Case 9:   Adenoma

Diagnostic Category:

Clinical Presentation:

45 year old woman on oral contraceptive pills (OCP) presents with a palpable hepatic mass.

MR: Adenomatosis in steatosis

Imaging Findings:

MR shows typical adenomatosis within a fatty liver with multiple hypervascular adenomas. The largest biopsy proven adenoma in segment 4/5 is fatty, which can be seen on fat saturated T1w and the opposed-phase image (compare to non fatty smaller adenoma in segment 6, which is not hypointense on opposed-phase image).

Note that masses don't show washout on equilibrium phase on the exam with the extracellular contrast agent. Compare to the exam with the hepatospecific agent Gd-EOB-DTPA where the masses are hypointense on hepatobiliary phase. Adenomas are only slightly hyperintense on T2, which is typical for most hepatocytic lesions. Masses had decreased in size after discontinuation of oral contraceptives when compared to CT that was done 7 years earlier (see CT).