Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT.

Abstract

To determine the computed tomographic (CT) characteristics of confluent fibrosis complicating liver cirrhosis, CT scans of 420 cirrhotic patients without hepatic malignancy who underwent hepatic transplantation were correlated with freshly resected whole liver specimens. In 59 patients, CT demonstrated 70 focal abnormalities corresponding to confluent fibrosis. The lesions were characterized by shape and location: 49 wedge-shaped lesions radiated from the porta hepatis, eight peripheral bandlike lesions were remote from the porta hepatis, and 13 lesions were seen as total lobar or segmental fibrosis. Associated volume loss was seen in 62 of the 70 lesions as retraction of the overlying hepatic capsule or total shrinkage of the segmental or lobar involvement. At plain CT, all 70 lesions were areas of lower attenuation than adjacent liver. At contrast material-enhanced CT, 51 of 64 lesions were iso-attenuating or minimally hypo-attenuating. The authors conclude that confluent fibrosis has a characteristic appearance at CT. Recognition of its characteristics may help radiologists differentiate confluent fibrosis from hepatic neoplasms in cirrhotic patients.

Confluent hepatic fibrosis in liver cirrhosis: possible relation with middle hepatic venous drainage

“…The prevalence of confluent fibrosis in our study (3.4%, 30 of 879 patients) is lower than that in Ohtomo's study [4], thought to be due to the difference in the stage of the cirrhosis. Two-thirds of the patients were classified as Child-Pugh class A in our study, and this study population consisted largely of less advanced cirrhosis as compared with the patients with relatively advanced cirrhosis who underwent liver transplantation in Ohtomo's study.…”

“…The developmental mechanism of confluent fibrosis has been speculated to be related to impaired portal microcirculation [4,22]. It is based on the fact that decreased or absent portal blood supply was detected on CT during arterial portography [23], and that the reduction of portal flow resulted in loss of the volume of hepatocytes with increased fibrosis and segmental atrophy of the liver [24].…”

“…The presence of confluent fibrosis was evaluated based on the original report of Ohtomo et al [4]. The imaging findings are as follows: the shape is wedge-shaped, peripheral and band-shaped lesions remote from the central portion of the liver, or segmental involvement.…”

“…It is demonstrated as broad fibrotic scars, and the imaging findings have been summarized as a focal, often wedge-shaped mass, with either overlying capsule retraction or focal flattening of the capsule, most often involving the anterior and medial segment, and less frequently the posterior segment [4,5]. Ohtomo et al [4] speculated that the mechanism of this change might be related to impaired portal microcirculation, although the intrahepatic portal venous system was grossly patent.…”

“…Ohtomo et al [4] speculated that the mechanism of this change might be related to impaired portal microcirculation, although the intrahepatic portal venous system was grossly patent. After the original reports, several cases showing similar locations of confluent fibrosis were described [6][7][8][9][10].…”