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Telangiectatic Focal Nodular Hyperplasia: US, CT, and MR Imaging Findings with Histopathologic Correlation in 13 Cases¹

¹ From the Departments of Radiology (P.A., V.V., G.B., B. Taouli, Y.M.), Pathology (V.P., B. Terris), and Digestive Surgery and Transplantation Unit (J.B.), Hopital Beaujon, Clichy, France. From the 1999 RSNA scientific assembly. Received February 12, 2002; revision requested April 10; final revision received November 17; accepted December 16. Address correspondence to G.B., Department of Radiology, University of Palermo, via Villaermosa 29, 90139 Palermo, Italy (e-mail: gbranca@yahoo.com).

View larger version (121K): [in a new window]   Figure 1a. Images show multiple lesions of telangiectatic FNH in a 46-year-old woman. (a) Transverse CT scan obtained in the late hepatic arterial phase demonstrates a strong and heterogeneous enhancement pattern in two lesions (arrows). (b) Transverse T1-weighted gradient-echo (160/4.9) MR image shows a hyperintense lesion. Note satellite hyperintense lesion (arrow) that was not clearly seen on T2-weighted MR images (not shown). At resection, lesion did not contain fat but had marked sinusoidal dilatation and a few areas of hemorrhage. (c) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained 5 minutes after contrast material injection shows persistent enhancement of both lesions.

View larger version (125K): [in a new window]   Figure 1b. Images show multiple lesions of telangiectatic FNH in a 46-year-old woman. (a) Transverse CT scan obtained in the late hepatic arterial phase demonstrates a strong and heterogeneous enhancement pattern in two lesions (arrows). (b) Transverse T1-weighted gradient-echo (160/4.9) MR image shows a hyperintense lesion. Note satellite hyperintense lesion (arrow) that was not clearly seen on T2-weighted MR images (not shown). At resection, lesion did not contain fat but had marked sinusoidal dilatation and a few areas of hemorrhage. (c) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained 5 minutes after contrast material injection shows persistent enhancement of both lesions.

View larger version (108K): [in a new window]   Figure 1c. Images show multiple lesions of telangiectatic FNH in a 46-year-old woman. (a) Transverse CT scan obtained in the late hepatic arterial phase demonstrates a strong and heterogeneous enhancement pattern in two lesions (arrows). (b) Transverse T1-weighted gradient-echo (160/4.9) MR image shows a hyperintense lesion. Note satellite hyperintense lesion (arrow) that was not clearly seen on T2-weighted MR images (not shown). At resection, lesion did not contain fat but had marked sinusoidal dilatation and a few areas of hemorrhage. (c) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained 5 minutes after contrast material injection shows persistent enhancement of both lesions.

View larger version (126K): [in a new window]   Figure 2a. Images show a large telangiectatic FNH lesion in a 39-year-old woman. (a) Transverse T2-weighted fast spin-echo (3,250/110) MR image shows a heterogeneous lesion (solid arrows) that is predominantly hyperintense to surrounding liver parenchyma, except for a central hypointense area (open arrow). Microscopic examination of this area showed large puddles of blood that separated nodules of hepatocytes. (b) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained during the hepatic arterial phase demonstrates mild heterogeneous lesion enhancement (arrows). (c) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained during delayed-phase imaging shows the lesion as slightly hyperintense due to persistent enhancement.

View larger version (124K): [in a new window]   Figure 2b. Images show a large telangiectatic FNH lesion in a 39-year-old woman. (a) Transverse T2-weighted fast spin-echo (3,250/110) MR image shows a heterogeneous lesion (solid arrows) that is predominantly hyperintense to surrounding liver parenchyma, except for a central hypointense area (open arrow). Microscopic examination of this area showed large puddles of blood that separated nodules of hepatocytes. (b) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained during the hepatic arterial phase demonstrates mild heterogeneous lesion enhancement (arrows). (c) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained during delayed-phase imaging shows the lesion as slightly hyperintense due to persistent enhancement.

View larger version (110K): [in a new window]   Figure 2c. Images show a large telangiectatic FNH lesion in a 39-year-old woman. (a) Transverse T2-weighted fast spin-echo (3,250/110) MR image shows a heterogeneous lesion (solid arrows) that is predominantly hyperintense to surrounding liver parenchyma, except for a central hypointense area (open arrow). Microscopic examination of this area showed large puddles of blood that separated nodules of hepatocytes. (b) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained during the hepatic arterial phase demonstrates mild heterogeneous lesion enhancement (arrows). (c) Transverse T1-weighted gradient-echo (160/4.9) MR image obtained during delayed-phase imaging shows the lesion as slightly hyperintense due to persistent enhancement.

View larger version (154K): [in a new window]   Figure 3a. Images show multiple lesions of telangiectatic FNH in a 50-year-old woman. (a) Transverse unenhanced CT scan demonstrates a large, slightly hypoattenuating mass (arrowheads). A satellite tumor is also seen (arrow). (b) Transverse CT scan obtained during the hepatic arterial phase demonstrates strong and heterogeneous lesion enhancement. The smaller lesion (arrow) enhances more homogeneously. (c) Transverse CT scan obtained 5 minutes after contrast material injection demonstrates a slightly hyperattenuating mass (arrowheads). Note also hyperattenuation of the satellite lesion (arrow). (d) Transverse T2-weighted fast spin-echo (3,250/110) MR image demonstrates strong hyperintensity of the two lesions. Note the lack of a central scar and the heterogeneity of the largest lesion. (e) Transverse T1-weighted (160/4.9) MR image obtained during bolus infusion of contrast material shows strong and heterogeneous lesion enhancement. The satellite lesion (arrow) also enhances. (f) Transverse T1-weighted (160/4.9) MR image obtained during delayed-phase imaging shows hyperintensity of the large (arrowheads) and small (arrow) lesions.

View larger version (159K): [in a new window]   Figure 3b. Images show multiple lesions of telangiectatic FNH in a 50-year-old woman. (a) Transverse unenhanced CT scan demonstrates a large, slightly hypoattenuating mass (arrowheads). A satellite tumor is also seen (arrow). (b) Transverse CT scan obtained during the hepatic arterial phase demonstrates strong and heterogeneous lesion enhancement. The smaller lesion (arrow) enhances more homogeneously. (c) Transverse CT scan obtained 5 minutes after contrast material injection demonstrates a slightly hyperattenuating mass (arrowheads). Note also hyperattenuation of the satellite lesion (arrow). (d) Transverse T2-weighted fast spin-echo (3,250/110) MR image demonstrates strong hyperintensity of the two lesions. Note the lack of a central scar and the heterogeneity of the largest lesion. (e) Transverse T1-weighted (160/4.9) MR image obtained during bolus infusion of contrast material shows strong and heterogeneous lesion enhancement. The satellite lesion (arrow) also enhances. (f) Transverse T1-weighted (160/4.9) MR image obtained during delayed-phase imaging shows hyperintensity of the large (arrowheads) and small (arrow) lesions.

View larger version (146K): [in a new window]   Figure 3c. Images show multiple lesions of telangiectatic FNH in a 50-year-old woman. (a) Transverse unenhanced CT scan demonstrates a large, slightly hypoattenuating mass (arrowheads). A satellite tumor is also seen (arrow). (b) Transverse CT scan obtained during the hepatic arterial phase demonstrates strong and heterogeneous lesion enhancement. The smaller lesion (arrow) enhances more homogeneously. (c) Transverse CT scan obtained 5 minutes after contrast material injection demonstrates a slightly hyperattenuating mass (arrowheads). Note also hyperattenuation of the satellite lesion (arrow). (d) Transverse T2-weighted fast spin-echo (3,250/110) MR image demonstrates strong hyperintensity of the two lesions. Note the lack of a central scar and the heterogeneity of the largest lesion. (e) Transverse T1-weighted (160/4.9) MR image obtained during bolus infusion of contrast material shows strong and heterogeneous lesion enhancement. The satellite lesion (arrow) also enhances. (f) Transverse T1-weighted (160/4.9) MR image obtained during delayed-phase imaging shows hyperintensity of the large (arrowheads) and small (arrow) lesions.

View larger version (145K): [in a new window]   Figure 3d. Images show multiple lesions of telangiectatic FNH in a 50-year-old woman. (a) Transverse unenhanced CT scan demonstrates a large, slightly hypoattenuating mass (arrowheads). A satellite tumor is also seen (arrow). (b) Transverse CT scan obtained during the hepatic arterial phase demonstrates strong and heterogeneous lesion enhancement. The smaller lesion (arrow) enhances more homogeneously. (c) Transverse CT scan obtained 5 minutes after contrast material injection demonstrates a slightly hyperattenuating mass (arrowheads). Note also hyperattenuation of the satellite lesion (arrow). (d) Transverse T2-weighted fast spin-echo (3,250/110) MR image demonstrates strong hyperintensity of the two lesions. Note the lack of a central scar and the heterogeneity of the largest lesion. (e) Transverse T1-weighted (160/4.9) MR image obtained during bolus infusion of contrast material shows strong and heterogeneous lesion enhancement. The satellite lesion (arrow) also enhances. (f) Transverse T1-weighted (160/4.9) MR image obtained during delayed-phase imaging shows hyperintensity of the large (arrowheads) and small (arrow) lesions.

View larger version (138K): [in a new window]   Figure 3e. Images show multiple lesions of telangiectatic FNH in a 50-year-old woman. (a) Transverse unenhanced CT scan demonstrates a large, slightly hypoattenuating mass (arrowheads). A satellite tumor is also seen (arrow). (b) Transverse CT scan obtained during the hepatic arterial phase demonstrates strong and heterogeneous lesion enhancement. The smaller lesion (arrow) enhances more homogeneously. (c) Transverse CT scan obtained 5 minutes after contrast material injection demonstrates a slightly hyperattenuating mass (arrowheads). Note also hyperattenuation of the satellite lesion (arrow). (d) Transverse T2-weighted fast spin-echo (3,250/110) MR image demonstrates strong hyperintensity of the two lesions. Note the lack of a central scar and the heterogeneity of the largest lesion. (e) Transverse T1-weighted (160/4.9) MR image obtained during bolus infusion of contrast material shows strong and heterogeneous lesion enhancement. The satellite lesion (arrow) also enhances. (f) Transverse T1-weighted (160/4.9) MR image obtained during delayed-phase imaging shows hyperintensity of the large (arrowheads) and small (arrow) lesions.

View larger version (129K): [in a new window]   Figure 3f. Images show multiple lesions of telangiectatic FNH in a 50-year-old woman. (a) Transverse unenhanced CT scan demonstrates a large, slightly hypoattenuating mass (arrowheads). A satellite tumor is also seen (arrow). (b) Transverse CT scan obtained during the hepatic arterial phase demonstrates strong and heterogeneous lesion enhancement. The smaller lesion (arrow) enhances more homogeneously. (c) Transverse CT scan obtained 5 minutes after contrast material injection demonstrates a slightly hyperattenuating mass (arrowheads). Note also hyperattenuation of the satellite lesion (arrow). (d) Transverse T2-weighted fast spin-echo (3,250/110) MR image demonstrates strong hyperintensity of the two lesions. Note the lack of a central scar and the heterogeneity of the largest lesion. (e) Transverse T1-weighted (160/4.9) MR image obtained during bolus infusion of contrast material shows strong and heterogeneous lesion enhancement. The satellite lesion (arrow) also enhances. (f) Transverse T1-weighted (160/4.9) MR image obtained during delayed-phase imaging shows hyperintensity of the large (arrowheads) and small (arrow) lesions.