CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis, differential diagnosis, and pitfalls

Abstract

The differential diagnosis of extrahepatic abdominopelvic masses is wide. Demonstration of fat within a lesion at noninvasive imaging is an important clue for narrowing the differential diagnosis. Macroscopic fat is readily identified with both computed tomography (CT) and magnetic resonance (MR) imaging. Demonstration of microscopic fat is more difficult and may require special techniques. Identification of fat with CT is based on x-ray resorption and therefore on the attenuation (typically less than -20 HU). Several MR imaging techniques have been developed for fat suppression. Two of the most widely available are spectroscopic fat saturation and chemical shift (in-phase/opposed-phase) imaging. Entities with predominantly macroscopic fat include myelolipoma, angiomyolipoma, teratoma, liposarcoma, lipoma, epiploic appendagitis, omental infarction, and mesenteric panniculitis. Lesions with predominantly microscopic fat include adrenal adenoma and some teratomas. Other fat-containing entities involve the mesentery and bowel wall; these include fibrofatty mesenteric proliferation and submucosal fat deposition.