Presentation
Known to have a small hepatic mass discovered on ultrasound 3 years ago. MRI for characterization.
Patient Data
Small well-defined lesion is noted in the left lobe of the liver (segment 3) measuring 22 x 16 x 14 mm, hypointense to the normal liver on T1, slight high signal on T2 and T2 fat sat with early intense enhancement on arterial phase and almost isointense to the liver on portal venous phase suggestive of focal nodular hyperplasia.
The liver is normal in size with a smooth surface. No other hepatic lesion was seen.
The rest of the abdominal organs is unremarkable.
Case Discussion
MRI features suggestive of focal nodular hyperplasia (FNH).
On imaging the main differential diagnoses include:
-
hypervascular hepatic metastases:
- usually multiple
- older patients with known primary tumor
-
hepatic adenoma
- usually more heterogeneous on the portal and delayed phases
- no gadoxetate retention on delayed phase MR
- associated with fat, calcification or hemorrhage
-
hepatocellular carcinoma (HCC)
- usually in cirrhosis patient
- vascular invasion
-
fibrolamellar hepatocellular carcinoma
- radiating/central scar
- calcification more common
- 70% present with metastases
- biliary, vascular, and nodal invasion