Match each patient's clinical presentation and multiphasic abdominal imaging findings with the most likely primary hepatic lesion.
- A 65-year-old man with chronic hepatitis C. Computed tomography shows a 3-cm lesion exhibiting avid arterial phase hyperenhancement and rapid contrast washout during the portal venous phase.Hepatocellular carcinoma
- A 40-year-old asymptomatic woman. Magnetic resonance imaging reveals a 4-cm lesion with peripheral, nodular, discontinuous arterial enhancement and progressive centripetal fill-in on delayed phases.Hepatic cavernous hemangioma
- A 32-year-old healthy woman. Computed tomography displays a 5-cm lesion with intense homogeneous arterial enhancement and a central stellate area that retains contrast on delayed venous imaging.Focal nodular hyperplasia
- A 28-year-old woman on long-term oral contraceptives presenting with right upper quadrant pain. Imaging displays a 6-cm lesion with homogeneous arterial hyperenhancement without a central scar or portal venous washout.Hepatic adenoma
- A 70-year-old man with weight loss. Imaging shows a solitary liver lesion with rim-like peripheral arterial enhancement, progressive central fill-in, and overlying hepatic capsular retraction.Intrahepatic cholangiocarcinoma
Answer
Hepatocellular carcinoma presents with arterial hyperenhancement and rapid washout. Hepatic cavernous hemangioma shows peripheral nodular enhancement with centripetal fill-in. Focal nodular hyperplasia features an arterially enhancing mass with a delayed-enhancing central scar. Hepatic adenoma is a hypervascular mass lacking a scar, associated with oral contraceptives. Intrahepatic cholangiocarcinoma exhibits rim enhancement, delayed central fill-in, and characteristic capsular retraction.
The diagnostic evaluation of focal liver lesions depends heavily on characterizing their blood supply through multiphasic contrast imaging. Hepatocellular carcinoma receives its blood exclusively from the hepatic artery, leading to early arterial enhancement, whereas the surrounding parenchyma is supplied by the portal vein, resulting in rapid washout. Hepatic cavernous hemangiomas are slow-flow vascular spaces that fill from the periphery to the center over time. Focal nodular hyperplasia represents a hyperplastic response to an aberrant artery; it enhances intensely in the arterial phase but contains a central fibrotic scar that typically retains contrast on delayed imaging. Hepatic adenomas are benign epithelial tumors strongly associated with oral contraceptive use; they show arterial enhancement but lack the central scar. Intrahepatic cholangiocarcinomas are highly desmoplastic, causing rim-like arterial enhancement, delayed central fill-in due to the dense stroma, and characteristic retraction of the overlying liver capsule.
Step-by-Step Solution
Key Concept
Diagnosis of focal liver lesions using multiphasic contrast-enhanced imaging.