Surgery Multiple Choice Questions
Haemangioma Liver
Ultrasound- Homogenous echogenic lesion which shows posterior acoustic enhancement.
Atypical larger lesions have heterogenous echotexture, calcification hypoechoic areas
haemorrahge or scarring. They have echogenic periphery with hypoechoic centre.
CT and MRI- Peripheral Nodular enhancement in arterial phase progressing to uniform enhancement in delayed phase
Small lesions might not show any enhancement and haemangiomas have to be considered in D/d of hypodense and hyperenhancing lesions.
MRI Hypointense on T1W
Hyperintense on T2W
Metastatic deposits on heavy T2W loose the hyperintense signal whereas haemangiomas contiune to be hyperintense.
Welcome to the Surgery Multiple Choice Questions (MCQS)
This is a review of imaging modality and diffential diagnosis of common hepatic lesions
Focal Nodular Hyperplasia
Ultrasound- Homogenous Isoechoic lesion.
These are diagnosed on the basis of isoechoic texture, central scar and Doppler Ultrasound findings of
arterial vessels radiating from the centre to the periphery (Spoke Wheel Pattern).
Contrast Enhanced Ultrasound- Homogenous enhancement in arterial phase and isoechoic in portal venous pahse.
Metastasis become hypoechoic in delayed imaging
CT scan --Iso or Hypodense to the liver with low attenuating central scar.
It is well circumscribed, no haemorrage, no fat or calcification.
Diffuse enhancement in arterial phase, iso dense or hypodense in portal venous pahse.
Scar of FNH is hypodense in arterial and venous phase and shows enhancement in delayed pahse. Other hypervascular tumors of the liver are Hepatocellular Carcinoma, Adenoma, Fibrolamellar HCC and Hypervascular metastasis.
MRI - It is the most sensitive and specific for FNH. It is Isointense on T1W and hyperintense on T2W
Scar is hyperintense.
Adenoma Liver
Ultrasound- Echogeninc due to high lipid content
These can have necrosis and haemorrage.
Colour Doppler differentiates FNH from Adenoma
It shows large subcapsular vessels.
CT scan --Peripheral enhancement in arterial phase, isodense in the portal venous phase.
Shows haemorrage, fat or calcification.
MRI - It can be either hypointense or hyperintense on T1W.
Most lesions are heterogeous onT2W
Features that differentiate Adenoma from FNH are T1W heterogenicity, absent uptake of SPIO (Superparamagnetic Iron Oxide.
