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Benign nodules mimicking hepatocellular carcinoma on gadoxetic acid-enhanced liver MRI.

Song KD, Jeong WK - Clin Mol Hepatol (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Although diagnostic accuracy of imaging techniques for HCC has been improved through recent advances in MR techniques and new hepatocyte-specific contrast agents, misdiagnosis is encountered not uncommonly in real clinical practice. To reduce the rate of misdiagnosis, doctors should be familiar with the clinical manifestation and the imaging findings of false positive and false negative cases. We here report three cases with benign hepatic nodules mimicking HCC: bile duct adenoma, angiomyolipoma and pseudolymphoma.

No MeSH data available.


Related in: MedlinePlus

A 59-year-old male patient with bile duct adenoma (arrows) in segment V/VIII of the liver. The nodule shows arterial hypervascularity (A) but does not show washout of contrast on delayed phase of CT (B). On MRI, it shows arterial hypervascularity (C) and washout of contrast on delayed phase images (D). It shows high SI on T2WI (E). It reveals diffusion restriction (F). CT, computed tomography; MRI, magnetic resonance imaging; SI, signal intensity; T2WI, T2-weighted images.
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Figure 1: A 59-year-old male patient with bile duct adenoma (arrows) in segment V/VIII of the liver. The nodule shows arterial hypervascularity (A) but does not show washout of contrast on delayed phase of CT (B). On MRI, it shows arterial hypervascularity (C) and washout of contrast on delayed phase images (D). It shows high SI on T2WI (E). It reveals diffusion restriction (F). CT, computed tomography; MRI, magnetic resonance imaging; SI, signal intensity; T2WI, T2-weighted images.

Mentions: A 59-year-old male patient with hepatitis B virus cirrhosis, who was under surveillance for HCC, showed a mass on a computed tomography (CT) scan. The mass was not seen on the previous CT scan which was performed 15 months ago. Arterial phase images showed a 1-cm hypervascular mass in the subcapsular area of segment V/VIII of the liver (Fig. 1). However, the mass did not show washout of contrast on delayed phase images. Gadoxetic acid-enhance Liver magnetic resonance imaging (MRI) was performed three months later for further evaluation. There was no significant interval change in size. The mass showed low signal intensity (SI) on T1-weighted images (T1WI), high SI on T2-weighted images (T2WI), hypervascularity on arterial phase, washout of contrast on portal and delayed phases, and low SI on hepatobiliary phase. The mass demonstrated high SI on diffusion-weighted images (DWI) and low apparent diffusion coefficient (ADC) value. Liver function tests showed normal range of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The serum tumor marker, α-fetoprotein (AFP) was also normal range. Our impression was HCC. He underwent tumorectomy. However, the histologic diagnosis was intrahepatic bile duct adenoma on a background of hepatitis B virus cirrhosis.


Benign nodules mimicking hepatocellular carcinoma on gadoxetic acid-enhanced liver MRI.

Song KD, Jeong WK - Clin Mol Hepatol (2015)

A 59-year-old male patient with bile duct adenoma (arrows) in segment V/VIII of the liver. The nodule shows arterial hypervascularity (A) but does not show washout of contrast on delayed phase of CT (B). On MRI, it shows arterial hypervascularity (C) and washout of contrast on delayed phase images (D). It shows high SI on T2WI (E). It reveals diffusion restriction (F). CT, computed tomography; MRI, magnetic resonance imaging; SI, signal intensity; T2WI, T2-weighted images.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493364&req=5

Figure 1: A 59-year-old male patient with bile duct adenoma (arrows) in segment V/VIII of the liver. The nodule shows arterial hypervascularity (A) but does not show washout of contrast on delayed phase of CT (B). On MRI, it shows arterial hypervascularity (C) and washout of contrast on delayed phase images (D). It shows high SI on T2WI (E). It reveals diffusion restriction (F). CT, computed tomography; MRI, magnetic resonance imaging; SI, signal intensity; T2WI, T2-weighted images.
Mentions: A 59-year-old male patient with hepatitis B virus cirrhosis, who was under surveillance for HCC, showed a mass on a computed tomography (CT) scan. The mass was not seen on the previous CT scan which was performed 15 months ago. Arterial phase images showed a 1-cm hypervascular mass in the subcapsular area of segment V/VIII of the liver (Fig. 1). However, the mass did not show washout of contrast on delayed phase images. Gadoxetic acid-enhance Liver magnetic resonance imaging (MRI) was performed three months later for further evaluation. There was no significant interval change in size. The mass showed low signal intensity (SI) on T1-weighted images (T1WI), high SI on T2-weighted images (T2WI), hypervascularity on arterial phase, washout of contrast on portal and delayed phases, and low SI on hepatobiliary phase. The mass demonstrated high SI on diffusion-weighted images (DWI) and low apparent diffusion coefficient (ADC) value. Liver function tests showed normal range of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The serum tumor marker, α-fetoprotein (AFP) was also normal range. Our impression was HCC. He underwent tumorectomy. However, the histologic diagnosis was intrahepatic bile duct adenoma on a background of hepatitis B virus cirrhosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Although diagnostic accuracy of imaging techniques for HCC has been improved through recent advances in MR techniques and new hepatocyte-specific contrast agents, misdiagnosis is encountered not uncommonly in real clinical practice. To reduce the rate of misdiagnosis, doctors should be familiar with the clinical manifestation and the imaging findings of false positive and false negative cases. We here report three cases with benign hepatic nodules mimicking HCC: bile duct adenoma, angiomyolipoma and pseudolymphoma.

No MeSH data available.


Related in: MedlinePlus