As a result of the generalized reduction in parenchymal density of the liver that occurs with fatty infiltration, lower density mass lesions such as metastases can be "lost" as there is very little density difference between the mass and the adjacent fatty liver. Primovist is taken up by hepatocytes in the liver irrespective of fatty change whereas the malignant cells do not, thus there is a signal intensity difference and the lesions are visible. The metastases also show restricted diffusion due to the presence of tightly bound water molecules in the cytoplasm of malignant cells with large nuclei.