Focal fatty steatosis in a cirrhotic liver

Case contributed by Dr Dalia Ibrahim

Presentation

Patient with known HCV and liver cirrhosis. Currently seen hypodense area on triphasic CT study with possibilities including hypovascular HCC or cholangiocarcinoma, for better characterization using triphaisc MRI assessment.

Patient Data

Age: 60 years
Gender: Male

Cirrhotic liver showing right hepatic lobe segment V and caudate lobe segment I irregular geographic areas of abnormal signal eliciting isointense/high signal on T1 WI, high signal on T2 with signal suppression on STIR and Out-of-phase sequences. No diffusion restriction. No contrast enhancement on any of the dynamic phases.

Splenomegaly with upper polar area of abnormal signal and capsular retraction, likely sequel of old splenic infarct.

Dilated portosystmic collaterals.

 

Signal drop-out on out-of-phase sequence.

No mass effect or architectural distortion.

Case Discussion

Focal fatty change in the liver could be debatable in some cases, and easily mis-diagnosed as a tumor.

MRI helps for better characterization of hepatic focal lesions. In focal hepatic steatosis, out-of-phase or other lipid-sensitive MR imaging sequences are helpful for diagnosis of focal fatty steatosis. Other criteria of focal steatosis include absence of mass effect and normal course of the hepatic and portal vessels through the lesions. Absence of diffusion restriction and contrast enhancement.

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