肝硬化是慢性肝病的末期，会导致结构扭曲和灌注异常。它是发展为肝细胞癌（HCC）的主要风险因素。非肝硬化肝脏中常见的疾病实体，如血管瘤，在肝硬化肝脏中可能很少见，而似恶性肿瘤的良性实体，如融合型肝纤维化和聚集性结节样增生可能会模仿恶性肿瘤的外观。HCC通常具有典型的影像学特征，如肝脏影像报告和数据系统确定的主要特征。然而，HCC也可能具有一系列非典型或罕见的外观，如囊性HCC、低血管造影的HCC或含有巨观脂肪的HCC。带有特定基因突变（例如CTNNB-1突变的HCC）的HCC可能具有在其他类型的HCC中找不到的独特影像特征。此外，与HCC相比，肝硬化肝脏中较不常见的恶性肿瘤（如胆管癌和转移瘤）在临床上也会出现区分困难。良性和恶性病变的非典型影像特征可能存在挑战，准确诊断具有挑战性。因此，对这些特征的熟悉以及对肝硬化肝脏中疾病实体的发病率的理解对于放射科医师对肝硬化肝脏的评估是至关重要的。作者展示了肝硬化中良性和恶性病变的典型和非典型特征，并讨论了评估肝硬化肝脏的各种成像模式，包括无对比剂和增强超声、CT和MRI中的技术陷阱和独特优势。美国政府工作出版物在与RSNA签署的独家许可下发表。本文的问答题目可在补充材料中获得。

Cirrhosis is the end stage of chronic liver disease and causes architectural distortion and perfusional anomalies. It is a major risk factor for developing hepatocellular carcinoma (HCC). Common disease entities in noncirrhotic livers, such as hemangiomas, can be rare in cirrhotic livers, and benign entities such as confluent hepatic fibrosis and focal nodular hyperplasia-like lesions may mimic the appearance of malignancies,. HCC usually has typical imaging characteristics, such as the major features established by the Liver Imaging Reporting and Data System. However, HCC can also have a spectrum of atypical or uncommon appearances, such as cystic HCC, hypovascular HCC, or macroscopic fat-containing HCC. HCCs with certain genetic mutations such as CTNNB-1-mutated HCC can harbor unique imaging features not seen in other types of HCC. In addition, malignancies that are less common than HCC, such as cholangiocarcinoma and metastases, which can be difficult to differentiate, can still occur in cirrhotic livers. Atypical imaging features of benign and malignant lesions can be challenging to accurately diagnose. Therefore, familiarity with these features and an understanding of the prevalence of disease entities in cirrhotic livers are key in the daily practice of radiologists for evaluation of cirrhotic livers. The authors illustrate the typical and atypical features of benign and malignant lesions in cirrhosis and discuss the technical pitfalls and unique advantages associated with various imaging modalities in assessing cirrhotic livers, including noncontrast and contrast-enhanced US, CT, and MRI. Work of the U.S. Government published under an exclusive license with the RSNA. Quiz questions for this article are available in the supplemental material.