All Rights Reserved. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Sclerosing angiomatoid nodular transformation (SANT) is a rare benign nonneoplastic vascular lesion of the spleen, first reported in 2004, consistent with multiple angiomatoid nodules separated by fibrous stroma. The diffusion restriction was defined as iso or high signal intensity on the DWI with iso or low signal intensity on the ADC map compared with unaffected splenic parenchyma in that literature. The Prior studies [85,86,87] suggested that an abnormality in the expression or site of MRPs in the hepatocytes may correlate with hyperintensity on HBP, but this theory is still controversial. In non-cirrhotic patients, FNH and FNH-like lesions are likely the most common lesions showing hyperintensity in the HBP. Case 2: central tegmental tract T2 hyperintensity, see full revision history and disclosures, central tegmental tract T2 hyperintensity, symmetrical central nervous system lesions. View larger version (281K) Fig. Among 14 patients, 12 patients underwent MR scan, 5 patients underwent CT scan and 3 patients underwent PET-CT. On CT, all 5 lesions showed hypodensity on non-contrast images and spoke-wheel enhancing pattern after contrast administration, and calcification was observed. The causative mechanism and the clinical relevance of this imaging finding are still unclear. Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Radiology 210:443450, Lee YH, Kim SH, Cho MY, Shim KY, Kim MS (2007) Focal nodular hyperplasia-like nodules in alcoholic liver cirrhosis: radiologic-pathologic correlation. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Right column: Lesions that should not be considered periventricular: (H) lesion not touching the lateral ventricles; An infratentorial lesion is defined as a T 2-hyperintense lesion in the brainstem, cerebellar peduncles or cerebellum. Eur Radiol 26:407416, Min JH, Kim YK, Choi SY et al (2017) Differentiation between cholangiocarcinoma and hepatocellular carcinoma with target sign on diffusion-weighted imaging and hepatobiliary phase gadoxetic acid-enhanced MR imaging: Classification tree analysis applying capsule and septum. A SHC is hypoattenuating on computed tomography (CT) images (020 HU) and appears as hypointense on T1 and strongly hyperintense on T2 images with magnetic resonance imaging (MRI). Cystic change or necrosis was absent in all 12 patients. Clin Nucl Med. 2008;9 Suppl:S52-5. Specifically, -cateninactivated HCAs, -cateninactivated-inflammatory HCA and HCAHCC are expected to show a hyperintense signal on HBP, and HCAHCC might show a faster sinusoidal excretion because of their increased MRP3 expression [44, 46]. Abdom Radiol (NY) 41:2532, International Working Party (1995) Terminology of nodular hepatocellular lesions. It also acts as a practical framework that allows the radiologists to plan the overall treatment. It helps in accurately diagnosing and assessing the diseases. Both the wide bore and open MRI scan methods help radiologists in narrowing the diagnosis. In clinical practice, most focal liver lesions do not uptake hepatobiliary contrast agents. Eur Radiol 28:42434253, van Kessel CS, de Boer E, ten Kate FJ, Brosens LA, Veldhuis WB, van Leeuwen MS (2013) Focal nodular hyperplasia: hepatobiliary enhancement patterns on gadoxetic-acid contrast-enhanced MRI. SANT does not appear to be related to age or gender, although some reports have reported a middle-aged female predominance. Sclerosing angiomatoid nodular transformation of the spleen: clinical and radiologic characteristics. Its not easy for common people to understand the neuropathology of MRI hyperintensity. Bloated or distended bellies. WebBenign developmental hepatic cyst is the second most common benign hepatic lesion (after cavernous hemangioma). Yoshimura N, Saito K, Shirota N, Suzuki K, Akata S, Oshiro H, et al. Van Beers BE, Pastor CM, Hussain HK (2012) Primovist, Eovist: what to expect? Gadoxetate disodium-enhanced MRI demonstrates a small HCC nodule (arrow) that (c) enhances in the hepatic arterial phase and (d) is hypointense in the hepatobiliary phase. Hemangiomas and hamartomas can be distinguished from SANT by their hyperintensity on T2WI. WebThe vast majority of focal liver lesions are hyperintense on T2-weighted magnetic resonance (MR) images. Considering the challenges in the differential diagnosis between FNH-like lesions and HCC, specific diagnosis requires extensive clinical, laboratory and imaging work-up, including follow-up every 6months if liver lesions have features of FNH-like lesions and alpha 1-fetoprotein levels are low, or liver biopsy if imaging features are atypical, if significant changes occur over time or if serum alpha 1-fetoprotein becomes elevated [49]. Among 14 patients, one underwent CT, MRI and PET-CT scan, 2 underwent CT and MRI scan and 2 underwent MRI and PET-CT scan. It produces images of the structures and tissues within the body. In addition to the above considerations and prior to any decision on patient management, it is important to investigate whether the patient has any prior cross-sectional imaging available and to compare all prior examinations, particularly the oldest available one, with the current examination, in order to assess for lesion stability in size or changes of imaging presentations over time. World J Radiol. A 55-year-old man with HCV-related cirrhosis and multiple HCCs. PubMedGoogle Scholar. Lack of appetite or feeling full after eating very little food. 2015;39(2):3157. On T1WI, 10 cases (83.3%) were isointense and 2 cases (16.7%) were slightly hypointense. The wide space makes it easier to conduct brain MRI and other body parts as required. Google Scholar. 12.7C) shows a low tracer uptake, indicating a benign lesion. Although our pathologic review observed hemorrhage in four cases, no hyperintensity on T1WI or hyperdensity on unenhanced CT was presented in our study. Absence of splenomegaly and abdominal lymphadenopathy is helpful in distinguishing SANT from lymphoma. 1. FV and DSG wrote the first draft of the manuscript; GB, RC, AB-S and AT were major contributors in revising the manuscript; FV and DSG identified and collected most of the images; AB-S provided one of the cases; all authors read and approved the final manuscript. The requirement for informed consent was waived by the Ethics Committee of Zhongshan Hospital of Fudan University because of the retrospective nature of the study. [1] [13] The gross pathologic feature of SANT is a well-defined mass composed of numerous angiomatoid nodules separated by fibrosclerotic stroma that often form a central stellate scar. Intern Med. In medicine, MRI hyperintensity is available in three forms according to its location on the brain. A spoke-wheel enhancing pattern is the typical finding for the diagnosis of SANT. Foregut cysts usually possess a definable enhancing wall.[3]. 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The health practitioners claim that the tissue appears brighter on the sequence when there is high water or protein content. If the lesion is suspicious for malignancy (i.e., HCC, cholangiocarcinoma or metastases) but without a definitive imaging diagnosis, biopsy should be indicated to allow for a better patient-tailored management. Gastroenterology 111:526528, Kozaka K, Kobayashi S, Yoneda N et al (2019) Doughnut-like hyperintense nodules in the hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: imaging and clinicopathological features. An elderly woman with a history of anemia. Demirci I, Kinkel H, Antoine D, Szynaka M, Klosterhalfen B, Herold S, et al. Most MRI reports are black and white with shades of gray. Our study included a case showing marked enhancement on arterial phase and remained hyperintensity on delayed phase. poliomyelitis-like syndrome. King A, Walshe J, Kendall B et al. Cholangiocarcinoma and some metastases may demonstrate central contrast retention in the HBP due to fibrotic stroma. At the time the article was created Yahya Baba had no recorded disclosures. Monoacinar nodules are usually 0.110mm in diameter, while large multiacinar nodules are usually 515mm in diameter [26]. Generally, the resected specimen showed the lesions well-circumscribed appearance with central gray-white stellate fibrous scar. Ma J, Zhang W, Wang L, Zhu Z, Wang J, Zhang J, et al. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China, Department of Pathology, Zhongshan Hospital, Fudan University, No. FNH is the second most common benign liver tumor with a prevalence of 0.030.9% in the general adult population, with a peak incidence among women between 30 and 40years old [24, 25]. 2F, G, H). PubMed Staff Login The largest lesions are confluent in the right lobe, showing hypointensity on unenhanced T1-weighted Staff Login For instance, An et al. Firstly, some modalities information was incomplete due to the natural characteristic of the retrospective study. Approximately 8090% of cases of HCCs develop in cirrhotic patients [9]. Become a Gold Supporter and see no third-party ads. Need attention: Very non-specific finding. It might be a siple cyst or a tumor. An ultrasound might differentiate them. Created for people with ongoing healthcare needs but benefits everyone. Simple cyst in the anterior segment of the right liver lobe. If you log out, you will be required to enter your username and password the next time you visit. 1E and 2D), and 2 cases (16.7%) showed hyperintentisy with central hypointensity. Activation of -catenin protein causes uncontrolled hepatocyte proliferation and overexpression of OATP1B3 responsible for iso- or hyperintensity on HBP [32, 45, 46]. CD68-positive staining pattern is also helpful. However, it is important to recognize this entity in oncologic patients treated with oxaliplatin in order to avoid misdiagnosis with metastases. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. What is a 2cm t2-hyperintense lesion in the right hepatic lobe an indication of? Cirrhosis-associated regenerative nodules are innumerable well-defined nodules scattered within cirrhotic parenchyma, surrounded by scar tissue and typically measuring 115mm in diameter [26]. If material is not included in the articles Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. It also indicates the effects on the spinal cord. AJR Am J Roentgenol 201:W603W611, Koh J, Chung YE, Nahm JH et al (2016) Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI. Compared to gadobenate dimeglumine, gadoxetate disodium is administered at a lower dose (0.1mmol/kg vs 0.025mmol/kg of body weights), has greater uptake (50% vs. 35%) and has earlier onset uptake by the hepatocytes (starting from40min vs. 6090s after contrast injection), which results in differences in the enhancement of hepatic parenchyma and vessels on portal venous, delayed and hepatobiliary phase (HBP), as well as earlier acquisition of HBP [2,3,4,5,6]. Approximately 8090 % of cases of HCCs develop in cirrhotic patients [ 9 ] allows the to! A Recipient Address and/or check the Send me a copy checkbox multiple HCCs as required, Akata S Oshiro... Due to the natural characteristic of the right liver lobe ) were hypointense. 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