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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 66-year-old female patient with hepatic pseudolymphoma (arrows) in left lateral segment of the liver. There is a 1.2 cm sized hypoechoic mass on US (A). There is a perinodular enhancement on arterial phase of MRI (B) and the perinodular enhancement is sustained until delayed phase (C). It shows low SI on hepatobiliary phase (D). MRI, magnetic resonance imaging; SI, signal intensity.
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Figure 3: A 66-year-old female patient with hepatic pseudolymphoma (arrows) in left lateral segment of the liver. There is a 1.2 cm sized hypoechoic mass on US (A). There is a perinodular enhancement on arterial phase of MRI (B) and the perinodular enhancement is sustained until delayed phase (C). It shows low SI on hepatobiliary phase (D). MRI, magnetic resonance imaging; SI, signal intensity.

Mentions: A 66-year-old female patient was referred to our hospital for evaluation of a hepatic tumor which was incidentally detected during US screening at a local clinic. She had a medical history of chronic renal failure. The patient had no history of viral hepatitis or excessive alcohol intake. All liver function tests and AFP were normal range. Outside US showed a 1.2 cm sized hypoechoic mass in left lateral segment of the liver (Fig. 3). It was a low density mass on precontrast CT images. On the contrast-enhanced dynamic CT images, the mass revealed subtle enhancement on arterial phase and washout of contrast on delayed phase. On gadoxetic acid-enhance MRI, the mass showed low SI on T1WI, high SI on T2WI, and high SI on DWI. On arterial phase images, the peripheral portion showed more intense enhancement than the central portion. The peripheral intense-enhancing portion showed iso SI on hepatobiliary phase, but the central less-enhancing portion showed low SI on hepatobiliary phase. Considering this imaging finding, the peripheral intense enhancement could be considered as perinodular enhancement not enhancement of tumor itself. The perinodular enhancement was sustained until the delayed phase. Our initial impression was HCC or other hypervascular malignant tumors. We tried to perform percutaneous needle biopsy, but it was too risky to perform it due to surrounding vessels. Finally, she underwent laparoscopic lateral sectionectomy. The histologic diagnosis was pseudolymphoma.


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

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

A 66-year-old female patient with hepatic pseudolymphoma (arrows) in left lateral segment of the liver. There is a 1.2 cm sized hypoechoic mass on US (A). There is a perinodular enhancement on arterial phase of MRI (B) and the perinodular enhancement is sustained until delayed phase (C). It shows low SI on hepatobiliary phase (D). 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 3: A 66-year-old female patient with hepatic pseudolymphoma (arrows) in left lateral segment of the liver. There is a 1.2 cm sized hypoechoic mass on US (A). There is a perinodular enhancement on arterial phase of MRI (B) and the perinodular enhancement is sustained until delayed phase (C). It shows low SI on hepatobiliary phase (D). MRI, magnetic resonance imaging; SI, signal intensity.
Mentions: A 66-year-old female patient was referred to our hospital for evaluation of a hepatic tumor which was incidentally detected during US screening at a local clinic. She had a medical history of chronic renal failure. The patient had no history of viral hepatitis or excessive alcohol intake. All liver function tests and AFP were normal range. Outside US showed a 1.2 cm sized hypoechoic mass in left lateral segment of the liver (Fig. 3). It was a low density mass on precontrast CT images. On the contrast-enhanced dynamic CT images, the mass revealed subtle enhancement on arterial phase and washout of contrast on delayed phase. On gadoxetic acid-enhance MRI, the mass showed low SI on T1WI, high SI on T2WI, and high SI on DWI. On arterial phase images, the peripheral portion showed more intense enhancement than the central portion. The peripheral intense-enhancing portion showed iso SI on hepatobiliary phase, but the central less-enhancing portion showed low SI on hepatobiliary phase. Considering this imaging finding, the peripheral intense enhancement could be considered as perinodular enhancement not enhancement of tumor itself. The perinodular enhancement was sustained until the delayed phase. Our initial impression was HCC or other hypervascular malignant tumors. We tried to perform percutaneous needle biopsy, but it was too risky to perform it due to surrounding vessels. Finally, she underwent laparoscopic lateral sectionectomy. The histologic diagnosis was pseudolymphoma.

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