ULTRASOUND - LIVER

Alternative Names:  Liver ultrasound, liver sonography, ultrasound of the liver

ROLE OF ULTRASOUND

To assess the:

• Size

• Capsular contour (smooth, coarse, lobulated)

• Parenchymal echogenicity

• Vascularity

• Biliary tree

• Masses or collections

PREPARATION

Ideally, fast the patient for 6 hours to reduce bowel gas and prevent gall bladder contraction.

LIMITATIONS

Obesity and patients with severe cases of metabolic disorders such as haemachromatosis and fatty infiltration will reduce detail and the diagnotic yield of the scan.

EQUIPMENT SELECTION AND TECHNIQUE

• Depending on the size of the patient a curved linear array 2-6Mhz.

• If there is nodularity of the liver border then a linear array with a 7-12MHZ frequency will better appreciate this.

• Good colour / power / Doppler capabilities when assessing vessels or vascularity of a structure.

• Be prepared to change focal zone position and frequency output of probe (or probes) to adequately assess both superficial and deeper structures.

SCANNING TECHNIQUE

• Begin doing a full sweep through the liver.

• You will need the patient to take deep inspirations to fully visualise the superior borders of the liver.

• Look in transverse up and down the left lobe from a subcostal approach.

• Look in transverse through the right lobe subcostally or intercostally.

• Roll the patient in a left lateral decubitus position for assessment of the rt lobe only after checking for fluid.

• Bowel gas can overlie the liver in a subcostal approach, so getting the patient to distend their abdomen can help with visualisation.

Also looking intercostally between each rib space can ensure thorough visualisation.
Look For:

• Homogeneous v's Attenuative(normal v's fatty liver)

• Smooth v's coarse echotexturebmode image here

• Size: To measure the size of the liver, use a sagittal approach in the mid clavicular line. Measure from the diaphragm to the inferior border on bmode image. This can be very subjective. Also look at the lower edge of liver in relation to the Rt kidney. It should finish half way down the kidney. Bmode image an enlarged liver will have rounded borders.

  Once you have thoroughly scanned though the liver, then start taking images.

Document the normal anatomy and any pathology found, including measurements and vascularity if indicated.

LIVER ULTRASOUND SAMPLE PROTOCOL (TYPICALLY)

This sample protocol is meant for educaional purposes and he exaxt technique will depend on the patient's clinical indication for the examination and the radiologist's guidance.

An liver series should include the following minimum images;

1. Longitudinal

   1. Left lobe with measurements

   2. Caudate lobe

   3. IVC

   4. Porta hepatis with color doppler

   5. Comparison to Rt Kidney

2. Transverse

   1. Left lobe

   2. Left hepatic vein

   3. Left portal vein

   4. Right portal vein

3. Middle and Right hepatic vein

• Demonstrate hepatopetal flow in portal vein

• Demonstrate hepatic vein flow

• Document the normal anatomy. Any pathology found in 2 planes, including measurements and any vascularity.

Schedule Your Liver Ultrasound Today!

• If you are looking for professional radiology services at your imaging site/center, call us at 1-800-626-8315 or contact us for a consultation. 

• If you live in Los Angeles, Century City, Glendale, Mid-Wilshire and need to schedule a radiology examination such as a MRI, CT Scan, Ultrasound, X ray, or PET scan, contact us to schedule an appointment. 

• If you are in search of other things, we're surprisingly resourceful!  Call us 1-800-626-8315 or contact us via our contact form.

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• Ultrasound of the liver informational page including indications, role of liver ultrasound, limitations,scanning technique, and basic hard copy imaging.
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