Ultrasonography of the hepatobiliary tract
- Umaprasanna S Karnam, MD
Umaprasanna S Karnam, MD
- Jordan Valley Hospital
- West Jordan, UT
- K Rajender Reddy, MD
K Rajender Reddy, MD
- Ruimy Family President's Distinguished Professor of Medicine
- Professor of Medicine in Surgery
- Director of Hepatology
- Director, Viral Hepatitis Center
- Medical Director of Liver Transplantation
- University of Pennsylvania School of Medicine
- Stephan Anderson, MD
Stephan Anderson, MD
- Professor of Radiology
- Boston University School of Medicine
- Section Editors
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Jonathan B Kruskal, MD, PhD
Jonathan B Kruskal, MD, PhD
- Section Editor — Kidney Disease
- Professor of Radiology
- Harvard Medical School
Ultrasound is the least invasive radiologic modality for imaging the liver and biliary tract. Unlike computed tomographic scanning and magnetic resonance imaging (MRI), the technique is portable, quick, and can be used to efficiently guide interventional procedures. Ultrasound uses no ionizing radiation to create the image and is therefore the initial technique of choice in pregnant women, in patients with contrast allergies, or in those in whom MRI is contraindicated .
This topic will discuss the role of ultrasound in the evaluation of the liver and the intra- and extrahepatic bile ducts. Contrast-enhanced ultrasound and the use of ultrasound for the evaluation of the gallbladder are discussed briefly here and in more detail separately. (See "Acute cholecystitis: Pathogenesis, clinical features, and diagnosis", section on 'Ultrasonography' and "Uncomplicated gallstone disease in adults", section on 'Transabdominal ultrasound' and "Gallbladder cancer: Epidemiology, risk factors, clinical features, and diagnosis", section on 'Ultrasound' and "Gallbladder polyps and cholesterolosis", section on 'Ultrasonography' and "Contrast-enhanced ultrasound for the evaluation of liver lesions".)
Ultrasound relies upon the transmission of targeted sound waves of varying selected frequencies through tissues, with subsequent computerized conversion of the signals from the reflected waves into anatomical images on a screen. The degree of reflection of sound waves depends upon the interface between tissues with different acoustic properties. The degree of echogenicity depends upon the ability of the tissue being evaluated to reflect or absorb the ultrasound waves. Thus, a fatty liver will attenuate the ultrasound beam somewhat, limiting full evaluation of the liver parenchyma. Similarly, waves are not transmitted through air; liver lying below interposed loops of bowel will therefore be poorly visualized .
Normal measurements on ultrasound — Measurements of components of the hepatobiliary tree depend upon the skill of the ultrasonographer obtaining the measurements, and there is variability in terms of what is considered "normal." However, some general estimates are available regarding the expected sizes of structures in the hepatobiliary tree:
●Gallbladder: The gallbladder wall should be less than or equal to 2 mm (in a distended or fasting gallbladder). Collapsed gallbladders, seen when the subject has eaten, typically appear slightly more thickened. Typically, the maximum "normal" dimension of the gallbladder is 5 X 10 cm.
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- Normal measurements on ultrasound
- Color flow Doppler ultrasound
- Duplex Doppler ultrasonography
- Vascular indices and ratios
- CLINICAL USE
- Detection of pneumobilia
- Evaluation of right upper quadrant pain
- Evaluation of obstructive jaundice
- Screening for hepatocellular carcinoma
- Evaluation before and after liver transplantation
- Follow-up of TIPS
- Liver tumor staging and treatment
- Diagnosis of ascites
- Assessment of hepatic fibrosis
- Evaluation of liver lesions
- Intraoperative and laparoscopic ultrasound
- Contrast agents
- SUMMARY AND RECOMMENDATIONS