Benign focal liver lesions: The role of magnetic resonance imaging

Figure 3 A 25-year-old female with 10-year history of oral contraceptive pill presented to the emergency department with diffuse abdominal pain. Liver magnetic resonance imaging demonstrated multiple hepatic lesions, the larger 15 cm in diameter in S4-S5-S8 shows iso-hyperintense signal on T1-weighted sequences, with dishomogenous hypointense central component with peripheral hyperintensity. The lesion is isointense on T2-weighted sequences with marked hyperintensity of the central component; on diffusion weighted images the mass presents a slight increase in signal while the central portion has a marked signal increase. At the dynamic study, the mass has wash-in that persists on the portal venous and delayed phase while the central portion illustrates minimum enhancement. The mass is hypointense on the hepatobiliary phase with a marked hypointense central portion. Liver biopsy demonstrated a hepatic adenoma with a bleeding component. At 13 mo follow-up, the lesion presented a slightly reduced diameter while the central bleeding component was almost completely reabsorbed. A: Out-of-phase T1-weighted image; B: In-phase T1-weighted image; C: T2-weighted image; D: T2-Spectral Attenuated Inversion Recovery; E: High b-value diffusion weighted imaging; F: Arterial phase magnetic resonance imaging (MRI); G: Portal venous phase MRI; H: Delayed phase MRI; I-L: Hepatobiliary phase MRI.