Diagnostic Accuracy of MRI in Differentiating Hepatocellular Adenoma From Focal Nodular Hyperplasia: Prospective Study of the Additional Value of Gadoxetate Disodium

Bieze, Matthanja; Esschert, Jacomina W. van den; Nio, C. Yung; Verheij, Joanne; Reitsma, Johannes B.; Terpstra, Valeska; Gulik, Thomas M. van; Phoa, Saffire S.K.S.

doi:10.2214/ajr.11.7750

Cited by 105 publications

(99 citation statements)

References 31 publications

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“…A lobular border is often described as a typical sign for the diagnosis of FNH, but our research group and others have found that the occurrence of a lobular border is not uncommon in HCAs (21,22).…”

Section: Conventional Mri Findings For Hepatocellular Adenomamentioning

confidence: 61%

“…The surrounding liver steatosis, intralesional fat accumulation, faint arterial enhancement pattern and presence of multiple lesions are more or less typical for HCA but can also occur in FNH (21)(22)(23). A lobular border is often described as a typical sign for the diagnosis of FNH, but our research group and others have found that the occurrence of a lobular border is not uncommon in HCAs (21,22).…”

Section: Conventional Mri Findings For Hepatocellular Adenomamentioning

confidence: 61%

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Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings

Thomeer¹,

Bröker²,

Lussanet³

et al. 2014

Diagn Interv Radiol

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Hepatocellular adenoma (HCA) is a generally benign liver tumor with the potential for malignancy and bleeding. HCAs are categorized into four subtypes on the basis of genetic and pathological features: hepatocyte nuclear factor 1α-mutated HCA, β-catenin-mutated HCA, inflammatory HCA, and unclassified HCA. Magnetic resonance imaging (MRI) plays an important role in the diagnosis, subtype characterization, and detection of HCA complications; it is also used to differentiate HCA from focal nodular hyperplasia. In this review, we present an overview of the genetic abnormalities, oncogenesis, and typical and atypical MRI findings of specific subtypes of HCA using contrast-enhanced MRI with or without hepatobiliary contrast agents (gadobenate dimeglumine and gadoxetate disodium). We also discuss their different management implications after diagnosis.

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Section: Conventional Mri Findings For Hepatocellular Adenomamentioning

confidence: 61%

Section: Conventional Mri Findings For Hepatocellular Adenomamentioning

confidence: 61%

Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings

Thomeer¹,

Bröker²,

Lussanet³

et al. 2014

Diagn Interv Radiol

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“…A prospective study of histopathologic analyses of 54 focal liver lesions larger than 2 cm (24 FNH and 28 HCA) found that, as compared with GdDTPA, GdEOBDTPA was associated with increased diagnostic sensitivity for both HCA (50% vs 96%) and FNH (68% vs 96%). Bleeding, fat, and glycogen were more commonly present in adenomas, whereas a central scar was predictive of FNH (62) . A retrospective histopathologic study of 115 focal liver lesions (44 FNH and 71 HCA) concluded that the presence of contrast uptake of FNH vs. hypointensity of HCAs in the hepatobiliary phase yielded an accuracy of 92% for differential diagnosis of these lesions (63) .…”

Section: Focal Nodular Hyperplasia and Liver-specific Contrast Agentsmentioning

confidence: 92%

Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations

Strauss

Ferreira

França

et al. 2015

Arq. Gastroenterol.

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-Spaceoccupying lesions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no followup after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenomas and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenomas are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumor size >5 cm and inflammatory subtype. Hepatocellular adenomas may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have been associated with hepatocellular adenomas growth, particularly of the hepatocyte nuclear factor1alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of the liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the absence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liverspecific contrast agents are indicated.

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“…Presence of enhanced T2 weight images that further enhance on gadolinium administration is highly characteristic of HCA [25] . Studies of late have tried to characterize these lesions into its four genotypic types based on MRI features.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…In comparison to the existing gadolinium-based contrast agents for MRI, gadobenate dimeglumine or gadoxetate disodium enhanced liver MRI (hepatobiliary specific contrast agents) have both renal and hepatobiliary clearance. Owing to variable contrast uptake observed in hepatobiliary phase, HCA (being hypointense) can be differentiated from FNH (being iso-or hyperintense on delayed imaging) [25] .…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Hepatocellular adenoma: An update

Vijay

Elaffandi

Khalaf

2015

WJH

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Hepatocellular adenomas (HCA) are rare benign liver tumors. Recent technological advancements have helped in the early identification of such lesions. However, precise diagnosis of hepatocellular incidentalomas remains challenging. Studies at the molecular level have provided new insights into the genetics and pathophysiology of these lesions. These in turn have raised questions over their existing management modalities.However, the rarity of the tumor still restricts the quality of evidence available for current recommendations and guidelines. This article provides a comprehensive review on the etiology, molecular biology, pathophysiology, clinical manifestations, and complications associated with HCA. It also elaborates on the genetic advancements, existing diagnostic tools and current guidelines for management for such lesions. Core tip: Hepatocellular adenomas despite being benign liver neoplasms often pose diagnostic and therapeutic challenges. Studies at the molecular level have provided new insights into the genetics and pathophysiology of these lesions. These in turn have raised questions over their existing management modalities. This article provides a comprehensive review and update on the topic.

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Diagnostic Accuracy of MRI in Differentiating Hepatocellular Adenoma From Focal Nodular Hyperplasia: Prospective Study of the Additional Value of Gadoxetate Disodium

Abstract: This study shows high sensitivity of gadoxetate disodium-enhanced MRI when standard series are combined with the hepatobiliary phase for differentiation of FNH and HCA in lesions larger than 2 cm.

Cited by 105 publications

References 31 publications

Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings

Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings

Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations

Hepatocellular adenoma: An update

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