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Imaging of benign focal hepatic lesions
- 11. Non contrast Arterial Portal venous Delayed
- 23. Nodular transformation of the liver, diffuse nodular hyperplasia and noncirrhotic nodulation CAUSES Drugs myeloproliferative, lymphoproliferative collagen vascular disease
- 34. slowly perfused vascular space
- 35. Dynamic vascular enhancement pattern may vary with the size of the lesions d/d hypervascular tumor
- 42. Originates from bile duct.
- 54. Bacterial and fungal abscesses -multiple Amoebic abscesses - frequently single.
- 58. Large well-defined cystic liver mass with numerous peripheral daughter cysts
Editor's Notes
- (Bile duct epithelium)
- Adenoma and FNH hepatocellular origin// hormone induced
- Prediliction to have hemorrhage
- If multiple Hepatic adenomatosis// Neither portal vein nor bile ducts // Fat predominance is seen in Female predominant adenoma HNF1alfa
- Echogenitcity is d/t fat and glycogen There is a large, solid echogenic mass in the right lobe of the liver. fairly well defined hypoechoic rim.
- hyperechoic lesion with attenuation of the beam suggesting possible fat content.//Better assessed on CT
- Large lesion in liver reaching upto subcapsular loation containing hemorrhage in a femal recieveing contraceptive (Hypodense- Presence of fat and glycogen)//well marginated and isoattenuating to liver
- Since it is a hypervascular lesion moderate enhancement in arterial phase// venous phase isodense to liver
- One mass locatedhypodense compared to the parenchyma in non-contrast phase. It has arterial and venous contrast enhancement, more pronounced in the periphery, with hypodense halo on arterial phase. In delayed phase, it fades away and no washout seen. There are no signs of recent bleeding. Portal and hepatic veins are patent.
- A well-demarcated lesion in the right lobe of the liver is slightly hyperintense on the T2-weighted image (A) and slightly hypointense on the T1-weighted image (B). This hepatic adenoma shows strong arterial phase enhancement (C) with washout in the late phase (D).
- TBIDA(Trimethyl bromoiminodiacetic acid)
- Nodular proliferation of hepatocytes around an abnormal artery embedded in a fibrous scar
- H and n rare due to excellent vascularity
- A B Figure 86-13 Focal nodular hyperplasia: color Doppler ultrasound. A. There is a large hypoechoic mass in the right lobe of the liver. B. It is quite vascular on color Doppler imaging. A //Focal nodular hyperplasia: ultrasound findings. A. Sonogram demonstrates a large lesion in the right lobe of the liver (arrows). B. Contrast-enhanced sonogram demonstrates early arterial enhancement of FNH; note that central scar shows no enhancement (arrow).
- A. On noncontrast scans, FNH is usually isodense with normal liver. Note the central scar. B. This lesion shows striking enhancement during the arterial phase with the exception of the scar. C. The lesion rapidly becomes isodense with normal liver. / If vessels radiating from central scar to the periphery of the tumor is visualized , a near definite diagnosis of FNH
- A. A large lesion is seen on this T2-weighted image obtained with fat suppression. The lesion is isointense to the normal liver, and the central scar is hyperintense (arrow). B. Gadolinium-enhanced early arterial phase demonstrates homogeneous enhancement of the lesion. The central scar (arrow) does not enhance early.
- Lesion enhaces on arterial phase and scar enhances on delayed phase
- Healty liver parenchyma– absence of fibrosis is important distinction regenerating cirrotic nodules
- NCCT multiple hypodense nodules
- non-neoplastic nodules that arise in a cirrhotic liver. // Siderotic nodules- hyperdense on UECT and hypointense on both T1 and T2.
- Dyplastic nodules have an imaging appearance close to hcc// HCC –Hyper on T2.. Hcc ha Dn pv arterial enhanceet/’/ nodule within nodle appearnace
- (opposite to HCC – Hyperintens eon T2
- Benign tumr of vascular origin.//vascular spaces lined by endothelium, fibrous stroma// cavernous subtype (capillary /cavernous/plexiform(arterial).
- Mostly diagnosed as incidental lesions but their differentiation from hepatic neoplasms is important
- adjacent to the right hepatic vein, three small, well-marginated, uniformly hyperechoic hemangiomas // No significant flow is identified on power doppler .. Peripheral feeding vessels are seen. d/d focal nodular hyperplasia / hepatic adenoma with high fat content /focal fatty change: focal hepatic steatosis
- Contrast-enhanced computed tomography reveal a rounded lesion in the left hepatic lobe
- Discontinuous peripheral nodular enhancement in arterial phase is almost isodense to the aorta, and, as contrast diffuses toward the center of the lesion (centripetal), uniform filling in delayed images
- In the arterial phase there is a homogenously enhancing lesion in left lobe of liver suggestive of flash filling haemangioma. // can only be differentiated on delayed phase
- T2: hyperintense relative to liver parenchyma, but less than the intensity of CSF or of a hepatic cyst
- A. Nonenhanced T2-weighted MR image shows a large hyperintense hepatic mass. B. Nonenhanced T1-weighted image shows low signal intensity. There is a central scar (arrow) that is often seen in large hemangiomas. C and D. Gadolinium enhancement demonstrates the characteristic peripheral nodular enhancement pattern that shows centripetal progression.
- Delayed scintiscan shows persistent uptake of the isotope within the tumor
- Characteristic appearance on USG // well-marginated, anechoic lesion a imperceptible wall and posterior acoustic enhancementwith normal adjacent liver
- .// Contrast-enhanced CT shows a homogeneously non enhancing hypodense area with cystic attenuation in the left lobe of the liver// In case of complications – debris, thickened septa and complex internal fluid //
- T1-weighted image cysts show low signal intensity and no enhancement after the intravenous administration of contrast material.
- A well defined large solitary unilocular cystic mass at the hepatic interlobar region, with enhancing thin smooth wall (fibrous capsule) with thin internal septations. The content is homogenous and of low density (HU = 0-10). No calcification.
- Important to diff from cystic mets//more variable in size and enhacing// Ultrasound shows many small round echogenic liver lesions// multiple small hypoattenuating liver lesions.
- Coronal, T2-weighted MRI scan shows multiple, tiny hyperintense lesions in the liver// Coronal MRCP
- Gelatinous mesenchymal tissue within the cyst
- Undego fibrosis with ages
- A. Contrastenhanced CT scan shows a well-circumscribed, heterogeneous tumor of the right lobe with foci of fat (arrow).
- Difficult to differentiate from hemangioma
- TI /TI fat sat// Chemical shift imaging on in phase and out phase
- Portal vein is seeded gastrointestinal infections- appendicitis/ coloitis/diverticulitits/// Biliary tree- ascending cholangitis
- Early phases –echogenic and solid.// Spherical hypoechoic mass with posterior acoustic enhancement containing coarse debris and irregular wall.
- Few air foci if noted increases suspicious of liver abscess
- A large unilocular mass with an enhancing wall demonstrates a thin peripheral hypoattenuating rim of surrounding edema that is ypical of amebic abscesses.
- Outer pericyst –fibrous wall// LAMILATED ECTOCYST/inner germinal layer(sclices) / aughtre cyst
- Ultrasonography images show a lesion with mixed echogenicity, with hydatid sand
- Longitudinal scan shows a rounded, well-defined, multilocular hypoechoic lesion with echogenic internal septa due to E. granulosus. B. Hydatid cyst in the right lobe with wavy bands of delaminated endocyst (water lily sign, arrows).
- Attenuation and signal intensity in mother cyst is more than daughter cyst.
- discrete wall, separated internal membranes and several ‘daughter cysts’ .