A 32-year-old woman taking combined oral contraceptives has an incidental 4 cm liver lesion. MRI shows homogeneous arterial enhancement with a non-enhancing central area that appears bright on T2-weighted images. Hepatobiliary phase imaging shows retained contrast within the lesion except in the central scar. What does this appearance indicate?

• A Hepatocellular carcinoma with a central necrotic core
• B Fibrolamellar hepatocellular carcinoma
• C Hepatic adenoma with central haemorrhage
• D Focal nodular hyperplasia with a central fibrous scar ✓

Explanation

A T2-bright central scar with retention of hepatocyte-specific contrast on delayed hepatobiliary phase is characteristic of focal nodular hyperplasia, a benign lesion formed by a hyperplastic response to a local vascular anomaly. It contains functioning hepatocytes and Kupffer cells, so it takes up gadoxetate while the scar does not. Oral contraceptives enlarge hepatic adenomas rather than FNH, and FNH itself is not hormone dependent. Adenomas do not retain hepatobiliary contrast.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.