A 40-year-old woman undergoes MRI liver for a 3 cm lesion incidentally found on ultrasound. On dynamic contrast-enhanced MRI, the lesion shows peripheral nodular enhancement in the arterial phase, progressive centripetal fill-in on portal venous and equilibrium phases, with the centre remaining non-enhancing. What is the most likely diagnosis?

• A Hepatocellular carcinoma
• B Hepatic metastasis
• C Cavernous hepatic haemangioma ✓
• D Focal nodular hyperplasia

Explanation

Cavernous hepatic haemangioma has a pathognomonic enhancement pattern: discontinuous peripheral nodular enhancement in the arterial phase matching the aortic signal intensity, followed by progressive centripetal fill-in on delayed phases, often with persistent enhancement on equilibrium images. The non-enhancing central scar in large haemangiomas represents fibrous tissue or thrombosed vascular spaces. HCC shows arterial hyperenhancement with washout on portal venous phase. FNH has a central scar that enhances on delayed phases and shows homogeneous early enhancement. Metastases typically show rim enhancement or are hypovascular.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.