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Fat-Containing Nodules in the Cirrhotic Liver: Chemical Shift MRI Features and Clinical Implications

¹ All authors: Department of Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dogok-Dong, Gangnam-Gu, Seoul 135-720, South Korea.

OBJECTIVE. The purpose of this study was to determine the ability of MRI to predict malignancy in fat-containing nodules in the cirrhotic liver.

MATERIALS AND METHODS. In 38 patients with cirrhotic livers, focal lesions 5 mm containing fatty components were identified on chemical shift gradient-echo MRI. Positive predictive values (PPVs) for benignity and malignancy were calculated on the basis of lesion size, T1-weighted hypointensity, T2-weighted hyperintensity, and arterial hypervascularity on the initial MR images. The number of the fatty nodules (group A, up to 4; group B, numerous) in individual patients was also correlated with the malignant potential of the lesions that were verified pathologically or by follow-up imaging studies.

RESULTS. In 31 group A patients, 21 (47%) of the 45 lesions showed a malignant course, and their mean diameter (18.8 mm) was larger (p = 0.007) than that (10.5 mm) of benign lesions. In seven group B patients, all 35 lesions (the five largest lesions in each patient; mean diameter, 7.8 mm) proved to be benign. The PPV of larger ( 15 mm) fat-containing nodules for malignancy was 85% (11/13 lesions). Six (55%) of 11 immediately diagnosed hepatocellular carcinomas were entirely hypointense on unenhanced in-phase T1-weighted images. The PPV of T2-weighted hyperintensity and arterial hypervascularity for the diagnosis of malignancy was 100% in group A patients.

CONCLUSION. In the cirrhotic liver, large size ( 15 mm) and T1-weighted hypointensity on in-phase images strongly suggest malignancy of the fat-containing nodules. The presence of numerous nodules < 1 cm suggests that the lesions are benign.

Keywords: cancer • cirrhosis • hepatocellular carcinoma • liver • liver disease • MRI

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