The many faces of cirrhosis

  • Ryan B. SchwopeEmail author
  • Matthew Katz
  • Timothy Russell
  • Michael J. Reiter
  • Christopher J. Lisanti


There are many different imaging features of cirrhosis, some of which are less commonly recognized. It is important that the radiologist is familiar with these features as cirrhosis can be first discovered on imaging performed for other indications, thus alerting the clinician for the need to screen for complications of cirrhosis and referral for potential treatment. This article reviews the various imaging findings of cirrhosis seen on cross-sectional imaging of the abdomen and pelvis.


Cirrhosis Imaging features CT MRI Ultrasound 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Asrani SK, Larson JJ, Yawn B, Therneau TM, Kim WR (2013) Underestimation of liver- related mortality in the United States. Gastroenterology145 (2):375-382 e371-372.
  2. 2.
    Zhu RX, Seto WK, Lai CL, Yuen MF (2016) Epidemiology of Hepatocellular Carcinoma in the Asia-Pacific Region. Gut Liver 10 (3):332-339. CrossRefGoogle Scholar
  3. 3.
    Zhou WC, Zhang QB, Qiao L (2014) Pathogenesis of liver cirrhosis. World J Gastroenterol 20 (23):7312-7324. CrossRefGoogle Scholar
  4. 4.
    Heidelbaugh JJ, Bruderly M (2006) Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician 74 (5):756-762Google Scholar
  5. 5.
    Heidelbaugh JJ, Sherbondy M (2006) Cirrhosis and chronic liver failure: part II. Complications and treatment. Am Fam Physician 74 (5):767-776Google Scholar
  6. 6.
    Wiegand J, Berg T (2013) The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. Deutsches Arzteblatt international 110 (6):85-91. Google Scholar
  7. 7.
    Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus (2015). Hepatology 62 (3):932-954.
  8. 8.
    Taouli B, Ehman RL, Reeder SB (2009) Advanced MRI methods for assessment of chronic liver disease. AJR American journal of roentgenology 193 (1):14-27. CrossRefGoogle Scholar
  9. 9.
    Sangster GP, Previgliano CH, Nader M, Chwoschtschinsky E, Heldmann MG (2013) MDCT Imaging Findings of Liver Cirrhosis: Spectrum of Hepatic and Extrahepatic Abdominal Complications. HPB Surg 2013:129396. CrossRefGoogle Scholar
  10. 10.
    Tchelepi H, Ralls PW, Radin R, Grant E (2002) Sonography of diffuse liver disease. J Ultrasound Med 21 (9):1023-1032; quiz 1033-1024Google Scholar
  11. 11.
    Yano K, Ohtsubo M, Mizota T, Kato H, Hayashida Y, Morita S, Furukawa R, Hayakawa A (2000) Riedel's lobe of the liver evaluated by multiple imaging modalities. Intern Med 39 (2):136-138CrossRefGoogle Scholar
  12. 12.
    Ito K, Mitchell DG, Gabata T (2000) Enlargement of hilar periportal space: a sign of early cirrhosis at MR imaging. J Magn Reson Imaging 11 (2):136-140CrossRefGoogle Scholar
  13. 13.
    Ito K, Mitchell DG (2004) Imaging diagnosis of cirrhosis and chronic hepatitis. Intervirology 47 (3-5):134-143. CrossRefGoogle Scholar
  14. 14.
    Okazaki H, Ito K, Fujita T, Koike S, Takano K, Matsunaga N (2000) Discrimination of alcoholic from virus-induced cirrhosis on MR imaging. AJR Am J Roentgenol 175 (6):1677-1681. CrossRefGoogle Scholar
  15. 15.
    Awaya H, Mitchell DG, Kamishima T, Holland G, Ito K, Matsumoto T (2002) Cirrhosis: modified caudate-right lobe ratio. Radiology 224 (3):769-774. CrossRefGoogle Scholar
  16. 16.
    Gibo M, Murata S, Kuroki S (2001) Pericaval fat collection mimicking an intracaval lesion on CT in patients with chronic liver disease. Abdom Imaging 26 (5):492-495CrossRefGoogle Scholar
  17. 17.
    O'Donohue J, Ng C, Catnach S, Farrant P, Williams R (2004) Diagnostic value of Doppler assessment of the hepatic and portal vessels and ultrasound of the spleen in liver disease. Eur J Gastroenterol Hepatol 16 (2):147-155CrossRefGoogle Scholar
  18. 18.
    Di Lelio A, Cestari C, Lomazzi A, Beretta L (1989) Cirrhosis: diagnosis with sonographic study of the liver surface. Radiology 172 (2):389-392. CrossRefGoogle Scholar
  19. 19.
    Bader TR, Beavers KL, Semelka RC (2003) MR imaging features of primary sclerosing cholangitis: patterns of cirrhosis in relationship to clinical severity of disease. Radiology 226 (3):675-685. CrossRefGoogle Scholar
  20. 20.
    Dodd GD, 3rd, Baron RL, Oliver JH, 3rd, Federle MP (1999) End-stage primary sclerosing cholangitis: CT findings of hepatic morphology in 36 patients. Radiology 211 (2):357-362. CrossRefGoogle Scholar
  21. 21.
    Jha RC, Mitchell DG, Weinreb JC, Santillan CS, Yeh BM, Francois R, Sirlin CB (2014) LI-RADS categorization of benign and likely benign findings in patients at risk of hepatocellular carcinoma: a pictorial atlas. AJR Am J Roentgenol 203 (1):W48-69. CrossRefGoogle Scholar
  22. 22.
    Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K (2009) Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT. AJR Am J Roentgenol 192 (5):1341-1347. CrossRefGoogle Scholar
  23. 23.
    Ahn IO, de Lange EE (1998) Early hyperenhancement of confluent hepatic fibrosis on dynamic MR imaging. AJR Am J Roentgenol 171 (3):901-902. CrossRefGoogle Scholar
  24. 24.
    Lim JH (2003) Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol 181 (3):819-827. CrossRefGoogle Scholar
  25. 25.
    Blachar A, Federle MP, Brancatelli G (2002) Hepatic capsular retraction: spectrum of benign and malignant etiologies. Abdom Imaging 27 (6):690-699. CrossRefGoogle Scholar
  26. 26.
    Wenzel JS, Donohoe A, Ford KL, 3rd, Glastad K, Watkins D, Molmenti E (2001) Primary biliary cirrhosis: MR imaging findings and description of MR imaging periportal halo sign. AJR Am J Roentgenol 176 (4):885-889. CrossRefGoogle Scholar
  27. 27.
    Queiroz-Andrade M, Blasbalg R, Ortega CD, Rodstein MA, Baroni RH, Rocha MS, Cerri GG (2009) MR imaging findings of iron overload. Radiographics 29 (6):1575-1589. CrossRefGoogle Scholar
  28. 28.
    Siegelman ES, Mitchell DG, Semelka RC (1996) Abdominal iron deposition: metabolism, MR findings, and clinical importance. Radiology 199 (1):13-22. CrossRefGoogle Scholar
  29. 29.
    Wells ML, Fenstad ER, Poterucha JT, Hough DM, Young PM, Araoz PA, Ehman RL, Venkatesh SK (2016) Imaging Findings of Congestive Hepatopathy. Radiographics 36 (4):1024-1037. CrossRefGoogle Scholar
  30. 30.
    Pedersen JS, Bendtsen F, Moller S (2015) Management of cirrhotic ascites. Ther Adv Chronic Dis 6 (3):124-137. CrossRefGoogle Scholar
  31. 31.
    Al-Busafi SA, McNabb-Baltar J, Farag A, Hilzenrat N (2012) Clinical manifestations of portal hypertension. Int J Hepatol 2012:203794. Google Scholar
  32. 32.
    Robertson F, Leander P, Ekberg O (2001) Radiology of the spleen. Eur Radiol 11 (1):80-95. CrossRefGoogle Scholar
  33. 33.
    Westaby S, Wilkinson SP, Warren R, Williams R (1978) Spleen size and portal hypertension in cirrhosis. Digestion 17 (1):63-68. CrossRefGoogle Scholar
  34. 34.
    Taylor AJ, Dodds WJ, Erickson SJ, Stewart ET (1991) CT of acquired abnormalities of the spleen. AJR Am J Roentgenol 157 (6):1213-1219. CrossRefGoogle Scholar
  35. 35.
    Prassopoulos P, Daskalogiannaki M, Raissaki M, Hatjidakis A, Gourtsoyiannis N (1997) Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus. Eur Radiol 7 (2):246-248. CrossRefGoogle Scholar
  36. 36.
    Berzigotti A, Zappoli P, Magalotti D, Tiani C, Rossi V, Zoli M (2008) Spleen enlargement on follow-up evaluation: a noninvasive predictor of complications of portal hypertension in cirrhosis. Clin Gastroenterol Hepatol 6 (10):1129-1134. CrossRefGoogle Scholar
  37. 37.
    Sagoh T, Itoh K, Togashi K, Shibata T, Nishimura K, Minami S, Asato R, Noma S, Fujisawa I, Yamashita K, et al. (1989) Gamna-Gandy bodies of the spleen: evaluation with MR imaging. Radiology 172 (3):685-687. CrossRefGoogle Scholar
  38. 38.
    Loreno M, Travali S, Bucceri AM, Scalisi G, Virgilio C, Brogna A (2009) Ultrasonographic study of gallbladder wall thickness and emptying in cirrhotic patients without gallstones. Gastroenterology research and practice 2009:683040. CrossRefGoogle Scholar
  39. 39.
    Dodd GD, 3rd, Baron RL, Oliver JH, 3rd, Federle MP, Baumgartel PB (1997) Enlarged abdominal lymph nodes in end-stage cirrhosis: CT-histopathologic correlation in 507 patients. Radiology 203 (1):127-130. CrossRefGoogle Scholar
  40. 40.
    Dietrich CF, Stryjek-Kaminska D, Teuber G, Lee JH, Caspary WF, Zeuzem S (2000) Perihepatic lymph nodes as a marker of antiviral response in patients with chronic hepatitis C infection. AJR Am J Roentgenol 174 (3):699-704. CrossRefGoogle Scholar
  41. 41.
    Kim YJ, Raman SS, Yu NC, To'o KJ, Jutabha R, Lu DS (2007) Esophageal varices in cirrhotic patients: evaluation with liver CT. AJR Am J Roentgenol 188 (1):139-144. CrossRefGoogle Scholar
  42. 42.
    Bolondi L, Gandolfi L, Arienti V, Caletti GC, Corcioni E, Gasbarrini G, Labo G (1982) Ultrasonography in the diagnosis of portal hypertension: diminished response of portal vessels to respiration. Radiology 142 (1):167-172. CrossRefGoogle Scholar
  43. 43.
    Bolondi L, Mazziotti A, Arienti V, Casanova P, Gasbarrini G, Cavallari A, Bellusci R, Gozzetti G, Possati L, Labo G (1984) Ultrasonographic study of portal venous system in portal hypertension and after portosystemic shunt operations. Surgery 95 (3):261-269Google Scholar
  44. 44.
    Mandal L, Mandal S, Bandyopadhyay D, Datta S (2011) Correlation of portal vein diameter and splenic size with gastro-oesophageal varices in cirrhosis of liver. J Ind Aca Clin Med 12 (4):266-270Google Scholar
  45. 45.
    Zoli M, Dondi C, Marchesini G, Cordiani MR, Melli A, Pisi E (1985) Splanchnic vein measurements in patients with liver cirrhosis: a case-control study. J Ultrasound Med 4 (12):641-646CrossRefGoogle Scholar
  46. 46.
    Geleto G, Getnet W, Tewelde T (2016) Mean Normal Portal Vein Diameter Using Sonography among Clients Coming to Radiology Department of Jimma University Hospital, Southwest Ethiopia. Ethiopian journal of health sciences 26 (3):237-242CrossRefGoogle Scholar
  47. 47.
    Gerstenmaier JF, Gibson RN (2014) Ultrasound in chronic liver disease. Insights into imaging 5 (4):441-455. CrossRefGoogle Scholar
  48. 48.
    Keedy A, Westphalen AC, Qayyum A, Aslam R, Rybkin AV, Chen MH, Coakley FV (2008) Diagnosis of cirrhosis by spiral computed tomography: a case-control study with feature analysis and assessment of interobserver agreement. J Comput Assist Tomogr 32 (2):198-203. CrossRefGoogle Scholar
  49. 49.
    Stamm ER, Meier JM, Pokharel SS, Clark T, Glueck DH, Lind KE, Roberts KM (2016) Normal main portal vein diameter measured on CT is larger than the widely referenced upper limit of 13 mm. Abdominal radiology (New York) 41 (10):1931-1936. CrossRefGoogle Scholar
  50. 50.
    Schwope RB, Margolis DJ, Raman SS, Kadell BM (2010) Portal vein aneurysms: a case series with literature review. Journal of radiology case reports 4 (6):28-38. CrossRefGoogle Scholar
  51. 51.
    Kim JH, Lee JM, Yoon JH, Lee DH, Lee KB, Han JK, Choi BI (2016) Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma: Diagnostic Accuracy of Gadoxetic Acid-enhanced MR Imaging. Radiology 279 (3):773-783. CrossRefGoogle Scholar
  52. 52.
    Kinjo N, Kawanaka H, Akahoshi T, Matsumoto Y, Kamori M, Nagao Y, Hashimoto N, Uehara H, Tomikawa M, Shirabe K, Maehara Y (2014) Portal vein thrombosis in liver cirrhosis. World J Hepatol 6 (2):64-71. CrossRefGoogle Scholar
  53. 53.
    Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV (2010) Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging. Radiology 254 (1):154-162. CrossRefGoogle Scholar
  54. 54.
    von Kockritz L, De Gottardi A, Trebicka J, Praktiknjo M (2017) Portal vein thrombosis in patients with cirrhosis. Gastroenterology report 5 (2):148-156. CrossRefGoogle Scholar
  55. 55.
    Garcia-Pagan JC, Valla DC (2009) Portal vein thrombosis: a predictable milestone in cirrhosis? J Hepatol 51 (4):632-634. CrossRefGoogle Scholar
  56. 56.
    Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, Quarin C, Garay V, and Imventarza O (2007) Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome. HPB 9(5): 352–356. CrossRefGoogle Scholar
  57. 57.
    De Gaetano AM, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K (1995) Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography. AJR Am J Roentgenol 165 (5):1151-1155. CrossRefGoogle Scholar
  58. 58.
    McNaughton DA, Abu-Yousef MM (2011) Doppler US of the liver made simple. Radiographics 31 (1):161-188. CrossRefGoogle Scholar
  59. 59.
    Joshi G, Crawford KA, Hanna TN, Herr KD, Dahiya N, Menias CO (2018) US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing beyond Gallbladder and Biliary Disease. Radiographics 38 (3):766-793. CrossRefGoogle Scholar
  60. 60.
    Tublin ME, Dodd GD, 3rd, Baron RL (1997) Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 168 (3):719-723. CrossRefGoogle Scholar
  61. 61.
    Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J (2017) Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 65(1):310-335. CrossRefGoogle Scholar
  62. 62.
    D’Amico G, De Franchis R; Cooperative Study Group (2003) Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 38(3):599-612. Google Scholar
  63. 63.
    Krige JE, Kotze UK, Distiller G, Shaw JM, Bornman PC (2009) Predictive factors for rebleeding and death in alcoholic cirrhotic patients with acute variceal bleeding: a multivariate analysis. World J Surg 33(10):2127-35. CrossRefGoogle Scholar
  64. 64.
    Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program (2009) Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol 104(7):1802-29.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyBrooke Army Medical CenterSan AntonioUSA
  2. 2.Uniformed Services University of the Health SciencesBethesdaUSA
  3. 3.Department of RadiologyEisenhower Army Medical CenterFort GordonUSA
  4. 4.Department of RadiologyStony Brook University Medical CenterStony BrookUSA

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