MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules

Qian, Haizhen; Li, Shihong; Ji, Ming; Lin, Guowei

doi:10.1097/meg.0000000000000642

Cited by 8 publications

(10 citation statements)

References 34 publications

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“…MR images: On T1 gradient echo before gadolinium, the lesion shows a slightly hypointense signal (black arrow) a; after Gd-BOPTA administration, no contrast enhancement can be seen (black arrow) b, c, d; thin rim enhancement (arrowheads) is seen in the delayed phase e; in the hepatobiliary phases, the fill-in pattern is also not observed (black arrow) f. can reliably assess arterial phase enhancement on continuous image acquisition from the arrival of the first microbubbles to peak arterial enhancement. Indeed, the US contrast agent avalaible in our country (i. e. SonoVue) is a purely blood pool agent, that lacks extravascular interstitial diffusion that is best appreciated by MRI in late scans [23][24][25] and, even better, in delayed and very delayed scans [26].…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver – a Multicenter Report

et al. 2021

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Purpose This multicenter retrospective study highlights the contrast-enhanced ultrasound (CEUS) findings in a series of histologically proven solitary necrotic nodules (SNN) of the liver, a poorly understood pathologic entity of uncertain origin that mimics malignancy. Materials and Methods 22 patients (M/F 13/9; mean age 59.4 years, SD ± 10.7, range 35–81) with histological diagnosis of SNN and CEUS were selected from clinical, imaging, and pathological archives of 7 US interventional centers, each of which provided 1 to 6 cases (mean 2.8). Pathological diagnosis was made on 20 US-guided biopsies and 2 surgical specimens. 2 patients had 2 SNNs with identical CEUS findings so that imaging analysis was carried out on 24 nodules. Results SNN was an incidental finding in healthy people in 10 cases (45.5 %), and it was discovered during follow-up for either known extrahepatic malignancies (9 cases = 41 %) or chronic liver disease (3 cases = 13.5 %). SNNs had a mean size of 19.3 mm (SD ± 6.5, range 9–40). On B-mode US, SNNs appeared hypoechoic in 14 cases (66.7 %), “target-like” in 7 cases (29.2 %), and homogeneously hyperechoic in 1 case (4.1 %). On CEUS, all lesions appeared devoid of contrast enhancement (“punched out” aspect) in the arterial, portal venous, and late phases after US contrast agent injection. A uniformly thin, hyperenhancing ring in the early arterial phase and isoenhanced with the surrounding parenchyma in the portal venous and late phases was found in 10 nodules (41.6 %). Clinical and imaging follow-up (mean duration 42.2 months, SD ± 34.9, range 2–108) was available in 15 patients with 16 SNNs: no changes in size and echostructure were seen. Conclusion CEUS can contribute to the diagnosis of SNN when a “punched out” appearance in all vascular phases with or without thin rim enhancement in the very early arterial phase is present in healthy subjects in whom a focal liver lesion is incidentally found. In patients with a history of chronic liver disease or malignancy, US-guided biopsy represents the unavoidable first-line diagnostic modality.

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Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver – a Multicenter Report

et al. 2021

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“…1-A proper contrast-enhanced CT/MRI examination with a state-of-the art apparatus is mandatory for proper characterization of liver lesions, particularly in patients with chronic viral hepatitis (22)(23)(24)(25). According to recent data, an MRI examination with a hepatocyte-specific agent is preferred (26,27). 2-Even the most specific examination method may fail in rare situations (27), especially outside academic centers.…”

Section: Discussionmentioning

confidence: 99%

“…According to recent data, an MRI examination with a hepatocyte-specific agent is preferred (26,27). 2-Even the most specific examination method may fail in rare situations (27), especially outside academic centers. The suggestion stated by Portolani et al (16) to repeat the imaging examination 4-6 months later is a practical safeguard.…”

Section: Discussionmentioning

confidence: 99%

Malignant Tumors Misdiagnosed as Liver Hemangiomas

et al. 2021

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Background and Aim: To derive lessons from the data of patients who were followed for various periods with the misdiagnosis of liver hemangioma and eventually found to have a malignancy.Material and Methods: The records of 23 patients treated between 2003 and 2018 were analyzed retrospectively.Results: Twelve patients were men and 11 were women; median (range) age was 55 (35–80). The principal diagnostic modality for the initial diagnosis was ultrasonography (n:8), magnetic resonance imaging (MRI) (n:13), and computed tomography (CT) (n:2). At our institution, MRI was performed in 16 patients; the diagnosis was made with the available MRI and CT studies in five and two patients, respectively. In other words, the ultrasonography interpretations were not confirmed on MRI; in others, the MRI or CT examinations were of low quality or they had not been interpreted properly. Fifteen patients underwent surgery; the other patients received chemotherapy (n:6) or chemoembolization (n:2). The misdiagnosis caused a median (range) 10 (0–96) months delay in treatment. The final diagnoses were hepatocellular carcinoma in 12 patients, cholangiocarcinoma in four patients, metastatic mesenchymal tumor, metastasis of colon cancer, metastatic neuroendocrine carcinoma, sarcomatoid hepatocellular carcinoma, angiosarcoma, thoracic wall tumor, and metastatic tumor of unknown primary in one patient each.Conclusions: High-quality MRI with proper interpretation and judicious follow up are vital for the accurate differential diagnosis of liver lesions.

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“…Small hepatic lesions can be more challenging to characterize. Several studies have shown that small intrahepatic cholangiocarcinoma, hemangioma, and metastases may mimic the enhancement characteristics of HCC (18)(19)(20). Unlike the LI-RADS 5 category, which has a low cut-off value for diameter (1 cm), LI-RADS 4 applies the same high probability of HCC for lesions of varying sizes, including those with a diameter of <1 cm.…”

Section: Discussionmentioning

confidence: 99%

Performance of Gd‑EOB‑DTPA‑enhanced MRI for the diagnosis of LI‑RADS 4 category hepatocellular carcinoma nodules with different diameters

Tang

2018

Oncol Lett

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In 2011, the American College of Radiology released a standardized reporting and data collection system, named Liver Imaging Reporting and Data System (LI-RADS), to improve the consistency of diagnostic imaging examinations of hepatocellular carcinoma (HCC). When the LI-RADS guideline was updated in 2014, hepatobiliary contrast agents, including gadoxetate acid (Gd-EOB-DTPA), were incorporated into the system. However, the diagnostic performance of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for nodules of different diameters has not been addressed. In the present study, a total of 263 LI-RADS 4 category hepatic nodules were examined blindly and independently by two radiologists. All nodules were divided into two datasets: Set 1 (n=86) that included nodules with iso/hypo-intensity in the arterial phase (HCC, n=42; non-HCC, n=44) and set 2 (n=177) that included nodules with hyper-intensity in the arterial phase (HCC, n=131; non-HCC, n=46). The diagnostic performance of Gd-EOB-DTPA-enhanced MRI for evaluation of nodules with different diameters was evaluated. The present study revealed that the diagnostic performance of Gd-EOB-enhanced MRI of larger nodules (>2 cm) was higher compared with (<2 cm) smaller nodules. The FPR of large nodules (>2 cm) with a hypervascular pattern was lower compared with smaller nodules (<2 cm) with hypovascular pattern. In conclusion, Gd-EOB-enhanced MRI is useful for the diagnosis of HCC where hypervascular LI-RADS 4 nodules are >2 cm in diameter. However, Gd-EOB-enhanced MRI may be of limited use for the assessment of nodules that <20 mm due to low diagnostic performance and high FPR.

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MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules

Cited by 8 publications

References 34 publications

Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver – a Multicenter Report

Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver – a Multicenter Report

Malignant Tumors Misdiagnosed as Liver Hemangiomas

Performance of Gd‑EOB‑DTPA‑enhanced MRI for the diagnosis of LI‑RADS 4 category hepatocellular carcinoma nodules with different diameters

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