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BACKGROUND: Multiple Ultrasound tests & CT scans (with contrast) looking

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Posted on Mon, 18 Feb 2019
Question: BACKGROUND: Multiple Ultrasound tests & CT scans (with contrast) looking for NAFLD/Non-Alcoholic Fatty Liver Disease, NASH/Non-Alcoholic Steatohepatitis, Liver Fibrosis & Cirrhosis. (2013) Abd. CT with IV contrast report: "... Liver within normal limits." (2014) Abd. Ultrasound report: "liver is prominent in size... demonstrates increased echogenicity likely reflecting fatty infiltration. No focal liver lesion is seen." (2017) Abd. CT with IV contrast: "hepatomegaly measuring 26 cm in length with diffuse steatosis." (2019) Abd. Ultrasound "... liver is enlarged in size measuring 18.8 cm in length. There is diffuse increased echogenicity to liver parenchyma likely reflecting fatty infiltration. No focal hepatic lesion is noted." QUESTION: What could explain the 2- 1/2 inch "shrinkage" in liver size from 26 cm. on CT back in 2017 to current liver size 18.8 cm. on recent (2019) Ultrasound (other than possible fibrosis or cirrhosis)? By how much margin of error could either the CT scans & Ultrasounds be inaccurate from the actual liver size? Shouldn't both tests reflect roughly the same sizes (if there is no fibrosis/cirrhosis)?
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Follow up: Dr. Vivek Chail (55 minutes later)
Sorry, forgot to add the following info: 2014 Ultrasound report: "...common bile duct measures 5mm." Current (2019) Ultrasound report: "...common bile duct measures 3mm." Does this difference or "shrinkage" in the bile duct size point more likely toward an actual shrinkage of the liver, rather than a discrepancy in size measurement of the liver between the old CT scan and the current Ultrasound?
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Answered by Dr. Vivek Chail (19 hours later)
Brief Answer:
Please request review of ultrasound measurement after viewing 2017 CT image

Detailed Answer:
Hi,
Thanks for writing in to us.

There is a lot of subjective differences in the measurement of the liver and the variations are more in ultrasound scan measurements.

A margin of 5 percent error can be expected between the ultrasound and CT measurements and rarely the error can go up to 10 percent.

It is difficult to comment the shrinkage of the liver from 26 cm to 18 cm from 2017 till now (a change of 30 percent) unless you have taken any significant measures to control food intake and glucose deposition in the liver.

Probably you may request the doctor who has reported your recent ultrasound to look at your 2017 CT images and review the measurements.

Regards,
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

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BACKGROUND: Multiple Ultrasound tests & CT scans (with contrast) looking

Sorry, forgot to add the following info: 2014 Ultrasound report: "...common bile duct measures 5mm." Current (2019) Ultrasound report: "...common bile duct measures 3mm." Does this difference or "shrinkage" in the bile duct size point more likely toward an actual shrinkage of the liver, rather than a discrepancy in size measurement of the liver between the old CT scan and the current Ultrasound?