Which structures are isoechoic or less echogenic than the liver?

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Echogenicity relative to the liver is a key reference when evaluating abdominal organs on ultrasound. The liver parenchyma provides a standard brightness, and structures that are isoechoic or less echogenic than the liver appear the same brightness or darker.

The kidneys, specifically the renal cortex, are typically not brighter than the liver, so they are seen as iso- or hypoechoic relative to liver. The spleen, in many individuals, has a brightness level that is similar to or slightly less than the liver, making it isoechoic or less echogenic as well. In contrast, the pancreas tends to be a bit more echogenic than the liver, so it is usually brighter.

Thus, the kidneys and spleen are the structures that are isoechoic or less echogenic than the liver.