RD7.3 | Imaging in Liver Parenchymal Disease — Summary & Reflection

KEY TAKEAWAYS

Imaging in Liver Parenchymal Disease — Key Points

• Ultrasonography (USG) is the first-line modality for diffuse liver disease and the recommended tool for cancer surveillance — inexpensive, radiation-free, contrast-free, real-time, and (with Doppler) able to assess portal flow.
• Fatty liver (steatosis) on USG: increased parenchymal echogenicity, loss of the hepatorenal echo contrast (liver brighter than the right renal cortex), and posterior beam attenuation.
• Cirrhosis on USG: nodular surface, coarse heterogeneous echotexture, and segmental change (caudate-lobe hypertrophy, right-lobe atrophy).
• Portal hypertension on USG/Doppler: splenomegaly, ascites, portosystemic collaterals (recanalised paraumbilical vein), portal vein dilatation and, in advanced disease, reversed (hepatofugal) flow.
• Transient elastography (FibroScan) non-invasively measures liver stiffness to stage and monitor fibrosis, often avoiding biopsy.
• Multiphasic CT and MRI characterise focal lesions using the liver's dual blood supply; hepatocellular carcinoma shows arterial-phase hyperenhancement with washout (LI-RADS), allowing imaging diagnosis without biopsy in a cirrhotic liver.
• HCC surveillance: abdominal ultrasound every 6 months, ± serum AFP, in patients with cirrhosis — to catch small, curable tumours.
• Contrast safety: iodinated contrast (CT) is generally avoided when eGFR <30 mL/min/1.73m²; gadolinium (MRI) is used with caution in severe renal impairment.
• Management is imaging-driven: steatosis → lifestyle/metabolic management + fibrosis assessment; cirrhosis → surveillance + varices screening; portal hypertension → endoscopy/intervention; HCC → staging and stage-appropriate treatment.

REFLECT

On your next clinic or ward attachment, when a patient has deranged liver function tests, follow the imaging journey deliberately: was an ultrasound the first investigation, and what did it actually show about echogenicity, surface contour, the spleen and the portal vein? If cirrhosis was found, ask whether the patient was enrolled in 6-monthly ultrasound surveillance and endoscopic varices screening — and if not, why not. When a nodule appears, notice whether multiphasic imaging was used to look for arterial hyperenhancement and washout before a diagnosis was made. Consciously linking each ultrasound finding to its management consequence — bright liver to risk-factor modification, nodular liver to surveillance, arterial-washout nodule to cancer staging — is how the imaging stops being a report and becomes the engine of the patient's care.