Ghosting artifact mimicking enhancing liver nodule-liver hemangioma

Case contributed by Assis Prof Faeze Salahshour

Presentation

A liver mass on the US exam referred for characterization

Patient Data

Age: 45 years
Gender: Female

A large lobulated mass with high signal on T2 images and discontinuous peripheral nodular enhancement, and centripetal fill-in, is visible in segment 6th and 7th of the liver in favor of cavernous hemangioma. A small lesion in segment 3 of the liver is visible, which likely is a small hemangioma. On pre-contrast and axial dynamic post-contrast images, another round small lesion is visible on segment 7th of the liver. The lesion shows apparent hyper-enhancement on the arterial phase, suspected washout on the second image, and apparent progressive enhancement on two later post-contrast images. Such lesion is not present on the coronal post-contrast and other non-contrast images. On scrutinized reviewing, the lesion goes out of the liver to the lower thorax, and a similar symmetric lesion is visible on the left side, suggestive of a ghost artifact.

The orange and yellow arrows depict ghost artifacts mimicking an enhancing hepatic lesion.

Case Discussion

Phase-encoded motion artifact results from the motion of tissue or fluid during scanning, which presents as ghosting in the direction of phase-encoding in periodic motions. This artifact may mimic pathology and is often in the direction of the short axis of the image. On the axial images of the abdomen, ghosting is usually in the anteroposterior direction. In the present case, the ghosting and phase-encoding are in an unusual left-to-right direction.

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Case information

rID: 81727
Published: 4th Oct 2020
Last edited: 6th Oct 2020
Inclusion in quiz mode: Included
Institution: Tehran University of Medical Sciences (TUMS)