liver lesions hyperintense on hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. Top row: schematics showing the uptake mechanism of hepatobiliary contrast agents. Bottom row: corresponding schematics of the signal characteristics of liver and focal observations. Left column: a uptake in hepatocytes and (b) corresponding signal characteristics in normal liver. Middle column: c increased uptake due to overexpression of OATP1B3 and (d) corresponding iso- or hyperintense signal characteristics of focal observations (from left to right: FNH, nodule with hyperintense rim, hyperintense HCC, HCC with nodule-in-nodule architecture and HCC with peritumoral hyperintensity). Right column: e increased uptake due to retention in fibrotic stroma or aberrant expression of OATP1B3 and (f) representative target imaging appearance (lower row) of intrahepatic cholangiocarcinoma or metastasis

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 73-year-old man with colon cancer and liver metastases. Gadobenate dimeglumine-enhanced MRI in (a) arterial phase and (b) hepatobiliary phase demonstrates two liver metastases with different signal characteristics. A metastasis (black arrow) shows homogenous arterial phase hyperenhancement with a peripheral hypointense rim in the hepatobiliary phase. A second metastasis (white arrow) shows peripheral rim enhancement with a peripheral hypointense rim and cloud-like central enhancement in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 71-year-old man with HCV-related cirrhosis and multiacinar cirrhotic nodules. Gadoxetate disodium-enhanced MR shows multiple multiacinar cirrhotic nodules that are (a) isointense to surrounding liver parenchyma in the precontrast T1-weighted sequence and (b) in the hepatic arterial phase, (c) show enhancement in the portal venous phase due to early uptake of hepatobiliary contrast and (d) are hyperintense in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 43-year-old man with HCV-related cirrhosis and multiple cirrhotic regenerative nodules. Gadoxetate disodium-enhanced MRI shows multiple cirrhotic regenerative nodules that are hyperintense on hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 55-year-old man with HCV-related cirrhosis and multiple HCCs. Gadoxetate disodium-enhanced MRI shows an HCC mass in the caudate lobe with (a) arterial phase hyperenhancement in the arterial phase, (b) non-peripheral washout in the portal venous phase and (c) hypointensity in the hepatobiliary phase with peripheral hyperintensity (arrow), suggesting microvascular invasion

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 72-year-old man with HCV-related cirrhosis. Gadoxetate disodium-enhanced MRI shows a lesion with (a) arterial phase hyperenhancement and (b) nodule-in-nodule architecture with a smaller inner hyperintense nodule (arrow) within a larger outer hypointense nodule in hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 65-year-old patient with HCV-related cirrhosis and hepatocellular carcinoma. Gadobenate dimeglumine-enhanced MRI shows an HCC with (a) arterial phase hyperenhancement (arrow) in the arterial phase, (b) non-peripheral washout in the portal venous phase and (c) iso-hyperintensity in the hepatobiliary phase surrounded by a non-enhancing capsule

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 71-year-old woman with cholangiocarcinoma. Gadoxetate disodium-enhanced MRI shows an intrahepatic mass-forming cholangiocarcinoma with (a) continuous rim enhancement on hepatic arterial phase and (b) a target pattern on hepatobiliary phase with peripheral hypointense rim (arrow) and inhomogeneous contrast media uptake with a central enhancing area (asterisk) likely related to fibrous stroma

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. Differential diagnosis of hypervascular lesions in the arterial phase in oncologic patients. Top row: 53-year-old woman with breast cancer and focal nodular hyperplasia. Gadobenate dimeglumine-enhanced MRI demonstrates a focal nodular hyperplasia (arrow) that (a) enhances in the hepatic arterial phase and (b) is hyperintense in the hepatobiliary phase. Bottom row: 58-year-old man with pharyngeal carcinoma and hepatocellular carcinoma. Gadoxetate disodium-enhanced MRI demonstrates a small HCC nodule (arrow) that (c) enhances in the hepatic arterial phase and (d) is hypointense in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 46-year-old woman with focal nodular hyperplasia. Gadoxetate disodium-enhanced MRI shows a focal nodular hyperplasia that is (a) nearly isointense to liver parenchyma in the precontrast T1-weighted sequence, (b) with marked hyperenhancement (arrow) in the arterial phase, (c) mildly hyperintense in the portal venous phase and (d) hyperintense in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 40-year-old woman with sigmoid adenocarcinoma and liver metastases treated with chemotherapy (XELOX regimen). a Contrast-enhanced CT shows a FNH-like nodule (arrow) that is hypervascular in the arterial phase. Gadoxetate disodium-enhanced MRI performed 2 years later (b) in the arterial phase and (c) hepatobiliary phase shows size increase which raises the suspicion of metastasis. However, the hepatobiliary phase (c) demonstrates a hyperintense rim establishing the diagnosis of FNH-like nodule

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 41-year-old man with cavernous transformation of the portal vein and FNH-like nodules. Gadoxetate disodium-enhanced MRI shows two FNH-like nodules (arrows) that are hyperintense in the hepatobiliary phase with central small hypointensity due to a central scar

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 38-year old woman with Budd–Chiari syndrome and FNH-like nodule. Gadobenate dimeglumine-enhanced MRI demonstrates a FNH-like nodule that shows (a) arterial phase hyperenhancement (arrow) and (b) hyperintensity in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 63-year-old man with liver steatosis and focal fat sparing area in segment 4. Gadoxetate disodium-enhanced MRI shows (a) in the opposed-phase and (b) in-phase images a fat sparing area with similar signal unlike the background liver that has marked signal drop in the opposed-phase sequence. The area of fat sparing is (c) slightly hyperintense (arrow) to the background liver in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 46-year-old woman with clinical history of oral contraceptive use and pathology-proven hepatocellular adenoma. Gadoxetate disodium-enhanced MRI shows a normal liver characterized by (a) no significant signal drop of hepatic parenchyma in the opposed phase compared to (b) the in-phase and (c) a hepatocellular adenoma (arrow) that shows contrast enhancement in the arterial phase and (d) heterogeneous hyperintensity in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 44-year-old woman with focal nodular hyperplasia. Gadobenate dimeglumine-enhanced MRI shows a focal nodular hyperplasia that is (a) hypervascular in the arterial phase and (b) demonstrates a hyperintense rim (arrow) in the hepatobiliary phase

Spectrum of

liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. A 57-year-old woman with secondary sclerosing cholangitis and periportal hyperintensity on hepatobiliary phase. Gadoxetate disodium-enhanced MRI shows both thick tramline-like periportal hyperintensity (black arrow) and nodular-like periportal hyperintensity (white arrow)