Imaging Appearance in Acute Liver Failure: Correlation with Clinical and Pathology Findings

Background and Aim Acute liver failure (ALF) is characterized by sudden liver injury without underlying chronic liver disease. Excluding underlying cirrhosis in these patients is often difficult and liver biopsy may be impractical. We review the imaging appearance of acute hepatic failure in patient...

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Bibliographic Details
Published in:Digestive diseases and sciences 2014-08, Vol.59 (8), p.1987-1995
Main Authors: Romero, Miriam, Palmer, Suzanne L., Kahn, Jeffrey A., Ihde, Lauren, Lin, Leah Muhm, Kosco, Anne, Shinar, Ron, Ghandforoush, Aslan, Chan, Linda S., Petrovic, Lydia M., Sher, Linda S., Fong, Tse-Ling
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biochemistry
CT imaging
Diagnostic imaging
Female
Gastroenterology
Hepatology
Humans
Hypertension
Liver
Liver - diagnostic imaging
Liver - pathology
Liver cirrhosis
Liver failure
Liver Failure, Acute - diagnosis
Liver Failure, Acute - pathology
Liver Failure, Acute - surgery
Liver Transplantation
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Middle Aged
Oncology
Original Article
Pneumoviridae
Retrospective Studies
Tomography, X-Ray Computed
Transplant Surgery
Transplantation
Ultrasonography
Young Adult
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Summary:Background and Aim Acute liver failure (ALF) is characterized by sudden liver injury without underlying chronic liver disease. Excluding underlying cirrhosis in these patients is often difficult and liver biopsy may be impractical. We review the imaging appearance of acute hepatic failure in patients who underwent transplant and correlate these findings with clinical, laboratory and pathology parameters. Methods This is a retrospective review of 47 patients without known chronic liver disease who presented to three institutions between 2002 and 2010 with ALF, 46 of which underwent subsequent orthotopic liver transplantation. Pre-transplant ultrasound, computed tomography and magnetic resonance imaging scans were reviewed for parenchymal homogeneity, surface nodularity and evidence of portal hypertension. Explant histopathology, laboratory values and time intervals between symptom onset to initial imaging and transplant were correlated with imaging findings. Results The majority of patients with ALF had abnormal radiographic findings. Ascites was seen in 65 % of patients. Splenomegaly, collateral vessel formation and hepatofugal flow in the portal vein were present in 28, 15 and 9 % of patients, respectively. Nodular liver surface was noted in 23 % of patients, more commonly in patients who had been ill for more than 7 days. Liver surface nodularity correlated with massive hepatic necrosis on histology and wrinkled capsule on visual inspection of explanted liver specimen. Conclusion Imaging findings in ALF was variable and can resemble cirrhosis. Assessment for underlying cirrhosis in the setting of liver failure should not be based on imaging findings.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-014-3106-6