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 |