One case of EOB-MRI being useful for diagnosis of a hepatic inflammatory pseudotumor

Saitama Medical University Hospital
Dept. of Radiology
Drs. Yuki Hara, Eito Kozawa, and Atsushi Kondo

DATE : 2021


Patient’s background and MRI objectives

Patient’s background

Male, 50s, body weight: 58 kg.

Investigation objectives

A high C-reactive protein level was shown during chemotherapy for acute myelogenous leukemia, so contrast computed tomography (CT) was performed to investigate the etiology in detail, and a hepatic mass was found. Initially, the lesion was suspected of being an abscess, but it showed no contraction after antibiotic administration, and contrast ultrasonography showed blood flow in the lesion region, so diagnosis as an abscess was ruled out. Therefore, EOB-MRI was performed for more detailed investigation.

Contrast agent used

Gadoxetate disodium(Gd-EOB-DTPA) injection, 0.1 mL/kg

Case explanation

As the lesion was suspected of being an inflammatory hepatic mass on the basis of various imaging results, a hepatic biopsy was performed, and a pathological diagnosis consistent with an inflammatory pseudotumor was made. Antibiotic administration and leukemia treatment were continued, and follow-up CT showed the hepatic mass to decrease in size and finally disappear.

Imaging signs

A: simple
B: arterial phase
C: portal phase
D: delayed phase

Fig. 1. Dynamic CT (A: simple; B: arterial phase;
C: portal phase; D: delayed phase)

A mass 25 mm in diameter, with somewhat indistinct delineation, was found in S8 of the liver (→).
The margin showed delayed dark staining in a ring shape, and in the arterial phase there was faint contrast in the interior of the lesion.
CT showed the lesion to have expanded in comparison with 11 days previously (not shown), indicating short-term changes in size.

Fig. 2. CT coronal section (portal phase)
Fig. 2. CT coronal section (portal phase)

Fig. 2. CT coronal section (portal phase)

A similar lesion to that in S8 (A: →) was found in the lower part of S5/6 (B: →).

Fig. 3. EOB-MRI
Fig. 3. EOB-MRI

Fig. 3. EOB-MRI

In the dynamic study, the marginal region showed a ring-shaped, low-signal area, and was suspected, taking the CT findings into consideration, of being a fibrotic entity. In T2WI and DWI, the interior showed a faint high signal (▲), but it showed delayed dark staining, so the signs were different from those expected with an abscess. In the hepatobiliary phase after 20 minutes, the entire mass showed a low signal.

Photography protocol

Imaging type Photography
Fat saturation
ETL number
Dual echo FLASH 18 s 1.23
170 70
Contrast agent administration
Dynamic VIBE 15 s 1.2 3.5 10 Q-fat sat
DWI EPI 3 min 17 s 65 6100 90 SPAIR
T2WI TSE 5 min 90 3000 120 SPAIR 14
HBP VIBE 15 s 1.2 3.5 10 Q-fat sat
Imaging type P-MRI
Holding breath
k-space In-plane
resolution (mm)
Slice thickness FOV
FOV (%)
Dual echo 2 + sequential 0.7×0.7 6 350 75
Contrast agent administration
Dynamic 3 + sequential 1.4×1.4 3.5 350 87.5
DWI 2 - sequential 2.3×2.3 6 360 81.3
T2WI 3 - *Note: 1.1×1.1 6 350 100
HBP 3 + sequential 1.4×1.4 3.5 350 87.5
Imaging type Phase direction
(step number)
Read direction
(matrix number)
Actual scan
Slice Gap
Slice number 3D actual scan
3D over
Dual echo 173 256 1.8 24
Contrast agent administration
Dynamic 179 256 100 60 56 20
DWI 104 160 0 35
T2WI 320 0 38
HBP 179 256 100 60 56 20

Devices used and contrast conditions

MRI device MAGNETOM Skyra
Automatic injection device Sonic Shot GX
Work station
  Dose (mL) Administration rate (mL/s) Photography timing
Gadoxetate disodium(Gd-EOB-DTPA) 0.1mL/kg 1 Test bolus
Physiological saline solution for flushing 2
  • *Note:T2WI was performed with diaphragmatic respiration synchronization (prospective acquisition correction) and the blade method.
    DWI was performed with free-breathing.

Usefulness of Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI with this patient

No reviews covering the imaging signs with hepatic inflammatory pseudotumors have been published, and, as hepatic inflammatory pseudotumors take various forms, it is often difficult to distinguish them from malignant tumors and/or abscesses. With the present patient, delayed dark staining was found, reflecting the high degree of fibrosis of the lesion, and, together with the time-course of size changes, this suggested the possibility of the lesion being an inflammatory mass. Further investigations were then performed until the final diagnosis was made.

  • *The case introduced is just one clinical case, so the results are not the same as for all cases.
  • *Please refer to the Package Insert for the effects and indications, dosage and administration method, and warnings, contraindications, and other precautions with use.