Multifocal nodular fatty infiltration of the liver mimicking metastatic disease on CT: imaging findings and diagnosis using MR imaging
AbstractAbstract
[en] The aim of this study was to describe the MR appearance of multifocal nodular fatty infiltration of the liver (MNFIL) using T1-weighted in-phase (IP) and opposed-phase (OP) gradient-echo as well as T2-weighted turbo-spin-echo sequences with fat suppression (FSTSE) and without (HASTE). Magnetic resonance imaging examinations at 1.5 T using T1-weighted IP and OP-GRE with fast low angle shot (FLASH) technique, and T2-weighted FSTSE, T2-weighted HASTE of 137 patients undergoing evaluation for focal liver lesions were reviewed. Five patients were identified in whom CT indicated metastatic disease; however, no liver malignancy was finally proven. Diagnosis was confirmed by biopsy (n=3), additional wedge resection (n = 1) or follow-up MRI 6-12 months later (n=5). Regarding the identified five patients, the number of focal liver lesions was 2 (n=2) and more than 20 (n=3). The MR imaging characteristics were as follows: OP-image: markedly hypointense (n=5); IP image: isointense (n=2) or slightly hyperintense (n=3); T2-weighted FSTSE-image: isointense (n=5); T2-weighted HASTE image isointense (n=1); slightly hyperintense (n=4). On OP images all lesions were sharply demarcated and of almost spherical configuration (n=5). Further evaluation by histology or follow-up MR imaging did not give evidence of malignancy in any case. Histology revealed fatty infiltration of the liver parenchyma in three patients. Magnetic resonance follow-up showed complete resolution in two patients and no change in three patients. Multifocal nodular fatty infiltration can simulate metastatic disease on both CT and MR imaging. The combination of in-phase (IP) and opposed-phase (OP) gradient-echo imaging can reliably differentiate MNFIL from metastatic disease. (orig.)
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