Focal Nodular Hyperplasia and Hepatic Adenoma: Differentiation with Low-Mechanical-Index Contrast-Enhanced Sonography

Kim, Tae Kyoung; Jang, Hyun‐Jung; Burns, Peter N.; Murphy-Lavallée, Jessica; Wilson, Stephanie R.

doi:10.2214/ajr.07.2493

Cited by 149 publications

(111 citation statements)

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“…After contrast agent injection, our findings confirm the previously reported strong arterial enhancement on dynamic contrast-enhanced images followed by sustained enhancement, without any statistically significant difference among imaging modalities [5,7,10,13]. In this regard, although the study of Luciani et al [3] mainly focused on MRI findings, FNHs were reported to be less often typical in men than in women (61.1 vs. 77.8 %), but the described differences were not statistically significant and no explanation for this finding was provided.…”

Section: Discussionsupporting

confidence: 91%

“…For MRI studies, the hepatocellularspecific phase was also assessed. For US and CEUS studies, the colour Doppler images and spectral waveforms were also evaluated for each lesion, as were the following parameters [9][10][11]:…”

Section: Image Analysismentioning

confidence: 99%

“…For the remaining 29 lesions, a combination of size stability during a follow-up period of at least 1 year and imaging features consistent with FNH was used. The CEUS diagnostic criteria for FNH were based on arterial phase centrifugal filling and stellate vascularity, followed by sustained contrast enhancement on the hepatic venous phase and extended hepatic venous or late phase [10]. The CT diagnostic criteria were: mild hypoattenuation or isoattenuation on precontrast scan; rapid, homogeneous and strong enhancement in the arterial phase except for the central scar; near isoattenuation to liver parenchyma in the hepatic venous and delayed phases.…”

Section: Reference Standardmentioning

confidence: 99%

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Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different?

et al. 2013

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Purpose This study was undertaken to compare the imaging findings of focal nodular hyperplasia (FNH) in men and women, as seen on multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS). Materials and methods Two radiologists reviewed 195 imaging studies (17 MDCT, 81 MRI and 97 CEUS examinations) pertaining to 111 FNHs (mean size 3 cm) in 91 patients (mean age 39 years). For each lesion, the readers assessed size, location, echogenicity, attenuation, or signal intensity in comparison with adjacent liver parenchyma on both unenhanced and postcontrast images. Results Eighty-nine FNHs (mean size 3.1 cm) were observed in 73 women (mean age 37.9 years) and 22 FNHs (mean size 2.7 cm) in 18 men (mean age 41.2 years). No statistically significant differences were found between men and women in terms of age, FNH lesions per patient (1.22 and 1.21, respectively), size, baseline and enhancement pattern on MRI, CEUS and MDCT (p \ 0.05). A central scar in FNHs was depicted in 4/18 (22.2 %) men and 16/63 (25.4 %) women on MRI (p \ 0.05), and in 1/2 (50 %) men and 7/15 (46.7 %) women on MDCT (p \ 0.05), whereas a spoke-wheel pattern, central scar, and/or feeding vessel were seen in 5/17 (29.4 %) men and 22/80 (27.5 %) women on CEUS (p \ 0.05).Conclusions Our results did not show any differences in imaging features, age of occurrence and size of FNH between men and women.

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Section: Discussionsupporting

confidence: 91%

Section: Image Analysismentioning

confidence: 99%

Section: Reference Standardmentioning

confidence: 99%

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Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different?

et al. 2013

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“…[10][11][12][13][14][15][16][17] MRI is considered the most comprehensive and noninvasive imaging work-up for HCA diagnosis. 11,12,15,16 MRI findings include fatty, necrotic, and hemorrhagic components, but a homogeneous hypervascular appearance may also be observed.…”

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Hepatocellular adenomas: Magnetic resonance imaging features as a function of molecular pathological classification

et al. 2008

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Hepatocellular adenomas (HCAs) are a group of benign tumors forming three molecular pathological subgroups: (1) hepatocyte nuclear factor 1␣ (HNF-1␣)-inactivated, (2) ␤-catenin-activated, and (3) inflammatory. Some HCAs present both ␤-catenin activation and inflammation. We analyzed magnetic resonance imaging (MRI) data for correlations between features on imaging and pathological classification of HCAs. We included 50 cases for which pathology specimens were classified into three groups based on immunohistochemical staining. Two characteristic MRI profiles were identified corresponding to HNF-1␣-inactivated and inflammatory HCAs. Fifteen HCAs were HNF-1␣-inactivated. The corresponding lesions showed (1) diffuse signal dropout on T1-weighted chemical shift sequence due to steatosis, (2) isosignal or slight hypersignal on T2-weighted (T2W) images, and (3) moderate enhancement in the arterial phase, with no persistent enhancement in the portal venous and delayed phases. For the diagnosis of HNF-1␣-inactivated HCA, the positive predictive value of homogeneous signal dropout on chemical shift images was 100%, the negative predictive value was 94.7%, the sensitivity was 86.7%, and the specificity was 100%. Twenty-three HCAs were inflammatory and showed (1) an absence or only focal signal dropout on chemical shift sequence; (2) marked hypersignal on T2W sequences, with a stronger signal in the outer part of the lesions, correlating with sinusoidal dilatation areas; and (3) strong arterial enhancement, with persistent enhancement in the portal venous and delayed phases. Marked hypersignal on T2W sequences associated with delayed persistent enhancement had a positive predictive value of 88.5%, a negative predictive value of 84%, a sensitivity of 85.2%, and a specificity of 87.5% for the diagnosis of inflammatory HCA. Conclusion: HNF-1␣-mutated HCAs and inflammatory HCAs were associated with specific MRI patterns related to diffuse fat repartition and sinusoidal dilatation, respectively. (HEPATOLOGY 2008;48:808-818.) H epatocellular adenoma (HCA) is a rare type of benign monoclonal liver neoplasm, occurring mostly in young women using oral contraceptives. Several molecular features associated with HCA have recently been described (for review, see Rebouissou et al. 1 ).Biallelic-inactivating mutations of the TCF1 gene inactivating hepatocyte nuclear factor 1␣ (HNF-1␣) have been identified in 35% to 50% of HCAs. 2-4 Furthermore, HCAs harboring HNF-1␣ mutations have been shown to display repressed gluconeogenesis, together with activa-

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“…This particular clinical setting allowed the authors to attempt to predict a histological diagnosis which is usually not possible in a more diverse patient population including also oncological and cirrhotic patients. Anyway, in routine clinical practice it is often not possible to predict a histological diagnosis by CEUS since many benign lesions appear hypervascular and even after microbubble injection are often indistinguishable; a small hypervascular haemangioma, an FNH, and a hepatocellular adenomas can all appear iso or hypervascular at portal-late phase; the only exception is the hepatocellular adenomas which may appear hypovascular on portal-late phase [22]. Malignant lesions may also not be differentiated since HCCs, cholangiocarcinomas and liver metastases prevalently appear hypervascular during the arterial phase and present washout of contrast agent with hypovascular appearance at portal-late phase, even though HCC may appear isovascular to the adjacent liver parenchyma in about 40% of cases [6][7][8][9].…”

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confidence: 99%

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

Quaia

2010

Eur Radiol

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Contrast-enhanced US (CEUS) using intravenous agents is a rapidly evolving field even though the main clinically recognized application is the characterization of focal liver lesions. Several reports have described the improvement provided by CEUS in the characterization of focal liver lesions in comparison to unenhanced US. CEUS with low transmit power insonation allows the real-time assessment of focal liver lesion contrast enhancement and vascularity during the different dynamic phases after injection of an intravenous contrast agent. CEUS allows the accurate characterization of focal liver lesions as benign or malignant based on the lesion contrast enhancement pattern during the arterial phase and lesion vascularity during portal-late phase in comparison to the adjacent liver parenchyma. During the portal-late phase, benign lesions present prevalently a sustained contrast enhancement with hyper or isovascular appearance to the adjacent liver while malignant lesions present prevalently microbubble washout with hypovascular appearance. On the other hand, the histology of focal liver lesions can only be confidently predicted in selected cases by CEUS, as in liver haemangiomas presenting typical nodular peripheral enhancement with subsequent centripetal fill-in and focal nodular hyperplasia with central spoke wheelshaped contrast enhancement.Grey-scale ultrasound (US) is the most widespread imaging procedure for investigating the liver parenchyma due to its relative low cost, availability, safety, and high patient acceptance. However conventional unenhanced gray-scale US is somewhat limited in characterizing focal liver lesions, and several papers have described the general capabilities of contrast-enhanced US (CEUS) in improving focal liver lesion characterization [1][2][3][4][5][6][7][8][9][10][11].Recently, European Radiology has published several papers regarding the capabilities of CEUS in focal liver lesion characterization [12][13][14][15][16]. Soussan et al. [16] presented an interesting study evaluating the role of CEUS in the characterization of solid focal liver lesions in comparison to contrast-enhanced MR imaging. In this study authors analysed a series of 47 patients with 50 incidental focal liver lesions-24 focal nodular hyperplasias (FNHs), 11 hepatocellar adenomas, 10 haemangiomas, 1 focal fatty changes, and 4 malignancies including 2 hepatocellular adenomas with malignant foci, 1 hepatocellular carcinoma (HCC), and 1 epithelioid haemangioendotheliomadetected by US and scheduled for contrast-enhanced MR imaging. All patients underwent CEUS after intravenous injection of an US contrast agent consisting of sulphur hexafluoride-filled microbubbles (SonoVue, Bracco, Italy). The MR images and CEUS cine-clips of each lesion were randomly assigned to two blinded readers, with 17 and 22 years of experience in MR imaging and 8 years of experience in CEUS, who independently reviewed all the examinations and were asked to provide the most likely histological diagnosis for each focal liver lesion a...

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Focal Nodular Hyperplasia and Hepatic Adenoma: Differentiation with Low-Mechanical-Index Contrast-Enhanced Sonography

Cited by 149 publications

References 34 publications

Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different?

Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different?

Hepatocellular adenomas: Magnetic resonance imaging features as a function of molecular pathological classification

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

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