This case shows the importance of identifying any background liver parenchyma changes before characterizing lesions. With lipid-rich adenomas we expect the lesion to become hypointense to liver on out-of-phase T1 imaging. In this case the lesion became slightly hyperintense because the background fatty liver lost signal, while the lipid-poor adenoma maintained it's signal.

The enhancement pattern - arterial enhancement, washout and lack of hepatocellular uptake differentiates it from focal nodule hyperplasia.

The lesion is incidental to the patient's deranged LFTs.