Benign focal liver lesions: The role of magnetic resonance imaging

Figure 11  A 20-year-old female with tuberous sclerosis. Liver magnetic resonance imaging demonstrates a small focal lesion in S8 hyperintense on in-phase T1-weighted images, with signal loss on opposed-phase sequences with marginal india-ink artifact because of chemical shift, hyperintense on T2 turbo spin echo sequences, hypointense on T2-Spectral Attenuated Inversion Recovery (SPAIR) images, without increased signal on diffusion weighted images and hypointense in all phases during dynamic study and on the hepatobiliary phase (HBP). These features are consistent with lipoma. A second nodule in S2-S3 depicts a hyperintense signal on in-phase T1-weighted images, with signal loss on opposed-phase sequence, hyperintense on T2-TSE images, hypointense on T2-SPAIR sequences, without increased signal on diffusion weighted images. The nodule presents minimal vascularization during dynamic study and appears hypointense on HBP, such features are compatible with angiomyolipoma. A: In-phase T1-weighted image; B: Out-of-phase T1-weighted image; C: T2-weighted image; D: T2-Spectral Attenuated Inversion Recovery (SPAIR); E: High b-value diffusion weighted imaging; F: Portal venous phase magnetic resonance imaging (MRI); G: Hepatobiliary phase (HBP) MRI; H: In-phase T1-weighted image; I: Out-of-phase T1-weighted image; J: T2-weighted image; K: T2-SPAIR; L: High b-value diffusion weighted imaging; M: portal venous phase MRI; N: HBP MRI.