konfluierende hepatische Fibrose

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.

  • wedge-shaped regions of hypoattenuation on non-contrast CT
  • hypoattenuating on the arterial and portal venous phases
  • the fibrosis may gradually enhance
  • 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.

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