US Shear Wave Elastography Abdomen US shear wave elastography is increasingly used to assess liver stiffness in chronic liver parenchymal disease. Various US elastography techniques have evolved in recent years that use different shear wave generation and propagation. These include transient elastography, acoustic radiation force impulse elastography, supersonic shear wave, and real-time tissue elastography. Controlled attenuation parameter is a novel method for the measurement of hepatic steatosis that uses the same radiofrequency data used for quantification of liver stiffness. Shi at al [18] performed a meta-analysis to look at performance of controlled attenuation parameter in detection of severity of steatosis (>S1, >S2, >S3). The sensitivity and specificity were 78% and 79% for S1, 85% and 79% for S2 and, 83% and 79% for S3 steatosis, respectively. Receiver operating characteristic analysis was 85% for >S1, 88% for >S2, and 87% for >S3. According to the meta- analysis, controlled attenuation parameter has a good sensitivity and specificity for detecting hepatic fat content; however, accuracy is limited. However, CT is not useful as the first modality of choice for the diagnosis of mildly elevated aminotransferases due to mild fatty infiltration for multiple reasons, including failure to detect early steatosis, lack of accuracy, and reliability [20,23,24]. Abnormal Liver Function Tests CT Abdomen and Pelvis Without and With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis without and with IV contrast in this clinical scenario. MR Elastography Abdomen MR elastography is the most useful modality to estimate liver fibrosis. MR elastography is currently being investigated to diagnose NAFLD without liver fibrosis and therefore is not an initial investigation.
Abnormal Liver Function Tests. US Shear Wave Elastography Abdomen US shear wave elastography is increasingly used to assess liver stiffness in chronic liver parenchymal disease. Various US elastography techniques have evolved in recent years that use different shear wave generation and propagation. These include transient elastography, acoustic radiation force impulse elastography, supersonic shear wave, and real-time tissue elastography. Controlled attenuation parameter is a novel method for the measurement of hepatic steatosis that uses the same radiofrequency data used for quantification of liver stiffness. Shi at al [18] performed a meta-analysis to look at performance of controlled attenuation parameter in detection of severity of steatosis (>S1, >S2, >S3). The sensitivity and specificity were 78% and 79% for S1, 85% and 79% for S2 and, 83% and 79% for S3 steatosis, respectively. Receiver operating characteristic analysis was 85% for >S1, 88% for >S2, and 87% for >S3. According to the meta- analysis, controlled attenuation parameter has a good sensitivity and specificity for detecting hepatic fat content; however, accuracy is limited. However, CT is not useful as the first modality of choice for the diagnosis of mildly elevated aminotransferases due to mild fatty infiltration for multiple reasons, including failure to detect early steatosis, lack of accuracy, and reliability [20,23,24]. Abnormal Liver Function Tests CT Abdomen and Pelvis Without and With IV Contrast There is no relevant literature to support the use of CT abdomen and pelvis without and with IV contrast in this clinical scenario. MR Elastography Abdomen MR elastography is the most useful modality to estimate liver fibrosis. MR elastography is currently being investigated to diagnose NAFLD without liver fibrosis and therefore is not an initial investigation.