Focal nodular hyperplasia
PH coeliac disease. Abdominal pain. Incidental finding on hepatic ultrasound. MRI for lesion characterization. Recently started oral contraceptives.
Routine study with use of hepatocyte contast agent - Primovist (gadoxetic acid)
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Well-defined nodule in segment 3 with isointense periphery and subtle hyperintense centre. Early enhancement of mass, slightly increased over the adjacent liver parenchyma. Delayed (60 mins) scan shows persistent peripheral enhancement of the mass with central stellate "washout". b value = 800 with minimal signal in the mass indicating non-restriction of diffusion.
Appearances are typical of FNH, ie well defined margins, early peripheral enhancement (> than surrounding liver), persistent peripheral enhancement with Primovist indicating the presence of hepatocytes, non restriction of diffusion and central stellate scar showing subtle T2 brightening and non persistent enhancement on delayed scanning. The early (arterial phase) enhancement is often a little more intense.