Doppler US can demonstrate hemodynamic alterations related to infection (such as elevated velocity in the main hepatic artery in acute cholecystitis) or indicative of portal hypertension as seen in fibrosis or infiltrative liver diseases. The diagnostic value of Doppler US of the portal vein for the evaluation of liver function is still controversial [74]. US Shear Wave Elastography Abdomen There is no relevant literature to support the use of US shear wave elastography in the evaluation of cholestasis. US shear wave elastography is used to assess for evaluation of liver fibrosis, which may nonspecifically elevate ALP; however, it has a limited to no role in the initial imaging of suspected cholestasis. US Abdomen US is the most useful imaging modality to evaluate conjugated hyperbilirubinemia due to liver parenchymal cause (alcoholic or viral hepatitis and cirrhosis) or biliary obstruction. US shows a positive predictive value of 98% and a sensitivity in the range of 65% to 95% for the diagnosis of liver parenchymal disease. Biliary obstruction can be demonstrated on US with a wide range of sensitivity (32%-100%) and specificity (71%-97%); however, the cause for distal obstruction may be obscured by overlying bowel gas [54]. US Abdomen with IV Contrast There is no relevant literature to support the use of CEUS in this clinical scenario. caxuda US Duplex Doppler Abdomen US duplex Doppler abdomen is not useful for this clinical scenario. US Shear Wave Elastography Abdomen US shear wave elastography is not useful as the first-line imaging modality to assess hyperbilirubinemia. Liver fibrosis can be demonstrated using elastography techniques with improved accuracy in higher stages of fibrosis (area under the curve, 0.88 and 0.91 for S2 and S4 fibrosis, respectively) [18]. There is no evidence to support use of US shear wave elastography in biliary obstruction.
Abnormal Liver Function Tests. Doppler US can demonstrate hemodynamic alterations related to infection (such as elevated velocity in the main hepatic artery in acute cholecystitis) or indicative of portal hypertension as seen in fibrosis or infiltrative liver diseases. The diagnostic value of Doppler US of the portal vein for the evaluation of liver function is still controversial [74]. US Shear Wave Elastography Abdomen There is no relevant literature to support the use of US shear wave elastography in the evaluation of cholestasis. US shear wave elastography is used to assess for evaluation of liver fibrosis, which may nonspecifically elevate ALP; however, it has a limited to no role in the initial imaging of suspected cholestasis. US Abdomen US is the most useful imaging modality to evaluate conjugated hyperbilirubinemia due to liver parenchymal cause (alcoholic or viral hepatitis and cirrhosis) or biliary obstruction. US shows a positive predictive value of 98% and a sensitivity in the range of 65% to 95% for the diagnosis of liver parenchymal disease. Biliary obstruction can be demonstrated on US with a wide range of sensitivity (32%-100%) and specificity (71%-97%); however, the cause for distal obstruction may be obscured by overlying bowel gas [54]. US Abdomen with IV Contrast There is no relevant literature to support the use of CEUS in this clinical scenario. caxuda US Duplex Doppler Abdomen US duplex Doppler abdomen is not useful for this clinical scenario. US Shear Wave Elastography Abdomen US shear wave elastography is not useful as the first-line imaging modality to assess hyperbilirubinemia. Liver fibrosis can be demonstrated using elastography techniques with improved accuracy in higher stages of fibrosis (area under the curve, 0.88 and 0.91 for S2 and S4 fibrosis, respectively) [18]. There is no evidence to support use of US shear wave elastography in biliary obstruction.