Hepatic Masses On Mri

Front 1

Hepatic Adenoma

Back 1

On T1: varies with presence of lipid, hemorrhage and necrosis; portions of tumor isointense to hyperintense to liver. Intratumoral lipid common, confirmed by chemical shift imaging.
T2: Variable but usually hyperintense to liver.
Hypervascular on dynamic CE imaging, but not as vascular as FNH.
No central scar.

Front 2

Focal Nodular Hyperplasia

Back 2

Mass on T1: isointense to slightly hypointense to liver.
T2: isointense to slightly hyperintense to liver.
Markedly hypervascular on dynamic CE imaging; isointense on portal venous phase, and slightly hyperintense on delayed phase.

Hint 2

Central Scar
On T1: hypointense to surrounding mass.
On T2: hyperintense to surrounding mass.
CE imaging: hypovascular to mass on arterial phase with increased enhancement on delayed phase.

Front 3

Fibrolamellar Hepatocellular Carcinoma

Back 3

Mass on T1: homogeneously hypointense to liver.
Mass on T2: heterogeneously hyperintense to liver.
Dynamic gadolinium enhanced: heterogeneous enhancement on arterial and portal venous phases.
Aggressive lesions: possible portal vein invasion and/or extrahepatic extension.

Hint 3

Central Scar:
T1 and T2: hypointense to mass and liver.
Scar usually does not enhance.

Front 4

Intraductal Peripheral Cholangiocarcinoma

Back 4

T1: hypointense to liver.
T2: hyperintense to liver, with central aras of focally increased or decreased SI relative to hyperintense periphery; biliary dilation peripheral to mass in > 50%.
Dynamic CE imaging: rim enhancement with heterogeneous centripetal progression with intratumoral fibrosis showing delayed enhancement.

Front 5

Biliary cystadenoma/cystadenocarcinoma

Back 5

Multilocular cystic mass with internal septations/nodularity.
T1 and T2 SI vary with type of fluid contents; proteinaceous/mucinous or hemorrhagic fluid is T1 hyperintense and T2 hypointense as compared with simple/bilious fluid.
Cystadeonma not reliably distinguished from cystadenocarcinoma by MRI

Front 6

Hemangioma

Back 6

T1: hypointense to liver.
T2: markedly hyperintense to liver, hyperintense to spleen.
Heavily T2: hyperintense to liver and spleen, hypointense to CSF.
Dynamic CE imaging: three patterns.
1. immediate uniform hyperenhancement (typically smaller lesions)
2. Peripheral nodular with centripetal progression to uniform enhancement (most common pattern)
3. Peripheral nodular with centripetal progression but persistent central hypointensity (larger hemangiomas with nonenhancing central scar).