Focal hepatic steatosis

Case contributed by Associate Professor Natalie Yang

Presentation

Incidental finding on imaging.

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

CT

CT demonstrates the presence of a low attenuation geographic lesion, with vessels coursing through without displacement.

Ultrasound

Ultrasound demonstrates an ovoid, homogenously hyperechoic lesion

MRI

T1 in-phase image shows a subtle hyperintense “mass” corresponding to previous US and CT, which uniformly loses signal on the T1 opposed-phase scan. The lesion has angular margins, vessels coursing through undistorted with enhancement less than normal liver parenchyma. Subtle high signal intensity is demonstrated on the T2 non fat suppressed imaging, which loses signal with fat suppression. 

Case Discussion

Focal hepatic steatosis is often recognized by:

  • Location:  peri-ligamentous, peri-portal
  • Distribution of lesions
  • Presence of non-distorted, traversing blood vessels

Despite this, patchy focal fat deposition and relative fatty sparing may be mistaken for a focal neoplasm (particular at US and CT) and thus MR in-phase and opposed-phase imaging allows reliable differentiation

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