What is your differential at this point?
A large T2 hyperintense mass with a centrally more hyperintense region is compatible with focal nodular hyperplasia, haemangioma, a metastasis, or possibly well-differentiated hepatocellular carcinoma (HCC). This patient has no risk factors for HCC and no known primary. There is only the single lesion in the liver. If deciding between hemangioma and FNH, the lesion T2 hyperintensity favors hemangioma. Don't be thrown by the central "scar".
There is a relatively well-marginated mass in the right lobe of the liver measuring 11.3 x 6.9 x 14.3 cm.
- majority of the lesion is moderately T2 hyperintense, with central irregular regions that are even more T2 hyperintense
- T1 hypointense
- no loss of signal on the out-of-phase sequence
- no ascites or perihepatic fluid
- no evidence of cirrhosis or portal hypertension
- displays mass effect on adjacent vessels
- MRI (bSSFP):
- MRI (T1 out-of-phase):
- MRI (T1 in-phase):
- MRI (T2):
- MRI (T2 fat sat):