EURORAD ESR

Case 13659

Focal confluent fibrosis in HCV-related liver cirrhosis

Author(s)
Tonolini Massimo, M.D.; Adriana Vella, M.D.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 55 year(s)
 
 
  • Figure 1
    Unenhanced and dynamic contrast-enhanced multidetector CT
     

    Unenhanced scans showed characteristic liver morphology and contours consistent with known liver cirrhosis (a), focal capsular retraction with smooth contour in the 6th segment (arrowhead in b), no significant...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Unenhanced scans showed characteristic liver morphology and contours consistent with known liver cirrhosis (a), focal capsular retraction with smooth contour in the 6th segment (arrowhead in b), no significant...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (c) and coronal (d) arterial-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with associated linear enhancement (thin arrows) in the adjacent parenchyma.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (c) and coronal (d) arterial-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with associated linear enhancement (thin arrows) in the adjacent parenchyma.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Coronal maximum-intensity projection (MIP) reconstructed image showed non-displaced and non-interrupted arterial vessels (arrow) reaching the lateral aspect of right liver lobe involved by capsular retraction.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (f) and coronal (g) portal venous-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with persistently identifiable linear enhancement (thin arrows) in the...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (f) and coronal (g) portal venous-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with persistently identifiable linear enhancement (thin arrows) in the...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (h) and coronal (i) delayed-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with appearance of wedge-shaped enhancing region (*) involving the adjacent parenchyma.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (h) and coronal (i) delayed-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with appearance of wedge-shaped enhancing region (*) involving the adjacent parenchyma.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;
     
     
  • Figure 2
    Liver MRI 5 months later - unenhanced images
     

    Axial fat-suppressed T1-weighted image showed minimally increased capsular retraction (arrowhead) at lateral aspect of right liver lobe, with wedge-shaped hypointense region (arrow) compared to the liver parenchyma...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (b) and coronal (c) T2-weighted images showed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (b) and coronal (c) T2-weighted images showed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial fat-suppressed T2-weighted images confirmed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial fat-suppressed T2-weighted images confirmed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma, apparently pointing...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    The wedge-shaped region (arrows) did not show abnormal restricted diffusion on high (800) b-value diffusion-weighted image (f), with some shine-through effect on corresponding apparent diffusion coefficient (ADC) map...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    The wedge-shaped region (arrows) did not show abnormal restricted diffusion on high (800) b-value diffusion-weighted image (f), with some shine-through effect on corresponding apparent diffusion coefficient (ADC) map...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;
     
     
  • Figure 3
    Liver MRI 5 months later - Dynamic contrast-enhanced study
     

    Arterial-phase acquisition after bolus Gadobutrol (0.1ml/kg) injection confirmed previous CT finding of elongated early enhancement (thin arrow) located centrally within the wedge-shaped abnormality of the right liver...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    The same elongated enhancement (thin arrow) persisted in the portal venous phase, located centrally within the wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Axial (c) and coronal (d,e) delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;

    Delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead) and apex pointing towards the...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cirrhosis;
     
     
Unenhanced scans showed characteristic liver morphology and contours consistent with known liver cirrhosis (a), focal capsular retraction with smooth contour in the 6th segment (arrowhead in b), no significant attenuation changes suggesting focal lesions.
 
Unenhanced scans showed characteristic liver morphology and contours consistent with known liver cirrhosis (a), focal capsular retraction with smooth contour in the 6th segment (arrowhead in b), no significant attenuation changes suggesting focal lesions.
 
Axial (c) and coronal (d) arterial-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with associated linear enhancement (thin arrows) in the adjacent parenchyma.
 
Axial (c) and coronal (d) arterial-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with associated linear enhancement (thin arrows) in the adjacent parenchyma.
 
Coronal maximum-intensity projection (MIP) reconstructed image showed non-displaced and non-interrupted arterial vessels (arrow) reaching the lateral aspect of right liver lobe involved by capsular retraction.
 
Axial (f) and coronal (g) portal venous-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with persistently identifiable linear enhancement (thin arrows) in the adjacent parenchyma.
 
Axial (f) and coronal (g) portal venous-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with persistently identifiable linear enhancement (thin arrows) in the adjacent parenchyma.
 
Axial (h) and coronal (i) delayed-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with appearance of wedge-shaped enhancing region (*) involving the adjacent parenchyma.
 
Axial (h) and coronal (i) delayed-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with appearance of wedge-shaped enhancing region (*) involving the adjacent parenchyma.
 
Axial fat-suppressed T1-weighted image showed minimally increased capsular retraction (arrowhead) at lateral aspect of right liver lobe, with wedge-shaped hypointense region (arrow) compared to the liver parenchyma and no mass effect.
 
Axial (b) and coronal (c) T2-weighted images showed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.
 
Axial (b) and coronal (c) T2-weighted images showed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.
 
Axial fat-suppressed T2-weighted images confirmed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.
 
Axial fat-suppressed T2-weighted images confirmed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma, apparently pointing towards the hepatic hilum.
 
The wedge-shaped region (arrows) did not show abnormal restricted diffusion on high (800) b-value diffusion-weighted image (f), with some shine-through effect on corresponding apparent diffusion coefficient (ADC) map image (g).
 
The wedge-shaped region (arrows) did not show abnormal restricted diffusion on high (800) b-value diffusion-weighted image (f), with some shine-through effect on corresponding apparent diffusion coefficient (ADC) map image (g).
 
Arterial-phase acquisition after bolus Gadobutrol (0.1ml/kg) injection confirmed previous CT finding of elongated early enhancement (thin arrow) located centrally within the wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead).
 
The same elongated enhancement (thin arrow) persisted in the portal venous phase, located centrally within the wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead).
 
Axial (c) and coronal (d,e) delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule.
 
Delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead).
 
Delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead) and apex pointing towards the hepatic hilum.
 
 
 
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