u00e9 muito importante j\u00e1 que s\u00e3o justamente esses pacientes os candidatos \u00e0 tratamentos de inten\u00e7\u00e3o curativa <sup>2,3<\/sup>.<\/p>\r\n\r\n\r\n\r\n<p><strong>Como resultado, todas as diretrizes internacionais apoiam a vigil\u00e2ncia do CHC nestes pacientes com base no exame semestral de ultrassonografia hep\u00e1tica, associado ou n\u00e3o a dosagem s\u00e9rica de alfafetoprote\u00edna (AFP) <sup>3-5<\/sup>, com uma sensibilidade global variando de 58% a 89% e uma especificidade de 90% <sup>6<\/sup>. <\/strong><\/p>\r\n\r\n\r\n\r\n<p>No entanto, estudos prospectivos e meta analises de popula\u00e7\u00f5es controladas e inclu\u00eddas em programa de rastreios peri\u00f3dicos de CHC descrevem uma sensibilidade inferior a 30% para a detec\u00e7\u00e3o de CHC inicial em certa popula\u00e7\u00f5es de pacientes cirr\u00f3ticos. Em primeiro lugar, 20-30% dos cirr\u00f3ticos apresentam uma nodularidade e heterogeneidade parenquimatosa que pode dificultar a detec\u00e7\u00e3o de CHC precoce por ultrassonografia<sup>7<\/sup>. A sensibilidade do US tamb\u00e9m pode ser reduzida em obesos e\/ou pacientes com doen\u00e7a hep\u00e1tica gordurosa associada \u00e0 disfun\u00e7\u00e3o metab\u00f3lica ou \u201cMetabolic Dysfunction Associated Steatotic Liver Disease (MASLD)\u201d devido \u00e0 atenua\u00e7\u00e3o sonora posterior causada por esta condi\u00e7\u00e3o<sup>8<\/sup>. Finalmente, as compet\u00eancias e conhecimentos t\u00e9cnicos do m\u00e9dico ultrassonografista tamb\u00e9m impactam diretamente na capacidade diagn\u00f3stica do m\u00e9todo<sup>9,10<\/sup>.<\/p>\r\n\r\n\r\n\r\n<p>Na tentativa de endere\u00e7ar estas limita\u00e7\u00f5es e melhorar portanto a jornada do paciente no rastreio do CHC, o American College of Radiology (ACR) prop\u00f4s uma nova diretriz para o rastreio de n\u00f3dulos em pacientes cirr\u00f3ticos chamado <strong>Liver Imaging Reporting And Data System per US (US-LI-RADS\u00ae)<\/strong> <sup>11<\/sup>.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-us-lirads\" class=\"wp-block-heading\"><strong>US-LIRADS<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>US-LI-RADS\u00ae consiste na estrutura\u00e7\u00e3o do exame de ultrassonografia de rastreio em pacientes cirr\u00f3ticos, propondo um desde um detalhamento t\u00e9cnico da realiza\u00e7\u00e3o do exame at\u00e9 um formato estruturado na comunica\u00e7\u00e3o dos resultados e eventuais limita\u00e7\u00f5es no relat\u00f3rio do exame. Se trata de:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Um documento din\u00e2mico, a ser expandido e refinado \u00e0 medida que o conhecimento se acumule e em resposta ao feedback dos usu\u00e1rios.<\/li>\r\n\r\n\r\n\r\n<li>Desenvolvido para melhorar a comunica\u00e7\u00e3o, atendimento ao paciente, educa\u00e7\u00e3o e pesquisa.<\/li>\r\n\r\n\r\n\r\n<li>Apoiado e endossado pelo American College of Radiology (ACR)<\/li>\r\n\r\n\r\n\r\n<li>Desenvolvido por um comit\u00ea multidisciplinar de radiologistas e hepatologistas com experi\u00eancia em ultrassonografia hepatobiliar, com contribui\u00e7\u00e3o e aprova\u00e7\u00e3o do Comit\u00ea de Dire\u00e7\u00e3o do LI-RADS.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p>Consiste na estrutura\u00e7\u00e3o t\u00e9cnica do exame da comunica\u00e7\u00e3o entre o m\u00e9dico ultrassonografista e o m\u00e9dico solicitante atrav\u00e9s de um l\u00e9xico de terminologia padronizada, atlas ilustrativo e diretrizes para a confec\u00e7\u00e3o do laudo.<\/p>\r\n\r\n\r\n\r\n<p>O US-LI-RADS requer dois tipos de avalia\u00e7\u00e3o:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>a primeira delas \u00e9 de comunicar claramente ao m\u00e9dico atrav\u00e9s de um score de visualiza\u00e7\u00e3o se naquele momento do exame foi poss\u00edvel avaliar com seguran\u00e7a todo o f\u00edgado do paciente e\/ou se o f\u00edgado tem uma condi\u00e7\u00e3o fact\u00edvel de rastreio de les\u00f5es focais por ultrassografia (figura 1). S\u00e3o elas: \r\n<ul class=\"wp-block-list\">\r\n<li>A. Limita\u00e7\u00f5es m\u00ednimas ou nenhuma (figura 2);<\/li>\r\n\r\n\r\n\r\n<li>B. Limita\u00e7\u00f5es moderadas (figura 3)<\/li>\r\n\r\n\r\n\r\n<li>C. Limita\u00e7\u00f5es acentuadas (Figura 4).<\/li>\r\n<\/ul>\r\n<\/li>\r\n\r\n\r\n\r\n<li>\u00c9 recomendado nas categorias B e especialmente C a complementa\u00e7\u00e3o do rastreio de CHC com m\u00e9todo seccional contrastado (TC\/RM) e \u00e9 onde tem se discutido mais a indica\u00e7\u00e3o dos protocolos abreviados de Resson\u00e2ncia Magn\u00e9tica<sup>12.<\/sup>.<\/li>\r\n\r\n\r\n\r\n<li>A segunda avalia\u00e7\u00e3o trata justamente de categorizar os achados de les\u00f5es focais e prop\u00f5e ainda uma conduta. Tr\u00eas categorias s\u00e3o poss\u00edveis: \r\n<ul class=\"wp-block-list\">\r\n<li>US-1 Negativo (Sem les\u00e3o focal ou achado(s) definitivamente benigno(s), recomendando indica\u00e7\u00e3o de novo rastreio por US em 6 meses;<\/li>\r\n\r\n\r\n\r\n<li>US-2 Sublimiar (Achado(s) &lt; 10 mm de di\u00e2metro e n\u00e3o definitivamente benignos), ), recomendando indica\u00e7\u00e3o de novo rastreio por US em 3 meses e<\/li>\r\n\r\n\r\n\r\n<li>US-3 Positivo (Achado(s) \u2265 10 mm de di\u00e2metro, n\u00e3o definitivamente benigno e \/ou trombose venosa nova), por fim, recomendando indica\u00e7\u00e3o de estudo seccional com contraste multif\u00e1sico (Figura 6).<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n\r\n\r\n<div class=\"wp-block-image is-style-default\">\r\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/US-LI-RADS.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"wp-image-8274\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2024\/01\/US-LI-RADS.png\" alt=\"\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\"><br \/>F<em>igura 1: Score de visualiza\u00e7\u00e3o US-Lirads.<\/em><\/figcaption>\r\n<\/figure>\r\n<\/div>\r\n\r\n\r\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-2.jpg\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" data-id=\"8206\" class=\"alignnone wp-image-8206\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-2.jpg\" alt=\"\" width=\"669\" height=\"434\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 2: Score A de visualiza\u00e7\u00e3o: A textura hep\u00e1tica finamente heterog\u00eanea e a varredura ultrassonogr\u00e1fica \u00e9 completa<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-2-II.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" data-id=\"8207\" class=\"alignnone wp-image-8207\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-2-II.jpg\" alt=\"\" width=\"627\" height=\"424\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 2: Score A de visualiza\u00e7\u00e3o: A textura hep\u00e1tica finamente heterog\u00eanea e a varredura ultrassonogr\u00e1fica \u00e9 completa<\/figcaption>\r\n<\/figure>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex\">\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-3.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" data-id=\"8208\" class=\"alignnone wp-image-8208\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-3.jpg\" alt=\"\" width=\"653\" height=\"414\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 3: Score B de visualiza\u00e7\u00e3o: A textura j\u00e1 \u00e9 mais grosseira e\/ou a varredura ultrassonogr\u00e1fica pode n\u00e3o ser completa, potencialmente, afetando a sensibilidade do m\u00e9todo. Recomenda-se complementa\u00e7\u00e3o com estudo seccional multif\u00e1sico independentemente dos achados do estudo ultrassonogr\u00e1fico.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-3-II.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" data-id=\"8209\" class=\"alignnone wp-image-8209\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-3-II.jpg\" alt=\"\" width=\"763\" height=\"582\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 3: Score B de visualiza\u00e7\u00e3o: A textura j\u00e1 \u00e9 mais grosseira e\/ou a varredura ultrassonogr\u00e1fica pode n\u00e3o ser completa, potencialmente, afetando a sensibilidade do m\u00e9todo. Recomenda-se complementa\u00e7\u00e3o com estudo seccional multif\u00e1sico independentemente dos achados do estudo ultrassonogr\u00e1fico.<\/figcaption>\r\n<\/figure>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-3 is-layout-flex wp-block-gallery-is-layout-flex\">\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-4.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" data-id=\"8210\" class=\"alignnone wp-image-8210\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-4.jpg\" alt=\"\" width=\"159\" height=\"129\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 4: Score C de visualiza\u00e7\u00e3o: Se trata do pior cen\u00e1rio poss\u00edvel, a textura hep\u00e1tica se mostra grosseiramente heterog\u00eanea e\/ou a barredura \u00e9 bastante limitada, afetando a senbilidade do m\u00e9todo. Recomenda-se complementa\u00e7\u00e3o com estudo seccional multif\u00e1sico independentemente dos achados do estudo ultrassonogr\u00e1fico.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-4-II.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" data-id=\"8211\" class=\"alignnone wp-image-8211\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-4-II.jpg\" alt=\"\" width=\"166\" height=\"129\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 4: Score C de visualiza\u00e7\u00e3o: Se trata do pior cen\u00e1rio poss\u00edvel, a textura hep\u00e1tica se mostra grosseiramente heterog\u00eanea e\/ou a barredura \u00e9 bastante limitada, afetando a senbilidade do m\u00e9todo. Recomenda-se complementa\u00e7\u00e3o com estudo seccional multif\u00e1sico independentemente dos achados do estudo ultrassonogr\u00e1fico.<\/figcaption>\r\n<\/figure>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n<div class=\"wp-block-image\">\r\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/TABELA-2.png\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-8212\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/TABELA-2.png\" alt=\"\" width=\"735\" height=\"447\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\"><br \/><em>Figura 5: Classifica\u00e7\u00e3o das les\u00f5es identificadas, nos acessos ac\u00fasticos dispon\u00edveis.<\/em><\/figcaption>\r\n<\/figure>\r\n<\/div>\r\n\r\n\r\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-4 is-layout-flex wp-block-gallery-is-layout-flex\">\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-6.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" data-id=\"8213\" class=\"alignnone wp-image-8213\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-6.jpg\" alt=\"\" width=\"502\" height=\"508\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 6: US-LIrads 3: A. N\u00f3dulo hipoecog\u00eanico irregular justacapsular no segmento<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-6-II.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" data-id=\"8214\" class=\"alignnone wp-image-8214\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-6-II.jpg\" alt=\"\" width=\"699\" height=\"501\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">II. B. N\u00f3dulo hiperecog\u00eanico em f\u00edgado cirr\u00f3tico &gt; 1,0 cm.<\/figcaption>\r\n<\/figure>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-rastreio-vascular-e-diagnostico-de-hpcs\" class=\"wp-block-heading\"><strong>Rastreio vascular e diagn\u00f3stico de HPCS<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>Devemos considerar na avalia\u00e7\u00e3o mutiparam\u00e9trica hep\u00e1tica por US em pacientes cirr\u00f3ticos o estadiamento vascular. Em primeiro lugar, checar o calibre, permeabilidade e padr\u00e3o de fluxo das veias hep\u00e1ticas, sistema portal e art\u00e9ria hep\u00e1tica \u00e9 fundamental para que se compreenda o <em>status quo<\/em> da cirrose e da hipertens\u00e3o portal, bem como de seu n\u00edvel de gravidade, al\u00e9m de buscar outras complica\u00e7\u00f5es da cirrose como, por exemplo, as tromboses.<\/p>\r\n\r\n\r\n\r\n<p>Achados indiretos para o diagn\u00f3stico de Hipertens\u00e3o Portal Clinicamente Significativa (HPCS) s\u00e3o de suma import\u00e2ncia j\u00e1 que se trata de um importante ponte de corte para o reconhecimento de pacientes que apresentam maior risco de complica\u00e7\u00f5es que afetam a sobrevida global, al\u00e9m de ser condi\u00e7\u00e3o que influencia na tomada de decis\u00e3o terap\u00eautica em pacientes BCLC 0, A e B <sup>13,14<\/sup>. Os achados ultrassonogr\u00e1ficos principais do diagn\u00f3stico indireto de HPCS na avalia\u00e7\u00e3o multiparam\u00e9trica de pacientes cirr\u00f3ticos s\u00e3o: A presen\u00e7a de recanaliza\u00e7\u00e3o da veia paraumbilical e\/ ou a presen\u00e7a de circula\u00e7\u00e3o colateral abdominal, sendo as varizes no territ\u00f3rio das veias g\u00e1strica esquerda, g\u00e1stricas curtas e regi\u00e3o periespl\u00eanica as mais comuns, e, por fim, a detec\u00e7\u00e3o de ascite e\/ou anastomoses porto sist\u00eamicas<sup>14<\/sup>(Figura 7).<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-5 is-layout-flex wp-block-gallery-is-layout-flex\">\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-7.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" data-id=\"8215\" class=\"alignnone wp-image-8215\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-7.jpg\" alt=\"\" width=\"892\" height=\"622\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 7: Presen\u00e7a de calibrosas varizes periespl\u00eanicas e anastomose esplenorrenal espont\u00e2nea caracterizam o diagn\u00f3stico de HPCS, sem a necessidade de investiga\u00e7\u00e3o complementar com estudo hemodin\u00e2mico.<\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2024\/01\/FIGURA-7-II.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" data-id=\"8216\" class=\"alignnone wp-image-8216\" src=\"https:\/\/gastropedia.com.br\/wp-content\/uploads\/2023\/12\/FIGURA-7-II.jpg\" alt=\"\" width=\"800\" height=\"595\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\">Figura 7: Presen\u00e7a de calibrosas varizes periespl\u00eanicas e anastomose esplenorrenal espont\u00e2nea caracterizam o diagn\u00f3stico de HPCS, sem a necessidade de investiga\u00e7\u00e3o complementar com estudo hemodin\u00e2mico.<\/figcaption>\r\n<\/figure>\r\n<\/figure>\r\n\r\n\r\n\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-elastografia-2d-swe\" class=\"wp-block-heading\"><strong>Elastografia 2D SWE<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>N\u00e3o s\u00f3 para o diagn\u00f3stico n\u00e3o invasivo de hepatopatia cr\u00f4nica avan\u00e7ada a elastograf\u00eda ARFI tem sido discutida e j\u00e1 amplamente aplicada. Tem sido crescente a discuss\u00e3o do papel da elastograf\u00eda Point Share Wave e 2DSWE tamb\u00e9m no acesso \u00e0 rigidez hep\u00e1tica e espl\u00eanica para predi\u00e7\u00e3o de varizes esof\u00e1gicas de alto risco<sup>15<\/sup>, ainda que estejamos pendentes de valida\u00e7\u00e3o de pontos de corte e maior consolida\u00e7\u00e3o de seu n\u00edvel de evid\u00eancia. Por fim, tamb\u00e9m tem sido discutida a acur\u00e1cia diagn\u00f3stica da elastograf\u00eda hep\u00e1tica por ultrassom na predi\u00e7\u00e3o de complica\u00e7\u00f5es como CHC e HPCS no paciente cirr\u00f3tico com hepatite C ap\u00f3s tratamento dom DAAs<sup>16<\/sup>.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-quantificacao-gordurosa-hepatica-e-acesso-a-quantificacao-de-inflamacao\" class=\"wp-block-heading\"><strong>Quantifica\u00e7\u00e3o gordurosa hep\u00e1tica e acesso a quantifica\u00e7\u00e3o de inflama\u00e7\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>Nos \u00faltimos anos a ind\u00fastria de tecnologia em ultrassom tem se dedicado ao desenvolvimento e aperfei\u00e7oamento de softwares tamb\u00e9m dirigidos a quantifica\u00e7\u00e3o gordurosa para diagn\u00f3stico e seguimento da doen\u00e7a hep\u00e1tica gordurosa associada \u00e0 disfun\u00e7\u00e3o metab\u00f3lica e doen\u00e7a hep\u00e1tica gordurosa alc\u00f3olica, al\u00e9m da quantifica\u00e7\u00e3o tamb\u00e9m da inflama\u00e7\u00e3o hep\u00e1tica nas mais diversas etiologias das doen\u00e7as hep\u00e1ticas difusas. Estas novas ferramentas j\u00e1 est\u00e3o dispon\u00edveis e autorizadas para aplica\u00e7\u00e3o na pr\u00e1tica cl\u00ednica e parecem bastante promissoras. No entanto, est\u00e3o pendentes de maior consolida\u00e7\u00e3o de seu n\u00edvel de evid\u00eancia <sup>17,18<\/sup>.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"h-referencias\" class=\"wp-block-heading\">Refer\u00eancias<\/h2>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\">\r\n<li>Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020;18:2650\u201366<\/li>\r\n\r\n\r\n\r\n<li>Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7:6.<\/li>\r\n\r\n\r\n\r\n<li>European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69:182\u2013236.<\/li>\r\n\r\n\r\n\r\n<li>Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358\u201380.<\/li>\r\n\r\n\r\n\r\n<li>Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017;11: 317\u201370.<\/li>\r\n\r\n\r\n\r\n<li>Kim CK, Lim JH, Lee WJ. Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients. J Ultrasound Med. 2001;20:99\u2013104<\/li>\r\n\r\n\r\n\r\n<li>Simmons O, Fetzer DT, Yokoo T, Marrero JA, Yopp A, Kono Y, et al. Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis. Aliment Pharmacol Ther. 2017;45:169\u201377<\/li>\r\n\r\n\r\n\r\n<li>Wong LL, Reyes RJ, Kwee SA, Hernandez BY, Kalathil SC, Tsai NC. Pitfalls in surveillance for hepatocellular carcinoma: How successful is it in the real world? Clin Mol Hepatol. 2017;23: 239\u201348<\/li>\r\n\r\n\r\n\r\n<li>Sato T, Tateishi R, Yoshida H, Ohki T, Masuzaki R, Imamura J, et al. Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C. Hepatol Int. 2009;3:544\u201350.<\/li>\r\n\r\n\r\n\r\n<li>Schoenberger H, Chong N, Fetzer DT, Rich NE, Yokoo T, Khatri G, et al. Dynamic changes in ultrasound quality for hepatocellular carcinoma screening in patients with cirrhosis. Clin Gastroenterol Hepatol. 2022;20:1561\u201369.e4.<\/li>\r\n\r\n\r\n\r\n<li>Shuchi K. Rodgers , David T. Fetzer , Helena Gabriel , James H. Seow , Hailey H. Choi , et al. RadioGraphics 2019 39:3,690-708.<\/li>\r\n\r\n\r\n\r\n<li>An JY, Pe\u00f1a MA, Cunha GM, Booker MT, Taouli B, Yokoo T, Sirlin CB, Fowler KJ. Abbreviated MRI for Hepatocellular Carcinoma Screening and Surveillance. Radiographics. 2020 Nov-Dec;40(7):1916-1931.<\/li>\r\n\r\n\r\n\r\n<li>Reig M, Forner A, Rimola J, Ferrer-F\u00e0brega J, Burrel M, Garcia-Criado \u00c1, Kelley RK, Galle PR, Mazzaferro V, Salem R, Sangro B, Singal AG, Vogel A, Fuster J, Ayuso C, Bruix J. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022 Mar;76(3):681-693.<\/li>\r\n\r\n\r\n\r\n<li>de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII &#8211; Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974<\/li>\r\n\r\n\r\n\r\n<li>Liu Y, Tan HY, Zhang XG, Zhen YH, Gao F, Lu XF. Prediction of high-risk esophageal varices in patients with chronic liver disease with point and 2D shear wave elastography: a systematic review and meta-analysis. Eur Radiol. 2022 Jul;32(7):4616-4627.<\/li>\r\n\r\n\r\n\r\n<li>Nicoletti A, Ainora ME, Cintoni M, Garcovich M, Funaro B, Pecere S, De Siena M, Santopaolo F, Ponziani FR, Riccardi L, Grieco A, Pompili M, Gasbarrini A, Zocco MA. Dynamics of liver stiffness predicts complications in patients with HCV related cirrhosis treated with direct-acting antivirals. Dig Liver Dis. 2023 Nov;55(11):1472-1479.<\/li>\r\n\r\n\r\n\r\n<li>Park J, Lee JM, Lee G, Jeon SK, Joo I. Quantitative Evaluation of Hepatic Steatosis Using Advanced Imaging Techniques: Focusing on New Quantitative Ultrasound Techniques. Korean J Radiol. 2022<\/li>\r\n\r\n\r\n\r\n<li>Schulz M, Wilde AB, Demir M, M\u00fcller T, Tacke F, Wree A. Shear wave elastography and shear wave dispersion imaging in primary biliary cholangitis-a pilot study. Quant Imaging Med Surg. 2022 Feb;12(2):1235-1242.<\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<h2 id=\"h-como-citar-este-artigo\" class=\"wp-block-heading\">Como citar este artigo<\/h2>\r\n\r\n\r\n\r\n<p class=\"has-background\" style=\"background-color: #cbd1d8;\">Branco CP. \u201cUltrassonografia Multiparam\u00e9trica hep\u00e1tica em cirrose\u201d Gastropedia 2024, vol. 1. Dispon\u00edvel em: Ultrassonografia Multiparam\u00e9trica hep\u00e1tica em cirrose<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Introdu\u00e7\u00e3o A avalia\u00e7\u00e3o multiparam\u00e9trica hep\u00e1tica por ultrassom (AMH-US) em pacientes cirr\u00f3ticos consiste na pesquisa minuciosa e peri\u00f3dica de achados ultrassonogr\u00e1ficos que cuja detec\u00e7\u00e3o impactem diretamente na sobrevida do paciente. Tais&hellip;<\/p>\n","protected":false},"author":5737,"featured_media":7869,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[21,18,397],"tags":[],"ano":[396],"tipo":[121],"volume":[57],"class_list":["post-7856","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-figado","category-gastroenterologia","category-traducao","ano-396","tipo-assuntos-gerais","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Ultrassonografia Multiparam\u00e9trica Hep\u00e1tica em Cirrose - Gastropedia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/ultrassonografia-multiparametrica-hepatica-em-cirrose\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ultrassonografia Multiparam\u00e9trica Hep\u00e1tica em Cirrose\" \/>\n<meta property=\"og:description\" content=\"Introdu\u00e7\u00e3o A avalia\u00e7\u00e3o multiparam\u00e9trica hep\u00e1tica por ultrassom (AMH-US) em pacientes cirr\u00f3ticos consiste na pesquisa minuciosa e peri\u00f3dica de achados ultrassonogr\u00e1ficos que cuja detec\u00e7\u00e3o impactem diretamente na sobrevida do paciente. 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