Examination of the Liver and Biliary Tract: Imaging Techniques

In addition to basic diagnostics and the collection of liver values, device examinations can also provide information about liver and bile duct disorders – after all, you want to know where in the machinery the jam or leak is located and the extent of the disorder.

Imaging techniques

Quite different imaging techniques can be used to diagnose the condition, and these are selected depending on the suspected cause.

Ultrasound (sonography)

Compared with palpation, ultrasound allows much more accurate information about organ size, tissue structure, and diffuse or local changes such as fatty liver or gallstones. If a tissue sample is needed (for example, if a tumor is suspected or to assess connective tissue changes), the corresponding site can be targeted and checked during liver puncture under ultrasound guidance.

With an additional device, Doppler and duplex sonography can be used to make the blood flow visible and audible in color and thus assess the vessels and detect occlusions or varicose veins. Other imaging techniques are usually reserved for more specialized problems.

Computed tomography (CT) and magnetic resonance imaging (MRI).

In cases of doubt or difficult questions, these examinations can complement sonography. They are also used to evaluate injuries, for example, after a traffic accident. MRI plays a particularly important role in the evaluation of tumors and bile duct changes.

ERC(P) (endoscopic retrograde cholangio-[pancreato-]graphy).

An endoscope can be used to detect and often remove gallstones in the bile ducts. This is advanced – as in a gastroscopy – into the duodenum, then contrast material is injected into the bile ducts, which are then assessed on x-ray. However, endoscopic examination is not usually performed in coagulopathy because of the risk of bleeding.

Liver Scintigraphy

Liver scintigraphy uses radiolabeled red blood cells to assess liver function, bile flow, and flow through the hepatic vessels. For this purpose, a radiopharmaceutical is injected into a vein. With the help of a gamma camera, the path of this substance through the body can be visualized. In this way, it can be assessed whether the substance is properly absorbed by the liver and excreted via the bile ducts.
The examination is paid for by health insurance companies. It is not recommended during pregnancy.

Treatment of bile and liver

Gallstones can be manifested by a feeling of pressure in the right upper abdomen, bloating, flatulence, and malaise, especially when fatty foods and cold drinks are ingested, as well as by recurrent colic. While the latter problem can be solved comparatively easily and then usually definitively by removing the gallbladder, in advanced liver disease with the consequence of cirrhosis, i.e. conversion into non-functioning connective tissue, there is usually only the option of liver transplantation or only relief of symptoms without a cure.

This is why early diagnosis is so important. All diseases of the liver (for example viral infections, chronic poisoning, alcohol abuse) can ultimately lead to liver cirrhosis and thus to symptoms. Targeted questioning of the affected person about his medical history (anamnesis) therefore serves above all to first get on the right track; for an exact determination of the cause, various diagnostic procedures must then usually be used, such as the determination of viruses or antibodies in the blood.

  • Kuntz, E. (2002): Brennpunkt Leber. Hädecke Verlag.
  • Müller, C., Baumgart, G. (2007): liver diseases. Publishing House of Physicians.
  • Aschoff, A. (2015): The cirrhotic liver – which imaging is best and why? Congress paper.

  • Online information of the liver cancer help: diagnosis of liver cancer. (Accessed 09/2020)