Advanced Sonography of the Liver and Biliary System: Imaging, Clinical Applications, and Interventions

George Tsoukatos, BPS, R.T.(R)(ARRT)®*

^*Medical Imaging Consultant, Germantown, NY

Address correspondence to: George Tsoukatos, BPS, R.T.(R)(ARRT)^®*, Radiology Support Services, PO Box 215, Germantown, NY 12526. E-mail: radiologytechnique@gmail.com.

Disclosure Statement: The author reports having no significant financial or advisory relationships with corporate organizations related to this activity.

ABSTRACT

Diffuse liver diseases encompass a wide range of viral, metabolic, cholestatic, or autoimmune conditions as well as vascular diseases that typically originate in the right upper quadrant (RUQ). As is often ordered by clinicians, sonography is often the first imaging procedure that is used for diagnostic investigation in this area as it is a low-cost, widely available modality. New sonographic imaging techniques are grouped into software that optimizes existing 2-dimensional (D) B-mode grayscale ultrasound scans and newer adjunctive imaging techniques. In order for clinicians to accurately diagnose patients with liver, gallbladder (GB), and/or biliary tract diseases or conditions, it is imperative that radiologic technologists are well versed in performing both traditional and more detailed sonographic imaging studies. This course provides a thorough review of the anatomical regions of the RUQ, specifically the liver, GB, and biliary tract as well as their structure and function. Recommended sonographic imaging techniques will be reviewed including 2D B-mode grayscale, color Doppler, and contrast-enhanced sonography, elastography, and fusion imaging, among several others. Ideal scanning techniques for each study and anatomy as well as common benign and malignant pathologies that may be encountered and correlation to their sonographic findings are detailed. Interventional procedures including sonography-guided biopsy, abscess drainages, and radiofrequency ablation techniques will also be discussed. A review of basic sonography physics, instrumentation, transducer types, and common artifacts will also be provided. Extensive examples of how different pathologies and procedures appear on screen are included.