Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury. It is well known that cirrhosis is the origin of multiple extrahepatic abdominal complications and a markedly increased risk of hepatocellular carcinoma (HCC). This tumor is the sixth most common malignancy worldwide and the third most common cause of cancer related death. With the rising incidence of HCC worldwide, awareness of the evolution of cirrhotic nodules into malignancy is critical for an early detection and treatment. Adequate imaging protocol selection with dynamic multiphase Multidetector Computed Tomography (MDCT) and reformatted images is crucial to differentiate and categorize the hepatic nodular dysplasia. Knowledge of the typical and less common extrahepatic abdominal manifestations is essential for accurately assessing patients with known or suspected hepatic disease. The objective of this paper is to illustrate the imaging spectrum of intra- and extrahepatic abdominal manifestations of hepatic cirrhosis seen on MDCT. 1. Introduction Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury characterized by extensive fibrosis and nodular regeneration replacing the normal liver parenchyma [1]. It is well known that cirrhosis is associated with a markedly increased risk of hepatocellular carcinoma (HCC), the sixth most common malignancy worldwide and third most common cause of cancer related death. The detection of hepatic malignancy in cirrhotic patients is a diagnostic challenge due to distortion of the hepatic architecture [2]. In this article we discuss and illustrate the wide spectrum of intra- and extrahepatic findings on Computed Tomography (CT) in patients with cirrhosis. 2. Hepatic Manifestations Common pathologic features of cirrhosis include hepatic fibrosis, nodular distortion of hepatic architecture, and perfusion abnormalities. Thefibrotic changes appear as bridging bands or focal confluent fibrosis. Bridging bands usually have variable thickness and may mimic a tumor capsule due to delayed contrast enhancement. Focal confluent fibrosis is defined as a peripheral wedge-shaped hypoattenuated area on unenhanced and venous phase CT. On delayed phase, enhancement of the lesion may occur [3]. Overlying capsular retraction with volume loss in areas of focal confluent fibrosis is an important feature to differentiate this entity from malignant conditions [4] (Figure 1). Figure 1: Confluent fibrosis in a 55-year-old male with alcoholic cirrhosis. (a) An unenhanced axial CT image shows a v-shaped
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