Liver mass MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

On MRI, characteristic features for the diagnosis of liver mass, include: higher soft tissue contrast, lack of radiation exposure, lesion characterization by evaluation of signal intensities, improving detection of hypervascular lesions, and characterization of the dynamics of contrast uptake.[1]

MRI

On MRI, characteristic features for the diagnosis of liver mass, include:

  • Higher soft tissue contrast
  • Lack of radiation exposure
  • Lesion characterization by evaluation of signal intensities
  • Improving detection of hypervascular lesions
  • Characterization of the dynamics of contrast uptake
Disease Ultrasound CT scan MRI
Hepatocellular adenoma
  • Heterogeneous
  • Hyperechoic if steatotic
  • Anechoic center if hemorrhage
  • Well demarcated with peripheral enhancement
  • Homogenous more often than heterogeneous
  • Hypodense if steatotic
  • Hyperdense if hemorrhagic
  • HNF1 α: signal lost on chemical shift; moderate arterial enhancement without persistent enhancement during the delayed phase
  • IHCA: markedly hyperintense on T2 with stronger signal peripherally; persistent enhancement in the delayed phase
  • β-Catenin: inflammatory subtype has the same appearance as IHCA
    • Noninflammatory is heterogeneous with no signal dropout on chemical shift
    • Isointense of T1 and T2 with strong arterial enhancement and delayed washout
Hemangioma
  • Hyperechoic with well-defined rim and with few intranodular vessels
  • Discontinuous peripheral nodular enhancement
  • Isoattenuating to the aorta with progressive centripetal fill-in
  • T1: Hypointense; discontinuous peripheral enhancement with centripetal fill-in
  • T2: Hyperintense relative to spleen
FNH
  • Generally isoechoic
  • Central scar
  • Arterial phase shows homogenous hyperdense lesion
  • Returns to precontrast density during the portal phase that is hypo or isodense
  • T1: Isointense or slightly hypointense. Gadolinium produces early enhancement with central scar enhancement during the delayed phase
  • T2: Slightly hyperintense or isointense
NRH
  • Isoechoic/hyperechoic
  • Nonenhancing nodules, sometimes hypodense, with variable sizes (most sub-centimeter)
  • T1: hyperintense
  • T2: varied intensity (hypo/iso/hyperintense)
Simple hepatic cysts (SHCs)
  • Anechoic
  • Homogeneous
  • Fluid filled
  • Smooth margins
  • Well-demarcated
  • Water-attenuated
  • Smooth lesion without an internal structure
  • No enhancement with contrast
  • T1: hypointense signal intensity
  • T2: hyperintense signal intensity
Biliary cystadenomas (BCs)
  • Irregular walls
  • Internal septations forming loculi
  • Heterogeneous
  • Internal septations
  • Irregular papillary growths
  • Thickened cyst walls
  • T1: Hypointense signal intensity
  • T2: Hyperintense signal intensity
Hydatid cysts (HCs)
  • May appear similar to SHC.
    • Progress to develop
    • Thick calcified walls
    • Hyperechoic/hypoechoic contents.
  • Daughter cysts in the periphery
  • Hypodense lesion with hypervascular pericyst wall
  • Distinct endocyst wall
  • Calcified walls and septa
  • Daughter cysts within the periphery of the mother cyst
  • T1: Hypointense signal intensity of cyst contents
  • T2: Hyperintense signal intensity of cyst contents
  • Hypointense rim on T2
  • Daughter cysts within the periphery of the mother cyst
  • Collapse parasitic membranes as floating linear structures within cyst

References

  1. Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.

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