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AJR Teaching File: Incidental Hepatic Mass

Sean D. Beaty1, Alvin C. Silva1 and Giovanni DePetris2

1 Department of Diagnostic Radiology, Mayo Clinic, 13400 E Shea Blvd., Scottsdale, AZ 85259.
2 Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ.


Figure 1
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  		Fig. 1A —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Triphasic enhanced CT scans of liver reveal two subtle ring-enhancing hepatic masses (arrows) with low-attenuation centers on portal phase images that become nearly isoenhancing to liver on delayed phase (not shown). Incidental calcifications involving lateral limb of right adrenal gland (B) are related to prior hemorrhage.

 

Figure 2
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  		Fig. 1B —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Triphasic enhanced CT scans of liver reveal two subtle ring-enhancing hepatic masses (arrows) with low-attenuation centers on portal phase images that become nearly isoenhancing to liver on delayed phase (not shown). Incidental calcifications involving lateral limb of right adrenal gland (B) are related to prior hemorrhage.

 

Figure 3
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  		Fig. 1C —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Fat-saturated T2-weighted (C), unenhanced T1-weighted (D), and dynamic gadobenate dimeglumine (MultiHance, Bracco)–enhanced T1-weighted (E, arterial phase; F, portal venous phase) MR images reveal two hepatic masses (arrows, C–F) enhancing in similar fashion as on CT. However, masses show target-like appearance with delayed central enhancement and peripheral washout on 1-hour delayed phase images (arrowheads, G and H). Note that hepatic lesions are isointense with normal splenic tissue on unenhanced T1- and T2-weighted series (C and D).

 

Figure 4
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  		Fig. 1D —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Fat-saturated T2-weighted (C), unenhanced T1-weighted (D), and dynamic gadobenate dimeglumine (MultiHance, Bracco)–enhanced T1-weighted (E, arterial phase; F, portal venous phase) MR images reveal two hepatic masses (arrows, C–F) enhancing in similar fashion as on CT. However, masses show target-like appearance with delayed central enhancement and peripheral washout on 1-hour delayed phase images (arrowheads, G and H). Note that hepatic lesions are isointense with normal splenic tissue on unenhanced T1- and T2-weighted series (C and D).

 

Figure 5
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  		Fig. 1E —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Fat-saturated T2-weighted (C), unenhanced T1-weighted (D), and dynamic gadobenate dimeglumine (MultiHance, Bracco)–enhanced T1-weighted (E, arterial phase; F, portal venous phase) MR images reveal two hepatic masses (arrows, C–F) enhancing in similar fashion as on CT. However, masses show target-like appearance with delayed central enhancement and peripheral washout on 1-hour delayed phase images (arrowheads, G and H). Note that hepatic lesions are isointense with normal splenic tissue on unenhanced T1- and T2-weighted series (C and D).

 

Figure 6
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  		Fig. 1F —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Fat-saturated T2-weighted (C), unenhanced T1-weighted (D), and dynamic gadobenate dimeglumine (MultiHance, Bracco)–enhanced T1-weighted (E, arterial phase; F, portal venous phase) MR images reveal two hepatic masses (arrows, C–F) enhancing in similar fashion as on CT. However, masses show target-like appearance with delayed central enhancement and peripheral washout on 1-hour delayed phase images (arrowheads, G and H). Note that hepatic lesions are isointense with normal splenic tissue on unenhanced T1- and T2-weighted series (C and D).

 

Figure 7
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  		Fig. 1G —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Fat-saturated T2-weighted (C), unenhanced T1-weighted (D), and dynamic gadobenate dimeglumine (MultiHance, Bracco)–enhanced T1-weighted (E, arterial phase; F, portal venous phase) MR images reveal two hepatic masses (arrows, C–F) enhancing in similar fashion as on CT. However, masses show target-like appearance with delayed central enhancement and peripheral washout on 1-hour delayed phase images (arrowheads, G and H). Note that hepatic lesions are isointense with normal splenic tissue on unenhanced T1- and T2-weighted series (C and D).

 

Figure 8
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  		Fig. 1H —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Fat-saturated T2-weighted (C), unenhanced T1-weighted (D), and dynamic gadobenate dimeglumine (MultiHance, Bracco)–enhanced T1-weighted (E, arterial phase; F, portal venous phase) MR images reveal two hepatic masses (arrows, C–F) enhancing in similar fashion as on CT. However, masses show target-like appearance with delayed central enhancement and peripheral washout on 1-hour delayed phase images (arrowheads, G and H). Note that hepatic lesions are isointense with normal splenic tissue on unenhanced T1- and T2-weighted series (C and D).

 

Figure 9
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  		Fig. 1I —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Hepatic sonogram shows well-defined hypoechoic mass that corresponds to ring-enhancing lesion in posterior segment of right hepatic lobe on CT and MRI examinations.

 

Figure 10
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  		Fig. 1J —62-year-old man with primary hepatic lymphoma and hepatitis C virus–related cirrhosis. Representative histologic section of liver from sonographically guided biopsy shows atypical large lymphocytes surrounding residual bile ducts, consistent with large B-cell lymphoma. (H and E, x40)

 

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