What Is a Liver Ultrasound?
A liver ultrasound is a type of abdominal ultrasound, an imaging test that uses high-frequency sound waves to create pictures of the organs and structures in your abdomen, or belly area.
A liver ultrasound focuses on your liver and the area around it. It’s used to screen for liver disease or other conditions, or to check the condition of your liver.
This imaging test can provide a lot of information about your liver, including its size and stiffness, and whether your liver has fat buildup, scar tissue, inflammation, or lesions. Some of these findings can mean you have liver disease, such as metabolic dysfunction-associated steatotic liver disease and cirrhosis of the liver.
How Does a Liver Ultrasound Work?
A liver ultrasound uses a wand, called a transducer, to transmit high-frequency sound waves into your body. It picks up the sound waves that bounce back, which creates an image of your liver and the area around it.
An ultrasound technician, also called a sonographer, puts the transducer on your skin, along with gel that improves the contact between the transducer and your skin. They move the transducer around your abdomen to get pictures of different parts of your liver and surrounding areas.
The sound waves used in a liver ultrasound can help your doctor “see” your liver and its traits, including how big it is, its texture, and whether there are any masses or buildup.
After the test, the sonographer’s images from your liver ultrasound are sent to a radiologist to analyze and interpret. Then they send a report to your doctor.
Types of Liver Ultrasounds
There are a few types of liver ultrasounds that your doctor might order, depending on your symptoms or what your doctor is looking for. They include:
Standard liver ultrasound
A standard liver ultrasound is also called an upper right quadrant ultrasound because it focuses on the upper right part of your abdomen, including your liver, gallbladder, bile ducts, and part of your pancreas.
These organs are connected by bile ducts and are part of your biliary system, which provides bile to your digestive tract. The organs near your liver may be involved in your liver’s condition.
Vascular liver ultrasound
A vascular liver ultrasound focuses on the blood vessels that go through your liver. This lets your health care provider see how blood flows through your liver.
This type of ultrasound combines a standard ultrasound with a Doppler ultrasound, which can show your blood flow. The Doppler ultrasound works by bouncing sound waves off the red blood cells that flow through your blood vessels.
A vascular liver ultrasound is sometimes called a duplex ultrasound because it includes both standard and Doppler ultrasounds. It can show the direction and speed of blood flow.
Contrast-enhanced ultrasound of the liver (CEUS)
A CEUS uses tiny gas bubbles to create contrast in the ultrasound images, because the bubbles reflect the sound waves. If a previous liver ultrasound revealed lesions, your doctor may order a CEUS to see them more clearly.
Before a CEUS begins, your health care provider will inject the gas bubbles into a vein. The bubbles will travel to your liver and then be visible during the ultrasound.
Elastography ultrasound (transient elastography)
An elastography ultrasound, also called transient elastography, measures the stiffness in your liver. With this type of ultrasound, the sonographer uses a different type of transducer, which uses sound waves to send vibrations into your liver. It measures how fast the vibrations move through your liver. The vibrations move faster if you have stiffness in your liver.
This stiffness may be a sign of fibrosis, or scar tissue. If you have scar tissue, that might mean you have chronic liver disease.
Reasons You Might Get a Liver Ultrasound
A liver ultrasound can help your doctor check your liver, which they might want to do for several reasons. These reasons include if you have:
- Symptoms of liver disease, such as belly pain and jaundice, or yellowing of your skin and the whites of your eyes
- Other test results, such as from a blood test, that indicate liver disease
- Already been diagnosed with liver disease, and your doctor wants to check the stage of your disease
- Liver disease, and your doctor wants to check how your treatment is working
A liver ultrasound can show several signs of disease and problems, including fat buildup, scar tissue, lesions, inflammation, and swelling in your liver.
If you have signs of liver disease, a liver ultrasound can help your doctor diagnose the problem and decide whether you need treatment. If you’ve already been diagnosed with liver disease, an ultrasound can help your doctor assess your treatment plan and whether it should be adjusted.
What to Expect With a Liver Ultrasound
A liver ultrasound is a safe, noninvasive test that’s generally painless. There are no real risks, other than the chance that it might not work well enough to provide useful images.
Before the procedure
Before your liver ultrasound, you may be asked to fast, or go without eating, for six to 12 hours before the test. This empties your digestive system so that food and gas don’t get in the way of the ultrasound waves. Your provider may ask you to avoid chewing gum and smoking as well.
In some cases, depending on the reason for your ultrasound, you may be asked to avoid drinking water beforehand, too. Drinking water can affect the stiffness of your liver, so it can throw off the accuracy of the ultrasound’s measurements of your liver’s stiffness.
But in other cases, drinking beforehand is OK, because a full bladder can be helpful during the procedure.
You may be asked to change into a gown or to move your clothing away from your abdomen so your sonographer can get to the area around your liver easily.
During the procedure
When it’s time for your liver ultrasound, you’ll be asked to lie on a table, usually on your back.
When the sonographer starts the ultrasound, you’ll feel the transducer move around on your abdomen, but it doesn’t usually hurt. You won’t be able to hear the sound waves. The sonographer will be looking at a computer screen that’s connected to the transducer, and they may take still images as well as short videos.
The sonographer may ask you to adjust your breathing or your position so that they can get specific images. A liver ultrasound usually takes about half an hour, but it may take longer if the sonographer recommends taking more images. Sometimes, during a standard liver ultrasound, the sonographer will recommend doing a Doppler, elastography, or contrast-enhanced ultrasound at the same time.
The pressure of the transducer on your skin usually doesn’t cause any pain or discomfort, but if the area is tender, it may be slightly painful.
After the procedure
The images from your liver ultrasound will be sent to a radiologist, who is trained to interpret and analyze the images. Then they will create a report that they send to your primary care doctor or the doctor who ordered your liver ultrasound.
Sometimes, the radiologist may be there at the time of your ultrasound and able to discuss the images with you before your doctor does.
After the procedure, you can go back to your normal activities, including eating and drinking.
Liver Ultrasound Results
The detailed results of your liver ultrasound depend on the type of ultrasound you get. But with all types, the ultrasound can reveal signs of a healthy liver and signs of liver disease and other problems.
Normal liver ultrasound results
A liver ultrasound may show these signs that your liver is normal:
- It is a certain size, shape, and color (a shade of gray).
- The surface of your liver is smooth and soft, without lumps or bulges.
- Your blood vessels and bile ducts are not enlarged.
If you have a liver lesion, a normal result from a CEUS may be that the lesion appears to be benign.
If you have an elastography ultrasound, normal results will be that your liver has little or no scarring. Results from an elastography ultrasound also show the amount of fat in your liver. A a healthy liver has 5% or less fat.
Abnormal liver ultrasound results
Abnormal results from a liver ultrasound may reveal that your liver is not the size it should be – it may be enlarged or shrunken. The color of your liver may be too light or too dark, and the surface may be lumpy.
If you have a CEUS, it might show details of a lesion that suggest it may be cancerous.
If you have an elastography ultrasound, abnormal results may show moderate to severe scarring or too much fat in your liver.
Interpreting Your Liver Ultrasound Results
Your radiologist will give an ultrasound report to your doctor, and your doctor will discuss the results with you. The specifics in this report will depend on which type of liver ultrasound you have, but here are some of the results it’s likely to contain.
Lesions
Liver lesions are growths, which can be benign or cancerous. They show up as spots on the ultrasound. CEUS and Doppler ultrasound can help identify what type of lesion you have.
An ultrasound may find that a lesion is a liver hemangioma, a benign type of lesion. Another benign lesion is a liver cyst, which is filled with fluid. Liver ultrasounds can also help identify lesions that are cancerous tumors.
Echogenicity (echotexture)
Echogenicity, or echotexture, is how bright the tissue is. Echogenic means it’s brighter, and the echoes of the ultrasound waves get reflected instead of absorbed. If there is less echo or reflection and the image is darker, it’s called hypoechoic.
If your liver is echogenic, that might indicate fatty liver. Your liver’s echotexture can also mean there are other conditions, such as scarring and swelling.
Other things your report might mention
Along with findings about lesions and echogenicity, your report may contain your radiologist’s findings about:
- Fibrosis, or scar tissue in your liver
- Ascites, or a buildup of fluid in your abdominal cavity. This can mean you have advanced liver disease.
- Calculi, which are calcified stones. These could be gallstones or kidney stones.
- Extra blood vessels or bile ducts, which your liver can develop in rare cases
Your report is also likely to contain an “impression” section, which will include a summary of the findings of the test. Your radiologist may also describe possible causes of the findings they listed, as well as recommendations for follow-up, such as further testing. This helps your doctor decide what the next steps should be.
Conditions That Can Affect Liver Ultrasound Results
Some conditions may affect the results of a liver ultrasound. They include:
- Intestinal gas. Gas in your digestive tract may affect your test results.
- Calcifications in the liver. Liver calcification may disrupt the ultrasound image.
- Obesity. A thick layer of abdominal fat can weaken the ultrasound beam.
- Having food or water in your stomach. Your doctor might ask you to fast before a liver ultrasound so that food doesn't obscure the ultrasound beam.
Remember, the findings of a liver ultrasound have to be interpreted by your radiologist. Depending on the skill and experience of the technician doing your test and the radiologist interpreting its findings, there's room for human error in its results.
Takeaways
A liver ultrasound can help your doctor check the condition of your liver, either to see if you have signs of liver disease or to assess your treatment if you've already been diagnosed with liver disease. A liver ultrasound is a noninvasive test that uses sound waves to create images of your liver and the areas around it. An ultrasound technician moves a wand around on the skin of your abdomen to get the images, and it’s usually painless. This test can give your doctor a lot of information about your liver that can help diagnose and treat your condition.
Liver Ultrasound FAQs
What is a liver ultrasound looking for?
A liver ultrasound is looking for abnormalities in your liver, or signs of liver disease, such as fatty liver disease and cirrhosis.
Why can't you drink water before a liver ultrasound?
Your health care provider may ask you not to drink water for a few hours before a liver ultrasound. Drinking water can affect the stiffness of your liver, so when the ultrasound measures your liver stiffness, it may be inaccurate.
What are common warning signs of a damaged liver?
Several things may indicate liver damage and disease. They include jaundice, or yellowing of the eyes; dark urine; nausea; abdominal pain; swelling in your legs, ankles, and feet; and severely itchy skin.
Why do I need a liver ultrasound?
Your doctor may order a liver ultrasound if you have symptoms of liver disease or if you have test results that show you might have liver disease. If you have liver disease, you may need a liver ultrasound so your doctor can check the condition of your liver.
How long does a liver ultrasound take?
A liver ultrasound usually takes about 30 minutes, but it may take longer than that.
Why do you have to fast for a liver ultrasound?
Your health care provider may ask you to fast before a liver ultrasound because food and gas can get in the way of the ultrasound waves.
