Hepatocellular carcinoma with central scar on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging

Background Central scars are rarely reported in conventional hepatocellular carcinoma (HCC). The presence of central scars on imaging might lead to erroneous diagnosis of hepatic tumors. Purpose To determine imaging features of HCC with central scars on magnetic resonance imaging (MRI) including gadoxetic acid-enhanced and diffusion-weighted imaging (DWI). Material and Methods Fifty-one patients with 51 surgically confirmed HCCs with central scars (fibrotic scar: n = 50; myxoid scar: n = 1; range = 1.2–15 cm; mean = 3.7 cm) underwent liver MRI that consisted of T1- and T2-weighted (T2W) imaging, gadoxetic acid-enhanced arterial, portal, 3-min late phase, and 20-min hepatobiliary phase (HBP), and DWI. Two reviewers evaluated morphology, signal intensity, and enhancement features of tumors and central scars for each image and reached consensus. Results Lobulated contour was seen for 30 tumors (58.8%); the rest were round or oval masses. Central scars (range = 0.2–6.0 cm; mean = 0.9 cm) were most commonly seen as defects within hyperenhancement on arterial phase images (n = 47, 92.2%), bright (n = 28, 54.9%) or dark areas (n = 15, 29.4%) on T2W imaging, areas of central darkness on high b-value DWI (b = 800) (n = 31, 60.8%), and/or central enhancement on HBP (n = 36, 70.6%), mimicking a target appearance. Tumor capsule was seen in 35 (39 pathology, 74.5%) and intratumoral septum in 35 (41 pathology, 78.4%) tumors on gadoxetic acid-enhanced MRI. Conclusion Non-fibrolamellar HCC may show central scar. HCC with central scar mimics cholangiocarcinoma by showing a target appearance on HBP and DWI. Tumor capsule and intratumoral septum might be useful for characterizing HCC with central scar.