| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 All authors: Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Received March 10, 2000;
accepted after revision May 26, 2000.
Address correspondence to H. Okazaki.
Abstract
 Top Abstract IntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
MATERIALS AND METHODS. The MR examinations of 53 patients with cirrhosis (38 men and 15 women; age range, 28-73 years) caused by hepatitis B (n = 16), hepatitis C (n = 18), or alcohol abuse (n = 19) were retrospectively reviewed independently by two radiologists. The following MR features were assessed by each radiologist independently: volume indexes of the spleen and of each liver segment (based on 3-axis measurements), the nodularity of the surface, and the presence of regenerative nodules, ascites, iron or fat deposition, varices or collateral veins, the right posterior hepatic notch, and an expanded gallbladder fossa.
RESULTS. The mean values of the volume index of the caudate lobe were significantly greater (p < 0.0001) in the group with alcoholic cirrhosis than those in the group with viral cirrhosis. The frequency of visualization of the right posterior hepatic notch in the patients with alcoholic cirrhosis was significantly greater (p < 0.05) than that in the patients with viral cirrhosis. The size of regenerative nodules of the liver in the patients with cirrhosis caused by hepatitis B was significantly greater (p < 0.02) than that in the patients with alcoholic cirrhosis.
CONCLUSION. Enlargement of the caudate lobe and the presence of the right posterior hepatic notch on MR imaging are more frequent findings of alcoholic cirrhosis than of virus-induced cirrhosis.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
MR Imaging Technique
All examinations were performed on a 1.5-T MR imaging unit (Magnetom
Vision; Siemens, Erlangen, Germany) using a phased array torso coil. All
patients underwent axial T1-weighted and T2-weighted MR imaging, T1-weighted
imaging included the following two sequences: in-phase gradient-echo imaging
(TR range/TE, 180-210/4.4 or 9.0; flip angle, 90°) and opposed-phase
gradient-echo imaging (180-210/2.2 or 7.0; flip angle, 90°). T2-weighted
images were obtained by breath-hold fast spin-echo sequences (TR
range/effective TE, 2500-3000/70 or 93). Dynamic in-phase gradient-echo images
were obtained before and after an antecubital IV bolus injection of 0.1
mmol/kg of body weight of gadopentetate dimeglumine (Magnevist; Schering,
Berlin, Germany) followed by a 20-mL flush of sterile normal saline in all
patients. Contrast-enhanced imaging was initiated immediately after completion
of the saline injection and was repeated two or three times within 3 min of
each other to obtain multiphase images (arterial, portal, and delayed phases).
Finally, delayed-phase contrast-enhanced gradient-echo images were acquired,
with or without fat suppression, 4-10 min after injection of contrast
material. The imaging matrix was 256 x 128, 256 x 160, or 256
x 192 pixels for gradient-echo images and 256 x 192 pixels for
breath-hold fast spin-echo images, usually with a rectangular field of view
(to reduce the number of phase-encoding acquisitions). The section thickness
was 8-10 mm with an intersection gap of 2 mm or smaller.
Imaging Interpretation
Two radiologists experienced in hepatic MR imaging reviewed all
examinations retrospectively and scored the findings independently without
knowledge of patient status. The following measurements were obtained and
categoric findings were documented: three-axis measurements
[11,
16] of the spleen and of each
segment of the liver, the presence of a nodular surface, the presence of
ascites, the visualization of regenerative nodules, the presence of hepatic
iron or fat deposition, the presence of varices or collateral vessels, the
presence of the right posterior hepatic notch
(Fig. 1), and the presence of
an expanded gallbladder fossa
[17].
|
For the measurement of the liver, hepatic segments were classified as right anterior, right posterior, medial left, lateral left, or caudate. The measurements of the long and short axes of the spleen and each liver segment were obtained from axial images. Cephalocaudal measurements were obtained by calculating length from axial images with the finding. These measurements were used to calculate the volume indexes. Volume indexes were calculated as a simple product of these three diameters for each liver segment and for the spleen. These indexes do not provide an accurate measurement of volumes but give a number that is related to the size of each segment. All transverse measurements of the liver segments were made approximately at or less than 1 cm below the bifurcation of the main portal vein.
Measurements of the spleen were obtained at the level of the splenic hilum.
The liver was assessed visually: the nodularity of the surface, the presence
of ascites, and iron or fat deposition were scored on a severity scale (none =
0, mild = 1, moderate = 2, severe = 3). Fat deposition was assessed by
comparing opposed-phase images with in-phase images. Regenerative nodules were
evaluated on T2-weighted images, contrast-enhanced dynamic images, or both.
Regenerative nodules were defined as hypointense lesions with hyperintense
septa on T2-weighted and contrast-enhanced dynamic images. Visualization of
regenerative nodules was scored on the basis of three grades (none = 0, subtle
= 1, definite = 2). If regenerative nodules were identified in the liver, the
size of regenerative nodules was scored (<8 mm = 0, 
8 mm = 1).
Additionally, the presence of iron or fat deposition in regenerative nodules
and the visibility of internodular band were scored (no = 0, yes = 1). Varices
and collateral vessels were evaluated on contrast-enhanced dynamic images. The
presence of varices or collateral vessels was recorded (none = 0, present = 1)
for the following five locations: gastroesophageal, paraesophageal,
splenorenal, and paraumbilical sites and other locations. The total number of
sites, varying from none to five, at which varices or collateral vessels were
visible was then scored. The presence of the right posterior hepatic notch and
of an expanded gallbladder fossa was also recorded (none = 0, present = 1).
When the opinions of two observers were inconsistent in the evaluation of the
categoric findings, a third observer served as the tiebreaker, and a majority
opinion was then used as the final decision. Regarding the MR measurements,
averaged values of the two observers were used for data analysis.
Statistical Analysis
Results were expressed as means plus or minus the standard error. The
unpaired Student's t test was used to analyze multiple MR
measurements and findings between the group with viral cirrhosis and the group
with alcoholic cirrhosis. A p value of less than 0.05 was considered
to indicate a statistically significant difference.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
|
|
|
|
|
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
In this study, the frequency of visualization of the right posterior hepatic notch in the patients with alcoholic cirrhosis was significantly greater than that in the patients with viral cirrhosis. The right posterior hepatic notch may be a consequence of hypertrophy of the caudate lobe and atrophy of the right hepatic lobe, because the caudate lobe of the patients with alcoholic cirrhosis tended to be larger than that of the patients with viral infection. This finding is simple to evaluate in clinical practice, compared with quantitative measurements, and may reflect considerable enlargement of the caudate lobe in patients with alcoholic cirrhosis. The diffuse morphologic changes present in cirrhotic livers can distort the liver contour and parenchymal architecture. Ohtomo et al. [8, 15] reported that wedge-shaped fibrosis was seen most frequently in patients with alcoholic cirrhosis (19% [18/97]) in contrast to patients with cirrhosis caused by viral infection (6% [6/100]). The reason for this difference is unclear; however, alcohol is known to produce distinct histologic fibrosis in the liver. Long-standing inflammation with obstruction of the biliary system may cause regional fibrosis and compensatory hypertrophy of other liver segments and may account for the different distribution seen in alcohol-related cirrhosis.
The configuration of the margin of the liver corresponds to the size of the underlying regenerative nodules [20,21,22]. A margin that is smooth or deformed by multiple small nodules is typical of micronodular cirrhosis; a coarse nodularity of the margin is the result of macronodular cirrhosis. In this study, no significant difference existed between the two groups regarding nodularity of the liver surface. However, the regenerative nodules of the liver in the patients with hepatitis B—induced cirrhosis were significantly larger than those in the patients with alcoholic cirrhosis. Several investigators have proved using laparoscopy that the regenerative nodules in cirrhosis caused by hepatitis B tended to be larger than those in cirrhosis resulting from other causes. Our results suggest that the size and appearance of regenerative nodules can be noninvasively assessed with MR imaging. Ito et al. [20] reported that the occurrence of hepatocellular carcinoma may be associated causally with iron deposition in large regenerative nodules in patients with cirrhosis. Therefore, MR imaging may be a useful modality for assessing regenerative nodules as a possible risk factor for the development of hepatocellular carcinoma.
This study has several limitations. The first limitation concerns the small size of our study population. A larger series might have revealed additional MR features for differentiation between viral and alcoholic cirrhosis. Second, our study was limited to patients who were from a particular practice and who had cirrhosis caused entirely by viral hepatitis or alcohol abuse. Patients with primary sclerosing cholangitis and those with Budd-Chiari syndrome in which the caudate lobe tends to enlarge were excluded from our study population. Dodd et al. [13] reported that the caudate lobe was the most frequent region of hypertrophy in patients with end-stage cirrhosis caused by primary sclerosing cholangitis. In addition, patients with viral and possible alcoholic cirrhosis or with a cryptic cause for their liver disease were not included in this study. It is unclear how the addition of patients with cirrhosis resulting from these other causes would have affected our results. Further studies may be necessary. The third limitation of this study is the lack of pathologic confirmation of cirrhosis in most patients because liver biopsy was obviated on the basis of a clinical diagnosis of cirrhosis. Pathologic examination can evaluate the severity of fibrosis and the activity of hepatitis in cirrhotic livers. However, in clinical practice, it is important to evaluate not only hepatic conditions but also extrahepatic conditions such as varices. Finally, MR measurements and findings in this study can also be assessed by means of helical CT, although MR imaging may offer a more extensive and comprehensive evaluation of cirrhosis, including findings such as minimal ascites, fat and iron deposition, and detection of regenerative nodules and dysplastic nodules.
In conclusion, enlargement of the caudate lobe and the presence of the right posterior hepatic notch on MR imaging are more frequent findings in alcoholic cirrhosis than that in viral cirrhosis. Conversely, regenerative nodules tend to be larger in patients with hepatitis B—induced cirrhosis than in those with alcoholic cirrhosis.
|
TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferences |
|---|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  K. C. Tan The Right Posterior Hepatic Notch Sign Radiology, July 1, 2008; 248(1): 317 - 318. [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. d. A. Bezerra, G. D'Ippolito, R. P. Caldana, D. D. Leopoldino, G. R. Batista, D. R. Borges, G. de Jesus Lopes Filho, and M. Ahmed Differentiating Cirrhosis and Chronic Hepatosplenic Schistosomiasis Using MRI Am. J. Roentgenol., March 1, 2008; 190(3): W201 - W207. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Vilgrain, B. Condat, C. Bureau, A. Hakime, A. Plessier, D. Cazals-Hatem, and D. C. Valla Atrophy-Hypertrophy Complex in Patients with Cavernous Transformation of the Portal Vein: CT Evaluation Radiology, October 1, 2006; 241(1): 149 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. R. Bader, K. L. Beavers, and R. C. Semelka MR Imaging Features of Primary Sclerosing Cholangitis: Patterns of Cirrhosis in Relationship to Clinical Severity of Disease Radiology, March 1, 2003; 226(3): 675 - 685. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Awaya, D. G. Mitchell, T. Kamishima, G. Holland, K. Ito, and T. Matsumoto Cirrhosis: Modified Caudate-Right Lobe Ratio Radiology, September 1, 2002; 224(3): 769 - 774. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
