Liver mass MRI: Difference between revisions

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__NOTOC__
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{{Liver mass}}
{{Liver mass}}
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==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
Line 16: Line 14:


*Characterization of the dynamics of contrast uptake
*Characterization of the dynamics of contrast uptake
{| class="wikitable"
{|
!
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
!Ultrasound
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ultrasound
!CT scan
! align="center" style="background:#4479BA; color: #FFFFFF;" + |CT scan
!MRI
! align="center" style="background:#4479BA; color: #FFFFFF;" + |MRI
|-
|-
|Hepato cellular adenoma
! align="center" style="background:#DCDCDC;" + |Hepatocellular adenoma
|
| align="left" style="background:#F5F5F5;" + |
* Heterogeneous
* Heterogeneous
* Hyperechoic if steatotic  
* Hyperechoic if steatotic  
* Anechoic center if hemorrhage
* Anechoic center if hemorrhage
|
| align="left" style="background:#F5F5F5;" + |
* Well demarcated with peripheral enhancement
* Well demarcated with peripheral enhancement
* Homogenous more often than heterogeneous
* Homogenous more often than heterogeneous
* Hypodense if steatotic
* Hypodense if steatotic
* Hyperdense if hemorrhagic
* Hyperdense if hemorrhagic
|
| align="left" style="background:#F5F5F5;" + |
* HNF1 α: signal lost on chemical shift; moderate arterial enhancement without persistent enhancement during delayed phase
* 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
* IHCA: markedly hyperintense on T2 with stronger signal peripherally; persistent enhancement in delayed phase
* β-Catenin: inflammatory subtype has the same appearance as IHCA
 
* β-Catenin: inflammatory subtype has same appearance as IHCA
** Noninflammatory is heterogeneous with no signal dropout on chemical shift
** Noninflammatory is heterogeneous with no signal dropout on chemical shift
** Isointense of T1 and T2 with strong arterial enhancement and delayed washout
** Isointense of T1 and T2 with strong arterial enhancement and delayed washout
|-
|-
|Hemangioma
! align="center" style="background:#DCDCDC;" + |Hemangioma
|
| align="left" style="background:#F5F5F5;" + |
* Hyperechoic with well-defined rim and with few intranodular vessels
* Hyperechoic with well-defined rim and with few intranodular vessels
|
| align="left" style="background:#F5F5F5;" + |
* Discontinuous peripheral nodular enhancement
* Discontinuous peripheral nodular enhancement
* Isoattenuating to aorta with progressive centripetal fill-in
* Isoattenuating to the aorta with progressive centripetal fill-in
|
| align="left" style="background:#F5F5F5;" + |
* T1: hypointense; discontinuous peripheral enhancement with centripetal fill-in
* T1: Hypointense; discontinuous peripheral enhancement with centripetal fill-in
 
* T2: Hyperintense relative to spleen
* T2: hyperintense relative to spleen
|-
|-
|FNH
! align="center" style="background:#DCDCDC;" + |FNH
|
| align="left" style="background:#F5F5F5;" + |
* Generally isoechoic
* Generally isoechoic
|
| align="left" style="background:#F5F5F5;" + |
* Central scar
* Central scar
* Arterial phase shows homogenous hyperdense lesion
* Arterial phase shows homogenous hyperdense lesion
* Returns to precontrast density during portal phase that is hypo or isodense
* 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 delayed phase
* T1: Isointense or slightly hypointense. Gadolinium produces early enhancement with central scar enhancement during the delayed phase
 
* T2: Slightly hyperintense or isointense
* T2: slightly hyperintense or isointense
|-
|-
|NRH
! align="center" style="background:#DCDCDC;" + |NRH
|Isoechoic/hyperechoic
| align="left" style="background:#F5F5F5;" + |
|
*Isoechoic/hyperechoic
| align="left" style="background:#F5F5F5;" + |
* Nonenhancing nodules, sometimes hypodense, with variable sizes (most sub-centimeter)
* Nonenhancing nodules, sometimes hypodense, with variable sizes (most sub-centimeter)
|
| align="left" style="background:#F5F5F5;" + |
* T1: hyperintense
* T1: hyperintense
* T2: varied intensity (hypo/iso/hyperintense)
* T2: varied intensity (hypo/iso/hyperintense)
|-
|-
|Simple hepatic cysts (SHCs)
! align="center" style="background:#DCDCDC;" + |Simple hepatic cysts (SHCs)
|
| align="left" style="background:#F5F5F5;" + |
* Anechoic
* Anechoic
* Homogeneous
* Homogeneous
* Fluid filled
* Fluid filled
* Smooth margins
* Smooth margins
|
| align="left" style="background:#F5F5F5;" + |
* Well-demarcated
* Well-demarcated
* Water-attenuated
* Water-attenuated
* Smooth lesion without an internal structure
* Smooth lesion without an internal structure
* No enhancement with contrast
* No enhancement with contrast
|
| align="left" style="background:#F5F5F5;" + |
* T1: hypointense signal intensity
* T1: hypointense signal intensity
* T2: hyperintense signal intensity
* T2: hyperintense signal intensity
|-
|-
|Biliary cystadenomas (BCs)
! align="center" style="background:#DCDCDC;" + |Biliary cystadenomas (BCs)
|
| align="left" style="background:#F5F5F5;" + |
* Irregular walls
* Irregular walls
* Internal septations forming loculi
* Internal septations forming loculi
|
| align="left" style="background:#F5F5F5;" + |
* Heterogeneous  
* Heterogeneous  
* Internal septations
* Internal septations
* Irregular papillary growths
* Irregular papillary growths
* Thickened cyst walls
* Thickened cyst walls
|
| align="left" style="background:#F5F5F5;" + |
* T1: Hypointense signal intensity
* T1: Hypointense signal intensity
* T2: Hyperintense signal intensity
* T2: Hyperintense signal intensity
|-
|-
|Hydatid cysts (HCs)
! align="center" style="background:#DCDCDC;" + |Hydatid cysts (HCs)
|
| align="left" style="background:#F5F5F5;" + |
* May appear similar to SHC.
* May appear similar to SHC.
** Progress to develop
** Progress to develop
** Thick calcified walls  
** Thick calcified walls  
** Hyperechoic/hypoechoic contents.
** Hyperechoic/hypoechoic contents.
 
* Daughter cysts in the periphery
* Daughter cysts in periphery.
| align="left" style="background:#F5F5F5;" + |
|
* Hypodense lesion with hypervascular pericyst wall
* Hypodense lesion with hypervascular pericyst wall
* Distinct endocyst wall
* Distinct endocyst wall
* Calcified walls and septa easily detected.
* Calcified walls and septa  
* Daughter cysts seen peripherally within mother cyst.
* Daughter cysts within the periphery of the mother cyst
|
| align="left" style="background:#F5F5F5;" + |
* T1: Hypointense signal intensity of cyst contents.
* T1: Hypointense signal intensity of cyst contents
 
* T2: Hyperintense 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
* Hypointense rim on T2.
* Collapse parasitic membranes as floating linear structures within cyst
 
* Daughter cysts seen peripherally within mother cyst.
 
* Collapse parasitic membranes seen 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

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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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