1. Differential Diagnosis
Fat containing HCC
Fatty metamophosis of HCC
- 17% of small HCC, a/w decrease in the number of intratumoral arteries MR
- hypervascularisation in the arterial phase, washout in portal/delayed phase
- high SI on T1WI, SI drop on chemical shift images (Hm, intratumoral fat)
- bulky tumor : capsule, mosaic perfusion
Arterial
Portal
Delayed

2. Differential Diagnosis
Fat containing HCC
Fatty metamophosis of HCC
- 17% of small HCC, a/w decrease in the number of intratumoral arteries MR
- hypervascularisation in the arterial phase, washout in portal/delayed phase
- high SI on T1WI, SI drop on chemical shift images (Hm, intratumoral fat)
- bulky tumor : capsule, mosaic perfusion
T2WI
In-phase
Out-of-phase

3. Differential Diagnosis
Hepatic AML
Non-homogeneous, variable high SI on T1WI/T2WI
SI drop on fat-suppressed images
Non-homogeneous early and persistence of enhancement
Washout in the portal phase and delayed phase, no fibrous capsule
Vessels are present in and around the tumor
T2WI
In-phase
Out-of-phase

4. Differential Diagnosis
Hepatic AML
Non-homogeneous, variable high SI on T1WI/T2WI
SI drop on fat-suppressed images
Non-homogeneous early and persistence of enhancement
Washout in the portal phase and delayed phase, no fibrous capsule
Vessels are present in and around the tumor
Arterial
Portal
Delayed

5. Hepatic AML Benign mesenchymal neoplasm Diagnosis Treatment
Heterogeneous mixture of smooth muscle cells, thick-walled blood vessels, and mature adipose tissue
Liver : 2nd m/c, asymptomatic
Diagnosis
Pathologic finding supported by immunohistochemical staining
HMB-45 (+) : smooth muscle cell
Treatment
Asymptomatic : observation
Abdominal pain, bleeding : surgical resection

6. Hepatic AML Radiographic findings
Single or multiple, round or lobulated fat containing mass lesions
Seen more commonly in the right hepatic lobe
Presence of both fat and prominent vascularity, fat proportion 5-90%
Hepatic AML has been misdiagnosed as HCC >50% frequency

7. Hepatic AML Radiographic findings
US : hetero or homogenous echogenic/ heterogenous hypoechoic
CT and MRI
Presence of fatty component
Marked inhomogenous early enhancement , delay washout
On hepatobiliary phase : low SI
Diffusion restriction d/t muscle and fat components
FDG-PET
Varying amounts of FDG uptake (hemorrhage, inflammatory response)

8. Hepatic AML DDx. with fat containing HCC
Early venous return in the arterial or portal phase
73% of AML vs. 8% of HCC , portal vein or hepatic vein
More prominent & ecstatic tumoral vs. connecting early draining vein
Seen with smaller tumor size
HCC : arterial branches that were connected to feeding artery
Irregular tumor border with capsular formation
80% of HCC vs. 0.5% of AML

9. Hepatic AML DDx. with fat containing HCC
Upstream bile duct dilatation, PV or HV involvement
Necrosis, retraction of liver surface
Without symptoms and risk factors for liver malignancy
Chronic hepatitis, liver cirrhosis, alcohol abuse
With normal serum tumor markers

10. Hepatic AML Hepatic AML
European Journal of Radiology, 2010; 73:

11. Hepatic AML
HCC
European Journal of Radiology, 2010; 73:

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Abdomen Imaging 2014; 39:
Surgical Case Reports 2015;1:38
Surgical Case Reports 2015;1:11
Clinical and Molecular Hepatology 2012; 18: