Splenoportal Doppler sonography provides specific findings in cirrhosis and may therefore be a useful tool in differentiating between splenomegaly of portal hypertensive or haematological origin. In patients with cirrhosis, the presence of splenomegaly is associated with the presence of larger oesophageal varices.

SUMMARYIn early stage hepatocellular carcinoma (HCC), liver transplantation, surgical resection and percutaneous techniques are classified as radical treatments, and may be offered to about 25% of all patients with HCC evaluated in referral centres. The restricted inclusion criteria for surgical resection and the shortage of liver donors for transplantation have stimulated an increasing demand for minimally invasive treatments able to achieve effective and reproducible percutaneous tumour ablation, with less associated morbidity and lower cost than other interventions. Among percutaneous techniques, ethanol injection has proven to be highly effective in single HCC up to 3 cm, with a rate of complete response of 80%, being well tolerated and with a limited risk of minor complication. In larger and⁄or multinodular HCC the efficacy is reduced to 50% of complete response in nodules between 3 and 5 cm, and to lower rate in larger tumours.Alternative options to ethanol injection have been recently proposed, including radiofrequency, microwave and laser thermal ablation, aimed to extend the necrotic area thus improving the rate of complete response. To date, radiofrequency is the most used technique, with a reported rate of complete response of 90-98% in nodules smaller than 3 cm, and with the advantage of fewer sessions, otherwise counteracted by a higher rate of side-effects. Microwave and laser are promising technologies, but only few clinical data are available. Randomized controlled trials are needed in order to assess treatment response, long-term survival, rate of complication and cost-efficacy of newer technologies in comparison to ethanol injection.

We used a new sonographic technique, real-time contrast-enhanced harmonic sonography at low acoustic energy, to evaluate liver perfusion and liver metastases from colorectal cancer in a 73-year-old woman after chemotherapy. After 6 weeks of chemotherapy, liver metastases that had been clearly visible on conventional sonography before chemotherapy were no longer detectable on conventional sonography but were still evident on contrast-enhanced sonography. At about 6 months after initiation of chemotherapy, the lesions were all visible again on conventional sonography and had become significantly larger, although some no longer showed contrast enhancement during the arterial phase. In this case, changes in arterial perfusion over time did not parallel the response of liver metastases to chemotherapy.

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Hepatic artery pseudo-aneurysm is a rare but severe complication of liver transplantation, which generally requires immediate surgical or angiographic treatment. The diagnosis is usually made by splanchnic percutaneous angiography. We report a case of an intra-hepatic pseudo-aneurysm after surgical correction of a thrombosed hepatic artery and its successful response to conservative management. Duplex Doppler ultrasound, associated with a new B-mode contrast-based sonographic technique, called "perfusional angiosonography", was used to diagnose the intra-hepatic pseudo-aneurysm. The combination of the two ultrasound techniques was useful in following the course of the pseudo-aneurysm, without further need for angiography. Eventually, this pseudo-aneurysm underwent spontaneous obliteration.