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Homogeneous marked T2 or T2* hypointensity

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Definition:

  • Having homogeneous and markedly lower signal intensity than liver at T2 or T2* weighted MR imaging.

Usage

  • Applies to observations that unequivocally:

    • Are homogeneously and markedly hypointense relative to liver on T2w or T2*w images or that have moderate or marked signal loss on the second echo of a dual-echo imaging acquisition. The hypointensity relative to liver is more pronounced with longer echo times and, if dual-echo imaging is performed, with greater echo spacing.  Note that fat will also result in signal loss on second echo of dual-echo imaging if out-of-phase echo is acquired after the in-phase echo and distinction between T2* effects and fat can be difficult in this situation.

    • Also applies to masses that are a conglomeration of smaller nodules, each of which is uniform in size and appearance including homogeneous and marked hypointensity relative to liver on T2w or T2*w images. This differs from multi-nodule-in-nodule appearance in which the individual nodules differ in size or appearance.

  • Homogeneous marked T2 or T2* hypointensity is an ancillary feature favoring benignity.

  • Radiologists at their discretion may apply homogeneous marked T2 or T2* hypointensity to downgrade category.

If unsure about feature:

Synonyms:

  • Synonyms: T2 Hypointensity, Low T2 Signal

  • Preferred terms: Homogeneous marked T2 or T2* hypointensity

  • Rationale for preferred terms: Most descriptive term

Background:

  • HCCs have variable signal intensity on T2w imaging

  • Signal intensity on T2w imaging may be helpful in differentiating between HCC tumor grades

 

References:

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2.         Earls, J.P., et al., Dysplastic nodules and hepatocellular carcinoma: thin-section MR imaging of explanted cirrhotic livers with pathologic correlation. Radiology, 1996. 201(1): p. 207-14.

3.         Ebara, M., et al., Small hepatocellular carcinoma: relationship of signal intensity to histopathologic findings and metal content of the tumor and surrounding hepatic parenchyma. Radiology, 1999. 210(1): p. 81-8.

4.         Ebara, M., et al., Diagnosis of small hepatocellular carcinoma: correlation of MR imaging and tumor histologic studies. Radiology, 1986. 159(2): p. 371-7.

5.         Enomoto, S., et al., Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis. Hepatol Int, 2011. 5(2): p. 730-7.

6.         Honda, H., et al., Small hepatocellular carcinoma on magnetic resonance imaging. Relation of signal intensity to angiographic and clinicopathologic findings. Invest Radiol, 1997. 32(3): p. 161-8.

7.         Inoue, E., et al., Magnetic resonance imaging-histologic correlation of small hepatocellular carcinomas adenomatous hyperplasias. Invest Radiol, 1993. 28(8): p. 691-7.

8.         Itoh, K., et al., Hepatocellular carcinoma: MR imaging. Radiology, 1987. 164(1): p. 21-5.

9.         Kadoya, M., et al., Hepatocellular carcinoma: correlation of MR imaging and histopathologic findings. Radiology, 1992. 183(3): p. 819-25.

10.       Kajiwara, M., MR imaging of small hepatocellular carcinoma (< or = 20 mm)--correlation with vascularity and histological features. Kurume Med J, 1997. 44(4): p. 327-38.

11.       Kanematsu, M., et al., Expression of vascular endothelial growth factor in hepatocellular carcinoma and the surrounding liver and correlation with MRI findings. AJR Am J Roentgenol, 2005. 184(3): p. 832-41.

12.       Kelekis, N.L., et al., Hepatocellular carcinoma in North America: a multiinstitutional study of appearance on T1-weighted, T2-weighted, and serial gadolinium-enhanced gradient-echo images. AJR Am J Roentgenol, 1998. 170(4): p. 1005-13.

13.       Khan, A.S., et al., Value of delayed hypointensity and delayed enhancing rim in magnetic resonance imaging diagnosis of small hepatocellular carcinoma in the cirrhotic liver. J Magn Reson Imaging, 2010. 32(2): p. 360-6.

14.       Kim, T.K., et al., Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma. Radiology, 2011. 259(3): p. 730-8.

15.       Kim, Y.K., et al., Hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis: potential of DW imaging in predicting progression to hypervascular HCC. Radiology, 2012. 265(1): p. 104-14.

16.       Krinsky, G.A. and G. Israel, Nondysplastic nodules that are hyperintense on T1-weighted gradient-echo MR imaging: frequency in cirrhotic patients undergoing transplantation. AJR Am J Roentgenol, 2003. 180(4): p. 1023-7.

17.       Krinsky, G.A., et al., Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology, 2001. 219(2): p. 445-54.

18.       Li, C.S., et al., Magnetic resonance imaging appearance of well-differentiated hepatocellular carcinoma. J Comput Assist Tomogr, 2006. 30(4): p. 597-603.

19.       Matsui, O., et al., Adenomatous hyperplastic nodules in the cirrhotic liver: differentiation from hepatocellular carcinoma with MR imaging. Radiology, 1989. 173(1): p. 123-6.

20.       Muramatsu, Y., et al., Early hepatocellular carcinoma: MR imaging. Radiology, 1991. 181(1): p. 209-13.

21.       Nasu, K., et al., Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. AJR Am J Roentgenol, 2009. 193(2): p. 438-44.

22.       Rosenkrantz, A.B., et al., Infiltrative hepatocellular carcinoma: comparison of MRI sequences for lesion conspicuity. Clin Radiol, 2012. 67(12): p. e105-11.

23.       Shimizu, A., et al., Small hyperintense hepatic lesions on T1-weighted images in patients with cirrhosis: evaluation with serial MRI and imaging features for clinical benignity. Magn Reson Imaging, 2007. 25(10): p. 1430-6.

24.       Shinmura, R., et al., Cirrhotic nodules: association between MR imaging signal intensity and intranodular blood supply. Radiology, 2005. 237(2): p. 512-9.

25.       Winter, T.C., 3rd, et al., Early advanced hepatocellular carcinoma: evaluation of CT and MR appearance with pathologic correlation. Radiology, 1994. 192(2): p. 379-87.

 




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