Hepatic pseudolesions and how to spot them

Congress:

ECR 2020

Poster Number:

C-06611

Type:

Educational Exhibit

Keywords:

MR, CT, Liver, Abdomen, Abdominal Viscera, Contrast agent-intravenous, Diagnostic procedure, Education, Education and training, Not applicable

Authors:

A. V. Neagu, C.-I. Betianu; Bucharest/RO

DOI:

10.26044/ecr2020/C-06611

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-06611

Fig. 1: Dual blood supply and third inflow

Fig. 3: Characteristic locations of FFC and focal sparing

Fig. 2: Pharmacodynamics of normal liver contrast enhancement(up) and of THAD (down)

Fig. 22: Arterial phase CT scan pre (left) and post (right) right portal vein ligation....

Fig. 33: Typical appearance of FFC. Unenhanced and enhanced CT images present a...

Fig. 34: Multifocal fatty liver with no obvious relationship to vascular flow. CT scan...

Fig. 32: Typical appearance of FFC. Unenhanced and enhanced CT images present a...

Fig. 25: Multiple colorectal hepatic metastases. Multiple nodular hypoattenuating...

Learning objectives

To study the etiology, pathophysiology and to describe US, CT and MRI appearance of hepatic pseudolesions. To recognize vascular anatomical variants on various imaging studies. To discriminate pseudolesions from true lesions.

Background

Pseudolesions of the liver are non-neoplastic abnormalities and can be divided into parenchymal and vascular changes. Pesudolesions often occur due to blood flow abnormalities and can be found in both cirrhotic and non-cirrhotic livers.[1] The liver has dual blood supply with the portal vein carrying 75% of blood and the hepatic artery with 25% of blood and a drainage route through the hepatic veins. Both systems have communications between them that allow supporting mechanisms.[1] There are anatomical variations of liver blood vessels of which only...

Findings and procedure details

TABLE OF CONTENTS -Parenchymal Pseudolesions oFocal Fatty Liver and Focal Spared Areas oInflammatory Pseudotumors (IPT) oPeliosis Hepatis oConfluent Hepatic Fibrosis oSegmental Hypertrophy oParenchymal Compression -Vascular Pseudolesions oTransient Hepatic Attenuation/Intensity Differences (THAD/THID) oVascular Malformations Parenchymal Pseudolesions Focal Fatty Liver and Focal Spared Areas Fat accumulation is one of the most common conditions of the liver. Fatty liver is characterized by the accumulation of triglyceride droplets in hepatocytes not in the extracellular matrix.[4] Focal Fatty Change (FFC) is related to veins of third inflow(Fig. 3). These veins...

Conclusion

In patients with cancer, some forms of pseudolesions can cause panic, therefore, in-depth knowledge of liver hemodynamics and enhancement patterns is important in judging whether an abnormal finding is induced by a true lesion. Although pseudolesions tend to have a typical appearance, there are many cases with atypical patterns. CT and ultrasonography are useful for the diagnosis of pseudolesions but MRI appears to be the more sensitive in solving diagnostic problems.

Personal information and conflict of interest

A. V. Neagu; Bucharest/RO - nothing to disclose C.-I. Betianu; Bucharest/RO - nothing to disclose

References

1.Schneider G, Grazioli SL, Saini S, eds. Hepatic pseudolesions. In: MRI of the Liver: Imaging Techniques, Contrast Enhancement, Differential Diagnosis. 2nd edn. Milan: Springer-Verlag Italia 2006: 152-185. 2.Kobayashi, Satoshi & Gabata, Toshifumi & Matsui, Osamu. (2010). Radiologic manifestation of hepatic pseudolesions and pseudotumors in the third inflow area. Imaging in Medicine. 2. 10.2217/iim.10.50. 3.Itai Y, Matsui O.'Nonportal' splanchnic venous supply to the liver: abnormal findings on CT, US and MRI.Eur Radiol1999;9:237-43. 10.1007/s003300050661. 4.Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB (2006)...