Evaluation of focal liver lesions by magnetic resonance imaging and correlation with pathology


  • Uma Maheswara Rao M. Department of Radiodiagnosis, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
  • Lakshman Rao Ch. Department of Radiodiagnosis, Maharaja Institute of Medical sciences, Nellimarla, Vijayanagaram, Andhra Pradesh, India




Focal liver lesions, MRI Liver, Liver metastases, Liver abscess, Hemangioma liver


 Background: The goals of imaging in focal liver lesions is to assess the number, size, location and characterize the lesions as benign / malignant with newer imaging modalities and confirmation of pathology by Fine needle aspiration cytology or by biopsy. This is essential for treatment planning and prognosis.

Methods: A total of 42 patients detected to have focal lesions in liver on ultra-sonogram were characterized on MRI on the basis of morphology, signal characteristics, enhancement patterns. Extra hepatic spread is suggested by capsular breach, peritoneal metastases and lymph node enlargement. Tissue diagnosis was obtained by fine needle aspiration cytology/ Tru cut biopsy/ surgery. Hemangiomas and simple cysts were followed up for an average period of 7.5 months by imaging without biopsy.

Results: Out of 42 patients, 28 were males (68%) and 14 were females (32%). The age range was 20 to 70 years with a mean age of 51 years for malignant lesions. The right lobe of liver was involved in 26 (62%), left lobe in 7 (17%) and both lobes in 9(21%) cases. There were 24 benign and 18 malignant lesions. The mean ADC value was 2.092 X 10-3 sec/ mm2 and 1.241 X 10-3 sec/ mm2 for benign and malignant lesions respectively. The difference in mean ADC values in both the groups was significant (p<0.0001).

Conclusions: MRI was able to predict diagnosis in 38 of the 42 lesions (90%) which were proved on pathology or by follow up imaging. MRI could not provide specific diagnosis in two early abscess, one each of multifocal hepatocellular carcinoma and regenerative nodules. Thus MR imaging is a powerful tool for the evaluation of focal liver lesions.


Karhunen PJ. Benign hepatic tumours and tumour like conditions in men. J ClinPathol. 1986;39(2):183-8.

Schwartz LH, Gandras EJ, Colangelo SM, Ercolani MC, Panicek DM. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology. 1999;210:71-4.

Yoon SS, Tanabe KK. Surgical treatment and other regional treatments for colorectal cancer liver metastases. Oncologist. 1999;4:197-208.

McFarland EG, Mayo-Smith WW, Saini S, Hahn PF, Goldberg MA, Lee MJ. Hepatichemangiomas and malignant tumors: improved differentiation with heavily T2-weighted conventional spin-echo MR imaging. Radiology. 1994;193(1):43-7.

Coenegrachts K, Delanote J, Ter Beek L, Haspeslagh M, Bipat S, Stoker J, et al. Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques. Br J Radiol. 2007;80:524-31.

Bruegel M, Gaa J, Waldt S, Woertler K, Holzapfel K, Kiefer B, et al. Diagnosis of hepatic metastasis: comparison of respiration- triggered diffusion-weighted echoplanar MRI and five t2-weighted turbo spinechosequences . AJR Am J Roentgenol. 2008;191:1421-9 .

Nasu K, Kuroki Y, Nawano S. Hepaticmetastases: diffusion-weighted sensitivity encodingversus SPIO-enhanced MR Imaging Radiology. 2006;239:122-30 .

Parikh T, Drew SJ, Lee VS, Wong S, Hecht EM, Babb JS, et al. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology. 2008;246:812-22.

Obuz F, Oksüzler M, Seçil M, Sağol O, Karademir S, Astarcioğlu H. Efficiency of MR imaging in the detection of malignant liver lesions. Diagn Interv Radiol. 2006;12(1):17-21.

Pawluk RS, Tummala S, Brown JJ, Borrello JA. A retrospective analysis of the accuracy of T2 -weighted images and dynamic gadolinium-enhanced sequences in the detection and characterization of focal hepatic lesions. J MagnReson Imaging. 1999;9:266-73.

Soyer P, Gouhiri M, Rondeau Y, Spelle L, Mosnier H, Scherrer A. Non-breath-hold fast spin-echo versus breath hold fast spin-echo and spoiled gradient-recalled echo MR imaging in the detection of hepatic tumors: correlation with surgical findings. AJR Am J Roentgenol. 1997;168:1199-204.

Catasca JV, Mirowitz SA. T2 weighted MR imaging of the abdomen: fast spin-echo vs conventional spin-echo sequences. AJR Am J Roentgenol. 1994;162:61-7.

Coulam CH, Chan FP, Li KC. Can a multiphasic contrast-enhanced three-dimensionalfast spoiled gradient-recalled echo sequence be sufficient for liver MR imaging? AJR Am J Roentgenol. 2002;178:335-41.

Kelekis NL, Semelka RC, Woosley JT. Malignant lesions of the liver with high signalintensity on T1-weighted MR images. J Magn Reson Imaging . 1996;6:291-4.

Marani SA, Canossi GC, Nicoli FA, Alberti GP, Monni SG, Casolo PM. Hydatid disease: MR imaging study. Radiology. 1990;175(3):701-6.

Méndez RJ, Schiebler ML, Outwater EK, Kressel HY. Radiology. Hepatic abscesses: MR imaging findings. 1994;190(2):431-6.

Inan N, Arslan A, Akansel G, Anik Y, Sarisoy HT, Ciftci E, Demirci A. Diffusion-weighted imaging in the differential diagnosis of simple and hydatid cysts of the liver. AJR Am J Roentgenol. 2007;189(5):1031-6.

Chan JH, Tsui EY, Luk SH, Fung AS, Yuen MK, Szeto ML, et al. Diffusion-weighted MR imaging of the liver: distinguishing hepatic abscess from cystic or necrotic tumor. Abdom Imaging. 2001;26:161-5.

Vilgrain V, Fléjou JF, Arrivé L, Belghiti J, Najmark D, Menu Y, et al. Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology. 1992;184(3):699-703.

Portmann B, Stewart S, Higenbottam TW, Clayton PT, Lloyd JK, Williams R Nodular transformation of the liver associated with portal and pulmonary arterial hypertension. Gastroenterology. 1993;104(2):616-21.

Lee IJ, Jeong SH, Choi JW, Park HS, Lee KH, Kim H Radiological findings in a case of multiple focal nodular hyperplasia associated with portal vein atresia and portopulmonary hypertension Korean J Radiol. 2008;9(4):386-9.

MatildeNino-Murcia M, Olcott EW, Jeffrey RB Jr, Lamm RL, Beaulieu CF, Jain KA. Focal liver lesions: pattern based classification scheme for enhancement at arterial phase CT. Radiology. 2000;215(3):746-51.

Maetani Y, Itoh K, Egawa H, Haga H, Sakurai T, Nishida N, Ametani F, Shibata T, Kubo T, Tanaka K, Konishi J Benign hepatic nodules in Budd-Chiari syndrome: radiologic-pathologic correlation with emphasis on the central scar. AJR Am J Roentgenol. 2002;178(4):869-75.

Vilgrain V, Lewin M, Vons C, Denys A, Valla D, Flejou JF, et al. Hepatic nodules in Budd-Chiari syndrome: imaging features. Radiology. 1999;210:443-50.




How to Cite

Rao M., U. M., & Ch., L. R. (2016). Evaluation of focal liver lesions by magnetic resonance imaging and correlation with pathology. International Journal of Research in Medical Sciences, 4(11), 4659–4668. https://doi.org/10.18203/2320-6012.ijrms20163503



Original Research Articles