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

• Ahn TR
• Kim YE
• Park CH
• Jung EA

• KMID: 2175617
• DOI: http://doi.org/10.13104/imri.2015.19.3.200

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

1. Leite NP, Kased N, Hanna RF, et al. Cross-sectional imaging of extranodal involvement in abdominopelvic lymphoproliferative malignancies. Radiographics. 2007; 27:1613–1634.

2. Gazelle GS, Lee MJ, Hahn PF, Goldberg MA, Rafaat N, Mueller PR. US, CT, and MRI of primary and secondary liver lymphoma. J Comput Assist Tomogr. 1994; 18:412–415.

3. Campos JT, Sirlin CB, Choi JY. Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas. Insights Imaging. 2012; 3:451–474.

4. Grazioli L, Olivetti L, Mazza G, Bondioni MP. MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma. Int J Hepatol. 2013; 2013:374170.

5. Tomasian A, Sandrasegaran K, Elsayes KM, Shanbhogue A, Shaaban A, Menias CO. Hematologic malignancies of the liver: spectrum of disease. Radiographics. 2015; 35:71–86.

6. Lee SA, Lee CH, Jung WY, et al. Paradoxical high signal intensity of hepatocellular carcinoma in the hepatobiliary phase of Gd-EOB-DTPA enhanced MRI: initial experience. Magn Reson Imaging. 2011; 29:83–90.

7. Ha S, Lee CH, Kim BH, et al. Paradoxical uptake of Gd-EOB-DTPA on the hepatobiliary phase in the evaluation of hepatic metastasis from breast cancer: is the "target sign" a common finding? Magn Reson Imaging. 2012; 30:1083–1090.

8. Lee HJ, Im JG, Goo JM, et al. Peripheral T-cell lymphoma: spectrum of imaging findings with clinical and pathologic features. Radiographics. 2003; 23:7–26. discussion 26-28

9. Tababi S, Kharrat S, Sellami M, et al. Extranodal NK/T-cell lymphoma, nasal type: report of 15 cases. Eur Ann Otorhinolaryngol Head Neck Dis. 2012; 129:141–147.

10. Haimerl M, Verloh N, Fellner C, et al. MRI-based estimation of liver function: Gd-EOB-DTPA-enhanced T1 relaxometry of 3T vs. the MELD score. Sci Rep. 2014; 4:5621.