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Clinical Scenarios
- I have undergone an ultrasound examination and identification was made of a lesion in the liver.
This is the ideal scenario for evaluation of the patient by state-of-the-art MRI examination. The disadvantage with MRI is that there is a greater range in the quality of MRI examinations and in the expertise of investigators with MRI. MRI is able to characterize the great majority of liver lesions without the requirement for additional investigation. Depending on the clinical picture, it may be necessary to do a biopsy (see "Do I Need a Liver Biopsy?").
- I am a patient with colon cancer who has had a colon or rectal tumor removed and now I am undergoing follow-up imaging investigation to make sure that I do not have liver disease.
In this setting, quite often CT and MRI are performed comparably. In patients who are very thin, ultrasound also may perform very well as a screening modality for liver metastases. PET scan is highly effective and should be performed on all patients before and after colon and rectal cancer treatments.
- I am a patient with a liver lesion in which a biopsy of this lesion is being recommended. What type of modality should be used to direct the needle biopsy?
In general, in experienced hands both CT and ultrasound performed comparably for needle biopsies. There are some circumstances where ultrasound is preferred, for example in lesions that are located very high in the liver, just underneath the diaphragm, the ability of ultrasound to biopsy this area makes it a preferable technique. CT is often used in the setting where there is difficulty visualizing the liver either because of the large size of the patient or the close approximation of bowel. On occasion, patients are also transferred from either CT to ultrasound or ultrasound to CT. Similarly, patients may be transferred from ultrasound to CT if the lesion cannot be visualized under ultrasound or the lesion is located very deep within a large or obese patient which renders it very difficult to see by ultrasound, or there is intestine in between the ultrasound transducer and the liver lesion which renders ultrasound unable to visualize the lesion adequately. For more information see, "Do I need a liver biopsy?"
