Sparing of Fatty Infiltration Around Focal Hepatic Lesions in Patients with Hepatic Steatosis: Sonographic Appearance with CT and MRI Correlation
Kyoung Won Kim1,
Min Ju Kim2,
Seung Soo Lee1,
Hyoung Jung Kim3,
Yong Moon Shin1,
Pyo-Nyun Kim1 and
Moon-Gyu Lee1
1 Department of Radiology, Asan Medical Center, University of Ulsan College of
Medicine, 388-1, Pungnap 2-dong, Songpa-ku, Seoul 138-736, Korea.
2 Department of Radiology, National Cancer Center, Gyeonggi-do, Korea.
3 Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul,
South Korea.
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Fig. 1A —50-year-old woman with hepatic steatosis and hemangioma.
Peritumoral sparing of fatty infiltration is present around hemangioma.
Transverse sonogram shows increased liver echogenicity suggestive of hepatic
steatosis. Well-defined hypoechoic mass with thick hyperechoic rim is
surrounded by geographic hypoechoic area (arrowheads).
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Fig. 1B —50-year-old woman with hepatic steatosis and hemangioma.
Peritumoral sparing of fatty infiltration is present around hemangioma.
Unenhanced CT scan shows low hepatic attenuation suggestive of hepatic
steatosis and pericaval mass with profoundly low attenuation. Geographic
hyperdense area (arrowheads) around tumor corresponds to peritumoral
hypoechoic area in A, suggesting presence of peritumoral sparing of
fatty infiltration.
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Fig. 1C —50-year-old woman with hepatic steatosis and hemangioma.
Peritumoral sparing of fatty infiltration is present around hemangioma.
Contrast-enhanced hepatic arterial phase CT scan shows temporal peritumoral
enhancement (arrowheads) around hemangioma possibly caused by
arterioportal shunt.
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Fig. 1D —50-year-old woman with hepatic steatosis and hemangioma.
Peritumoral sparing of fatty infiltration is present around hemangioma.
In-phase gradient-echo T1-weighted MR image shows hypointense pericaval
mass.
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Fig. 1E —50-year-old woman with hepatic steatosis and hemangioma.
Peritumoral sparing of fatty infiltration is present around hemangioma.
Opposed-phase gradient-echo T1-weighted MR image shows low signal intensity of
hepatic parenchyma, suggesting hepatic steatosis. Geographic peritumoral
hyperintense area (arrowheads) corresponds to peritumoral hypoechoic
area in A. Finding indicates presence of peritumoral sparing of fatty
infiltration.
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Fig. 2A —70-year-old woman with hepatic steatosis and high-flow
hemangioma with arterioportal shunt. Peritumoral sparing of fatty infiltration
is present around hemangioma. Oblique sagittal sonogram shows increased liver
echogenicity suggestive of hepatic steatosis. Small hypoechoic mass with thick
hyperechoic rim (arrows) is surrounded by wedge-shaped hypoechoic
area (arrowheads).
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Fig. 2B —70-year-old woman with hepatic steatosis and high-flow
hemangioma with arterioportal shunt. Peritumoral sparing of fatty infiltration
is present around hemangioma. Color Doppler sonogram shows vigorous
intratumoral blood flow (long arrows). Reversed blood flow in portal
branch (short arrows) parallel to feeding artery suggests presence of
high-flow hemangioma with arterioportal shunt.
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Fig. 2C —70-year-old woman with hepatic steatosis and high-flow
hemangioma with arterioportal shunt. Peritumoral sparing of fatty infiltration
is present around hemangioma. Unenhanced CT scan shows inhomogeneously low
hepatic attenuation suggestive of mild hepatic steatosis. Subtle hyperdense
area (arrowheads) around tumor (arrow) suggests presence of
peritumoral sparing of fatty infiltration.
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Fig. 2D —70-year-old woman with hepatic steatosis and high-flow
hemangioma with arterioportal shunt. Peritumoral sparing of fatty infiltration
is present around hemangioma. Contrast-enhanced hepatic arterial phase CT scan
shows strong homogeneous enhancement of tumor (arrow) and peritumoral
parenchymal enhancement (arrowheads) suggestive of high-flow
hemangioma with arterioportal shunt.
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Fig. 3A —79-year-old man with hepatic steatosis and hepatocellular
carcinoma. Peritumoral sparing of fatty infiltration is present around
hepatocellular carcinoma. Transverse sonogram shows increased liver
echogenicity suggestive of hepatic steatosis. Hypoechoic mass (arrow)
and wedge-shaped hypoechoic area (arrowheads) are present in right
hepatic lobe.
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Fig. 3B —79-year-old man with hepatic steatosis and hepatocellular
carcinoma. Peritumoral sparing of fatty infiltration is present around
hepatocellular carcinoma. Unenhanced CT scan shows low hepatic attenuation
suggestive of hepatic steatosis and well-defined hypoattenuating mass.
Ill-defined hyperdense rim (arrowheads) surrounds tumor, which
corresponds to peritumoral hypoechoic area in A. Finding represents
peritumoral sparing of fatty infiltration.
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Fig. 3C —79-year-old man with hepatic steatosis and hepatocellular
carcinoma. Peritumoral sparing of fatty infiltration is present around
hepatocellular carcinoma. Contrast-enhanced hepatic arterial phase CT scan
shows enhancing tumor surrounded by wedge-shaped parenchymal enhancement
(arrowheads) in right hepatic lobe. It is not definite whether this
type of temporal enhancement indicates arterioportal shunt or corona-like
enhancement. Diagnosis of hepatocellular carcinoma was made after percutaneous
biopsy of tumor.
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Fig. 4A —65-year-old woman with hepatic steatosis and
cholangiocarcinoma. Peritumoral sparing of fatty infiltration surrounds
cholangiocarcinoma. Transverse sonogram shows increased liver echogenicity
suggestive of hepatic steatosis and slightly hypoechoic mass in right hepatic
lobe. Mass is surrounded by wedge-shaped hypoechoic areas
(arrowheads). Capsular retraction adjacent to mass (arrows)
is evident.
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Fig. 4B —65-year-old woman with hepatic steatosis and
cholangiocarcinoma. Peritumoral sparing of fatty infiltration surrounds
cholangiocarcinoma. Unenhanced CT scan shows low hepatic attenuation
suggestive of hepatic steatosis and low-attenuation mass in right hepatic
lobe. Wedge-shaped peritumoral hyperdense area (arrowheads)
corresponds to peritumoral hypoechoic area in A. Finding represents
peritumoral sparing of fatty infiltration.
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Fig. 4C —65-year-old woman with hepatic steatosis and
cholangiocarcinoma. Peritumoral sparing of fatty infiltration surrounds
cholangiocarcinoma. Contrast-enhanced hepatic arterial phase CT scan shows
tumor encasing right anterior segmental portal vein (arrow). Rimlike
and wedge-shaped parenchymal enhancement (arrowheads) surrounds
tumor. Right hepatectomy was performed; pathologic diagnosis of mass was
cholangiocarcinoma.
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Fig. 5A —57-year-old man with hepatic steatosis and metastasis from
gallbladder carcinoma. Peritumoral sparing of fatty infiltration surrounds
metastatic lesion. Oblique sagittal sonogram shows increased liver
echogenicity suggestive of hepatic steatosis and slightly hypoechoic mass with
subtle hyperechoic rim (long arrow) in right hepatic lobe. Mass is
surrounded by large hypoechoic areas (arrowheads). Tram
track–like hypoechoic lesion (short arrows) surrounding small
tubular structure, presumed to be thrombosed portal branch, is adjacent to
mass.
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Fig. 5B —57-year-old man with hepatic steatosis and metastasis from
gallbladder carcinoma. Peritumoral sparing of fatty infiltration surrounds
metastatic lesion. Unenhanced CT scan shows low hepatic attenuation suggestive
of hepatic steatosis and low-attenuation mass (long arrow) with
ill-defined geographic peritumoral hyperdense area (arrowheads)
corresponding to peritumoral hypoechoic area in A. Finding represents
peritumoral sparing of fatty infiltration. Small dotlike low-attenuation
lesion (short arrow) is adjacent to mass.
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Fig. 5C —57-year-old man with hepatic steatosis and metastasis from
gallbladder carcinoma. Peritumoral sparing of fatty infiltration surrounds
metastatic lesion. Contrast-enhanced hepatic arterial phase CT scan shows
ill-defined tumor with poor contrast enhancement (long arrow),
geographic peritumoral parenchymal enhancement (arrowheads), and lack
of opacification of portal branch (short arrow). Diagnosis of
metastasis from gallbladder carcinoma was made after percutaneous biopsy of
tumor.
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Fig. 6A —55-year-old man with hepatic steatosis and metastasis from
renal cell carcinoma. Peritumoral sparing of fatty infiltration is present
around metastatic lesions. Oblique sagittal sonogram shows increased liver
echogenicity suggestive of hepatic steatosis and hypoechoic mass
(asterisk) surrounded by slightly hypoechoic area
(arrowheads) in right hepatic lobe.
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Fig. 6B —55-year-old man with hepatic steatosis and metastasis from
renal cell carcinoma. Peritumoral sparing of fatty infiltration is present
around metastatic lesions. In-phase gradient-echo T1-weighted MR image shows
multiple hypointense metastatic masses.
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Fig. 6C —55-year-old man with hepatic steatosis and metastasis from
renal cell carcinoma. Peritumoral sparing of fatty infiltration is present
around metastatic lesions. Opposed-phase gradient-echo T1-weighted MR image
shows low parenchymal signal intensity in right hepatic lobe, suggesting
hepatic steatosis. Subsegmental hyperintense area (arrowheads)
surrounds metastatic lesions (arrows) corresponding to peritumoral
hypoechoic area in A. Finding represents peritumoral sparing of fatty
infiltration.
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Fig. 6D —55-year-old man with hepatic steatosis and metastasis from
renal cell carcinoma. Peritumoral sparing of fatty infiltration is present
around metastatic lesions. Contrast-enhanced CT scan shows diffuse tumoral
enhancement (arrows) and arterial hyperperfusion around tumors
(arrowheads) probably caused by siphoning effect of hypervascular
metastatic lesions. Right hepatectomy was performed; pathologic diagnosis was
metastasis from renal cell carcinoma.
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Fig. 7A —56-year-old man with hepatic steatosis and pyogenic abscess.
Peritumoral sparing of fatty infiltration is present around abscess. Oblique
sagittal sonogram shows increased liver echogenicity suggestive of hepatic
steatosis and hypoechoic lesion (asterisk) surrounded by slightly
hypoechoic area (arrowheads) in right hepatic lobe.
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Fig. 7B —56-year-old man with hepatic steatosis and pyogenic abscess.
Peritumoral sparing of fatty infiltration is present around abscess.
Unenhanced CT scan shows low hepatic attenuation suggestive of hepatic
steatosis and low-attenuation mass (asterisk) in right hepatic lobe.
Ill-defined peritumoral hyperdense area (arrowheads) corresponds to
peritumoral hypoechoic area in A. Finding represents peritumoral
sparing of fatty infiltration.
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Fig. 7C —56-year-old man with hepatic steatosis and pyogenic abscess.
Peritumoral sparing of fatty infiltration is present around abscess.
Contrast-enhanced hepatic arterial phase CT scan shows segmental hepatic
arterial hyperperfusion (arrowheads) around large abscess
(asterisk) in right hepatic lobe. Diagnosis of pyogenic abscess was
made with percutaneous fine-needle aspiration of lesion.
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Fig. 8A —63-year-old man with hepatic steatosis and parasitic abscess.
Peritumoral sparing of fatty infiltration is present around abscess. Oblique
coronal sonogram shows increased liver echogenicity suggestive of hepatic
steatosis and slightly hypoechoic lesion with hyperechoic rim
(arrows) surrounded by ill-defined hypoechoic area
(arrowheads) in right hepatic lobe.
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Fig. 8B —63-year-old man with hepatic steatosis and parasitic abscess.
Peritumoral sparing of fatty infiltration is present around abscess.
Unenhanced CT scan shows low hepatic attenuation suggestive of hepatic
steatosis and small low-attenuation lesion (arrow) with peritumoral
hyperdense area (arrowheads) corresponding to peritumoral hypoechoic
area in A. Finding represents peritumoral sparing of fatty
infiltration.
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Fig. 8C —63-year-old man with hepatic steatosis and parasitic abscess.
Peritumoral sparing of fatty infiltration is present around abscess.
Contrast-enhanced CT scan shows ill-defined parenchymal enhancement
(arrowheads) surrounding small necrotic lesion (arrow) in
right hepatic lobe. Diagnosis of parasitic abscess was made after percutaneous
needle biopsy of lesion. Enzyme-linked immunosorbent assay result was positive
for Fasciola hepatica.
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Fig. 9A —65-year-old woman with hepatic steatosis and simple cyst.
Peritumoral sparing of fatty infiltration is present around cyst. Transverse
sonogram shows increased liver echogenicity suggestive of hepatic steatosis
and anechoic cystic lesion in left hepatic lobe. Ill-defined boundary
(arrowheads) between hepatic parenchyma and lesion and focal
dilatation of segmental intrahepatic duct (arrows) suggest
complicated cyst or cystic tumor.
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Fig. 9B —65-year-old woman with hepatic steatosis and simple cyst.
Peritumoral sparing of fatty infiltration is present around cyst. Unenhanced
CT scan shows low hepatic attenuation suggestive of hepatic steatosis and
well-defined cystic lesion in left hepatic lobe surrounded by thin hyperdense
rim (arrowheads). Focal dilatation of segmental intrahepatic duct
(arrows) also is present.
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Fig. 9C —65-year-old woman with hepatic steatosis and simple cyst.
Peritumoral sparing of fatty infiltration is present around cyst. In-phase
gradient-echo T1-weighted MR image shows cystic lesion with low signal
intensity.
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Fig. 9D —65-year-old woman with hepatic steatosis and simple cyst.
Peritumoral sparing of fatty infiltration is present around cyst.
Opposed-phase gradient-echo T1-weighted MR image shows low signal intensity of
hepatic parenchyma suggestive of hepatic steatosis. Thin rim
(arrowheads) of high signal intensity around cyst suggests
peritumoral sparing of fatty infiltration. Because of mass effect of lesion,
left hepatic lobectomy was performed for diagnosis of cystic tumor. Diagnosis
of simple biliary cyst was made at pathologic examination. (H and E)
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Fig. 9E —65-year-old woman with hepatic steatosis and simple cyst.
Peritumoral sparing of fatty infiltration is present around cyst. Low-power
photomicrograph shows mild fatty infiltration in hepatic parenchyma.
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Fig. 9F —65-year-old woman with hepatic steatosis and simple cyst.
Peritumoral sparing of fatty infiltration is present around cyst. Low-power
photomicrograph shows peritumoral sparing of fatty infiltration in hepatic
parenchyma surrounding cyst. (H and E)
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