Résumé
La cirrhose hépatique est une maladie chronique et progressive caractérisée par de la fibrose et sur le plan anatomique par la présence de nodules anormaux. Il en résulte un dysfonctionnement cellulaire, l'apparition d'une nécrose suivie de régénération. Le diagnostic définitif est habituellement posé par biopsie, mais les méthodes d'imagerie peuvent être utilisées comme techniques non invasives. Dans cet article, nous revoyons la contribution de l'IRM au diagnostic et au traitement de la cirrhose hépatique. Nous décrivons d'un point de vue spécifique les altérations morphologiques (hépatosplénomégalie, hypertension portale, ascite, adénopathie lymphatique, fibrose hépatique confluante), les modifications de l'intensité du signal (l'homogénéité de la texture hépatique, septa fibreux) et les différents types de rehaussement après administration de contraste (chélateurs de gadolinium, MnDPDP, particules d'oxyde de fer) qui permettent le diagnostic et les degrés successifs de la cirrhose. Enfin, nous discutons brièvement les étapes de la carcinogenèse conduisant au développement du carcinome hépatocellulaire.
Abstract
Liver cirrhosis is a chronic and progressive process characterized by fibrosis and anatomically abnormal nodules. Cirrhosis results in liver cell dysfunction, necrosis and regeneration. Although the definitive diagnosis is usually made by biopsy, diagnostic imaging can serve as a noninvasive diagnostic modality. In this review, the value of MR in the diagnosis and management of liver cirrhosis will be evaluated. Specifically, t morphologic changes (gross liver appearance, portal hypertension, splenomegaly, ascites, hilar lymphadenopathy, confluent hepatic fibrosis), signal intensity changes (inhomogeneous hepatic texture, fibrous septa) and contrast enhancement patterns (intravascular and interstitial gadolinium chelates, MnDPDP, iron oxide particles) that allow a diagnosis and grading of cirrhosis will be described. Also, the steps in carcinogenesis leading to the development of hepatocellular carcinomas will be briefly discussed.
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De Martí-Bonmatí, L. IRM dans l'évaluation de la cirrhose hépatique. Acta Endosc 30, 429–438 (2000). https://doi.org/10.1007/BF03015794
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DOI: https://doi.org/10.1007/BF03015794