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Malignant lesions of the liver with high signal intensity on T1‐Weighted MR images

Our purpose was to identify the histologic types of malignant liver lesions with high signal intensity (SI) on T1‐weighted images and to describe the MR imaging features. Thirteen patients with malignant liver lesions high in SI on T1‐weighted images were studied with a 1.5‐T MR imager using pre‐ and serial postcontrast spoiled gradient‐echo (SGE) sequences (all patients), T2‐weighted fat‐suppressed spin‐echo sequences (all patients), precontrast T1‐weighted fat‐suppressed spin‐echo sequences (five studies in five patients), and precontrast out‐of‐phase SGE sequences (seven studies in six patients). Images were reviewed retrospectively to determine number of lesions; lesion size; SI of lesions on T1‐weighted, T2‐weighted, and fat‐attenuated T1‐weighted images; distribution of high SI in lesions on T1‐weighted images; and tumor enhancement pattern. Seven patients had multiple tumors high in SI on T1‐weighted images and six patients had solitary tumors. Seventy‐two lesions were less than 1.5 cm in diameter and 35 lesions were more than 1.5 cm in diameter. Nine patients had solid malignant lesions and four patients had cystic malignant lesions. All tumors more than 1.5 cm in diameter were heterogeneously high in SI on T1‐weighted images, and all tumors less than 1.5 cm were completely homogeneous or homogeneous with a small central hypointense focus. All tumors were more conspicuous on T1‐weighted fat‐attenuated images, both on excitation spoiled fat‐suppressed spin‐echo or on out‐of‐phase SGE images with the exception of one fat‐containing hepatocellular carcinoma (HCC). In one patient with melanoma metastases and one patient with multiple myeloma nodules, appreciably more lesions were detected on out‐of‐phase SGE images. Causes of hyperintensity were considered to be either fat, melanin, central hemorrhage, or high protein content, all of which may be seen in a variety of tumors. Fat‐attenuation techniques are helpful in the detection of these lesions.