26. An Internist's Approach to Radiologic Examination of the Liver

  1. E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)5,6,7,8
  1. Anthony E. Hanbidge MB, BCh, FRCP(C)1,2,3,4 and
  2. Korosh Khalili MD, FRCPC1

Published Online: 4 SEP 2012

DOI: 10.1002/9781118314968.ch26

Hepatology: Diagnosis and Clinical Management

Hepatology: Diagnosis and Clinical Management

How to Cite

Hanbidge, A. E. and Khalili, K. (2012) An Internist's Approach to Radiologic Examination of the Liver, in Hepatology: Diagnosis and Clinical Management (ed E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118314968.ch26

Editor Information

  1. 5

    Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada

  2. 6

    University of Toronto, Toronto, Ontario, Canada

  3. 7

    Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada

  4. 8

    University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada

Author Information

  1. 1

    Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada

  2. 2

    Abdominal Imaging, Toronto Western Hospital, Toronto, Ontario, Canada

  3. 3

    Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Toronto, Ontario, Canada

  4. 4

    Women's College Hospital, Toronto, Ontario, Canada

Publication History

  1. Published Online: 4 SEP 2012
  2. Published Print: 12 OCT 2012

ISBN Information

Print ISBN: 9780470656174

Online ISBN: 9781118314968

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Keywords:

  • imaging;
  • hepatobiliary;
  • ultrasound;
  • computed tomography;
  • magnetic resonance;
  • general internist

Summary

Imaging is essential when evaluating suspected hepatobiliary disease. Ultrasound is the most widely available cross-sectional imaging modality. It is portable, inexpensive, and does not use ionizing radiation. Generally, the liver offers an excellent acoustic window, facilitating ultrasound evaluation for both diffuse and focal hepatic disease. It also evaluates the gallbladder and bile ducts in detail. Doppler ultrasound assesses patency of the hepatic vasculature and documents the direction and character of blood flow.

Consequently, ultrasound is the first choice when imaging the majority of patients with suspected hepatobiliary disease. It will frequently answer the clinical question alone or will direct the next most appropriate imaging investigation. Computed tomography, magnetic resonance, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and image-guided biopsy may be necessary beyond ultrasound, either alone or in combination, for certain diagnoses. This chapter outlines imaging algorithms for common hepatobiliary scenarios that present to the general internist.