Regenerative hepatic nodules (RNs) are a form of non neoplastic nodules that arise in a cirrhotic liver. This may be slightly different from the term nodular regenerative hyperplasia which are described histopathologically as regenerative nodules with little or no hepatic fibrosis and largely healthy hepatic architecture 1.
They can be of two types:
- micronodules <3 mm
- macronodules >3 mm
There may be accumulation of iron in the nodules when they are termed siderotic nodules.
Regenerative nodules are rarely visible on non-contrast CT unless they are siderotic. Siderotic regenerative nodules (containing iron) are hyperdense to liver on precontrast imaging and become isodense to liver on post contrast phases.
They enhance similar to the normal liver parenchyma and thus may not be distinguishable in cirrhotic liver. There is no arterial phase enhancement.
CT arterial portography (CTAP)
Contrast injection is given into superior mesenteric artery (after arterial vascular access).
RNs are generally visualised as enhancing nodules surrounded by lower attenuation thin septa.
CT hepatic arteriography (CTHA)
Contrast injection is given into common hepatic artery (after arterial vascular access).
RNs are generally visualised as non-enhancing nodules surrounded by enhancing fibrous septa.
CTHA is considered more sensitive than the former in depicting regenerative nodules 4.
Regenerative nodules are common in a cirrhotic liver. About 25% of regenerative liver nodules have increased iron deposition (siderotic nodules) in comparison to normal hepatocytes, which is why they may be hypointense on T2 and T2*.
They usually do not enhance or enhance less than the liver parenchyma.
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- 1. Gupta AA, Kim DC, Krinsky GA et-al. CT and MRI of cirrhosis and its mimics. AJR Am J Roentgenol. 2004;183 (6): 1595-601. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Xu H, Kong X, Xiong Y et-al. MR features of regenerative nodules and dysplastic nodules in the cirrhotic liver. J. Huazhong Univ. Sci. Technol. Med. Sci. 2005;25 (5): 601-3. - Pubmed citation
- 3. Lee JM, Choi BI. Hepatocellular nodules in liver cirrhosis: MR evaluation. Abdom Imaging. 2011;36 (3): 282-9. doi:10.1007/s00261-011-9692-2 - Pubmed citation
- 4. Lim JH, Kim EY, Lee WJ et-al. Regenerative nodules in liver cirrhosis: findings at CT during arterial portography and CT hepatic arteriography with histopathologic correlation. Radiology. 1999;210 (2): 451-8. Radiology (full text) - Pubmed citation
Synonyms & Alternative Spellings
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|Regenerative hepatic nodules||✗|
|Hepatic nodular regeneration||✗|
|Hepatic regenerative nodules||✗|
|Regenerative liver nodules||✗|
|Regenerative liver nodule||✗|
|Regenerative hepatic nodule||✗|