This is a benign, hamartomatous malformation that is most common in young women. It is the second most common benign tumour after haemangi...
This is a benign, hamartomatous malformation that is most common in young women. It is the second most common benign tumour after haemangioma. The tumour is made up of hyperplastic liver tissue arranged in an abnormal fashion. They are asymptomatic and rarely bleed.
US
• Well-defined lesion, usually peripheral right lobe
• Usually less than 5 cm
• Mostly solitary (about 20% are multiple)
• Large central vessel that may be detectable on Doppler
• Basket/spoke wheel pattern on contrast US
MRI
• Calcification, necrosis and haemorrhage are rare.
• Isointense and resembles normal liver.
• Marked enhancement post-contrast on the arterial phase with radiating septa.
• Arterial enhancement of the lesion, delayed enhancement of the scar.
• FNH retains gadobenate and appears isointense, building to hyperintense 1-3 hours later.
• 50% have a central scar.
• Central scar is bright on T2 (central scar of FLC shows low T2 signal), low on T1.
CT
• Isodense/slightly hypoattenuating lesion on unenhanced CT.
• Hypodense scar may enhance.
• Intense transient arterial enhancement, isodense to liver on the venous phase.
• 70% show normal or increased uptake on technetium-99m-labelled sulphur colloid scan—specific to FNH (colloid is a Kupffer cell agent, Kupffer cells are present in normal liver and FNH—not present
in e.g. FLC).
• Technetium-99m HIDA scan shows immediate uptake and delayed clearance in 90%.
Focal nodular hyperplasia. Post-contrast axial images from an MRI of the liver. (a) Arterial phase imaging shows an avidly enhancing lesion with a hypointense central scar (white arrow). (b) Delayed phase imaging shows the lesion to become isointense to the background lines with enhancement of the central scar (red arrow).
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