SEGMENTAL ANATOMY OF LIVER PICTORIAL, ON ULTRASOUND AND ON COMPUTED TOMOGRAPHY IMAGING FEATURES OF LIVER CIRRHOSIS ON ULTRASOUND , CT AND MRI

1. SEGMENTAL ANATOMY OF LIVER
AND
IMAGING IN LIVER CIRRHOSIS

9. Liver segments in ultrasound, based on Couinaud classification (II, IV, VIII, VI):
right hepatic vein
intermediate hepatic vein
left hepatic vein
inferior vena cava

10. Liver segments in ultrasound-based on Couinaud classification:
ligamentum teres
main lobar fissure
branch of portal vein

23. IMAGING IN LIVER CIRRHOSIS
MODALITIES :
ULTRASOUND
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMGING
ELASTOGHRAPHY

24. ULRASOUND IN LIVER CIRRHOSIS

47. COMPUTED TOMOGRAPHY IN LIVER CIRRHOSIS
CT is insensitive in early cirrhosis
surface and parenchymal nodularity
regenerative nodules (majority):
isodense/hyperdense to the rest of liver
siderotic nodules (minority): hyperdense due to
accumulation of iron 6
fatty change (variable)

48. parenchymal heterogeneity both on the pre and post
IV contrast scans
predominantly portal venous supply to dysplastic
nodules
in advanced cirrhosis, nodular margin and lobar
hypertrophy/atrophy may be demonstrated (see
above)
signs of portal hypertension
portal vein enlargement
portal venous thrombosis +/- cavernous
transformation
splenomegaly
portosystemic collaterals
upper abdominal lymphadenopathy in end-stage

49. Selected images from a CT demonstrate very
advanced cirrhosis with a small nodular liver with hypertrophy
of the caudate lobe and extensive ascites.

50. Massive abdominopelvic ascites are seen.
The liver is atrophic and shows marginal irregularity in
keeping with cirrhosis.

51. MRI IN LIVER CIRRHOSIS
MRI is also insensitive in early cirrhosis but has a
significant role in screening cirrhotic livers for small HCCs .
MRI findings include:
morphologic changes (same as on CT and ultrasound)
regenerative nodules (or cirrhotic nodules)
T1
variable, usually isointense
occasionally mildly hyperintense
no early enhancement and washout as most supply
is from the portal vein 7,9
T2
usually isointense 9
hypointense if siderotic

52. dysplastic nodules
maybe of low or high grade, and thus have a
variable appearance
low-grade nodules will resemble
regenerative nodules
high-grade nodules will resemble HCCs 9
small hepatocellular carcinoma (HCC)
T1 C+ (Gd):arterial phase enhancement and
washout 7
late enhancing capsule
growth in the interval between studies
T2: typically mildly or
moderatelyhyperintense

53. Sono-elastography in liver cirrhosis
Sonoelastography may also be useful to
assess the amount of liver fibrosis .
Suggested values for diagnosis
>7 kPa: advanced fibrosis
12.5-15 kPa: cirrhosis