Cirrhosis

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Hepatic cirrhosis is a disease that leads to irreversible fibrosis of the parenchyma. It is localized in the spaces between the portal tracts and destroys the normal hepatic architecture. However, the development of cirrhosis in patients suffering from viral hepatitis is frequently inhibited by treatment with interferon [14].

Generally, diagnosis of liver cirrhosis is achieved by histological examination of a liver biopsy, whereas imaging is performed to determine the anatomical distribution of the disease.

Typical features of advanced hepatic cirrhosis on diagnostic imaging are nodular contours and enlargement of the caudate lobe and lateral segment of the left lobe, combined with atrophy of the right lobe [26,59]. However, regional hypertrophy of certain liver segments, such as the caudate lobe, and atrophy of the right lobe are less likely to occur in alcohol-induced liver cirrhosis, which is one of the more frequent causes of cirrhosis [24].

As liver atrophy seems to be localized around the portal vein and the liver hilum, an empty region in the gallbladder fossa is typically seen, which contains periportal fat. Although cirrhosis affects the entire organ, the actual volume of fibrous scar tissue is very small compared with the whole liver volume and thus it has little influence on the relaxation times of hepatocellular tissue. For this reason, cirrhosis alone is difficult to depict on MRI [25].

However, as liver cirrhosis is often accompanied by hepatitis or inflammation, cirrhotic livers frequently show prolonged T1 and/or T2 relaxation times [66].

Furthermore, cirrhotic livers tend to accumulate iron, which leads to decreased hepatic SI. Frequently, the distortion and nodular appearance of intrahepatic vessels is helpful for the diagnosis of cirrhosis on MR images.

Similarly, the decreased caliber of segmental veins compared with the intrahepatic inferior cav-al vein can be interpreted as a sign of liver cirrhosis [42] (Fig. 6).

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