Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT

To determine the computed tomographic (CT) characteristics of confluent fibrosis complicating liver cirrhosis, CT scans of 420 cirrhotic patients without hepatic malignancy who underwent hepatic transplantation were correlated with freshly resected whole liver specimens. In 59 patients, CT demonstrated 70 focal abnormalities corresponding to confluent fibrosis. The lesions were characterized by shape and location: 49 wedge-shaped lesions radiated from the porta hepatis, eight peripheral bandlike lesions were remote from the porta hepatis, and 13 lesions were seen as total lobar or segmental fibrosis. Associated volume loss was seen in 62 of the 70 lesions as retraction of the overlying hepatic capsule or total shrinkage of the segmental or lobar involvement. At plain CT, all 70 lesions were areas of lower attenuation than adjacent liver. At contrast material-enhanced CT, 51 of 64 lesions were iso-attenuating or minimally hypo-attenuating. The authors conclude that confluent fibrosis has a characteristic appearance at CT. Recognition of its characteristics may help radiologists differentiate confluent fibrosis from hepatic neoplasms in cirrhotic patients.