Fat-containing liver lesions: a pictorial review

Parente, Daniella Braz; Oliveira Neto, Jaime Araújo; Araújo, Antonio Luis Eiras de; Rodrigues, Rosana Souza; Perez, Renata Mello; Marchiori, Edson

doi:10.1590/0100-3984.2016.0147

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Pictorial Essay • Radiol Bras 51 (1) • Jan-Feb 2018 • https://doi.org/10.1590/0100-3984.2016.0147 linkcopy

Fat-containing liver lesions: a pictorial review

Lesões hepáticas que contêm gordura: ensaio iconográfico

Authorship SCIMAGO INSTITUTIONS RANKINGS

The aim of this pictorial essay is to review the spectrum of fat-containing liver lesions and their characterisation on magnetic resonance imaging with focus on the radiological features that aid in the differential diagnoses. Fat-containing liver lesions comprise a heterogeneous group of tumours with variable imaging findings. Magnetic resonance imaging clearly displays the micro- and macroscopic fat components of the lesions and other characteristic features that are helpful tools to make the differential diagnosis.

Keywords:
Fatty liver/diagnostic imaging; Liver neoplasms/diagnostic imaging; Magnetic resonance imaging

Authorship

person Daniella Braz Parente

schoolMD, PhD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilMD, PhD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.schoolD’Or Institute for Research and Education, BrazilD’Or Institute for Research and EducationBrazilBrazilD’Or Institute for Research and Education, Brazil

person Jaime Araújo Oliveira Neto

schoolMD, D’Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.D’Or Institute for Research and EducationBrazilRio de Janeiro, RJ, BrazilMD, D’Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.

person Antonio Luis Eiras de Araújo

schoolMD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilMD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.schoolD’Or Institute for Research and Education, BrazilD’Or Institute for Research and EducationBrazilBrazilD’Or Institute for Research and Education, Brazil

person Rosana Souza Rodrigues

person Renata Mello Perez

person Edson Marchiori

schoolMD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilMD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

Mailing address: Dra. Daniella Braz Parente. Rua General Garzon, 100, ap. 1002, Lagoa. Rio de Janeiro, RJ, Brazil, 22470-010. E-mail:
daniella.parente@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilMD, PhD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.

D’Or Institute for Research and Education, BrazilD’Or Institute for Research and EducationBrazilBrazilD’Or Institute for Research and Education, Brazil

MD, D’Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.D’Or Institute for Research and EducationBrazilRio de Janeiro, RJ, BrazilMD, D’Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.

MD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilMD, Universidade Federal do Rio de Janeiro (UFRJ) and D’Or Institute for Research and Education, Rio de Janeiro RJ, Brazil.

D’Or Institute for Research and Education, BrazilD’Or Institute for Research and EducationBrazilBrazilD’Or Institute for Research and Education, Brazil

MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilMD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

Figures

Figures (8)

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Figure 1 Hepatic lipomatous lesion. A: Axial in-phase T1-weighted GRE image shows a small hyperintense lesion (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows peripheral signal loss (arrow). This is a lipomatous lesion and can represent either a lipoma or an angiomyolipoma.

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Figure 2 Pseudolipoma of Glisson’s capsule. A: Axial in-phase T1- weighted GRE sequence shows a small subcapsular hyperintense lesion (arrow). B: Axial out-of-phase T1-weighted GRE image shows peripheral signal loss (arrow).

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Figure 3 Teratocarcinoma metastasis from an ovarian source with peritoneal dissemination. A: Axial in-phase T1-weighted GRE image shows a small hyperintense lesion on the hepatic dome (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows peripheral signal loss (arrow). Mild diffuse decrease in the signal intensity of the liver, due to steatosis is also observed.

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Figure 4 Focal hepatic steatosis. A: Axial in-phase T1-weighted MRI scan shows a hyperintense lesion in the posterior region of segment IV (arrow). B: Axial out-of-phase T1-weighted image shows uniform decrease in the signal intensity of the lesion (arrow).

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Figure 5 Multinodular hepatic steatosis. A: Axial in-phase T1-weighted GRE sequence shows multiple slightly hyperintense foci diffusely distributed in the liver. B: Axial out-of-phase T1-weighted GRE sequence shows signal loss in the foci.

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Figure 6 Focal nodular hyperplasia. A: Axial in-phase T1-weighted GRE sequence shows a hypointense lesion (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows diffuse signal loss within the lesion (arrow). C: Axial gadolinium-enhanced T1-weighted GRE arterial phase image shows intense homogeneous enhancement of the entire lesion (arrow), except for the central scar (arrowhead). D: Axial gadolinium-enhanced T1-weighted GRE equilibrium phase image shows that the lesion has become isointense relative to the surrounding parenchyma, and that the central scar has enhanced (arrow).

Thumbnail

Figure 7 Fat-containing regenerative nodules. A: Axial T1-weighted image shows a cirrhotic liver, with volume increase of the caudate and left lobes, with nodular contour and heterogeneous signal intensity. B: Axial T1-weighted out-of-phase image demonstrates multiple diffuse small nodules with signal loss, characteristic of steatotic regenerative nodules. C: Axial T1-weighted image with fat saturation venous phase image shows nodule enhancement to the same degree as the adjacent liver.

Thumbnail

Figure 8 Hepatocellular carcinoma with focal fat deposition. A: Axial in-phase T1-weighted GRE sequence shows a heterogeneously hyperintense lesion (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows focal areas of signal loss within the lesion (arrow). C,D: On axial T1-weighted image with fat saturation arterial phase image (C), the lesion demonstrates strong homogeneous enhancement with washout (D) and pseudocapsule enhancement (arrow).

imageFigure 1 Hepatic lipomatous lesion. A: Axial in-phase T1-weighted GRE image shows a small hyperintense lesion (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows peripheral signal loss (arrow). This is a lipomatous lesion and can represent either a lipoma or an angiomyolipoma. open_in_new

imageFigure 2 Pseudolipoma of Glisson’s capsule. A: Axial in-phase T1- weighted GRE sequence shows a small subcapsular hyperintense lesion (arrow). B: Axial out-of-phase T1-weighted GRE image shows peripheral signal loss (arrow). open_in_new

imageFigure 3 Teratocarcinoma metastasis from an ovarian source with peritoneal dissemination. A: Axial in-phase T1-weighted GRE image shows a small hyperintense lesion on the hepatic dome (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows peripheral signal loss (arrow). Mild diffuse decrease in the signal intensity of the liver, due to steatosis is also observed. open_in_new

imageFigure 4 Focal hepatic steatosis. A: Axial in-phase T1-weighted MRI scan shows a hyperintense lesion in the posterior region of segment IV (arrow). B: Axial out-of-phase T1-weighted image shows uniform decrease in the signal intensity of the lesion (arrow). open_in_new

imageFigure 5 Multinodular hepatic steatosis. A: Axial in-phase T1-weighted GRE sequence shows multiple slightly hyperintense foci diffusely distributed in the liver. B: Axial out-of-phase T1-weighted GRE sequence shows signal loss in the foci. open_in_new

imageFigure 6 Focal nodular hyperplasia. A: Axial in-phase T1-weighted GRE sequence shows a hypointense lesion (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows diffuse signal loss within the lesion (arrow). C: Axial gadolinium-enhanced T1-weighted GRE arterial phase image shows intense homogeneous enhancement of the entire lesion (arrow), except for the central scar (arrowhead). D: Axial gadolinium-enhanced T1-weighted GRE equilibrium phase image shows that the lesion has become isointense relative to the surrounding parenchyma, and that the central scar has enhanced (arrow). open_in_new

imageFigure 7 Fat-containing regenerative nodules. A: Axial T1-weighted image shows a cirrhotic liver, with volume increase of the caudate and left lobes, with nodular contour and heterogeneous signal intensity. B: Axial T1-weighted out-of-phase image demonstrates multiple diffuse small nodules with signal loss, characteristic of steatotic regenerative nodules. C: Axial T1-weighted image with fat saturation venous phase image shows nodule enhancement to the same degree as the adjacent liver. open_in_new

imageFigure 8 Hepatocellular carcinoma with focal fat deposition. A: Axial in-phase T1-weighted GRE sequence shows a heterogeneously hyperintense lesion (arrow). B: Axial out-of-phase T1-weighted GRE sequence shows focal areas of signal loss within the lesion (arrow). C,D: On axial T1-weighted image with fat saturation arterial phase image (C), the lesion demonstrates strong homogeneous enhancement with washout (D) and pseudocapsule enhancement (arrow). open_in_new

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