Cirrhosis is the final step of liver injury, and is not usually reversible. Hepatocellular necrosis leads to fibrosis and nodule regenerati...
Cirrhosis is the final step of liver injury, and is not usually reversible. Hepatocellular necrosis leads to fibrosis and nodule regeneration. The process may occur over weeks or years. Patients have altered immunity and undergo changes in the vascular bed both in the liver and in the lungs. Cirrhotic patients are at increased risk of pulmonary complications including bacterial pneumonia, hydrothorax, pulmonary hypertension and adult respiratory distress syndrome. The top three causes of cirrhosis are hepatitis C, alcohol and idiopathic. Hepatocellular carcinoma (HCC) develops in up to 25% of patients with cirrhosis.
• Advised for surveillance every 6 months (rule out hepatocellular carcinoma [HCC]).
• Atrophy of segments VI and VII (i.e. right lobe), hypertrophy of segments I, II and III (left lobe).
• Echotexture has a coarse, ‘starry night’ appearance.
• Increased arterial flow, surface nodularity in advanced cirrhosis.
• Regenerative nodules are hypoechoic.
• Ascites.
CT
• CT and MRI are insensitive to early cirrhotic change.
• Reduced attenuation due to fatty infiltration.
• Irregular heterogeneous liver with low attenuation and ascites.
• Retracted capsule with low attenuation beneath may represent focal fibrosis—rare, diagnosed by biopsy.
MRI
• Regenerative nodules may be high signal on T1 (due to iron accumulation, ‘siderotic nodule’) and low signal on T2—opposite pattern to a metastasis.
• HCCs have enhancing pseudocapsules, whereas dysplastic nodules do not.
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