Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI

Abstract

BackgroundA solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers.ObjectivesTo analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool.Patients and MethodsThis study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis.ResultsCT and MRI appearance and correlation with pathology types: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively.ConclusionsIn conclusion, CT and MRI are useful tools for SNN diagnosis.

A Challenging Case of Solitary Necrotic Nodules of the Liver Mimicking Hepatic Metastases: CT, MRI, and PET-CT Findings

“…On contrastenhanced MR imaging, Geng et al [4] noted that none of the lesions showed contrast enhancement on all phases. However, other studies have reported that thin rimenhancement may be seen due to the fibrous capsule [6], such as in our case.…”

“…On contrast-enhanced CT, solitary necrotic nodules usually present as well-defined low-or iso-attenuated nodules. Usually, the lesions show no contrast-enhancement, but thin rim-enhancement may be seen [6]. The lesion may also have calcifications [7].…”

Oxaliplatin toxicity presenting as a liver nodule – case report

“…Diffusion-weighted MRI could have been done in order to investigate this nodule, and is nowadays performed more frequently in our centre. An alternate differential diagnosis would be of a necrotic nodule but distinction from a CRCLM is sometimes difficult [ 13 ]. Intraoperative ultrasound displayed a hyperechoic mass in segment 8, which is unusual in colorectal liver metastases.…”

MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules

“…IPT and SNN can also present as HHN. Twenty-seven IPT and SNN in our study appeared to be heterogeneous, with mixed or patchy high signals on T2WI, which resulted from liquefaction or fibrosis in the nodule 11 . In our study, mild hyperintensity appeared only in IPT and SNN.…”