Imaging

Cirrhosis

Preliminary Diagnosis: Cirrhosis

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

  • Doppler ultrasound

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

Advantages

  • Doppler ultrasound is relatively fast and inexpensive.

  • Can be used for screening patients for hepatocellular carcinoma who have already developed cirrhosis

  • Can be used to monitor development of other complications of cirrhosis including portal hypertension and ascites

  • No ionizing radiation

  • Early changes of cirrhosis including fibrosis and micronodule formation are better identified in comparison to CT and MRI

Disadvantages

  • Ultrasound is not diagnostic for hepatocellular carcinoma.

  • Ultrasound can be limited in patients with large body habitus

  • Operator dependent

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

No significant contraindications

IV. What alternative imaging techniques are available?

  • Three-phase contrast-enhanced CT

  • Gadolinium-enhanced MRI

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

Three-phase contrast-enhanced CT

Advantage

  • Can be helpful in monitoring patients with cirrhosis for development of hepatocellular carcinoma, as ultrasound is not specific

Disadvantages

  • Requires ionizing radiation

  • More expensive compared with ultrasound

  • Early changes of cirrhosis are not demonstrated.

MRI with gadolinium contrast

Advantages

  • Superior to other modalities in evaluating dysplastic nodules in a cirrhotic liver

  • Can be helpful in monitoring patients with cirrhosis for development of hepatocellular carcinoma, as ultrasound is not specific

Disadvantages

  • More expensive compared with ultrasound

  • Time consuming

  • Requires

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

  • Iodinated contrast is contraindicated in patients with renal failure

  • Iodinated contrast is contraindicated in patients with severe allergy.

  • Gadolinium contrast is contraindicated in patients with poor renal function.

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