Liver cirrhosis with confluent fibrosis. Coronal
(A) and axial fat-suppressed (B)
SS-FSE T2-WI, axial pre- (C) and postcontrast
fat-suppressed 3D-GRE T1-WI in the arterial (D) and
interstitial (E) phases, and coronal postcontrast
fat-suppressed 3D-GRE T1-WI in the interstitial phase
(F). There is a linear pattern of fibrosis
throughout the liver, with a focal region of confluent fibrosis in
segments 7 and 8 peripherally (arrow, A,B), that is
moderately high in signal on T2-WI (A,B) and mildly low
in signal on T1-weighted image (C) and demonstrates
negligible enhancement on early postcontrast image (D)
and moderate enhancement on delayed image (E,F). The
fine pattern of fibrosis is better depicted on late postgadolinium
images as linear enhancing structures (E,F). Note the
distorted anatomy and capsular retraction of segment 7, in relation
to the more prominent region of fibrosis. The absence of portal vein
thrombus, lack of arterial hyper-enhancement and delayed progressive
enhancement allows the confident diagnosis of confluent fibrosis and
excludes diffuse HCC.