E2726. Cirrhosis and Mimics: Radiographic Findings
  1. Acacia Sheppard; Donald and Barbara Zucker School of Medicine
  2. Bertin Mathai; Donald and Barbara Zucker School of Medicine
  3. John Hines; Huntington Hospital Northwell Health
Cirrhosis is the bleak and often irreversible consequence of chronic liver disease. The most common culprit in the United States is alcohol, though viral hepatitis and non-alcoholic steatohepatitis (NASH) are close behind. In the past, definitive diagnosis was made with biopsy which carries considerable risks of bleeding and infection. More recently, a combined picture of clinical presentation, physical examination, laboratory findings and imaging have been used.

Educational Goals / Teaching Points
Ultrasound is by far the most practical imaging modality. It is low cost, low risk and, when combined with other non-invasive markers of fibrosis, has a positive predictive value of 77.8%. While the role of computed tomography (CT) and magnetic resonance imaging (MRI) in the initial diagnosis of cirrhosis is unclear, a variety of characteristic findings can certainly be visualized. The purpose of this exhibit is to review the radiologic signs and pathologic correlations of cirrhosis. We examine a range of morphologic and parenchymal changes that take place in the setting of chronic liver disease, as well as several mimics to look out for.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Examples of imaging findings in cirrhosis include a nodular liver surface, caudate lobe enlargement and, less commonly, a reticular pattern of enhancement on delayed contrast-enhanced MRI. Quantitative measurement of liver fibrosis using MR elastography and artificial intelligence (AI) applications will also be presented. Finally, we will identify important secondary features and complications of cirrhosis that the radiologist should be aware of.

Prompt recognition of radiographic signs can help ensure patients with indeterminate and subclinical cirrhosis are diagnosed appropriately. This allows for earlier intervention and improved patient outcomes.