Liver Ultrasound

What is a liver ultrasound?

A liver ultrasound is a simple and painless imaging test of your liver and the surrounding area. Healthcare providers use ultrasound to screen for liver diseases. An ultrasound, or sonogram, takes pictures of the inside of your body by bouncing high-frequency sound waves off your organs. You won’t hear the sounds. You’ll only feel the sonographer moving a probe (transducer wand) around on your skin.

Why would a doctor order a liver ultrasound?

A healthcare provider might order a liver ultrasound if you have symptoms of liver disease, or if you have results from another type of test that indicate liver disease (like a blood test). Ultrasound offers a quick and easy way for your provider to investigate these findings. If you’ve already been diagnosed with liver disease, your provider might order a liver ultrasound to check how your liver is doing.

Can an ultrasound show liver problems?

A liver ultrasound can show signs of fat storage in your liver (steatotic liver disease), inflammation and swelling (hepatitis), and scar tissue (fibrosis or cirrhosis). These are the three main stages of chronic liver disease. The scan may also show liver lesions, abnormal spots or growths on your liver. Special types of liver ultrasounds can evaluate the blood flow through your liver or how stiff its tissues are.

What conditions can a liver ultrasound diagnose?

A liver ultrasound can be instrumental in diagnosing many liver conditions. It isn’t always enough by itself for your provider to make a final diagnosis, but it can point them in the right direction. You may need further tests to follow up on your ultrasound results and determine the exact type of liver disease you have. You might need a biopsy to investigate a lesion or spot on your liver ultrasound to confirm what it is.

Some conditions liver ultrasounds can help diagnose include:

Stages of chronic liver disease:

• Hepatitis.
• Steatosis.
• Cirrhosis.

Liver lesions:

• Liver cysts.
• Liver hemangioma.
• Liver cancer.

Vascular conditions of the liver:

• Ischemia.
• Budd-Chiari-syndrome.
• Portal hypertension.

Other conditions affecting your biliary system:

• Ascites.
• Cholecystitis.
• Choledocholithiasis.

What are the different types of liver ultrasounds?

Types of liver ultrasounds include:

• Standard (upper right quadrant abdominal ultrasound).
• Vascular ultrasound (Doppler ultrasound).
• Elastography ultrasound (transient elastography).
• Contrast ultrasound (CEUS).

Standard liver ultrasound

A standard liver ultrasound is a modified abdominal ultrasound. Providers sometimes call it an upper right quadrant ultrasound. The upper right quadrant of your abdomen includes your liver, gallbladder, bile ducts, right kidney and part of your pancreas. While your sonographer focuses mainly on your liver, these other organs can be involved in your condition. They’re all connected within your biliary system.

Vascular liver ultrasound

A vascular ultrasound of the liver looks specifically at the blood vessels that run through your liver. Providers use them to see how blood flows through your liver. It’s also called a duplex ultrasound because it combines standard ultrasound images of your liver with Doppler ultrasound images of your blood vessels and blood flow. The Doppler method records blood cells’ speed and direction.

Elastography ultrasound

An elastography ultrasound (transient elastography) is a special type of ultrasound that measures the stiffness or fibrosis in your liver. Fibrosis comes from scar tissue. A lot of it indicates cirrhosis. A little indicates chronic liver disease that could lead to cirrhosis over time. Your sonographer will use a special transducer that measures how fast vibrations travel through your liver. A faster speed indicates fibrosis.

Contrast-enhanced ultrasound of the liver

Your provider might order a contrast-enhanced ultrasound (CEUS) of your liver to see clearer images of lesions they spotted on a standard ultrasound. Contrast makes these lesions easier to see and identify. The contrast agent isn’t a dye, but tiny gas bubbles that reflect sonographic waves. Your provider will inject them into your vein before your test, then they’ll travel to your liver in your bloodstream.

What kind of prep does a liver ultrasound require?

One of the conveniences of a liver ultrasound is that it requires little to no preparation. However, when possible, your healthcare provider might ask you to fast — to go without eating — for six to 12 hours beforehand. The purpose of fasting before an ultrasound is to empty your digestive system, so food and gas won’t interfere with the ultrasound waves. It also helps dilate your gallbladder for easier viewing.

Can I drink water before my ultrasound?

Consult your provider about drinking water before your liver ultrasound. Some might ask you to avoid it for just a few hours beforehand. In other cases, a full bladder might actually be helpful for your scan.

What happens during a liver ultrasound?

You’ll have your liver ultrasound in a hospital or imaging center. A healthcare provider will position you on an exam table, usually face-up to start. The ultrasound equipment includes a computer console with a screen and a transducer wand attached to it with a cord. The transducer is a type of microphone that’ll transmit inaudible sound waves to your organs. It looks like a wand with a smooth, flat end.

Your sonographer will apply a clear, hypoallergenic, warmed gel to your abdomen. This helps provide smooth and seamless contact between the transducer wand and your skin. Then they’ll move the flat end of the wand around on the gel. There’s little pressure, and you won’t feel it much, unless you’re very sore. As it moves, the transducer sends real-time images of your organs to the computer screen.

Your provider will take snapshots and sometimes short videos of what they see during the exam. They might ask you to adjust your position or breathing while they attempt to capture an image. Depending on what they find, they might suggest additional steps, like a Doppler ultrasound, elastography or contrast enhancement. They can usually perform these extra steps during the same session.

How long does a liver ultrasound take?

Liver ultrasounds usually take around half an hour. A more detailed analysis or a special type of ultrasound will take a little longer. You might want to plan for a full hour from start to finish.

What should I expect after my liver ultrasound?

Your sonographer will send the images from your test to a radiologist. The radiologist will study the images and write a detailed report. Sometimes, they might be available to discuss their initial findings with you right away. Otherwise, they’ll send their report to your primary healthcare provider. Once your procedure is over, you can go home and resume eating, drinking and all of your normal activities.

What are the benefits or advantages of ultrasound for evaluating the liver?

A liver ultrasound is often a healthcare provider’s first choice for evaluating the liver because it’s safe, noninvasive and painless. It doesn’t involve radiation exposure or foreign materials entering your body. Even the contrast agent is harmless. Since it’s not dye but gas, there’s no risk of causing an allergic reaction. Ultrasound is also the fastest available imaging test, which makes it a practical choice.

Are there any risks or side effects from a liver ultrasound?

There are no side effects from a liver ultrasound. The only risk is that it might not work. Taking a sonogram is a manual process that depends a bit on individual technique and also on whether anything in your body is blocking the sound waves. Intestinal gas, fatty tissue or calcification can sometimes interfere with the ultrasound beam. There’s also some room for error in interpreting the images.

Since a liver ultrasound is usually the first test your provider will use to screen for liver problems, you don’t need to worry too much about the small risk of inaccurate or inadequate results. Whatever your results say, your healthcare provider will probably suggest following them up with other tests. They’ll want to learn more about your condition or your symptoms if they’re still unexplained.

What is a normal vs. abnormal liver ultrasound?

A normal liver on an ultrasound has a certain expected size, shape and color (shade of gray). A radiologist can measure the size and shade against other nearby organs to compare them. The surface should be smooth and soft, not lumpy or coarse. Protrusions or spots on the surface might indicate cysts or solid masses. A radiologist might also look for enlarged (dilated) blood vessels or bile ducts.

An enlarged or shrunken liver indicates liver disease. A lumpy surface indicates scarring (cirrhosis) or tumors. Some lesions are normal, but there shouldn’t be too many. The brightness or darkness of the color indicates the texture of the tissues. Fatty liver disease might make it brighter, while inflammation might make it denser and darker. Your ultrasound report will explain what your radiologist sees.

What do results from a liver ultrasound mean?

Your report will describe:

• “Echogenicity” or “echotexture”. This refers to the brightness of the tissue. It’s “echogenic” if it’s brighter, because the echoes of the ultrasound waves bounce back more instead of being absorbed. It’s “hypoechoic” if there’s little echo, making the picture darker. The “echotexture” of your liver can suggest scarring, swelling, fat storage or buildup of other metabolic products.
• Lesions. Lesions are spots on your liver ultrasound that represent wounds or growths. A radiologist can often identify the type of lesion it is from the ultrasound. The echotexture can distinguish a fluid-filled cyst from a solid tumor. A Doppler or contrast-enhanced ultrasound is especially helpful for distinguishing tumors because it shows what kind of blood supply they have.

Your report might also mention:

• Ascites. This describes a buildup of fluid in your abdominal cavity surrounding your liver. It’s a sign of advanced liver disease.
• Calculi. These are calcified stones, either gallstones or kidney stones, that may appear in your ultrasound.
• Extra blood vessels or bile ducts. Your liver might develop extra pathways if the original ones aren’t working.
• Fibrosis. An elastography ultrasound measures the scar tissue in your liver, which can help stage liver disease.

When will I have my results?

It may take a few days to weeks for your radiologist to deliver the final ultrasound report to your primary healthcare provider and for your provider to be able to discuss those results with you.

A note from Cleveland Clinic

A liver ultrasound can reveal a lot about your liver for such a quick, simple test. When special techniques are involved, ultrasound can help your healthcare provider diagnose serious conditions like cirrhosis, portal hypertension, fatty liver disease and liver cancer, with similar accuracy to other tests. It can also help rule out these types of diseases before putting you through more complicated or invasive tests.