Liver Imaging in Living Donor Liver Transplant & Liver Related disease By Dr. Munazza Zafar

2. 1. Hepatic Cysts
 Simple Cyst
 Complex Cyst
2. Hemangioma
3. Focal Nodular Hyperplasia
4. Adenoma
5. HCC
6. Intra hepatic Cholangio CA
7. Hepatic Metastasis
8. BCS

6.  Hydatid
 Infective
 Mucinous
 BCA
 BCAC

12. 1. Inhomogeneous hypodense (0-45HU) Single /
multiloculated cavity
2. Double Target sign ( Wall enhancement +
surrounding hypodense zone)
3. Cluster Sign ( several abnormal foci in the same
anatomic area)
4. Air density.

18. T1WT2W
Out of phase Fat Suppressed

22. Most common benign liver tumor .
2nd most common liver tumor after mets.
Sharply Demarcated lesion usually hyperechoic on USG.
On Doppler no Doppler signals / signals with peak velocity
< 50 cm/sec
On CT large lesions usually heterogeneous enhancement
Peripheral Nodular Enhancement not continuous.
- look at blood pool
- at all times (2-3 Phases).
Rapid contrast filling in small hemangiomas on CT & MRI
D/D with hyper vascular tumor (don’t remain
hyperattenuating on delayed phase)
On MRI similar enhancement pattern as CT

27. Small Hemangiomas:
Small HCC ,
hypervascular
metastases may mimic
small hemangiomas
because they all show
homogeneous
enhancement in the
arterial phase.

28. Peripheral enhancement:
Nodular or globular and
discontinuous.
 Rim enhancement is
never hemangioma.
 Rim enhancement is a
feature of malignant
lesions i.e,metastasis.

32. - Most frequent hepatic tumor in young woman of
after use of contraceptive steroid.
- Right lobe of the liver, subcapsular location 6 to
30 cm in size.
- Well circumscribed lesion with pseudo capsule.
- On CT slight arterial phase enhancement.
- Iso to hypodense on delayed phase.
- Hemorrhage an necrosis can be see.

37.  1/3rd of all malignancies of the liver & 2nd most common hepatic tumor
after HCC
 Average age 50 – 60 years
 Size of 5 – 20 cm in diameter satellite nodules in 65%
 Abdominal pain, weight loss & pain less jaundice.
 On USG dilated biliary tree, hyper, Iso or hypoechoic mass.
On CT
• Homogeneous round to oval hypodense mass with irregular borders.
• Peripheral washout sign (early minimal rim enhancement with
progressive filling & clearing of the contrast in rim of lesion on delayed
images).
• Marked delayed enhancement 74%
• Encasement of arteries & retraction of liver capsule
On MRI
• Hypointense on T1W & hyperintense periphery (viable tumor) + large
central hypointensity (fibrosis) on T2W,
• Tumor enhancement on post contrast.

42.  Syndrome of global / segment hepatic venous
outflow obstruction.
 All ages
 Causes
› Idiopathic 66%
› Five P’s.
 Paroxysmal nocturnal hemoglobulinuria.
 Platelets (thrombocytosis).
 Pill (contraseptive.
 Pregnancy.
 Polycythemia rubra vera.

43.  On USG
 Hepatosplenomegaly.
 Caudate lobe hypertrophy.
 Ascites.
 Non visualization of hepatic veins or decreased diameter.
 Portal vein diameter > 12 mm
 On CT
 Global liver enlargement + diffuse hypoattenuation
 Flip-flop enhancement pattern on CT & MRI
 Mortal liver enhancement due to hepatic congestion.
 Failure to identified hepatic veins.
 Hepatic vein thrombi in 18 – 53 %

46. Thank You