On CT, 'central scar' with radiating fibrous bands in a liver mass showing homogeneous arterial hyperenhancement and washout in delayed phase is characteristic of which entity?

• A Focal nodular hyperplasia (FNH) ✓
• B Hepatocellular adenoma
• C Hepatocellular carcinoma (fibrolamellar type)
• D Cholangiocarcinoma (mass-forming type)

Explanation

Focal nodular hyperplasia (FNH) characteristically shows: (1) homogeneous intense arterial hyperenhancement due to anomalous central artery, (2) rapid washout to near-isodense in portal phase, (3) central stellate scar that is hypodense on CT (fibrous tissue) but T2 hyperintense on MRI (contains vessels, myxoid change), and (4) spoke-wheel arterial pattern on angiography. On MRI with hepatobiliary contrast agents (Gd-EOB-DTPA/Primovist), FNH shows retention in hepatobiliary phase (iso/hyperintense to liver), confirming functional hepatocytes — a definitive diagnostic feature. Fibrolamellar HCC also has a central scar but in a non-cirrhotic young patient with AFP normal; scar is T2 hypointense and calcified.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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