Portal Vein Thrombosis

The etiology of portal vein thrombosis falls into the Virchow trias, comprising reduced blood flow within the vessel, changes in the consistency of blood which affects flow properties, and pathologies of the vessel wall. Thus, etiological factors of portal vein thrombosis are slow flow secondary to cirrhosis, obstruction of the vessel by porto-hepatic lymphadenopathy, direct invasion by cancer, inflammatory changes secondary to pancreatitis, sclerosing cholangitis, abdominal infections,...

Percutaneous Ethanol Injection PEI

Several studies have shown that PEI is an effective alternative to surgery in cases of small HCC. Tumor cell destruction is achieved by alcohol-induced immediate coagulative necrosis of the affected tissue as a consequence of protein denatu-ration and cellular dehydration 16 . The maximum diameter of HCC lesions that can be treated successfully by PEI is approximately 3 cm. Larger lesions are less amenable to treatment with this technique because the ethanol distributes less homogeneously,...

Hodgkins and Non Hodgkins Lymphoma NHL Burkitt Lymphoma

Primary lymphoma of the liver is a very rare malignancy with a frequency of about 0.016 of all cases of NHL. The most frequent form of primary liver lymphoma is diffuse large B-cell NHL which occurs primarily in immunodeficient patients. To determine the primary nature of a hepatic lesion, systemic lymphoproliferative disease should first be ruled out. Secondary liver involvement as a result of Hodgkin's lymphoma and NHL is more frequent. In advanced cases the incidence varies from 25-50 ....

Arterio Venous Malformations

Arterio-venous (AV) malformations of the liver are rare and are caused either iatrogenically in liver biopsy and liver surgery, or are distributed diffusely in patients with hereditary hemorrhagic teleangiectasia (HHT Osler's disease) 23 . In general, AV-malformations may occur between the hepatic artery and the hepatic vein, as well as between the hepatic artery and the portal-venous system. Typical findings on dynamic MR images of the liver for singular AV-malformations post-biopsy or surgery...

Choledochal Cyst and Cystic Dilatation of the Bile Duct

Choledochal cysts are anomalies of the biliary system characterized by dilatation of the extra- or intrahepatic bile ducts (see Chapt. 7,Imaging of the Biliary Tree and Gallbladder Diseases, section 7.2.2.1,Choledochal Cyst and Cystic Dilatation of the Bile Duct). Although choledochal cysts may become evident at any age, diagnosis is made within the first ten years of age in about 60 of cases. They are more frequent in females than in males with a ratio of about 4 1. In newborns and infants,...

Hepatoblastoma HB

Hepatoblastoma

HB is the most common primary hepatic malignancy in children and represents approximately 45 of all pediatric liver neoplasms. It is generally detected in children younger than five years of age in roughly 66 of cases the mean age for detection is one year. From an etiological point of view, a correlation has been observed with prematurity, with a gestational age of < 37 weeks, and with a birth weight of < 1000 g. Other risk factors are trisomy 18, hemi-hypertrophy, Beckwith-Wiede-mann...

Undifferentiated Embryonal Sarcoma UES

UES was first recognized as a clinical pathological entity in 1978 93 . This neoplasm had previously been attributed various terms, including embryonal sarcoma, primary sarcoma, fibromyxosarcoma, and malignant mesenchymoma. Although rare, UES is the fourth most frequent hepatic neoplasm in infancy after HB, hemangioendothelioma and HCC. UES occurs predominantly in children between six and ten years of age 22 , although it has also been known to affect adults 9 . The incidence is almost the same...

Segmental Anatomy of the Liver

Liver Segments Mri

The segmental anatomy of the liver is based on the vascular supply and drainage of the parenchyma. Until recently, classification of the liver lobes and sub-segments in the international literature was not uniform. Whereas British and American publications tended to follow the terminology of Goldsmith and Woodburne 8 , in Europe and Japan the most common nomenclature used by radiologists and surgeons was based on the description of Couinaud and Bismuth 3,5 .According to the terminology of...

Siderosis

In patients suffering from transfusional siderosis, the liver shows a similar decrease in SI as that seen in hemochromatosis. However, transfusional siderosis can easily be distinguished by examination of the SI of the spleen and pancreas. While the spleen demonstrates decreased SI in patients with transfusional siderosis, it usually does not show any SI decrease in cases of hemochromatosis. In contrast, the pancreas usually demonstrates a significant drop of SI in cases of hemochromatosis,but...

Hepatic Angiosarcoma HAS

HAS is an extremely rare neoplasm in pediatric subjects, with only a few dozen cases having been reported. HAS is frequently considered to be the malignant form of iHe 1 . In this regard, exposure to comparatively high levels of arsenic, both during pregnancy and in the postnatal period, has been shown to contribute to the onset of HAS in the presence of IHE 26 . The mean age of onset of HAS in children is four years. Histologically, this neoplasm is composed of malignant endothelial cells...

Techniques in Pediatric Liver Imaging

The results of pediatric liver CT and MR imaging depend mainly on good sedation and thus an interdisciplinary approach to evaluation is necessary. Significant changes in the examination method are needed in both helical CT and MRI when dealing with pediatric patients. The CT protocol typically requires image acquisition during the arterial and portal-venous phases and also, whenever necessary, the equilibrium phase. The slice thickness is typically 5 mm or less with a pitch ranging from 1 to...

Epithelioid Hemangioendothelioma

Eus And Hyperechoic Liver Lesions

Epithelioid hemangioendothelioma (EHE) is a rare malignant hepatic neoplasm of vascular origin that develops in adults. It is more common in women than in men. No risk factors or specific causes have been identified 102 . Macroscopically, two different types of EHE have been described 27 . The nodular type represents an early manifestation of the disease. In the majority of cases there are multiple nodular lesions ranging in size from 1 to a maximum of 3 cm. Frequently, the nodules are found in...

Surgical Resection

The role of surgical resection in the treatment of hepatic metastases of primary colorectal carcinomas is well-recognized and may contribute to the five year survival of 25 to 37 of affected patients 9 . However, the approach to the surgical treatment of hepatic metastases from primary tumors other than colorectal cancer is less obvious, and is highly dependent upon the type of primary tumor. Nevertheless, a reported five year survival rate of 21 after resection of metastases from...

References

Angiosarcoma of the liver and spleen in an infant. Pediatr Pathol Lab Med 1985 4 331-339 2. Apicella PL, Mirowitz SA, Weinreb JC. Extension of vessels through hepatic neoplasms MR and CT findings. Radiology 1994 191 135-136 3. Babbitt DP. Congenital choledochal cyst new etio-logic concept based on anomalous relationships of common bile duct and pancreatic bulb. Ann Radiol 1969 12 231-240 4. Bartolozzi C, Cioni D, Donati F, et al. Focal liver lesions MR...

Biliary Atresia

The causes and clinical presentation of biliary atresia in pediatric subjects are as described in Chapter 7, Imaging of the Biliary Tree and Gallbladder Diseases, section 7.2.2.3,Biliary Atresia. Most infants with biliary atresia are chemically jaundiced from birth. Jaundice is obstructive in type, with dark urine and pale stools. Initially, the infants have hepatomegaly with minimal or no splenomegaly. Later, progressive fibrosis and subsequent cirrhosis (Fig. 27) lead to all the complications...

Mesenchymal Hamartoma

Liver Doctor

Mesenchymal hamartoma is an uncommon lesion accounting for about 10 of all childhood liver tumors. It most likely represents a localized abnormality of ductal plate development that precedes birth it is therefore usually considered a benign cystic developmental lesion rather than a true neoplasm. It occurs almost exclusively in young children (average age 15 months) with a male to female ratio of approximately 2 1. Children typically present with progressive abdominal enlargement, and an...

Metastases

Metastases are the most common malignant focal liver lesions in the non-cirrhotic liver. However, metastases are relatively uncommon in the cirrhotic liver where HCC is more frequent. The liver is second only to regional lymph nodes as a site of metastatic disease autopsy series of patients with primary tumors indicate that at the time of death, approximately 50 of patients have metastatic disease of the liver 78 . Although metastases can develop in the liver via hematogenous spread from most...

Storage Disease Metabolic Diseases

A considerable number of metabolic diseases cause liver injury in infants and children. In many cases, the liver is the sole organ clinically affected by the metabolic disease. In other metabolic diseases, other organs tissues are affected but liver disease still constitutes a major cause of morbidity and mortality. Some of the diseases are relatively common. For instance, a-1-antitrypsin deficiency affects approximately 1 in 1,800 live births, while the incidence of cystic fibrosis is as high...

Hepatocellular Carcinoma

HCC is the second most common malignant liver tumor of infancy. Whereas hepatoblastoma typically occurs in children under five years of age, HCC demonstrates two peak periods of onset, one between four and five years of age and the other between 12 and 14 years of age 74 . Etiological and predisposing factors for HCC include glycogenosis types I, III, IV, VI and IX, galac-tosemia, thyroxinosis, biliary cirrhosis secondary to atresia of the bile ducts, and hepatitis B or C viral infection. The...

Portal Hypertension

Portal hypertension is frequently a systemic complication of liver cirrhosis, however different pathologies such as obstruction at the post-sinusoidal (e.g. hepatic vein), sinusoidal (e.g. cirrhosis) or pre-sinusoidal (e.g. portal vein) level may also cause portal hypertension 27 . The most common cause of portal hypertension is liver cirrhosis. Associated complications include variceal bleeding, ascites and splenomegaly. A primary consequence of the increased pressure in the portal tract is...

Benign Focal Liver Lesions of Hepatocellular Origin

The cellular structure of FNH is similar to that of the normal hepatic parenchyma apart from the presence of an abnormal biliary system. Since FNH contains the same elements as normal liver but with a disordered architecture, it mimics the appearance of normal liver and may be difficult to detect using any of the imaging modalities without exogenous contrast agents. On unenhanced MR imaging, the lesion is iso- to hypointense compared to normal liver on T1-weighted images, frequently with a...

Mri Image Of A Human Polycystic Liver

Congenital hepatic fibrosis in polycystic kidney disease. In contrast to the situation in adult polycystic kidney disease, the liver is not affected by cysts in congenital fibrosis associated with infantile polycystic kidney disease. Images a-c show fibrosis of the liver with cirrhotic changes and dilatation of the peripheral bile ducts (arrows). Additionally, hypertrophy of Segment 1 and the left liver lobe can be noted. In (c), polycystic kidneys are displayed. These are better...

Contrast Agents for Liver MR Imaging

3.1.1 Non-Specific Gadolinium Chelates 3.1.2 Hepatocyte-Targeted Contrast Agents 3.1.3 Agents with Combined Extracellular and Hepatocyte-Specific Distribution 3.1.4 RES-Specific Contrast Agents 3.2 Injection Schemes for Liver MRI with Different Contrast Agents 3.3 Radiologic Classification of Focal Liver Lesions on Unenhanced and Contrast-Enhanced MRI The imaging evaluation of patients with suspected liver masses has three principal purposes evaluation of the intra- and extrahepatic extent of...

Hepatobiliary Rhabdomyosarcoma RMS

Although RMS is the most common neoplasm of the biliary tree in children, it is a rare disease, accounting for approximately 1 of all RMS in pedi-atric patients. RMS usually occurs in children of about three years of age and is rarely seen after the first decade of life. There may be a slight predominance among males 84 . Although the early histological classification of RMS was different in the United States 37 and Europe 12 , a universal classification now exists 66 . Hepatobiliary RMS in...

Clinical Implications

Mrv Brain Planning

3D CE MR portography permits accurate evaluation of the intra- and extrahepatic portal-venous system as well as the hepatic veins (Fig. 15). Due to the large field of view, the short time of acquisition, the lack of radiation, the non-invasive nature of the procedure and the low risk of complications, MR portography is regarded as superior to conventional catheter digital subtraction angiography (DSA). Clinical applications of 3D CE MR portography include the assessment of portal hypertension...

Thalassemia Macroscopic Image

Klatskin Tumor

Histology of hepatic adenoma arranged in plates that are two to three cells thick, separated by sinusoids Fig. 9. Histology of hepatic adenoma arranged in plates that are two to three cells thick, separated by sinusoids Fig. 10. Macroscopic aspect of liver adenoma with large intra-lesional hemorrhage Dysplastic focus is defined as congeries of hepato-cytes, measuring less than 1 mm in diameter, which show dysplasia but no histological signs of malignancy. Dysplastic foci generally occur...

Multimodality Treatment of Hepatic Lesions

Only about 30 of patients with hepatic metastat-ic disease are suitable for hepatic resection. The majority of patients with liver metastases or primary malignant liver tumors are not candidates for this therapeutic approach due to advanced hepatic tumor spread 1 . To overcome this dilemma, a multi-modality treatment approach involving combined surgical, interventional, focal ablative and chemotherapeutic methods has been proposed to achieve a better five year patient survival. With the...

Anatomy 721

Mri Having Problem

The liver is divided into the left and right lobe, and each lobe is divided into segments on the basis of its vascular anatomy and biliary drainage. The in-trahepatic bile ducts generally follow the internal hepatic segmental anatomy. In the left lobe, a left medial segment duct and a left lateral segment duct normally join to form the main left hepatic duct. The right hepatic duct branches near its origin at the common hepatic duct. Frequently, the right hepatic duct has a dorso-caudal branch,...

Budd Chiari Syndrome Acute Chronic

Budd Chiarisyndrome

Budd-Chiari syndrome is defined as an obstruction of the venous outflow from the sinusoidal bed of the liver. It leads to portal hypertension, ascites and progressive hepatic failure 57 . The treatment of Budd-Chiari syndrome depends on the cause of the obstruction and, hence, careful examination of the hepatic veins, the inferior caval vein (ICV) and the right atrium is necessary 37, 73 . For example, a membranous occlusion of the ICV is a common cause of obstruction in the Asian population....

Hereditary Haemorrhagic Telangiectasia HHT

HHT, also called Rendu-Osler-Weber disease or Osler's disease, is a vascular, hereditary, autosomic dominant disorder that occurs with a frequency of approximately 10-20 cases 100,000 15 . HHT is characterized by the presence of mucocutaneous or visceral angiodysplastic lesions, the latter most frequently seen in the liver, lung, brain, and gastrointestinal tract. Hepatic involvement accounts for 10-40 of cases and is characterized by the presence of intrahepatic shunts (arterioportal,...

Biliary Atresia Triangular Cord Sign

Triangular Cord

Same case as demonstrated in Fig. 9. MRCP demonstrates diffuse, hyperintense, round and cystic lesions, distributed in both lobes of the liver, with a flower tree appearance communication between sacculi and bile ducts (Fig. 11), which is positively demonstrated with Gd-BOPTA and other hepatobiliary contrast agents if contrast material is present within the sacculi and bile ducts during the hepatobiliary phase after administration (Fig. 12). Differential...

Images Anatomy For Mri Liver Contrast

Arterioportal Shunt Liver

HCC following treatment by RF ablation. On the pre-contrast CT scan (a) a well-defined, slightly hypodense nodule (arrow) surrounded by a hypodense rim is demonstrated in segment VII of the right liver lobe. During the arterial phase (b) after contrast medium administration a markedly hyperdense area (arrowhead) is seen near the necrotic lesion. This area becomes isodense in the portal venous phase (c) and represents an APS post RF ablation Fig. 27a-c....

Leiomyosarcoma Malignant Fibrous Histiocytoma and Fibrosarcoma

These neoplasms are very rare tumors of the liver which usually occur in patients between 40 and 60 years of age, without gender predilection. Leiomyosarcoma is the most common of these lesions but to date only 54 cases have been described in the literature 29 . Microscopically, leiomyosarcomas originate from mesenchymal elements of the liver, and are composed of large smooth muscle spindle cells. Malignant fibrous histiocytoma was first described as a separate pathologic entity in the 1960s...

Non Hodgkins Lymphoma and Hodgkins Disease

Hepatic Lymphoma

Hepatic lymphoma is usually a secondary liver lesion that occurs in more than 50 of patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma 75 . Although primary hepatic lymphoma does exist, it is extremely rare because the amount of lymphatic tissue in the liver is very small, present only in the periportal spaces. Primary hepatic lymphoma has been reported in middle-aged men infected with the human immunodeficiency virus, in patients under pharma-cologic immunosuppression, and in organ...

Malignant Neoplasms of the Gallbladder

Normal And Sick Gallbladder

Gallbladder carcinoma is the fifth most common malignancy of the gastrointestinal tract 37 . While there doesn't appear to be any difference between males and females in the incidence of gallbladder carcinoma, there are indications of demographic differences in the age of patients diagnosed with this neoplasm in the United States the average age at diagnosis is about 70 years, while in India it is 40-50 years. The four most important factors associated with the development of gallbladder...

Steatosis Hepatis

Bopta Hepatic Phase

Accumulation of fat within hepatocytes is commonly found in diabetic or obese patients or in patients who have been exposed to ethanol or other chemical toxins. In addition, in patients with advanced malignant neoplasms, fatty changes of the liver may be present due to poor nutrition and the hepatotoxic effects of chemotherapy. In most cases, fatty liver is associated with elevated levels of hepatic transaminases 48,74 . Fatty changes are distributed either diffusely, giving rise to a patchy...

Imaging of Benign Focal Liver Lesions

Lesions Compared Hemangiomas

4.1 Primary Benign Liver Lesions 4.1.2 Focal Nodular Hyperplasia 4.1.4 Nodular Regenerative Hyperplasia 4.2 Secondary Benign Liver Lesions Each of the cellular components of the liver - he-patocytes, biliary epithelium and mesenchyme -can give rise to benign tumors. It is possible to classify these tumors based on their cellular origin Hepatocellular adenoma Hepatocellular hyperplasia Focal nodular hyperplasia (FNH) Nodular regenerative hyperplasia Congenital hepatic fibrosis or polycystic...

Histopathologic Classification of Liver Pathologies

Regenerative Liver Cells

Benign and Malignant Nodular Hepatocellular Benign and Malignant Tumors of the Biliary Bile Duct Carcinoma (Cholangiocarcinoma) Malignant Epitheloid Hemangioendothelioma Undifferentiated (Embryonal) Sarcoma Rhabdomyosarcoma (Sarcoma Botryoides) Other Tumor-like Lesions Peliosis Hepatis Transfusional Iron Overload (Hemosiderosis) 2.8.5 Primary Sclerosing Cholangitis 2.8.7 Primary Biliary Cirrhosis 2.8.8 Secondary Biliary Cirrhosis 2.8.11 Liver Disease in Patients with Cystic Kidneys 2.8.12...

Comparing Single And Multiple Ring Enhancing Lesions Table

Weighted And Weighed

Larger SPIO particles such as ferumoxides are administered by drip infusion and T2-weighted images are acquired more than 20 min after injection Fig. 19. Smaller USPIO particles such as SH U 555 A can be administered as a bolus, whereupon they distribute initially in the intravascu-lar-extravascular space permitting dynamic T1-weighted imaging. Thereafter, like ferumoxides, SH U 555 A particles are taken up by Kupffer cells allowing T2-weighted delayed imaging Fig. 19. Smaller USPIO...

Transient Hepatic Attenuation Differences THAD

THAD is associated with numerous intrahepatic vascular conditions, particularly intrahepatic shunts. Intrahepatic shunts can be divided into arterio-portal, arteriosystemic, and portosystemic, depending on the vascular connection. APS are the most common form of intrahepatic shunts, and are commonly associated with HCC or with iatrogenic causes, such as liver biopsy (Fig. 25) or radio-frequency (RF) ablation (Fig. 26). In APS a direct communication between the feeding arterial vessels of the...

Malignant Biliary Neoplasms 741

Biliary Cystadenocarcinoma

Cholangiocellular carcinoma (CCC) is a primary malignant tumor arising from the bile duct epithelium and comprises 10-25 of all liver and biliary tract cancers. CCC is usually classified as intra- or extrahepatic based on the location of the involved ducts. Intrahepatic CCC can be further subdivided into peripheral and hilar. A tumor that arises peripheral to the secondary bifurcation of the left or right hepatic duct is considered a peripheral intra-hepatic CCC, whereas a tumor that arises...

Jflk i

Difference Weighted Mri Lesions

Patient with history of renal cell carcinoma. The precontrast CT scan (a) shows a large, slightly hypo-dense lesion (arrows) located in segment VIII of the right liver lobe. In the arterial phase of the dynamic study after contrast medium administration (b) the hemangioma demonstrates an irregular and marked enhancement with progressive but incomplete filling in the portal-venous (c) and equilibrium (d) phases Fig. 6a-d. Atypical hemangioma. Patient with history...

Parenchymal Pseudolesions

Fat Attenuation

Hepatic pseudolesions are non-neoplastic abnormalities which may be sub-divided into parenchymal pseudolesions and vascular pseudolesions. Parenchymal pseudolesions include focal fatty change, focal sparing, inflammatory pseudotumor, confluent fibrosis, pseudotumor hypertrophy and hepatic peliosis. Vascular pseudolesions, on the other hand, are non-neoplastic hepatic pseudole-sions such as APS, THAD, and vascular abnormalities associated with Budd-Chiari syndrome. Non-neoplastic abnormalities...

Benign Biliary Neoplasms 731

Uss Biliary

Biliary cystadenoma is a rare cystic neoplasm that represents less than 5 of all intrahepatic cysts of biliary origin that arise from intra- and extrahep-atic bile ducts 27 . This neoplasm may occur anywhere along the intra- or extrahepatic bile ducts, although about 80 of lesions are found partly or completely within the liver. The cause of biliary cystadenoma is unknown, although it could be related to a congenital anomaly of the biliary primitive bud. This neoplasm can be classified as...

Fibrolamellar Hepatocellular Carcinoma

Flc Hepatic Mri

Fibrolamell r hepatocellular carcinoma FLC is an uncommon tumor with clinical and pathological features different from those of hepatocellular carcinoma 19 . This neoplasm occurs predominantly in young adult patients, who have no history of cirrhosis or chronic liver disease 20 . Macro-scopically, tumor size varies from 5 to 20 cm. The appearance of FLC is somewhat similar to that of focal nodular hyperplasia, with a central scar and multiple fibrous septa. Although hemorrhage is rare in FLC,...

Confluent Hepatic Fibrosis

Confluent hepatic fibrosis is a mass-like fibrosis seen in approximately 15 of patients with advanced cirrhosis who are candidates for liver transplantation. The imaging findings of confluent fibrosis result in it being characterized due to its specific location in the liver, which is frequently the medial segment of the left and or right lobe. Calcifications or dilatation of the biliary ducts are very rare. Imaging techniques such as US are not specific for the diagnosis of confluent hepatic...

Techniques for Liver MR Imaging

Mri Liver Images

1.2 MR Imaging Techniques and Concepts 1.2.3 The Uncooperative Patient Examination Magnetic resonance imaging MRI is establishing a role as a primary diagnostic technique with evidence showing MR to have advantages over computer tomography CT as regards diagnostic sensitivity and specificity for many pathologies of solid organs, bile and pancreatic ducts, bowel, peritoneum, and retroperitoneum. MRI is particularly well-suited to the evaluation of liver pathology due to an ability to generate...

Regenerative Nodules

Nodular Liver Surface

Regenerative nodules frequently arise in cirrhotic livers as a result of heterogeneous regeneration in the grossly distorted liver architecture. These lesions, which are usually less than 5 mm in diameter, show a heterogeneous pattern on MR images. Larger regenerative nodules, measuring more than 5 mm in diameter, can be found in about one third of cirrhotic livers, while nodules larger than 10 mm only occur in about 10 of cases 72 . Regenerative nodules on ultrasound US and CT may mimic...

Hypovascular Metastases

Hypovascular metastases are the most frequent malignancies in the liver. In the United States, colon cancer is the most common primary site and approximately 50,000 cases of hepatic colorectal metastases are encountered annually. Lesion detection is size-related, with lesions smaller than 1 cm being difficult to identify with conventional techniques. Unfortunately, a postmortem assessment of the size of liver metastases has shown that the ratio between metastases larger than 1 cm and those...

Hemochromatosis

Hemochromatosis is a disease caused by an increased intestinal absorption of dietary iron, bound as ferritin or hemosiderin, and is characterized by excessive parenchymal iron accumulation 29 . The primary organs affected by hemochro-matosis are the liver, pancreas and heart. Thus, liv Fig. 9a-d. Longstanding hemochromatosis. The liver and pancreas show decreased SI on T2-weighted a, b and Tl-weighted c, d images, while the spleen demonstrates essentially normal SI. Note that the atrophy of the...

Parenchymal Compression

Eovist Liver Mri Hemangioma

Diaphragmatic compression of liver parenchyma due to contraction of diaphragmatic muscle bundles may create hypodense pseudonodular areas especially in segments VII and VIII of the liver. This is a typical occurrence at the time of the CT or MR examination when patients inspire deeply causing a focal increase in tissue pressure in the sub-capsular region. The result is a decrease in portal perfusion while the hepatic arterial perfusion remains relatively unchanged Fig. 24 . Pseudolesions due to...

Cholangiocellular Carcinoma CCC

Delayed Enhancement Liver

Cholangiocellular carcinoma CCC is usually classed as intrahepatic or extrahepatic depending on the site of origin. Intrahepatic cholangio-carcinoma ICC is a malignant neoplasm arising from the epithelium of the intrahepatic bile ducts and represents approximately 10 of all CCC. Hilar Klatskin's and bile duct cholangiocarcinomas account for the remaining 90 of the lesions. The neoplasm is usually a large, firm mass and in 1020 of cases there are several satellite nodules around the main lesion....

Pathophysiologic Background

The liver uniquely receives a dual blood supply approximately 1000-1200 ml min of blood arrives via the portal vein and approximately 400 ml min arrives via the hepatic artery. In a non-cirrhotic liver, blood perfusion occurs at pressures of approximately 7 mmHg and 100 mmHg, via the portal vein and hepatic artery, respectively. Arterio-portal parenchymal perfusion demonstrates the degree of reciprocity of the arterial and portal venous contributions by virtue of vascular flux through dynamic...

Normal Anatomy and Variants

Hepatic Artery Variants

The blood supply to the intra-abdominal organs derives from three major branches of the abdominal aorta the celiac artery CA , the SMA and the IMA. Although numerous anatomical variants exist, in the majority of cases CE MRA allows a detailed depiction of the typical and atypical vascular anatomy of the splanchnic vessels 2, 11, 17, 33 . Of principal interest for the arterial supply of the liver are the CA and the SMA, however, since collateral supply between the three major branches exists,...

Malignant Focal Liver Lesions of Hepatocellular Origin

Nodular Enhancement Mri

From Regenerative Nodules to Hepatocellular Carcinoma HCC According to the terminology established by an International Working Party in 1994, there are three steps in the development of HCC regenerative nodule, dysplastic nodule low-grade high-grade with focus of HCC and small lt 2 cm HCC. Regenerative nodules are benign lesions with an exclusive portal venous blood supply. Low-grade dysplastic nodules, on the other hand, show slight cytologic atypia with mainly large cell changes, while...

Regional Transarterial Chemoembolization TACE

Neither systemic or local chemotherapy nor chemoembolization are primary techniques normally used with the aim of curing liver metastases. They are mainly considered a second-line treatment in patients with metastases of colorectal carcinoma. On the other hand TACE is frequently used for curative treatment of HCC, especially in Asia. TACE therapy is based on the differential blood supply of normal liver tissue and hepatic tumors. Whereas arterial perfusion accounts for about 25 of the blood...