What is the role of MRI in the workup of fibrolamellar hepatocellular carcinoma?

Updated: Sep 05, 2019
  • Author: W Ross Stevens, MD; Chief Editor: John Karani, MBBS, FRCR  more...
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Magnetic resonance imaging (MRI) of the liver can be useful in detecting and characterizing primary tumors, and MRI may be slightly more sensitive than CT scanning in detecting multiple intrahepatic recurrent lesions. However, MRI is less sensitive than CT scanning in the detection of extrahepatic disease. Tumors are usually hypointense on T1-weighted images and hyperintense on T2-weighted images, with a fibrous central scar that remains hypointense on both T1- and T2-weighted images. On gadolinium-enhanced MRI, fibrolamellar HCC is characterized by marked heterogeneous enhancement on the arterial phase that washes out and leaves an isointense or hypointense lesion on the portal venous phase. [17, 18, 19, 8, 15, 16]

The imaging time with MRI examinations tends to be longer than with CT scanning or ultrasonography. In patients who are unwilling or unable to remain still during the imaging period, poor-quality images can result because of motion artifact; these artifacts can limit the usefulness of the MRI examination. Some patients may become claustrophobic while they are in the MRI machine; patients may require sedation, or they may not be able to complete the examination. Because of the high magnetic field strength, MRI is contraindicated in patients with a cardiac pacemaker or some internal metallic object, such as an aneurysm clip or metal shrapnel or filings in a critical location. [17, 12, 10, 18, 19]

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