Sharp indentation in the posteroinferior surface of right lobe of liver (between the right lobe and caudate lobe approximately at the level of right kidney) seen on axial computed tomography (CT) and magnetic resonance (MR) images [1] is known as the ‘right posterior hepatic notch’ sign (Fig. 1). It is believed to result from atrophy of the posterior segments of right lobe of liver and hypertrophy of the caudate lobe of liver, due to hepatic fibrosis, and alteration in portal blood flow [2, 3].
Axial contrast-enhanced CT just above the level of upper pole of right kidney shows the ‘right posterior hepatic notch’ sign (black arrow). White arrow shows the atrophic pancreas with calcific foci. Arrowhead denotes minimal perisplenic free fluid
Caudate lobe hypertrophy and a right posterior hepatic notch are more common in alcoholic cirrhosis than in viral-related cirrhosis [4]. While the right posterior hepatic notch sign has a relatively low sensitivity of 67–72% for diagnosis of cirrhosis, positive predictive value (75–82%) and specificity (87–98%) are higher [1, 3].
References
Ito K, Mitchell D (2003) Right posterior hepatic notch sign: a simple diagnostic MR finding of cirrhosis. J Magn Reson Imaging 18:561–566
Tan KC (2008) The right posterior hepatic notch sign. Radiology 248(1):317–318
Bolog N, Oancea I, Andreisek G, Mangrau A, Caruntu F (2009) Diagnosis performance of MR imaging signs of cirrhosis: the caudate to right lobe ratio, the posterior right hepatic notch, and the expanded gallbladder fossa. Curr Health Sci J. 35(1):16–22
Okazaki H, Ito K, Fujita T, et al. (2000) Discrimination of alcoholic from virus-induced cirrhosis on MR imaging. AJR Am J Roentgenol. 175(6):1677–1681
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Indiran, V., Jagannathan, K. Right posterior hepatic notch sign. Abdom Radiol 42, 2780 (2017). https://doi.org/10.1007/s00261-017-1199-z
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DOI: https://doi.org/10.1007/s00261-017-1199-z