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Transient Hepatic Attenuation or Intensity Difference (THADs and THIDs)
Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Transient hepatic attenuation difference (THAD)
              • Transient hepatic intensity difference (THID)
            • Definitions

              • Transient increase in hepatic attenuation (or intensity) during arterial phase CT (or MR) due to regional variations in balance between hepatic arterial and portal venous blood flow

            IMAGING

            • General Features

              • Imaging Recommendations

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Nuclear Medicine Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Bhattacharya A et al: Segmental hepatic concentration of 18F-FDG-labeled autologous leukocytes causing a "pseudo-lesion" on PET/CT in a patient with transient hepatic attenuation difference. Clin Nucl Med. 38(10):e399-401, 2013
                                          2. Ames JT et al: Septic thrombophlebitis of the portal venous system: clinical and imaging findings in thirty-three patients. Dig Dis Sci. 56(7):2179-84, 2011
                                          3. Desser TS: Understanding transient hepatic attenuation differences. Semin Ultrasound CT MR. 30(5):408-17, 2009
                                          4. Torabi M et al: CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 28(7):1967-82, 2008
                                          5. Ahn JH et al: Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol. 20(2):385-94, 2010
                                          6. Kim SW et al: Diffuse pattern of transient hepatic attenuation differences in viral hepatitis: a sign of acute hepatic injury in patients without cirrhosis. J Comput Assist Tomogr. 34(5):699-705, 2010
                                          7. Pradella S et al: Transient hepatic attenuation difference (THAD) in biliary duct disease. Abdom Imaging. 34(5):626-33, 2009
                                          8. Hwang SH et al: Transient hepatic attenuation difference (THAD) following transcatheter arterial chemoembolization for hepatic malignancy: changes on serial CT examinations. Eur Radiol. 18(8):1596-603, 2008
                                          9. Colagrande S et al: Transient hepatic intensity differences: part 1, Those associated with focal lesions. AJR Am J Roentgenol. 188(1):154-9, 2007
                                          10. Köseoğlu K et al: Transient hepatic attenuation differences at biphasic spiral CT examinations. Diagn Interv Radiol. 11(2):96-101, 2005
                                          11. Colagrande S et al: Transient hepatic attenuation differences (THAD) not connected to focal lesions. Radiol Med. 104(1-2):25-43, 2002
                                          12. Arita T et al: Hepatic perfusion abnormalities in acute pancreatitis: CT appearance and clinical importance. Abdom Imaging. 24(2):157-62, 1999
                                          13. Yamasaki M et al: Transient hepatic attenuation difference (THAD) in patients without neoplasm: frequency, shape, distribution, and causes. Radiat Med. 17(2):91-6, 1999
                                          14. Itai Y et al: Transient hepatic attenuation differences on dynamic computed tomography. J Comput Assist Tomogr. 11(3):461-5, 1987
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Transient hepatic attenuation difference (THAD)
                                                      • Transient hepatic intensity difference (THID)
                                                    • Definitions

                                                      • Transient increase in hepatic attenuation (or intensity) during arterial phase CT (or MR) due to regional variations in balance between hepatic arterial and portal venous blood flow

                                                    IMAGING

                                                    • General Features

                                                      • Imaging Recommendations

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Nuclear Medicine Findings

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Bhattacharya A et al: Segmental hepatic concentration of 18F-FDG-labeled autologous leukocytes causing a "pseudo-lesion" on PET/CT in a patient with transient hepatic attenuation difference. Clin Nucl Med. 38(10):e399-401, 2013
                                                                                  2. Ames JT et al: Septic thrombophlebitis of the portal venous system: clinical and imaging findings in thirty-three patients. Dig Dis Sci. 56(7):2179-84, 2011
                                                                                  3. Desser TS: Understanding transient hepatic attenuation differences. Semin Ultrasound CT MR. 30(5):408-17, 2009
                                                                                  4. Torabi M et al: CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 28(7):1967-82, 2008
                                                                                  5. Ahn JH et al: Nontumorous arterioportal shunts in the liver: CT and MRI findings considering mechanisms and fate. Eur Radiol. 20(2):385-94, 2010
                                                                                  6. Kim SW et al: Diffuse pattern of transient hepatic attenuation differences in viral hepatitis: a sign of acute hepatic injury in patients without cirrhosis. J Comput Assist Tomogr. 34(5):699-705, 2010
                                                                                  7. Pradella S et al: Transient hepatic attenuation difference (THAD) in biliary duct disease. Abdom Imaging. 34(5):626-33, 2009
                                                                                  8. Hwang SH et al: Transient hepatic attenuation difference (THAD) following transcatheter arterial chemoembolization for hepatic malignancy: changes on serial CT examinations. Eur Radiol. 18(8):1596-603, 2008
                                                                                  9. Colagrande S et al: Transient hepatic intensity differences: part 1, Those associated with focal lesions. AJR Am J Roentgenol. 188(1):154-9, 2007
                                                                                  10. Köseoğlu K et al: Transient hepatic attenuation differences at biphasic spiral CT examinations. Diagn Interv Radiol. 11(2):96-101, 2005
                                                                                  11. Colagrande S et al: Transient hepatic attenuation differences (THAD) not connected to focal lesions. Radiol Med. 104(1-2):25-43, 2002
                                                                                  12. Arita T et al: Hepatic perfusion abnormalities in acute pancreatitis: CT appearance and clinical importance. Abdom Imaging. 24(2):157-62, 1999
                                                                                  13. Yamasaki M et al: Transient hepatic attenuation difference (THAD) in patients without neoplasm: frequency, shape, distribution, and causes. Radiat Med. 17(2):91-6, 1999
                                                                                  14. Itai Y et al: Transient hepatic attenuation differences on dynamic computed tomography. J Comput Assist Tomogr. 11(3):461-5, 1987