Liver mass MRI: Difference between revisions

Jump to navigation Jump to search
m (Bot: Removing from Primary care)
 
(6 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Liver mass}}
{{Liver mass}}
{{CMG}}{{AE}}{{MV}}
{{CMG}}; {{AE}}{{MV}}


==Overview==
==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.<ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref>
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.<ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref>


==MRI==
==MRI==
On MRI, characteristic features for the diagnosis of liver mass, include:
On MRI, characteristic features for the diagnosis of liver mass, include:
:*Higher soft tissue contrast
*Higher soft tissue contrast
:*Lack of radiation exposure
*Lack of radiation exposure
:*Lesion characterization by evaluation of signal intensities  
*Lesion characterization by evaluation of signal intensities  
::*Improving detection of hypervascular lesions
*Improving detection of hypervascular lesions  
:*Characterization of the dynamics of contrast uptake
 
 
 
[[Image: Hepatoblastoma-1.jpg|center|thumb|400px]]


*Characterization of the dynamics of contrast uptake
{|
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ultrasound
! align="center" style="background:#4479BA; color: #FFFFFF;" + |CT scan
! align="center" style="background:#4479BA; color: #FFFFFF;" + |MRI
|-
! align="center" style="background:#DCDCDC;" + |Hepatocellular adenoma
| align="left" style="background:#F5F5F5;" + |
* Heterogeneous
* Hyperechoic if steatotic
* Anechoic center if hemorrhage
| align="left" style="background:#F5F5F5;" + |
* Well demarcated with peripheral enhancement
* Homogenous more often than heterogeneous
* Hypodense if steatotic
* Hyperdense if hemorrhagic
| align="left" style="background:#F5F5F5;" + |
* 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
|-
! align="center" style="background:#DCDCDC;" + |Hemangioma
| align="left" style="background:#F5F5F5;" + |
* Hyperechoic with well-defined rim and with few intranodular vessels
| align="left" style="background:#F5F5F5;" + |
* Discontinuous peripheral nodular enhancement
* Isoattenuating to the aorta with progressive centripetal fill-in
| align="left" style="background:#F5F5F5;" + |
* T1: Hypointense; discontinuous peripheral enhancement with centripetal fill-in
* T2: Hyperintense relative to spleen
|-
! align="center" style="background:#DCDCDC;" + |FNH
| align="left" style="background:#F5F5F5;" + |
* Generally isoechoic
| align="left" style="background:#F5F5F5;" + |
* Central scar
* Arterial phase shows homogenous hyperdense lesion
* Returns to precontrast density during the portal phase that is hypo or isodense
| align="left" style="background:#F5F5F5;" + |
* T1: Isointense or slightly hypointense. Gadolinium produces early enhancement with central scar enhancement during the delayed phase
* T2: Slightly hyperintense or isointense
|-
! align="center" style="background:#DCDCDC;" + |NRH
| align="left" style="background:#F5F5F5;" + |
*Isoechoic/hyperechoic
| align="left" style="background:#F5F5F5;" + |
* Nonenhancing nodules, sometimes hypodense, with variable sizes (most sub-centimeter)
| align="left" style="background:#F5F5F5;" + |
* T1: hyperintense
* T2: varied intensity (hypo/iso/hyperintense)
|-
! align="center" style="background:#DCDCDC;" + |Simple hepatic cysts (SHCs)
| align="left" style="background:#F5F5F5;" + |
* Anechoic
* Homogeneous
* Fluid filled
* Smooth margins
| align="left" style="background:#F5F5F5;" + |
* Well-demarcated
* Water-attenuated
* Smooth lesion without an internal structure
* No enhancement with contrast
| align="left" style="background:#F5F5F5;" + |
* T1: hypointense signal intensity
* T2: hyperintense signal intensity
|-
! align="center" style="background:#DCDCDC;" + |Biliary cystadenomas (BCs)
| align="left" style="background:#F5F5F5;" + |
* Irregular walls
* Internal septations forming loculi
| align="left" style="background:#F5F5F5;" + |
* Heterogeneous
* Internal septations
* Irregular papillary growths
* Thickened cyst walls
| align="left" style="background:#F5F5F5;" + |
* T1: Hypointense signal intensity
* T2: Hyperintense signal intensity
|-
! align="center" style="background:#DCDCDC;" + |Hydatid cysts (HCs)
| align="left" style="background:#F5F5F5;" + |
* May appear similar to SHC.
** Progress to develop
** Thick calcified walls
** Hyperechoic/hypoechoic contents.
* Daughter cysts in the periphery
| align="left" style="background:#F5F5F5;" + |
* Hypodense lesion with hypervascular pericyst wall
* Distinct endocyst wall
* Calcified walls and septa
* Daughter cysts within the periphery of the mother cyst
| align="left" style="background:#F5F5F5;" + |
* 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==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WS}}
[[Category:Disease]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Gastroenterology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Surgery]]
[[Category:Surgery]]

Latest revision as of 22:32, 29 July 2020

Liver Mass Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Evaluation of Liver Mass

Staging

History and Symptoms

Physical Examination

Laboratory Studies

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Liver mass MRI On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Liver mass MRI

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Liver mass MRI

CDC on Liver mass MRI

Liver mass MRI in the news

Blogs on Liver mass MRI

Directions to Hospitals Treating bone or soft tissue mass

Risk calculators and risk factors for Liver mass MRI

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.