Arterial phase hyperenhancement is a LI-RADS major feature used to categorize masses that are neither definite benign entities nor probable benign entities and that lack features of non-HCC malignancy or tumor in vein When hepatic veins are congested, contrast is prevented from diffusing through the liver in a normal manner. This results in a mottled pattern of contrast enhancement in the arterial and early portal venous phase with decreased enhancement of the liver periphery
.** I need what does this mean? Previous blood work negative for hepatitis, also elevated liver enzymes To assess a possible correlation between active acute hepatitis and the development of abnormal liver perfusion demonstrated as heterogeneous enhancement on arterial phase gadolinium‐enhanced MRI. Dynamically‐enhanced MRI of the liver can detect reversible perfusion abnormalities that correlate with acute hepatitis The optimal cut-off value for the determination of arterial enhancement was a more than 8.8 HU difference between the HCC and the surrounding liver on arterial phase CT. This criterion yielded 97.1% sensitivity, 87.5% specificity, and 94.6% accuracy. However, a considerable number of HCCs (25.9%, 38/147) showed less of an HU difference on arterial phase compared to this specific cut-off value
On arterial-phase imaging, brisk heterogeneous enhancement is noted, with persistent and progressive enhancement in the portal-venous phase. Ninety-minute delayed hepatobiliary-phase imaging shows hypointensity of these lesions relative to the adjacent liver, although there is some heterogeneous internal enhancement that is increased from. • The late arterial (or portal inflow) phase of enhancement occurs ≈25 to 35 seconds after contrast administration, when arteries enhance and portal veins begin to enhance, but hepatic veins do not enhance
Heterogeneous nutmeg-like enhancement is typically visible in the arterial phase, which persists in the delayed phase images. Restricted diffusion may be present Enhancement of the HCC is heterogeneous. On the arterial phase post contrast T1w fat-saturated sequence there are mildly hyperenhancing nodules along the lateral aspect of the HCC (arrowhead) that wash out on the equilibrium phase (arrowhead) Purpose: To assess a possible correlation between active acute hepatitis and the development of abnormal liver perfusion demonstrated as heterogeneous enhancement on arterial phase gadolinium-enhanced MRI. Dynamically-enhanced MRI of the liver can detect reversible perfusion abnormalities that correlate with acute hepatitis They demonstrate less contrast enhancement on arterial phase CT than seen with FNH and become isodense on venous phase imaging. Large adenomas may be heterogeneous as a result of bleeding and.
The net effect is that HCC appears to have washed out when moving from arterial to portal venous phases of imaging . 16 According to the American Association for the Study of Liver Diseases, a hepatic lesion >1 cm that demonstrates arterial enhancement with washout in the venous or delayed phase in MR or CT is certain enough to be HCC. Contrast tumor enhancement is observed on the left during arterial phase. The wash-out phenomenon can be seen on the right, during portal venous phase. HCC appearance on 2D ultrasound is that of a solid tumor, with imprecise delineation, with heterogeneous structure, uni- or multilocular (encephaloid form) flow (7). Arterial phase hyperenhancement is defined as enhancement in the arterial phase that is unequivocally greater than that of the surrounding liver according to the current major guidelines (1, 2). On the basis of these guidelines, the nodule with absolute arterial enhancement, low density, or signal intensity (SI
Figure 9. Computed tomography of axial planes obtained in arterial phase (A), portal phase (B), and late phase (C). Non-cirrhotic liver shows mass in right hepatic lobe (black arrow) with typical behavior of hepatocellular carcinoma. Heterogeneous enhancement in the arterial phase (A), and portal phase (B) with wash-out in delayed phase (C) Regenerative nodule in 53-year-old woman with Budd-Chiari syndrome. (A) CT in the arterial phase shows heterogeneous enhancement of the liver, central hypertrophy with hyperenhancement which is characteristic findings of Budd-Chiari syndrome. There is a subcapsular hypervascular nodule (arrow) What is this saying about my liver and pancreas? Freaking out. I know the growth is nothing, but the heterogeneous liver - Answered by a verified Doctor. Heterogeneous enhancement of the liver on the early arterial phase, could be related to hepatocellular disease. No focal 2
Diffuse homogeneous or heterogeneous enhancement during arterial phase, enhancement similar to that of the liver parenchyma during portal venous and late phases, homogeneous or heterogeneous: Focal fatty sparing: Hypoechoic, triangular shape, segmental distribution, no vessel homogenously hyperattenuating to surrounding liver on arterial phase of enhancement and in homogenously hypoattenuating on portal venous phase. This arterial hypervascularity and heterogeneous appearance is a hallmark of HCC with washout of intralesional contrast on portal venous and delayed phase images. Additional imaging feature A heterogeneous liver appears to have different masses or structures inside it when imaged via ultrasound. These masses may be benign genetic differences or a result of liver disease. In most cases, a finding of heterogeneous liver is followed by further medical testing to determine the cause of the heterogeneity
Focal hypereosinophilic necrosis nodule in a 55-year-old man with no liver disease. a Arterial phase, b PV phase, c HCP, d T2-weighted. Small non-spherical lesion with ill-defined margins in the right lobe with poor enhancement in the arterial and PV phase, mixed hypointensity on the HCP and slightly hyperintense in T2-weighted (black arrows. Due to their predominant arterial supply, many small HCCs enhance vividly in the arterial phase of hepatic contrast enhancement, becoming iso- or hypoattenuating with hepatic parenchyma in the portal-venous phase of enhancement. Delayed-phase images show most HCC lesions as hypodense compared with surrounding liver . The washout of contrast in.
Heterogeneous enhancement: Hyperintensity or increased attenuation after contrast agent administration that varies across the structure in whole or in part enhances relative to precontrast imaging AND has an attenuation or intensity equal to background liver during the arterial phase On arterial and portal venous phases, liver showed significantly heterogeneous contrast enhancement and showed homogenous enhancement in the hepatic parenchymal phase. On the magnetic resonance cholangiopancreatography, irregular biliary ducts with strictures and dilatation were seen
Arterial phase peripheral enhancement is an independent predictor of poor OS. • The imaging features of combined hepatocellular carcinoma-cholangiocarcinoma are complex and are not correlated with the alpha fetoprotein or CA19-9 levels. • Age, CA19-9 > 37 U/ml, arterial phase peritumoral enhancement, and delayed enhancement are independent. However, the enhancement pattern of hepatic metastases can be variable, ranging from minimal to marked, as well as from homogeneous to heterogeneous. A peripheral washout sign may sometimes be seen on delayed phase images To investigate the effect of computed tomography (CT) using hepatic arterial phase (HAP) and portal venous phase (PVP) contrast on dose calculation of stereotactic body radiation therapy (SBRT) for liver cancer. Twenty-one patients with liver cancer were studied. HAP, PVP and non-enhanced CTs were performed on subjects scanned in identical positions under active breathing control (ABC) A case of heterogeneous late-phase hepatic enhancement (HLHE) using contrast‐enhanced ultrasound (CEUS) with SonoVue is presented, where HLHE lasted after 50 min of injection. This study aims to review prior literature on this topic, to characterize the features of HLHE in the liver, and to find possible and reliable explanations for this phenomenon enhancement at late arterial phase, returns to normal in portal phase. Delayed enhancement of the central scar. Hepatic adenoma Almost exclusively women, steroid use, AFP-negative. Background liver normal. Heterogeneous due to hemorrhage and necrosis. Early enhancement, appears isoattenuating relative to the liver on delayed scans. Nodular.
Gatti M, Calandri M, Bergamasco L, Darvizeh F, Grazioli L, Inchingolo R, et al. Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia. Radiol Med. 2020;125(4):348-55 On the pre-contrast GRE Tl-weighted in-phase (b) and out-of-phase (c) images the lesion appears hyper- and hypointense, respectively, compared to the normal liver parenchyma. On the arterial phase image (d) of the dynamic series after Gd-BOPTA injection, the nodule demonstrates marked and heterogeneous enhancement demonstrate heterogeneous enhancement on arterial-phase images, with washout (becoming hypointense to background liver) and a thick, enhancing capsule on delayed-phase images. The T2 signal is variable, though it may be mildly elevated. The DWI signal is also variable, with some HCCs demonstrating little or no restricted diffusion (D) The arterial phase shows that the mass was initially obviously heterogeneously enhanced after the administration of gadolinium. (E) Both the portal phase and (F) delayed-phase images show that the enhancement degree of the lesion was decreased but still visible. (G)In-phase and (H) out-phase images show signal decline within the lesion
Similar findings have been reported on CT and MR images where a well-circumscribed hypervascular mass with homogeneous enhancement is highly suggestive of a low-grade tumor. At the opposite end, an ill-defined hypovascular tumor on arterial and portal phase with heterogeneous enhancement is more common in grade 2 or NEC [59,60,61] Pre-contrast CT scans revealed a large, heterogeneous, low density mass, with a well demarcated margin in the 4th and 8th segments of the liver. The size of the tumour was approximately 96x117x95 mm. Contrast-enhanced CT showed intense and heterogeneous enhancement of the lesion on arterial phase, which was slightly hypodense on portal CT scans.
Arterial phase: Homogeneous hyperenhancement or Necrotic/hemorrhagic areas: HNF1-α: Signal lost on chemical shift; homogeneous, discrete arterial enhancement without persistence during delayed. Gadoxetate disodium-enhanced MRI shows a normal liver characterized by (a) no significant signal drop of hepatic parenchyma in the opposed phase compared to (b) the in-phase and (c) a hepatocellular adenoma (arrow) that shows contrast enhancement in the arterial phase and (d) heterogeneous hyperintensity in the hepatobiliary phase A lesion with heterogeneous enhancement was regarded as hyper-attenuating when most of it was enhanced during the arterial phase compared with the pre-contrast phase. Hyper-attenuation on the arterial phase followed by washout in the portal or equilibrium phase was defined as typical enhancement For example, the presence of a hypervascular pattern in a heterogeneous enhancing hepatic lesion during the arterial phase, is a feature often associated with HCCs . In human medicine, the increasing availability of triple-phase CT, magnetic resonance imaging (MRI) and positron emission tomography (PET) have improved the scope to detect and. Transient heterogeneous enhancement was seen on the arterial phase of dual phase helical CT of the liver. The shape of the enhancement was appeared wedged or patchy. These phenomena without liver tumor were observed in 23 (2.3%) of 1012 patients with suspected hepatobiliary disease. Plain CT showed no attenuation difference in the liver
Arterial Phase Hyperenhancement(APHE) Washout is temporal reduction in nodule enhancement relative to background liver, following some degree of arterial phase enhancement. Washout Degree of Washout Intensity Mild washout Subtype of washout on CEUS in which observation becomes less enhanced than liver, but not devoid of enhancement The 20 nodules exhibited irregular and heterogeneous enhancement on the arterial phase. Only one nodule with tumor size of 1.2 cm (serum AFP level of 84.6 μg/L) showed a regular enhancement on the arterial phase. Washout on portal venous phase occurred in all nodules, and a central scar was not found in any nodules The typical appearance of FNH is a diffusely homogeneous, hyperenhancing, slightly lobulated mass during the arterial phase of imaging (Fig. 1B). 1-6 The contrast enhancement quickly equilibrates with the normal liver parenchyma during the portal venous phase, and the lesion may be difficult to visualize (Fig. 1C). On MRI, FNH may have subtle. 4.5-cm mass in segment VI of liver shows rim-like enhancement on (A) arterial phase image and peripheral washout with enhancing capsule (arrow) on (B) delayed phase image. Mass shows hypointensity on (C) HBP image and heterogeneous hyperintensity with central dark area (thin arrows) on (D) T2WI FNH is perfused by the hepatic arterial system and shows marked, nearly uniform arterial phase enhancement (Figure 2E). The degree of lesion enhancement lessens on subsequent contrast-enhanced images, with lesion signal intensity approaching that of the surrounding liver parenchyma
(B) Axial, non-enhanced CT image showing a calcified mass in the liver (arrow). (C) Axial CT image in the arterial phase, showing the heterogeneous enhancement of the lesions (white arrow and white arrowhead). (D) Axial CT image in the venous phase, revealing lesions with signs of washout in the venous phase (white arrow and white arrowhead) Tumors enhance in arterial phase. Liver will enhance in the portal venous phase. Will be visible as hyperdense lesions in a relatively hypodense liver. also called the hepatic phase because there already must be enhancement of the hepatic veins. HCC Cirrhotic liver with a single nodule in the right lobe showing marked arterial phase enhancement. On contrast-enhanced CT , the tumor reveals a heterogeneous enhancement, which may be hyperdense relative to liver parenchyma in the early arterial postcontrast phase and usually appears iso- or hypodense on delayed images (11). Invasion of the portal vein and its subsequent thrombosis must be evaluated in all suspected cases of hepatoblastoma
Computed tomography findings of FNH: Mixed phase (hepatic arterial phase/portal venous phase during hepatic enhancement) shows intense homogeneous enhancement with hypodense focal central scar (a); on delayed phase (b), the lesion appears substantially isodense to liver parenchyma with persistent enhancement of central scar It can provide information about liver anatomy and its vasculature to the surgeon. Triphasic contrast-enhanced CT is non-enhanced, arterial and portal venous phase or arterial, venous, and the delayed phase. Arterial phase enhancement begins approximately 20 to 25 seconds after IV contrast injection Normally the liver has a dual blood supply. 80% of the blood supply to the liver parenchyma is by the portal vein and the rest of the blood supply, i.e. 20% is by the hepatic artery.When an IV contrast is administered to a patient, the enhance is seen in the portal venous phase, but the blood supply to any tumors in the liver is 100% through the hepatic artery, and therefore they will show. CT • The majority of metastases are of low attenuation on unenhanced and portal phase imaging • Hypervascular tumours may show transient arterial enhancement, becoming isoattenuating to liver during the portal phase • Central necrosis, rim enhancement and calcification (in mucinsecreting metastases of GI origin) can also be demonstrated. A 53-year-old female had multiple HEHE lesions in the right hepatic lobe. a-b: Multiple homogeneous signal masses were observed on T1WI and T2WI.c-e: The enhanced scan showed rim enhancement in the arterial phase and progressive centripetal enhancement in the portal and delayed phases.f: Magnification 200×.Epithelium-like tumor cells were closely arranged
Abdominal dynamic CT revealed a low-density 65-mm diameter mass with an irregular margin in plain, peripheral early ring enhancement in the arterial phase, and internal heterogeneous enhancement in the delayed phase (Fig. 1d-g). Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic response imaging (EOB-MRI. The arterial enhancement washes out rapidly and completely without exception within the arterial time frame (0-45s). Rapid washout should be helpful in differentiation of metastases from primary liver tumors and may explain the generally hypovascular appearance of metastases on contrast-enhanced CT or MR In the venous phase, HCC demonstrates washout and becomes isodense with the liver parenchyma, thereby making its detection difficult . About 10%-20% of HCCs are hypovascular and show contrast enhancement slightly less than that in the surrounding liver on arterial phase images, making the imaging differentiation with DNs difficult
(A,B) Conventional ultrasound showed diffuse enhancement of the liver parenchyma echo, attenuation of the deep echo, and 3.3×2.6 cm hypoecho under the capsule of the upper right anterior lobe, with a regular morphology and clear boundary; (C) enhanced ultrasound showed high enhancement and an increased measured value in the arterial phase of. enhancement during the early phase (arterial/pancreatic) (Figure 1). The enhancement is usually uniform. Sometime, with heterogeneous enhancement because of necrotic and hemorrhagic changes. Patients with hypo-enhancing tumors liver and brai Dynamic MRI (C) shows subtle homogeneous enhancing lesion on arterial phase. And this lesion shows low signal intensity when compared with adjacent liver parenchyma on delayed phase (arrows). Note.-Delay = 20 minutes delayed phase, PP = portal phase. Click for larger imag The enhancement of HCC was significantly reduced in the hepatic arterial phase image (A), whereas the enhancement of adjacent hepatic parenchyma was increased due to the HAPS (white arrows). On equilibrium phase (B), the extension of the tumor can be identified accurately as heterogeneous low density versus adjacent non-cancerous tissue (black.
The nodule displayed heterogeneous enhancement in the late arterial phase , with sustained enhancement in the portal venous and equilibrium phases (figure 1B,C). Six months after MDCT, a liver MR was performed using extracellular paramagnetic contrast. The liver showed steatosis (figure 1D,E) but n In this series, 11 (91.7%) of 12 lesions showed heterogeneous (n = 3) or homogeneous (n = 8) hyperenhancement during the arterial phase of CEUS. The enhancement of the lesions was seen earlier than the enhancement of adjacent liver parenchyma, consistent with evidence reported in the literature [7, 11, 19-21]. The hypervascularity in hepatic.
On dynamic contrast-enhanced MRI, the tumor showed heterogeneous enhancement during the arterial phase (D), as well as decreased enhancement during the portal (E) and delayed phases (F), and showing relative hypointensity. Compared with the peripheral liver parenchyma, the tumor showed a wash-out pattern rim-like or heterogeneous enhancement on the arterial phase and a progressive dynamic pattern. These tumors usually coincide with chronic hepatitis or cirrhosis and poor prognosis appears to be associated with TNM staging. Keywords: Liver, Sarcomatous carcinoma, Combined hepatocellular-cholangiocarcinoma, Cholangiocarcinoma, Hepatocellular. Phases of Enhancement in Liver. Because the liver derives approximately 25% of its blood supply from the hepatic artery and the remaining 75% from the portal vein, there are several phases of enhancement after the intravenous administration of a bolus of contrast material. The first is the hepatic arterial phase typically occurring 15 to 25.
Arterial phase enhancement on abdominal CT and BMI are predictors of treatment's efficacy. Streptozotocin should be the preferred cytotoxic agent in order to save anthracycline for systemic. Over half of the ICC nodules (54.1%) had a peripheral rim-like enhancement during the arterial phase, whereas during the portal and delayed phase, 26 nodules (49.1%) showed a centripetal. In the arterial phase there is homogeneous enhancement of arterial intensity, frequently seen in small hemangiomas. In the portal venous phase and in the equilibrium phase it has the same enhancement as the aorta. So all appearances are consistent with a hemangioma, a benign, non-solid vascular lesion 3D T1W images showed peripheral enhancement of the liver tumors in the arterial phase, gradual fill-in enhancement (heterogeneous enhancement) in the portal phase, and homogeneous low signal intensities in the hepatobiliary phase (Figure 2B). Diffusion-weighted images (DWI) showed mild high signal intensity of the liver tumor heterogeneous and hypodense on precontrast CT images. Significant diffuse heterogeneous enhancement was observed during the arterial phase in 8 cases, and the enhancement was slightly higher than the attenuation of the surrounding normal liver parenchyma and indistinct edges of small lesions during the portal phase. Wel
liver nodules, so it is helpful for diagnosis of benign and malignant lesions. In recent years, some clinical research it was defined as heterogeneous enhancement. The enhancement patterns for all nodules were observed during the arterial phase (0-30 s), the portal Arterial/portal phase enhancement Late phase wash ou enhancement in the portal phase; however, mild negative enhancement of the lesion compared with the liver in the portal venous phase is sometimes seen. The central scar is frequently seen as a hypoechoic area within the lesion, more conspicuously in the portal venous phase than in the arterial phase. The central scar may be dispropor The three mHCCs showed rapidly overall hyper-enhancement during the arterial phase and hypo-enhancement during the portal phase on CE-IOUS (Fig. 1H-J). One of two DNs showed peripheral hyper-enhancement (arrows) in the arterial phase and heterogeneous iso-enhancement in the portal phase of CE-IOUS (Fig. 7B-E). The remaining DN showed delayed. Early heterogeneous enhancement occurs during the arterial phase and progresses to more homogeneous enhancement during delayed phases. The central scar does not enhance during the arterial phase, but it may demonstrate mild enhancement in the later portal or equilibrium phases
Mass found on regular US surveillance. A greyscale image shows a small hypoechoic liver nodule in a very heterogeneous liver (A); at the peak of arterial phase (AP) enhancement, 20 s, the mass is brightly enhanced (B); at one minute, there is isoenhancement. The nodule is now invisible but marked by the arrow (C); there is late and weak washout. Figure 5. These liver-specific contrast magnetic resonance images reveal a hypointense lesion in (A) arterial phase and (B) hepa-tobiliary phase. The hepatobiliary phase image provides a better depiction of the mass, which has a thin peripheral rim with an in-ternal, heterogeneous enhancement pattern A, CT scan in arterial phase (API reveals both central and peripheral enhancement (heterogeneous en- hancement with hyperdense components). B, Corresponding CT scan in portal vein phase (PVP) shows lesion as hypodense Arterial phase: multiple small, hypointense, lesions. Non- enhancing on the early phase Penitoneal implants from mucinous adenocarcinoma scallop the surface of the liver and spleen. Contrast-enhanced: large, ill-defined, low-attenuation lesion. heterogeneous enhancement, decreased attenuation (arrowhead) corresponds to necrosis Also, the majority of liver metastases shows heterogeneous or ring enhancement on the arterial phase images, confirming their definite diagnosis. Multifocal nodular fatty deposition is an unusual pattern of liver steatosis that consists of multiple round or oval fat foci randomly distributed throughout the liver
If there is acute chronic inflammation, the liver may have patchy areas of heterogeneous arterial enhancement that persist or become isoattenuating on later phases. This enhancement is differentiated from focal lesions by a lack of defined margins or any corresponding signal abnormality on the precontrast sequences b = 1000 s/mm2 (5B) show a heterogeneous mass (arrow) with high signal intensity in the right lobe bordering the liver capsule. The axial T1w image (5C) shows the mass as hypointense (arrow). The axial T1w image (5D) obtained in the arterial phase shows heterogeneous hypervascular enhancement of the mass (arrow) attenuation, when compared with the surrounding liver parenchyma. A lesion with heterogeneous enhancement was regarded as hyper-attenuating when most of it was enhanced during the arterial phase compared with the pre-contrast phase. Hyper-attenuation on the arterial phase followed by washout in the portal or equilibriu
Gatti M, Calandri M, Bergamasco L, Darvizeh F, Grazioli L, Inchingolo R, et al. Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia. Radiol Med. 2020;125(4):348-55 T1W arterial phase DWI T1W portal phase Multifocal liver hepatocellular carcinoma A 57-year-old male with decompensated cirrhosis is referred to MRI to visualize the hepatocellular carcinoma (HCC) and the lesion extension and to help assess the feasibility of an Yttrium radioembolization. CT shows a heterogeneous liver without obvious nodule heterogeneous enhancement (17). In cirrhotic patients, a triple phase CT (non-contrast, arterial and portal venous phases), have been associated with sensitivities of 59-68% in detecting the presence of hepatocellular carcinoma (18). The optimal timing for the arterial phase of a study is debatable, with some authors recommending a delay of 20 strong arterial enhancement and delayed washout THCA Variable appearance Hypo- to isoattenuating T1: heterogeneous and well -defined iso- to hyperintense mass. Strongly hyperintense with persistent contrast enhancement in delayed phase Hemangioma Hyperechoic with well-defined rim and with few intranodular vessels Discontinuous periphera On the post contrast CT, the mass exhibited enhancement. During the early arterial phase, 20 sec after contrast injection, of a multiphase post contrast CT study, there was heterogeneous peripheral enhancement (Figure 2A). On the late arterial phase, 45 sec after contrast administration, there was progressive contrast enhancement (Figure 2B)