Figure 1
Axial (A, B, and C) and coronal (D) contrast-enhanced CT of the abdomen in the portal venous phase at time of the initial diagnosis. (A) shows multiple hypodense lesions throughout the liver and the spleen. (B) and (C) demonstrates lymph nodes of intermediate size (white arrow) at the retroperitoneum and along the lesser curvature of the stomach. The liver is slightly enlarged.
Figure 2
MRI of the upper abdomen at time of the initial diagnosis. Axial fat suppressed (FS) T2-weighted image (WI) (A), shows multiple hypointense liver and splenic lesions. Axial FS T1-WI before (B) and after administration of gadolinium-BOPTA contrast (C), show multiple hypointense focal lesions throughout the liver and spleen enhancing less than the surrounding liver and splenic parenchyma. FS T1-WI 1 hour after administration of gadolinium-BOPTA (D) shows delayed enhancement of the splenic lesions, whereas the liver lesions are not visible against the background of liverspecific enhancement of the normal liver.
Figure 3
Imaging examinations four years later: Axial (A) and coronal (B and D) contrast-enhanced CT of the abdomen in the portal venous phase. (A) shows a nodular contour of the liver with a relative enlarged caudate lobe. (B) shows multifocal hypodense splenic lesions. (C) demonstrates esophageal varices (black arrow). Axial FS T2-WI (D) shows a heterogeneity of the liver parenchyma with multiple relative hypointense lesions diffuse throughout the liver.
Figure 4
Sirius red staining. Portal tract is elongated due to connecting periportal fibrosis in keeping with stage F3 liver fibrosis (Metavir classification).