Dr. Pepe’s Diploma Casebook: Case 8 – SOLVED!

Dear Friends,

This week’s case is a 61-year-old man who was treated surgically for colon cancer 9 months ago. Normal CT at that time.

Fig. 1

Most likely diagnosis:

1. Liver metastasis
2. Nodular fatty infiltration of the liver
3. Hepatocellular carcinoma
4. None of the above

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    14 Responses to : Dr. Pepe’s Diploma Casebook: Case 8 – SOLVED!

    1. Ricardo Macareno says:

      Its nodular fatty infiltration of the liver because the signal falls in the oppossed-fase T1w.

    2. Marcy says:

      I think that with the OP and the IP MRI sequences the findings suggest a Nodular fatty infiltration of the liver. Moreover that is one of the typical localization.

    3. Kelvin says:

      Nodular fatty infiltration of the liver.

      In normal practice we should always look at the arterial phase – HCC might have a major fatty component. The arterial phase would show peripheral (most often continuous and heterogeneous) enhancement, most often with washout in the portal venous/hepatic venous phase.

      Besides that, HCC is obviously unlikely here since there are no features of cirrhosis.

    4. Burak says:

      Should be the fatty infiltration of the liver.there is signal loss in the FS images suggesting as the fatty composition .there is No mass effect and therefore no findings of arteriel enhancment and anyportal shunting.however IF a patent has a history of malignancy in other sites,the lesion is almost % 90 Probably benign.

    5. Genchi Bari Italia says:

      L’esame tc mostra lesione ipodensa. L’esame rm con sequenze pesate in T1 GE in opposizione di fase, dimostra lesione ipointensa ed isointensa livello della porta hepatis. Tale lesione non può essere un hhc , perchè non era presente alla tc iniziale, si presenta in un fegato non cirrotico e non può raggiungere tali dimensioni in 9mesi. Restano pertanto 2 ipotesi:metastasi ed area focale di infiltrazione grassa.L’esame rm è stato eseguito , senza mdc, in condizioni basali(sufficienti pertanto a formulare una diagnosi) che è di area focale di grasso, per le caratteristiche di segnale GE T1 in opposizione di fase, per la sede(porta hepatis) e per la mancanza di effetto-massa.

    6. Lonci says:

      Based on the chemical shift sequences, it’s focal fatty infiltration.

    7. ABED says:

      steatose focale segment IV coussinet graisseux
      en opposition de phase le signal graisseux chutte

    8. Diego Toapanta says:

      Aunque el cáncer de colon tiende a provocar metástasis hepáticas, por las características de la imagen se trataría de una lesión en relación con infiltración grasa focalizada en el segmento IV

    9. daca says:

      2. Nodular fatty infiltration of the liver

    10. Gabriela says:

      Nodular fatty infiltration of the liver because the signal dropped in T1 opposite of phase.

    11. Gabriela says:

      Nodular fatty infiltration of the liver because the signal dropped in T1 opposite of phase and also there isn’t an enhancing rim of the lesion on CT ( as one would expect in a colon cancer metastasis)

    12. Angelis Barlampas says:


      Focal nodular lesion at the medial segment of left liver lobe, near the calciform ligament , which is a typical location of focal nodular fatty infiltration.
      In addition the MRI out of face sequence states , that it is a fatty lesion
      He had a recent previous ct, so if it is a hcc with a fatty component , we have to expect its existense at the previous exam.
      Colon metastases very rarely have a fatty component.
      The patient possibly receives chemotherapy , which has caused the diffuse fatty infiltration of the liver and has decreased substantially its attenuation. That is why we have the faulse impression of I.v constrast enhanced liver parechyma (no one tell us about I.v constrast administration)
      The most suitable diagnosis could be focal nodular fatty infiltration

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