Preliminary Diagnosis: Cirrhosis
I. What imaging technique is first-line for this diagnosis
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Doppler ultrasound
II. Describe the advantages and disadvantages of this technique for diagnosis of cirrhosis.
Advantages
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Doppler ultrasound is relatively fast and inexpensive.
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Can be used for screening patients for hepatocellular carcinoma who have already developed cirrhosis
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Can be used to monitor development of other complications of cirrhosis including portal hypertension and ascites
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No ionizing radiation
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Early changes of cirrhosis including fibrosis and micronodule formation are better identified in comparison to CT and MRI
Disadvantages
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Ultrasound is not diagnostic for hepatocellular carcinoma.
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Ultrasound can be limited in patients with large body habitus
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Operator dependent
III. What are the contraindications for the first-line imaging technique?
No significant contraindications
IV. What alternative imaging techniques are available?
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Three-phase contrast-enhanced CT
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Gadolinium-enhanced MRI
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cirrhosis.
Three-phase contrast-enhanced CT
Advantage
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Can be helpful in monitoring patients with cirrhosis for development of hepatocellular carcinoma, as ultrasound is not specific
Disadvantages
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Requires ionizing radiation
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More expensive compared with ultrasound
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Early changes of cirrhosis are not demonstrated.
MRI with gadolinium contrast
Advantages
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Superior to other modalities in evaluating dysplastic nodules in a cirrhotic liver
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Can be helpful in monitoring patients with cirrhosis for development of hepatocellular carcinoma, as ultrasound is not specific
Disadvantages
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More expensive compared with ultrasound
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Time consuming
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Requires
VI. What are the contraindications for the alternative imaging techniques?
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Iodinated contrast is contraindicated in patients with renal failure
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Iodinated contrast is contraindicated in patients with severe allergy.
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Gadolinium contrast is contraindicated in patients with poor renal function.
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