Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound

Abstract

Non-invasive differentiation of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) is difficult. The aim of this study was to assess the accuracy of contrast-enhanced phase inversion ultrasound to differentiate between histologically proven FNH and HCA, analysing the arterial and (early) portal venous phase. 32 patients with histological proven FNH (n=24) or HCA (n=8) have been included in this prospective study. Examination technique: Siemens Elegra, phase inversion harmonic imaging (PIHI) with low mechanical index (MI)<0.2-0.3 using SonoVue (BR 1). The contrast enhancing tumour characteristics were evaluated during the hepatic arterial (starting 8-22 s) and early portal venous phase (starting 12-30 s). The image analysis was performed by three examiners. In 23 of 24 patients with FNH the contrast pattern revealed pronounced arterial and (early) portal venous enhancement. Homogeneous enhancement was detected during the hepatic arterial phase in all eight patients with HCA. In contrast to patients with FNH, no enhancement was seen during the portal venous phase. In conclusion, contrast-enhanced phase inversion ultrasound demonstrated pronounced arterial and portal venous enhancement in patients with focal nodular hyperplasia. In contrast, after homogeneous enhancement during hepatic arterial phase, no enhancement during hepatic portal venous phase was detected in patients with hepatocellular adenoma. Therefore, this technique might improve the functional characterization of benign hypervascular focal liver lesions.

Diagnosis and management of hepatic focal nodular hyperplasia

“…A few remained mildly hyperechoic or became slightly hypoechoic. These findings of ours are consistent with those that have emerged from previous studies [71,72], and they provide confirmation based on a larger series of lesions of previous descriptions of the CEUS features of FNH: intense, homogeneous enhancement in the arterial phase (present in 97.7% of the patients we examined) and isoechogenicity or weak hyperechogenicity in the portal and parenchymal phases (95.4% of our cases). None of the lesions we studied presented frank hypoechogenicity in the late phase, a feature that is more suggestive of a malignant lesion.…”

“…Its use in FNH patients was evaluated in a recent study [71], whose results have yet to be validated in other series. In 23 of the 24 FNH nodules examined, second-generation CEUS revealed marked hyperechogenicity in both the arterial phase (8e22 s after injection of the contrast agent) and the early portal phase (12e30 s after injection).…”

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

“…This differentiation is essential because of different therapeutic approaches. 19 In contrast, the role of real-time CEUS in characterizing hemangiomas has not yet been determined.…”

“…The criteria reported for this setting were peripheral nodular enhancement during the arterial phase, iris-diaphragm sign using time-analysis of contrast enhancement within 0-180 seconds to analyze the arterial phase in comparison with the hepatic artery and portal venous phase in comparison with the surrounding portal vein (branches) as described. 13,19 Reference Imaging Examinations and Liver Biopsy. Reference imaging examinations (e.g., CT, MRI, and scintigraphy) were performed as part of the clinical workup of the patients-in several cases outside of our institution-and not for the purpose of this study.…”

Untitled

“…The acronym CEUS refers to contrast-enhanced ultrasound techniques in general [1][2][3][4][5][6][7][8][9][10][11]. Dynamic contrast enhanced ultrasound (DCE-US) refers to quantitative time intensity curve (TIC) analysis [11][12][13] using either bolus injection of microbubbles [13][14][15][16] or intravenous infusion with disruption-replenishment technique [17] which are used for treatment response evaluation in oncology [18] and for activity assessment in inflammation of the bowel wall in inflammatory bowel disease [19][20][21][22].…”