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In the latter case, the diagnosis can be difficult. Rapid diagnosis of maternal-fetal emergencies and situations requiring specialized interventions are crucial to preserve the maternal liver and guarantee materno-fetal survival. While detailed questioning of the patient and a clinical examination are highly important, imaging is often essential to reach a diagnosis of these liver diseases and lesions. Three groups of liver diseases may be observed during pregnancy: (1) diseases related to pregnancy: intrahepatic cholestasis of pregnancy, pre-eclampsia, eclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and acute fatty liver of pregnancy; (2) liver diseases that are more frequent during or exacerbated by pregnancy: acute herpes simplex hepatitis, Budd-Chiari syndrome, hemorrhagic hereditary telangiectasia, hepatocellular adenoma, portal vein thrombosis, and cholelithiasis; (3) coincidental conditions, including acute hepatitis, incidental focal liver lesions, metabolic dysfunction\u2013associated steatotic liver disease, cirrhosis, hepatocellular carcinoma, liver abscesses and parasitosis, and liver transplantation. Specific knowledge of the main imaging findings is required to reach an early diagnosis, for adequate follow-up, and to avoid adverse consequences in both the mother and the fetus.<\/jats:p><jats:p><jats:bold>Critical relevance statement<\/jats:bold> Pregnancy-related liver diseases are the most important cause of liver dysfunction in pregnant patients and, in pregnancy, even common liver conditions can have an unexpected turn. Fear of radiations should never delay necessary imaging studies in pregnancy.<\/jats:p><jats:p><jats:bold>Key points<\/jats:bold><\/jats:p><jats:p>\u2022 Pregnancy-related liver diseases are the most frequent cause of liver dysfunction during gestation.<\/jats:p><jats:p>\u2022 Fear of radiation should never delay necessary imaging studies.<\/jats:p><jats:p>\u2022 Liver imaging is important to assess liver emergencies and for the diagnosis and follow-up of any other liver diseases.<\/jats:p><jats:p>\u2022 Common liver conditions and lesions may take an unexpected turn during pregnancy.<\/jats:p><jats:p>\u2022 Pregnancy-specific diseases such as pre-eclampsia and HELLP syndrome must be rapidly identified. However, imaging should never delay delivery when it is considered to be urgent for maternal-fetal survival.<\/jats:p>\n                <jats:p><jats:bold>Graphical Abstract<\/jats:bold><\/jats:p>","DOI":"10.1186\/s13244-024-01622-x","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T13:02:31Z","timestamp":1709038951000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Liver imaging and pregnancy: what to expect when your patient is expecting"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1617-5609","authenticated-orcid":false,"given":"Giorgia","family":"Porrello","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cannella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Bernuau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Agman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Brancatelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Dioguardi Burgio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Vilgrain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"key":"1622_CR1","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1016\/j.beem.2011.07.004","volume":"25","author":"U Feldt-Rasmussen","year":"2011","unstructured":"Feldt-Rasmussen U, Mathiesen ER (2011) Endocrine disorders in pregnancy: physiological and hormonal aspects of pregnancy. 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