Figure 1
Simple epithelial cysts. T2-weighted MRI in the axial and coronal planes (A and B, respectively), showing thin-walled cysts, with a homogeneous fluid content, which can be unilocular or contain up to two thin internal septa (arrows).
Figure 2
Caroli’s disease. MRI cholangiography with maximum intensity projection (A) showing multifocal cystic dilatations of the intrahepatic bile ducts (arrow). Contrast-enhanced T1-weighted sequence (B) showing the central dot sign, representing a portal branch in the middle of the dilated bile duct (arrow), which is quite characteristic of this condition. C: Contrast-enhanced CT scan of a patient with Caroli’s disease, in the pyelographic phase, showing dilatation of the biliary tree (arrow) and medullary sponge kidneys (asterisks).
Figure 3
Ciliated cysts on MRI. Contrast-enhanced T2-weighted images, in the axial and coronal planes (A and B, respectively), showing a unilocular cyst near the posterior capsule of liver segment IV (arrows) with slightly thick contents and no solid components. In another patient, a cyst in a similar location is seen on an axial T2-weighted image (C), in this case with a air-fluid level (arrow), also without detectable enhancement on a contrast-enhanced T1-weighted image with digital subtraction (D).
Figure 4
Biliary hamartomas. Ultrasound (A) showing small cysts with the typical comet-tail artifact (arrow). T2-weighted MRI sequence (B) and MRI cholangiography (C) clearly showing multiple small hyperintense cysts distributed throughout the liver parenchyma.
Figure 5
Polycystic liver disease on MRI. Note that, as with renal involvement, there is a tendency for liver volume to increase due to multiple, confluent cysts. On an axial T2-weighted image (A), most cysts appear as simple cysts, with thin or no internal septa (arrow). On a contrast-enhanced coronal T1-weighted image (B), the cysts can have variable signal intensity (arrows) due to the blood/high protein content, although they do not show nodular enhancement.
Figure 6
CT scans of cysts of traumatic origin. A: Biloma. A large pericapsular collection (asterisk) is observed in the manipulated region of the hepatic dome. Note the heterogeneous content, with some gaseous foci, and the thick walls with enhancement, denoting an inflammatory component. B: Seromas at nodulectomy sites. Note the small, hypodense, homogeneous fluid collections (arrows), a relatively common finding in the postoperative context. C,D: Hematoma. A hyperdense collection without significant enhancement can be seen in the left liver lobe (asterisk), containing a small focus of active bleeding in the arterial phase (arrow).
Figure 7
Mucinous cystadenoma in a 56-year-old female patient. A: Axial T2-weighted MRI showing a multiloculated cyst with thick walls and septa in liver segment IVa (arrow). B: Axial Tl-weighted MRI with contrast enhancement of walls and septa, without evident mural nodules.
Figure 8
Liver metastasis from a neu-roendocrine tumor of the small bowel. Axial T1-weighted images before and after contrast injection (A and B, respectively), showing a predominantly liquid lesion in the right liver lobe, with blood content and coarse peripheral enhancement (arrows). Coronal CT reconstruction (C) showing the primary hypervascular lesion in the small bowel (circle) and its representation in the surgical specimen (D).
Figure 9
Liver metastasis from urothelial carcinoma of the bladder. Axial CT scan in the pyelographic phase, showing the primary bladder lesion (A) and a rare pattern of cyst-like liver metastases (B,C), with enhancement mainly restricted to their walls and with irregular septa (arrows).
Figure 10
Cystic hepatocellular carcinoma with necrosis/cystic degeneration (asterisk), confirmed by CT-directed percutaneous biopsy.
Figure 11
Undifferentiated sarcoma in a nine-year-old child. A: MRI showing a large heterogeneous mass (asterisk) with marked necrosis, characterized by a predominance of signal hyperintensity on T2-weighted images (A,B), sometimes forming air-fluid levels, together with layers of blood content (arrow in C), as well as predominantly septal and peripheral enhancement (arrow in D).
Figure 12
Pyogenic liver abscess in a patient with abdominal pain, fever, and leukocytosis. On MRI, the collection is seen to have thick walls and a hyperintense signal on T2-weighted images (arrow in A), in addition to a multiloculated appearance and content with markedly restricted diffusion (B,C). Contrast-enhanced CT of the same patient (D,E) showing the “double-target” sign, characterized by a hyperdense inner border surrounded by a hypodense ring (edema), the latter with delayed enhancement (arrows).
Figure 13
Types I and II hydatid cysts. On MRI, type I (A,B) presents as a thin-walled, unilocular lesion (asterisk) in the right liver lobe, resembling a simple epithelial cyst. Type II (C) has a multilocular appearance, with thin septa and confluent daughter cysts (arrow).
Figure 14
Types III and IV hydatid cysts. Unenhanced CT scan (A) showing a cyst with a diffusely calcified center (arrow) in the left liver lobe and its representation in the surgical specimen (B), indicative of an inactive (type III) hydatid cyst. Coronal T2-weighted MRI sequence (C) showing the focal rupture of a large hydatid cyst into the portal vein (arrow), a finding corroborated on a contrast-enhanced CT scan (D). This aspect represents angioinvasive hydatidosis, a rare type of presentation of hepatic cystic echinococcosis, classified as a type IV hydatid cyst.
Figure 15
Specific liver infections. Contrast-enhanced CT scan (A) showing an amebic abscess presenting as a thick-walled, “target-shaped” collection (asterisk) in the right liver lobe. Contrast-enhanced CT scan (B) showing fungal microabscesses presenting as multiple hypodense lesions widely distributed throughout the liver parenchyma (arrows), simulating metastases. Ultrasound (C) showing a fungal microabscess with a central nidus and an external hyperechoic halo, characterizing the “bull’s eye” sign.
Figure 16
Peribiliary cysts. Coronal T2-weighted MRI scan (A) and contrast-enhanced axial Tl-weighted MRI in the hepatobiliary phase (B) showing multiple, small, simple-appearing cysts with a characteristic periductal distribution, which are often associated with chronic liver disease.
Figure 17
Giant cavernous hemangioma with an air-fluid level. A large, predominantly liquid mass can be seen in the left liver lobe. Note the multiloculated appearance with internal echoes (asterisk) on ultrasound (A) and multiple pockets with an air-fluid level on contrast-enhanced T2-weighted MRI (B), with predominantly peripheral enhancement (C), an atypical presentation pattern for hemangioma. The diagnosis was made by ultrasound-guided percutaneous biopsy.
Hepatic cysts: a survival guide
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