Chapter I./3.: Radiological aspects of hepatic cirrhosis, multiple hepatocellular carcinoma, umbilical metastasis

Kinga Karlinger

I./3.1.: Introduction

Primary imaging method of the liver is US. Yet, even the two lesions (hepatic cirrhosis and hepatocellular carcinoma), which are shown on the preparations, do not belong to the lesions which can be easily diagnosed by US. Regarding the etiopathogenesis of hepatic cirrhosis we only refer to the leading causes here: toxic-alcoholic, viral hepatitis B, C, D, autoimmune hepatitis, primary and secondary biliary cirrhosis, metabolic (Wilson’s disease, hemochromatosis, congestion). We recline mainly upon indirect signs on the course of imaging methods. Following signs can be observed by any kind of imaging modalities: liver volume increases in early stage, whilst liver shrinkage develops in late stage only. Important to note that the process affects the right lobe preferably, and volume of caudate lobe and left lobe increases. Contours of the left lobe become rounded conspicuously.

Further on, irregularity and lobulation can be observed on liver contour (according to smaller or larger nodules) in addition to finger-like retractions. Liver structure also changes, vessels become cambered, their branchings are shifted away, caliber of hepatic veins is narrower and irregular, portal veins can be also „amputated” (suddenly terminates even in case of a larger vein), portal vein itself broadens (intra- and extrahepatically as well). Tortuous-cavernous veins can be observed in the hepatic hilum. Umbilical vein can be recanalized (Cruveilhier-Baumgarten syndrome). Ascites develops later on, splenomegaly is seen and tortous, dilated portosystemic collaterals become conspicuous (splenic hilum, esophagus, included in the examination areas: splenic hilum, veins of oesophagus and periumblilical veins). The wall of the gallbladder might be thickened.

The chapter structure

• I./3.1.: Introduction

• I./3.2.: Ultrasound – US

• I./3.3.: Magnetic resonance imaging – MRI

• I./3.4.: Hepatocellular carcinoma – HCC

  • I./3.4.1.: General remarks

  • I./3.4.2.: Ultrasound – US

  • I./3.4.3.: Computed tomography, CT

  • I./3.4.4.: Magnetic resonance (imaging), MR(I)

• I./3.5.: Transient Hepatic Attenuation Differences (CT) – THAD; Transient Hepatic Intensity Differencies (MRI) – THID

  • I./3.5.1.: THAD/THID-phenomenon, morphologic causes

  • I./3.5.2.: Appearence of THAD/THID phenomenon in each phases of dynamic imaging

  • I./3.5.3.: Physiological causes of THAD/THID phenomenon

  • I./3.5.4.: Decrease of portal venous flow

  • I./3.5.5.: Arterio-portal (AV) shunt

  • I./3.5.6.: Increase of hepatic arterial flow

  • I./3.5.7.: Decrease of hepatic arterial flow

  • I./3.5.8.: Decrease in hepatic venous flow

  • I./3.5.9.: Other causes

  • I./3.5.10.: Conclusions

• I./3.6.: Other imaging methods

• I./3.7.: Take home messages

References