Table 2 Specific lesions and imaging features
From: Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas
Lesion | T1-weighted imaging | T2-weighted imaging | Contrast dynamic imaging | Hepatobiliary phase | Pitfalls/comments |
|---|---|---|---|---|---|
RN | Hypointense | Hypointense | Enhance | Isointense | |
DN | Hyperintense | hypointense | Do not enhance | Hypo- or hyperintense | |
HCC | Hypointense | Hyperintense | Usually intense enhancement with washout | Variable | Some HCCs will uptake Gd-EOB-DTPA in the hepatobiliary phase. |
FL-HCC | Hypointense | Hyperintense with hypointense central scar | Enhances, hypovascular scar | Heterogeneous enhancement | |
THID | No alteration | No alteration | Hypervascular lesion, fades in PV phase | No alteration | |
FNH | Hypo- to isointense | Hyper- to isointense. Central scar hyperintense | Arterial uniform enhancement. Scar enhances in delayed imaging | Iso- to hyperintense | Gd-EOB-DTPA permits the evaluation of the internal architecture (with the internal reticulation), which permit more confidence in the diagnosis. |
Adenoma | Hyper- to isointense | Moderately hyperintense | Enhance in arterial phase | Hypointense | |
Focal hypereosinophilic necrosis | Hypointense | Hyperintense | Enhancement in PV phase | Mixed intensity | Difficult to rule out metastases |
Confluent fibrosis | Hypointense | Hyperintense | Delayed enhancement | Hypointense | |
Haemangioma | Hypointense | Markedly hyperintense | Progressive centripetal enhancement | Hypointense | Pseudowashout |
Focal fat/focal sparing | Hyperintense loosing signal in opposed phase imaging/ hypointense | Hypointense | |||
Cholangiocarcinoma | Hypointense | Hyperintense | Delayed enhancement | Hypointense | |
Hypervascular | |||||
metastases | Hypointense | Iso- to hyperintense | Arterial enhancement. Peripheral washout | Hypointense | Central pooling of Gd-EOB-DTPA in the hepatobiliary phase |
Hypovascular metastases | Hypointense | Iso- to hyperintense | No significant enhancement | Hypointense | |
Foreign body reaction | Hypointense | Hyperintense with hypointense bands | Peripheral enhancement | Hypointense | |
Cyst | Hypointense | Hyperintense | No enhancement | No enhancement | |
Hamartoma | Hypointense | Hyperintense | No enhancement | No enhancement | |
Cystadenoma/cystadenocarcinoma | Hypointense | Hyperintense | Nodular parietal enhancement points to carcinoma | No enhancement | |
Angiomyolipoma | Containing macro or microscopic fat suppressed with fat suppressing or opposed phase imaging | Intense arterial enhancement | |||
Lipoma | Hyperintense, with loss of signal with fat suppression | Hyperintense | No enhancement | No enhancement | |
Inflammatory pseudotumour | Hypointense | Hyperintense | Peripheral or delayed enhancement | No enhancement | |
Granuloma | Hypointense | Hypointense | May show delayed enhancement | No enhancement | |
Abscess | Hypointense | Hyperintense | Presence of a enhancing capsule | No enhancement | |
Lymphoma | Hypointense | Variable | Faint peripheral enhancement | No enhancement |