Hemangioma is the most common benign liver tumor. When enhancement is present, it is usually very thin (2 mm) and observed only on equilibrium-phase images, related to the fibrous component of the lesions [45]. They can advise you about whether any particular treatment is needed. There may be a large number of patients with benign indeterminate lesions who are not evaluated by hepatobiliary specialists. Focal nodular hyperplasia (FNH) is the second most common benign lesion of the liver most frequently occurring in healthy, young and middle-aged women [ 1 3 ]. 2013;62:15201. Scand. AJR Am J Roentgenol. Detection of colorectal hepatic metastases using MnDPDP MR imaging and diffusion-weighted imaging (DWI) alone and in combination. National Library of Medicine Fuentes-Orrego JM, Hayano K, Kambadakone AR, et al. However, in the majority, the tumor is idiopathic. Thus, we propose that IOUS should be used as an adjunct to preoperative imaging techniques to improve the staging of CRLM and thereby help select the most appropriate treatment. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. They return variable T2 signal. On T1-weighted images, HCC shows variable signal intensity relative to hepatic parenchyma. Epub 2014 Aug 12. (2022). Epithelioid hemangioendothelioma. Metastases. Jeon SK, Lee JM, Joo I, Lee DH, Ahn SJ, Woo H, Lee MS, Jang JY, Han JK. Simple hepatic cysts are common, occurring in 514% of the general population. Those with cancer of liver disease may need close follow up. World J. Surg. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. An MR examination of the liver routinely includes dynamic contrast-enhanced pulse sequences and diffusion-weighted imaging (DWI). Surgical resection confirmed an inflammatory adenoma. Y.Y. 2008;47:97104. On the (b) 10 mins delayed image, the tumor demonstrates late enhancement, which allows better delineation of the tumor (arrows) from the surrounding hepatic parenchyma, Peripheral cholangiocarcinoma. MR imaging of the liver can now be performed at both 1.5 and 3.0 T; the latter has significantly improved in image quality due to advancements in both imaging hardware and software. Recurrence was defined as radiological or pathological confirmed recurrence at the site of the previous indeterminate nodule. WebIodine quantification performed using single-phase contrast-enhanced DECT material attenuation images improves the characterization of small (< 2 cm) incidental indeterminate hypoattenuating hepatic lesions, compared with conventional attenuation measurements. Solitary indeterminate lesions were detected in 43 (71.7%) patients. Of 33 patients with visible nodules on IOUS, 25 (75.8%) underwent surgical resection and four (12.1%) underwent radiofrequency ablation. 1999;10:196201. Blood tests can identify viral hepatitis infection or markers that identify liver disease. Radiology. There is incomplete enhancement of the lesion, Hemangioma type 3: liver-specific MR contrast agent. With regard to the use of diffusion-weighted MRI for HCC evaluation, higher b-value (e.g., 800 s/mm2) DWI may help in the identification of disease, particularly if the suspected nodule also demonstrates typical vascularity pattern at contrast-enhanced MRI. Assessment of liver lesions takes into consideration their appearance and vascularity on a variety of imaging modalities: cystic liver lesions hypervascular liver lesions liver tumors There is a strong association with prior exposure to carcinogens such as vinyl chloride and Thorotrast, as well as in patients with hemochromatosis. Cancer Manag. Baron RL, Brancatelli G. Computed tomographic imaging of hepatocellular carcinoma. The pLNR could be used to help select which patients can undergo conservative therapy, at least in metachronous CRLM. IOUS showed indeterminate nodules in 33 (55.0%) patients but no indeterminate nodules in 27 (45.0%) patients. (d) On the gadoxetic acid-enhanced images in the hepatobiliary phase, there is little to no enhancement. (c) In the venous phase, the lesion is not visible. The CT attenuation or MR signal intensity characteristics are nonspecific, although occasional tumoral calcifications may be seen. https://doi.org/10.1186/s12876-019-1036-7 (2019). On CT, they appear as small cystic lesions of round, oval, or irregular shape without contrast enhancement, although thin rim enhancement may sometimes be present, thus mimicking hypovascular liver metastases [40]. Cite this article. CAS (2017). https://doi.org/10.1148/radiol.2016151975 (2016). Jones et al. Lee MH, Kim YK, Park MJ, Hwang J, Kim SH, Lee WJ, Choi D. Gadoxetic acid-enhanced fat suppressed three-dimensional T1-weighted MRI using a multiecho dixon technique at 3 tesla: emphasis on image quality and hepatocellular carcinoma detection. The prognostic impact after hepatic resection for CRLM varies based on KRAS status and site of the primary CRC6. Delayed phase images show most HCC lesions as hypodense compared with surrounding liver. On CT, hemangiomas are well-defined hypodense masses. is responsible for the analysis and interpretation of data for the work, critical revision of the article, statistical analysis, final approval of the version to be published and is accountable for all aspects of the work. Focal nodular hyperplasia: natural course observed with CT and MRI. Biliary hamartomas are typically small (510 mm in size) and usually widely distributed in both lobes of the liver. H.H. Tsilimigras, D. I. et al. A European study showed that MRI was necessary to characterize small equivocal lesions detected by CT better14. Adenoma (HNF1A subtype). These tumors are best seen in the arterial phase and may become isodense and difficult to detect at the later phases of contrast enhancement. Hepatic Like all cancers, cancerous lesions of the liver are caused by changes to the DNA that make cells replicate uncontrollably. 2013;33:165368. This Institutional Review Board-approved retrospective study included 101 patients [45% men, median age 63 years (34-85)] treated for localized pancreatic adenocarcinoma at Brigham and Women's Hospital and Dana Farber Cancer Institute from January 1999 to December 2007. Multidetector computed tomography (MDCT) and magnetic resonance (MR) imaging provide noninvasive insights into liver anatomy and the pathophysiology of liver diseases, which allows for better disease diagnosis, monitoring of disease evolution and treatment response, as well as for guiding treatment decisions. Liver lesions are often discovered through imaging tests. Kim, Y.-Y., Park, M.-S., Aljoqiman, K. S., Choi, J.-Y. Jeffrey RB Jr, Tolentino CS, Chang FC, Federle MP. This site needs JavaScript to work properly. Laghi A, Iannaccone R, Rossi P, et al. Free-breathing contrast-enhanced T1-weighted gradient-echo imaging with radial k-space sampling for paediatric abdominopelvic MRI. IntraoperatIve ultrasonography In detectIng and assessment of colorectal lIver metastases. Laing RW, et al. Dose-modified 256-MDCT of the abdomen using low tube current and hybrid iterative reconstruction. Sultana S, Awai K, Nakayama Y, et al. AJR Am J Roentgenol. On delayed imaging, the enhancement usually fades to a similar extent as the blood pool. Hepatol. Surg. However, high levels of IR may induce a pixelated (plastic-like) image texture and may render image quality unacceptable [10]. PLoS ONE 12, e0189797. and transmitted securely. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). MDCT of chest, abdomen, and pelvis using attenuation-based automated tube voltage selection in combination with iterative reconstruction: an intrapatient study of radiation dose and image quality. At CT and MR imaging, lesions tend to be hypodense at unenhanced CT and hypointense on T1-weighted images, with peripheral enhancement at dynamic contrast-enhanced studies [67]. Hence, appropriate clinical and laboratory corroboration is vital toward making the right radiological diagnosis. Comparison of MRI with liver-specific contrast agents and multidetector row CT for the detection of hepatocellular carcinoma: a meta-analysis of 15 direct comparative studies. Although less common than leukocytosis, leukopenia is associated with a worse prognosis.7, 18, 19Increased serum activities of liver enzymes (ALT, ALP, aminotransferase, and gamma-glutamyl transpeptidase) and increased total bilirubin are commonly reported, and sometimes reflect concurrent lipidosis or cholangitis. (c) The gadoxetic-enhanced T1-weighted GRE image in the hepatobiliary phase shows two additional small subcapsular metastases (arrows) not seen on unenhanced MRI or MDCT (not shown). The reported incidence is at least one hepatic lesion too small to characterize in 29.4% of women without definite liver metastasis on CT [ 6 ]. Google Scholar. In cirrhotic patients, transient focal enhancement is most often caused by arterial-portal shunting, resulting in inappropriately early focal areas of portal venous distribution enhancement in the liver. Radiology. THAD are not associated with lesion hypodensity in the portal venous or delayed phases of contrast enhancement. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. In most such cases, however, careful evaluation will show that the tumoral enhancement does not follow characteristics of blood pool at all phases or that there are other features, such as multiple lesions, that make the diagnosis of hemangioma unlikely [71, 72]. Neoplasia. If tumors grow large, they may cause symptoms and need to be removed. HCA with mutations of catenin b1 may also show contrast uptake in the hepatobiliary phase of MRI using liver-specific contrast media. For patients with a history of extrahepatic malignancy, liver metastases are a potential cause of solid liver lesions. In such patients, the evaluation begins with a search for metastatic disease in other organs (eg, CT of the abdomen and pelvis as well as chest imaging). Another useful recent implementation is non-Cartesian radial T1-weighted imaging, which allows 3D volume T1-weighted imaging of the liver to be performed in free breathing. PubMed Central Radiology. Eur Radiol. CAS Radiology. Contrast-enhanced MDCT remains the modality of choice for routine liver imaging. Besides showing greater accuracy for the diagnosis of indeterminate nodules found on CT, MRI revealed new lesions in 138/389 patients (35.5%). 1999;213:35261. Dilated intrahepatic bile ducts proximal to an intrahepatic CCC can also provide clues to the diagnosis, as biliary obstruction is usual with intrahepatic metastases (with the exception of colorectal cancer [69]. Conventional CT: Notice tiny liver lesion. Clin. (d) Hepatobiliary phase imaging of another FNH: homogenous uptake of the liver-specific MR contrast agent, the spoke-wheel central scar is typically not enhanced. Coarse calcifications may be observed at US and CT in both cystadenoma and cystadenocarcinoma and is not a sign of benignity. A 45-year-old woman with incident lesion (arrows) in the right lobe of the liver. Web2. Correspondence to Of these lesions, two-thirds were too small to characterize, whereas the others were predominantly cysts or hemangiomas. Theyll guide a small probe into the tumor in your liver, usually through tiny cuts jacr.org/article/S1546-1440(17)30889-X/fulltext, wchh.onlinelibrary.wiley.com/doi/full/10.1002/tre.777, cancer.net/cancer-types/liver-cancer/statistics, 7 Ways to Improve the Health of Your Liver, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT. Vandecaveye V, De Keyzer F, Verslype C, et al. Diseases of the Abdomen and Pelvis 2018-2021, https://doi.org/10.1007/978-3-319-75019-4_17, Rights and C: Liver specimen containing a microrhabdomyosarcoma R1 tumor (arrow) too small to be superficially visible. Clinical variables known to be prognostic for patients with pancreatic cancer were also recorded. Schwartz LH, Gandras EJ, Colangelo SM, Ercolani MC, Panicek DM. CrossRef The lollipop sign: a new cross-sectional sign of hepatic epithelioid hemangioendothelioma. A central scar is present in about 67% of larger lesions and about 33% of smaller lesions [34]. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Even when benign, these tumors have a propensity for malignant degeneration, and any such tumor should be considered as potentially malignant. These variants of HCA do not have typical imaging features and may be difficult to differentiate from HCC or FNH. This work is supported by Grant No. In addition, some well-differentiated or moderately differentiated HCC may appear isointense or hyperintense on delayed images due to higher levels of OATP1B3 and MRP3 receptor expression. Healthline Media does not provide medical advice, diagnosis, or treatment. Clin Orthop Relat Res. 2006;186:15719. J. Oncol. There are many types of liver disease, ranging from those that are treatable to those that require a liver transplant. Schima, W., Koh, DM., Baron, R. (2018). A comparison of diagnostic imaging modalities for colorectal liver metastases. CRC patients treated with chemotherapy primarily underwent surgery for CRC along with liver resection if synchronous metastasis were present. Much more important is that it can help to make a firm diagnosis of HCC by showing typical lesion contrast washout, if it had not been present in the portal venous phase [52]. Effects of injection rates of contrast material on arterial phase hepatic CT. AJR Am J Roentgenol. In a study of 295 patients in Scotland, the total number of lymph nodes retrieved and the total number of negative lymph nodes were not associated with overall survival in either colon or rectal cancers. We explain what causes them and how theyre treated. Most lesions 1 THAD are usually peripherally located in the liver, appear wedge shaped, and may be poorly circumscribed. About 1520% of liver metastases are detected at the time of the diagnosis of the colorectal cancer and additional 3545% of liver metastasis are newly diagnosed during the course of the colorectal cancer treatment5. 2013;267:77686. Too small to characterize liver lesions These are usually lesions under a centimeter. 1994;192:36771. Nonetheless, the majority of small hypodense liver lesions even in the oncology patient are usually benign. For these lesions, radiologists would often report their diagnostic impression (eg, cystic, hemangioma, suspicious for metastatic disease) yet still deem the lesion to be of uncertain signicance due to the subcentimeter size. Whereas most large HCC are hyperintense on T2-weighted images, smaller lesions, measuring even 34 cm, can appear isointense or hypointense. PLoS ONE https://doi.org/10.1371/journal.pone.0189797 (2017). https://doi.org/10.1055/s-0029-1242462 (2009). Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Eur Radiol. Overall survival by the existence of liver lesions. 2007;188:14753. 17.11). T.Y. The differential diagnosis of CRLM may include primary intrahepatic cholangiocarcinoma, primarily because CRC is usually an adenocarcinoma4. Kim TK, Lee KH, Jang JJ, et al. Holzapfel K, Reiser-Erkan C, Fingerle AA, et al. The use of liver-specific contrast agents may also help toward the identification of isoenhancing or hypoenhancing HCC that do not show typical hypervascularity in the arterial phase of contrast enhancement. CrossRef Springer, Cham. They can be cancerous or noncancerous. WebIn 92.7%-96.9% of women with breast cancer and hepatic lesions deemed TSTC but no definite liver metastases at initial CT, the lesions represented a benign finding. 2002;223:51724. Indeterminate nodules were visible on IOUS in 33 (55.0%) patients and were not detected on IOUS in 27 (45.0%) patients. In segment 4, a lesion is only faintly seen. It usually appears as a solitary, hypodense lesion, with an enhancing wall that may be smooth or nodular, and is often associated with an incomplete rim of edema. (a) T1-weighted in-phase GRE image demonstrates a very large mass in a young woman. Echo-enhanced Doppler sonography of focal nodular hyperplasia of the liver. J.C. is responsible for the concept and design of work, critical revision of the manuscript for important intellectual content, study supervision, technical support, final approval of the version to be published and is accountable for all aspects of the work. To help identify the clinical content of family medicine. Effect of injection rate of contrast material on CT of hepatocellular carcinoma. For comparison measured iodine uptake in background liver (red ROI) is about 1.1 mg/mL. AJR Am J Roentgenol. Liver lesions predicted the occurrence of metastatic disease to the liver compared with patients without lesions (67.7% with lesions vs 44.4% without, P = .034). Lymph node ratio and liver metachronous metastases in colorectal cancer. Creasy, J. M. et al. 2006;186:14138. 17.2), especially during dynamic contrast-enhanced acquisitions [17]. Oral contraceptive use and focal nodular hyperplasia of the liver. On ultrasound, the lesion is usually isoechoic or slightly hypoechoic [33] to liver, but appears hypoechoic in patients with diffuse hepatic steatosis. At contrast-enhanced T1-weighted MRI, they are hypervascular, often with contrast washout in the portal venous or delayed phase. The appearance is consistent with multiple hepatic abscesses. In general, HCC is considered in a setting of cirrhosis or chronic liver disease. Permissions team. Liver cysts are sacs in the liver that may contain fluid or a solid mass of cells. On dynamic contrast-enhanced CT or MR, adenomas usually show marked arterial-phase enhancement, with rapid transition to either iso- or hypoattenuating/intense to hepatic parenchyma on portal venous phase imaging. In recent years, dual-energy and spectral CT technique has emerged, where the utilization of dual-source or polychromatic X-ray beams and the differential attenuation of such beams of different energies in tissues are applied to improve the detection of hypervascular hepatocellular carcinomas [14] or for the quantification of hepatic iron content [15]. https://doi.org/10.1634/theoncologist.2012-0121 (2012). PubMedGoogle Scholar. Intrahepatic bile duct dilatation due to liver metastases from colorectal carcinoma. 17.3). The majority of FNH tend to remain static in size, although FNH may increase in size on follow-up (311%), although oral contraceptives do not appear to stimulate FNH growth [38, 39]. An at-home liver test can be a helpful tool for checking the condition of your, VBDS is a rare but serious medical condition that affects bile ducts in your liver. They appear as unilocular or multilocular cystic masses, with the typical anechoic and hypoechoic US appearance and near water-like attenuation contents on CT, with peripheral soft tissue nodularity and traversing septations. 97, 7682. This chapter is published under an open access license. Measured iodine uptake in the lesion (blue ROI) is zero! On MR imaging examinations, cysts are well-defined, homogeneous lesions that appear hypointense on T1-weighted images and markedly hyperintense on T2-weighted images. DSilva, M., Cho, J.Y., Han, HS. Some may even be harmful. After neoadjuvant chemotherapy combined with targeted therapy, the resectability rate has increased up to 7090%, and concurrently 70% of unresectable patients2,3. (c) In the hepatobiliary phase after 20 min, the lesion shows hypointensity due to lack of hepatocellular uptake. Mol. Eur J Radiol. Activation of sonic hedgehog pathway occurs in approximately 5% of HCA. Malignant lesions are cancerous. Cellular origin of hepatocellular carcinoma. The nodules that could not be detected by IOUS were followed up, except for any that were unintentionally resected as part of a larger surgical specimen. Iannacone R, Laghi A, Catalano C, et al. 14-2018-032 from SNUBH Research Fund. Radiology. Vardhanabhuti V, Loader R, Roobottom CA. Statistical analysis was performed using SPSS for Windows version 20 (Chicago, Illinois, USA). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Cholangiocarcinoma: pictorial essay of CT and cholangiographic findings. 17.15) [57]. Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma. 2011;259:7308. Recurrence was detected by imaging in eight (47.0%) patients. J Magn Reson Imaging. Intralesional fat is uncommon and, when present, is often patchy or heterogeneous. Lim, G. H., Koh, D. C. S., Cheong, W. K., Wong, K. S. & Tsang, C. B. S. Natural history of small, indeterminate hepatic lesions in patients with colorectal cancer. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Theres no scientific evidence that liver detoxes and cleanses actually work. Epub 2005 Apr 15. The combination of hyperdensity on arterial-phase images combined with washout to hypodensity on venous- or delayed phase images, although not sensitive (33%), is highly specific (100%) for the diagnosis of HCC [54] (Fig. In this chapter, we will highlight imaging of focal liver lesions, focusing on the use of MDCT and MR imaging for disease detection and characterization. Conventional filtered back projection (FBP), the standard CT image reconstruction technique for many years, has given way to iterative reconstruction (IR). Liver lesions are abnormal growths of liver cells that can be cancerous or noncancerous. (a) Normal dose MDCT in the venous phase (120 kVp, ref. PubMed Central 2006;59:4604. Benign focal liver lesions have been shown to have higher ADC value than malignant liver lesions, although there is significant overlap [22]. The most common risk factor worldwide for liver cancer is chronic hepatitis B or hepatitis C infection. Among these 60 patients, 43 (71.7%) had solitary indeterminate nodules, 36 (60%) had synchronous lesions, and 24 (40%) had metachronous CRLM. There are multiple foci of high T2-weighted signal within the liver, suggestive of biliary hamartomas. Radiology. Eur. The cystic areas show variable signal intensity at T1-weighted MRI, including being hyperintense to liver related to its proteinaceous content. See additional information. US is frequently used for disease screening and surveillance of cirrhosis patients. Radiographics. 17.8 and 17.9). Materials and methods: Subcapsular lesions that do not exhibit mass effect or a round nature should be carefully evaluated before suggesting the diagnosis of HCC. In the arterial phase, there is also associated increased parenchyma enhancement surrounding many of the lesions. Limited detection of small (10 mm) colorectal liver metastasis at preoperative CT in patients undergoing liver resection. HCC typically do not show contrast retention of liver-specific contrast medium in the hepatobiliary phase, which can add confidence toward the detection and characterization of HCC (Fig. Inflammatory HCA may also harbor activating mutations of b-catenin in exon 3 and are therefore at risk of malignant transformation. They are hypointense on T1-weighted and markedly hyperintense on T2-weighted imaging, sometimes with a lobular contour. All the patients were followed up until October 2019, with a median of 18months (range 1130months). Radiology. On unenhanced T1- and T2-weighted MR images, FNH returns signal intensity similar to hepatic parenchyma but is usually slightly different on either T1- or T2-weighted images. Copyright 2012 American Society for Radiation Oncology. Using a 64-plus-detector-row system, the entire liver can be scanned within 14 s using a submillimeter detector configuration allowing for high-quality multiplanar reconstructions (MPR) [1]. Weg N, Scheer MR, Gabor MP. Liver-specific (or hepatobiliary) MR contrast agents are available and have specific roles in the management of focal liver lesions. Although CT is the most common imaging modality to screen patients with CLRM, there is increasing evidence to show that MRI with hepatocyte-specific tissue contrast is better to detect small lesions characterized as indeterminate on CT with a positive predictive value of 91%12. Investig Radiol. Internet Explorer). 2000;175:16570. Overall survival by pretreatment carbohydrate antigen (CA) 19-9 level (A) and resectability (B). Radiology. for details of this license and what re-use is permitted. Concentric zones of marked enhancement have also been reported. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 1999 Jan;210(1):71-4. doi: 10.1148/radiology.210.1.r99ja0371. HHS Vulnerability Disclosure, Help Article Unable to load your collection due to an error, Unable to load your delegates due to an error. Conversion surgery after cetuximab or bevacizumab plus FOLFIRI chemotherapy in colorectal cancer patients with liver- and/or lung-limited metastases. Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. By contrast, a subset of HCA (510%) is associated with mutations of CTNNB1 in two hot spots in exon 7 and 8, which does not confer an increased risk of malignancy. AJR Am J Roentgenol. Dis. WebAnother common systemic occurrence is cholestatic pruritus which can result from diseases of the liver, gallbladder, or biliary tract. Google Scholar. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in (d) The delayed phase scan reveals washout of the lesion, which is now hypoattenuating (arrow). Coloproctol. (a) Contrast-enhanced MDCT in the arterial phase demonstrates several predominantly hypervascular liver metastases of neuroendocrine cancer of the pancreas. https://doi.org/10.1007/978-3-319-75019-4_17, DOI: https://doi.org/10.1007/978-3-319-75019-4_17. Note that the free-breathing acquisition in this patient resulted in better delineation of the smaller liver metastases as T1 hypointense lesions against the enhancing liver parenchyma (arrows). LIVER MRI IS increasingly used for detection and characterization of focal liver lesions and for the evaluation of diffuse liver disease (1-6). 2005;5:S14956. WebIf benign liver lesions are small and dont cause symptoms, no treatment is needed. Sci Rep 11, 13744 (2021). All rights reserved. The dendritic cells traffic to the skin dLN and present the processed sporozoite antigens to nave CD8+ T cells. Subcentimeter lesions in the liver are common in patients with a new diagnosis of pancreatic cancer. FNH is most likely in young women with a non-cirrhotic liver and if the lesion is homogeneous and near-isodense/near-isointense on unenhanced CT/MR imaging with a central T2-weighted hyperintense scar. The lesions are shown with the same conspicuity. It is also important to document whether vascular invasion or distant metastasis is present. 17.19). 1991;157:499501. Gadoxetic acid-enhanced magnetic resonance imaging: Hepatocellular carcinoma and mimickers. The excess accumulation of iron in the liver may cause severe symptoms and may lead to several liver lesions and cancer complications.
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