Cross posted ask docs , hoping for some clarity, thank you.
Female 36 years, 175cm , 55kg -Australia
Graves’ disease Medications , carbimazole , OCP
CT showed multiple FNH with central scars.
MRI shows multiple solid lesions more consistent with adenoma and not FNH - my question is , how does the CT show obvious central scars consistent with FNH, but no mention of them on the MRI?
Thanks in advance
CT report below:
Test Name: CT Abdomen/Pelvis with contrast Clinical information: CT Abdomen/Pelvis with contrast HISTORY: Correlated with ultrasound. Heterogeneous liver possible abnormality near the head of pancreas. Elevated LFTs biliary picture. TECHNIQUE: CT abdomen and pelvis non contrast, arterial, portal venous phase and delayed. Correlation: Ultrasound abdomen 16/1/2023 FINDINGS: There are multiple hepatic lesion/masses of varying sizes that are isoattenuating on non-contrast CT demonstrating bright homogeneous arterial enhancement with a central non-enhancing scar. The lesions demonstrate hypoattenuation to liver on portal venous phase. The central scars demonstrate no delayed enhancement. -The largest right hepatic lobe mass is in segment 1 sub-capsular region measuring 22 x 22 mm. (Series 8 image 13). -The largest left hepatic lobe mass measures 41.5 x 32 mm (series 8 image 18) - Segment IVb mass measures 331.6 x 24.5 mm (series 8 image 26). -There is a dominant mass that is continuous with the left hepatic lobe inferior edge extending to L5 level inferiorly measuring 76 x 35 x 87 mm (series 8 image 39, series 14 image 147) Central hepatic arteries are enlarged. No evidence of cirrhosis or portal hypertension. Within pancreatic head, there is a well-circunscribed mass like arterial enhancing region with which becomes is intense to the remainder of the pancreas on portal venous phase. This region is hypo attenuating compared to the remainder of the pancreas on delayed phase imaging. No pancreatic duct dilatation or peripancreatic stranding. No peripancreatic collection or pseudocyst formation. Remainder of the intra-abdominal viscera are unremarkable. Portal and splenic veins are patent. Abdominal aorta and its visceral branches are opacified normally. No intra-abdominal lymphadenopathy. Small and large bowel calibre and appearances are within normal limits. Visualised skeleton appears unremarkable. No suspicious osseous lesion. Lung bases are clear. COMMENT: -Multiple hypervascular arterial enhancing lesions disseminated throughout the liver with a dominant exophytic midline mass extending inferiorly. These could represent multiple bertan hepatic lesions like multiple focal nodular hyperplasia or hepatic -arshalte sundrome.
And MRI:
Findings External portal venous multiplanar CT from 30/1/2023 noted. The liver is enlarged with the right lobe measuring 19 cm and the left lobe measuring up to 21 cm craniocaudally.
There are extensive focal solid liver lesions. The largest is a markedly exophytic large mass arising from the inferior undersurface of the segment III best appreciated on coronal imaging. There is a slightly bilobed appearance and measures up to 98 mm craniocaudally by up to 79 mm transversely and 35 mm AP. Most of the solid lesions demonstrate similar arterial phase characteristics with arterial phase enhancement. This is most conspicuous in the subcapsular segment 6 lesion which measures 25 x 18 mm and the inferior segment 4B lesion measuring 32 x 28 mm. There is also patchy arterial phase enhancement within the dominant segment III lesion. The segment II and III there is a markedly heterogeneous with patchy arterial phase enhancement which affects most of the parenchyma with some traversing hepatic vessels. Most of the lesions are iso-enhancing on portal venous phase imaging, although there is patchy hypo-vascularity within multiple superior left lobe lesions. The 3-minute phase imaging is iso-enhancing to slightly hypo-enhancing. Hepatospecific phase imaging is markedly heterogeneous. Most of the dominant arterial phase lesions are hypointense, however the large exophytic segment III lesion is relatively iso-enhancing.
The lesions demonstrate generally heterogeneous diffusion weighted characteristics. The weighted imaging, the background hepatic parenchyma is heterogeneous with bridging areas of T2 hyperintensity. There is no underlying steatosis. The portal vein enhances normally. There is minor prominence of the intrahepatic biliary tree, particularly within the right lobe. The extrahepatic bile ducts are normal. Gallbladder unremarkable. Spleen is not enlarged. No significant pancreatic or renal abnormality. There is no significant upper abdominal lymphadenopathy.
Conclusion Markedly heterogeneous liver parenchyma with innumerable focal hepatic lesions with an number of dominant arterially enhancing lesions which are hypointense on hepatospecific phase imaging consistent with adenomas. The dominant exophytic lesion arising from segment 3 has dimensions of up to 98 x 79 x 35 mm, with patchy arterial phase enhancement but relatively iso- enhancing on the hepatospecific phase. There is markedly heterogeneous parenchyma within segment 2/3/4A likely reflecting a confluence of multiple focal lesions which demonstrate patchy arterial phase enhancement and hypointensity on hepatospecific phase imaging likely reflecting multiple confluent adenomas. The 2 largest lesions within the right lobe have Primovist characteristics more typical of adenomas.
The background hepatic parenchyma is markedly heterogeneous throughout without clear features of steatosis or cirrhosis. The lesions are not typical of focal nodular hyperplasia or haemangiomas. Overall appearances would favour hepatic adenomatosis and risk factor of oral contraceptive use is noted. Inflammatory adenomas are a possibility, however other hepatocellular lesions remain within the differential diagnosis.
No pancreatic abnormalities are demonstrated.
The large exophytic left lobe lesion would benefit from surgical review.
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source https://www.reddit.com/r/Radiology/comments/11tjq3r/liver_adenoma_vs_fnh/
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