DIAGNOSIS PLEASE n CASE 235 Radiology: Volume 281: Number 2—November 2016 n radiology.rsna.org 639 Case 235: Hepatic Adenomatosis Due to Inflammatory Adenomas 1 Gavin Low, MBChB, MPhil, MRCS, FRCR Harini Dharmana, MBChB, FRCR Samantha Saravana-Bawan, MD Safwat Girgis, MD, FRCPC Part one of this case appeared 4 months previously and may contain larger images. Published online 10.1148/radiol.2016150420 Content code: Radiology 2016; 281:639–645 1 From the Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440-112 St, 2A2.41 WMC, Edmonton, AB, Canada T6G 2B7. Received February 18, 2015; revision requested March 20; revision received April 24; accepted May 6; final version accepted May 8. Address correspondence to G.L. (e-mail: timgy@ yahoo.com). Conflicts of interest are listed at the end of this article. q RSNA, 2016 Imaging Findings At MR imaging, at least 10 multifo- cal lesions were seen in both lobes of the liver. This included the index le- sion, which was seen in segment 7 at the subcapsular border. The tumors ranged from smaller than 1 cm to 10 cm, while the index lesion measured 8.9 cm. The patient had a large body habitus, with a thick layer of subcu- taneous fat. The background liver showed signal intensity loss on the op- posed-phase T1-weighted image (Fig 1b) when compared with the in-phase T1-weighted image (Fig 1a), consistent with hepatic steatosis. In contrast, the lesions had higher signal intensity than the background steatotic liver on the opposed-phase T1-weighted im- age (Fig 1b) because of the absence of intralesional steatosis. On the T2- weighted image (Fig 2), the lesions History An asymptomatic 33-year-old woman was referred to the Hepatology Department in 2013 for work-up of inde- terminate multifocal liver masses. These lesions were discovered incidentally at multiphase contrast material– enhanced multidetector computed tomography (CT) per- formed in 2004 to investigate right lower quadrant pain. Imaging surveillance at sporadic intervals revealed slow progressive growth of the lesions over time; however, the number of lesions remained constant. There was no his- tory of cancer, nor were there predisposing factors for chronic liver disease or cirrhosis. The patient had a his- tory of menorrhagia, which was managed with oral con- traceptive use for 20 years; this was stopped in 2013 after hysterectomy. The patient’s g-glutamyl transferase (77 U/L [1.28 mkat/L]; normal level, ,55 U/L [,0.92 mkat/L]) and C-reactive protein (97.1 mg/L [924.8 nmol/L]; nor- mal level, ,8 mg/L [,76.2 nmol/L]]) levels were chroni- cally elevated at serum testing. In 2013, 9 years after the initial CT examination, magnetic resonance (MR) imaging with gadoxetic acid (Primovist; Bayer Healthcare, Whip- pany, NJ) was performed. Finally, ultrasonography (US)- guided biopsy of one of the lesions (in segment 5/6) was performed a year after MR imaging. had heterogeneous intermediate to high signal intensity, which was most conspicuous at the lesion periphery (termed atoll sign). On fat-suppressed gadoxetic acid–enhanced T1-weighted MR images, lesions showed heteroge- neous hypervascularity in the arterial phase (Fig 3a), which persisted into the portal phase (Fig 3b). In the hepa- tospecific phase (Fig 3c) at 20 minutes, the lesions had low signal intensity compared with that of the surrounding liver parenchyma. The initial CT exam- ination in 2004 showed the index le- sion in segment 7 was a hypervascular 4.1-cm mass (Fig 4); this lesion had doubled in size at MR imaging in 2013. Discussion Hepatic adenoma is a rare benign monoclonal neoplasm that histologi- cally is composed of a sheet- or cord- This copy is for personal use only. To order printed copies, contact reprints@rsna.org