Liver Measurement
and Normal Value
Liver Span
Liver span: The liver span is the craniocaudal dimension of the liver, commonly measured along the midclavicular line (MCL).
Measurement Example
Example liver span: 13.5 cm
Normal Ultrasound Liver Span by Age
| Age | Normal Range |
|---|---|
| 0–2 years | 40–100 mm |
| 3–8 years | 65–120 mm |
| 9–12 years | 75–130 mm |
| 13–18 years | 85–140 mm |
| Adults (18+ years) | 95–145 mm |
Left Lobe AP Diameter
LL AP diameter: The left lobe anteroposterior (AP) diameter is the maximum thickness of the left hepatic lobe measured in centimeters on ultrasound, typically obtained in the sagittal plane from the anterior to posterior margin of the left lobe.
Normal Ultrasound Left Lobe AP Diameter
| Age | Normal Range |
|---|---|
| 0–2 years | 15–35 mm |
| 3–8 years | 25–50 mm |
| 9–12 years | 35–55 mm |
| 13–18 years | 45–65 mm |
| Adults | 50–70 mm |
Caudate Lobe AP Diameter
Caudate lobe AP diameter: The anteroposterior dimension of the caudate lobe can be documented as part of liver morphology assessment.
| Age | Normal Range |
|---|---|
| 0–2 years | 30–60 mm |
| 3–8 years | 50–80 mm |
| 9–12 years | 65–95 mm |
| 13–18 years | 80–110 mm |
| Adults | 90–120 mm |
Glisson's Capsule Thickness
Glisson's capsule: The fibrous capsule surrounding the liver may be assessed sonographically as part of the structural evaluation.
| Age | Supplied Range |
|---|---|
| 0–2 years | 0.03–0.05 mm |
| 3–8 years | 0.04–0.06 mm |
| 9–12 years | 0.05–0.07 mm |
| 13–18 years | 0.06–0.08 mm |
| Adults | 0.07–0.10 mm |
Portal Vein Diameter
Portal vein diameter: Portal vein calibre is assessed sonographically and may vary with age and physiological conditions.
| Age | Normal Range |
|---|---|
| 0–2 years | 3–6 mm |
| 3–8 years | 5–8 mm |
| 9–12 years | 7–10 mm |
| 13–18 years | 8–12 mm |
| Adults | 9–13 mm |
Hepatic Vein Diameter
Hepatic vein diameter: Hepatic veins are assessed for calibre and Doppler waveform characteristics.
| Age | Normal Range |
|---|---|
| 0–2 years | 2–4 mm |
| 3–8 years | 3–5 mm |
| 9–12 years | 4–6 mm |
| 13–18 years | 5–7 mm |
| Adults | 5–8 mm |
Common Bile Duct Diameter
CBD diameter: The common bile duct diameter is measured sonographically and interpreted according to age and clinical context.
| Age | Supplied Reference |
|---|---|
| Newborn | < 1 mm |
| 1 month–1 year | < 2 mm |
| 1–10 years | < 3 mm |
| 10–18 years | < 4 mm |
| Adults < 60 years | < 6 mm |
| Elderly ≥ 60 years | < 8 mm |
Supplied Note
The supplied reference indicates that in elderly patients the CBD may measure up to approximately 10 mm.
Liver Lesion Measurement
Lesion measurement: A focal liver lesion should be documented using three orthogonal dimensions whenever appropriate.
Length
L — maximum dimension of the lesion.
Width
W — dimension perpendicular to the length measurement.
Thickness
T — third orthogonal dimension.
Area
Lesion area may be obtained by trace measurement.
Standard Documentation
Lesion size = L × W × T
Liver Volume
Liver volume: Liver volume can be documented in millilitres as part of quantitative liver assessment.
| Age | Supplied Volume Range |
|---|---|
| 0–2 years | 100–300 mL |
| 3–8 years | 400–700 mL |
| 9–12 years | 600–1000 mL |
| 13–18 years | 800–1400 mL |
| Adults | 1060–2223 mL |
Lesion Volume
Lesion volume can also be recorded when volumetric measurement is available.
Hepatic Vein Doppler
Hepatic vein Doppler: Hepatic vein Doppler evaluation includes waveform pattern, systolic and diastolic velocities and reversal components.
Age-Based Hepatic Vein Doppler Reference
| Age | Waveform | S Velocity | Reference |
|---|---|---|---|
| 0–2 years | Monophasic / Biphasic common | 10–20 cm/s | Age-dependent waveform |
| 3–8 years | Triphasic most common | 15–25 cm/s | S ≥ D |
| 9–12 years | Triphasic | 20–30 cm/s | S ≥ D |
| 13–18 years | Triphasic ~80% | 20–30 cm/s | S ≥ D |
| Adults | Triphasic ~80% | 25–35 cm/s | S ≥ D; peak velocity >10 |
Adult Hepatic Vein Doppler Parameters
| Parameter | Reference |
|---|---|
| S | 20–50 cm/s |
| D | 10–30 cm/s |
| A reversal | ≤ 10–15 cm/s |
| V reversal | ≤ 5–10 cm/s |
| S/D | >1, typically 1.5–2.5 |
| A reversal duration | <20–30 ms |
Waveform Components
S: systolic forward flow.
D: diastolic forward flow.
A: atrial contraction-related reversal component.
V: venous filling / waveform component.
Portal Vein Doppler
Portal vein Doppler: Portal venous flow is normally hepatopetal. Doppler assessment includes peak velocity, direction, pulsatility and flow volume.
Age-Based Portal Vein Doppler Reference
| Age | Direction | PSV | Reference |
|---|---|---|---|
| 0–2 years | Hepatopetal | 15–30 cm/s | Lower cutoff 10 cm/s preterm; 15 cm/s term |
| 3–8 years | Hepatopetal | 14–41 cm/s | Median ~26 cm/s |
| 9–12 years | Hepatopetal | 14–41 cm/s | Median ~26 cm/s |
| 13–18 years | Hepatopetal | 15–40 cm/s | Median ~26 cm/s |
| Adults | Hepatopetal | 20–40 cm/s | Mean ~19–21 cm/s |
Adult Portal Vein Doppler Parameters
| Parameter | Reference |
|---|---|
| Peak systolic velocity | 15–40 cm/s |
| Diastolic velocity | 10–30 cm/s |
| Mean velocity | 15–25 cm/s |
| PI | 0.5–1.2 |
| Flow volume | 600–1200 mL/min |
| Flow direction | Hepatopetal |
| Phasicity | Mild phasicity |
| S/D variance | 1.0–2.0 |
Portal Flow Direction
Hepatopetal indicates flow toward the liver.
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