Hepatic infarction is seen as nonenhancing wedge-shaped hepatic parenchyma. Vascular cause for ischemic hepatitis can be identified on postcontrast imaging, including MR angiogram [38,49]. Several investigations have shown impaired uptake of liver-specific agents in hepatic dysfunction. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid is a paramagnetic hepatobiliary MR contrast agent, which (due to its OATP1B1/B3-dependent hepatocyte-specific uptake and paramagnetic properties) is used for evaluation of liver function analysis [50-53]. US Abdomen with IV Contrast CEUS is not a first-line imaging modality to assess the hepatic parenchyma in acute severe hepatitis or ischemia. Investigations to use as adjunct to check vascular patency in transplant livers has been tried [60], but there is a lack of relevant literature to support the use of CEUS in this clinical scenario. Abnormal Liver Function Tests US Duplex Doppler Abdomen Duplex Doppler can be added to routine grayscale US to look for vascular patency in patients with suspected ischemic insult. US Shear Wave Elastography Abdomen There is no relevant literature to support the use of US shear wave elastography in toxic or ischemic liver injury. Choledocholithiasis is the most common cause of extrahepatic biliary obstruction and elevated ALP of liver origin. Additional etiologies of extrahepatic biliary obstruction include malignant obstruction, biliary strictures, and infections (eg, AIDS cholangiopathy, and liver flukes). Isolated elevated ALP of hepatic origin (without other elevated liver function tests) that persists over time suggests a chronic cholestatic process, such as partial bile duct obstruction, primary biliary cholangitis, primary sclerosing cholangitis, or drug-induced cholestasis. Infiltrative liver diseases such as sarcoidosis, amyloidosis, and hepatic metastases, among others, may also lead to intrahepatic cholestasis.
Abnormal Liver Function Tests. Hepatic infarction is seen as nonenhancing wedge-shaped hepatic parenchyma. Vascular cause for ischemic hepatitis can be identified on postcontrast imaging, including MR angiogram [38,49]. Several investigations have shown impaired uptake of liver-specific agents in hepatic dysfunction. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid is a paramagnetic hepatobiliary MR contrast agent, which (due to its OATP1B1/B3-dependent hepatocyte-specific uptake and paramagnetic properties) is used for evaluation of liver function analysis [50-53]. US Abdomen with IV Contrast CEUS is not a first-line imaging modality to assess the hepatic parenchyma in acute severe hepatitis or ischemia. Investigations to use as adjunct to check vascular patency in transplant livers has been tried [60], but there is a lack of relevant literature to support the use of CEUS in this clinical scenario. Abnormal Liver Function Tests US Duplex Doppler Abdomen Duplex Doppler can be added to routine grayscale US to look for vascular patency in patients with suspected ischemic insult. US Shear Wave Elastography Abdomen There is no relevant literature to support the use of US shear wave elastography in toxic or ischemic liver injury. Choledocholithiasis is the most common cause of extrahepatic biliary obstruction and elevated ALP of liver origin. Additional etiologies of extrahepatic biliary obstruction include malignant obstruction, biliary strictures, and infections (eg, AIDS cholangiopathy, and liver flukes). Isolated elevated ALP of hepatic origin (without other elevated liver function tests) that persists over time suggests a chronic cholestatic process, such as partial bile duct obstruction, primary biliary cholangitis, primary sclerosing cholangitis, or drug-induced cholestasis. Infiltrative liver diseases such as sarcoidosis, amyloidosis, and hepatic metastases, among others, may also lead to intrahepatic cholestasis.