Presentation
Concern for liver mass
Patient Data
Hetergeneous and nodular enhancement of the liver with pre-contrast HU of -4 (!) indicating hepatic steatosis. Notice how well you can see the vessels due to the low-attenuation liver tissue on the noncontrast series. No displacement or narrowing of vessels. No adenopathy. No ascites. Ventral herniorraphy.
Diffuse loss of signal of the lower attenuation (on CT) liver tissue on opposed phase, confirming steatosis in a nodular/geographic pattern. Notice the confusing appearance on SSFSE which can overlap with tumor.
Case Discussion
It is essential to become comfortable with the typic and atypical appearances of fatty liver, which can include geographic and nodular appearance that overlap with infiltrative HCC or cholangiocarcinoma. In this case, there is profound steatosis on CT (HU -4 on noncontrast images), but in a pattern that makes the normal liver tissue look like tumor at first glance. All series support normal sequential enhancement of this liver tissue (without washout or heterogeneity apart from the staetosis), and there is no vascular narrowing, tumor thrombus or ascites. These combined CT/MRI imaging findings allow you to confidently make the diagnosis of nodular/geographic steatosis without further evaluation.
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