From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.).
Radiographics. 2023 Sep;43(9):e230043. doi: 10.1148/rg.230043.
Cirrhosis is the end stage of chronic liver disease and causes architectural distortion and perfusional anomalies. It is a major risk factor for developing hepatocellular carcinoma (HCC). Common disease entities in noncirrhotic livers, such as hemangiomas, can be rare in cirrhotic livers, and benign entities such as confluent hepatic fibrosis and focal nodular hyperplasia-like lesions may mimic the appearance of malignancies,. HCC usually has typical imaging characteristics, such as the major features established by the Liver Imaging Reporting and Data System. However, HCC can also have a spectrum of atypical or uncommon appearances, such as cystic HCC, hypovascular HCC, or macroscopic fat-containing HCC. HCCs with certain genetic mutations such as -mutated HCC can harbor unique imaging features not seen in other types of HCC. In addition, malignancies that are less common than HCC, such as cholangiocarcinoma and metastases, which can be difficult to differentiate, can still occur in cirrhotic livers. Atypical imaging features of benign and malignant lesions can be challenging to accurately diagnose. Therefore, familiarity with these features and an understanding of the prevalence of disease entities in cirrhotic livers are key in the daily practice of radiologists for evaluation of cirrhotic livers. The authors illustrate the typical and atypical features of benign and malignant lesions in cirrhosis and discuss the technical pitfalls and unique advantages associated with various imaging modalities in assessing cirrhotic livers, including noncontrast and contrast-enhanced US, CT, and MRI. Work of the U.S. Government published under an exclusive license with the RSNA. Quiz questions for this article are available in the supplemental material.
肝硬化是慢性肝病的终末期阶段，会导致肝脏结构变形和血流异常。它是肝细胞癌（HCC）发展的主要危险因素。在非肝硬化肝脏中常见的疾病实体，如血管瘤，在肝硬化肝脏中可能很少见，而良性实体，如融合性肝纤维化和局灶性结节性增生样病变，可能会模拟恶性肿瘤的外观。HCC 通常具有典型的影像学特征，例如由肝脏成像报告和数据系统确立的主要特征。然而，HCC 也可能具有一系列非典型或不常见的表现形式，如囊性 HCC、少血供 HCC 或含大量脂肪的 HCC。具有某些基因突变（如-β-catenin 突变）的 HCC 可能具有在其他类型 HCC 中未见的独特影像学特征。此外，在肝硬化肝脏中仍可能发生比 HCC 少见的恶性肿瘤，如胆管癌和转移瘤，这些恶性肿瘤难以鉴别。良性和恶性病变的非典型影像学特征可能难以准确诊断。因此，熟悉这些特征以及了解肝硬化肝脏中疾病实体的患病率是放射科医生日常评估肝硬化肝脏的关键。作者说明了肝硬化中良性和恶性病变的典型和非典型特征，并讨论了各种影像学方式在评估肝硬化肝脏方面的技术缺陷和独特优势，包括非增强和增强超声、CT 和 MRI。本文相关的美国政府工作是以与 RSNA 的专有许可证形式发布的。本文的测验问题可在补充材料中找到。
