Review Article

MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma

Figure 3

Atypical inflammatory adenoma. (a) In S VI homogeneous well-delineated isointense lesion in axial T2w fat-suppressed image (arrow). (b-c) T1w in- and out-phased images. The mass is isointense relative to the hepatic parenchyma. Note large vessels at the periphery of the lesion (arrowheads). (d–g) DWI sequences. The lesion does not show any increase of signal intensity from 50 (d) to 400 (e) and to 800 (f) b values. IN ADC map (g) the nodule shows isointense signal. (h–l) In dynamic evaluation after Gd-EOB-DTPA administration the mass shows discrete enhancement in arterial phase (i) with slightly wash out in portal (j) and equilibrium (k) phases. After 5′ (l) the nodule is more hypointense. (m-n) In hepatobiliary phases after 10′ (m) and 20′ (n), the lesion is definitively heterogeneously hypointense relative to the adjacent liver parenchyma with exophytic growth. (o) Cut section shows large capsulated homogeneous mass. (p) Microscopically, significant sinusoidal dilatation (arrowheads), polymorphous inflammatory infiltrates (star), areas of peliosis, and thickened tortuous arteries (arrow) are demonstrated.
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