Images in GIM
Focal Nodular Hyperplasia
About the Author
Paul Trepanier is a radiologist in Nanaimo, British Columbia.
A 44-year-old female underwent liver ultrasonography to rule out gallstones as the cause of abdominal discomfort. A nonspecific, solid, isoechoic, well-circumscribed mass was identified in the right lobe. Figures 1 to 6 were obtained at three different institutions as the patient sought consultation from different physicians unbeknownst to each other. This overuse of radiology affords us the opportunity to correlate findings with different imaging techniques.
Figures 1 and 2 are from an arterial phase computed tomographic (CT) scan with intravenous contrast demonstrating avid enhancement of the focal nodular hyperplasia (FNH). The dysplastic lesion has a preferential hepatic arterial supply rather than the surrounding normal liver parenchyma, which has a predominantly portal venous blood supply. Figure 3 is from a hydroxyiminodiacetic (HIDA) scan, which demonstrates the retention of the tracer in the FNH. This dysplastic lesion lacks normal biliary duct drainage; therefore, the activity is retained relative to adjacent normal liver. Figures 4 and 5 are from a contrast-enhanced magnetic resonance image during the hepatic arterial and portal venous phases. The lesion has the same behaviour as discussed with the CT scan.
Figure 6 is from a red blood cell (RBC) scan to assess for potential hemangioma. The lesion is photopenic relative to adjacent liver, whereas a hemangioma demonstrates avid uptake because of the prominent vascular spaces. FNHs can be photopenic since they can be less vascular and may have limited portal venous branches.
 
Figure 1. Arterial phase CT scan of FNH (arrow). Figure 2. Arterial phase CT scan of FNH (arrow).
 
Figure 3. HIDA scan of FNH (arrow). Figure 4. Contrast-enhanced MRI of FNH (arrow).
 
Figure 5. Contrast-enhanced MRI of FNH (arrow). Figure 6. RBC scan of FNH (arrow).
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