Non-elastography key points:
- Liver biopsy is the current reference standard for diagnosis of hepatic fibrosis.
- Blood tests are valuable as an adjunct but are not the primary method of assessment.
- The most commonly used fibrosis grading system is METAVIR.
- Cross-sectional imaging diagnostic features: anatomic distortion, changes in parenchymal attenuation and signal intensity/echo texture, alterations of dynamic contrast enhancement.
- Anatomic signs of cirrhosis include surface nodularity, segmental hypertrophy or atrophy.
- Useful diagnostic signs are enlarged. Elarged portal hilar space, and large gallbladder fossa sign and posterior hepatic Notch sign. A 100 percent specific sign is the ratio of the caudate lobe width to the right hepatic width however this is prone to serious interobserver variability.
- Elastography is currently only practical in the ultrasound setting. Cut offs for elastography are manufacturer specific and vary with the technique. Scoring is done using the METAVIR system ranging from F0 to F4 This is based on shear wave elastography in most cases with a single manufacturer using transient elastography.
- MR elastography techniques have been developed but are not in widespread use and are probably impractical in the community setting.
UPDATE: Just a heads up that Tomato Shibby is not my preferred solution anymore. I’m not sure it’s even being developed. There was a HUGE performance discrepancy between it and Merlin, so I dropped it in favor of speed.
This page still gets a few hits so I thought I’d post a heads up. You can install a webserver on merlin but it will require some work.
While learning bootstrap3 and developing for beadopotamus.com, I had the need to internally serve the website so we could look at it on multiple devices to allow for screen size and color variations.
Turns out that Shibby’s Tomato has NGINX internal web server! Yay. Setting it up was not terribly difficult but required some tinkering.
- Make sure your flash drive is mounted under USB support.
- Under file sharing, you probably want to create a separate mount point for ease of SAMBA access to the directory. I did and it works well. I can use Brackets over the network to test changes in the dev environment.
- I created a www directory under the root and called it web.
- This directory houses the hosted files.
- Enable the webserver and point it to the correct directory.
I hope this helps someone. I couldn’t really find a tutorial on it so I fiddled with it until it worked.
The good news is that this is not externally accessible so there is little security threat.
The peculiar thing is the directory did not survive a reboot. I’m guessing that the router clears out the web server directory on reboot. Current config here. I’ll see if this survives a reboot.