What are the MRI findings of fatty liver?

Nov 05, 2025 Source: Cainiu Health

Dr. Gao Jun

Introduction

In general, fatty liver exhibits characteristic imaging findings on magnetic resonance imaging (MRI), including changes in liver signal intensity, patterns of fat infiltration, alterations in liver morphology and volume, visualization of hepatic vessels, and findings on fat-suppression sequences. Clinicians comprehensively evaluate the severity of fatty liver by integrating the patient's medical history, laboratory results, and MRI findings.

In general, fatty liver exhibits characteristic imaging findings on magnetic resonance imaging (MRI), primarily including changes in liver signal intensity, patterns of fat infiltration, alterations in liver morphology and volume, visibility of hepatic vessels, and findings on fat-suppression sequences. The specific analysis is as follows:

1. Changes in liver signal intensity: On conventional T1-weighted images, the liver signal in patients with fatty liver is typically higher than that of normal liver tissue, presenting a "bright liver" appearance; on T2-weighted images, the signal intensity is usually normal or mildly increased.

2. Patterns of fat infiltration: Fat infiltration in fatty liver can be diffuse or focal. Diffuse infiltration appears as uniformly increased signal intensity throughout the entire liver without significant regional differences. Focal infiltration manifests as patchy or nodular areas of high signal intensity in localized regions of the liver, which must be differentiated from liver tumors and other lesions to avoid misdiagnosis.

3. Liver morphology and volume changes: In mild fatty liver, liver morphology is often normal. As the disease progresses and fat accumulates within hepatocytes, the liver may show varying degrees of enlargement, characterized by disproportionate liver lobe sizes, a smooth liver capsule, and blunted liver edges. Some patients may also exhibit increased perihilar fat tissue.

4. Visibility of hepatic vessels: Due to increased liver signal intensity, the clarity of intrahepatic vessels on MRI may be reduced. On T1-weighted images, blood vessels appear with relatively low signal intensity, creating a marked contrast against the surrounding hyperintense liver tissue, leading to an appearance of vessel disappearance or compression with vessel narrowing.

5. Findings on fat-suppression sequences: On fat-suppression sequences, the high signal intensity in fatty liver regions significantly decreases, becoming similar to or consistent with that of normal liver tissue. This characteristic change effectively confirms that the elevated liver signal is caused by fat infiltration and serves as a key method for differentiating fatty liver from other liver diseases.

Clinicians integrate patient history, laboratory test results, and MRI findings to comprehensively assess the severity of fatty liver and formulate targeted treatment plans. Patients should maintain a healthy diet, increase physical activity, and reduce fat accumulation in the liver to help improve their condition.

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