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Regenerative Nodules in Liver Cirrhosis: Findings at CT during Arterial Portography and CT Hepatic Arteriography with Histopathologic Correlation

¹ Departments of Radiology (J.H.L., E.Y.K., W.J.L., H.K.L., Y.S.D., I.W.C.)
² Diagnostic Pathology (C.K.P.), Samsung Medical Center, College of Medicine, Sungkyunkwan University, 50 Irwon-dong, Kangnam-ku, Seoul 135-710, South Korea.

PURPOSE: To determine the appearance of regenerative nodules in patients with liver cirrhosis at computed tomography (CT) during arterial portography (CTAP) and CT hepatic arteriography (CTHA).

MATERIALS AND METHODS: CTAP and CTHA of the liver were performed in 28 consecutive patients with hepatocellular carcinoma (HCC) who were scheduled to undergo partial resection of the liver. Helical CTAP was performed after contrast material injection into the superior mesenteric artery followed by helical CTHA after contrast material injection into the hepatic artery. CT scans were analyzed for the presence of identifiable nodules and their size; results were correlated with gross and microscopic findings.

RESULTS: Resected livers showed cirrhosis in 20 patients, chronic hepatitis in four, and normal liver in four. Among the 20 patients with cirrhosis, regenerative nodules were demonstrated as enhancing 3–10-mm nodules surrounded by lower attenuation fibrous septa 0.8–1.5 mm thick at CTAP in seven patients and nonenhancing nodules of the same size surrounded by enhancing fibrous septa at CTHA in 15 patients. The degree of fibrosis determined the conspicuity of nodules.

CONCLUSION: Regenerative nodules in cirrhotic liver are visualized as enhancing nodules surrounded by lower attenuation thin septa at CTAP and nonenhancing nodules surrounded by enhancing fibrous septa at CTHA. CTHA is more sensitive than CTAP in depicting regenerative nodules (P < .005).

Index terms: Liver, blood supply, 95.79 • Liver, cirrhosis, 761.794 • Liver, CT, 761.12114, 761.12115, 761.12116 • Liver, nodules, 761.3198 • Liver neoplasms, diagnosis, 761.3198, 761.323

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