Liver MRI Interpretations: Key Questions for Your Doctor

How can I inquire about the interpretation of a liver MRI?

Dear Dr.
Chen,
Thank you for your previous candid and detailed responses to my questions on November 16 regarding "liver tumors" and December 29 about "cells that look different from the surrounding ones." However, I still have some unresolved issues I would like to discuss with you.
It has been four months since then, and my blood test results have not changed much: C+ fatty liver, AST: 82, ALT: 193, AFP: 4.
The ultrasound also shows no significant changes; the shadow has increased from 1 cm to 1.2 cm (the doctor mentioned that the irregular shape of the shadow may account for the difference in measurement, and it remains within an acceptable range).

After four months, the follow-up reports seem to have not clarified the situation further.

1.
Is it possible that the shadow (a localized area without fat) is located deep within the liver, making it harder to resolve? Or is there indeed a tumor present? (The doctor noted that the fat on the surface of the liver has decreased.)
2.
There are significant differences in the interpretations of the CT and MRI scans by various doctors (some mention a localized area without fat, others refer to abnormal normal cells, FNH, etc.).
Is there a way I can ask another doctor to review the MRI scans again? It is crucial to determine whether there is a tumor to further assess its type.
(It seems there are not many experts in this area, and I am unsure where to start.) I urgently need to hear an expert's opinion, as the longer this situation persists, the greater my anxiety becomes.

3.
Can a biopsy accurately obtain pathology from a 1 cm lesion? Is it possible to reduce the tumor immediately during the biopsy (e.g., through electrocautery)? What potential side effects could arise from this procedure (such as bleeding)?
I have many concerns swirling in my mind, so I apologize for the lengthy message and hope to hear your thoughts.
Thank you!

ROLA, 20~29 year old female. Ask Date: 2005/01/27

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, if you wish to have your case reviewed by a more experienced specialist, I recommend visiting the hepatobiliary department at a medical center, such as Professor Yang Pei-Ming or Professor Huang Kuan-Tang at National Taiwan University, or Professor Wu Chao-Ching at Taipei Veterans General Hospital.
Of course, Chang Gung, Shin Kong, and Tri-Service General Hospital also have experts, though I am less familiar with them.
Additionally, you might consider undergoing a PET scan at your own expense; malignant tumor tissues have a higher metabolic rate compared to normal cells, which can be detected by a PET scan.
This examination is available at all major medical centers, but it is quite expensive, so you may want to inquire with each center.
A one-centimeter lesion can potentially be sampled using biopsy or fine needle aspiration, and you can also consider treatments such as alcohol injection simultaneously.
Sincerely, Dr.
Chen Zhi-Ping, Internal Medicine.

Reply Date: 2005/01/27

More Info

Dear Patient,
Thank you for your detailed questions regarding your liver MRI interpretations and the concerns surrounding your liver health. I understand that navigating through medical reports and the implications of various findings can be quite stressful, especially when it involves potential tumors or liver lesions. Let’s address your questions one by one.

1. Possibility of the Shadow Being a Tumor: The fact that you have a shadow that has increased in size from 1 cm to 1.2 cm over four months is certainly something that warrants attention. The increase in size, albeit slight, can indicate a potential tumor, especially if it has irregular borders. However, it is also possible that this shadow could represent a benign condition, such as a focal nodular hyperplasia (FNH) or a hepatic adenoma, particularly if it is not enhancing in a typical manner for malignancy. The presence of a "non-fatty area" in the liver could suggest a variety of conditions, including steatosis (fatty liver disease) or other lesions. A deeper lesion may indeed be more challenging to characterize on imaging, but the key is to correlate these findings with clinical symptoms and laboratory results.

2. Discrepancies in Imaging Interpretations: It is not uncommon for different radiologists to interpret imaging studies differently, especially with complex cases like liver lesions. If you feel uncertain about the interpretations provided, seeking a second opinion from a radiologist who specializes in liver imaging can be beneficial. Many academic medical centers or specialized liver clinics have experts who can provide a more definitive interpretation of your MRI. You might also consider discussing your case with a hepatologist or a gastroenterologist who can help coordinate these opinions and guide you through the next steps.

3. Biopsy Concerns: Regarding your question about biopsy, it is indeed possible to obtain a tissue sample from a lesion that is 1 cm in size. However, the success of a biopsy can depend on the lesion's location and accessibility. A percutaneous biopsy (done through the skin) is commonly performed under imaging guidance (like ultrasound or CT) to ensure accuracy. As for the immediate destruction of the tumor during biopsy (e.g., using electrocautery), this is not typically done during a biopsy procedure. The primary goal of a biopsy is to obtain a clear tissue sample for pathological examination. There are risks associated with biopsies, including bleeding, infection, and damage to surrounding structures, but these risks are generally low when performed by experienced practitioners.

In summary, I recommend the following steps:
- Discuss the possibility of a second opinion with your primary care physician or specialist.

- Consider scheduling a consultation with a hepatologist who can provide a comprehensive evaluation of your liver health and the implications of the imaging findings.

- If a biopsy is deemed necessary, ensure that you discuss the procedure, its risks, and the expected outcomes with your healthcare provider.

It is understandable to feel anxious about your health, especially with the uncertainty surrounding your liver condition. Regular follow-ups and open communication with your healthcare team are crucial in managing your concerns effectively. Please do not hesitate to reach out for further clarification or support.

Best wishes for your health and peace of mind.

Sincerely,
Doctor Q&A Teams

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