CASE 89 Published on 11.04.2000

Hepatic nodule

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

M. Di Giulio, M. Corucci, D. Caramella

Patient

49 years, female

Categories

No Area of Interest ; Imaging Technique CT, MR, MR

No Procedure ; No Special Focus ;

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Clinical History

Asymptomatic. Previous use of oral contraceptives

Imaging Findings

Incidental US finding of a large hepatic nodule in the right lobe.

Discussion

Focal Nodular Hyperplasia: after the early contrast enhancement of the whole lesion, two zones can be recognized: a central zone ("scar") in which the enhancement has a longer duration, and a peripheral zone, whose MR signal behaviour closely resembles that of the normal liver parenchyma (3-5). However the scar is not always visible: its detection is reported in 20-31% of patients with CT and 35-69% of patients with MRI (2,4). The typical MR signal of the scar is not always present too, probably because of different degree of edema (5). In these cases a multimodality approach is essential for the correct diagnosis (1,4).

Differential Diagnosis List

Focal Nodular Hyperplasia

Final Diagnosis

Focal Nodular Hyperplasia

References

[1] Bartolozzi C, Lencioni R, Paolicchi A e Coll(1997)
Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography.
Eur Radiol 7(9): 1410-5. (PMID: 9369506)

[2] Lee MJ, Saini S, Hamm B et al (1991)
Focal nodular hyperplasia of the liver: MR findings in 35 proved cases.
AJR 156: 317-20. (PMID: 1898806)

[3] Mattison GR, Glazer GR, Quint LE e Coll (1987)
MR imaging of hepatic focal nodular hyperplasia: characterization and distinction from primary malignant hepatic tumors.
AJR 148: 711-15. (PMID: 3030082)

[4] Shamsi K, Deschepper A, Degryse H, Deckers F (1993)
Focal nodular hyperplasia of the liver: radiologic findings.
Abdom Imag 18: 32-8. (PMID: 8431691)

[5] Vilgrain V, Flejou JF, Arrive L et al (1992)
Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients.
Radiology 184: 699-703. (PMID: 1509052)

Case information

URL:	https://www.eurorad.org/case/89
DOI:	10.1594/EURORAD/CASE.89
ISSN:	1563-4086

Figure 1

CT study

No clear abnormality can be detected at the unenhanced scan

Contrast-enhanced CT: arterial phase. A large enhancing lesion of the right hepatic lobe is visible.

Contrast-enhanced CT: portal phase. The lesion becomes isodense to the normal liver parenchyma.

Figure 2

Unenhanced MR

Unenhanced SE T1 weighted MR image (0.5 T). No clear abnormality can be detected. The presence of a nodule can only be suspected on the basis of the displacement of the portal vein

Figure 3

Dynamic MR examination

Dynamic MR sequence (0.5 T): unenhanced T1 weighted image. The presence of a nodule can be suspected at the level of the 1st hepatic segment.

Dynamic MR sequence (0.5 T): enhanced T1 weighted image: early arterial phase. The nodule shows marked enhancement with respect to the normal liver parenchyma.

Dynamic MR sequence (0.5 T): enhanced T1 weighted image: arterial phase. The central portion of the nodule is hyperintense to the peripheral zone.

Dynamic MR sequence (0.5 T): enhanced T1 weighted image: portal phase. The central portion of the nodule is still slightly hyperintense with respect to the peripheral zone.