Hepatic metastases from colon carcinoma (triphasic MRI)
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- The liver is of average size with rather smooth outline. A large well-defined encapsulated focal lesion is seen involving the left hepatic lobe segment II, III and IV measuring 14.2 X 10.3 X 8 cm. This lesion elicits heterogeneous predominantly hypointense signal to the liver in the dual echo images and heterogeneous bright signal in T2 images with evidence of diffusion restriction. The lesion shows intense peripheral contrast enhancement in the arterial phase owing to non-enhancing central necrosis. There is rapid washout relative to background hepatic parenchyma in the portal venous and delayed phases.
- Other multiple small focal lesions are seen scattered within the right hepatic lobe showing similar signal pattern, diffusion restriction, rapid arterial contrast uptake and rapid washout in the subsequent phases. This lesions are seen in segments IV, VII, V and VIII, with the largest of which is seen at segment VII, measuring 2.8 X 2.6 cm.
- There is an ill-defined soft tissue mass involving the left colon with asymmetric circumferential mural thickening of the left colic flexure and proximal left colon. The mass narrows the colonic lumen with dilated transverse colon and deflated distal colon. The lesion shows hypointense T1 and hyperintense T2 signal with restricted diffusion. The colonic mass measures 8.4 X 5.1 X 3.8 cm. Pericolic fat stranding is noted with small pericolic lymphadenopathy.
- Normal pancreas, spleen and kidneys.
- No enlarged para-aortic lymphadenopathy or ascites.
Left colonic malignant mass lesion (colonic carcinoma) with multiple hepatic metastases.
The case is courtesy of Dr. Ahmad Yousry, MD. & Dr. Mohammed A. ElBeialy, FRCR, MD.
- 1- Koh DM, Collins DJ, Wallace T et-al. Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases. Br J Radiol. 2012;85 (1015): 980-9. doi:10.1259/bjr/91771639 - Free text at pubmed - Pubmed citation
- 2- Scurr ED, Collins DJ, Temple L et-al. Appearances of colorectal hepatic metastases at diffusion-weighted MRI compared with histopathology: initial observations. Br J Radiol. 2012;85 (1011): 225-30. doi:10.1259/bjr/11597735 - Free text at pubmed - Pubmed citation