Hepatic perfusional changes on CT and MRI: a radiology primer
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REVIEW
Hepatic perfusional changes on CT and MRI: a radiology primer Dane Gunter1 · Shaista Riaz2 · Ehsan A. Haider3 · Ryan Rebello3 · Michael N. Patlas4 · Abdullah Alabousi3 Received: 29 July 2020 / Revised: 16 September 2020 / Accepted: 24 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Hepatic perfusional changes are common in response to, or as a result of, a multitude of pathological processes. These can be neoplastic, inflammatory, fibrotic, or ischemic in origin, to name a few. The liver, having a dual blood supply, is a unique organ to study using contrast-enhanced CT and MRI imaging due to its varied appearance on multiphasic imaging. Knowledge of the CT and MRI appearance of hepatic perfusional changes, in addition to the clinical presentation, can often result in an accurate differential diagnosis. Many of the conditions that cause these changes in hepatic blood flow result in similar appearances on imaging. As a result, it is important that radiologists be aware of common pitfalls when dealing with hepatic perfusional changes to prevent misdiagnosis or delayed diagnosis. As such, this review will focus on some of the various causes of hepatic perfusional changes and how to accurately identify and diagnose them based on their CT and MRI appearance. Graphic abstract
Keywords Liver · Computed tomography · Magnetic resonance imaging · Perfusion
* Abdullah Alabousi [email protected]
Michael N. Patlas [email protected]
Dane Gunter [email protected]
1
University College Cork, School of Medicine, Cork, Ireland
2
Department of Radiology, McGill University, Montreal, QC, Canada
3
Department of Radiology, McMaster University, St Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada
4
Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada
Shaista Riaz [email protected] Ehsan A. Haider [email protected] Ryan Rebello [email protected]
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Introduction The liver is a unique organ, in that it has a dual blood supply from both the portal vein (75%) and hepatic artery (25%) [1]. These supply systems are not independent of one another and have many connections throughout the liver’s structure [1, 2]. The response of this dual supply system to different liver pathologies can result in a unique imaging appearance of perfusional changes on computed tomography (CT) and magnetic resonance imaging (MRI). These perfusional changes result from alterations in blood flow either directly as a result of the liver pathology or as a secondary response to the liver insult. Both CT and MR are useful in the assessment of the vasculature of the liver, as well as any alterations in the blood flow in the form of perfusional changes that may occur within this system. The use of rapid image acquisition allows for the hepatic parenchyma to be observed in multiple phases (arterial, portal venous, and delayed) following the injection of intravenous contrast [1]. The appearance of the liver on d
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