Presentation
Incidental finding on ultrasound performed for abdominal pain. MRI for characterization.
Patient Data
Well-marginated solid hypoechoic mass of the left lobe of the liver, hypervascular on color and superb microvascular imaging (SMI).
Small well-defined ovoid mass of the left lobe of the liver eliciting an isointense signal to the normal liver on T1 with a peripheral displacement of the surrounding hypointense vessels, slight high signal on T2 and T2 fat sat sequences. Early intense enhancement on arterial phase and almost isointense to the liver on portal venous phase displacing the enhanced venous vascular structures peripherally.
The rest of the abdominal organs is unremarkable.
Case Discussion
The MRI features are most consistent with focal nodular hyperplasia (FNH).
On imaging the main differential diagnoses include:
-
hepatic adenoma
- usually more heterogeneous on the portal and delayed phases
- no gadoxetate retention on delayed phase MR
- associated with fat, calcification or hemorrhage
-
hypervascular hepatic metastases:
- usually multiple
- patient known for primary cancer
-
hepatocellular carcinoma (HCC)
- usually in cirrhosis patient
- vascular invasion
-
fibrolamellar hepatocellular carcinoma
- radiating/central scar
- calcification more common
- 70% present with metastases
- biliary, vascular, and nodal invasion
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