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Transient Hepatic Intensity Differences: Part 1, Those Associated with Focal Lesions

¹ Department of Clinical Physiopathology, Section of Radiodiagnostics, University of Florence, Viale Morgagni 85, Florence 50134, Italy.
² Section of Radiodiagnostics, Ospedale SM Grazie Pozzuoli, Naples, Italy.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —34-year-old woman with fibronodular hyperplasia in left hepatic lobe determining homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial T2-weighted MR image (TR/TE, 830/80) shows slightly hyperintense nodule (arrow) in left hepatic lobe.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —34-year-old woman with fibronodular hyperplasia in left hepatic lobe determining homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (216/1.5) show rapid enhancement of lesion (arrow, B) and arterial phenomenon (arrowheads) of parenchyma in segments II-IV.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —34-year-old woman with fibronodular hyperplasia in left hepatic lobe determining homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (216/1.5) show rapid enhancement of lesion (arrow, B) and arterial phenomenon (arrowheads) of parenchyma in segments II-IV.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —34-year-old woman with fibronodular hyperplasia in left hepatic lobe determining homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial gradient-echo T1-weighted gadolinium-enhanced portal phase MR image (216/1.5) shows no parenchymal enhancement in segments II-IV.

View larger version (179K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —58-year-old woman with hemangioma in left hepatic lobe inducing homolateral transient hepatic intensity difference in liver segment II (segmental siphoning effect). Axial T2-weighted MR image (TR/TE, 862/320) shows highly hyperintense nodule (arrow) in left hepatic lobe, segment II.

View larger version (173K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —58-year-old woman with hemangioma in left hepatic lobe inducing homolateral transient hepatic intensity difference in liver segment II (segmental siphoning effect). Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (216/1.5) show enhanced lesion (arrow, B) and arterial phenomenon (arrowheads) involving only parenchyma of segment II.

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —58-year-old woman with hemangioma in left hepatic lobe inducing homolateral transient hepatic intensity difference in liver segment II (segmental siphoning effect). Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (216/1.5) show enhanced lesion (arrow, B) and arterial phenomenon (arrowheads) involving only parenchyma of segment II.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —58-year-old woman with inflammatory pseudotumor in right hepatic lobe causing homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial T2-weighted MR image (TR/TE, 12,000/84) shows large hyperintense mass (arrow).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —58-year-old woman with inflammatory pseudotumor in right hepatic lobe causing homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (146/2) show hypointense pseudotumor (arrow, B) and arterialization (arrowheads) surrounding lesion.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —58-year-old woman with inflammatory pseudotumor in right hepatic lobe causing homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial T2-weighted (12,000/82) (D) and axial gradient-echo T1-weighted (E) gadolinium-enhanced arterial phase (146/2) MR images obtained 3 months after A and B show pseudotumor size reduction (D) and consequent disappearance of arterial phenomenon (E). Note right pleural effusion.

View larger version (178K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —58-year-old woman with inflammatory pseudotumor in right hepatic lobe causing homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial T2-weighted (12,000/82) (D) and axial gradient-echo T1-weighted (E) gadolinium-enhanced arterial phase (146/2) MR images obtained 3 months after A and B show pseudotumor size reduction (D) and consequent disappearance of arterial phenomenon (E). Note right pleural effusion.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —43-year-old man with large subcapsular liver abscess in right lobe producing homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial T2-weighted MR image (TR/TE, 12,000/84) shows large hyperintense lesion (arrow).

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —43-year-old man with large subcapsular liver abscess in right lobe producing homolateral lobar transient hepatic intensity difference (lobar siphoning effect). Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (146/2) shows hypointense mass and lobar arterialization (arrowheads) in surrounding parenchyma.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —32-year-old man with liver abscess in right lobe that is inducing sectorial wedge-shaped transient hepatic intensity difference. Axial T2-weighted MR image (TR/TE, 12,000/84) shows hyperintense lesion (arrow) in segment V.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —32-year-old man with liver abscess in right lobe that is inducing sectorial wedge-shaped transient hepatic intensity difference. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (146/2) shows sectorial arterial phenomenon (arrowhead) in right hepatic lobe due to portal hypoperfusion secondary to portal branch thrombosis (arrow) induced by abscess.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —50-year-old man with small round hemangioma beneath Glisson's capsule in right hepatic lobe and intralesional arterioportal shunt producing sectorial wedge-shaped arterial phenomenon. Axial T2-weighted (TR/TE, 830/80) (A) and axial gradient-echo unenhanced T1-weighted (216/1.5) (B) MR images show right hepatic lobe nodule (arrow) that is strongly hyperintense in A and hypointense in B.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —50-year-old man with small round hemangioma beneath Glisson's capsule in right hepatic lobe and intralesional arterioportal shunt producing sectorial wedge-shaped arterial phenomenon. Axial T2-weighted (TR/TE, 830/80) (A) and axial gradient-echo unenhanced T1-weighted (216/1.5) (B) MR images show right hepatic lobe nodule (arrow) that is strongly hyperintense in A and hypointense in B.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —50-year-old man with small round hemangioma beneath Glisson's capsule in right hepatic lobe and intralesional arterioportal shunt producing sectorial wedge-shaped arterial phenomenon. Axial gradient-echo T1-weighted iron-oxide-enhanced arterial phase (C) and 10-minute delayed phase (D) MR images (216/1.5) show wedge-shaped arterial phenomenon (arrowhead, C) of parenchyma and late enhancement of hemangioma (arrow, D).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —50-year-old man with small round hemangioma beneath Glisson's capsule in right hepatic lobe and intralesional arterioportal shunt producing sectorial wedge-shaped arterial phenomenon. Axial gradient-echo T1-weighted iron-oxide-enhanced arterial phase (C) and 10-minute delayed phase (D) MR images (216/1.5) show wedge-shaped arterial phenomenon (arrowhead, C) of parenchyma and late enhancement of hemangioma (arrow, D).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E —50-year-old man with small round hemangioma beneath Glisson's capsule in right hepatic lobe and intralesional arterioportal shunt producing sectorial wedge-shaped arterial phenomenon. Axial sonogram (E), pulsed-wave Doppler sonogram (F), and color Doppler sonogram (G) (all obtained with convex, 3.5-MHz probe) show sectorial hypoechoic area (spare in fatty liver) that has same location and shape as sectorial arterial phenomenon (E), arteriovenous pulsed waves (F), and color pattern flow (G) inside hemangioma, indicating an intralesional shunt.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6F —50-year-old man with small round hemangioma beneath Glisson's capsule in right hepatic lobe and intralesional arterioportal shunt producing sectorial wedge-shaped arterial phenomenon. Axial sonogram (E), pulsed-wave Doppler sonogram (F), and color Doppler sonogram (G) (all obtained with convex, 3.5-MHz probe) show sectorial hypoechoic area (spare in fatty liver) that has same location and shape as sectorial arterial phenomenon (E), arteriovenous pulsed waves (F), and color pattern flow (G) inside hemangioma, indicating an intralesional shunt.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6G —50-year-old man with small round hemangioma beneath Glisson's capsule in right hepatic lobe and intralesional arterioportal shunt producing sectorial wedge-shaped arterial phenomenon. Axial sonogram (E), pulsed-wave Doppler sonogram (F), and color Doppler sonogram (G) (all obtained with convex, 3.5-MHz probe) show sectorial hypoechoic area (spare in fatty liver) that has same location and shape as sectorial arterial phenomenon (E), arteriovenous pulsed waves (F), and color pattern flow (G) inside hemangioma, indicating an intralesional shunt.

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —65-year-old man with liver cirrhosis and hepatocellular carcinoma causing sectorial wedge-shaped transient hepatic intensity difference induced by portal thrombosis secondary to tumor. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (TR/TE, 146/2) shows strongly enhancing nodule (white arrow) and related satellite (black arrow).

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —65-year-old man with liver cirrhosis and hepatocellular carcinoma causing sectorial wedge-shaped transient hepatic intensity difference induced by portal thrombosis secondary to tumor. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (146/2) shows arterialization (black arrowhead) and portal thrombosis (white arrowhead).

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —65-year-old man with liver cirrhosis and hepatocellular carcinoma causing sectorial wedge-shaped transient hepatic intensity difference induced by portal thrombosis secondary to tumor. Axial T2-weighted MR image (12,000/82) confirms portal thrombosis (arrowhead) and shows slight signal intensity changes in triangular area of arterial phenomenon due to small increase in amount of free water.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —27-year-old woman with echinococcus cyst and sectorial fan-shaped transient hepatic intensity difference. Axial T2-weighted MR image (TR/TE, 12,000/84) shows hyperintense round cyst (arrow) and slight hyperintensity of liver parenchyma at site of arterial phenomenon (arrowheads), probably due to increase in amount of free water.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —27-year-old woman with echinococcus cyst and sectorial fan-shaped transient hepatic intensity difference. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show lesion (arrows) positioned at apex of fan-shaped arterial phenomenon (arrowheads) caused by portal compression.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —27-year-old woman with echinococcus cyst and sectorial fan-shaped transient hepatic intensity difference. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR images (TR/TE, 146/2) show lesion (arrows) positioned at apex of fan-shaped arterial phenomenon (arrowheads) caused by portal compression.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —56-year-old man with sectorial fan-shaped transient hepatic intensity difference associated with cholangiocellular carcinoma. Axial iodinated contrast-enhanced arterial phase helical CT image shows sectorial arterial phenomenon (arrowheads) apparently not associated with focal lesion.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —56-year-old man with sectorial fan-shaped transient hepatic intensity difference associated with cholangiocellular carcinoma. Axial gradient-echo T1-weighted gadolinium-enhanced arterial phase MR image (TR/TE, 216/1.5) obtained 3 months after A shows small hypointense focal lesion (arrow) at apex of fan-shaped arterial phenomenon, causing portal branch infiltration and subsequent portal hypoperfusion.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —59-year-old man with large hepatic intraparenchymal metastasis from colon carcinoma and correlated sectorial fan-shaped transient hepatic intensity difference. Axial T2-weighted MR image (TR/TE, 12,000/84) shows hyperintense parahilar nodule (arrow) with associated slight signal intensity change (arrowhead) due to small increase in amount of free water. Note small fluid collection near Glisson's capsule.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —59-year-old man with large hepatic intraparenchymal metastasis from colon carcinoma and correlated sectorial fan-shaped transient hepatic intensity difference. Axial gradient-echo fat-suppressed T1-weighted unenhanced (146/2) (B) and axial gradient-echo fat-suppressed T1-weighted gadolinium-enhanced arterial phase (146/2) (C) MR images show wide fan-shaped arterial phenomenon with straight border (arrowhead, C) due to hypointense neoplastic lesion at its apex (arrow), causing portal compression. Note how segment III is also slightly enhanced. Although this transient hepatic intensity difference could look like lobar type because of distribution, this arterial phenomenon is undoubtedly sectorial because lesion, being hypodense and hypoenhancing, causes portal compression and not a primary increase in arterial flow.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C —59-year-old man with large hepatic intraparenchymal metastasis from colon carcinoma and correlated sectorial fan-shaped transient hepatic intensity difference. Axial gradient-echo fat-suppressed T1-weighted unenhanced (146/2) (B) and axial gradient-echo fat-suppressed T1-weighted gadolinium-enhanced arterial phase (146/2) (C) MR images show wide fan-shaped arterial phenomenon with straight border (arrowhead, C) due to hypointense neoplastic lesion at its apex (arrow), causing portal compression. Note how segment III is also slightly enhanced. Although this transient hepatic intensity difference could look like lobar type because of distribution, this arterial phenomenon is undoubtedly sectorial because lesion, being hypodense and hypoenhancing, causes portal compression and not a primary increase in arterial flow.

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