Focal nodular hyperplasia (CEUS)

Case contributed by Bálint Botz
Diagnosis almost certain


Known cholecystolithiasis, chronic RUQ pain. MRI requested to rule out cholangitis.

Patient Data

Age: 25 years
Gender: Female

MRI demonstrated no signs of cholangitis (MRCP not shown). In segment VII. of the right lobe a circumscribed mass was identified showing vivid enhancement in the arterial phase, with a hypoenhancing central scar, and without late phase washout. 

Other findings: gallstones, small splenic cysts


On conventional B-mode US the liver lesion could be barely discerned as a slightly hypoechogenic mass.

After IV contrast agent administration (SonoVue) in the early arterial phase, it demonstrated an early hyperenhancement following a spoke wheel pattern (due to the large size of the cine recording only the early arterial phase is shown).

During the late portal and sinusoidal phase, the lesion is still mildly hyperenhancing, while the nonenhancing central scar is best appreciated in this phase. It is worth mentioning that the central scar is also technically hypoenhancing in the arterial phase, though in practice the blooming artifact caused by the presence of concentrated microbubbles the adjacent tissues commonly obscures it.

Case Discussion

Typical MRI and CEUS appearance of FNH. Both imaging modalities demonstrated the characteristic early hyperenhancement without late phase washout, and the presence of a nonenhancing central scar. 

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