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Multiarterial Phase Dynamic MRI of Small Early Enhancing Hepatic Lesions in Cirrhosis or Chronic Hepatitis: Differentiating Between Hypervascular Hepatocellular Carcinomas and Pseudolesions

¹ Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
² GE Yokogawa Medical Systems, 67-4, Takakura-cho, Hachioji-shi, Tokyo 192-0033, Japan.

View larger version (80K): [in a new window]   Fig. 1A. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma starts to show early enhancement in second phase (arrow, B). Lesion is more clearly seen in third phase (C) and then shows rapid central washout and peritumoral coronal enhancement in fifth (E) and sixth phases (arrow, F). Segmental enhancement in right lobe caused by arterioportal shunt is also seen. No lesion is seen in this area.

View larger version (80K): [in a new window]   Fig. 1B. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma starts to show early enhancement in second phase (arrow, B). Lesion is more clearly seen in third phase (C) and then shows rapid central washout and peritumoral coronal enhancement in fifth (E) and sixth phases (arrow, F). Segmental enhancement in right lobe caused by arterioportal shunt is also seen. No lesion is seen in this area.

View larger version (91K): [in a new window]   Fig. 1C. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma starts to show early enhancement in second phase (arrow, B). Lesion is more clearly seen in third phase (C) and then shows rapid central washout and peritumoral coronal enhancement in fifth (E) and sixth phases (arrow, F). Segmental enhancement in right lobe caused by arterioportal shunt is also seen. No lesion is seen in this area.

View larger version (90K): [in a new window]   Fig. 1D. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma starts to show early enhancement in second phase (arrow, B). Lesion is more clearly seen in third phase (C) and then shows rapid central washout and peritumoral coronal enhancement in fifth (E) and sixth phases (arrow, F). Segmental enhancement in right lobe caused by arterioportal shunt is also seen. No lesion is seen in this area.

View larger version (98K): [in a new window]   Fig. 1E. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma starts to show early enhancement in second phase (arrow, B). Lesion is more clearly seen in third phase (C) and then shows rapid central washout and peritumoral coronal enhancement in fifth (E) and sixth phases (arrow, F). Segmental enhancement in right lobe caused by arterioportal shunt is also seen. No lesion is seen in this area.

View larger version (94K): [in a new window]   Fig. 1F. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma starts to show early enhancement in second phase (arrow, B). Lesion is more clearly seen in third phase (C) and then shows rapid central washout and peritumoral coronal enhancement in fifth (E) and sixth phases (arrow, F). Segmental enhancement in right lobe caused by arterioportal shunt is also seen. No lesion is seen in this area.

View larger version (67K): [in a new window]   Fig. 2A. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 53-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows faint early enhancement in second phase (arrow, B), is becoming dense in third (C) and fourth (D) phases, and shows central washout of lesion and coronal enhancement in sixth phase (arrow, F). Note hypointense lesion that was previously treated and nonhomogeneous enhancement of unknown origin in right hepatic lobe.

View larger version (78K): [in a new window]   Fig. 2B. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 53-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows faint early enhancement in second phase (arrow, B), is becoming dense in third (C) and fourth (D) phases, and shows central washout of lesion and coronal enhancement in sixth phase (arrow, F). Note hypointense lesion that was previously treated and nonhomogeneous enhancement of unknown origin in right hepatic lobe.

View larger version (87K): [in a new window]   Fig. 2C. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 53-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows faint early enhancement in second phase (arrow, B), is becoming dense in third (C) and fourth (D) phases, and shows central washout of lesion and coronal enhancement in sixth phase (arrow, F). Note hypointense lesion that was previously treated and nonhomogeneous enhancement of unknown origin in right hepatic lobe.

View larger version (100K): [in a new window]   Fig. 2D. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 53-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows faint early enhancement in second phase (arrow, B), is becoming dense in third (C) and fourth (D) phases, and shows central washout of lesion and coronal enhancement in sixth phase (arrow, F). Note hypointense lesion that was previously treated and nonhomogeneous enhancement of unknown origin in right hepatic lobe.

View larger version (102K): [in a new window]   Fig. 2E. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 53-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows faint early enhancement in second phase (arrow, B), is becoming dense in third (C) and fourth (D) phases, and shows central washout of lesion and coronal enhancement in sixth phase (arrow, F). Note hypointense lesion that was previously treated and nonhomogeneous enhancement of unknown origin in right hepatic lobe.

View larger version (106K): [in a new window]   Fig. 2F. —Hypervascular hepatocellular carcinoma with rapid central washout and peritumoral coronal enhancement in 53-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows faint early enhancement in second phase (arrow, B), is becoming dense in third (C) and fourth (D) phases, and shows central washout of lesion and coronal enhancement in sixth phase (arrow, F). Note hypointense lesion that was previously treated and nonhomogeneous enhancement of unknown origin in right hepatic lobe.

View larger version (89K): [in a new window]   Fig. 3A. —Hypervascular hepatocellular carcinoma without rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows early enhancement in second (arrow, B) and third (C) phases, but it is seen as isointense area compared with surrounding liver parenchyma during fourth (D), fifth (E), and sixth (F) phases. Rapid central washout and coronal enhancement are not observed. Confirmation of this small hepatocellular carcinoma was obtained by interval progression in size during follow-up MRI examinations. Note hypointense mass that was previously treated percutaneously.

View larger version (93K): [in a new window]   Fig. 3B. —Hypervascular hepatocellular carcinoma without rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows early enhancement in second (arrow, B) and third (C) phases, but it is seen as isointense area compared with surrounding liver parenchyma during fourth (D), fifth (E), and sixth (F) phases. Rapid central washout and coronal enhancement are not observed. Confirmation of this small hepatocellular carcinoma was obtained by interval progression in size during follow-up MRI examinations. Note hypointense mass that was previously treated percutaneously.

View larger version (123K): [in a new window]   Fig. 3C. —Hypervascular hepatocellular carcinoma without rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows early enhancement in second (arrow, B) and third (C) phases, but it is seen as isointense area compared with surrounding liver parenchyma during fourth (D), fifth (E), and sixth (F) phases. Rapid central washout and coronal enhancement are not observed. Confirmation of this small hepatocellular carcinoma was obtained by interval progression in size during follow-up MRI examinations. Note hypointense mass that was previously treated percutaneously.

View larger version (110K): [in a new window]   Fig. 3D. —Hypervascular hepatocellular carcinoma without rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows early enhancement in second (arrow, B) and third (C) phases, but it is seen as isointense area compared with surrounding liver parenchyma during fourth (D), fifth (E), and sixth (F) phases. Rapid central washout and coronal enhancement are not observed. Confirmation of this small hepatocellular carcinoma was obtained by interval progression in size during follow-up MRI examinations. Note hypointense mass that was previously treated percutaneously.

View larger version (110K): [in a new window]   Fig. 3E. —Hypervascular hepatocellular carcinoma without rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows early enhancement in second (arrow, B) and third (C) phases, but it is seen as isointense area compared with surrounding liver parenchyma during fourth (D), fifth (E), and sixth (F) phases. Rapid central washout and coronal enhancement are not observed. Confirmation of this small hepatocellular carcinoma was obtained by interval progression in size during follow-up MRI examinations. Note hypointense mass that was previously treated percutaneously.

View larger version (104K): [in a new window]   Fig. 3F. —Hypervascular hepatocellular carcinoma without rapid central washout and peritumoral coronal enhancement in 70-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular hepatocellular carcinoma shows early enhancement in second (arrow, B) and third (C) phases, but it is seen as isointense area compared with surrounding liver parenchyma during fourth (D), fifth (E), and sixth (F) phases. Rapid central washout and coronal enhancement are not observed. Confirmation of this small hepatocellular carcinoma was obtained by interval progression in size during follow-up MRI examinations. Note hypointense mass that was previously treated percutaneously.

View larger version (72K): [in a new window]   Fig. 4A. —Hypervascular pseudolesion in 55-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular pseudolesion starts to show early enhancement from third phase (arrow, C). Lesion enhancement continues until sixth phase (E). Lesion enhancement of hypervascular pseudolesion appears later and lasts longer than that of hypervascular hepatocellular carcinoma without rapid central washout shown in Figures 3A, 3B, 3C, 3D, 3E, and 3F. Rapid central washout and coronal enhancement are not seen.

View larger version (73K): [in a new window]   Fig. 4B. —Hypervascular pseudolesion in 55-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular pseudolesion starts to show early enhancement from third phase (arrow, C). Lesion enhancement continues until sixth phase (E). Lesion enhancement of hypervascular pseudolesion appears later and lasts longer than that of hypervascular hepatocellular carcinoma without rapid central washout shown in Figures 3A, 3B, 3C, 3D, 3E, and 3F. Rapid central washout and coronal enhancement are not seen.

View larger version (84K): [in a new window]   Fig. 4C. —Hypervascular pseudolesion in 55-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular pseudolesion starts to show early enhancement from third phase (arrow, C). Lesion enhancement continues until sixth phase (E). Lesion enhancement of hypervascular pseudolesion appears later and lasts longer than that of hypervascular hepatocellular carcinoma without rapid central washout shown in Figures 3A, 3B, 3C, 3D, 3E, and 3F. Rapid central washout and coronal enhancement are not seen.

View larger version (87K): [in a new window]   Fig. 4D. —Hypervascular pseudolesion in 55-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular pseudolesion starts to show early enhancement from third phase (arrow, C). Lesion enhancement continues until sixth phase (E). Lesion enhancement of hypervascular pseudolesion appears later and lasts longer than that of hypervascular hepatocellular carcinoma without rapid central washout shown in Figures 3A, 3B, 3C, 3D, 3E, and 3F. Rapid central washout and coronal enhancement are not seen.

View larger version (85K): [in a new window]   Fig. 4E. —Hypervascular pseudolesion in 55-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular pseudolesion starts to show early enhancement from third phase (arrow, C). Lesion enhancement continues until sixth phase (E). Lesion enhancement of hypervascular pseudolesion appears later and lasts longer than that of hypervascular hepatocellular carcinoma without rapid central washout shown in Figures 3A, 3B, 3C, 3D, 3E, and 3F. Rapid central washout and coronal enhancement are not seen.

View larger version (86K): [in a new window]   Fig. 4F. —Hypervascular pseudolesion in 55-year-old man. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Hypervascular pseudolesion starts to show early enhancement from third phase (arrow, C). Lesion enhancement continues until sixth phase (E). Lesion enhancement of hypervascular pseudolesion appears later and lasts longer than that of hypervascular hepatocellular carcinoma without rapid central washout shown in Figures 3A, 3B, 3C, 3D, 3E, and 3F. Rapid central washout and coronal enhancement are not seen.

View larger version (74K): [in a new window]   Fig. 5A. —Hypervascular pseudolesion in 58-year-old woman. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Lesion enhancement of hypervascular pseudolesion starts from second phase (arrow, B) and continues until sixth phase (E). Rapid central washout and coronal enhancement are not seen.

View larger version (84K): [in a new window]   Fig. 5B. —Hypervascular pseudolesion in 58-year-old woman. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Lesion enhancement of hypervascular pseudolesion starts from second phase (arrow, B) and continues until sixth phase (E). Rapid central washout and coronal enhancement are not seen.

View larger version (91K): [in a new window]   Fig. 5C. —Hypervascular pseudolesion in 58-year-old woman. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Lesion enhancement of hypervascular pseudolesion starts from second phase (arrow, B) and continues until sixth phase (E). Rapid central washout and coronal enhancement are not seen.

View larger version (100K): [in a new window]   Fig. 5D. —Hypervascular pseudolesion in 58-year-old woman. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Lesion enhancement of hypervascular pseudolesion starts from second phase (arrow, B) and continues until sixth phase (E). Rapid central washout and coronal enhancement are not seen.

View larger version (104K): [in a new window]   Fig. 5E. —Hypervascular pseudolesion in 58-year-old woman. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Lesion enhancement of hypervascular pseudolesion starts from second phase (arrow, B) and continues until sixth phase (E). Rapid central washout and coronal enhancement are not seen.

View larger version (98K): [in a new window]   Fig. 5F. —Hypervascular pseudolesion in 58-year-old woman. First- to sixth-phase images obtained with multiarterial phase contrast-enhanced dynamic MRI of whole liver. Lesion enhancement of hypervascular pseudolesion starts from second phase (arrow, B) and continues until sixth phase (E). Rapid central washout and coronal enhancement are not seen.

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