Introduction of liver ultrasound

Introduction to Liver Ultrasound

Purpose and Clinical Relevance

Purpose:
Liver ultrasound is a non-invasive, cost-effective, and widely accessible imaging modality used to evaluate the liver's structure and detect abnormalities. It is often the first-line imaging technique for assessing liver disease due to its safety (no radiation), real-time capability, and ability to guide interventional procedures.

Clinical Relevance:

• Early Detection of Liver Disease: Identifies early signs of fatty liver, hepatomegaly, or focal lesions.
• Assessment of Liver Size, Shape, and Texture: Helps evaluate hepatomegaly, atrophy, or nodular surface changes.
• Characterization of Liver Lesions: Differentiates benign (e.g., hemangioma, cysts) from malignant lesions (e.g., HCC, metastases).
• Monitoring Chronic Liver Disease: Tracks progression in hepatitis, NAFLD, and fibrosis.
• Guidance for Interventional Procedures: Real-time guidance for biopsies, drainages, and aspirations.
• Evaluation of Vascular and Biliary Systems: Assesses portal vein, hepatic veins, and biliary duct dilation.
• Surveillance in High-Risk Populations: Routine use for cirrhosis, chronic hepatitis B/C.
• Screening in Asymptomatic Patients: Detects incidental findings of early liver disease.

Indications for Liver Ultrasound

• Evaluation of Abnormal LFTs
  • Elevated ALT, AST, ALP, bilirubin
  • Unexplained enzyme abnormalities
• Assessment of Liver Size and Texture
  • Suspected hepatomegaly or atrophy
  • Palpable liver
• Characterization of Lesions
  • Cysts, hemangiomas, adenomas
  • Primary/metastatic tumors
• Cancer Surveillance
  • Cirrhosis
  • Chronic hepatitis B/C
  • NASH
• Chronic Liver Disease
  • NAFLD, alcoholic liver disease
  • Fibrosis or cirrhosis
• Portal Hypertension
  • Splenomegaly, ascites, varices
  • Doppler of portal vein
• Biliary Obstruction
  • Jaundice, RUQ pain
  • Elevated ALP, GGT
  • Gallstones, bile duct dilatation
• Guided Procedures
  • Biopsy, drainage, aspiration
• Follow-up Studies
  • Monitoring known lesions
  • Treatment response (e.g., ablation)
• Infectious or Inflammatory Causes
  • Pyogenic/amebic abscess
  • Hepatitis (viral or autoimmune)
• Pediatric Liver Conditions
  • Neonatal cholestasis
  • Congenital anomalies
  • Metabolic liver disease

Limitations and Contraindications

Limitations:

• Operator dependence
• Small/isoechoic lesions may be missed
• Obesity, gas, or ascites may impair view
• Difficulty distinguishing benign vs malignant lesions
• Limited field of view (deep dome lesions)
• No functional assessment (e.g., perfusion)
• Incomplete view of biliary tree

Contraindications:

• Recent surgery or trauma (pain, dressings)
• Non-cooperative patients (infants, confused)
• Excessive abdominal distension (gas, ascites)

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