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British Journal of Radiology 75 (2002),695-699 © 2002 The British Institute of Radiology

Case report

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

We report the case of a 30-year-old eastern European female who presented with right upper quadrant pain. Clinical examination was unremarkable and liver function tests were normal. CT identified a 5 cm lesion in segment V of the liver, which was of homogeneous low density with no calcification or significant enhancement. MRI showed the lesion to be hypointense to liver on T1 weighted sequences and isointense on T2 weighted sequences. Rapid arterial enhancement with gadolinium-DTPA faded without leaving a definite central scar. Ultrasound showed the lesion to be echogenic with minimal vascularity. Administration of a liver-specific microbubble contrast agent showed low uptake relative to the surrounding liver. Phosphorus-31 MR spectroscopy, localized to the lesion itself, revealed a markedly increased phosphomonoester resonance with a decreased phosphodiester resonance, compatible with increased cell turnover. Biopsy confirmed the lesion to be a hepatocellular adenoma. The diagnosis of a hepatic adenoma is difficult with tissue diagnosis the gold standard, but it may be suggested by a combination of imaging modalities. We have described two new imaging techniques not previously described in characterization of hepatic adenomata, namely ultrasound with contrast agent and MR spectroscopy.




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