Type:
Educational Exhibit
Keywords:
Not applicable, Neoplasia, Inflammation, Haemangioma, Imaging sequences, Ultrasound, MR, CT, Liver, Gastrointestinal tract, Abdominal Viscera
Authors:
S. RIAZ1, S. Al Duwaiki1, E. Haider1, A. Alabousi2; 1Hamilton/CA, 2Hamilton, ON/CA
DOI:
10.26044/ecr2020/C-10841
Conclusion
Radiologist should be aware of the broad potential causes of perfusional hepatic changes, including neoplastic and non-neoplastic etiologies. The radiologist, based on unique imaging findings, maybe the first to raise the suspicion for a number of significant pathologies that are difficult to otherwise diagnose based on clinical findings alone.
TIPS:
- In liver cirrhosis, functional arterioportal shunts are difficult to recognize and there could be confusion between THADS/THIDS and HCC.
- Hypervascular benign and malignant tumours exhibit Steal phenomenon, showing transient hyperdensity/hyperintensity on arterial phase leading to incorrect measurements, so they should be measured on T2 or DWI.
- When major vessels are patent, there may be involvement of intrahepatic microvessels such as in liver metastatic disease and antiphospholipid syndrome.
- Liver infarcts can be due to hepatic artery occlusion (liver transplant/ liver surgery or intervention) or infarction without hepatic artery occlusion (coagulation disorder such as antiphospholipid syndrome, sepsis, shock, trauma, anesthesia and HELLP). If multiple organs are involved, think of non-occlusive causes.
- In Budd Chiari, there can be regenerative nodules, hepatic infarcts and HCC. Obstruction of the portal/hepatic venous outflow results in regenerative nodules, which are hypervascular, bright on T1, multiple usually less than 4 cm and may show a central scar.
- No cause may be seen for many perfusion defects and these can be monitored with periodic follow-up.
- Types of hepatic shunts include: Hepatic artery to portal vein, hepatic artery to hepatic vein and portal vein to hepatic vein.