Liver Lesion Differential Diagnosis

The provided description of a liver lesion that is heterogeneous and hyperintense on T2 weighted images, hypointense on T1 weighted images, with arterial enhancement, retained signal intensity in the portal venous phase, and diffuse restriction, suggests several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Hepatocellular Carcinoma (HCC): This is the most common primary liver cancer, especially in patients with cirrhosis. The described imaging characteristics, including arterial enhancement and washout in the portal venous phase, are typical for HCC. The heterogeneous appearance and the specific signal characteristics on T1 and T2 weighted images also align with HCC.

• Other Likely Diagnoses

  • Hemangioma: Although typically homogeneous and showing a more gradual fill-in on dynamic imaging, some hemangiomas can appear heterogeneous, especially if they are large or have undergone degenerative changes. However, they usually do not show significant arterial enhancement followed by washout.
  • Focal Nodular Hyperplasia (FNH): This benign lesion can show arterial enhancement but typically does not have the same level of heterogeneity as described and often has a central scar. The signal characteristics on T1 and T2 can vary but usually do not show the specific pattern described.
  • Hepatic Adenoma: These lesions can be heterogeneous and show arterial enhancement. However, they are less likely to show the specific signal intensity characteristics on T1 and T2 weighted images as described and may have a different pattern of enhancement.

• Do Not Miss Diagnoses

  • Cholangiocarcinoma: Although less common, this malignancy can present with similar imaging characteristics, including heterogeneous appearance and arterial enhancement. It is crucial not to miss this diagnosis due to its poor prognosis and different management approach.
  • Metastasis: Liver metastases can have a wide range of appearances, including heterogeneity and variable enhancement patterns. They are a critical diagnosis not to miss due to their significant impact on patient management and prognosis.

• Rare Diagnoses

  • Intrahepatic Cholangiolocellular Carcinoma: A rare subtype of cholangiocarcinoma that can present with similar imaging features.
  • Hepatoblastoma: A rare liver tumor that primarily affects children but can occasionally be seen in adults, showing variable imaging characteristics.
  • Inflammatory Pseudotumor: A rare benign lesion that can mimic malignancy on imaging, showing heterogeneous appearance and variable enhancement patterns.

Each of these diagnoses has distinct clinical and imaging features, and a definitive diagnosis often requires a combination of imaging modalities, clinical correlation, and sometimes biopsy.