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| Diagnosis | Clinical features | Radiographic appearance |
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| Hemangioma | Most often asymptomatic, but can present with right upper quadrant pain and fullness.
Hepatomegaly, hepatic bruit, jaundice, GI bleed, and fever may occur. | Ultrasound: Well demarcated homogenous, hyperechoic mass.
CT scan: (triple phase with delayed imaging)
(i) Hypodense on noncontrast CT.
(ii) Peripheral enhancement on arterial phase.
(iii) Centripetal contrast enhancement on venous and delayed phases. |
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| Focal nodular hyperplasia | Largely benign symptomatology.
Abdominal discomfort and palpable liver mass sometimes seen. | Ultrasound: Variably hyper-, hypo-, or isoechoic.
A central scar is identified in 20% of cases.
CT scan:
Noncontrast: Hypo- or isodense (central scar in 1/3 of patients.)
Contrast study: Hyperdense during arterial phase and isodense during the portal venous phase.
MRI:
T1: Isointense
T2: Isointense to slightly hyperintense with generally hyperintense central scar.
Gadolinium: Hyperintense.
Nuclear imaging:
Technetium sulfur colloid scanning due to presence of Kupffer cells; 80% of lesions show active uptake. |
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| Hepatic cystadenoma | RUQ discomfort and pain; anorexia.
Frequently asymptomatic and an incidental finding. | Ultrasound:
Anechoic lesions with internal septations.
CT:
Hypodense lesions with focal enhancement postcontrast.
MRI:
Hypointense on T1-weighted images.
Hyperintense on T2-weighted images. |
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| Hepatic abscess | Fever, abdominal pain, nausea, vomiting, and anorexia. | Ultrasound:
Hypoechoic masses with irregularly shaped borders.
CT scan:
Hypodense masses with peripheral enhancement post-contrast. (Enhanced ring sign.) |
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| Hepatic adenoma | Episodic abdominal pain.
Frequently an incidental finding.
An abdominal mass is felt 30% of the time, hepatomegaly (25%).
Rarely, jaundice. | Ultrasound:
Often nonspecific. It could have well demarcated hyper echoic appearance or heterogeneous due to intratumoral bleeding.
CT scan:
Noncontrast: Well-defined hypo- or isodense lesions.
Contrast: Arterial phase, peripheral enhancement.
Portal venous phase: Centripetal flow.
Late phase: Isodense initially, then hypodense.
MRI:
Well-defined, but highly variable appearance. Most are hyperintense on T1-weighted and T2 images. There is early enhancement with gadolinium, but the lesion.
Nuclear imaging:
Most adenomas (>75%) do not take up Technetium, and it more frequently appears as a cold spot. |
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| Hepatic cystadenocarcinoma | Jaundice, abdominal pain, weight loss, and ascites due to portal vein compression. | Ultrasound:
Anechoic mass with echogenic internal septations.
CT scan:
Multiloculated hypodense masses with possible coarse calcifications.
MRI:
Fluid-containing multilocular cyst with homogenous low signal intensity on T1 and homogenous high signal intensity on T2.
Nuclear scans: No role. |
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| Hepatocellular carcinoma | RUQ pain, weight loss, decompensated liver disease; paraneoplastic phenomena such as erythrocytosis, hypercalcemia, and watery diarrhea. | Ultrasound:
Poorly defined margins and coarse, irregular internal echoes. Small tumors tend to be hypoechoic but become isoechoic or hyperechoic with increasing size.
CT scan:
Hypervascular lesion with arterial enhancement and rapid washout during the portal venous phase.
MRI:
HCC appears as high intensity lesions on T2 and low intensity on T1-weighted images. MRI is better than CT and USS in cirrhotic patients in differentiating regenerative nodules from HCC. |
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| Metastases | Abdominal pain, RUQ tenderness, jaundice, fever, weight loss, anorexia, hepatomegaly, and ascites. | Ultrasound:
Generally nonspecific appearance of liver mets. Usually, multiple hepatic nodules of myriad sizes which could be isoechoic, hyperechoic, or hypoechoic.
CT scan:
Hepatic metastases appear in a plurality of ways. The majority are hypoattenuating (due to hypervascularity). Noncontrast images are useful in detecting calcification and hemorrhage.
MRI:
Metastatic lesions are hyperintense on T1-weighted images and hypointense on T2-weighted. The morphologic characteristics on T2 that suggest metastases are as follows: Heterogeneous signal intensity with irregular and indistinct outer margins.
(i) Smooth or irregular central area of high signal intensity with surrounding ring of lower intensity. |
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| Cholangiocarcinoma | Painless jaundice, pruritus, abdominal pain, weight loss, fever, clay-colored stools, and dark urine. | Ultrasound:
Biliary dilatation and large hilar lesions.
Smaller lesions are more challenging to visualize.
Patients with primary sclerosing cholangitis may not show any ductal dilatation due to ductal fibrosis.
CT scan:
Ductal dilatation with possible mass lesions and lymphadenopathy.
MRI/MR cholangiography:
MRI shows liver parenchyma better than CT, and it also offers better imaging of bile ducts by cholangiography. With angiography, it is an excellent tool for staging.
Lesions appear hypointense on T1- and hyperintense on T2-weighted imaging. |
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| Hemangioendothelioma | Frequently asymptomatic.
RUQ pain, weight loss, and hepatomegaly. | Ultrasound:
Predominantly hypoechoic, but could be mixed and even hyperechoic.
CT scan:
Multiple hypodense lesions, frequently peripheral. Often, smaller lesions are seen to coalesce to form larger ones.
MRI:
T1-weighted: Hypointense lesions.
T2-weighted: Hyperintense lesions.
Postgadolinium: Occasional thin peripheral hypointense rim. |
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| Primary hepatic lymphoma | Hepatomegaly, splenomegaly; fever, night sweats, weight loss, and lymphadenopathy. | Ultrasound:
Usually hypoechoic lesions.
CT scan:
Single, well-defined hypodense lesion.
Nonspecific postcontrast appearance.
MRI:
T1-weighted: Hypointense.
T2-weighted: Variable intensity.
Gadolinium: It may show faint rim enhancement. |
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| Hemangioblastoma | Extremely rare liver lesion. Seen in the setting of von Hippel-Lindau syndrome. | Ultrasound:
Usually, multiple hyperechoic foci, but this is variable.
CT scan:
Variable appearances.
Noncontrast: Generally appearing as hypodensities.
Postcontrast: Early peripheral enhancement and partial centripetal isodense filling. |
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