Focal liver lesions MR imaging

Click to edit Master subtitle style

4/28/12

MRI Techniques Sequences

Coronal ultrafast spin-echo sequence (single breath-hold). Axial fast spin-echo (T2-weighted) images. Fat-saturated (frequency selective) images increase the conspicuity of liver lesions. Axial 2D dual spoiled gradientrecalled echo sequence (SPGR) (both 4/28/12 out-of-phase and inphase imaging

Sequences

T1-weighted imaging Diffusion-weighted imaging. Dynamic contrast materialenhanced imaging at 20 (arterial phase), 60 (portal venous phase), and 120 (equilibrium phase) seconds after the injection of Gd-BOPTA and again at 1 hour after injection
4/28/12

Contrast agents

Extracellular fluid agents. Hepatobiliary-specific agents. Combined agents. Reticuloendothelial agents, Blood-pool agents

4/28/12

Hepatobiliary-specific Agents (Gd-BOPTA)

These hepatobiliary-specific agents are taken up to varying degrees by functioning hepatocytes and are excreted in the bile. Gadolinium-based hepatobiliaryspecific agents initially distribute in the extracellular fluid compartment, just as extracellular fluid agents do, and are subsequently taken up by hepatocytes. 4/28/12

Focal liver lesions in MRI

Classification based on vascularization patterns
1. 2. 3.

Hypervascular lesions. Hypovascular lesions. Lesions presenting delayed persistent enhancement.

4/28/12

Hypervascular lesions

Characterized by strong contrast enhancement in the arterial phase scan. May be sharply demarcated or more diffuse appearance.

4/28/12

Hemangioma

well-circumscribed mass of bloodfilled spaces lined by endothelium on a thin fibrous stroma. On T2-weighted images, they are markedly hyperintense and have cystlike signal intensity. On T1-weighted images, hypointense relative to the liver.
4/28/12

Three distinct enhancement patterns:

Capillary Hemangioma

4/28/12

Focal Nodular Hyperplasia

Represent a hyperplastic response of the hepatic parenchyma to a preexisting arterial malformation. After hemangiomas, most incidental hypervascular liver lesions in noncirrhotic livers represent FNH and not adenoma. FNH - margin of the lesion, is typically ill-defined or lobulated.
4/28/12

Adenomas - margin is usually smooth

T1-weighted images - isointense relative to the liver T2-weighted images - isointense to slightly hyperintense. Central scar is T1 hypointense and T2 hyperintense.

4/28/12

4/28/12

4/28/12

Hepatic Adenoma

Hepatic adenoma is a very rare benign neoplasm. Multiple in about 20% of cases, especially in patients with glycogen storage disease. Composed of benign hepatocytes that are arranged in large plates or cords without acinar architecture. T1-weighted images - variable signal 4/28/12 intensity.

Hepatic adenoma

4/28/12

Hepatocellular Carcinoma

Cirrhotic nodules range from benign regenerative to premalignant dysplastic and frankly malignant HCC. T1-weighted MR imaging, HCC lesions less than 1.5 cm are often isointense, whereas larger lesions may be hyperintense secondary to lipid, copper, or glycogen. Fatty metamorphosis in a cirrhotic

4/28/12

Hepatocellular Carcinoma

In cirrhotic patients, a hypervascular mass with increased T2 signal similar to that of the spleen is suspicious for HCC. DWI - Well-differentiated tumors are often isointense, whereas moderately to poorly differentiated tumors are more often hyperintense. Arterial phase -heterogeneous 4/28/12 enhancement, portal venous and

Hepatocellular Carcinoma

4/28/12

Hypervascular Metastases

Hypovascular metastases show decreased enhancement relative to normal liver and are most conspicuous on portal venous phase images. Hypervascular metastases enhance earlier, are best seen on arterial phase images, and show washout on delayed images. These metastases typically arise

4/28/12

Hypervascular lesions arterial phase

4/28/12

Hypervascular lesions arterial phase

4/28/12

Hypovascular lesions

4/28/12

Delayed persistent enhancement

4/28/12

4/28/12