Focal nodular hyperplasia

Case contributed by Dr Ian Bickle

Presentation

Adult female with right upper quadrant pain. Gallstones? Incidental liver lesion on ultrasound. MRI for characterisation.

Patient Data

Age: 35 years
Gender: Female
MRI

Large well defined lesion with a central linear high T2 signal in segments 2/3 of the liver.

The lesion has avid enhancement on the arterial phase with persistent sparring of the central linear element even on the portal venous phase.

Annotated image

Summary of T1, and the various phases of the contrast study illustrating the nature of the focal liver lesion.

Note the enhancement of the central scar only on the delayed images when the rest of the lesion has washed out.

Case Discussion

Focal nodular hyperplasia (FNH) is a benign 'tumour-like' mass of the liver. It has characteristic imaging features on contrasted-enhanced cross-sectional imaging.

FNH is most frequently identified in young to middle-aged adults, with a strong female predilection.

On CT and MRI the imaging features are classical, which are:

  1. Intense early arterial phase enhancement, with the exception of the central fibrotic scar.
  2. Isointense to liver on portal venous phase.
  3. On the delay phase, the central scar enhances in most cases, as contrast is retained.

This lesion can be left well alone with no need for percutaneous biopsy.

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Case information

rID: 50662
Case created: 16th Jan 2017
Last edited: 26th Feb 2017
Inclusion in quiz mode: Included

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