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Review
. 2022 May 26;12(6):1323.
doi: 10.3390/diagnostics12061323.

Imaging Features of Post Main Hepatectomy Complications: The Radiologist Challenging

Carmen Cutolo  1 , Federica De Muzio  2 , Roberta Fusco  3 , Igino Simonetti  4 , Andrea Belli  5 , Renato Patrone  5 , Francesca Grassi  6   7 , Federica Dell'Aversana  6 , Vincenzo Pilone  1 , Antonella Petrillo  4 , Francesco Izzo  5 , Vincenza Granata  4
Affiliations
Review

Imaging Features of Post Main Hepatectomy Complications: The Radiologist Challenging

Carmen Cutolo et al. Diagnostics (Basel). .

Abstract

In the recent years, the number of liver resections has seen an impressive growth. Usually, hepatic resections remain the treatment of various liver diseases, such as malignant tumors, benign tumors, hydatid disease, and abscesses. Despite technical advancements and tremendous experience in the field of liver resection of specialized centers, there are moderately high rates of postoperative morbidity and mortality, especially in high-risk and older patient populations. Although ultrasonography is usually the first-line imaging examination for postoperative complications, Computed Tomography (CT) is the imaging tool of choice in emergency settings due to its capability to assess the whole body in a few seconds and detect all possible complications. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for delineating early postoperative bile duct injuries and ischemic cholangitis that may arise in the late postoperative phase. Moreover, both MDCT and MRCP can precisely detect tumor recurrence. Consequently, radiologists should have knowledge of these surgical procedures for better comprehension of postoperative changes and recognition of the radiological features of various postoperative complications.

Keywords: hepatectomy; postoperative complications; radiologists.

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Conflict of interest statement

The authors have no conflict of interest to disclose. The authors confirm that the article is not under consideration for publication elsewhere.

Figures

Figure 1
Figure 1
Postsurgical biloma assessed with MRI at 1 week post resection of VIII segment for liver metastasis. The biloma (arrow) appears hyperintense in T2 (A,B) sequences of MRI study.
Figure 2
Figure 2
Hepatic abscess in resected cholangiocarcinoma on VI hepatic segment, evaluated with MRI. Arrow shows air artifacts within the collection and hyperenhancement of hepatic parenchymal in arterial phase (A) of contrast study that disappears in portal (B) and hepatobiliary (C) phase of contrast study.
Figure 3
Figure 3
Hepatic abscess in resected hepatocellular carcinoma on VI hepatic segment, evaluated with CT. Arrow shows air artifacts within the collection in arterial (A) and portal (B) phase of contrast study.
Figure 4
Figure 4
CT-guided hepatic infected biloma drainage (arrows) and postprocedure assessment in portal phase of contrast study in axial (A) and coronal (B) plane.
Figure 5
Figure 5
Active bleeding (arrow) during arterial (A), portal (B), and late (C) phase of contrast study. In (D), arrow shows contrast collection in perihepatic space.
Figure 6
Figure 6
CT portal phase assessment in resected liver metastases patient. The arrow shows (A,B) mild portal thrombosis.
Figure 7
Figure 7
Bile leaks assessed with MRI T2-W sequence (A) and hepatospecific phase of contrast study (B). Arrow shows leak.
Figure 8
Figure 8
CT assessment in colorectal metastasis-resected patient (A). In (B), arrow shows a new lesion.
Figure 9
Figure 9
Patient with hepatosarcoma evaluated with MRI study ((A): T2-W sequence and (B): portal phase of contrast study). At MRI 6-month evaluation of arterial phase (C) and cholangiography (D) sequences show biliary strictures (arrow).
See this image and copyright information in PMC

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