Dysplastic liver nodules are focal nodular regions (≥ 1 mm) without definite evidence of malignancy.
They have been found in cirrhotic patients with a prevalence of 14% (size >1.0 cm) to 37% (size >0.5 cm) 2.
- nuclear atypia
- increased fat or glycogen in the cluster of dysplastic cells
They are broadly divided as 2,4:
- low grade: imaging appearance closer to regenerative nodule
- high grade: imaging appearance closer to hepatocellular carcinoma (HCC)
Cirrhotic changes are present but the nodules may not be visualised on ultrasound. Few cases have shown hypo- and hyperechoic nodules and the echogenicity relates to the fat content in the nodule.
Usually hypoattenuating, however they may be iso- or hyperattenuating to the hepatic parenchyma.
- contrast: they may show early arterial uptake but the contrast does not wash out on delayed phase (unlike HCC)
- T1: high, low, or homogeneous intensity
- in and out phase: shows fat accumulation
- T2: iso- to hypointense
- T1 C+ (Gd)
- high grade nodules show early contrast enhancement without washout on delayed phase
T2* C+ (SPIO)
- low grade nodules appear hypointense 13
- T1 C+ (Gd)
Treatment and prognosis
They are considered premalignant and hence follow-up is necessary. Percutaneous ablation therapy can be considered 9.
There can be some imaging overlap with hepatocellular carcinoma.
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