Q: Why is frequency-selective fat suppression not a good option on low field strength MRI magnets? show answer
Q: What is a way around using frequency-selective fat saturation on a lower-strength MRI magnet? show answer
Mass noted on abdominal ultrasound for right upper quadrant pain.
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There is a single 4.5 cm mass in the right hepatic lobe:
There is no evidence of cirrhosis or other diffuse hepatic disease. No other abnormality in the abdomen.
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On the postcontrast dynamic sequence, there is heterogeneous enhancement of the mass on the arterial phase, with progressive persistent enhancement on the later phases.
No abnormal enhancement elsewhere in the liver. Hepatic vessels are patent.
This is a case of a rare hepatic mesenchymal tumor called a solitary fibrous tumor.
The imaging features are not specific and a prospective diagnosis is not realistic. The point of this case is really the diagnostic reasoning to generate a reasonable differential for the mass.
On the precontrast images, a number of masses, benign and malignant are possible. One should always remember that, although less common, HCC can occur in a liver not affected by cirrhosis (although usually in this situation, there is an occult history of chronic hepatitis B infection) 2.
The postcontrast dynamic sequence, however, has a more benign enhancement pattern. Given the well-circumscribed heterogenously solid appearance of the mass, more rare fibrous tumours could be entertained on the differential
Given the rarity of these lesions, however, a biopsy is still necessary for a diagnosis. An atypical presentation of a common malignant lesion is still more typical than these rare lesions.
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