Presentation
Focal liver lesion on CT. Right upper lobe abnormality on CT. Biopsy negative for malignancy. Strong concern this is a false-negative biopsy. Liver metastasis?
Patient Data
MRI LIVER - PRIMOVIST
4.2 cm segment 8/5 mass with an 8 mm adjacent same segment lesion. 2.3 cm segment 7 subcapsular mass and 5 mm segment 6 lesion. Several sub-3mm lesions in segment 6 which are apparent on the delayed (20 minutes) and DWI sequences.
All are devoid of contrast.
Gallstones.
Cortical scarring of both kidneys.
Right upper lobe mass/collapse and apical fluid on the scanogram.
Case Discussion
Primovist (gadoxetate disodium) may be used in the evaluation of hepatic metastases. It is a hepatocyte -specific contrast agent. Therefore, metastases do not take up the contrast, as evidenced in this case, as they do not contain any hepatocytes.
An ultrasound-guided biopsy was performed of the segment 8/5 lesion.
Histology: Adenocarcinoma of the lung
It is always worth scrutinising the localizer images as these have a wider field of view and may assist in the definitive diagnosis. In this case, a right upper lobe local collapse and central mass are apparent.
Disclosure: I, Ian Bickle, have no actual or potential ethical or financial conflict of interest in relation to this contrast agent. This case is not intended to be a personal endorsement or recommendation of this product.