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Hepatic Transplantation

KEY FACTS Terminology Orthotopic liver transplantation (OLT) Imaging Allograft rejection No reliable imaging findings to suggest or confirm diagnosis Biliary leak From entry of T-tube: Easily treated From biliary anastomosis: Requires revision From intrahepatic ducts: Biliary necrosis; catastrophic Biliary obstruction Responds to balloon dilation & stenting Hepatic artery (HA) stenosis US: Damped waveform in HA distal to stenosis: Slow systolic upstroke; decreased resistive index (RI) (<…

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

KEY FACTS Terminology Shunt between main portal vein and hepatic vein created with balloon-expandable metallic stent Imaging US is primary imaging tool following transjugular intrahepatic portocaval shunt (TIPS) Goal of US: Detect stenosis before shunt occludes or symptoms recur Echogenic stent is easily seen on US but does not block sound transmission Color Doppler shows patency and flow direction within TIPS, portal vein, hepatic veins, and…

Budd-Chiari Syndrome

KEY FACTS Terminology Hepatic injury due to global or segmental hepatic venous outflow or inferior vena cava (IVC) obstruction Imaging Multiphasic CT or MR [± gadoxetate (Eovist) enhancement] Characteristic findings: Nodular regenerative hyperplasia in dysmorphic liver with venous collateral and ascites Hypertrophied caudate lobe with atrophy and necrosis of peripheral liver ("pseudotumor") Intrahepatic and systemic venous collaterals bypass obstructed hepatic veins and IVC – Spider web…

Portal Vein Occlusion

KEY FACTS Terminology Acute, chronic, or neoplastic occlusion of portal vein (PV) due to thrombosis, thrombophlebitis, or tumor invasion Chronic PV occlusion with numerous periportal collaterals is referred to as "cavernous transformation" Imaging Color Doppler US initially : Accurate and cost effective Periportal collaterals may be mistaken for patent PV Tumor vessels may be evident within PV mass Multiphasic, multiplanar enhanced CT or MR Contrast-enhanced CT…

Regenerative and Dysplastic Nodules

KEY FACTS Terminology Localized proliferation of liver parenchyma within cirrhotic liver in response to liver injury May progress to become dysplastic or even malignant [hepatocellular carcinoma (HCC)] Imaging Multiphasic gadoxetate (Eovist, Primovist)-enhanced MR, plus diffusion-weighted imaging is optimal imaging tool Regenerative: Innumerable nodules in cirrhotic liver with decreased signal intensity on T2WI or GRE – Hypovascular without washout or capsule – Typically < 2 cm; retain…

Nodular Regenerative Hyperplasia

KEY FACTS Terminology Diffuse micro- or macronodular transformation of hepatic parenchyma without fibrous septa between nodules Larger focal lesions are called multiacinar (large) regenerative nodules (LRNs) Benign lesions: No potential for malignant transformation Imaging Gadoxetate (Eovist)-enhanced, multiphasic MR is best imaging test for diagnosing large regenerative nodules Diffuse nodular regenerative hyperplasia (NRH) and focal LRNs have different etiologies and imaging features Diffuse NRH Associated with other…

Cirrhosis

KEY FACTS Terminology Chronic liver disease characterized by diffuse parenchymal injury, extensive fibrosis, and conversion of liver architecture into structurally abnormal nodules Imaging US, CT, and MR all play important role in detection of cirrhosis and surveillance for development of hepatocellular carcinoma (HCC) Nodular contour, widened fissures, and enlarged caudate lobe with ascites, splenomegaly, and varices Caudate: Right lobe ratio often > 1.0 in cirrhosis Classification…

Steatosis and Steatohepatitis

KEY FACTS Terminology Steatosis is metabolic complication of variety of toxic, ischemic, and infectious insults to liver Characterized by accumulation of increasing amounts of triglycerides within hepatocytes You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Autoimmune Hepatitis

KEY FACTS Terminology Chronic hepatitis of unknown etiology characterized by hyperglobulinemia, circulating autoantibodies, & inflammatory changes on hepatic histology You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here