Imaging

Hepatitis

Preliminary Diagnosis: Hepatitis

I. What imaging technique is first-line for this diagnosis

  • Ultrasound (US)

II. Describe the advantages and disadvantages of this technique for diagnosis of hepatitis.

Advantages

  • Real-time examination

  • Does not use ionizing radiation

  • Relatively inexpensive

Disadvantages

  • No specific findings in acute hepatitis

  • Findings are variable depending on the different etiologic factors that cause hepatic inflammation and stage of liver insult (most common findings are hepatomegaly and the “starry night liver” pattern)

  • Limited evaluation in obese patients

III. What are the contraindications for the first-line imaging technique?

  • No significant contraindications exist.

IV. What alternative imaging techniques are available?

  • MRI

  • CT

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hepatitis.

MRI

Advantages

  • May confirm and further evaluate focal lesions or diffuse alterations of the liver discovered at a prior US examination

Disadvantages

  • Expensive

  • Requires significant patient cooperation to minimize motion artifact

CT

Advantages

  • May confirm and further evaluate focal lesions or diffuse alterations of the liver discovered at a prior US examination

Disadvantages

  • Exposure to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

MRI

  • Contraindicated in patients with non-MR compatible metallic (ferromagnetic) hardware or foreign bodies, uncooperative or claustrophobic

  • Need to assess undermining clinical conditions before administration of IV contrast, including allergies and renal function.

MRI/CT

  • Need to assess undermining clinical conditions before administration of IV contrast, including allergies and renal function

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