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Infarcted Regenerative Nodules in Cirrhosis

CT and MR Imaging Findings with Pathologic Correlation

¹ Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213-2582.
² Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582.

View larger version (150K): [in a new window]   Fig. 1A. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Unenhanced CT scan shows oval hypoattenuated nodular lesion (arrow) that measures 1.5 cm in diameter in right lobe of liver. Note abundant ascites and changes of cirrhosis evident in hepatic morphology.

View larger version (147K): [in a new window]   Fig. 1B. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Arterial phase helical CT scan obtained at same level as A shows central and peripheral portions of lesion (arrow) as enhancing to approximately the same degree as liver parenchyma. Note that remaining lesion is mainly hypoattenuating.

View larger version (146K): [in a new window]   Fig. 1C. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Portal venous phase helical CT scan obtained at same level as A and B shows central and peripheral enhancement equal to that of liver parenchyma and encompassing larger proportion of lesion (arrow). Hypoattenuating portion of lesion occupies smaller component than that in A and B.

View larger version (128K): [in a new window]   Fig. 1D. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. T2-weighted fast spin-echo MR image (TR/TE, 4000/120; echo train length, 12) shows lesion (arrow) to be of moderately higher signal intensity than liver parenchyma. Signal intensity pattern resembles that seen in A—C.

View larger version (189K): [in a new window]   Fig. 1E. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Portal venous phase gradient-echo MR image (9.9/2.5; flip angle, 30°) obtained 60 sec after infusion of contrast material shows lesion (arrow) to be predominantly hypointense compared with enhancing liver parenchyma.

View larger version (119K): [in a new window]   Fig. 1F. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Delayed contrast-enhanced T1-weighted spin-echo MR image (533/12) obtained at same level as E shows central and peripheral portions of lesion (arrow) to be enhancing similar to or slightly more than liver parenchyma. Note that small component of lesion remains hypointense. Appearance resembles that in C.

View larger version (113K): [in a new window]   Fig. 1G. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Liver section obtained after transplantation from approximately same levels as A—F confirms peripheral lesion (arrows). Lesion represents peripheral collapse of parenchymal tissue with fibrosis and relative central sparing.

View larger version (147K): [in a new window]   Fig. 1H. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Low-power photomicrograph of resected liver specimen shows focal lesion of infarcted regenerative nodules. Capsule is parallel to and extends slightly beyond left border of image. Large necrotic nodule seen at 11-o'clock position (large arrow) appears as homogeneous eosinophilic mass with some clearing. Smaller necrotic nodules (small arrows) are seen at 4- and 5- o'clock positions. These nodules are part of composite lesion that runs from upper left to lower right borders of image. Much of this mass consists of collapsed parenchyma with fibrosis. A spared area of liver parenchyma exists centrally within lesions (arrowhead) and most likely corresponds to central region of contrast enhancement on A, B, C, and F. (H and E, x10)

View larger version (142K): [in a new window]   Fig. 1I. —Infarcted regenerative nodules in 55-year-old man with prior episode of bleeding from esophageal varices and gastric ulcer. Photomicrograph of lesion shows necrotic nodule (lower right) and surrounding dense fibrous tissue. Small blood vessel formation (arrowheads) reflects repair response. (H and E, x100)

View larger version (165K): [in a new window]   Fig. 2A. —Infarcted regenerative nodules in 47-year-old man with prior episode of gastrointestinal bleeding from esophageal varices. Unenhanced CT scan shows oval 1-cm lesion (arrow) hypoattenuating to adjacent liver parenchyma in lateral segment of liver.

View larger version (168K): [in a new window]   Fig. 2B. —Infarcted regenerative nodules in 47-year-old man with prior episode of gastrointestinal bleeding from esophageal varices. Arterial phase helical CT scan obtained at same level as A shows lesion (arrow) to be predominately hypoattenuating compared with surrounding liver parenchyma.

View larger version (175K): [in a new window]   Fig. 2C. —Infarcted regenerative nodules in 47-year-old man with prior episode of gastrointestinal bleeding from esophageal varices. Portal venous phase helical CT scan obtained at same level as A and B shows central portion of lesion (arrow) remaining hypoattenuating; however, peripheral portion has enhanced to similar degree as adjacent liver parenchyma.

View larger version (144K): [in a new window]   Fig. 3A. —Infarcted regenerative nodules in 67-year-old man with prior episode of massive bleeding from esophageal varices. Unenhanced CT scan shows large hypoattenuated lesion in posterior segment of liver. Note how lesion has bulging contour (arrows).

View larger version (142K): [in a new window]   Fig. 3B. —Infarcted regenerative nodules in 67-year-old man with prior episode of massive bleeding from esophageal varices. Conventional contrast-enhanced CT scan shows patchy enhancement of lesion with zones of enhancement equal to that of liver parenchyma; however, large regions of hypoattenuation persist.

View larger version (151K): [in a new window]   Fig. 3C. —Infarcted regenerative nodules in 67-year-old man with prior episode of massive bleeding from esophageal varices. Conventional contrast-enhanced CT scan obtained at higher level than A and B shows upper portion of large lesion (arrow) with heterogeneous enhancement and another smaller lesion (arrowheads), findings that mimic those of neoplastic disease.

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