Liver necrosis and regeneration after fulminant hepatitis: Pathologic correlation with CT and MR findings

PURPOSE: To characterize computed tomographic (CT) and magnetic resonance (MR) findings of liver necrosis and regeneration after fulminant hepatitis. MATERIALS AND METHODS: Three patients with fulminant hepatitis underwent CT before orthotopic liver transplantation; one also underwent MR imaging. These findings were retrospectively reviewed and compared with gross and histologic findings obtained after transplantation. RESULTS: Regions of liver necrosis demonstrated low attenuation on CT scans before contrast material was administered and enhanced to attenuation equal to or greater than that of liver regeneration on postcontrast CT images. Conversely, nodular liver regeneration demonstrated hyperattenuation on precontrast and hypoattenuatian on postcontrast CT images, which simulated neoplastic lesions. The necrotic liver parenchyma was seen as high and low intensity on T2- and T1-weighted MR images, respectively, whereas areas of regeneration appeared as hypo- and hyperintense. CONCLUSION: Characteristic patterns of liver regeneration after fulminant hepatitis may be seen at CT and MR imaging. Recognition of this regeneration process may avoid an incorrect diagnosis of malignancy.