Investig Magn Reson Imaging.  2015 Sep;19(3):200-204. 10.13104/imri.2015.19.3.200.

Hepatic Lymphoma Representing Iso-Signal Intensity on Hepatobiliary Phase, in Gd-EOB-DTPA-Enhanced MRI: Case Report

Affiliations
  • 1Department of Radiology, Seoul Medical Center, Seoul, Korea. radiokye@naver.com
  • 2Department of Pathology, Seoul Medical Center, Seoul, Korea.

Abstract

Image findings of hepatic lymphoma have been reported as variable, ranging from single or multiple small nodules to diffuse infiltrative patterns. On MRI, most hepatic lymphomas show T1 low signal intensity, T2 high signal intensity. Dynamic imaging reveals a hypointense appearance in the arterial phase, followed by delayed enhancement in the portal venous and transitional phase. In the hepatobiliary phase using a hepatocyte-specific contrast agent (which have recently aided in increasing the access to the focal liver lesions), hepatic lymphoma is known to exhibit low signal intensity. We report a case of hepatic lymphoma, which shows iso-signal intensity on hepatobiliary phase, using gadoxetic acid (Gd-EOB-DTPA).

Keyword

Hepatic lymphoma; Gd-EOB-DTPA; Magnetic resonance imaging

MeSH Terms

Liver
Lymphoma*
Magnetic Resonance Imaging*

Figure

  • Fig. 1 An 80-year-old man with secondary hepatic lymphoma. (a) On T2-weighted imaging, there was a high signal intensity nodule (arrow) in S4 of the liver. (b) T1-weighted image demonstrated a hypointense nodule in S4 of the liver. (c-e) On Gd-EOB-DTPA-enhanced MR imaging, the nodule was visualized with poor enhancement during portal phase (c), progressive heterogeneous enhancement in the transitional phase (d), and isosignal intensity on 20 minutes-delayed hepatobiliary phase (e). (f) Positron emission tomography (PET) showed intense fluorodeoxyglucose (FDG) uptake of the nodule in S4 of the liver and multifocal periportal area. (g) On T2-weighted imaging, there was a periportal infiltrative, slightly hypointense mass (arrow) in the right hepatic lobe. (h) T1-weighted image demonstrated an infiltrative hypointense mass in the right hepatic lobe. (i-k) On Gd-EOB-DTPA-enhanced MR imaging, the nodule was visualized with progressive enhancement during the portal (i) and transitional phase (j), and isosignal intensity on 20 minutes-delayed hepatobiliary phase (k). (l) PET showed intense FDG uptake of the periportal mass in the liver. (m) Photomicrography of the histopathological specimen from the hepatic lesion reveals multiple variable sized lymphoid infiltration, which have irregular nuclear contours (Hematoxylin & Eosin staining, × 200). In the immunohistochemical staining (not shown), the neoplastic cells showed cytoplasmic staining for CD3 and granular staining for granzyme-B and TIA-1, consistent with NK-T cell lymphoma, nasal type.


Reference

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