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Hepatocellular adenoma: diagnostic difficulties and novel imaging techniques

A K P Lim, FRCR1,2, N Patel, MSc1,3, W M W Gedroyc, FRCR4, M J K Blomley, FRCR1, G Hamilton, PhD1,3 and S D Taylor-Robinson, FRCP1,3

1 Robert Steiner MRI Unit, MRC Clinical Sciences Centre and Divisions of 2 Imaging and 3 Medicine A, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS and 4 Department of Interventional MRI, Imperial College School of Medicine, St. Mary's Hospital, Praed Street, London W2 1NY, UK



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  		Figure 1. Post-contrast (portal phase) axial CT image shows the non-enhancing lesion in segment V (arrow).

 


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  		Figure 2. (a) Low signal lesion in segment V depicted on T1 weighted MR image with fat saturation (arrow) (TR/TE: 400/17 ms). (b) The lesion appears isointense on fat saturated, T2 weighted MR sequences (arrow) (TR/TE: 6666/74.5 ms). (c) The lesion enhances rapidly post-iv enhancement with gadolinium-DTPA. The MR images were obtained immediately post-infusion of contrast medium (arrow) (TR/TE: 130/4.2 ms). (d) In the delayed phase, post-contrast administration, the lesion fades and becomes isointense to the rest of the liver parenchyma (arrow) (TR/TE: 130/4.2 ms).

 


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  		Figure 3. (a) The lesion in segment V appeared echogenic. (b) After administration of Levovist (Schering AG, Berlin, Germany), using a microbubble specific mode (ADI; Acuson Inc., Mountain View, CA), minimal activity is shown on ultrasound within the segment V lesion (arrowhead). Note the "bright" normal liver parenchyma, which demonstrates uptake of microbubble contrast agent (arrow). (c) Transverse ultrasound image of the lesion post-contrast, again demonstrating minimal activity using ADI mode (arrow).

 


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  		Figure 4. MR spectrum revealing normal metabolite ratios in the unaffected liver and an increased phosphomonoester (PME): phosphodiester (PDE) ratio within the lesion. Pi, inorganic phosphate; {gamma}-, {alpha}- and ß-NTP, {gamma}-, {alpha}- and ß-nucleoside triphosphate; ppm, parts per million.

 




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