Skip to main content
SpringerLink
Log in

Cirrhosis and LI-RADS

Abdominal Radiology volume 43, pages 26–40 (2018)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

References

  1. Schuppan D, Afdhal NH (2008) Liver cirrhosis. Lancet 371(9615):838–851. https://doi.org/10.1016/S0140-6736(08)60383-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  5. Batts KP, Ludwig J (1995) Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 19(12):1409–1417

    Article  CAS  PubMed  Google Scholar 

  6. Scheuer PJ (1991) Classification of chronic viral hepatitis: a need for reassessment. J Hepatol 13(3):372–374

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  8. Ishak K, Baptista A, Bianchi L, et al. (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22(6):696–699

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):255–258

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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):369–372

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    CAS  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  38. Morgan TR, Mandayam S, Jamal MM (2004) Alcohol and hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):S87–96

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):541–554

    CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  53. Mitchell DG, Palazzo J, Hann HW, et al. (1992) Mass-like hepatic hypertrophy: MRI findings with histologic correlation. Magn Reson Imaging 10(4):541–547

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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. 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

    Article  PubMed  PubMed Central  Google Scholar 

  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):80–88

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Ottawa, Ottawa, ON, Canada

    Demetrios Papadatos & Ania Z. Kielar

  2. Department of Radiology, Washington University School of Medicine, Washington University, 510 S Kingshighway, St. Louis, MO, 63110, USA

    Kathryn J. Fowler

  3. University of California, San Diego, San Diego, CA, USA

    Jennifer Cui & Claude B. Sirlin

Authors
  1. Demetrios Papadatos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathryn J. Fowler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ania Z. Kielar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claude B. Sirlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn J. Fowler.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Papadatos, D., Fowler, K.J., Kielar, A.Z. et al. Cirrhosis and LI-RADS. Abdom Radiol 43, 26–40 (2018). https://doi.org/10.1007/s00261-017-1425-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1425-8

Keywords

search

Navigation