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Review
. 2020 Jul 13;91(8-S):9-17.
doi: 10.23750/abm.v91i8-S.9969.

Hepatic tumors: pitfall in diagnostic imaging

Giulia Grazzini  1 , Diletta Cozzi  2 , Federica Flammia  3 , Roberta Grassi  4 , Andrea Agostini  5 , Maria Paola Belfiore  4 , Alessandra Borgheresi  6 , Maria Antonietta Mazzei  7 , Chiara Floridi  8 , Gianpaolo Carrafiello  9 , Andrea Giovagnoni  10 , Silvia Pradella  11 , Vittorio Miele  12
Affiliations
Review

Hepatic tumors: pitfall in diagnostic imaging

Giulia Grazzini et al. Acta Biomed. .

Abstract

On computed tomography (CT) and magnetic resonance imaging (MRI), hepatocellular tumors are characterized based on typical imaging findings. However, hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma can show uncommon appearances at CT and MRI, which may lead to diagnostic challenges. When assessing focal hepatic lesions, radiologists need to be aware of these atypical imaging findings to avoid misdiagnoses that can alter the management plan. The purpose of this review is to illustrate a variety of pitfalls and atypical features of hepatocellular tumors that can lead to misinterpretations providing specific clues to the correct diagnoses.

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Conflict of interest statement

Authors declare that they have no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Figure 1.
Figure 1.
FNH with the central scar on Gd-EOB-DTPA-enhanced MRI. The typical FNH shows a central scar (arrows) that appears as a hypointense band on T1 (A) and hyperintense on T2-weighted images (B). On contrast-enhanced MRI, FNH undergoes immediate enhancement on arterial phase (C) and enhancement similar to the liver on portal venous and late, delayed phases (D-E). In the hepatocyte phase, FNH shows isointensity with the central scar hypointense (F)
Figure 2.
Figure 2.
β-HCA on Gd-BOPTA-enhanced MRI. β-HCA shows heterogeneous signal intensity on T1- (A) and T2-weighted (C) with a signal dropout on opposed-phase T1-weighted image (B) due to the presence of hemorrhage and intralesional fat. On contrast-enhanced imaging, β-HCA demonstrates moderate enhancement in the arterial phase (D) and prolonged mild enhancement on the portal venous phase (E). On hepatocyte phase (F), β-HCA appears hypointense compared to the adjacent liver parenchyma. The presence of a capsule appearance (arrows) leads to differential diagnosis from HCC. On DWI (G-H) the absence of diffusion restriction is useful to distinguish β-HCA from HCC
Figure 3.
Figure 3.
Atypical HCC on Gd-BOPTA-enhanced MRI. Hypovascular HCC does not show typical arterial phase wash-in (A), but it is detected in the portal venous (B) and delayed phase (C) as a hypoenhancing nodule (circle). On the hepatobiliary phase, hypovascular HCC appears hypointense (D)
Figure 4.
Figure 4.
Well-differentiated HCC on Gd-BOPTA-enhanced MRI. HCC (circle) shows a slight hypointensity on T1-weighted image (A), slight hyperintensity on T2-weighted image (B), and typical arterial wash-in (C) and wash-out on portal phase (D). HCC appears hyperintense relative to background parenchyma in the hepatocyte phase (E) with a hypointense peripheral rim
See this image and copyright information in PMC

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