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Falciform ligament (liver)

The falciform ligament is a double-layered peritoneal fold that attaches the anterior surface of the liver to the anterior abdominal wall and diaphragm. It is sickle-shaped and lies in the midline, separating the right and left anatomical lobes of the liver on the diaphragmatic surface.

Contained within the free inferior edge of the falciform ligament is the ligamentum teres hepatis (round ligament of the liver), a fibrous remnant of the obliterated umbilical vein from fetal circulation. Posteriorly, the falciform ligament blends into the coronary ligament and attaches superiorly to the diaphragm.

Embryologically, it develops from the ventral mesentery, which also gives rise to the lesser omentum. Clinically, it is an important anatomical landmark in hepatobiliary surgery, liver transplantation, and radiology, and can serve as a pathway for the spread of infection or neoplastic disease.

Synonyms

  • Ligamentum falciforme hepatis

  • Falciform fold

  • Sickle-shaped ligament of liver

Function

  • Attaches the liver to anterior abdominal wall and diaphragm

  • Separates right and left anatomical lobes on anterior liver surface

  • Contains the ligamentum teres hepatis (round ligament)

  • Acts as an anatomical and surgical landmark during hepatobiliary operations

MRI Appearance

T1-weighted images:

  • Appears as a thin hypointense line between right and left hepatic lobes

  • Ligamentum teres within it appears low signal intensity

T2-weighted images:

  • Falciform ligament is low signal intensity; surrounding perihepatic fat enhances contrast

  • May be more conspicuous if fluid is present in peritoneal cavity

STIR:

  • Suppresses fat, allowing clearer visualization of ligament and round ligament

  • Pathological changes such as edema or tumor infiltration appear hyperintense

T1 Fat-Saturated (Pre-contrast):

  • Ligament remains as low to intermediate signal, distinguished from suppressed fat background

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Normal ligament shows no significant enhancement

  • Pathology (metastasis, tumor spread, or peritoneal deposits) may enhance along the falciform ligament

MRI Non-Contrast 3D Imaging:

  • Demonstrates the ligament’s relationship to anterior abdominal wall and liver lobes

  • Useful in pre-surgical planning and evaluation of peritoneal disease

CT Appearance

CT Pre-Contrast:

  • Appears as a thin linear soft-tissue density connecting anterior liver surface to anterior abdominal wall

  • Ligamentum teres may appear as a dense cord-like structure within

CT Post-Contrast:

  • Falciform ligament itself does not enhance

  • Pathological thickening or deposits may enhance after contrast

  • Ascitic fluid may highlight the ligament’s margins, making it more conspicuous

CT 3D Reconstructions:

  • Clearly show the falciform ligament and its relationship to the diaphragm and anterior abdominal wall

  • Helpful in surgical mapping and evaluation of peritoneal spread of malignancy

MRI images

falciform ligament liver MRI axial anatomy image -img-00000-00000

CT image

falciform ligament liver coronal image

CT image

falciform ligament liver ct axial image