CT and MRI of Hepatic Abscess in Patients with Chronic Granulomatous Disease
Reyes Garcia-Eulate1,
Nadeem Hussain2,
Theo Heller2,
David Kleiner3,
Harry Malech4,
Steven Holland5 and
Peter L. Choyke1
1 Molecular Imaging Program, National Cancer Institute, Bldg. 10, Rm. B3B69,
9000 Rockville Pike, Bethesda, MD 20892.
2 Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney
Diseases, Bethesda, MD.
3 Laboratory of Pathology, National Cancer Institute, Bethesda, MD.
4 Laboratory of Host Defenses, National Institute of Allergy and Infectious
Diseases, Bethesda, MD.
5 Laboratory of Clinical Infectious Diseases, Bethesda, MD.
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Fig. 1 —Scatter chart showing number of abscesses per patient, number
of episodes of abscess per patient, and number of abscesses per episode.
Y-axis represents numerator of each ratio, and size of circle
represents denominator. Number of abscesses per patient has bimodal
distribution with most patients having either 1 or 2 or 10 or more. Most
patients had only a few episodes and only a few abscesses (1 or 2) per
episode, but some patients showed numerous episodes with multiple
abscesses.
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Fig. 2A —16-year-old boy with chronic granulomatous disease (CGD)
shows typical histologic appearance of hepatic abscess. Unlike most abscesses,
center of abscess in CGD is filled with neutrophils and cell debris, and this
core is surrounded by palisade epithelioid histiocytes and then by layer of
histiocytes mixed with other inflammatory cells (mainly lymphocytes). Around
this is wide zone of fibrous and inflamed granulation tissue. Typical
abscesses showed liquified necrosis centrally. (H and E, x40)
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Fig. 2B —16-year-old boy with chronic granulomatous disease (CGD)
shows typical histologic appearance of hepatic abscess. Higher magnification
of vascular granulation tissue surrounding abscess shows numerous small
vessels with activated endothelium within fibrous stroma. Lymphocytes,
eosinophils, and macrophages are present in this region as well. (H and E,
x200)
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Fig. 3A —Patterns of enhancement on CT and MRI of hepatic abscess in
patients with chronic granulomatous disease. Drawing shows type 1, complete
central enhancement.
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Fig. 3B —Patterns of enhancement on CT and MRI of hepatic abscess in
patients with chronic granulomatous disease. Drawings show type 2, incomplete
central enhancement. Type 2 is subdivided into type 2a (B), small
central area with poor enhancement, and type 2b (C), peripheral
enhancement and multiseptal core enhancement suggesting multiloculated
abscess.
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Fig. 3C —Patterns of enhancement on CT and MRI of hepatic abscess in
patients with chronic granulomatous disease. Drawings show type 2, incomplete
central enhancement. Type 2 is subdivided into type 2a (B), small
central area with poor enhancement, and type 2b (C), peripheral
enhancement and multiseptal core enhancement suggesting multiloculated
abscess.
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Fig. 3D —Patterns of enhancement on CT and MRI of hepatic abscess in
patients with chronic granulomatous disease. Drawing shows type 3, peripheral
ring enhancement surrounding necrotic liquefied cavity.
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Fig. 4A —Hepatic abscess in patients with chronic granulomatous
disease showing different patterns of enhancement. 15-year-old boy with
homogeneous enhancement (type 1).
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Fig. 4B —Hepatic abscess in patients with chronic granulomatous
disease showing different patterns of enhancement. Same patient and episode as
A (type 2a): predominance of homogeneous enhancement with small central
area with poor enhancement.
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Fig. 4C —Hepatic abscess in patients with chronic granulomatous
disease showing different patterns of enhancement. 25-year-old man with
peripheral and multiseptal enhancement (type 2b).
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Fig. 4D —Hepatic abscess in patients with chronic granulomatous
disease showing different patterns of enhancement. 3-year-old boy with central
low attenuation and peripheral ring enhancement (type 3).
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Fig. 5 —This graph depicts relative frequency of each type of abscess
based on lesion size. Most small abscesses ( 1 cm) display homogeneous
enhancement (type 1), whereas 80% of abscesses between more than 1 cm and 3 cm
show incomplete central enhancement with small central hypoenhancing area
(type 2a). Most abscesses larger than 3 cm show either type 2a (incomplete
central enhancement) or type 2b (multiloculated with peripheral
enhancement).
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Fig. 6A —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 3-year-old boy
with homogeneous enhancement hepatic abscess (type 1) on T1-weighted
contrast-enhanced (A) and mild increased signal intensity on STIR
(B) images.
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Fig. 6B —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 3-year-old boy
with homogeneous enhancement hepatic abscess (type 1) on T1-weighted
contrast-enhanced (A) and mild increased signal intensity on STIR
(B) images.
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Fig. 6C —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 15-year-old boy
presents with enhancing hepatic lesion and low-signal central area (type 2a)
on T1-weighted contrast-enhanced (C) and moderately increased signal
intensity on STIR (D) images.
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Fig. 6D —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 15-year-old boy
presents with enhancing hepatic lesion and low-signal central area (type 2a)
on T1-weighted contrast-enhanced (C) and moderately increased signal
intensity on STIR (D) images.
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Fig. 6E —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 11-year-old boy
shows hepatic abscess with peripheral and septal enhancement (type 2b) on
T1-weighted contrast-enhanced image (E). On STIR image (F), this
lesion shows moderate but homogeneous intensity.
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Fig. 6F —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 11-year-old boy
shows hepatic abscess with peripheral and septal enhancement (type 2b) on
T1-weighted contrast-enhanced image (E). On STIR image (F), this
lesion shows moderate but homogeneous intensity.
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Fig. 6G —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 15-year-old boy
presents so-called classic appearance of abscess with enhancing ring and
necrotic central area (type 3) on T1-weighted contrast-enhanced image
(G). On STIR image (H), signal intensity is slightly higher
centrally within cavity compared with periphery.
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Fig. 6H —Patterns of enhancement of hepatic abscess in patients with
chronic granulomatous disease (CGD) on MRI are similar to CT. 15-year-old boy
presents so-called classic appearance of abscess with enhancing ring and
necrotic central area (type 3) on T1-weighted contrast-enhanced image
(G). On STIR image (H), signal intensity is slightly higher
centrally within cavity compared with periphery.
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Fig. 7A —Long-term sequelae of hepatic abscesses in chronic
granulomatous disease (CGD). Calcifications scattered within hepatic
parenchyma of different patients with CGD. 37-year-old man with punctate
calcifications near dome of liver because of previous abscess associated with
scarring.
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Fig. 7B —Long-term sequelae of hepatic abscesses in chronic
granulomatous disease (CGD). Calcifications scattered within hepatic
parenchyma of different patients with CGD. 39-year-old man with scattered
punctate calcifications without scarring.
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Fig. 7C —Long-term sequelae of hepatic abscesses in chronic
granulomatous disease (CGD). Calcifications scattered within hepatic
parenchyma of different patients with CGD. 12-year-old boy also with scattered
punctate calcifications, indicating this process can occur early in life.
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Fig. 7D —Long-term sequelae of hepatic abscesses in chronic
granulomatous disease (CGD). Calcifications scattered within hepatic
parenchyma of different patients with CGD. 39-year-old man showing masslike
calcifications within liver at site of previous abscess.
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Copyright © 2006 by the American Roentgen Ray Society.
