CT Abdomen MDCT may be useful in the setting of nonobstructive jaundice when there is questionable hepatic parenchymal disease based on laboratory findings, as these modalities may show changes of early fibrosis, cirrhosis, or general hepatic inflammation [124]. When imaging does not yield a cause for jaundice (ie, there is no biliary obstruction and no parenchymal process to explain jaundice), liver dysfunction or an infiltrative process must be excluded, and liver biopsy will be the most effective next step in diagnosis [12,32]. ERCP There is limited to no role for ERCP in the setting of nonobstructive jaundice. US Abdomen Endoscopic There is limited to no role for EUS in the setting of nonobstructive jaundice. Jaundice Summary of Recommendations Variant 1: US abdomen, CT abdomen with IV contrast, or MRI abdomen without and with IV contrast with MRCP is usually appropriate for the initial imaging of jaundice with no known predisposing conditions. These procedures are equivalent alternatives. Variant 2: CT abdomen with IV contrast, MRI abdomen without and with IV contrast with MRCP, MRI abdomen without IV contrast with MRCP, or US abdomen is usually appropriate for jaundice when initial imaging is suggestive of mechanical obstruction based on initial imaging, clinical condition, or laboratory values. These procedures are equivalent alternatives. Variant 3: MRI abdomen without and with IV contrast with MRCP, CT abdomen with IV contrast, or US abdomen is usually appropriate for jaundice when mechanical obstruction is not suspected in the setting of suspected medical, metabolic, or functional etiologies based on initial imaging, clinical condition, or laboratory values. These procedures are equivalent alternatives. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
Jaundice. CT Abdomen MDCT may be useful in the setting of nonobstructive jaundice when there is questionable hepatic parenchymal disease based on laboratory findings, as these modalities may show changes of early fibrosis, cirrhosis, or general hepatic inflammation [124]. When imaging does not yield a cause for jaundice (ie, there is no biliary obstruction and no parenchymal process to explain jaundice), liver dysfunction or an infiltrative process must be excluded, and liver biopsy will be the most effective next step in diagnosis [12,32]. ERCP There is limited to no role for ERCP in the setting of nonobstructive jaundice. US Abdomen Endoscopic There is limited to no role for EUS in the setting of nonobstructive jaundice. Jaundice Summary of Recommendations Variant 1: US abdomen, CT abdomen with IV contrast, or MRI abdomen without and with IV contrast with MRCP is usually appropriate for the initial imaging of jaundice with no known predisposing conditions. These procedures are equivalent alternatives. Variant 2: CT abdomen with IV contrast, MRI abdomen without and with IV contrast with MRCP, MRI abdomen without IV contrast with MRCP, or US abdomen is usually appropriate for jaundice when initial imaging is suggestive of mechanical obstruction based on initial imaging, clinical condition, or laboratory values. These procedures are equivalent alternatives. Variant 3: MRI abdomen without and with IV contrast with MRCP, CT abdomen with IV contrast, or US abdomen is usually appropriate for jaundice when mechanical obstruction is not suspected in the setting of suspected medical, metabolic, or functional etiologies based on initial imaging, clinical condition, or laboratory values. These procedures are equivalent alternatives. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.