Focal liver lesions in the cirrhotic patient: multislice spiral CT evaluation

Imaging of the cirrhotic patient is a very difficult task due to the several morphologic and structural alterations that occur in the hepatic parenchyma. The presence of areas of fibrosis and regenerative nodules, often associated with haemodynamic alterations due to the portal hypertension, can make the identification of hepatocellular carcinoma very difficult or, in many cases, simulate the presence of tumour. Despite the use of state-of-the-art equipment and optimised study protocols, computed tomography (CT) has poor sensitivity for the detection of hepatocellular carcinoma. The present article illustrates the spiral CT findings that most often can be found in the evaluation of cirrhotic patients. In particular, the authors illustrate the CT patterns of regenerative nodules, dysplastic nodules, hepatocellular carcinomas and of all lesions that may mimic hepatocellular carcinoma.