EURORAD ESR

Case 89

Hepatic nodule

Author(s)
M. Di Giulio, M. Corucci, D. Caramella
 
Patient
female, 49 year(s)

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).

Final Diagnosis

Focal Nodular Hyperplasia
 

MeSH

  1. Focal Nodular Hyperplasia [C06.552.270]
    Benign, usually asymptomatic nodule of the liver, occurring chiefly in women. It is a firm, highly vascular mass resembling cirrhosis, usually with a stellate fibrous core containing numerous small bile ducts, and having vessels lined by Kupffer cells. (Dorland, 28th ed)

References

  1. [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.

  2. [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.

  3. [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.

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

  5. [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.

Citation

M. Di Giulio, M. Corucci, D. Caramella (2000, Apr 12).
Hepatic nodule, {Online}.
URL: http://www.eurorad.org/case.php?id=89
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  • Figure 1
    CT study
    a b c  

    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
    a b c d e  

    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.

    Delayed SE T1 weighted image after contrast administration (0.5 T): the lesion is again isointense to the normal liver parenchyma

     
Figure 1

CT study

Figure 1a
No clear abnormality can be detected at the unenhanced scan
 
Figure 1b
Contrast-enhanced CT: arterial phase. A large enhancing lesion of the right hepatic lobe is visible.
 
Figure 1c
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

Figure 3a
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.
 
Figure 3b
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.
 
Figure 3c
Dynamic MR sequence (0.5 T): enhanced T1 weighted image: arterial phase. The central portion of the nodule is hyperintense to the peripheral zone.
 
Figure 3d
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.
 
Figure 3e
Delayed SE T1 weighted image after contrast administration (0.5 T): the lesion is again isointense to the normal liver parenchyma
 
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