Which imaging feature favors focal nodular hyperplasia over hepatic adenoma?

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Multiple Choice

Which imaging feature favors focal nodular hyperplasia over hepatic adenoma?

A central scar with radiating veins is a classic clue for focal nodular hyperplasia. This pattern reflects the lesion’s architecture: a central fibrous scar surrounded by proliferating hepatocytes and a network of abnormal arteries that radiate outward, often described as a spoke-wheel vascular pattern. On MRI, the central scar tends to enhance differently from the surrounding tissue—showing delayed enhancement due to fibrous tissue—while the radiating vessels are most evident in the arterial phase. This combination—central scar plus spoke-wheel vessels—is characteristic of FNH and is not typically seen with hepatic adenoma. Hepatic adenomas usually lack a central scar and the distinctive vascular pattern, though they can be hypervascular in the arterial phase and may have fat or hemorrhage components.

A central scar with radiating veins is a classic clue for focal nodular hyperplasia. This pattern reflects the lesion’s architecture: a central fibrous scar surrounded by proliferating hepatocytes and a network of abnormal arteries that radiate outward, often described as a spoke-wheel vascular pattern. On MRI, the central scar tends to enhance differently from the surrounding tissue—showing delayed enhancement due to fibrous tissue—while the radiating vessels are most evident in the arterial phase. This combination—central scar plus spoke-wheel vessels—is characteristic of FNH and is not typically seen with hepatic adenoma. Hepatic adenomas usually lack a central scar and the distinctive vascular pattern, though they can be hypervascular in the arterial phase and may have fat or hemorrhage components.

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