Intrahepatic diffuse periportal enhancement patterns on hepatobiliary phase gadoxetate disodium-enhanced liver MR images

Abstract

The purpose of this study was to investigate the findings of diffuse periportal enhancement in the liver on hepatobiliary phase gadoxetate disodium-enhanced magnetic resonance images by comparing with the finding of periportal hyperintensity on T2-weighted images and to reveal their clinical significance.Nineteen consecutive patients with diffuse periportal enhancement on hepatobiliary phase images constituted the study population. The intrahepatic diffuse periportal enhancement finding was assessed on whether it corresponded to periportal hyperintense patterns on T2-weighted images or not in the location, and the cases were classified into 2 groups according to this characteristic. Signal intensities at the periportal areas were also assessed on T1-, T2-, diffusion-weighted and dynamic images. Furthermore, possible associations between these image findings and the final diagnoses were explored.In 7 of the 19 patients, periportal enhancement area corresponded with the periportal hyperintensity area on T2-weighted images. In the remaining 12 patients, the finding of periportal T2-hyperintensity was absent or the periportal enhancement differed from the periportal T2-hyperintensity in the location. Diseases of the former group comprised autoimmune hepatitis, acute exacerbation of chronic hepatitis and acute alcoholic steatohepatitis, and those of the latter group primary sclerosing cholangitis, autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, and liver cirrhosis with miscellaneous etiology.Diffuse periportal enhancement during the hepatobiliary phase did not always correspond to periportal hyperintensity on T2-weighted images. In the classification based on whether enhancement area corresponded or not, each enhancement pattern appeared in different groups of liver diseases. Specifically, the former (corresponding) was associated with active inflammation such as hepatitis and the latter (not corresponding) was predominantly associated with a chronic change such as cirrhosis. Appropriate recognition of these periportal enhancement patterns may contribute to the improved diagnosis of diffuse liver diseases.

The value of periportal hyperintensity sign from gadobenate dimeglumine-enhanced hepatobiliary phase MRI for predicting clinical outcomes in patients with decompensated cirrhosis

“…Our study found that there was a significant difference in the frequency of periportal hyperintensity sign on HBP MRI between the control group and decompensated cirrhosis group, suggesting that periportal hyperintensity sign on HBP MRI may distinguish decompensated cirrhotic patients from compensated cirrhotic patients. The reason might be that patients with decompensated cirrhosis have poor liver function, resulting in a poor enhancement of liver parenchyma and a relative increase of signal intensity around the portal vein [ 17 , 24 ]. Ascites is the most common complication in patients with decompensated cirrhosis [ 25 ].…”

“…Second, clinical records were the principal source of information on cirrhosis diagnosis and not all cases were histopathologically confirmed [ 17 ]. Third, the sample size of patients with periportal hyperintensity sign was small [ 24 ]. Therefore, further clinical trials in larger populations are necessary in order to validate the present study findings.…”

Imaging features facilitate diagnosis of porto-sinusoidal vascular disorder

“…Conversely, established imaging signs of cirrhosis (nodular liver surface, hypertrophy of segment I and atrophy of segment IV) were also observed in a substantial number of patients with PSVD and can therefore not reliably rule-out PSVD on cross-sectional imaging. Also, two other studies found that periportal hyperintensity could not only be observed in the HBP but also on T2-weighted images in some patients potentially corresponding to periportal edema representing active inflammation [ 26 ] or periportal fibrosis [ 27 ]. However, this could not be confirmed in our patient cohort.…”

Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting

“…17 ) [ 91 ]. Periportal hyperintensity in the HBP is defined as relatively higher enhancement bandlike areas along the portal tracts which take the form of a periportal ring or tramline and lower enhancement of the remaining areas of the liver in the HBP [ 91 , 92 ]. The width of the hyperintense part may vary from less than 2 mm in the mild pattern to more than 3 mm in the severe pattern [ 88 ], and periportal HBP hyperintensity corresponds to periportal hyperintensity on T2-weighted images in 37% of the cases [ 92 ].…”