Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Benign liver lesions

  • Login to see the comments

Benign liver lesions

  1. 1. Solitary Liver Lesions A) Benign Tumours 1.Cavernous Haemangioma 2.Adenoma 3.Focal nodular hyperplasia 4.Mesenchymal Hamartoma
  2. 2. B)Infections 1. Abscess 2.Echinococcus cyst 3.Infective pseudotumour C)Trauma 1.Haematoma 2.Traumatic cyst
  3. 3. D) Malignant Tumours 1.Hepatocellular carcinoma 2.Metastasis E) Other 1.Fatty change 2.Simple cyst
  4. 4. CAVERNOUS HAEMANGIOMA Most common benign liver neoplasm. Usually in women, rare in children. Asymptomatic when small, mass effect when large. May be isolated or multiple Usually in the posterior segment of the right hepatic lobe. Usually less than 5 cm in diameter but can be very large.
  5. 5. They typically remain stable in size but may demonstrate growth. Rarely haemorrhage may occur. Pathologically, composed of many endothelium-lined vascular spaces separated by fibrous septa. Blood supply from the hepatic artery.
  6. 6. IMAGING FINDINGS Ultrasound features Well defined, rounded or ovoid hyperechoic lesion. Homogeneous when small, heterogeneous due to internal haemorrhage and necrosis when large. No/ minimal flow on color Doppler u/s.
  7. 7. IMAGING FINDINGS At unenhanced CT, a well defined hypodense lesion. At contrast-enhanced CT, a characteristic pattern of enhancement. Nodular peripheral puddling of contrast on early- phase images, followed by centripetal diffusion into the centre.
  8. 8. Persistence of contrast on delayed images. A central scar (if present) may not enhance, even on delayed images. Calcification within hemangiomas has been reported.
  9. 9. Spiral CT,contrast enhanced,arterial phase.well defined rounded hypodense lesion with peripheral nodular puddling.
  10. 10. Spiral CT contrast enhanced, arterial phase, oval shaped hypodense lesion with peripheral nodular contrast enhancement.
  11. 11. Delayed phase, central perfusion of contrast with persistence of contrast.
  12. 12. MR imaging Hemangiomas usually appear hypointense and well defined on T1-weighted images. Demonstrate a marked hyperintensity that increases with echo time on T2-weighted images . After administration of contrast, same characteristic pattern of enhancement as is seen at CT.
  13. 13. MRI T1W image, unenhanced, well defined rounded hypointense lesion in right lobe.
  14. 14. T1 post contrast
  15. 15. T1 post contrast,nodular puddling with central non enhancing scar
  16. 16. Focal nodular hyperplasia Second most common benign neoplasm of the liver after hemangioma.  Typically occurs in young women  Asymptomatic, some may present with right upper quadrant pain.  Increased prevalence in women taking oral contraceptives .
  17. 17. Composed of hepatocytes, Kupffer cells, primitive bile ductules not connected with the biliary tree, and blood vessels .  A central fibrous scar containing a small arteriovenous malformation may be present. Usually less than 5 cm in diameter , may be multiple and is often located near the liver surface.
  18. 18. IMAGING FEATURES Ultrasound findings Well defined mass of hypo, iso or hyperechogenicity. Doppler U/S demonstrates high velocity flow within the lesion.
  19. 19. At unenhanced CT, appears homogeneous, well defined, and hypo to isodense relative to the liver. At contrast-enhanced CT, it exhibits a characteristic pattern of enhancement. Enhances brightly on early-phase images with subsequent wash out.
  20. 20. On delayed scans, the mass may be isodense relative to the liver and therefore imperceptible except for any mass effect. A central scar (if present) may demonstrate delayed enhancement and may remain bright on subsequent images due to delayed washout .
  21. 21. Contrast enhanced spiral CT arterial phase, well defined heterogeneously enhancing oval lesion in left lobe with central non enhancing scar.
  22. 22. Arterial phase contrast enhanced spiral CT,isodense lesion displacing adjacent vessels, central non enhancing scar
  23. 23. Delayed scan, imperceptible lesion, persistantly enhancing central scar.
  24. 24. At MR imaging, Iso to hypointense on T1-weighted images and hyperintense on T2-weighted images. Demonstrates early arterial enhancement after administration of contrast with rapid wash out. However, the central scar shows delayed enhancement with delayed wash out.
  25. 25. T1W MRI, axial cuts, contrast enhanced,arterial phase showing an oval shaped brightly enhancing lesion in left lobe.
  26. 26. Delayed phase, lesion becoming isointense to normal liver
  27. 27. Hepatic abscess Localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents In developing countries, parasitic abscesses are most common, including amoebae echinococcus protozoa helminths
  28. 28. In developed countries, bacterial abscesses are most common, usually in association with a co-morbidity such as: Abdominal sepsis Immunocompromised Diabetes mellitus HIV/AIDS Elderly Chemotherapy / transplant recipients Malignancy
  29. 29. Trauma ERCP Cryptogenic
  30. 30. Most common bacterial agents are Gram negative and gram positive organisms Escherichia coli,Klebsiella pneumoniae,bacteroides anaerobic streptococci,enterococci Typical presentation is of right upper quadrant pain, fever and jaundice. Anorexia, malaise and weight loss are also frequently seen.
  31. 31. RADIOGRAPHIC FEATURES As a general rule, bacterial and fungal abscesses are often multiple, whereas amoebic abscesses are more frequently single. Amoebic abscesses are more common in a sub- diaphragmatic location Are more likely to spread through the diaphragm and into the chest. Amoebic abscess is more likely to be round or ovoid, hyporeflective with fine level echoes.
  32. 32. Ultrasound Findings Pyogenic abscesses are typically poorly demarcated with a variable appearance, ranging from predominantly hypoechoic to hyperechoic. Hyporeflective and irregular wall. Internal contents may show debris, fluid levels and septations. Gas bubbles may also be present. Doppler will demonstrate absence of flow.
  33. 33. Amoebic abscesses are typically single Peripherally located Well defined round or ovoid mass With fine low level internal echoes.
  34. 34. CT Scan Variable in appearance. In general, appears as peripherally enhancing, centrally low density lesion. Occasionally they appear solid, or contain gas.
  35. 35. Oval shaped hypodense lesion with peripherally enhancing irregular rim.
  36. 36. MRI T1 Heterogeneous Usually hypointense centrally May be slightly hyperintense in fugal abscess Enhancement of the capsule, although this may be absent in immunocompromised patients Multiple septations may be present T2 - tends to have hyperintense signal.
  37. 37. Hydatid cyst Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm The two main types of hydatid disease are caused by E granulosus and E multilocularis. Definitive host is dog. Human becomes the intermediate host when comes in contact with definitive host.
  38. 38. The right lobe is the most frequently involved Imaging findings depend on the stage of cyst growth whether the cyst is unilocular contains daughter cysts is partially calcified, or is completely calcified [dead]
  39. 39. Ultrasound findings US is the most sensitive modality for the detection of membranes, septa, and hydatid sand within the cyst. Simple cyst appears as well defined anechoic lesion with posterior acoustic enhancement.
  40. 40. Echogenic foci due to hydatid sand may be seen within the lesion by repositioning the patient. Quickly fall to the most dependent part of the cavity without forming visible strata—snow storm sign. Detachment of the endocyst from the pericyst-- “floating membranes”. Complete detachment of the membranes inside the cyst- water lily sign.
  41. 41. Multivesicular cysts manifest as well-defined fluid collections in a honeycomb pattern with multiple septa. Membranes may appear within the matrix as serpentine linear structures. Calcification seen in 20%–30% of cases. Usually manifests with a curvilinear or ringlike pattern. Or dense calcification of all components during healing phase.
  42. 42. Zoomed imaged, well defined oval shaped heterogeneous lesion with internal echoes. Internal echogenic serpentine structures—collapased membranes.
  43. 43. CT Scan findings Indicated when U/S fails due to: Patient-related difficulties (e.g, obesity, excessive intestinal gas, abdominal wall deformities, previous surgery) or Disease complications. CT may display the same findings as U/S.
  44. 44. Cyst fluid usually demonstrates water attenuation (3–30 HU). Calcification of the cyst wall or internal septa is easily detected at CT. Typically has a high-attenuation wall at unenhanced CT even without calcification. Detachment of the membranes is visualized as linear areas of increased attenuation within the cyst.
  45. 45. Hydatid cyst with collapsed parasitic membranes. Unenhanced CT scan shows a circular area of increased attenuation within the cyst representing detached membranes
  46. 46. MRI Findings A well defined hypointense lesion on T 1 and hyperintense on T2 W images. A characteristic sign of hydatid disease is a low- signal-intensity rim on T2-weighted images, represents the collagen rich outer layer of the hydatid cyst. Collapsed parasitic membranes appear as twisted linear structures within the cyst.
  47. 47. Noncalcified hydatid cysts. Axial T1-W MRI.two large cystic lesions in the right hepatic lobe. Anterior cyst has high SI(reduction in the water content of the fluid).Several round,nodular,low SI lesions--daughter cysts.Mother cyst has a characteristic low SI rim. Posterior cyst has homogeneous low SI with a double ring.hypointense outer ring– pericyst,partially “wrinkled,” intermediate SI inner ring-- incompletely detached membranes
  48. 48. THANKS

×