PMC8424748_01
(a) A well-defined heterogeneous lesion in the right lobe of liver with solid echogenic areas and anechoic cystic areas; (b) No obvious internal vascularity on Doppler imaging.
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It was solid and iso to hyperechoic in appearance with a few cystic areas (Figure 1a). No apparent internal vascularity was demonstrated on the colour Doppler study (Figure 1b).
(a) Axial contrast-enhanced CT images demonstrating the cystic appearance of the mass with eccentric internal vascularity (red arrow heads); (b) Sagittal maximum intensity projection image showing a tortuous artery supplying the periphery of the lesion as denoted by the black arrow.
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CT (CECT) and CE-MRI were requested for further evaluation of the lesion. Contrast-enhanced CT demonstrated a cystic appearing mass (attenuation: 20-25 HU) with peripheral internal vascularity (Figure 2a and b).
(a) Axial and (b) coronal T2W images showing a hyperintense cystic appearing lesion with heterogeneous internal components and fluid-fluid levels; (c) Axial T1W image revealing hyperintense, internal haemorrhagic contents; (d) Post-contrast T1W image indicating only peripheral vascularity (red arrow heads) with no obvious internal solid enhancing soft tissue.
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MRI revealed T2 hyperintensity with heterogeneous internal content and fluid-fluid levels (Figure 3a and b). Areas of variable T1 hyperintensity were also seen, possibly due to haemorrhagic components of varying ages (Figure 3c). No enhancing solid tissue was seen within the lesion on post-contrast (gadopentetate dimeglumine) T1 weighted (T1W) images except for a few peripheral enhancing vessels as seen on CECT (Figure 3d).
(a) Axial diffusion-weighted images image at b = 800 sec/mm2 shows heterogeneous content with hyperintensity areas that reveal low signal on the corresponding apparent diffusion coefficient map (b), indicating diffusion restriction. This was related to the internal haemorrhage and necrotic tissue. White arrows mark a focal haemorrhagic focus (marked T1 hyperintensity as seen in Figure 3C), showing significant restricted diffusion.
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Diffusion-weighted images (DWI) revealed variable signal with foci of restricted diffusion (Figure 4a and b), corresponding to the haemorrhagic and necrotic areas.