ALP may also be elevated nonspecifically in addition to other elevated liver biochemical tests in all types of liver diseases, including hepatitis, cirrhosis, sepsis, and heart failure. CT Abdomen and Pelvis With IV Contrast Although abdominal US is typically the first-line imaging modality for identifying biliary obstruction, contrast- enhanced CT of the abdomen and pelvis may help define the site of obstruction, potential etiology, and coexistent complications [63]. CT is considered less sensitive than MRI with MRCP for the evaluation of the bile ducts; however, CT may provide useful information regarding the etiology of cholestasis. There are advantages to including the pelvis in the CT abdomen and pelvis examination, including detecting pelvic ascites, pelvic collateral vessels in portal hypertension, and possible sources of obstruction (eg, lymphadenopathy). CT Abdomen and Pelvis Without and With IV Contrast CT of the abdomen and pelvis with and without IV contrast is not typically performed for this clinical scenario because there is no benefit from adding unenhanced images. CT Abdomen and Pelvis Without IV Contrast Although intra- and extrahepatic biliary ductal dilatation may be identified on CT abdomen and pelvis without IV contrast, contrast confers added benefit for assessment of ischemic liver injury and possible useful hemodynamic information, such as sequela of portal hypertension or hepatic congestion. There are advantages to including the pelvis in the CT abdomen and pelvis examination, including detecting pelvic ascites, pelvic collateral vessels in portal hypertension, and possible sources of obstruction (eg, lymphadenopathy). MR Elastography Abdomen MR elastography is currently the most accurate imaging modality for the diagnosis and staging of hepatic fibrosis; however, it has a limited to no role in the initial imaging of suspected cholestasis. Abnormal Liver Function Tests
Abnormal Liver Function Tests. ALP may also be elevated nonspecifically in addition to other elevated liver biochemical tests in all types of liver diseases, including hepatitis, cirrhosis, sepsis, and heart failure. CT Abdomen and Pelvis With IV Contrast Although abdominal US is typically the first-line imaging modality for identifying biliary obstruction, contrast- enhanced CT of the abdomen and pelvis may help define the site of obstruction, potential etiology, and coexistent complications [63]. CT is considered less sensitive than MRI with MRCP for the evaluation of the bile ducts; however, CT may provide useful information regarding the etiology of cholestasis. There are advantages to including the pelvis in the CT abdomen and pelvis examination, including detecting pelvic ascites, pelvic collateral vessels in portal hypertension, and possible sources of obstruction (eg, lymphadenopathy). CT Abdomen and Pelvis Without and With IV Contrast CT of the abdomen and pelvis with and without IV contrast is not typically performed for this clinical scenario because there is no benefit from adding unenhanced images. CT Abdomen and Pelvis Without IV Contrast Although intra- and extrahepatic biliary ductal dilatation may be identified on CT abdomen and pelvis without IV contrast, contrast confers added benefit for assessment of ischemic liver injury and possible useful hemodynamic information, such as sequela of portal hypertension or hepatic congestion. There are advantages to including the pelvis in the CT abdomen and pelvis examination, including detecting pelvic ascites, pelvic collateral vessels in portal hypertension, and possible sources of obstruction (eg, lymphadenopathy). MR Elastography Abdomen MR elastography is currently the most accurate imaging modality for the diagnosis and staging of hepatic fibrosis; however, it has a limited to no role in the initial imaging of suspected cholestasis. Abnormal Liver Function Tests