Which benign liver lesion is often described as having a central scar on imaging and is common in middle-aged women?

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A benign liver lesion that is often described as having a central scar on imaging and is most common in middle-aged women is focal nodular hyperplasia. The central scar comes from fibrous tissue in the lesion with ducts and malformed vessels radiating out from it, reflecting a hyperplastic response to an abnormal arterial supply. On imaging, this lesion typically shows strong arterial enhancement and a pattern of vessels that resemble spokes around the lesion, with the central scar often becoming more conspicuous or enhancing on delayed phases. In many cases, it also takes up certain hepatocyte-specific contrast agents similarly to normal liver tissue, helping distinguish it from other tumors.

This profile helps separate it from others: hepatic adenoma tends to occur in younger women, often linked to oral contraceptives, and usually lacks a classic central scar. Hemangioma is the most common benign tumor and shows peripheral nodular enhancement with progressive fill-in rather than a central scar. Hyperplastic nodules refer to regenerative nodules seen in other liver conditions and do not present with the characteristic central scar pattern.