MDCT Imaging Findings of Liver Cirrhosis: Spectrum of Hepatic and Extrahepatic Abdominal Complications

Abstract

Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury. It is well known that cirrhosis is the origin of multiple extrahepatic abdominal complications and a markedly increased risk of hepatocellular carcinoma (HCC). This tumor is the sixth most common malignancy worldwide and the third most common cause of cancer related death. With the rising incidence of HCC worldwide, awareness of the evolution of cirrhotic nodules into malignancy is critical for an early detection and treatment. Adequate imaging protocol selection with dynamic multiphase Multidetector Computed Tomography (MDCT) and reformatted images is crucial to differentiate and categorize the hepatic nodular dysplasia. Knowledge of the typical and less common extrahepatic abdominal manifestations is essential for accurately assessing patients with known or suspected hepatic disease. The objective of this paper is to illustrate the imaging spectrum of intra- and extrahepatic abdominal manifestations of hepatic cirrhosis seen on MDCT.

Large Silent Gastric Fundal Varices in Cirrhotic Patients: Role of Abdominal Multidetector Triphasic Computed Tomography.

“…Portal vein thrombosis was confirmed by the presence of noncontrast uptake areas in the portal vein on the portal venous phase of triphasic contrast computed tomography of the abdomen [13]. When the portal vein is occupied by malignant tumor thrombus, intraluminal enhancement may be seen [2].…”

“…It is known that cirrhosis is associated with a markedly increased risk of hepatocellular carcinoma (HCC), the sixth most common malignancy worldwide and one of the most common cause of cancer related death [1,2].…”

“…The retrogastric varices are seen in the posteromedia aspect of the gastric fundus near to the cardia. They are fed by the left gastric or the gastroepiploic vein and drain into the left renal vein through the gastrorenal shunt, whereas perisplenic varices drain directly into the left renal vein via the splenorenal shunt [2].…”

“…The administration of intravenous contrast is vital to delineate dilated venous structures [2]. Spiral imaging has dramatically improved CT in the evaluation of focal hepatic lesions less than 3 cm.…”

Image quality comparison between single energy and dual energy CT protocols for hepatic imaging

“…[5][6][7][8][9] For liver imaging, this technical advance yielded better lesion conspicuity, improved the z direction resolution, and allowed the capture of multiple phases of hepatic enhancement after a single contrast injection. 7,[10][11][12][13] Conventional hepatic CT exams are conducted at a single kVp (single energy, SE, though kVp may be selected based on patient size), with and without iodine contrast enhancement. 14,15 As first shown by Alvarez and Macovski, 16 data sets at low and high energies (dual energy, DE) can be combined using various processing methods to provide more information than SE CT.…”