This hepatic focal lesion is for better MRI assessment: When should we mention this statement in our radiological US/CT report? A pictorial review for juniors

Congress:

ECR 2020

Poster Number:

C-02619

Type:

Educational Exhibit

Keywords:

Performed at one institution, Not applicable, Neoplasia, Haemangioma, Cancer, Imaging sequences, Diagnostic procedure, Computer Applications-Detection, diagnosis, MR-Diffusion/Perfusion, MR, CT, MR physics, Liver, Computer applications, Oncologic Imaging

Authors:

M. Elmansy; Mansoura/EG

DOI:

10.26044/ecr2020/C-02619

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-02619

Fig. 9: Sum of MRI benefits in diagnosis of hepatic focal lesions

Fig. 7: Subtraction and DWI MRI showing: enhancing residual viable HCC post-TACE in...

Fig. 1: Hemangioma pattern of enhancement and SI on MRI

Fig. 4: Pattern of hepatic adenoma on CT & MRI which may be controversial on CT , but...

Fig. 5: Another state of art for chemical shift A colon cancer patient with suspected...

Learning objectives

To review computed tomography (CT) Imaging appearance of commonly seen hepatic focal lesions in our practice and correlate them with their imaging features in magnetic resonance imaging (MRI). To understand MRI protocol and how to make the best use of each sequence. To give a thematic answer to the juniors regarding the question: when do we order MRI (conventional, post-contrast and advanced sequences) in our radiological US/CT reports for better evaluation of hepatic focal lesions?.

Background

With the widespread of cross-sectional imaging, growth in the rate of incidentally detected focal liver lesions (FLL) has been observed. Reliable detection and characterization of FLL are critical for optimal patient management. The majority of FLL arising in the noncirrhotic liver are benign including Cysts, hemangiomas, focal nodular hyperplasias (FNH), and hepatocellular adenomas (HCA) are the most commonly encountered benign lesions [1]. The most commonly encountered malignant lesions in the noncirrhotic liver are metastases and rarely fibrolamellar carcinoma(FLC). Hepatocellular carcinomas (HCC), and to a lesser...

Findings and procedure details

MRI technique of liver examination at our unit: The technique is done on a 1.5 Tesla machine. Conventional sequences T1WI, T2WI, heavy T2WI, T1 2D/3D gradient echo sequences(vibe),& In-Out phase(chemical shift). Advanced sequences liver-specific contrast agents e.g Gd-BOPTA, Dynamic postcontrast, subtraction, DWI& ADC. In&outphase: based on chemical shift mechanism and works on omitting the intracellular fat specifically. DWI&ADC: diffusion-weighted images (DWI) performed before the dynamic study to rule out the effect of contrast media on apparent diffusion coefficient (ADC) values. It is also done on...

Conclusion

Multi-parametric merit of MRI gives radiologists much more malleability than other imaging modalities to narrow the differential diagnosis of hepatic focal lesions.

Personal information and conflict of interest

M. Elmansy; Mansoura/EG - nothing to disclose Mostafa Ahmed Mahmoud Elmansy, Assistant Lecturer, Radiology Department, Mansoura University. Phone: +201149522327/ Email : [email protected]

References

1-Nault, J.C., Bioulac–Sage, P. and Zucman–Rossi, J., 2013. Hepatocellular benign tumors—from molecular classification to personalized clinical care. Gastroenterology, 144(5), pp.888-902. 2-Bastati, N., Feier, D., Wibmer, A., Traussnigg, S., Balassy, C., Tamandl, D., Einspieler, H., Wrba, F., Trauner, M., Herold, C. and Ba-Ssalamah, A., 2014. Noninvasive differentiation of simple steatosis and steatohepatitis by using gadoxetic acid-enhanced MR imaging in patients with nonalcoholic fatty liver disease: a proof-of-concept study. Radiology, 271(3), pp.739-747. 3-Fowler, K.J., Brown, J.J., and Narra, V.R., 2011. Magnetic resonance imaging of focal liver lesions:...