Benign Neoplasms, Mass‐Like Infections, and Pseudotumors That Mimic Hepatic Malignancy at MRI

Abstract

A variety of conditions may mimic hepatic malignancy at MRI. These include benign hepatic tumors and tumor‐like entities such as focal nodular hyperplasia‐like lesions, hepatocellular adenoma, hepatic infections, inflammatory pseudotumor, vascular entities, and in the cirrhotic liver, confluent fibrosis, and hypertrophic pseudomass. These conditions demonstrate MRI features that overlap with hepatic malignancy, and can be challenging for radiologists to diagnose accurately. In this review we discuss the MRI manifestations of various conditions that mimic hepatic malignancy, and highlight features that may allow distinction from malignancy. Level of Evidence5 Technical Efficacy Stage3

Risk factors for bleeding hepatocellular adenoma in a United States cohort

“…Imaging features on MRI supportive of an adenoma in patients with no risk factors for liver disease are an arterial phase enhancing hepatic mass with variable signal intensity on later phase images or hypo‐intensity on hepatobiliary phase. In addition, the lesion may have the following associated features: intra‐lesional steatosis, increased signal intensity of T2 weighted or diffusion‐weighted images, presence of blood products, and no associated central scar 13‐15 . Of the 167 patients that met selection criteria, demographic data such as age, ethnicity, and gender were collected.…”

“…In addition, the lesion may have the following associated features: intra-lesional steatosis, increased signal intensity of T2 weighted or diffusion-weighted images, presence of blood products, and no associated central scar. [13][14][15] Of the 167 patients that met selection criteria, demographic data such as age, ethnicity, and gender were collected. Clinical data collected included: history of Type II diabetes, body mass index (BMI), tobacco and alcohol use (yes or no), oral contraception (OCP) use, duration and type used if available, anabolic steroid use, date of initial imaging, and date of most recent follow-up MRI scan.…”

ACG Clinical Guideline: Focal Liver Lesions

“…Biopsy is generally avoided, given the vascular nature of hemangiomas, although reports have indicated that risk of bleeding with biopsy of hemangiomas is low (0.15%) if small needles are used (142). Once the diagnosis of hemangioma is confirmed, no further follow-up imaging is needed, except for patients with underlying cirrhosis or risk of HCC, because lesions can mimic hemangioma early in the course of malignancy development (143,144). These patients should undergo follow-up imaging as recommended for FLL in the AASLD Hepatocellular Carcinoma Guidance (145).…”