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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