Skip to main content

Table 2 Summary of the imaging patterns for each cystic disease

From: Cystic liver lesions: a pictorial review

Disease US patterns CT patterns MRI patterns
Simple hepatic cyst Anechoic
Homogeneous
Smooth margins
Thin wall
No mural nodule nor septation
Hypoattenuation near water
Smooth margins
Thin wall
No mural nodule nor septation
No enhancement
HypoT1, hyperT2
Smooth margins
Thin wall
No mural nodule nor septation
No enhancement
Haemorrhagic cyst Anechoic/hyperechoic
Heterogeneous
Non-enhancing septas
“Fern leaf” aspect
Possibly painful during US exam
Higher attenuation than water
Hyperattenuation
Fluid–fluid level
No enhancement
Blood signal according to the stage of the bleeding
Heterogeneous
No enhancement
Infected cyst Anechoic/hyperechoic
Thick wall
Higher attenuation than water
Thick enhancing wall
Fluid–fluid level
Gas bubbles
Heterogeneous intensity
Thick enhancing wall
Possibly restricted water diffusion (when large)
Bile duct hamartoma Small and multiple
Hyperechoic
Comet-tail artefacts
“Snow storm” aspect
Small and multiple
Hypoattenuation
Irregular shape
No enhancement
Small and multiple
HypoT1, hyperT2
“Starry sky” aspect
No communication with the biliary tract
Caroli syndrome Diffuse fusiform dilatation of the biliary tract
“Central dot” sign
Hepatic dysmorphia
Same as US
Better visibility of the “central dot” sign
Intrahepatic lithiasis
Same as CT
Assessment of communication with the biliary tract
Caroli disease Diffuse aneurysmal dilatation of the biliary tract
“Central dot” sign
Same as US
Better visibility of the “central dot” sign
Intrahepatic lithiasis
Same as CT
Assessment of communication with the biliary tract
Polycystic liver disease Multiple simple hepatic cyst
Compression
Multiple simple hepatic cyst
Compression
Multiple simple hepatic cyst
Compression
Peribiliary cyst Multiple small peri-portal cysts
“String of pearls” aspect
Multiple small peri-portal cysts
“String of pearls” aspect
Not communicating with the biliary tract (MRCP and use of hepatobiliary MRI contrast agent may help)
Hepatic lymphatic malformation Multilocular
Enhancing thin septas on ECUS
Multilocular
Enhancing thin septas and wall
Possibly varying signal on T1 and T2
Dilated lymph duct on lymphoMR
Ciliated hepatic foregut duplication cyst Solitary and subcapsular
Mostly in the IV segment
Hypoechoic
Possibly heterogeneous, fluid–fluid level
Solitary and subcapsular
Mostly in the IV segment
Hyperattenuation/hypoattenuation higher than simple fluid
Fluid–fluid level
No enhancement
Solitary and subcapsular
Mostly in the IV segment
HyperT2 and hyperT1
Fluid–fluid level
No enhancement
Mucinous cystic neoplasm of the liver Solitary and large
Anechoic
Multilocular
Irregular margins
Septas and thick wall
Solitary and large
Hypoattenuation
Multilocular
Enhancing septas and (thick) wall
Mural nodule (invasive type)
Rare calcification (invasive type)
Solitary and large
Varying signal on T1 and T2
Multilocular
Enhancing septas and wall
Fluid–fluid level/protein rich fluid
Haemorrhagic fluid / mural nodule (invasive type)
Intraductal papillary neoplasm of the bile duct Mostly intraluminal hypo or hyperechoic mass with upstream duct dilatation Intraductal heterogeneous mass enhancing at arterial phase, non-increasing on portal and delayed phase HyperT2 and hypoT1 heterogeneous
Same enhancement as CT
Connection with the biliary tract on MRCP
Possibly restriction of diffusion
Cystic metastasis Non-purely anechoic
With thick wall, mural nodule, septas
Various type
Hypoattenuation with complex patterns: thick wall, septas, enhancement, mural nodule
Various type
HyperT2 with complex patterns: thick wall, septas, enhancement, mural nodule
Pyogenic abscess Heterogeneous
Anechoic/hypoechoic/hyperechoic
Hypoattenuation
“Double target” sign
“Honeycomb” pattern and “Cluster” sign
Gas bubbles
HyperT2, hypoT1
Same patterns as CT
Central restriction of diffusion (large abscess)
Hydatid cyst (first stages/patterns depend on the stage) Anechoic with possibly mobile internal echos and hyperechoic parts
Irregular margins
Hypoattenuation
Irregular margins
Wall calcifications
Internal septas, thick wall
HyperT2
HypoT2 wall and septas
Heterogeneous signal
Typical “wheel-spoke” pattern for CE2
Hepatic alveolar echinococcosis Hypoechoic/hyperechoic/anechoic
Heterogeneous
Irregular margins
Hypoattenuation
Heterogeneous
Irregular margins
Central calcifications
May deform the hepatic capsule
No enhancement
HyperT2, hypo to intermediate T1
HypoT2 and hypoT1 for fibrotic part
Multivesicular aspect