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type4him 09-13-2005 07:22 AM

Need help understanding my MRI
I need help understanding my MRI w/contrast report. Im waiting on doctor to call about the next step but in the meantime can anyone tell me what any of the following means? What does the "mass is hyperintense" mean?

1) The mass does not have a well defined capsule.
2) Neither does it have evidence of a central scar.
3) Its enhancement pattern & lack of pseudo capsule are atypical
4) The mass is hyperintense

Thanks-it sure feels good to talk with others on this. :)

amykcpa 09-13-2005 08:17 AM

Re: Need help understanding my MRI
I am certainly not an expert but I do have a liver tumor and it took a while to diagnose and get to the bottom of things. So I had plenty of time to research and read. I will share with you what I know.

My tumor is focal nodular hyperplasia (fnh). For awhile the doctors thought I had an adenoma so I did plenty of reading on both. These two tumors are fairly similar.

Adenoma typically has a well defined capsule while fnh almost never does.

Adenoma alomost never has a central scar while fnh usually does. However, if your fnh lesion is tiny then it may not have a central scar -- can make diagnosis of your fnh more difficult.

An fnh lesion can appear hyperintense during certain times of your mri imaging study - I don't know a lot about interpreting this part of the imaging study. It is difficult to understand but there is lots of information about this on the internet. You can read about how fnh and adenoma are supposed to appear on an mri and compare it to exactly what your mri written report states.

Did your mri report state a final conclusion about your liver tumor? I have never seen an imaging study written report that didn't sum things up at the end for you.

What segement is your liver tumor in? Have you thought about requesting a biopsy?

I hope this helps a little but I do suggest that you search and read for yourself about fnh and adenomas on the internet. There is a lot of good commentary which can help you sort out and understand your mri report better.

type4him 09-13-2005 09:40 AM

Re: Need help understanding my MRI
the impression states: "1)Suggestive of hepatic adenoma. Its enhancement pattern and lack of pseudo capsule are atypical. I would recommend conservative follow-up."

What do they mean by conservative follow-up? I havent been to a specialist, just my PCP and we are from a tiny town in the country and Im wondering my PCP has really ever delt with this before.


type4him 09-13-2005 09:43 AM

Re: Need help understanding my MRI
also its in the left lobe of the liver

amykcpa 09-13-2005 10:32 AM

Re: Need help understanding my MRI
Ok -- from what you say it looks like the radiologist thinks it is an adenoma even though it lacks some features that an adenoma might normally have such as a pseudo capsule and it's mri enhancement pattern is not exactly what was expected either.

The problem is that the appearance of an adenoma or fnh can vary widely on imaging studies.

Sometimes tumors in the left lobe of the liver are too dangerous to biopsy. However, you might want to see if you qualify for a biopsy. I did qualify and overall I was very happy I had it done. The biopsy might not give you the absolute definitive answer you are hoping for but it will help narrow the arena for you.

I would definitely consider seeking out a second opinion from a hepatologist or a liver transplant surgeon. My internist referred me to a specialist right away. The liver specialists see these types of tumors all the time. Your general practitioner probably doesn't see too terribly many of them. Based on my research they really are pretty rare -- it's just not an everyday thing.

The surgery to remove these tumors is really major -- you can read about several who have had the surgery on the fnh thread.

It is often recommended that adenomas be surgically removed since they can rupture and have a slight risk of malignant transformation after many years. Although some doctors recommend leaving an adenoma alone as long as it is less than 5cm. The treatement of this type of tumor VARIES WIDELY.

I do recommend that you continue to do research on the internet and read the fnh thread and hepatic adenoma threads here. There is a lot of good information -- many of the women were treated by highly respected specialists and you will have the opportunity to read about the advice that they were given. Obviously each situation is unique but you can at least get some idea of the treatment options that you might want to consider for yourself.

Fnh tumors are usually left in place unless they are very large, causing pain or continuing to increase in size.

amykcpa 09-13-2005 10:48 AM

Re: Need help understanding my MRI
One other thought --- I do know that Cleveland Clinic offers an offsite second opinion program. You have the opportunity to mail them your mri films and written report. They will have a specialist review the records for you. You do not have to travel to get the second opinion. I thought this might be of interest to you since you indicated that you live in a remote area.

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