Magnetic resonance (MR) examinations of 43 patients with 95 focal hepatic lesions (diameter, greater than 1 cm) were analyzed for lesion shape, homogeneity, and relative signal intensity compared with normal liver parenchyma, spleen, and skeletal muscle. On T1-weighted, balanced, and T2-weighted images, most metastases (74%), cavernous hemangiomas (76%), and cysts (82%) were smooth and round or oval, while the hepatocellular carcinomas all had irregular borders (40%) or were lobulated (60%). All lesions with irregular borders were malignant. Seventy percent of metastatic lesions, 85% of cavernous hemangiomas, and 100% of simple hepatic cysts were of homogeneous signal intensity, while 60% of hepatocellular carcinomas were inhomogeneous. Logistic regression analysis of multiple lesion characteristics showed that inhomogeneous lesions had a high likelihood of malignancy, while markedly hyperintense lesions had a very low probability of being malignant, regardless of other traits. Homogeneous lesions that were isointense or hyperintense compared with spleen on balanced images but were not markedly hyperintense on T2-weighted images also had a high likelihood of malignancy.

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