Right posterior hepatic notch sign: A simple diagnostic MR finding of cirrhosis

Purpose: To determine the frequency of occurrence of the right posterior hepatic notch sign at MR imaging in patients with cirrhosis, and to assess its diagnostic capability of this sign as a simple diagnostic MR finding of cirrhosis. Materials and Methods: This study population included 330 patients with pathologically proved cirrhosis (N = 202) or without clinical evidence of chronic liver diseases (N 128, control group). MR images were qualitatively evaluated for the presence of the right posterior hepatic notch sign. This sign was considered present if there was a sharp notch in the right posterior surface of the liver. The presence of the expanded gallbladder fossa sign was also evaluated during the same reading session. Results: The right posterior hepatic notch sign was observed in 145 of the 202 patients in the cirrhosis group, while this sign was seen in only two of the 128 patients in the control group (P < 0.0001). The sensitivity, specificity, and accuracy of this sign for the MR diagnosis of cirrhosis were 72%, 98%, and 82%, respectively. When the presence of either the expanded gallbladder fossa sign or the right posterior hepatic notch sign was considered for the MR diagnosis of cirrhosis, the sensitivity and accuracy increased to 86% and 89%, respectively. Conclusion: The right posterior hepatic notch sign can be used as a simple and highly specific sign of cirrhosis, if present. The diagnostic performance can be improved when the presence of either the expanded gallbladder fossa sign or the right posterior hepatic notch sign was considered.