Focal liver lesions: MR imaging–pathologic correlation

Bartolozzi, Carlo; Cioni, Dania; Donati, Francescamaria; Lencioni, Riccardo

doi:10.1007/s003300100845

Cited by 119 publications

(50 citation statements)

References 88 publications

(102 reference statements)

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“…Histopathologic verification was available in 5 cases of focal nodular hyperplasias and 5 cases of hemangiomas. The remaining cases of benign lesions showed typical MRI findings (Horton et al, 1999;Bartolozzi et al, 2001;Bruegel et al, 2008) in conjunction with stability in lesion size and morphology on serial cross-sectional imaging studies with a minimal follow-up interval of 6 months.…”

Section: Patientsmentioning

confidence: 94%

Diffusion-Weighted Imaging for the Left Hepatic Lobe has Higher Diagnostic Accuracy for Malignant Focal Liver Lesions

Han

Yin²,

Xiu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: This study was conducted to investigate whether apparent diffusion coefficient (ADC) measurements by dividing the liver into left and right hepatic lobes may be utilized to improve the accuracy of differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 269 consecutive patients with 429 focal liver lesions were examined by 3-T magnetic resonance imaging that included diffusion-weighted imaging. For 58 patients with focal liver lesions of the same etiology in left and right hepatic lobes, ADCs of normal liver parenchyma and focal liver lesions were calculated and compared using the paired t-test. For all 269 patients, ADC cutoffs for focal liver lesions and diagnostic accuracy in the left hepatic lobe, right hepatic lobe and whole liver were evaluated by receiver operating characteristic curve analysis. Results: For the group of 58 patients, mean ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. For differentiating malignant lesions from benign lesions in all patients, the sensitivity and specificity were 92.6% and 92.0% in the left hepatic lobe, 94.4% and 94.4% in the right hepatic lobe, and 90.4% and 94.7% in the whole liver, respectively. The area under the curve of the right hepatic lobe, but not the left hepatic lobe, was higher than that of the whole liver. Conclusions: ADCs of normal liver parenchyma and focal liver lesions in the left hepatic lobe were significantly higher than those in the right hepatic lobe. Optimal ADC cutoff for focal liver lesions in the right hepatic lobe, but not in the left hepatic lobe, had higher diagnostic accuracy compared with that in the whole liver.Keywords: Diffusion-weighted imaging -apparent diffusion coefficient -focal liver lesion -left and right hepatic lobes

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Section: Patientsmentioning

confidence: 94%

Diffusion-Weighted Imaging for the Left Hepatic Lobe has Higher Diagnostic Accuracy for Malignant Focal Liver Lesions

Han

Yin²,

Xiu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Areas of calcification in other lesions may also be found, as is the case in HCC, especially in its fibrolamellar variant, owing to central scar calcification (39). Some metastases also have calcifications and consequently low SI on T2-weighted images (29). This has been reported in metastases from mucinous cancers of the colon, stomach, breast, and ovary, as well as in cases of calcified-matrix-producing tumors such as osteosarcomas and chondrosarcomas (38).…”

Section: Calciummentioning

confidence: 95%

“…Various amounts of fibrous tissue are commonly present in several tumors. In fibrolamellar carcinoma, the tumors are formed by abundant fibrosis arranged in bands, or laminae (29,30), which explain their hypointense appearance (Fig 16). The presence of substantial amounts of fibrosis in cholan-giocellular carcinoma explains the presence of the low-SI areas seen on T2-weighted images (Fig 17) (8,9).…”

Section: Fibrosismentioning

confidence: 99%

The Hypointense Liver Lesion on T2-Weighted MR Images and What It Means

Curvo-Semedo¹,

Brito²,

Seco³

et al. 2010

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).Abbreviations FNH = focal nodular hyperplasia, FSE = fast spin echo, HCC = hepatocellular carcinoma, SI = signal intensity. ABSTRACTThe vast majority of focal liver lesions are hyperintense on T2-weighted magnetic resonance (MR) images. Rarely, however, hepatic nodules may appear totally or partially hypointense on those images. Causes for this uncommon appearance include deposition of iron, calcium, or copper and are related to the presence of blood degradation products, macromolecules, coagulative necrosis, and other conditions. Although rare, low signal intensity relative to surrounding liver on T2-weighted images may be seen in a wide spectrum of lesions. Examples include cases of focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, metastases, leyomioma, siderotic or dysplastic nodules, nodules in Wilson disease, granuloma, and hydatid cyst. On fat-suppressed T2-weighted images, nodules with a lipomatous component, such as lipoma, angiomyolipoma, hepatocellular adenoma, and hepatocellular carcinoma may also appear partially or totally hypointense. The conjunction of other MR imaging findings and their integration in the clinical setting may allow a correct diagnosis in a considerable proportion of cases. The cause for T2-weighted hypointensity may not be, however, always recognized, and only pathologic correlation may provide the answer. The aims of this work are to discuss the causes and mechanisms of hypointensity of liver lesions on T2-weighted images and proposing an algorithm for classification that may be useful as a quick reminder for the interested reader. INTRODUCTIONMagnetic resonance (MR) imaging of liver lesions is of pivotal importance in clinical practice. In abdominal MR imaging, T1-and T2-weighted sequences remain a basic requirement for lesion characterization. MR signal intensity (SI) of focal liver lesions is affected by numerous pathologic factors. Histologic features strongly affect T1 and T2 relaxation times and MR imaging is unique in its ability to explore intracellular content and recognize the presence of substances that may govern signal behavior. Owing to their high cellular water content, the majority of focal liver lesions appear hyperintense on T2-weighted images. In contrast to this most frequently seen MR imaging pattern, liver nodules may show total or partial hypointensity on T2-weighted images. The hypointense appearance can be classified as absolute or relative, depending on the native SI of adjacent liver parenchyma and sequence parameters (Fig 1). Although relative hypointensity depends on the native SI of liver, which can be modified by several circumstances (eg, inflammation, diffuse iron deposition, etc), it may be more commonly encountered when

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“…The relationship between FNH and contraceptives is still unclear as several authors have demonstrated that contraceptives may favour FNH progression [19] . The lesion is generally represented by a solid circumscribed mass, sometimes with lobulated contour ( Figure 1), with a central scar surrounded by nodules of hyperplastic hepatocytes and small bile ductuli [20] . FNHs may show a certain degree of histological heterogeneity, due to the variable degree of intra-lesional inflammation, fibrosis or fat content (the latter has been described as steatotic FNH).…”

Section: Evaluation Of Hepatic Adenoma and Focal Nodular Hyperplasiamentioning

confidence: 99%

Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI

Palmucci

2014

WJH

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Since its clinical introduction, several studies in literature have investigated gadolinium ethoxybenzhyl diethylenetriaminepentaacetic acid or gadoxetic acid (Gd-EOB-DTPA) properties. Following contrast injection, it provides dynamic vascular phases (arterial, portal and equilibrium phases) and hepatobiliary phase, the latter due to its uptake by functional hepatocytes. The main advantages of Gd-EOB-DTPA of focal liver lesion detection and characterization are discussed in this paper. Namely, we focus on the possibility of distinguishing focal nodular hyperplasia (FNH) from hepatic adenoma (HA), the identification of early hepatocellular carcinoma (HCC) and the pre-operative assessment of metastasis in liver parenchyma. Regarding the differentiation between FNH and HA, adenoma typically appears hypointense in hepatobiliary phase, whereas FNH is isointense or hyperintense to the surrounding hepatic parenchyma. As for the identification of early HCCs, many papers recently published in literature have emphasized the contribution of hepatobiliary phase in the characterization of nodules without a typical hallmark of HCC. Atypical nodules (no hypervascularizaton observed on arterial phase and/or no hypovascular appearance on portal phase) with low signal intensity in the hepatobiliary phase, have a high probability of malignancy. Finally, regarding the evaluation of focal hepatic metastases, magnetic resonance pre-operative assessment using gadoxetic acid allows for more accurate diagnosis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Magnetic resonance imaging; Liver; Image enhancement; Gadolinium diethylenetriaminepentaacetic acid; Carcinoma; Hepatocellular Core tip: This study highlights the added value of gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) in the detection and characterization of focal liver lesions. Three main topics are summarized: the role of gadoxetic acid in the evaluation of solid benign hepatic lesions, represented by hepatocellular adenoma and focal nodular hyperplasia; the diagnostic capability of hepatobiliary phase of gadoxetic acid-enhanced liver magnetic resonance imaging in the early identification of small hepatocellular carcinoma; the high diagnostic accuracy powered by gadoxetic enhanced-liver MRI in the detection of hepatic metastasis. Palmucci S. Focal liver lesions detection and characterization:The advantages of gadoxetic acid-enhanced liver MRI.

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Focal liver lesions: MR imaging–pathologic correlation

Cited by 119 publications

References 88 publications

Diffusion-Weighted Imaging for the Left Hepatic Lobe has Higher Diagnostic Accuracy for Malignant Focal Liver Lesions

Diffusion-Weighted Imaging for the Left Hepatic Lobe has Higher Diagnostic Accuracy for Malignant Focal Liver Lesions

The Hypointense Liver Lesion on T2-Weighted MR Images and What It Means

Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI

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