Liver Ultrasound Discrepancies: Your Questions Answered

Questions about liver ultrasound?

Hello Doctor: I have been diagnosed with hepatitis B and have been monitoring my liver function for about four years, with liver enzyme levels consistently below 80.
In March of this year, I self-paid for Hepcludex treatment, and by May, my viral load and liver enzymes were checked (94, 16.1).
In August, my follow-up tests showed (70, 16), and an ultrasound revealed a 2.5 cm shadow.
The doctors at Kaohsiung Veterans General Hospital arranged for a CT scan, which reported no findings.
However, when I went to another hospital for an ultrasound, the shadow was still visible.
The doctor then ordered an MRI, which also reported no findings.
By the end of November, during a follow-up at Kaohsiung, the ultrasound still showed the shadow.
The doctor only mentioned waiting for the next formal ultrasound report.
I have a few questions: 1.
Why can the ultrasound detect the shadow while the MRI and CT cannot? Is this a diagnostic error? 2.
Before starting the medication, my liver enzymes were consistently below 80, and my alpha-fetoprotein levels were around 8-13.
Why did my liver enzymes increase after starting the medication, even though my viral load significantly decreased? 3.
Should I seek a second opinion at another hospital, considering both the CT and MRI were performed at Kaohsiung? 4.
Do you have any other recommendations regarding these concerns? I am really worried.

Danxin, 40~49 year old female. Ask Date: 2017/12/10

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
It is advisable to discuss the details of your condition with your attending physician.
Further examinations may not be necessary, but follow-up is required.
If you still have concerns, a liver biopsy may be considered.
Changhua Hospital cares about your health.
Sincerely, Chen Shidian.

Reply Date: 2017/12/10

More Info

Understanding discrepancies in liver ultrasound findings, especially in the context of chronic hepatitis B, can be quite complex. Let's break down your concerns and provide clarity on each point.

1. Why can ultrasound detect something that MRI and CT cannot?
Ultrasound, CT, and MRI are different imaging modalities, each with its strengths and limitations. Ultrasound is particularly good at detecting fluid-filled structures and can sometimes pick up subtle changes in liver tissue that may not be as visible on CT or MRI. Factors such as the operator's experience, the patient's body habitus, and the presence of bowel gas can affect ultrasound results. Additionally, certain lesions may be transient or may change over time, which could explain why a lesion is seen on one ultrasound but not on subsequent imaging studies. It's also possible that the lesion is small or in a location that is difficult to visualize with CT or MRI, especially if there is overlying bowel gas or if the lesion is not well-defined.

2. Why did liver function tests change after starting medication?
The increase in liver enzymes (ALT and AST) after starting treatment could be due to several factors. One possibility is that the medication is causing a transient increase in liver enzyme levels as the liver responds to the treatment. This is not uncommon, especially with antiviral therapies. The decrease in viral load is a positive sign, indicating that the treatment is effective. However, the rise in liver enzymes suggests that the liver may be experiencing some stress or inflammation, which can occur as the virus is being cleared. It's essential to monitor these levels closely and discuss them with your healthcare provider.

3. Should you seek a second opinion at another hospital?
If you continue to have concerns about the discrepancies in imaging results and your health status, seeking a second opinion can be beneficial. Different hospitals may have varying levels of expertise and technology, which can influence the interpretation of imaging studies. Additionally, a fresh set of eyes may provide new insights or recommendations for further evaluation.

4. Other recommendations:
Given your history of chronic hepatitis B and the recent findings, it is crucial to maintain regular follow-ups with your healthcare provider. They may recommend additional imaging studies, such as a follow-up ultrasound or even a biopsy if there is a persistent concern about a lesion. It's also important to keep track of your liver function tests and any symptoms you may experience. If you have any new symptoms, such as abdominal pain, jaundice, or changes in your overall health, you should report these to your doctor immediately.

In conclusion, while discrepancies in imaging results can be concerning, they are not uncommon in the context of liver disease. Continuous monitoring, open communication with your healthcare provider, and possibly seeking a second opinion can help ensure that you receive the best possible care. Your health is paramount, and addressing these concerns proactively will aid in managing your condition effectively.

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