Common MRI features to determine if a focal hepatic lesion is hepatocellular or extrahepatocellular in origin

What are the common MRI features to determine if a focal hepatic lesion is hepatocellular or extrahepatocellular in origin?

Determination of the origin of a focal hepatic lesion as hepatocellular or extrahepatocellular is useful to establish a definitive diagnosis for the lesion. Commonly encountered lesions of hepatocellular origin include FNH, hepatic adenoma, focal hepatic steatosis, regenerative nodule, and HCC.

In general, lesions that are isointense to hyperintense in signal intensity relative to liver parenchyma on in-phase T1-weighted images are hepatocellular in origin, whereas lesions that are low in signal intensity relative to liver parenchyma are generally extrahepatocellular in origin. Presence of intralesional lipid content, as manifested by a loss of signal intensity within a hepatocellular origin hepatic lesion on out-of-phase T1-weighted images relative to in-phase T1-weighted images, is often seen in all of the hepatocellular origin hepatic lesions listed above except for FNH but is not seen in most extrahepatocellular origin hepatic lesions with the exception of lipid-containing hepatic metastases from clear cell renal cell carcinoma or adrenocortical carcinoma. Retention of hepatobiliary MRI contrast material within a lesion during the hepatobiliary phase of enhancement generally indicates presence of either focal hepatic steatosis, regenerative nodule, or FNH, whereas all other hepatic lesions appear hypointense relative to surrounding liver parenchyma during this phase of enhancement. Lesions with high T2-weighted signal intensity relative to liver but intermediate signal intensity relative to spleen tend to be due to a malignant neoplasm, whereas lesions with high T2-weighted signal intensity relative to both liver and spleen parenchyma are most often due to cysts or hemangiomas.

MRI Features of Hepatic Lesions of Hepatocellular Origin

LESIONT1-WT2-WHEAVILY T2-WPOSTCONTRAST T1-WOTHER
Focal steatosis== to ↑== on all phasesOften geographic in shape and in particular distribution, no mass effect upon vessels
FNH=;
↓ of central scar
=;
↑ of central scar
=↑↑↑ on A phase;
= on V, D, and HB phases;
↑ of central scar on D phase
Homogeneous enhancement, central scar, no lipid content
Hepatic adenoma= to ↑;
↑↑ if hemorrhagic
= to ↑=↑↑ on A phase;
= to ↓ on V and D phases; ↓ on HB phase
More heterogeneous, a/w oral contraceptive use
Regenerative nodule= to ↑;
↓ if siderotic
= to ↓== on all phasesSmall, multiple, in cirrhotic liver
HCC= to ↓= to ↑=↑↑ on A phase;
= to ↓ on V and D phases; ↓ on HB phase
More heterogeneous, often in cirrhotic liver, ± vascular invasion, ± metastatic disease

Table legend: T1-W means T1-weighted; T2-W means T2-weighted; = means approximately isointense to liver parenchyma; ↑ means increased signal intensity relative to liver parenchyma; ↓ means decreased signal intensity relative to liver parenchyma; means arterial; means venous; means delayed; HB means hepatobiliary; a/w means associated with.

MRI Features of Hepatic Lesions of Extrahepatocellular Origin

LESIONT1-WT2-WHEAVILY T2-WPOSTCONTRAST T1-WOTHER
Cyst↓↓↓;
↓↓ to ↑↑ if proteinaceous or hemorrhagic
↑↑↑;
↓↓ to ↑↑ if proteinaceous or hemorrhagic
↑↑↑;
↓↓ to ↑↑ if proteinaceous or hemorrhagic
No or minimal thin rim enhancement
Hemangioma↑↑↑↑↑Peripheral nodular discontinuous enhancement on A phase; centripetal fill-in on V phase; persistent enhancement on D phaseSometimes flash-filling in A phase when small in size; often central cleftlike area of cystic degeneration or liquefaction when large in size
Hepatic metastasis= to ↑Variable, may have continuous rim enhancement, ± “peripheral washout” sign in V or D phaseHistory of primary tumor often known, often heterogeneous, usually multiple, ± extrahepatic metastatic disease, no cirrhosis present
Abscess↓↓;
↓↓↓ if contains foci of gas
↑↑;
↓↓↓ if contains foci of gas
↑;
↓↓↓ if contains foci of gas
Rim and septal enhancement in A or V phase that persists in D phase, regional hyperenhancementOften clustered, may be surrounded by edema
Intrahepatic cholangiocarcinoma= to ↑Heterogeneous peripheral enhancement in A and V phases with gradual centripetal fill-in on D phaseHeterogeneous, ± biliary obstruction, ± capsular retraction, ± extrahepatic metastatic disease
Hepatic lymphoma= to ↑Hypoenhancing on all phasesHomogeneous, usually multiple, often associated with lymphadenopathy

Table legend: T1-W means T1-weighted; T2-W means T2-weighted; = means approximately isointense to liver parenchyma; ↑ means increased signal intensity relative to liver parenchyma; ↓ means decreased signal intensity relative to liver parenchyma; means arterial; means venous; means delayed.

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