Transient increase in hepatic attenuation (or intensity on MR) appearing as segmental wedge-shaped areas of enhancement during arterial-phase CT or MR, which become isoattenuating/isointense during portal venous phase 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
James A: Focal lesions of the liver: imaging appearances and management. Br J Hosp Med (Lond). 81(11):1-22, 2020
Elsayes KM et al: A comprehensive approach to hepatic vascular disease. Radiographics. 37(3):813-36, 2017
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
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
Torabi M et al: CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 28(7):1967-82, 2008
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
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
Pradella S et al: Transient hepatic attenuation difference (THAD) in biliary duct disease. Abdom Imaging. 34(5):626-33, 2009
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
Colagrande S et al: Transient hepatic intensity differences: part 1, Those associated with focal lesions. AJR Am J Roentgenol. 188(1):154-9, 2007
Köseoğlu K et al: Transient hepatic attenuation differences at biphasic spiral CT examinations. Diagn Interv Radiol. 11(2):96-101, 2005
Colagrande S et al: Transient hepatic attenuation differences (THAD) not connected to focal lesions. Radiol Med. 104(1-2):25-43, 2002
Arita T et al: Hepatic perfusion abnormalities in acute pancreatitis: CT appearance and clinical importance. Abdom Imaging. 24(2):157-62, 1999
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
Itai Y et al: Transient hepatic attenuation differences on dynamic computed tomography. J Comput Assist Tomogr. 11(3):461-5, 1987
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KEY FACTS
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TERMINOLOGY
Abbreviations
Transient hepatic attenuation difference (THAD)
Transient hepatic intensity difference (THID)
Definitions
Transient increase in hepatic attenuation (or intensity on MR) appearing as segmental wedge-shaped areas of enhancement during arterial-phase CT or MR, which become isoattenuating/isointense during portal venous phase 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
James A: Focal lesions of the liver: imaging appearances and management. Br J Hosp Med (Lond). 81(11):1-22, 2020
Elsayes KM et al: A comprehensive approach to hepatic vascular disease. Radiographics. 37(3):813-36, 2017
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
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
Torabi M et al: CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 28(7):1967-82, 2008
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
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
Pradella S et al: Transient hepatic attenuation difference (THAD) in biliary duct disease. Abdom Imaging. 34(5):626-33, 2009
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
Colagrande S et al: Transient hepatic intensity differences: part 1, Those associated with focal lesions. AJR Am J Roentgenol. 188(1):154-9, 2007
Köseoğlu K et al: Transient hepatic attenuation differences at biphasic spiral CT examinations. Diagn Interv Radiol. 11(2):96-101, 2005
Colagrande S et al: Transient hepatic attenuation differences (THAD) not connected to focal lesions. Radiol Med. 104(1-2):25-43, 2002
Arita T et al: Hepatic perfusion abnormalities in acute pancreatitis: CT appearance and clinical importance. Abdom Imaging. 24(2):157-62, 1999
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
Itai Y et al: Transient hepatic attenuation differences on dynamic computed tomography. J Comput Assist Tomogr. 11(3):461-5, 1987
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