Abdominal Radiology

, Volume 43, Issue 1, pp 26–40 | Cite as

Cirrhosis and LI-RADS

  • Demetrios Papadatos
  • Kathryn J. Fowler
  • Ania Z. Kielar
  • Jennifer Cui
  • Claude B. Sirlin
Invited article
  • 558 Downloads

Abstract

Chronic liver disease, irrespective of cause, can eventually lead to cirrhosis, which is the primary risk factor for developing hepatocellular carcinoma (HCC). In patients with cirrhosis or appropriate risk factors, HCC can be diagnosed by imaging with high specificity using liver imaging reporting and data system v2017, obviating the need for histologic confirmation. Confident recognition of cirrhosis by conventional imaging alone can be challenging, as radiologists are not always provided with the requisite information to determine if the patient has cirrhosis or other risk factors for HCC. Moreover, cirrhosis-associated abnormalities may impair the diagnostic accuracy of imaging for HCC. This article addresses the diagnosis of cirrhosis by non-invasive imaging and the implications of cirrhosis for imaging interpretation and accuracy.

Keywords

LI-RADS Cirrhosis Fibrosis Hepatocellular carcinoma Hepatocellular nodules Magnetic resonance imaging 

Notes

Compliance with ethical standards

Funding

This article has received no funding support.

Conflict of interest

Dr. Papadatos, Dr. Fowler, and Ms. Cui have no relevant conflicts of interest, Dr. Kielar reports research grants from GE, and Dr. Sirlin reports research grants from GE and Siemens.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    Schuppan D, Afdhal NH (2008) Liver cirrhosis. Lancet 371(9615):838–851.  https://doi.org/10.1016/S0140-6736(08)60383-9 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Tsochatzis EA, Bosch J, Burroughs AK (2014) Liver cirrhosis. Lancet 383(9930):1749–1761.  https://doi.org/10.1016/S0140-6736(14)60121-5 CrossRefPubMedGoogle Scholar
  3. 3.
    Ge PS, Runyon BA (2016) Treatment of patients with cirrhosis. N Engl J Med 375(8):767–777.  https://doi.org/10.1056/NEJMra1504367 CrossRefPubMedGoogle Scholar
  4. 4.
    Bedossa P, Poynard T (1996) An algorithm for the grading of activity in chronic hepatitis C. The METAVIR cooperative study group. Hepatology 24(2):289–293.  https://doi.org/10.1002/hep.510240201 CrossRefPubMedGoogle Scholar
  5. 5.
    Batts KP, Ludwig J (1995) Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 19(12):1409–1417CrossRefPubMedGoogle Scholar
  6. 6.
    Scheuer PJ (1991) Classification of chronic viral hepatitis: a need for reassessment. J Hepatol 13(3):372–374CrossRefPubMedGoogle Scholar
  7. 7.
    Kleiner DE, Brunt EM, Van Natta M, et al. (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41(6):1313–1321.  https://doi.org/10.1002/hep.20701 CrossRefPubMedGoogle Scholar
  8. 8.
    Ishak K, Baptista A, Bianchi L, et al. (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22(6):696–699CrossRefPubMedGoogle Scholar
  9. 9.
    Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379(9822):1245–1255.  https://doi.org/10.1016/S0140-6736(11)61347-0 CrossRefPubMedGoogle Scholar
  10. 10.
    Yeom SK, Lee CH, Cha SH, Park CM (2015) Prediction of liver cirrhosis, using diagnostic imaging tools. World J Hepatol 7(17):2069–2079.  https://doi.org/10.4254/wjh.v7.i17.2069 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Huber A, Ebner L, Heverhagen JT, Christe A (2015) State-of-the-art imaging of liver fibrosis and cirrhosis: a comprehensive review of current applications and future perspectives. Eur J Radiol Open 2:90–100.  https://doi.org/10.1016/j.ejro.2015.05.002 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Jha P, Poder L, Wang ZJ, et al. (2010) Radiologic mimics of cirrhosis. AJR Am J Roentgenol 194(4):993–999.  https://doi.org/10.2214/AJR.09.3409 CrossRefPubMedGoogle Scholar
  13. 13.
    Gupta AA, Kim DC, Krinsky GA, Lee VS (2004) CT and MRI of cirrhosis and its mimics. AJR Am J Roentgenol 183(6):1595–1601.  https://doi.org/10.2214/ajr.183.6.01831595 CrossRefPubMedGoogle Scholar
  14. 14.
    Dodd GD 3rd, Baron RL, Oliver JH 3rd, Federle MP (1999) Spectrum of imaging findings of the liver in end-stage cirrhosis: part I, gross morphology and diffuse abnormalities. AJR Am J Roentgenol 173(4):1031–1036.  https://doi.org/10.2214/ajr.173.4.10511173 CrossRefPubMedGoogle Scholar
  15. 15.
    Qayyum A, Lee GK, Yeh BM, et al. (2007) Frequency of hepatic contour abnormalities and signs of portal hypertension at CT in patients receiving chemotherapy for breast cancer metastatic to the liver. Clin Imaging 31(1):6–10.  https://doi.org/10.1016/j.clinimag.2006.09.028 CrossRefPubMedGoogle Scholar
  16. 16.
    Young ST, Paulson EK, Washington K, et al. (1994) CT of the liver in patients with metastatic breast carcinoma treated by chemotherapy: findings simulating cirrhosis. AJR Am J Roentgenol 163(6):1385–1388.  https://doi.org/10.2214/ajr.163.6.7992734 CrossRefPubMedGoogle Scholar
  17. 17.
    Schreiner SA, Gorman B, Stephens DH (1998) Chemotherapy-related hepatotoxicity causing imaging findings resembling cirrhosis. Mayo Clin Proc 73(8):780–783.  https://doi.org/10.4065/73.8.780 CrossRefPubMedGoogle Scholar
  18. 18.
    Di Lelio A, Cestari C, Lomazzi A, Beretta L (1989) Cirrhosis: diagnosis with sonographic study of the liver surface. Radiology 172(2):389–392.  https://doi.org/10.1148/radiology.172.2.2526349 CrossRefPubMedGoogle Scholar
  19. 19.
    Poff JA, Coakley FV, Qayyum A, et al. (2008) Frequency and histopathologic basis of hepatic surface nodularity in patients with fulminant hepatic failure. Radiology 249(2):518–523.  https://doi.org/10.1148/radiol.2492072168 CrossRefPubMedGoogle Scholar
  20. 20.
    Murakami T, Baron RL, Peterson MS (1996) Liver necrosis and regeneration after fulminant hepatitis: pathologic correlation with CT and MR findings. Radiology 198(1):239–242.  https://doi.org/10.1148/radiology.198.1.8539386 CrossRefPubMedGoogle Scholar
  21. 21.
    Dachman AH, Ros PR, Goodman ZD, Olmsted WW, Ishak KG (1987) Nodular regenerative hyperplasia of the liver: clinical and radiologic observations. AJR Am J Roentgenol 148(4):717–722.  https://doi.org/10.2214/ajr.148.4.717 CrossRefPubMedGoogle Scholar
  22. 22.
    Qayyum A, Graser A, Westphalen A, et al. (2004) CT of benign hypervascular liver nodules in autoimmune hepatitis. AJR Am J Roentgenol 183(6):1573–1576.  https://doi.org/10.2214/ajr.183.6.01831573 CrossRefPubMedGoogle Scholar
  23. 23.
    Rha SE, Lee MG, Lee YS, et al. (2000) Nodular regenerative hyperplasia of the liver in Budd-Chiari syndrome: CT and MR features. Abdom Imaging 25(3):255–258CrossRefPubMedGoogle Scholar
  24. 24.
    Casillas C, Marti-Bonmati L, Galant J (1997) Pseudotumoral presentation of nodular regenerative hyperplasia of the liver: imaging in five patients including MR imaging. Eur Radiol 7(5):654–658.  https://doi.org/10.1007/BF02742920 CrossRefPubMedGoogle Scholar
  25. 25.
    Scott GC, Berman JM, Higgins JL Jr (1997) CT patterns of nodular hepatic and splenic sarcoidosis: a review of the literature. J Comput Assist Tomogr 21(3):369–372CrossRefPubMedGoogle Scholar
  26. 26.
    Akhan O, Karaosmanoglu AD, Ergen B (2007) Imaging findings in congenital hepatic fibrosis. Eur J Radiol 61(1):18–24.  https://doi.org/10.1016/j.ejrad.2006.11.007 CrossRefPubMedGoogle Scholar
  27. 27.
    Futagawa S, Fukazawa M, Horisawa M, et al. (1980) Portographic liver changes in idiopathic noncirrhotic portal hypertension. AJR Am J Roentgenol 134(5):917–923.  https://doi.org/10.2214/ajr.134.5.917 CrossRefPubMedGoogle Scholar
  28. 28.
    Futagawa S, Fukazawa M, Musha H, et al. (1981) Hepatic venography in noncirrhotic idiopathic portal hypertension. Comparison with cirrhosis of the liver. Radiology 141((2):303–309.  https://doi.org/10.1148/radiology.141.2.7291551 CrossRefPubMedGoogle Scholar
  29. 29.
    Ghaferi AA, Hutchins GM (2005) Progression of liver pathology in patients undergoing the Fontan procedure: Chronic passive congestion, cardiac cirrhosis, hepatic adenoma, and hepatocellular carcinoma. J Thorac Cardiovasc Surg 129(6):1348–1352.  https://doi.org/10.1016/j.jtcvs.2004.10.005 CrossRefPubMedGoogle Scholar
  30. 30.
    Wells ML, Fenstad ER, Poterucha JT, et al. (2016) Imaging findings of congestive hepatopathy. Radiographics 36(4):1024–1037.  https://doi.org/10.1148/rg.2016150207 CrossRefPubMedGoogle Scholar
  31. 31.
    Horowitz JM, Venkatesh SK, Ehman RL, et al. (2017) Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel. Abdom Radiol (NY) 42(8):2037–2053.  https://doi.org/10.1007/s00261-017-1211-7 CrossRefGoogle Scholar
  32. 32.
    Sherman M (2010) Hepatocellular carcinoma: epidemiology, surveillance, and diagnosis. Semin Liver Dis 30(1):3–16.  https://doi.org/10.1055/s-0030-1247128 CrossRefPubMedGoogle Scholar
  33. 33.
    McGlynn KA, London WT (2005) Epidemiology and natural history of hepatocellular carcinoma. Best Pract Res Clin Gastroenterol 19(1):3–23.  https://doi.org/10.1016/j.bpg.2004.10.004 CrossRefPubMedGoogle Scholar
  34. 34.
    Ascha MS, Hanouneh IA, Lopez R, et al. (2010) The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology 51(6):1972–1978.  https://doi.org/10.1002/hep.23527 CrossRefPubMedGoogle Scholar
  35. 35.
    Bruix J, Sherman M, American Association for the Study of Liver D (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022.  https://doi.org/10.1002/hep.24199 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Caballeria L, Pares A, Castells A, et al. (2001) Hepatocellular carcinoma in primary biliary cirrhosis: similar incidence to that in hepatitis C virus-related cirrhosis. Am J Gastroenterol 96(4):1160–1163.  https://doi.org/10.1111/j.1572-0241.2001.03695.x PubMedGoogle Scholar
  37. 37.
    European Association for Study of L, European Organisation for R, Treatment of C (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer 48(5):599–641.  https://doi.org/10.1016/j.ejca.2011.12.021 CrossRefGoogle Scholar
  38. 38.
    Morgan TR, Mandayam S, Jamal MM (2004) Alcohol and hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):S87–96CrossRefPubMedGoogle Scholar
  39. 39.
    Tansel A, Katz LH, El-Serag HB, et al. (2017) Incidence and determinants of hepatocellular carcinoma in autoimmune hepatitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 15(8):1207–1217.  https://doi.org/10.1016/j.cgh.2017.02.006 CrossRefPubMedGoogle Scholar
  40. 40.
    Yeoman AD, Al-Chalabi T, Karani JB, et al. (2008) Evaluation of risk factors in the development of hepatocellular carcinoma in autoimmune hepatitis: implications for follow-up and screening. Hepatology 48(3):863–870.  https://doi.org/10.1002/hep.22432 CrossRefPubMedGoogle Scholar
  41. 41.
    Yu JS, Kim KW, Sung KB, Lee JT, Yoo HS (1997) Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging. Radiology 203(3):737–742.  https://doi.org/10.1148/radiology.203.3.9169697 CrossRefPubMedGoogle Scholar
  42. 42.
    Holland AE, Hecht EM, Hahn WY, et al. (2005) Importance of small (< or = 20-mm) enhancing lesions seen only during the hepatic arterial phase at MR imaging of the cirrhotic liver: evaluation and comparison with whole explanted liver. Radiology 237(3):938–944.  https://doi.org/10.1148/radiol.2373041364 CrossRefPubMedGoogle Scholar
  43. 43.
    Hwang SH, Yu JS, Kim KW, Kim JH, Chung JJ (2008) Small hypervascular enhancing lesions on arterial phase images of multiphase dynamic computed tomography in cirrhotic liver: fate and implications. J Comput Assist Tomogr 32(1):39–45.  https://doi.org/10.1097/RCT.0b013e318064c76b CrossRefPubMedGoogle Scholar
  44. 44.
    Motosugi U, Ichikawa T, Sou H, et al. (2010) Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology 256(1):151–158.  https://doi.org/10.1148/radiol.10091885 CrossRefPubMedGoogle Scholar
  45. 45.
    Hussain HK, Syed I, Nghiem HV, et al. (2004) T2-weighted MR imaging in the assessment of cirrhotic liver. Radiology 230(3):637–644.  https://doi.org/10.1148/radiol.2303020921 CrossRefPubMedGoogle Scholar
  46. 46.
    Kim TK, Chung JW, Han JK, et al. (1999) Hepatic changes in benign obstruction of the hepatic inferior vena cava: CT findings. AJR Am J Roentgenol 173(5):1235–1242.  https://doi.org/10.2214/ajr.173.5.10541095 CrossRefPubMedGoogle Scholar
  47. 47.
    Vilgrain V, Condat B, Bureau C, et al. (2006) Atrophy-hypertrophy complex in patients with cavernous transformation of the portal vein: CT evaluation. Radiology 241(1):149–155.  https://doi.org/10.1148/radiol.2411051102 CrossRefPubMedGoogle Scholar
  48. 48.
    Lory J, Schweizer W, Blumgart LH, Zimmermann A (1994) The pathology of the atrophy/hypertrophy complex (AHC) of the liver. A light microscopic and immunohistochemical study. Histol Histopathol 9(3):541–554PubMedGoogle Scholar
  49. 49.
    Ito K, Mitchell DG, Outwater EK, Blasbalg R (1999) Primary sclerosing cholangitis: MR imaging features. AJR Am J Roentgenol 172(6):1527–1533.  https://doi.org/10.2214/ajr.172.6.10350284 CrossRefPubMedGoogle Scholar
  50. 50.
    Dodd GD 3rd, Baron RL, Oliver JH 3rd, Federle MP (1999) End-stage primary sclerosing cholangitis: CT findings of hepatic morphology in 36 patients. Radiology 211(2):357–362.  https://doi.org/10.1148/radiology.211.2.r99ma49357 CrossRefPubMedGoogle Scholar
  51. 51.
    Bader TR, Beavers KL, Semelka RC (2003) MR imaging features of primary sclerosing cholangitis: patterns of cirrhosis in relationship to clinical severity of disease. Radiology 226(3):675–685.  https://doi.org/10.1148/radiol.2263011623 CrossRefPubMedGoogle Scholar
  52. 52.
    Blachar A, Federle MP, Brancatelli G (2001) Primary biliary cirrhosis: clinical, pathologic, and helical CT findings in 53 patients. Radiology 220(2):329–336.  https://doi.org/10.1148/radiology.220.2.r01au36329 CrossRefPubMedGoogle Scholar
  53. 53.
    Mitchell DG, Palazzo J, Hann HW, et al. (1992) Mass-like hepatic hypertrophy: MRI findings with histologic correlation. Magn Reson Imaging 10(4):541–547CrossRefPubMedGoogle Scholar
  54. 54.
    Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002) Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation. AJR Am J Roentgenol 178(4):877–883.  https://doi.org/10.2214/ajr.178.4.1780877 CrossRefPubMedGoogle Scholar
  55. 55.
    Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K (2009) Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT. AJR Am J Roentgenol 192(5):1341–1347.  https://doi.org/10.2214/AJR.07.2782 CrossRefPubMedGoogle Scholar
  56. 56.
    Mwangi I, Hanna RF, Kased N, et al. (2010) Apparent diffusion coefficient of fibrosis and regenerative nodules in the cirrhotic liver at MRI. AJR Am J Roentgenol 194(6):1515–1522.  https://doi.org/10.2214/AJR.09.3484 CrossRefPubMedGoogle Scholar
  57. 57.
    Ohtomo K, Baron RL, Dodd GD 3rd, et al. (1993) Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging. Radiology 189(3):871–874.  https://doi.org/10.1148/radiology.189.3.8234718 CrossRefPubMedGoogle Scholar
  58. 58.
    Choi JY, Lee JM, Sirlin CB (2014) CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 272(3):635–654.  https://doi.org/10.1148/radiol.14132361 CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Chernyak V, Tang A, Flusberg M, et al. (2017) LI-RADS(R) ancillary features on CT and MRI. Abdom Radiol (NY).  https://doi.org/10.1007/s00261-017-1220-6 Google Scholar
  60. 60.
    Galia M, Taibbi A, Marin D, et al. (2014) Focal lesions in cirrhotic liver: what else beyond hepatocellular carcinoma? Diagn Interv Radiol 20(3):222–228.  https://doi.org/10.5152/dir.2014.13184 CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Gerlach JT, Diepolder HM, Zachoval R, et al. (2003) Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology 125(1):80–88CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Demetrios Papadatos
    • 1
  • Kathryn J. Fowler
    • 2
  • Ania Z. Kielar
    • 1
  • Jennifer Cui
    • 3
  • Claude B. Sirlin
    • 3
  1. 1.University of OttawaOttawaCanada
  2. 2.Department of Radiology, Washington University School of MedicineWashington UniversitySt. LouisUSA
  3. 3.University of California, San DiegoSan DiegoUSA

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