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Ligamentum teres (round ligament of the liver)

The ligamentum teres hepatis, also known as the round ligament of the liver, is a fibrous remnant of the fetal left umbilical vein. During fetal life, the umbilical vein carries oxygenated blood from the placenta to the fetus. After birth, this vessel obliterates and becomes the ligamentum teres.

It runs within the free margin of the falciform ligament, extending from the umbilicus to the inferior surface of the liver, where it reaches the left branch of the portal vein at the umbilical fissure. The ligamentum teres serves as an important anatomical landmark in liver imaging and surgery, dividing the left lobe into medial and lateral segments (Couinaud segments III & IV).

Clinically, it may recanalize in conditions of portal hypertension, forming a portosystemic collateral pathway known as a caput medusae. It also serves as a critical reference in laparoscopic liver surgery and radiological segmentation.

Synonyms

  • Round ligament of the liver

  • Ligamentum teres hepatis

  • Obliterated umbilical vein

Function

  • Embryological remnant of the fetal umbilical vein

  • Serves as an anatomical landmark dividing left hepatic lobe into medial and lateral segments

  • May act as a collateral venous channel if recanalized in portal hypertension

MRI Appearance

T1-weighted images:

  • Appears as a linear, low-signal intensity band extending from umbilicus to left portal vein

  • Fat planes around ligamentum teres appear hyperintense

T2-weighted images:

  • Seen as a low-signal fibrous structure

  • If recanalized, appears as tubular hyperintense flow void representing venous channel

STIR:

  • Suppresses fat, improving visibility of ligament against surrounding parenchyma

  • Recanalized vein appears as hyperintense tubular signal

T1 Fat-Saturated (Pre-contrast):

  • Ligament itself appears as low-to-intermediate signal relative to suppressed fat background

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Fibrous ligament shows no enhancement

  • Recanalized ligamentum teres enhances like a vein, showing continuity with portal venous system

MRI 3D Reconstructions:

  • Clearly depict ligament course within falciform ligament, useful for surgical navigation and liver segmentation

CT Appearance

CT Pre-Contrast:

  • Appears as a linear soft-tissue density in falciform ligament, extending to left portal vein

  • Easily seen with surrounding fat contrast

CT Post-Contrast:

  • Fibrous ligament shows no enhancement

  • Recanalized ligamentum teres appears as a contrast-opacified tubular structure, continuous with portal vein

  • CT is highly effective in identifying portosystemic collaterals in portal hypertension

MRI image

MRI image

Ligamentum Teres (Round Ligament of the Liver) MRI coronal anatomy image -img-00000-00000

CT image

Ligamentum Teres (Round Ligament of the Liver) ct axial

CT image

Ligamentum Teres (Round Ligament of the Liver) ct coronal image