Congestive Hepatopathy: Pathophysiology, Workup, and Imaging Findings with Pathologic Correlation

IF 5.2 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiographics Pub Date : 2024-04-11 DOI:10.1148/rg.230121

Marta Flory, Khaled M. Elsayes, Ania Kielar, Carla Harmath, Jonathan R. Dillman, Mostafa Shehata, Natally Horvat, Marta Minervini, Robert Marks, Aya Kamaya, Amir A. Borhani

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引用次数: 0

Abstract

Liver congestion is increasingly encountered in clinical practice and presents diagnostic pitfalls of which radiologists must be aware. The complex altered hemodynamics associated with liver congestion leads to diffuse parenchymal changes and the development of benign and malignant nodules. Distinguishing commonly encountered benign hypervascular lesions, such as focal nodular hyperplasia (FNH)–like nodules, from hepatocellular carcinoma (HCC) can be challenging due to overlapping imaging features. FNH-like lesions enhance during the hepatic arterial phase and remain isoenhancing relative to the background liver parenchyma but infrequently appear to wash out at delayed phase imaging, similar to what might be seen with HCC. Heterogeneity, presence of an enhancing capsule, washout during the portal venous phase, intermediate signal intensity at T2-weighted imaging, restricted diffusion, and lack of uptake at hepatobiliary phase imaging point toward the diagnosis of HCC, although these features are not sensitive individually. It is important to emphasize that the Liver Imaging Reporting and Data System (LI-RADS) algorithm cannot be applied in congested livers since major LI-RADS features lack specificity in distinguishing HCC from benign hypervascular lesions in this population. Also, the morphologic changes and increased liver stiffness caused by congestion make the imaging diagnosis of cirrhosis difficult. The authors discuss the complex liver macro- and microhemodynamics underlying liver congestion; propose a more inclusive approach to and conceptualization of liver congestion; describe the pathophysiology of liver congestion, hepatocellular injury, and the development of benign and malignant nodules; review the imaging findings and mimics of liver congestion and hypervascular lesions; and present a diagnostic algorithm for approaching hypervascular liver lesions.

^©RSNA, 2024

Test Your Knowledge questions for this article are available in the supplemental material.

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充血性肝病：病理生理学、检查和影像学发现与病理学相关性

在临床实践中，肝脏充血的情况越来越多，这给诊断带来了隐患，放射科医生必须对此有所了解。与肝充血相关的复杂血流动力学改变会导致肝实质弥漫性改变，并形成良性和恶性结节。由于成像特征的重叠，将常见的良性高血管病变（如局灶性结节增生（FNH）样结节）与肝细胞癌（HCC）区分开来可能具有挑战性。FNH样病变在肝动脉期增强，相对于背景肝实质保持等度增强，但在延迟期成像时很少出现冲出，这与HCC可能出现的情况类似。异质性、存在增强囊、门静脉期冲出、T2 加权成像信号强度中等、弥散受限以及肝胆期成像缺乏摄取等特征都指向 HCC 诊断，尽管这些特征单独来看并不敏感。需要强调的是，肝脏成像报告和数据系统（LI-RADS）算法不能应用于充血肝脏，因为在这类人群中，LI-RADS 的主要特征在区分 HCC 和良性高血管病变方面缺乏特异性。此外，充血导致的形态变化和肝脏硬度增加也给肝硬化的影像诊断带来困难。作者讨论了肝脏充血背后复杂的肝脏宏观和微观血流动力学；提出了一种更具包容性的肝脏充血方法和概念；描述了肝脏充血、肝细胞损伤以及良性和恶性结节发生的病理生理学；回顾了肝脏充血和血管过度病变的影像学发现和模拟；并提出了一种处理肝脏血管过度病变的诊断算法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiographics 医学-核医学

CiteScore

8.20

自引率

5.50%

发文量

224

审稿时长

4-8 weeks

期刊介绍： Launched by the Radiological Society of North America (RSNA) in 1981, RadioGraphics is one of the premier education journals in diagnostic radiology. Each bimonthly issue features 15–20 practice-focused articles spanning the full spectrum of radiologic subspecialties and addressing topics such as diagnostic imaging techniques, imaging features of a disease or group of diseases, radiologic-pathologic correlation, practice policy and quality initiatives, imaging physics, informatics, and lifelong learning. A special issue, a monograph focused on a single subspecialty or on a crossover topic of interest to multiple subspecialties, is published each October. Each issue offers more than a dozen opportunities to earn continuing medical education credits that qualify for AMA PRA Category 1 CreditTM and all online activities can be applied toward the ABR MOC Self-Assessment Requirement.