Morphologic and Molecular Features of Hepatocellular Adenoma with Gadoxetic Acid–enhanced MR Imaging

Abstract

Purpose:To evaluate the diagnostic performance of imaging features of gadoxetic acid-enhanced magnetic resonance (MR) imaging to differentiate among hepatocellular adenoma (HCA) subtypes by using the histopathologic results of the new immunophenotype and genotype classification and to correlate the enhancement pattern on the hepatobiliary phase (HBP) with the degrees of expression of organic anion transporting polypeptide (OATP1B1/3), multidrug resistance-associated protein 2 (MRP) (MRP2), and MRP 3 (MRP3) transporters. Materials and Methods:This retrospective study was approved by the institutional review board, and the requirement for informed consent waived. MR imaging findings of 29 patients with 43 HCAs were assessed by two radiologists independently then compared with the histopathologic analysis as the standard of reference. Receiver operating characteristic curves and Spearman rank correlation coefficient were used to test the diagnostic performance of gadoxetic acid-enhanced MR imaging features, which included the retention or washout at HBP and degree of transporter expression. Interreader agreement was assessed by using the k statistic with 95% confidence interval. Results:The area under the curve for the diagnosis of inflammatory HCA was 0.79 (95% confidence interval: 0.64, 0.90); for the steatotic type, it was 0.90 (95% confidence interval: 0.77, 0.97); and for the b-catenin type, it was 0.87 (95% confidence interval: 0.74, 0.95). There were no imaging features that showed a significant statistical correlation for the diagnosis of unclassified HCAs. On immunohistochemical staining, OATP1B1/3 expression was the main determinant for the retention, whereas MRP3 was the key determinant for washout of gadoxetic acid at HBP (P , .001). MRP2 appeared to have no role. Conclusion:Gadoxetic acid-enhanced MR imaging features may suggest the subtype of HCA. The degree of OATP1B1/3 and MRP3 expression correlated statistically with gadoxetic acid retention and washout, respectively, in the HBP.q RSNA, 2015

OATPB1/B3 and MRP3 expression in hepatocellular adenoma predicts Gd‐EOB‐DTPA uptake and correlates with risk of malignancy

“…These findings, even if based on a relatively limited number of observations, suggest that signal intensity may be a surrogate marker of OATPB1/B3 presence or loss. In agreement with our results, Ba‐Ssalamah et al reported Gd‐EOB‐DTPA “retention” in 83% of b‐HCA on the HBP of Gd‐EOB‐DTPA‐enhanced MRI, while they inconsistently observed this hyperintensity in other HCA subtypes . However, this series did not include all subtypes.…”

“…Only a few studies aimed to elucidate this phenomenon, showing mostly a hypointense profile . In a recent radio‐pathological report, it has been suggested that, in HCA, the degree of OATPB1/B3 and MRP3 expression correlated, respectively, with Gd‐EOB‐DTPA “retention” and “washout” seen on HBP MR images . However, a precise pathological characterization of HT expression patterns in HCA subtype according to the most recent classification, particularly in HCA with less common phenotypes (atypical H‐HCA, ASS1+HCA), and with higher risk of malignant transformation (b‐IHCA, b‐HCA) and HCA‐HCC, is unclear.…”

Intrapatient Comparison of the Hepatobiliary Phase of Gd‐BOPTA and Gd‐EOB‐DTPA in the Differentiation of Hepatocellular Adenoma From Focal Nodular Hyperplasia

“…Although not all included lesions were confirmed by pathology, most of the discrepancies occurred in inflammatory subtype HCAs. Furthermore, in addition to the fact that these lesions can be intrinsically hyperintense, they may take up contrast in the HBP to a certain degree . This characteristic might go some way to explaining why inflammatory HCAs in our study population were more often iso‐ to hyperintense in the HBP using Gd‐BOPTA.…”

Diagnostic Value of Gd-EOB-DTPA-MRI for Hepatocellular Adenoma: A Meta-Analysis

“…First, it could be related to OATP1B1/3 and MRP3 expression. OATP1B1/3 could affect Gd-EOB-DTPA uptake by HCA cells, while MRP3 affects its excretion from the same cells; therefore, OATP1B1/3 and MRP3 levels, which vary substantially in different HCA subtypes, could directly affect the intensity of HBP signals 9.Second, fatty degeneration of the liver could also affect the relative intensity of HCA signals in the HBP5. Finally, chronic inflammation could reduce bile duct reactivity 14.…”

“…In addition, such scars are very difficult to identify by imaging examinations 26-28. For lesions >3 cm, the central scar could provide some evidence for the differential diagnosis between HCA and FNH, however, in some pathological subtypes of HCA, especially H-HCA, the incidence of scar sign in the lesion may reach 30% 9,11-12.…”