New diagnostic techniques in hepatobiliary disease

The liver and biliary tree have become increasingly accessible to the clinician through the new diagnostic techniques described in this chapter. There will undoubtedly be more developments and refinements in the years ahead. Already the new techniques of positron-emission tomography and nuclear magnetic resonance hint at a greater potential for improving our capacity to visualize hepatobiliary disease. It would be unrealistic, however, to expect any one of these techniques to become the single procedure of choice for diagnosis in all types of hepatobiliary disease. It will continue to be the clinician's task to pick the proper sequence of available tests to arrive at a diagnosis in the most rapid and efficient manner. It is unlikely that any busy surgeon can keep totally abreast of the subtleties of all new diagnostic techniques. It is clear that in many instances no single test is really the best, and choices should be made on the basis of the resources available. If the clinician is able to make an accurate assessment of the diagnostic capabilities of his or her institution and approaches each individual problem with a logical progression from first-line screening techniques to second-line invasive procedures, few mistakes will be made. The challenge is to minimize the risk, expense, and time involved in obtaining maximum information for definitive diagnosis and treatment.