EURORAD ESR

Case 13706

Potentially misleading hypointensity on hepatobiliary phase MRI with hepatocyte-specific contrast medium

Author(s)
Tonolini Massimo, M.D.; Vella Adriana, M.D.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy; E
mail:mtonolini@sirm.org
 
Patient
female, 53 year(s)
 
 
  • Figure 1
    Initial MRI with Gd-EOB-DTPA contrast: T2- and diffusion-weighted images
     

    T2-weighted images (a, b, c with fat suppression) showed a sizeable, moderately hyperintense lesion (*) in the 7th-8th liver segments, without mass effect on vessels (thin arrow).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    T2-weighted images (a, b, c with fat suppression) showed a sizeable, moderately hyperintense lesion (*) in the 7th-8th liver segments: the lesion has a wedge-shaped configuration and does not alter the liver contour...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    T2-weighted image with fat suppression) showed the moderately hyperintense lesion (*) in the 7th-8th liver segments, with straight margins, wedge-shaped configuration, no mass effect on vessels (thin arrow) and on...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    High b-value (800) diffusion.-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images did not show abnormally restricted diffusion in the sizeable liver lesion (*) centered in th 7th...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    High b-value (800) diffusion.-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images did not show abnormally restricted diffusion in the sizeable liver lesion (*) centered in th 7th...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Colonography CT; Special Focus: Cirrhosis;
     
     
  • Figure 2
    Initial MRI with Gd-EOB-DTPA: unenhanced and post-contrast T1-weighted images
     

    The sizeable, wedge-shaped lesion (*) centered in the 7th segment appeared hypointense on unenhanced T1-weighted acquisition, without bulging nor retraction of the overlying capsular contour (arrow).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    Coronal (d) and sagittal (e) portal venous phase images confirmed enhanced lesion without bulging nor retraction of the overlying capsular contour (arrows).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    Coronal (d) and sagittal (e) portal venous phase images confirmed enhanced lesion without bulging nor retraction of the overlying capsular contour (arrows).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    Delayed hepatobiliary phase acquisition 30 minutes after contrast injection showed the lesion (*) to be hypointense compared to the surrounding parenchyma, with moderate homogeneous enhancement consistent with chronic...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    The lesion's (*) hepatobiliary phase hypointensity was more pronounced on repeated T1-weighted gradient-recalled echo acquisition with modified (35° instead of standard 10°) flip angle. As a result the lesion's...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;
     
     
  • Figure 3
    Follow-up MRI with Gadobutrol: T2- and diffusion-weighted images
     

    Repeated MRI four months later including T2-weighted images (a,b, c with fat suppression) showed the liver lesion (*) with unchanged size, shape and absent mass effect on liver contour (arrow) - compared to Fig.1.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    Repeated MRI four months later including T2-weighted images (a,b, c with fat suppression) showed the liver lesion (*) with unchanged size, shape and absent mass effect on liver contour (arrow) - compared to Fig.1.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    Repeated MRI four months later including T2-weighted images (a,b, c with fat suppression) showed the liver lesion (*) with unchanged size, shape and absent mass effect on liver contour (arrow) - compared to Fig.1.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    Similarly, compared to Fig.1 unchanged appearance was seen on high b-value (800) diffusion-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    Similarly, compared to Fig.1 unchanged appearance was seen on high b-value (800) diffusion-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;
     
     
  • Figure 4
    Follow-up MRI with Gadobutrol: unenhanced and post-contrast T1-weighted images
     

    Four months later (compared to Fig. 2) the lesion (*) in the 7th liver segment still appeared T1-hypointense before intravenous contrast, without bulging nor retraction of the overlying capsular contour (arrow).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    The dynamic vascular study with nonspecific extracellular gadolnium contrast showed the lesion (*) to be hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c) and...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    The dynamic vascular study with nonspecific extracellular gadolnium contrast showed the lesion (*) to be hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c) and...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;

    The dynamic vascular study with nonspecific extracellular gadolnium contrast showed the lesion (*) to be hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c) and...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Cirrhosis;
     
     
T2-weighted images (a, b, c with fat suppression) showed a sizeable, moderately hyperintense lesion (*) in the 7th-8th liver segments, without mass effect on vessels (thin arrow).
 
T2-weighted images (a, b, c with fat suppression) showed a sizeable, moderately hyperintense lesion (*) in the 7th-8th liver segments: the lesion has a wedge-shaped configuration and does not alter the liver contour (arrow).
 
T2-weighted image with fat suppression) showed the moderately hyperintense lesion (*) in the 7th-8th liver segments, with straight margins, wedge-shaped configuration, no mass effect on vessels (thin arrow) and on liver contour (arrow).
 
High b-value (800) diffusion.-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images did not show abnormally restricted diffusion in the sizeable liver lesion (*) centered in th 7th segment.
 
High b-value (800) diffusion.-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images did not show abnormally restricted diffusion in the sizeable liver lesion (*) centered in th 7th segment.
 
The sizeable, wedge-shaped lesion (*) centered in the 7th segment appeared hypointense on unenhanced T1-weighted acquisition, without bulging nor retraction of the overlying capsular contour (arrow).
 
During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and equilibrium (f) phases.
 
During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and equilibrium (f) phases.
 
Coronal (d) and sagittal (e) portal venous phase images confirmed enhanced lesion without bulging nor retraction of the overlying capsular contour (arrows).
 
Coronal (d) and sagittal (e) portal venous phase images confirmed enhanced lesion without bulging nor retraction of the overlying capsular contour (arrows).
 
During dynamic vascular study with hepatocyte-specific gadolinium contrast, the lesion (*) was hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c-e) and equilibrium (f) phases.
 
Delayed hepatobiliary phase acquisition 30 minutes after contrast injection showed the lesion (*) to be hypointense compared to the surrounding parenchyma, with moderate homogeneous enhancement consistent with chronic compensated liver dysfunction.
 
The lesion's (*) hepatobiliary phase hypointensity was more pronounced on repeated T1-weighted gradient-recalled echo acquisition with modified (35° instead of standard 10°) flip angle. As a result the lesion's exact size and straight contours were better perceivable.
 
Repeated MRI four months later including T2-weighted images (a,b, c with fat suppression) showed the liver lesion (*) with unchanged size, shape and absent mass effect on liver contour (arrow) - compared to Fig.1.
 
Repeated MRI four months later including T2-weighted images (a,b, c with fat suppression) showed the liver lesion (*) with unchanged size, shape and absent mass effect on liver contour (arrow) - compared to Fig.1.
 
Repeated MRI four months later including T2-weighted images (a,b, c with fat suppression) showed the liver lesion (*) with unchanged size, shape and absent mass effect on liver contour (arrow) - compared to Fig.1.
 
Similarly, compared to Fig.1 unchanged appearance was seen on high b-value (800) diffusion-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images.
 
Similarly, compared to Fig.1 unchanged appearance was seen on high b-value (800) diffusion-weighted acquisition (d) and corresponding apparent diffusion coefficient (ADC,e) images.
 
Four months later (compared to Fig. 2) the lesion (*) in the 7th liver segment still appeared T1-hypointense before intravenous contrast, without bulging nor retraction of the overlying capsular contour (arrow).
 
The dynamic vascular study with nonspecific extracellular gadolnium contrast showed the lesion (*) to be hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c) and equilibrium (d) phases.
 
The dynamic vascular study with nonspecific extracellular gadolnium contrast showed the lesion (*) to be hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c) and equilibrium (d) phases.
 
The dynamic vascular study with nonspecific extracellular gadolnium contrast showed the lesion (*) to be hypervascularised in the arterial phase (b) with progressive, persistent enhancement in portal venous (c) and equilibrium (d) phases.
 
 
 
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