Confluent hepatic fibrosis
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. The sizeable, wedge-shaped lesion (*) centered in the 7th segment appeared hypointense on unenhanced T1-weighted acquisition, without bulging nor retraction of the overlying capsular contour (arrow).
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial (c) and coronal (d) arterial-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with associated linear enhancement (thin arrows) in the adjacent parenchyma.
Confluent
hepatic fibrosis • Confluent hepatic fibrosis - Ganzer Fall bei Radiopaedia
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and equilibrium (f) phases.
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. Coronal (d) and sagittal (e) portal venous phase images confirmed enhanced lesion without bulging nor retraction of the overlying capsular contour (arrows).
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and equilibrium (f) phases.
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. The dynamic vascular study with nonspecific extracellular gadolnium contrast showed the lesion (*) to be hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c) and equilibrium (d) phases.
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. T2-weighted images (a, b, c with fat suppression) showed a sizeable, moderately hyperintense lesion (*) in the 7th-8th liver segments: the lesion has a wedge-shaped configuration and does not alter the liver contour (arrow).
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. High b-value (800) diffusion.-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images did not show abnormally restricted diffusion in the sizeable liver lesion (*) centered in th 7th segment.
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. Repeated MRI four months later including T2-weighted images (a,b, c with fat suppression) showed the liver lesion (*) with unchanged size, shape and absent mass effect on liver contour (arrow) - compared to Fig.1.
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. Similarly, compared to Fig.1 unchanged appearance was seen on high b-value (800) diffusion-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images.
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. Similarly, compared to Fig.1 unchanged appearance was seen on high b-value (800) diffusion-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images.
Potentially
misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium. During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and equilibrium (f) phases.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Coronal maximum-intensity projection (MIP) reconstructed image showed non-displaced and non-interrupted arterial vessels (arrow) reaching the lateral aspect of right liver lobe involved by capsular retraction.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Unenhanced scans showed characteristic liver morphology and contours consistent with known liver cirrhosis (a), focal capsular retraction with smooth contour in the 6th segment (arrowhead in b), no significant attenuation changes suggesting focal lesions.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial (f) and coronal (g) portal venous-phase images confirmed capsular retraction (arrowheads) at the lateral aspect of right liver lobe, with persistently identifiable linear enhancement (thin arrows) in the adjacent parenchyma.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial fat-suppressed T1-weighted image showed minimally increased capsular retraction (arrowhead) at lateral aspect of right liver lobe, with wedge-shaped hypointense region (arrow) compared to the liver parenchyma and no mass effect.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial (b) and coronal (c) T2-weighted images showed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial (b) and coronal (c) T2-weighted images showed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial fat-suppressed T2-weighted images confirmed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial fat-suppressed T2-weighted images confirmed the well-demarcated region (arrows) underlying retracted capsule (arrowheads) with mildly hyperintense signal compared to the liver parenchyma, apparently pointing towards the hepatic hilum.
Focal
confluent fibrosis in HCV-related liver cirrhosis. The wedge-shaped region (arrows) did not show abnormal restricted diffusion on high (800) b-value diffusion-weighted image (f), with some shine-through effect on corresponding apparent diffusion coefficient (ADC) map image (g).
Focal
confluent fibrosis in HCV-related liver cirrhosis. Arterial-phase acquisition after bolus Gadobutrol (0.1ml/kg) injection confirmed previous CT finding of elongated early enhancement (thin arrow) located centrally within the wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead).
Focal
confluent fibrosis in HCV-related liver cirrhosis. Axial (c) and coronal (d,e) delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule.
Focal
confluent fibrosis in HCV-related liver cirrhosis. Delayed phase images clearly showed progressive homogeneous enhancement of the entire wedge-shaped abnormality of the right liver lobe, with retracted overlying capsule (arrowhead) and apex pointing towards the hepatic hilum.
MR imaging in
liver cirrhosis: classical and new approaches. Focal confluent fibrosis. STIR image shows a collapsed area with capsular-based wedge shape. The abnormality is moderately hyperintense in STIR (a) and shows progressive and delayed enhancement after contrast media administration (b, arterial; c, delayed phases)
Confluent hepatic fibrosis is a possible result of chronic injury to the liver, most commonly from cirrhosis or hepatic vascular injury.
Radiographic features
Confluent hepatic fibrosis is a cause of wedge-shaped or concave-marginated abnormalities in the cirrhotic liver: it occurs more frequently in the medial and anterior segments of the liver and tends to extend from the hilum to the periphery.
CT
- wedge-shaped regions of hypoattenuation on non-contrast CT
- hypoattenuating on the arterial and portal venous phases
- the fibrosis may gradually enhance
MRI
- wedge-shaped regions of moderate T2 hyperintensity
- T1 hypointensity (possible increased T1 signal from cholestasis)
- progressive postcontrast enhancement on the dynamic sequence but does not show enhancement on the delayed phase with hepatospecific contrast agents
- lack fat signal intensity
Confluent hepatic fibrosis is categorized as LR1 or LR2 in the LI-RADS classification system. If findings are indeterminate between fibrosis and hepatocellular carcinoma, it should be graded LR3 or LR4.
Differential diagnosis
The main differential diagnoses are:
- hepatocellular carcinoma
- enhancement pattern allows differentiation
- not associated with volume loss or capsular retraction
- cholangiocarcinoma
- peripheral cholangiocarcinoma may also show capsular retraction but generally is more masslike
- dilated intrahepatic bile ducts are also more common in cholangiocarcinoma than with confluent hepatic fibrosis
- hepatic epithelioid hemangioendothelioma
- may show capsular retraction but otherwise has a different appearance and enhancement pattern
Practical points
For unknown reasons, confluent fibrosis is more common in primary sclerosing cholangitis and alcohol-related cirrhosis than with viral cirrhosis.
Siehe auch:
Assoziationen und Differentialdiagnosen zu konfluierende hepatische Fibrose:
