The many faces of cirrhosis
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REVIEW
The many faces of cirrhosis Ryan B. Schwope1,2 · Matthew Katz3 · Timothy Russell1 · Michael J. Reiter4 · Christopher J. Lisanti1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract There are many different imaging features of cirrhosis, some of which are less commonly recognized. It is important that the radiologist is familiar with these features as cirrhosis can be first discovered on imaging performed for other indications, thus alerting the clinician for the need to screen for complications of cirrhosis and referral for potential treatment. This article reviews the various imaging findings of cirrhosis seen on cross-sectional imaging of the abdomen and pelvis. Keywords Cirrhosis · Imaging features · CT · MRI · Ultrasound
Introduction Cirrhosis, the final stage of chronic liver disease, is one of the leading causes of death in the western world and in the Asia–Pacific region [1, 2]. There are multiple etiologies of cirrhosis, the most common of which in the United States are chronic viral infection, alcohol abuse, and nonalcoholic fatty liver disease (Table 1). These etiologies are toxic to both hepatic parenchymal and nonparenchymal cells, resulting in increased collagen deposition and hepatic fibrosis [3]. Progression of hepatic fibrosis can lead to cirrhosis, which is often a silent disease until decompensation occurs [4]. Thus, identification of cirrhosis on routine cross-sectional imaging is important, as timely intervention can decrease disease progression and even result in regression of disease, thereby decreasing associated complications (Fig. 1) [3–6]. In addition, identification of cirrhosis initiates screening for associated life-threatening complications such as hepatocellular carcinoma (HCC) [7]. * Ryan B. Schwope [email protected] 1
Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX 78234, USA
2
Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
3
Department of Radiology, Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA 30905, USA
4
Department of Radiology, Stony Brook University Medical Center, 1011 Nicolls Road, Stony Brook, NY 11794, USA
There are many imaging findings that can alert the radiologist to the presence of cirrhosis. This article will review the spectrum of imaging findings associated with cirrhosis on cross-sectional imaging of the abdomen and pelvis, some of which are less commonly recognized. These imaging findings can be divided into morphological changes of the liver, extrahepatic findings, and vascular changes (Table 2). Some of these findings may suggest certain etiologies of cirrhosis (Table 3) and can have prognostic implications. The more advanced methods for assessment of cirrhosis, including ultrasound elastography and magnetic resonance elastography, are beyond the scope of this article and discussions of these techniques can be found elsewhere [8].
Hepatic manifestations An
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