Best test for the Liver---Blood, MRI, or Ultrasound? - Liver & Pancreas Disorders Message Board

Phlox · 11-16-2006, 01:16 AM

I was wondering if someone out there who has had all of these done, can tell me which is the most accurate? I think a Biopsy is probably the most accurate overall, but after that, which of the other tests would be the best to go by, or give definite results? Awhile back a doctor told me that it is "not common, but possible" for a persons bloodwork to look fine for the Liver, but are actually having Liver issues.

I would assume the best is the MRI, since I was also told recently by a blood doctor that UltraSounds are sort of like the "general, but not specific" type of tests to start with. If that is true with blood vessels, I would assume it would be true with the Liver...and that an MRI could reveal in more detail the shape of a persons Liver?

Thank you for any experiences & insights you may have!!

feelbad · 11-16-2006, 06:08 AM

Hi phlox,i do believe we have chatted before.what your doc stated was partially right about the bloodwork?only it is VERY common to have totally normal bloodwork and still have some major destruction going on in the liver and the kidneys.my kidneys look like crap upon ultrasound and are actually three times the normal size but amazingly(knock on wood here) all of my labs done on them are still way well within the normal ranges.strange but true.you will only see actual changes in the bloodwork when the actual destruction within any given organ reaches that 'magic' or detectable level.sometimes the destruction can be pretty severe before you will actually see any real changes in the numbers.this is why i personally would always reccomend to anyone who suspects there may be some sort of a problem with the kidneys and the liver to ALWAYS do the bloodwork AND also get an ultrasound along with it.this would really give you the best overall picture of whats going on.there are things they can do with ultrasound that cannot be done by MRI or biopsy and that is check the bloodflow within any given artery by using doppler.this will tell alot about how well bloodflow is and the actual velocity too.

this really would be the best way to start here really.i get an ultrasound on my kidneys and liver and bladder every year and bloodwork done about every six months.i have affectation of my liver along with the polycystic kidney disease i have.

i would NOT get a biopsy unless you really have to,at least not to begin with.there really are some risks involved with it that you really don't have to put yourself thru in order to find out just how well your liver is functioning.the biopsy would be something to consider a bit further down the road should anything actually show up on the other tests.why do that part of the testing if there really is no need right now ya know?

i wish you lots of luck here Phlox and hope things are okay for you.let me know how you do with all this.Marcia

danielm · 11-16-2006, 03:14 PM

Feelbad is pretty bang on the mark there.

I was diagnosed with fatty infiltration of the liver (NASH) about 5 months ago and the stages I went through after the blood tests were and ultrasound first and then a CT scan on the abdo region.

I didn't get a biopsy done at all, simply because it's a fairly invasive procedure and they don't like to go to that level unless they really need to confirm some previous finding. For me, it simply wasn't necessary - the blood tests show raised enzyme levels, the Ultrasound and CT confirmed inflamation of my liver and fatty deposits and that's all they needed.

With a change of diet, regular exercise and some natural vitamin supplements I was able to get my liver levels back to within normal ranges since then to now.

Not everyone with a liver disease needs to get a biopsy done. It certainly is quite definitive in producing a diagnosis, but it's usually down the order in terms of tests.

That all said - and getting back to your original question - I was told that the MRI/CT is usually more definitive than the Ultrasound because the MRI/CT gives a far clearer picture, providing a cross section view of the organ an Ultrasound cannot provide. But that was my experience - and I live in Australia, not the US.

I hope the info helps. Best of luck!

Elev8edLFTs · 11-16-2006, 04:59 PM

Hello

I have had a few of these tests done, I've had blood work up the ying yang, my alt, ast and alk phos are all extremely high, the ultra sound, biopsy and an MRI tomorrow...really it's up to your doctor and with all of my tests nothing has come back difinitive so it also depends on what is going on with your liver er kidneys. Biopsy honestly not so bad, big needle in the middle of my tummy not too scary, not fun but they do so many now that it really isn't that big of a deal, I was in and out in 4 hours, the actual procedure took 30 minutes, they just keep you forever to make sure your okay. There are a lot of risks but there are also a lot of risks walking down the street, in my opinion it was worth the risks to hopefully get an answer. Although I do agree that if you can wait for the biopsy, do. My doctor had said I wouldn't need one in the beginning but actually wanted to do it before the MRI so he had both in hand. The ultra sound was a problem for me, it actually wasn't very clear at all and was more a waste of time than anything, the MRI is supposed to be better but we'll see...don't know if that helped at all but good luck to you

Phlox · 11-17-2006, 01:53 AM

Thank you all so much for your helpful replies and kind words!! Marcia--youre right we have talked before, I recognized your name immediately & its great to see you again!! How have you been? Your son? I hope all is well! Daniel--I had heard the same as you, that MRI is very accurate, but I wasnt sure if it was the same for seeing if or what problems there are with a Liver. Elev8ted---please let us know how your MRI went, and if the results were any clearer for you---I really hope it comes through for you and helps!

About the tests and why I wondered, well, I had heard of the risks with Biopsy, so I was hoping I wouldnt have to do that unless necessary. I have been struggling lately to find out what is wrong with me, since I have been having some symptoms I cant explain. I have been getting very tired lately which seems like it just sneaks up on me, and usually around the same time I almost always get this strange rash--or some kind of "mottled, splotchy" marks--on the underside of my arms, near the bicep, elbow, and underside of my forearms. Also the veins in those areas seem to kind of darken and become visible, whereas they usually are not dark or even visible in some of them. When these episodes happen, its almost as if I feel like I have a sudden flu, where you feel exhausted and your eyes feel heavy, even twitching. About the same time, I can see the rash/marks under my arms, and it is freaking me out because I cant find out the reason why.

I have had some high Liver enzymes in the past, and was told I had a fatty liver, but my last few blood labs were normal and I stopped taking milk thistle. In trying to find out what else it could be, I thought I recently found out the answer: I found out last week that I have another Blood Clot in my left SC vein, exactly the same spot as before, only this time it is not completely blocking the vein. My Primary Dr. told me that this could be the reason for these symptoms, and I felt relieved at least knowing what it was. However when I went to the Vascular surgeon, he told me that the rash/purpleish marks wouldnt be on both arms from a blood clot only the arm with the clot, and that my sudden exhaustion shouldnt be from a blood clot, either.

If that is true, I feel like I am back at square one and thought maybe the other possibility is that it could be the Liver, despite the normal bloodwork...? The only other remote possibility I can come up with, is that I had recently had my teeth cleaned, and the dentist told me I had some bacteria under my gums. Since this can be released into your bloodstream during a teeth cleaning, I thought perhaps it could be affecting the spot where the blood clot is, or my liver if there were something wrong with it. Of course thats just guessing, but thats all I can do at this point until I find out why I have been having these symptoms.

So I think I will ask my Primary the next time I go, if I can get an MRI & an Ultrasound of my Liver/Kidneys, to try and eliminate them as a possibility. Im not sure what else to think, or what else it could be, which is why I wondered which Liver test would be the most accurate. Ive only had the bloodwork, so Im hoping to get a better test, soon. Sorry this turned out so long, I guess I am getting tired and didnt notice, hehe.