Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting

Abstract

Hepatobiliary MRI contrast agents are increasingly being used for liver imaging. In clinical practice, most focal liver lesions do not uptake hepatobiliary contrast agents. Less commonly, hepatic lesions may show variable signal characteristics on hepatobiliary phase. This pictorial essay reviews a broad spectrum of benign and malignant focal hepatic observations that may show hyperintensity on hepatobiliary phase in various clinical settings. In non-cirrhotic patients, focal hepatic observations that show hyperintensity in the hepatobiliary phase are usually benign and typically include focal nodular hyperplasia. In patients with primary or secondary vascular disorders, focal nodular hyperplasia-like lesions arise as a local hyperplastic response to vascular alterations and tend to be iso- or hyperintense in the hepatobiliary phase. In oncologic patients, metastases and cholangiocarcinoma are hypointense lesions in the hepatobiliary phase; however, occasionally they may show a diffuse, central and inhomogeneous hepatobiliary paradoxical uptake with peripheral rim hypointensity. Post-chemotherapy focal nodular hyperplasia-like lesions may be tricky, and their typical hyperintense rim in the hepatobiliary phase is very helpful for the differential diagnosis with metastases. In cirrhotic patients, hepatocellular carcinoma may occasionally appear hyperintense on hepatobiliary phase.

A case of focal nodular hyperplasia-like lesion presenting unusual signal intensity on the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance image

“…Regarding hypervascular hepatic tumors, HCC, the most common hypervascular malignant tumor, is frequently composed of inhomogeneous content due to multinodular configuration, dedifferentiation, degeneration, and necrosis. The heterogeneous nature could present a variety of intensities in the hepatobiliary phase, including hyper-, hypo-, or inhomogeneous intensity [22] . Beta-catenin mutated hepatocellular adenoma, a hypervascular tumor, could show inhomogeneous uptake of gadoxetic acid in the hepatobiliary phase [23] .…”

Benign Hepatic Nodules in Patients With Primary Extrahepatic Portal Vein Obstruction: Clinical and Magnetic Resonance Imaging Features

“…Since regenerative nodules have functional hepatocytes, they retain contrast in the hepatobiliary phase and appear isointense or hyperintense to the liver unlike other lesions. 23 Further, since these patients are at a higher risk of developing chronic viral hepatitis owing to multiple transfusions and interventions, it is worthwhile to exclude hepatocellular carcinoma. With the hepatobiliary phase of MRI, the sensitivity of detecting small hepatocellular carcinoma, which show hypointensity on hepatobiliary phase, is increased.…”

Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI

“…This “targetoid appearance” is also seen on the HBP of Gd-EOB-MRI, which indicates peripheral rim hypointensity and central cloud-like hyperintensity due to retained contrast material in the fibrotic stroma (“EOB-cloud enhancement”) (Fig. 7 ) [ 31 – 35 ]. Table 1 summarizes the main imaging features to differentiate mass-forming iCCA from its potential mimickers.…”