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This case is of a 41-year-old female with right upper

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quadrant pain for which an ultrasound was performed.

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Let's have a look at the ultrasound.

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So we can see a bunch of grayscale and color

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images performed to the right upper quadrant.

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And as we scroll over to evaluate the liver, we can see that

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there is an echogenic liver lesion in the left hepatic lobe.

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Some of the borders are a little bit

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ill-defined along this aspect over here.

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As we scroll through the images more, we can

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see it measures around two centimeters in size.

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And on the transverse image, we can also see it over

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here, echogenic, some borders are a little ill-defined.

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And so this lesion is really indeterminate, uh, patient's,

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uh, 41 years old, maybe something benign like a hemangioma.

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It could be something that's, uh, more worrisome,

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and so an MRI was suggested for further evaluation.

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So as we start looking at our liver MRI, we're

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gonna start with our T2-weighted sequences.

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On these sequences, you can see the liver

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lesion here in the left hepatic lobe.

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So, on the T2-weighted image performed without fat

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saturation, you can see that it is hyperintense.

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On the T2-weighted image performed with

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fat saturation, the turbo spin echo sequence,

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you can see that it is quite hyperintense.

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And remember, we're going to use this sequence to evaluate

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for the actual T2 content of any indeterminate liver lesion.

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And so already, when I look at this liver lesion and

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see its hyperintense T2 content that is somewhat

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similar to CSF, I'm not really worried about it.

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If that content was similar to the spleen over

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here, then I'd be a little bit more worried.

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However, given the T2 signal here,

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I'm not too worried about it.

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It may be a cyst, may be hemangioma, and

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I need to look at my other sequences.

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In order to better evaluate it.

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So next up we're going to look at

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our in and out of phase sequences.

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Over here we have the out-of-phase sequence.

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We can see that this lesion is T1 hypointense

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on the out-of-phase sequence.

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Here we have the in-phase sequence.

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Again, this lesion is T1 hypointense.

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And there is no signal loss in either the out-

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of-phase sequence or the in-phase sequence

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to suggest that this mass contains fat

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or anything that causes increased

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susceptibility, respectively.

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We'll then move on to the T1 FATSAT pre-contrast image,

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to see what this lesion looks like on this imaging study.

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So you have a T1 pre-contrast FATSAT, you can

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again see this image about 2 centimeters in

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size, pretty well-defined, looks like it's T1

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hypointense on this imaging sequence over here.

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And then we'll move on to our T2 FATSAT

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post-contrast imaging.

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Now these sequences become very

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important when we evaluate these lesions.

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So here we have the arterial phase image.

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We can see the lesion over here, and this demonstrates

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peripheral discontinuous puddling of contrast.

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So I'm going to draw the lesion out here and

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sort of show a little bit about what this lesion

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is doing in terms of its contrast enhancement.

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Bye for now.

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So it's out in the periphery and it's discontinuous,

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it's not ring enhancement, just little areas

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of enhancement seen associated with it.

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On the portal venous phase image, we can see that

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these areas of enhancement are becoming a little bit

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more prominent and they're kind of growing centrally.

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And, uh, oftentimes we call this centripetal enhancement.

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Finally, on the equilibrium phase images, we

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can see that this lesion over there is almost

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filled, and completely filled with contrast.

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So the post-contrast imaging sequences combined with

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the information gained from the T2-weighted images

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make this lesion diagnostic of a hepatic hemangioma.

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This is a very important lesion to be able to recognize

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because it is the most common benign liver lesion.

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It's seen in up to 20% of patient

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populations, more commonly seen in females.

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It can be solitary.

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Multiple cases can be seen, up to 40 percent of cases.

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They're often small and the great thing about hemangiomas

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is that there are essentially few to no complications.

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So if you're able to diagnose this as a hemangioma,

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you can rest assured that the patient will be okay.

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Now some hemangiomas tend to be pedunculated, so they, um,

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sort of arise off the liver in such a manner like this.

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And in those lesions, they've been described

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as potentially torsing upon its stalk

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and that can cause some abdominal pain.

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Some lesions that happen to be quite large and occupy a

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portion of the liver can also have some complications.

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We'll cover those lesions in another

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couple of cases that we see here.

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But overall, we're able to diagnose

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this T2 hyperintense mass.

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With peripheral discontinuous puddling of contrast, which

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fills in from the arterial to the equilibrium phase images,

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we can rest assured this will be a hepatic hemangioma.