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Focal Nodular Hyperplasia: Lesion Evaluation Using 16-MDCT and 3D CT Angiography

Ihab R. Kamel, Eleni Liapi and Elliot K. Fishman

Russell H. Morgan Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St., Suite 3235A, Baltimore, MD 21287.


Figure 1
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  		Fig. 1A —39-year-old woman with focal nodular hyperplasia. Axial image in arterial phase reveals hypervascular lesion in left lobe of liver (arrow, A) that becomes isodense to liver parenchyma in portal venous phase (B). Notice hypodense central scar (arrowheads, B) and displacement of left hepatic vein (arrow, B) by mass.

 

Figure 2
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  		Fig. 1B —39-year-old woman with focal nodular hyperplasia. Axial image in arterial phase reveals hypervascular lesion in left lobe of liver (arrow, A) that becomes isodense to liver parenchyma in portal venous phase (B). Notice hypodense central scar (arrowheads, B) and displacement of left hepatic vein (arrow, B) by mass.

 

Figure 3
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  		Fig. 2A —32-year-old woman with focal nodular hyperplasia. Axial image in arterial phase reveals multiple hypervascular lesions in both lobes of liver (arrows, A) that become isodense to liver parenchyma in portal venous phase (B).

 

Figure 4
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  		Fig. 2B —32-year-old woman with focal nodular hyperplasia. Axial image in arterial phase reveals multiple hypervascular lesions in both lobes of liver (arrows, A) that become isodense to liver parenchyma in portal venous phase (B).

 

Figure 5
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  		Fig. 3A —30-year-old woman with predominantly exophytic focal nodular hyperplasia (FNH). Coronal maximum-intensity-projection (MIP) image in arterial phase shows large branch from right hepatic artery (arrow) supplying center of lesion. Notice absence of short serpiginous vessels with abrupt angulation, serrated appearance, and variable diameter to suggest malignant vessels.

 

Figure 6
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  		Fig. 3B —30-year-old woman with predominantly exophytic focal nodular hyperplasia (FNH). Coronal volume-rendered image in same phase (B) shows tumor stain caused by feeding arteries dividing into smaller branches, resulting in typical reticular (netlike) pattern. Notice fine peripheral septations (arrowheads, B) characteristic of FNH. No peritumoral enhancement seen. Coronal MIP (C) and volume-rendered (D) images in portal venous phase show several large veins draining into middle hepatic vein (arrow).

 

Figure 7
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  		Fig. 3C —30-year-old woman with predominantly exophytic focal nodular hyperplasia (FNH). Coronal volume-rendered image in same phase (B) shows tumor stain caused by feeding arteries dividing into smaller branches, resulting in typical reticular (netlike) pattern. Notice fine peripheral septations (arrowheads, B) characteristic of FNH. No peritumoral enhancement seen. Coronal MIP (C) and volume-rendered (D) images in portal venous phase show several large veins draining into middle hepatic vein (arrow).

 

Figure 8
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  		Fig. 3D —30-year-old woman with predominantly exophytic focal nodular hyperplasia (FNH). Coronal volume-rendered image in same phase (B) shows tumor stain caused by feeding arteries dividing into smaller branches, resulting in typical reticular (netlike) pattern. Notice fine peripheral septations (arrowheads, B) characteristic of FNH. No peritumoral enhancement seen. Coronal MIP (C) and volume-rendered (D) images in portal venous phase show several large veins draining into middle hepatic vein (arrow).

 

Figure 9
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  		Fig. 3E —30-year-old woman with predominantly exophytic focal nodular hyperplasia (FNH). Coronal multiplanar reconstructed image in portal venous phase shows hypodense central scar (arrow) typical of FNH. See also Figures S3F and S3G, cine loops, in supplemental data online.

 

Figure 10
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  		Fig. 4A —41-year-old woman with focal nodular hyperplasia. Coronal maximum-intensity-projection image in arterial phase shows large branch from right hepatic artery supplying lesion. Notice central artery within scar (arrowhead).

 

Figure 11
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  		Fig. 4B —41-year-old woman with focal nodular hyperplasia. Coronal volume-rendered image in same phase shows lobular tumor with typical reticular pattern of enhancement, central scar (arrowhead), and peripheral septations (arrows).

 

Figure 12
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  		Fig. 4C —41-year-old woman with focal nodular hyperplasia. Coronal volume-rendered image in portal venous phase shows pseudocapsule (arrows) and draining middle hepatic vein.

 

Figure 13
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  		Fig. 5A —28-year-old woman with focal nodular hyperplasia. Coronal maximum-intensity-projection (MIP) image in arterial phase shows large branch from left hepatic artery (arrow) supplying center of lesion. Notice reticular pattern of enhancement and peripheral septations (arrowheads).

 

Figure 14
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  		Fig. 5B —28-year-old woman with focal nodular hyperplasia. Axial volume-rendered image in portal venous phase shows vascular displacement (arrows) and draining left hepatic vein.

 

Figure 15
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  		Fig. 5C —28-year-old woman with focal nodular hyperplasia. Axial multiplanar reconstructed image in portal venous phase shows pseudocapsule (arrows) and central scar (arrowhead).See also Figures S5D and S5E, cine loops, in supplemental data online.

 

Figure 16
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  		Fig. 6A —49-year-old woman with focal nodular hyperplasia. Coronal maximum-intensity-projection image in arterial phase shows small branch from right hepatic artery (arrow) supplying dome lesion.

 

Figure 17
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  		Fig. 6B —49-year-old woman with focal nodular hyperplasia. Coronal volume-rendered image in arterial phase shows reticular enhancement. Notice presence of peripheral septations (arrows). See also Figures S6C and S6D, cine loops, in supplemental data online.

 

Figure 18
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  		Fig. 7A —35-year-old woman with focal nodular hyperplasia. Coronal maximum-intensity-projection (MIP) image in arterial phase shows two branches from right hepatic artery (arrows) supplying dome lesion.

 

Figure 19
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  		Fig. 7B —35-year-old woman with focal nodular hyperplasia. Axial oblique MIP image with slightly different window setting shows small penetrating arterial branches (arrowheads) resulting in reticular pattern of enhancement.

 

Figure 20
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  		Fig. 7C —35-year-old woman with focal nodular hyperplasia. Coronal volume-rendered image in portal venous phase shows several veins draining into right and middle hepatic veins (arrows).

 

Figure 21
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  		Fig. 7D —35-year-old woman with focal nodular hyperplasia. Surrounding displaced veins and compressed hepatic parenchyma in C results in pseudocapsule (arrows) in portal venous phase. See also Figures S7E and S7F, cine loops, in supplemental data online.

 

Figure 22
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  		Fig. 8A —35-year-old woman with focal nodular hyperplasia. Coronal maximum-intensity-projection image in arterial phase shows small branch from replaced left hepatic artery (arrow) supplying dome lesion.

 

Figure 23
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  		Fig. 8B —35-year-old woman with focal nodular hyperplasia. Axial (B) and coronal (C) multiplanar reconstructions in arterial phase show reticular pattern of enhancement typical of focal nodular hyperplasia.

 

Figure 24
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  		Fig. 8C —35-year-old woman with focal nodular hyperplasia. Axial (B) and coronal (C) multiplanar reconstructions in arterial phase show reticular pattern of enhancement typical of focal nodular hyperplasia.

 

Figure 25
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  		Fig. 8D —35-year-old woman with focal nodular hyperplasia. Reticular pattern is less conspicuous in portal venous phase (arrows).

 

Figure 26
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  		Fig. 9A —63-year-old woman with focal nodular hyperplasia. Axial maximum-intensity-projection image in arterial phase shows small branch from left hepatic artery (arrow) supplying lesion.

 

Figure 27
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  		Fig. 9B —63-year-old woman with focal nodular hyperplasia. Axial arterial phase image reveals typical reticular pattern of hypervascular enhancement (arrow).

 

Figure 28
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  		Fig. 9C —63-year-old woman with focal nodular hyperplasia. Coronal volume-rendered image shows reticular pattern (arrow) persisting into portal venous phase.

 

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