Abdominal ultrasound is the suggested first imaging examination for evaluation of liver and spleen size, anatomy, and parenchymal character as well as flow to the portal vein, hepatic veins, hepatic artery, and the splenic vein. CT is not typically required, but may be recommended by the radiologist to complete the evaluation of an abnormality seen by US or NM imaging. Serial liver function testing is a good manner in which to evaluate and follow hepatic metabolic function. Imaging may not be necessary. If specific hepatic metabolic information via imaging technology is required, the preferred examination is the NM liver-spleen scan. CT guided biopsy of the liver may be reserved for cases in which a tissue diagnosis is required to guide subsequent therapy.