lUniversity of Alabama Medical Center, Birmingham, Alabama. mJohns Hopkins Bayview Medical Center, Baltimore, Maryland. nUniversity of Illinois College of Medicine, Chicago, Illinois; American College of Physicians. oJohns Hopkins Hospital, Baltimore, Maryland. pSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Chronic Liver Disease features. For patients without cirrhosis, determining the presence and severity of earlier stages of liver fibrosis may help guide management. CT Abdomen Noncontrast CT has limited utility in the assessment of hepatic fibrosis because it relies on the demonstration of gross structural changes, which are typically not present until very advanced stages of the disease. Contrast- enhanced CT can be more useful because it can demonstrate parenchymal heterogeneity and enhancement of lattice- like macroscopic bands of fibrosis throughout the hepatic parenchyma [21,22]. CT perfusion has been described for the assessment of hepatic fibrosis and cirrhosis, predominantly relying on increased proportion of arterial blood supply to the liver as fibrosis progresses [23]. However, this methodology is highly technique dependent and requires substantial postprocessing and therefore is not considered a clinical standard method for establishing the diagnosis of cirrhosis. There is no relevant literature that demonstrates incremental value of combining noncontrast with contrast-enhanced CT for this application. FDG-PET/CT Skull Base to Mid-Thigh Fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET is not a useful test for detecting liver fibrosis.
Chronic Liver Disease. lUniversity of Alabama Medical Center, Birmingham, Alabama. mJohns Hopkins Bayview Medical Center, Baltimore, Maryland. nUniversity of Illinois College of Medicine, Chicago, Illinois; American College of Physicians. oJohns Hopkins Hospital, Baltimore, Maryland. pSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Chronic Liver Disease features. For patients without cirrhosis, determining the presence and severity of earlier stages of liver fibrosis may help guide management. CT Abdomen Noncontrast CT has limited utility in the assessment of hepatic fibrosis because it relies on the demonstration of gross structural changes, which are typically not present until very advanced stages of the disease. Contrast- enhanced CT can be more useful because it can demonstrate parenchymal heterogeneity and enhancement of lattice- like macroscopic bands of fibrosis throughout the hepatic parenchyma [21,22]. CT perfusion has been described for the assessment of hepatic fibrosis and cirrhosis, predominantly relying on increased proportion of arterial blood supply to the liver as fibrosis progresses [23]. However, this methodology is highly technique dependent and requires substantial postprocessing and therefore is not considered a clinical standard method for establishing the diagnosis of cirrhosis. There is no relevant literature that demonstrates incremental value of combining noncontrast with contrast-enhanced CT for this application. FDG-PET/CT Skull Base to Mid-Thigh Fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET is not a useful test for detecting liver fibrosis.