Confluent hepatic fibrosis in cirrhosis: ferumoxides-enhanced MR imaging findings

Abstract

We describe ferumoxides-enhanced magnetic resonance imaging findings in a 60-year-old man with confluent hepatic fibrosis in advanced cirrhosis. The extension and internal structure of confluent fibrosis were well demonstrated with ferumoxides-enhanced proton-density spin-echo magnetic resonance images, showing a wedge-shaped area of high signal intensity corresponding to the extension of fibrosis and internal focal areas of low signal intensity, presumably corresponding to residual functioning liver parenchyma. This case suggests a potential utility of ferumoxides-enhanced magnetic resonance imaging for characterizing this tumor-mimicking disorder.

Small hypervascular hepatocellular carcinomas: value of “washout” on gadolinium-enhanced dynamic MR imaging compared to superparamagnetic iron oxide-enhanced imaging

“…Meanwhile, superparamagnetic iron oxide (SPIO)-enhanced MR imaging has been accepted as one of the most sensitive techniques for imaging focal liver lesions [5,6]. In the cirrhotic liver, the value of SPIO could be limited by the structural or functional alterations related to the cirrhosis itself in addition to the difficulty of differentiating HCC which could take up SPIO in the same way as regenerative or dysplastic nodules [7][8][9][10]. Because of its specificity for distinguishing hypervascular pseudolesions that preserve Kupffer cell function, however, SPIO-enhanced MRI also has value for characterising overt HCCs in the cirrhotic liver [11].…”

Double-contrast MRI (DC-MRI) in the study of the cirrhotic liver: utility of administering Gd-DTPA as a complement to examinations in which SPIO liver uptake and distribution alterations (SPIO-LUDA) are present and in the identification and characterisation of focal lesions

“…La fibrosi epatica assume un aspetto confluente nel 14% dei pazienti con cirrosi avanzata, con problemi di diagnosi differenziale con la cancro-cirrosi [28,39].…”

“…Le riserve sull'uso dei MdC SPIO nella cirrosi epatica si basano sulla possibilità che in tale patologia il notevole sovvertimento della struttura e delle funzioni epatiche, le alterazioni vascolari intraepatiche, la presenza di processi flogistici e la steatosi possano alterare il meccanismo d'azione dei MdC SPIO, riducendone l'efficacia e che gli HCC ben differenziati possano captare i MdC SPIO come i noduli di rigenerazione (NR) e i noduli displasici (ND) rendendone difficile l'identificazione e la caratterizzazione [23][24][25][26][27][28][29]. Le cur in cirrhosis and other liver conditions have been grouped together and termed SPIO-LUDA (liver uptake and distribution alterations) [30].…”

“…Reservations regarding the use of SPIO agents in liver cirrhosis are based on the possibility that the significant subversion of liver structure and function, intrahepatic vascular alterations, presence of inflammatory processes, and steatosis can alter the action of ferumoxides and reduce their effectiveness and that well-differentiated HCC can take up SPIO in the same way as regenerative nodules (RN) and dysplastic nodules (DN), thus making their differentiation difficult [23][24][25][26][27][28][29]. The alterations in liver uptake and distribution of SPIO that can ocresezione epatica per HCC.…”

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

“…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].…”