title: Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT.
abstract: OBJECTIVE
  The objective of this study was to assess the long-term natural history of focal confluent fibrosis in cirrhotic liver with CT.
  
  
  METHODS
  Two radiologists retrospectively reviewed in consensus 118 liver CT examinations in 26 patients (19 men, seven women; age range, 32-68 years; mean age, 50 years) performed over approximately 6 years. Helical CT scans were obtained before and 30-35 and 65-70 seconds after injection of 125-150 mL of contrast medium at a rate of 4-5 mL/s. Proof of cirrhosis was based on liver transplantation (n = 6), biopsy (n = 9), or imaging findings (n = 11). The number, location, and attenuation of fibrotic lesions and presence of trapped vessels were evaluated. Variation of hepatic retraction associated with the development of focal confluent fibrosis lesions was assessed using the ellipsoid volume formula and an arbitrary retraction index.
  
  
  RESULTS
  Each radiologist identified 41 focal confluent fibrosis lesions. All lesions were identified by both radiologists. Twelve patients (46%) had a single lesion, 13 (50%) had two lesions, and one (4%) had three lesions. Thirty-four (83%) of 41 lesions were located in segment IV, VII, or VIII. Thirty-two lesions (78%) were hypoattenuating on unenhanced images, 25 lesions (61%) were hypoattenuating on hepatic arterial phase images, and 20 lesions (49%) were isoattenuating on portal venous phase images. Seven lesions (17%) were or became hyperattenuating at follow-up on portal venous phase images. Trapped vessels were found in six lesions (15%). The retraction index showed a significant increase over time (r = 0.423, p < or = 0.0001).
  
  
  CONCLUSIONS
  The degree of capsule retraction associated with focal confluent fibrosis evolves with time and relates to the natural evolution of cirrhosis.
authors.affiliation: Istituto di Radiologia, Università di Palermo, Via Villaermosa 29, Palermo, Italy. gbranca@yahoo.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Brancatelli
authors.forename: Richard L
authors.initials: RL
authors.lastname: Baron
authors.forename: Michael P
authors.initials: MP
authors.lastname: Federle
authors.forename: Gianvincenzo
authors.initials: G
authors.lastname: Sparacia
authors.forename: Karen
authors.initials: K
authors.lastname: Pealer
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D006801:Humans; D007482:Iothalamate Meglumine / Q000008:administration & dosage; D016014:Linear Models; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods*; D014283:Triiodobenzoic Acids / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol; D007482:Iothalamate Meglumine