9. Pre contrast Arterial Phase Portal venous
phase
Delayed
Hepatocelluar Ca Low attenuation Homogenous
enhancement
Washout of
lesion
Isodense
Adenoma Low attenuation Homogenous
enhancement 85%
Iso or
hypodense
Iso or hypodense
Haemangioma Low attenuation Peripheral puddles Partial Fill in Complete fill in
FNH Iso/Low
attenuation
Homogenous
enhancement
Hypodense Isodense
Hypervascular Mets Low attenuation Homogenous
enhancement
Hypodense
Metastasis Low attenuation Hypodense Hypodense
Cyst Low attenuation No enhancement
Abscess Low attenuation may
have irregular margins
Transient regional
enhancement
Ring
enhancement
Multiphasic CT of Liver
10. T1W T2W Gadolinium
Hepatocellular Ca
,iso or (fat degeneration)
Metastasis
Haemanigioma
++ (like CT)
Adenoma
often
FNH
+ delayed
FLC
+ delayed
MRI of Liver
11. FOCAL FAT SPARING
Diagnostic confusion
with tumors
Common sites
Periportal region of the
medial segment of left
lobe (segment IV)
Either side of falciform
ligament
Cranial aspect of GB
fossa
Characteristic features:
Geographic appearance
Lack of mass effect
Vessels through the
lesion
12. FOCAL NODULAR LIVER
LESIONS:
• Regenerative nodule
• Cirrhotic nodule
• Low grade dysplastic nodule
(adenomatous
hyperplasia)
• High grade dysplastic nodule
(adenomatous
hyperplasia with atypia)
• Dysplastic nodule with subfoci of HCC
(early HCC)
• HCC (overt HCC)
13. Hepatocellular Carcinoma
Most common primary malignancy of the liver
Rising incidence, attributed to a rise in hepatitis B
and C infection
Typically diagnosed in adults(late middle
age/elderly)
Pt with cirrhosis present earlier
14. Risk factors:
hepatitis B (HBV) infection
hepatitis C (HCV) infection
alcoholism
biliary cirrhosis
food toxins e.g. aflatoxins
congenital biliary atresia
inborn errors of metabolism
haemochromatosis
alpha-1 antitrypsin deficiency
type 1 glycogen storage disease
Wilson disease
Hepatocellular Carcinoma
15.
16. USG
USG - vary
Small HCC’s (<3cms) ->
hypoechoic with posterior
acoustic enhancement ( fatty
change/ marked sinusoidal
dilatation)
>3cms- mosaic or mixed pattern
May invade poratl vein
CD:central vascularity
17.
18.
19.
20.
21.
22. CT SCAN
3 patterns:
Solitary
Multicentric
Diffuse
Large hypodense
mass
Central low
attenuation due to
necrosis
23. CT
Focal calcification -
7.5%
Majority -
hypervascular
arterial phase
Heterogenous
enhancement due to
central necrosis
Isodense on delayed
images
Angioinvasive: portal
vein /IVC
Central Necrosis-
Hetrogeneous +C
24. Arterial phase
Demonstration of
arterial branches
tumour
Arterio portal shunts
Arterio-portal shunt: The arterial phase CT image shows a
large enhancing lesion (m) in the segments 3 and 4 of liver with
contrast in the left hepatic artery (arrow) and left branch of portal vein
(arrow head) suggesting arterio-portal shunting
25.
26. Portal venous invasion by hepatocellular carcinoma.
portal phase-expanded low attenuation focus in right portal vein.
27.
28.
29. IVC invasion: The axial CT image shows
an exophytic
mass (m) arising from left lobe of liver
extending into the IVC (arrow)
30. MRI
Small HCC’s v/s regenerative
Cirrhotic nodule: hyper on T1 , hypo on T2
HCC : hypo on T1, hyperintense on T2
HCC arising in a siderotic nodule: “nodule within a
nodule” appearance
HCC - a small focus of high signal intensity
within the low signal intensity nodule(T2).
31.
32.
33. Hepatocellular carcinoma and regenerative nodule.
T1w MRI (A) and T2w MRI (B) demonstrating a hepatocellular
carcinoma (white arrowhead) and an adjacent atypical regenerative
nodule (black arrowhead).
Majority of hepatomas have decreased signal intensity on T1WI
-increased signal -fat or glycogen content