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    Different Methods For Ascites Volume Estimation by US

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    Denis Pogorevici
    There are several methods used to estimate ascites volume using ultrasound imaging, each with limitations. These include: 1. Semi-quantitative assessment of fluid in 5 abdominal regions (minimal to massive). This is subjective and relies on operator experience. 2. Measuring the smallest fluid depth and estimating volume as 5L for 5cm depth, increasing 1L for each additional cm. 3. Measuring the longest fluid depth and estimating volume as the depth in cm multiplied by 100cc. 4. Measuring fluid stripe width in Morrison's pouch and correlating to estimated volumes of 250-1000cc. 5. The "Ascites Index" method sums ultrasound measurements of

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    Different Methods For Ascites Volume Estimation by US

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    Denis Pogorevici
    73 views1 page
    There are several methods used to estimate ascites volume using ultrasound imaging, each with limitations. These include: 1. Semi-quantitative assessment of fluid in 5 abdominal regions (minimal to massive). This is subjective and relies on operator experience. 2. Measuring the smallest fluid depth and estimating volume as 5L for 5cm depth, increasing 1L for each additional cm. 3. Measuring the longest fluid depth and estimating volume as the depth in cm multiplied by 100cc. 4. Measuring fluid stripe width in Morrison's pouch and correlating to estimated volumes of 250-1000cc. 5. The "Ascites Index" method sums ultrasound measurements of

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    Different Methods for Ascites Volume Estimation by US

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    There are several methods used to estimate ascites volume using ultrasound imaging, each with limitations. These include: 1. Semi-quantitative assessment of fluid in 5 abdominal regions (minimal to massive). This is subjective and relies on operator experience. 2. Measuring the smallest fluid depth and estimating volume as 5L for 5cm depth, increasing 1L for each additional cm. 3. Measuring the longest fluid depth and estimating volume as the depth in cm multiplied by 100cc. 4. Measuring fluid stripe width in Morrison's pouch and correlating to estimated volumes of 250-1000cc. 5. The "Ascites Index" method sums ultrasound measurements of

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    73 views1 page

    Different Methods For Ascites Volume Estimation by US

    Uploaded by

    Denis Pogorevici
    There are several methods used to estimate ascites volume using ultrasound imaging, each with limitations. These include: 1. Semi-quantitative assessment of fluid in 5 abdominal regions (minimal to massive). This is subjective and relies on operator experience. 2. Measuring the smallest fluid depth and estimating volume as 5L for 5cm depth, increasing 1L for each additional cm. 3. Measuring the longest fluid depth and estimating volume as the depth in cm multiplied by 100cc. 4. Measuring fluid stripe width in Morrison's pouch and correlating to estimated volumes of 250-1000cc. 5. The "Ascites Index" method sums ultrasound measurements of

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    Different methods for ascites volume

    estimation by US
    Actualizat cu aproximativ 8 luni în urmă
    Different methods for ascites volume estimation by US: 
    • The method of assessment of free fluid in the abdomen is not well standardized by any organization. 
    • Various methods have been used in different clinical & practical and research studies. Each method is liable to errors & variations
    and all of which depends on experience, expertise of operators. 
    • Methods: 
    1- Semi quantitative measure (subjective assessment): is generally not helpful clinically & needs experience, expertise and is
    subject to significant operator variability. It is classification of ascites as minimal & mild & moderate & severe & massive by looking
    for the presence of fluid in five areas of the abdomen namely RUQ (perihepatic and morrison's pouch), LUQ (perisplenic), right
    paracolic gutter, left paracolic gutter and pelvis: 
    - Fluid in 1 location = minimal ascites.
    - Fluid in 2 locations = mild ascites. 
    - Fluid in 3 locations = moderate ascites. 
    - Fluid in 4 locations = marked ascites. 
    - Fluid in 5 locations = massive ascites. 
    2- The smallest fluid depth measured from the most superficial bowel loop to the abdominal wall & the fluid volume is 5 L for depth
    measurement of 5 cm & for every 1 cm increase in the measured depth, there is an average 1 L increase in the volume. Smallest
    fluid depth (cm) X 1000 = volume (cc). 
    3- Longest fluid depth: Measure the maximal fluid depth (AP diameter) x 100= volume in cc. 
    Depth of deepest pocket (cm) X 100 = volume (cc). 
    4- Morrison’s pouch: small anechoic stripe in the Morison pouch represents approximately 250 mL of fluid while 0.5 cm and 1 cm
    stripes represent approximately 500 mL and 1 L of free fluid, respectively. 
    Width of fluid in Morrison’s pouch (cm) X 1000 = volume (cc). 
    5- Ascitic fluid Index method: the proposed Ascites Index seems to by a promising tool in estimating ascites volume. It is simple to
    implement and may be estimated using basic ultrasound equipment. Ultrasound measurements of the volume of ascites are
    performed in the 4 quadrants of the abdomen in the vicinity of the liver, spleen and bilaterally above the inguinal ligament. Pockets
    of free fluid were measured in millimeters, perpendicularly to the tangents of each quadrant of the abdomen. The obtained values
    were totalled, creating the Ascites Index (AsI), similary to the amniotic fluid index. Index below 50 = mild & 50 - 150 = moderate &
    above 150 = marked ascites. 
    6- Scoring method in traumatic cases: two scoring systems currently exist for the FAST examination & patients with scores more
    than 3 require exploratory laparotomy: 
    (a) 1st scoring system: One point was assigned to each of the 5 anatomic sites in which free fluid is detected during the FAST scan,
    with a score ranging from 0 to 8): no fluid = 0 & right upper quadrant (hepatorenal = Morrison’s pouch) = 1 & left upper quadrant
    (splenorenal & lesser sac) = 1 & right lower quadrant (right paracolic gutter) = 1 & left lower quadrant (left paracolic gutter) =1
    and pelvis = 1. - Fluid of more than 2 mm in depth in the hepatorenal or the splenorenal space was given 2 points for each instead
    of 1. 
    - Floating loops of bowel were given 1 point. 
    (b) 2nd scoring system (= measurement plus points in other 4 areas) 
    - Measuring the depth (maximal AP dimension) of fluid in the deepest pocket (e.g. in the pelvis).
    - And give 1 point for fluid if present in each of the remaining other 4 areas (e.g. heptorenal & splenorenal & right paracolic gutter
    and left paracolic gutter). 
    - For example if the largest collection of fluid was in the pelvis of depth (9 cm) determined by measuring the fluid from anterior to
    posterior & Morison’s pouch shows additional site for fluid while other areas show no fluid, so one point is given for Morison’s
    pouch, resulting in a hemoperitoneum score of 10 (9 + 1).

    N.B.When we measure depth = (AP dimension) we use TS scan & when we measure longitudinal dimension (craniocudal
    dimension) we use LS scan.
    In AFI and ascites index we use LS to measure longitudinal (CC) dimension in 4 quadrants and summate the 4 measures to get the
    score.

    Some of references in this topic: 


    (1) Can the smallest depth of ascitic fluid on sonograms predict the amount of drainable fluid? Irshad A, Ackerman SJ, Anis M,
    Campbell AS, Hashmi A, Baker NL. J Clin Ultrasound, 2009; 37(8):440 - 444. 
    (2) Ultrasound in abdominal trauma. John S. Rose. Emerg Med Clin N Am, 2004; 22: 581–599. 
    (3) Ultrasonographic Determination of Ascitic Volume. Inadomi 2003. From Hepatology, 2003, DOI: 10.1002/hep.510240314. From:
    Hepatology Volume 24, Issue 3, pages 549–551, 1996. 
    (4) Focused abdominal sonography for trauma in the emergency department for blunt abdominal trauma. Chi Leung Tsui, Hin Tat
    Fung, Kin Lai Chung, and Chak Wah Kam. Int J Emerg Med, 2008; 1(3): 183–187. 
    (5) Role of US in the Diagnosis of Intraabdominal Catastrophes. Kimberley L. McKenney. RadioGraphics, 1999, 19: 1332-1339.
    (6) Ascites index—a new method of ultrasound evaluation of ascites volume in patients with ovarian cancer. P. R. Szkodziak.
    Ultrasound in Obstetrics & Gynecology, 2010.

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