← All patterns
Hypervascular liver lesions
AbdomenCT / MRI
Lesions showing arterial-phase hyperenhancement in a non-cirrhotic liver. Enhancement pattern on later phases and clinical history distinguish benign from malignant.
Differential
Haemangioma
common- •Peripheral nodular discontinuous enhancement, centripetal fill-in
- •Very bright on heavily T2-weighted images (light-bulb)
- •Retention of contrast on delayed phase
Focal nodular hyperplasia
common- •Homogeneous arterial enhancement with central scar
- •Scar enhances late; retains hepatobiliary contrast (iso/hyper)
- •Young woman, no capsule
Hypervascular metastases (NET, RCC, melanoma, thyroid)
common- •Multiple lesions, arterial enhancement with washout
- •Known primary (neuroendocrine, renal, melanoma)
Hepatic adenoma
less-common- •Intralesional fat/haemorrhage; drops signal opposed-phase
- •Loss of hepatobiliary contrast uptake
- •Oral contraceptive / anabolic steroid use
Transient hepatic attenuation difference
less-common- •Wedge-shaped subsegmental arterial blush, isodense on portal phase
- •No mass, no washout
Hepatocellular carcinoma
rare- •Arterial enhancement with washout and capsule
- •Usually background cirrhosis / raised AFP
Key discriminators
- •Delayed retention (haemangioma) vs washout (HCC/mets)
- •Central scar (FNH)
- •Intralesional fat/haemorrhage (adenoma)
- •Hepatobiliary-phase uptake (FNH retains, adenoma/malignancy loses)
- •Single vs multiple; known primary
Work-up / next steps
- 1.Multiphase MRI with hepatobiliary contrast agent
- 2.Chemical-shift imaging for fat (adenoma)
- 3.Correlate with OCP use and tumour markers
- 4.Biopsy if adenoma vs FNH remains uncertain or malignancy possible
References
- Radiopaedia: Hypervascular liver lesions.
- Silva AC et al. Hepatic MR imaging. RadioGraphics.
Educational clinical decision support only. This differential does not make a diagnosis, is not a medical device, and must never substitute for interpretation by a qualified radiologist correlated with the full clinical picture and prior imaging.