Focal nodular hyperplasia

Case contributed by Ian Bickle


Right upper quadrant pain. ? Gallstones. Incidental liver lesion on ultrasound. MRI for characterization.

Patient Data

Age: 35 years
Gender: Female

A large well-defined lesion with a central linear high T2 signal in segments II/III 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.

A smaller lesion with identical enhancement characteristics high in segment II close to the dome of the liver indicating a synchronous lesion.

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 'tumor-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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