US can confirm the absence of a mechanical obstruction, with specificities ranging between 71% to 97% [20-25]. US images may suggest an alternate etiology for the elevated bilirubin (such as cirrhosis), with US having an overall sensitivity of 65% to 95%, with a positive predictive value of 98% for the detection of cirrhosis [15-19]. The most accurate finding on sonography in liver cirrhosis is a nodular surface, which is more sensitive on the undersurface of the liver than the superior surface (86% versus 53%) [15]. If the US is negative, the American College of Gastroenterology recommends additional laboratory testing assessing for liver failure, ultimately suggesting a liver biopsy [32]. MRI Abdomen MRI with MRCP may be of additional value in the setting of a negative US and clinical workup inconclusive for the etiology of the bilirubin elevation, particularly if there is concern for potential primary sclerosing cholangitis or primary biliary cirrhosis [32,105]. Proceeding directly to liver biopsy may run the risk of a false-negative biopsy, as the early disease process is patchy in the initial stages of primary sclerosing cholangitis or primary biliary cirrhosis; these diseases are nonglobal in their initial manifestations. Therefore, MRCP may help better detect pathology in these situations [121-123]. MRI may be useful when there is questionable hepatic parenchymal disease based on laboratory findings, as these modalities may show changes of early fibrosis (particularly if MR elastography is used), cirrhosis, or general hepatic inflammation [124]. Although there are not many data comparing contrast-enhanced MRI with noncontrast MRI in the setting of a nonobstructive jaundice, there are data showing that contrast administration improves the sensitivity for the detection of acute cholangitis and the detection of primary sclerosing cholangitis [125,126].
Jaundice. US can confirm the absence of a mechanical obstruction, with specificities ranging between 71% to 97% [20-25]. US images may suggest an alternate etiology for the elevated bilirubin (such as cirrhosis), with US having an overall sensitivity of 65% to 95%, with a positive predictive value of 98% for the detection of cirrhosis [15-19]. The most accurate finding on sonography in liver cirrhosis is a nodular surface, which is more sensitive on the undersurface of the liver than the superior surface (86% versus 53%) [15]. If the US is negative, the American College of Gastroenterology recommends additional laboratory testing assessing for liver failure, ultimately suggesting a liver biopsy [32]. MRI Abdomen MRI with MRCP may be of additional value in the setting of a negative US and clinical workup inconclusive for the etiology of the bilirubin elevation, particularly if there is concern for potential primary sclerosing cholangitis or primary biliary cirrhosis [32,105]. Proceeding directly to liver biopsy may run the risk of a false-negative biopsy, as the early disease process is patchy in the initial stages of primary sclerosing cholangitis or primary biliary cirrhosis; these diseases are nonglobal in their initial manifestations. Therefore, MRCP may help better detect pathology in these situations [121-123]. MRI may be useful when there is questionable hepatic parenchymal disease based on laboratory findings, as these modalities may show changes of early fibrosis (particularly if MR elastography is used), cirrhosis, or general hepatic inflammation [124]. Although there are not many data comparing contrast-enhanced MRI with noncontrast MRI in the setting of a nonobstructive jaundice, there are data showing that contrast administration improves the sensitivity for the detection of acute cholangitis and the detection of primary sclerosing cholangitis [125,126].