Review
Hepatic capsular retraction: An updated MR imaging review

https://doi.org/10.1016/j.ejrad.2019.01.037Get rights and content

Highlights

  • Hepatic capsular retraction is an uncommon finding that can help to refine a differential diagnosis.

  • The discovery of new entities causing capsular retraction has expanded the differential.

  • MRI allows for improved detection and characterization of lesions causing capsular retraction.

Abstract

Hepatic capsular retraction is a morphologic descriptor that refers to invagination or focal flattening of the typical smooth contour of the liver capsule. It is an uncommon finding that, when combined with other imaging features and clinical context, can help to refine the differential diagnosis in patients with liver lesions. Although this descriptor has historically been used in reference to a small subset of benign and malignant lesions, the differential has since been expanded with the discovery of new entities causing capsular retraction as well as with novel and increased use of liver-directed treatment techniques. Additionally, modern imaging techniques now allow for improved detection and characterization of capsular retraction. In this review, we discuss these common and uncommon causes of capsular retraction, with an emphasis on findings from body MRI.

Section snippets

Background

Hepatic capsular retraction is a morphologic descriptor referring to invagination or focal flattening of the typical smooth contour of the liver capsule. It is a rare finding on cross-sectional imaging, seen in approximately 2% of patients [1]. While once believed to be exclusively correlated with hepatic malignancy, capsular retraction is in fact also associated with several types of benign lesions and with post-treatment changes [[2], [3], [4]]. Although nonspecific, the finding of hepatic

Intrahepatic cholangiocarcinoma

Cholangiocarcinoma is the second most common primary liver cancer and can arise from either the intrahepatic or extrahepatic bile ducts. Intrahepatic cholangiocarcinoma is less common than the extrahepatic form, although its prevalence in the United States is increasing [9]. Chronic biliary inflammation is the most common risk factor for the development of intrahepatic cholangiocarcinoma; this chronic inflammation may be caused by inflammatory conditions such as primary sclerosing cholangitis

Hepatic hemangioma

Hemangiomas, the most common benign liver neoplasms, arise from proliferative vasculature and are supported by a fibrous matrix. They are incidentally discovered in 2.5% to 3.4% of imaged lesions [35,36]. Capsular retraction can be seen in association with hepatic hemangiomas in three different settings: giant hemangiomas [37], hemangiomas occurring in patients with liver cirrhosis [5,[38], [39], [40]], and sclerosing hemangiomas (also called thrombosed or hyalinized hemangiomas) [[38], [39],

“Pseudocirrhosis” after treatment for hepatic metastases

Pseudocirrhosis in the setting of treated metastatic disease can be the result of reactive changes in both the lesion itself and in the uninvolved liver parenchyma after nonoperative therapy (Fig. 8). Post-treatment changes contributing to capsular retraction include necrosis, fibrosis, and atrophy of the lesion [1,2,34,50,51], as well as nodular regenerative hyperplasia in the liver parenchyma adjacent to the treated tumor [[51], [52], [53]]. Capsular retraction is most frequently described

Chronic biliary obstruction

Chronic biliary obstruction is often associated with hepatic capsular retraction and may result from various causes including traumatic, vascular, inflammatory, infectious, and neoplastic processes. The exact mechanism of capsular retraction varies by specific process; two representative processes are discussed in further detail below.

Mimickers of capsular retraction

Since the identification of capsular retraction can potentially lead to further imaging or surgical intervention, it is important to distinguish true capsular retraction from pseudo capsular retraction. One commonly seen cause of pseudo capsular retraction is extrinsic compression of the hepatic capsule by the adjacent ribs or diaphragm; this finding can be easily confirmed with review of multiplanar reformats. Similarly, penetrating or blunt trauma may distort the hepatic parenchyma to give an

Conclusion

Hepatic capsular retraction is associated with a variety of conditions and is a useful feature in liver imaging. It may be indicative of an underlying fibrotic process (either neoplastic or non-neoplastic in origin) or of focal parenchymal atrophy in response to vascular insult or chronic biliary obstruction. By itself, capsular retraction provides a useful list of potential differential diagnosis considerations. However, when combined with other imaging findings and clinical data, the presence

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Acknowledgement

None.

References (69)

  • M.E. Flisak et al.

    Inflammatory pseudotumor of the liver: appearance on MRI

    Clin. Imaging

    (1994)
  • J. Bosch et al.

    Pathophysiology of portal hypertension

    Gastroenterol. Clin. North Am.

    (1992)
  • P. Soyer et al.

    CT of hepatic tumors: prevalence and specificity of retraction of the adjacent liver capsule

    Am. J. Roentgenol.

    (1994)
  • N. Sans et al.

    Is capsular retraction a specific CT sign of malignant liver tumor?

    Eur. Radiol.

    (1999)
  • D. Da Ines et al.

    Hepatic capsular retraction: spectrum of diagnosis at MRI

    Acta Radiol. Short Rep.

    (2014)
  • A. Blachar et al.

    Hepatic capsular retraction: spectrum of benign and malignant etiologies

    Abdom. Imaging

    (2002)
  • G.X.V. Tan et al.

    Causes of hepatic capsular retraction: a pictorial essay

    Insights Imaging

    (2016)
  • D.M. Yang et al.

    Various causes of hepatic capsular retraction: CT and MR findings

    Br. J. Radiol.

    (2002)
  • Y. Shaib et al.

    The epidemiology of cholangiocarcinoma

    Semin. Liver Dis.

    (2004)
  • V. Vilgrain et al.

    Intrahepatic cholangiocarcinoma: MRI and pathologic correlation in 14 patients

    J. Comput. Assist. Tomogr.

    (1997)
  • J.H. Lim

    Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings

    Am. J. Roentgenol.

    (2003)
  • Y.E. Chung et al.

    Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation

    RadioGraphics

    (2009)
  • C. Valls et al.

    Intrahepatic peripheral cholangiocarcinoma: CT evaluation

    Abdom. Imaging

    (2000)
  • G. Mamone et al.

    Intrahepatic mass-forming cholangiocarcinoma: enhancement pattern on Gd-BOPTA-MRI with emphasis of hepatobiliary phase

    Abdom. Imaging

    (2015)
  • R. Kim et al.

    Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging

    Eur. Radiol.

    (2016)
  • H.J. Park et al.

    Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma

    Abdom. Imaging

    (2013)
  • J. Bruix et al.

    Management of hepatocellular carcinoma

    Hepatology

    (2005)
  • S. Tsunematsu et al.

    Intratumoral artery on contrast-enhanced computed tomography imaging: differentiating intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma

    Abdom. Imaging

    (2015)
  • A. Mehrabi et al.

    Primary malignant hepatic epithelioid hemangioendothelioma

    Cancer

    (2006)
  • J.M. Läuffer et al.

    Epithelioid hemangioendothelioma of the liver: a rare hepatic tumor

    Cancer

    (1996)
  • A. Giardino et al.

    Hepatic epithelioid hemangioendothelioma: a report from three university centers

    Radiol. Bras.

    (2016)
  • J.H. Lee et al.

    Magnetic resonance findings of hepatic epithelioid hemangioendothelioma: emphasis on hepatobiliary phase using Gd-EOB-DTPA

    Abdom. Radiol.

    (2017)
  • P.C. Buetow et al.

    Malignant vascular tumors of the liver: radiologic-pathologic correlation

    RadioGraphics

    (1994)
  • Y.-P. Zhu et al.

    Primary hepatic angiosarcoma: a report of two cases and literature review

    World J. Gastroenterol.

    (2015)
  • Cited by (0)

    View full text