Introduction

Modern imaging technology has allowed imaging of the liver to excel in ways not dreamed possible just ten or 15 years ago. It is imperative for radiologists to be aware of new capabilities and opportunities for evaluating liver disease by imaging. Imaging of the liver, similar to other organs, runs the gamut from the detection of anatomic variations and congenital anomalies, visualization of vascular disease, detection, characterization and staging of liver tumors and infections, and evaluation of trauma and post-surgical changes. Differing modalities and the understanding of different imaging techniques, including contrast utilization, is essential to optimize patient diagnoses.

In the current environment of cost containment, the most appropriate modality should be chosen to answer the clinical question. Ultrasonography (US) is widely available and is the most inexpensive modality for imaging the liver parenchyma. However, it is limited by low sensitivity and specificity. Contrast-enhanced computed tomography (CT) has emerged as the modality of choice for routine liver imaging. Magnetic resonance (MR) imaging is used primarily as a problem solving technique for liver evaluation when CT or US are equivocal. The present chapter highlights imaging of hepatic parenchymal diseases focusing on CT and MR, but including US and scintigraphy in selected cases. Course participants should gain an understanding of how these liver diseases appear at CT and MR and learn how to optimize contrast enhancement techniques and diagnoses by learning the impact of timing in the different phases of contrast enhancement after intravenous (iv) injection of contrast agents. The relative performance of different imaging modalities in diagnosing liver diseases will be compared.

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