GI Radiology > Liver > Diffuse > Cirrhosis

Diffuse Hepatic Disease

Cirrhosis

  1. Pathogenesis:
  • Causes of cirrhosis include: a) alcohol, b) alpha1-antitrypsin, c) postnecrotic (hepatitis), d) metabolic disease: Wilson, hemochromatosis, glycogen storage disease, e) PBC, PSC, f) congestive heart failure
     
  • The most common cause in North America is alcohol abuse.
     
  • Cirrhosis pathology consists of hepatocyte necrosis, fibrosis, and nodular regeneration.
     
  • Cirrhosis increases risk of developing hepatocellular carcinoma. The risk of malignancy is also increased with several other causes of liver failure, including hemochromatosis, Wilson's disease, aflatoxin, and chronic active hepatitis.
     
  • In cirrhotic liver, a regenerating nodule may resemble HCC.
  1. Radiographic findings:
  • Signs of advanced cirrhosis on imaging:
    • Liver surface nodularity
    • Contracted liver with ascites
    • Atrophy of the posterior segments (VI, VII) of the right lobe
    • Enlarged caudate lobe (I) and lateral segments (II, III) of the left lobe
    • Prominent umbilical vein
    • Irregular enhancement
       
  • U/S: advanced cirrhotic liver appears to be nodular, irregular, and contracted with relatively enlarged caudate lobe (C) and lateral segment (L) of the left lobe. Fatty infiltration and fibrosis give a coarse echotexture of the liver parenchyma.

  • Noncontrast CT: depending on the extent of fatty infiltration, fibrosis, and regenerating nodules, the hepatic parenchyma may have either homogeneous or heterogeneous decreased attenuation.
     
  • Contrast CT: areas of fibrosis and regeneration may become isodense to parenchyma. The surface of the liver may be very nodular in cirrhosis.

  • T1-weighted MRI: looks normal with slightly heterogeneous signal intensity as with T2 except that areas of fibrosis may be of low signal.
     
  • T2-weighted MRI: looks normal with slightly heterogeneous signal intensity as with T1 except that areas of fibrosis may be of high signal.
 

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