HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colagrande, S. Articles by Ragozzino, A. Search for Related Content PubMed PubMed Citation Articles by Colagrande, S. Articles by Ragozzino, A. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Transient Hepatic Intensity Differences: Part 2, Those Not Associated with Focal Lesions

¹ Department of Clinical Physiopathology, Section of Radiodiagnostics, University of Florence, Viale Morgagni 85, Florence 50134, Italy.
² Section of Radiodiagnostics, Ospedale SM Grazie Pozzuoli, Naples, Italy.

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —58-year-old man with liver cirrhosis and sectorial transient hepatic intensity differences due to portal thrombosis secondary to hepatocellular carcinoma radiofrequency ablation. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase image (TR/TE, 146/2) shows wedge-shaped arterial phenomenon (arrowhead) caused by portal branch thrombosis (arrow). Note also another hypointense treated nodule in anterior portion of liver segment V, with peripheral enhanced area due to arterial reaction.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —63-year-old man with sectorial transient hepatic intensity difference in right hepatic lobe caused by congenital arterioportal shunt. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show arterial phenomenon (arrowheads) caused by arterioportal shunt (arrow, A).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —63-year-old man with sectorial transient hepatic intensity difference in right hepatic lobe caused by congenital arterioportal shunt. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show arterial phenomenon (arrowheads) caused by arterioportal shunt (arrow, A).

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —42-year-old woman with sectorial transient hepatic intensity differences in right hepatic lobe caused by posttraumatic arterioportal shunt. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (TR/TE, 146/2) shows wedge-shaped arterial phenomenon (arrowheads) caused by arterioportal shunt (arrow) due to percutaneous hepatic biopsy performed 1 month earlier.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —61-year-old man with postbiopsy focal cholangitis and sectorial transient hepatic intensity differences. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (TR/TE, 146/2) shows wedge-shaped arterial phenomenon (arrowhead) caused by peribiliary plexus impairment secondary to dilation of inflamed subsegmental biliary vessels (arrow).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —57-year-old woman with cholangitis and nonsectorial transient hepatic intensity differences in hepatic dome. Axial T2-weighted MR image (TR/TE, 12,000/82) shows localized dilation of bile ducts (arrow). Note small perihepatic effusion.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —57-year-old woman with cholangitis and nonsectorial transient hepatic intensity differences in hepatic dome. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (146/2) show further appearance of arterializations with biliary vessel disease: peribiliary (arrows, B), distributed along dilated biliary vessels, and pseudoglobular, mimicking a focal lesion (arrowhead, C).

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —57-year-old woman with cholangitis and nonsectorial transient hepatic intensity differences in hepatic dome. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (146/2) show further appearance of arterializations with biliary vessel disease: peribiliary (arrows, B), distributed along dilated biliary vessels, and pseudoglobular, mimicking a focal lesion (arrowhead, C).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —69-year-old man with postsurgical subcapsular collection and polymorphous transient hepatic intensity differences. Axial T2-weighted MR image (TR/TE, 12,000/84) reveals hyperintense collection (arrow) beneath Glisson's capsule, causing compression on adjacent marginal liver parenchyma.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —69-year-old man with postsurgical subcapsular collection and polymorphous transient hepatic intensity differences. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (146/2) shows polymorphous arterial phenomenon (arrowheads) laterally positioned to hypointense collection and caused by extrinsic compression of liver surface.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —40-year-old man with polymorphous transient hepatic intensity differences due to anomalous venous supply and drainage by right gastric vein. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show polygonal arterial phenomenon in segment IV (arrowheads).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —40-year-old man with polymorphous transient hepatic intensity differences due to anomalous venous supply and drainage by right gastric vein. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show polygonal arterial phenomenon in segment IV (arrowheads).

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —56-year-old woman with segmental localized steatosis in liver segment IV due to persistent polymorphous perfusion alterations. Axial gradient-echo T1-weighted (TR/TE, 216/1.5) (A) and axial T2-weighted (872/210) (B) MR images show signal intensity variation of segment IV (arrows) with respect to surrounding liver parenchyma.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —56-year-old woman with segmental localized steatosis in liver segment IV due to persistent polymorphous perfusion alterations. Axial gradient-echo T1-weighted (TR/TE, 216/1.5) (A) and axial T2-weighted (872/210) (B) MR images show signal intensity variation of segment IV (arrows) with respect to surrounding liver parenchyma.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —56-year-old woman with segmental localized steatosis in liver segment IV due to persistent polymorphous perfusion alterations. Axial iodinated contrast-enhanced arterial phase helical CT image better shows relative hypodensity in segment IV (arrow) caused by segmental fat accumulation secondary to persistent hemodynamic changes.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —63-year-old woman with gallstone causing inflammatory changes, main biliary duct compression (Mirizzi syndrome), and related polymorphous transient hepatic intensity differences. Axial T2-weighted MR image (TR/TE, 12,000/84) reveals large calculus lodged in gallbladder (arrow), wall thickening, and slight parenchymal hyperintensity due to inflammation.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —63-year-old woman with gallstone causing inflammatory changes, main biliary duct compression (Mirizzi syndrome), and related polymorphous transient hepatic intensity differences. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (146/2) shows wide arterial phenomenon caused by spread of inflammatory mediators (arrowheads).

View larger version (173K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —60-year-old woman with previous hepatocellular carcinoma treated with radiofrequency ablation and polymorphous transient intensity difference in right hepatic lobe. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show irregularly shaped arterial phenomenon (arrowhead, B) positioned laterally to large hypointense lesion that is outcome of radiofrequency ablation (arrow).

View larger version (171K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —60-year-old woman with previous hepatocellular carcinoma treated with radiofrequency ablation and polymorphous transient intensity difference in right hepatic lobe. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show irregularly shaped arterial phenomenon (arrowhead, B) positioned laterally to large hypointense lesion that is outcome of radiofrequency ablation (arrow).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —65-year-old woman with focal triangular steatosis in liver segment VIII that represents end stage of previous persistent sectorial perfusion alterations caused by hepatic biopsy. Steatosis represents the final outcome of a persistent arterial phenomenon: It may appear to be either irregular (Figs. 10A and 10B) or regular and sectorial, depending on characteristics of portal vessel damage or injury. Axial gradient-echo T1-weighted (TR/TE, 216/1.5) unenhanced (A) and axial T1-weighted (216/1.5) gadolinium-enhanced (B) arterial phase MR images show slightly wedge-shaped hyperintensity compared with surrounding parenchyma and relatively wedge-shaped hypoenhancing area, respectively (arrows).

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —65-year-old woman with focal triangular steatosis in liver segment VIII that represents end stage of previous persistent sectorial perfusion alterations caused by hepatic biopsy. Steatosis represents the final outcome of a persistent arterial phenomenon: It may appear to be either irregular (Figs. 10A and 10B) or regular and sectorial, depending on characteristics of portal vessel damage or injury. Axial gradient-echo T1-weighted (TR/TE, 216/1.5) unenhanced (A) and axial T1-weighted (216/1.5) gadolinium-enhanced (B) arterial phase MR images show slightly wedge-shaped hyperintensity compared with surrounding parenchyma and relatively wedge-shaped hypoenhancing area, respectively (arrows).

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11C —65-year-old woman with focal triangular steatosis in liver segment VIII that represents end stage of previous persistent sectorial perfusion alterations caused by hepatic biopsy. Steatosis represents the final outcome of a persistent arterial phenomenon: It may appear to be either irregular (Figs. 10A and 10B) or regular and sectorial, depending on characteristics of portal vessel damage or injury. Axial helical CT image confirms triangular hypodense area (arrow) in segment VIII.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11D —65-year-old woman with focal triangular steatosis in liver segment VIII that represents end stage of previous persistent sectorial perfusion alterations caused by hepatic biopsy. Steatosis represents the final outcome of a persistent arterial phenomenon: It may appear to be either irregular (Figs. 10A and 10B) or regular and sectorial, depending on characteristics of portal vessel damage or injury. Axial sonogram (convex, obtained with 3.5-MHz probe) shows sectorial triangular area that is hyperechoic with respect to surrounding liver parenchyma (arrow).

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —23-year-old man with hepatic vein obstruction (Budd-Chiari syndrome) associated with a diffuse patchy pattern of transient hepatic intensity differences. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (TR/TE, 216/1.5) reveals diffuse marble aspect of liver parenchyma caused by sinusoidal obstruction and consequent transsinusoidal plexus activation. Hypointense oval structure in caudate lobe is due to obstructed transjugular intrahepatic portosystemic stent-shunt.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A —44-year-old woman with portal trunk and right portal branch obstruction due to central cholangiocellular carcinoma and related diffuse central-peripheral pattern of transient hepatic intensity difference. Axial T2-weighted MR image (TR/TE, 12,000/84) reveals hyperintense mass (arrow) causing portal blood flow obstruction before sinusoids.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B —44-year-old woman with portal trunk and right portal branch obstruction due to central cholangiocellular carcinoma and related diffuse central-peripheral pattern of transient hepatic intensity difference. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (146/2) shows diffuse peripheral enhancement of liver parenchyma (arrowheads) and relative hypoperfusion of central areas (arrows).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13C —44-year-old woman with portal trunk and right portal branch obstruction due to central cholangiocellular carcinoma and related diffuse central-peripheral pattern of transient hepatic intensity difference. Axial gradient-echo T1-weighted gadolinium-enhanced portal venous phase MR image (146/2) confirms enhanced mass (arrow) and shows central-peripheral pattern is visible but fading (not so evident as on arterial phase image).

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —51-year-old man with obstruction of main bile duct due to pancreatic head carcinoma (not shown), dilation of entire biliary tree, and diffuse peribiliary pattern of transient hepatic intensity difference. Axial T2-weighted MR image (TR/TE, 12,000/84) shows hyperintense dilated biliary vessels (long-standing biliary obstruction) (arrow) determining impairment of peribiliary plexus.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —51-year-old man with obstruction of main bile duct due to pancreatic head carcinoma (not shown), dilation of entire biliary tree, and diffuse peribiliary pattern of transient hepatic intensity difference. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (146/2) reveal diffuse cylindric enhancement of liver parenchyma spread along dilated bile ducts (arrowheads).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14C —51-year-old man with obstruction of main bile duct due to pancreatic head carcinoma (not shown), dilation of entire biliary tree, and diffuse peribiliary pattern of transient hepatic intensity difference. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (146/2) reveal diffuse cylindric enhancement of liver parenchyma spread along dilated bile ducts (arrowheads).

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati