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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 30-year-old female patient with hepatic angiomyolipoma (arrows) in segment IV/I of the liver. There is a 1.6 cm sized hyperechoic mass in segment IV/I (A). On T1-weighed in-phase (B) and out-of-phase (C) images, there is a focal fatty area within the tumor (white arrow head). On arterial phase of MRI (D), the early draining vein is not definite but the left hepatic vein shows early enhancement (black arrow head). It shows low SI on hepatobiliary phase (E) and diffusion restriction (F). MRI, magnetic resonance imaging; SI, signal intensity.
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Figure 2: A 30-year-old female patient with hepatic angiomyolipoma (arrows) in segment IV/I of the liver. There is a 1.6 cm sized hyperechoic mass in segment IV/I (A). On T1-weighed in-phase (B) and out-of-phase (C) images, there is a focal fatty area within the tumor (white arrow head). On arterial phase of MRI (D), the early draining vein is not definite but the left hepatic vein shows early enhancement (black arrow head). It shows low SI on hepatobiliary phase (E) and diffusion restriction (F). MRI, magnetic resonance imaging; SI, signal intensity.

Mentions: A 30-year-old female patient was referred to our hospital for evaluation of a hepatic tumor which was incidentally detected during ultrasound (US) screening at a local clinic. The patient had no symptom or history of viral hepatitis or excessive alcohol intake. All liver function tests and AFP were normal range. On outside US, there was a 1.6 cm hyperechoic mass in segment IV/I of the liver (Fig. 2). On contrast enhanced CT scan, the mass showed low density on precontrast images, hypervascularity on arterial phase, and washout of contrast on portal and delayed phases. For further evaluation, gadoxetic acid-enhanced liver MRI was performed. On T1-weighted in-phase and out-of-phase images, the mass contained focal fat tissue. On arterial phase, early draining vein was not seen but the left hepatic vein showed early enhancement. The mass showed low SI on T1WI, high SI on T2WI, high SI on DWI, and low SI on hepatobiliary phase (Fig. 2). Our first impression was fat-containing HCC. However, she did not have any risk factors for HCC, and underwent percutaneous needle biopsy. The histologic diagnosis was hepatic angiomyolipoma. Conservative management with close follow-up was decided because she did not have any symptoms and the size of tumor was relatively small. However, the size increased to 2.5 cm on follow-up MRI performed 9 months later. Finally, she underwent left hemihepatectomy and caudate lobectomy, and angiomyolipoma was confirmed.


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

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

A 30-year-old female patient with hepatic angiomyolipoma (arrows) in segment IV/I of the liver. There is a 1.6 cm sized hyperechoic mass in segment IV/I (A). On T1-weighed in-phase (B) and out-of-phase (C) images, there is a focal fatty area within the tumor (white arrow head). On arterial phase of MRI (D), the early draining vein is not definite but the left hepatic vein shows early enhancement (black arrow head). It shows low SI on hepatobiliary phase (E) and diffusion restriction (F). MRI, magnetic resonance imaging; SI, signal intensity.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A 30-year-old female patient with hepatic angiomyolipoma (arrows) in segment IV/I of the liver. There is a 1.6 cm sized hyperechoic mass in segment IV/I (A). On T1-weighed in-phase (B) and out-of-phase (C) images, there is a focal fatty area within the tumor (white arrow head). On arterial phase of MRI (D), the early draining vein is not definite but the left hepatic vein shows early enhancement (black arrow head). It shows low SI on hepatobiliary phase (E) and diffusion restriction (F). MRI, magnetic resonance imaging; SI, signal intensity.
Mentions: A 30-year-old female patient was referred to our hospital for evaluation of a hepatic tumor which was incidentally detected during ultrasound (US) screening at a local clinic. The patient had no symptom or history of viral hepatitis or excessive alcohol intake. All liver function tests and AFP were normal range. On outside US, there was a 1.6 cm hyperechoic mass in segment IV/I of the liver (Fig. 2). On contrast enhanced CT scan, the mass showed low density on precontrast images, hypervascularity on arterial phase, and washout of contrast on portal and delayed phases. For further evaluation, gadoxetic acid-enhanced liver MRI was performed. On T1-weighted in-phase and out-of-phase images, the mass contained focal fat tissue. On arterial phase, early draining vein was not seen but the left hepatic vein showed early enhancement. The mass showed low SI on T1WI, high SI on T2WI, high SI on DWI, and low SI on hepatobiliary phase (Fig. 2). Our first impression was fat-containing HCC. However, she did not have any risk factors for HCC, and underwent percutaneous needle biopsy. The histologic diagnosis was hepatic angiomyolipoma. Conservative management with close follow-up was decided because she did not have any symptoms and the size of tumor was relatively small. However, the size increased to 2.5 cm on follow-up MRI performed 9 months later. Finally, she underwent left hemihepatectomy and caudate lobectomy, and angiomyolipoma was confirmed.

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