HEPATIC INFARCTION CAUSED BY ARTERIAL INSUFFICIENCY - SPECTRUM AND EVOLUTION OF CT FINDINGS

PURPOSE. To determine the CT imaging appearances of liver infarction d ue to arterial insufficiency and to attempt to understand reasons for apparent discrepancy of appearance in prior reports. MATERIALS AND MET HODS. Thirty-seven CT examinations from 18 patients with proven hepati c infarction were evaluated for character, location, and evolution of lesions by all investigators, with a consensus interpretation, Etiolog ies of infarction included posttransplant complication (15), laparosco pic cholecystectomy complication (2), and traumatic arterial injury (1 ). Proof of hepatic infarction was made by hepatectomy (11), biopsy (1 ), or clinical course compatible with infarction with angiographic (3) or surgical (3) evidence of hepatic arterial abnormality, In patients without histologic proof of infarction, all lesions seen at CT were c onsidered to be due to hepatic infarction, except those meeting the cr iteria for hemangioma, In 10 patients, serial examinations were availa ble over 2-180 days and a determination of serial changes in specific lesions was made using a similar image analysis. RESULTS. Of 55 lesion s identified, 53 could be classified into three shapes-wedge-shaped (1 8), rounded or oval (26), or irregularly shaped low-attenuation lesion s paralleling bile ducts (9), The other two lesions were flat hypodens e areas along the posterior aspect of the medial left hepatic lobe, We dge-shaped lesions were peripherally located; rounded lesions were eit her peripheral (10) or central (26). The caudate robe was spared excep t in one patient. Of 16 serially followed wedge-shaped lesions, four e volved into rounded lesions. No rounded lesions became wedge-shaped. C ONCLUSION. Hepatic infarction caused by arterial disease produces a sp ectrum of CT findings, Prior reported discrepancies in appearance may be due to the small number of cases in each report and the variety of potential imaging appearances, as well as evolutionary changes.