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Wang F, Yang Q, Zhang Y, Liu J, Liu M, Zhu J. 3D variable flip angle T1 mapping for differentiating benign and malignant liver lesions at 3T: comparison with diffusion weighted imaging. BMC Med Imaging 2022; 22:146. [PMID: 35982406 PMCID: PMC9389795 DOI: 10.1186/s12880-022-00873-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different methods have been used to improve the imaging diagnosis of focal liver lesions (FLL). Among them, magnetic resonance imaging (MRI) has received more attention since it provides significant amount of information without radiation exposure. However, atypical imaging characteristics of FLL on MRI may complicate the differential diagnosis between benign and malignant FLL. This study aimed to compare the diagnostic value of T1 mapping and diffusion-weighted imaging (DWI) for differentiating of benign and malignant FLLs. METHODS This retrospective study enrolled 294 FLLs, including 150 benign and 144 malignant lesions. Whole liver T1 mapping sequences were obtained before and 2 min after the administration of Gd-DTPA to acquire native T1 and enhanced T1 and ΔT1%. Additionally, DWI sequence was conducted to generate apparent diffusion coefficient (ADC) maps. These quantitative parameters were compared using one-way analysis of variance, and the diagnostic accuracy of T1 mapping and ADC for FLLs was calculated by area under the curve (AUC). RESULTS Significant differences were observed regarding the native T1, enhanced T1, ΔT1%, and ADC between benign and malignant FLLs. Furthermore, the sensitivity and specificity of the parameters are as follows: native T1 0.797/0.702 (cut off value 1635.5 ms); enhanced T1, 0.911/0.976 (cutoff value 339.2 ms); ΔT1%, 0.901/0.905 (cutoff value 70.8%); and ADC, 0.975/0.952 (cutoff value 1.21 × 10-3 mm2/s). The ideal cutoff values for native T1 and ADC in identifying cyst and haemangioma were 2422.9 ms (AUC 0.990, P < 0.01) and 2.077 × 10-3 mm2/s (AUC 0.949, P < 0.01), respectively, with a sensitivity and specificity of 0.963/1 and 0.852/0.892, respectively. ADC was significantly positively correlated with T1 and ΔT1%, and significantly negatively correlated with enhanced T1. CONCLUSION The 3D Variable flip angle T1 mapping technique with Gd-DTPA has a high clinical potential for identifying benign and malignant FLLs. The enhanced T1 and ΔT1% values have similar diagnostic accuracy compared with DWI in evaluating FLLs. Native T1 shows better performance than DWI in distinguishing benign liver lesions, specifically, cysts, and haemangioma.
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Affiliation(s)
- Fei Wang
- Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, 352 Renmin Road, Anqing, 246000, China
| | - Qing Yang
- Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, 352 Renmin Road, Anqing, 246000, China
| | - Yupei Zhang
- Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, 352 Renmin Road, Anqing, 246000, China
| | - Jun Liu
- Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, 352 Renmin Road, Anqing, 246000, China
| | - Mengxiao Liu
- Siemens Healthcare Ltd., Shanghai, 201318, China
| | - Juan Zhu
- Department of Medical Imaging, Anqing Hospital Affiliated to Anhui Medical University, 352 Renmin Road, Anqing, 246000, China.
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González-Ballesteros XA, Muñoz-Leija D, Muñoz-Díaz AC, Negreros-Osuna AA. Oxaliplatin related multiple focal nodular hyperplasia mimicking metastasis from a gastric cancer. J Oncol Pharm Pract 2022; 28:1914-1916. [DOI: 10.1177/10781552221084617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The FOLFOX6 scheme is a combination drug chemotherapy that contains calcium leucovorin (folinic acid), fluorouracil, and oxaliplatin, the chronic use of chemotherapy with oxaliplatin can progress to focal nodular hyperplasia (FNH), which is a benign hepatic lesion. Case report We present a case of a 26- year-old female diagnosed with an ovarian mixed germ cell tumor with extension to the peritoneum, treated with 12 cycles in 9 months with neoadjuvant chemotherapy FOLFOX 6 scheme and oophorectomy. A three-year follow-up CT showed three nodular and hypervascular hepatic lesions suspicious of metastatic disease; an MRI with liver-specific contrast confirmed the diagnosis of FNH. Management and outcome The patient continued her follow-up without other treatment and metastatic disease. Discussion While most multiple liver lesions in a patient with cancer will be suspicious of metastasis, a careful drug history should be obtained, as an oxaliplatin-related side effect to develop FNH has been reported. MRI with liver-specific contrast has a positive predictive value of 95% because of the biliary excretion through OATP1B3 transporter, expressed in functional hepatocytes and overexpressed in some liver tumors such as FNH, so it should be performed when FNH is suspected.
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Affiliation(s)
- Xavier A González-Ballesteros
- Department of Radiology, Hospital Universitario “Dr José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - David Muñoz-Leija
- Department of Radiology, Hospital Universitario “Dr José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Ana C Muñoz-Díaz
- Department of Radiology, Hospital Universitario “Dr José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Adrián A Negreros-Osuna
- Department of Radiology, Hospital Universitario “Dr José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Grazzini G, Cozzi D, Flammia F, Grassi R, Agostini A, Belfiore MP, Borgheresi A, Mazzei MA, Floridi C, Carrafiello G, Giovagnoni A, Pradella S, Miele V. Hepatic tumors: pitfall in diagnostic imaging. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:9-17. [PMID: 32945274 PMCID: PMC7944669 DOI: 10.23750/abm.v91i8-s.9969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
On computed tomography (CT) and magnetic resonance imaging (MRI), hepatocellular tumors are characterized based on typical imaging findings. However, hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma can show uncommon appearances at CT and MRI, which may lead to diagnostic challenges. When assessing focal hepatic lesions, radiologists need to be aware of these atypical imaging findings to avoid misdiagnoses that can alter the management plan. The purpose of this review is to illustrate a variety of pitfalls and atypical features of hepatocellular tumors that can lead to misinterpretations providing specific clues to the correct diagnoses. (www.actabiomedica.it)
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Affiliation(s)
- Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Federica Flammia
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Alessandra Borgheresi
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy..
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy.
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Focal Nodular Hyperplasia After Treatment With Oxaliplatin: A Multiinstitutional Series of Cases Diagnosed at MRI. AJR Am J Roentgenol 2018; 210:775-779. [DOI: 10.2214/ajr.17.18867] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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5
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Luo M, Zhang L, Jiang XH, Zhang WD. Intravoxel incoherent motion: application in differentiation of hepatocellular carcinoma and focal nodular hyperplasia. Diagn Interv Radiol 2018; 23:263-271. [PMID: 28703102 DOI: 10.5152/dir.2017.16595] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to explore whether intravoxel incoherent motion (IVIM)-related parameters of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) demonstrate differences that could be used to differentiate and improve diagnostic efficiency. METHODS A total of 27 patients, including 22 with HCC and 5 with FNH, underwent liver 3.0 T magnetic resonance imaging for routine sequences. They were concurrently examined by IVIM diffusion-weighted imaging (DWI) scanning with 11 different b values (0-800 s/mm2). IVIM-derived parameters, such as pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADCtotal), were quantified automatically by post-processing software and compared between HCC and FNH groups. A receiver operating characteristic (ROC) curve was then created to predict their diagnostic value. RESULTS D* was weak in terms of reproducibility among the other parameters. ADCtotal, D, and D* were significantly lower in the HCC group than in the FNH group, while f did not show a significant difference. ADCtotal and D had the largest area under the curve values (AUC; 0.915 and 0.897, respectively) and similarly high efficacy to differentiate the two conditions. CONCLUSION IVIM provides a new modality to differentiate the HCC and FNH. ADCtotal and D demonstrated outstanding and comparable diagnosing utility.
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Affiliation(s)
- Ma Luo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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Busireddy KK, Ramalho M, AlObaidy M, Matos AP, Burke LM, Dale BM, Semelka RC. Multiple focal nodular hyperplasia: MRI features. Clin Imaging 2017; 49:89-96. [PMID: 29190518 DOI: 10.1016/j.clinimag.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe MRI features of multiple Focal Nodular Hyperplasia (FNHs). METHODS 40 consecutive subjects (37 females, mean age, 38.8years) were included. All studies were independently reviewed. This was an observational study to define the radiological features of multifocal FNH. RESULTS 130 lesions were evaluated. The majority (88.5%), were peripheral in location. 92.3% lesions were lobulated. Marked enhancement was present in 94.6% lesions. In the portal venous and delayed phase, 46.2% and 47.7% lesions were mildly hyperintense. Central scar was present in 77% lesions. CONCLUSIONS Distinctive features included predominant subcapsular location and mild hyperintensity in the delayed phase, seen in nearly 50% of FNHs.
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Affiliation(s)
- Kiran K Busireddy
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Miguel Ramalho
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA; Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - Mamdoh AlObaidy
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA; Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - António P Matos
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA; Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - Lauren M Burke
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Brian M Dale
- MR Research and Development, Siemens Medical Solutions, Morrisville, NC, USA
| | - Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA.
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Peng Z, Li C, Chan T, Cai H, Luo Y, Dong Z, Li ZP, Feng ST. Quantitative evaluation of Gd-EOB-DTPA uptake in focal liver lesions by using T1 mapping: differences between hepatocellular carcinoma, hepatic focal nodular hyperplasia and cavernous hemangioma. Oncotarget 2017; 8:65435-65444. [PMID: 29029443 PMCID: PMC5630343 DOI: 10.18632/oncotarget.18918] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/14/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives To investigate the difference of T1 relaxation time on Gd-EOB-DTPA-enhanced MRI in hepatocellular carcinoma (HCC), hepatic focal nodular hyperplasia (FNH) and cavernous hemangioma of liver (CHL), and to quantitatively evaluate the uptake of Gd-EOB-DTPA in these three focal liver lesions (FLLs). Results The T1P of CHL was significantly higher than those of HCC and FNH (P < 0.05). Reduction of T1 relaxation time on hepatobiliary phase could be observed in all three types of lesions. There were significant differences of T1P, T1E, T1D and T1D% between FNH, CHL and HCC (P < 0.001). Spearman correlation analysis revealed that T1D% was the best indicator for diagnostic differentiation, with a correlation coefficient of 0.702. Discriminant analysis using three variables (T1P, T1E, and T1D%) showed that the classification accuracy was 88.2%. Materials and Methods 74 patients diagnosed with focal liver lesions underwent Gd-EOB-DTPA-enhanced MRI including T1 mapping were enrolled, consisting of 51 HCCs, 10 FNHs, and 13 CHLs. T1 relaxation times of these lesions were measured on pre-contrast (T1P) and on hepatobiliary phase images at 20 minute after contrast (T1E). The reduction of T1 relaxation time on hepatobiliary (T1D) and the percentage reduction (T1D%) was calculated. The differences of T1P, T1E, T1D and T1D% in these FLLs were analyzed. The usefulness of these parameters for classification of FLLs was evaluated. Conclusions Uptake of Gd-EOB-DTPA is different between in HCC, FNH and CHL. These three lesions can be distinguished using T1 mapping.
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Affiliation(s)
- Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Chang Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Tao Chan
- Department of Diagnostic Radiology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
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Amisaki M, Honjo S, Iida N, Kuwamoto S, Fujiwara Y. Focal nodular hyperplasia that mimicked a liver metastasis from a soft tissue sarcoma: a case report. Surg Case Rep 2017; 3:59. [PMID: 28455622 PMCID: PMC5409908 DOI: 10.1186/s40792-017-0332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Imaging modalities (computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI)) have only limited ability to distinguish liver focal nodular hyperplasia (FNH) from metastatic liver tumors. Here, we report a patient who underwent surgery for benign FNH that mimicked a liver metastasis from soft tissue sarcoma (STS). Case presentation A 23-year-old man with a history of several surgeries for metastatic abdominal STS, developed a hepatic tumor accompanying peritoneal STS recurrence. He was diagnosed with a metastatic liver tumor from the STS, based on imaging studies for the hepatic tumor that showed a growing hypervascular lesion and hypo-intensity in hepatic phase on dynamic CT and MRI. However, when the liver and peritoneal tumors were resected, histological diagnosis showed the hepatic tumor to be benign liver FNH. Conclusions Although FNH should be considered as a differential diagnosis for hypervascular hepatic tumors, it has few typical findings, and its appropriate management is controversial. A lesion strongly suspected of being a metastatic liver tumor might require surgical resection.
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Affiliation(s)
- Masataka Amisaki
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, 683-8504, Japan
| | - Soichiro Honjo
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, 683-8504, Japan.
| | - Noriyuki Iida
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, 683-8504, Japan
| | - Satoshi Kuwamoto
- Division of Molecular Pathology, Department of Pathology, Tottori University Hospital, Yonago, Japan
| | - Yoshiyuki Fujiwara
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, 683-8504, Japan
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Dioguardi Burgio M, Ronot M, Salvaggio G, Vilgrain V, Brancatelli G. Imaging of Hepatic Focal Nodular Hyperplasia: Pictorial Review and Diagnostic Strategy. Semin Ultrasound CT MR 2016; 37:511-524. [PMID: 27986170 DOI: 10.1053/j.sult.2016.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign solid liver lesion after hemangioma, occurring more frequently in young women. The prime differential diagnoses include hepatocellular adenoma, hepatocellular carcinoma, and hypervascular metastasis. As the management of FNH is typically conservative, imaging plays a key role in diagnostic pathway, and misdiagnosis may have a major clinical effect. In this article, we describe the ultrasound, computed tomography, and magnetic resonance imaging features of FNH, underlining the importance of typical radiological features that allow a specific noninvasive diagnosis. We present a large spectrum of a typical imaging findings that FNH may present and discuss the up-to-date diagnostic strategy.
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Affiliation(s)
- Marco Dioguardi Burgio
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France
| | - Maxime Ronot
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France; University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 1149, Paris, France
| | - Giuseppe Salvaggio
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies Di.Bi.Med., University of Palermo, Palermo, Italy
| | - Valérie Vilgrain
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France; University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 1149, Paris, France
| | - Giuseppe Brancatelli
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies Di.Bi.Med., University of Palermo, Palermo, Italy.
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Bratton AK, Nykamp SG, Gibson TWG, Cruz-Arámbulo R, Kruth SA. Evaluation of hepatic contrast enhancement with a hepatocyte-specific magnetic resonance imaging contrast agent (gadoxetic acid) in healthy dogs. Am J Vet Res 2015; 76:224-30. [PMID: 25710758 DOI: 10.2460/ajvr.76.3.224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine, by means of MRI, the time to maximal contrast enhancement in T1-weighted images following IV administration of gadoxetic acid in healthy dogs and assess the impact of gadoxetic acid on the signal intensity of T2-weighted images. ANIMALS 7 healthy dogs. PROCEDURES No hepatic abnormalities were detected during ultrasonographic examination. Each dog was anesthetized and positioned in dorsal recumbency for MRI. Transverse T1- and T2-weighted images of the liver were acquired prior to and following (at 5-minute intervals) IV injection of 0.1 mL of gadoxetic acid/kg. Signal intensity of the liver parenchyma was measured in 3 regions of interest in the T1- and T2-weighted images before and at various times point after contrast agent administration. Time versus signal-to-noise ratio curves were plotted to determine time to maximal contrast enhancement and contrast agent-related changes in signal intensity in T2-weighted images. RESULTS Analysis of T1-weighted images revealed that mean ± SD time to maximal enhancement after gadoxetic acid injection was 10.5 ± 3.99 minutes. Signal intensity of T2-weighted images was not significantly affected by gadoxetic acid administration. No injection-related adverse effects were observed in any dog. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that gadoxetic acid can be used for hepatic MRI in healthy dogs and the resultant hepatic enhancement patterns are similar to those described for humans. Maximal contrast enhancement occurred between 10 and 15 minutes after contrast agent injection; thus, T2-weighted images may be obtained in the interval between injection and maximal enhancement for a more time-efficient clinical protocol.
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Affiliation(s)
- Alexandra K Bratton
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
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Matos AP, Velloni F, Ramalho M, AlObaidy M, Rajapaksha A, Semelka RC. Focal liver lesions: Practical magnetic resonance imaging approach. World J Hepatol 2015; 7:1987-2008. [PMID: 26261689 PMCID: PMC4528273 DOI: 10.4254/wjh.v7.i16.1987] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/24/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
With the widespread of cross-sectional imaging, a growth of incidentally detected focal liver lesions (FLL) has been observed. A reliable detection and characterization of FLL is critical for optimal patient management. Maximizing accuracy of imaging in the context of FLL is paramount in avoiding unnecessary biopsies, which may result in post-procedural complications. A tremendous development of new imaging techniques has taken place during these last years. Nowadays, Magnetic resonance imaging (MRI) plays a key role in management of liver lesions, using a radiation-free technique and a safe contrast agent profile. MRI plays a key role in the non-invasive correct characterization of FLL. MRI is capable of providing comprehensive and highly accurate diagnostic information, with the additional advantage of lack of harmful ionizing radiation. These properties make MRI the mainstay for the noninvasive evaluation of focal liver lesions. In this paper we review the state-of-the-art MRI liver protocol, briefly discussing different sequence types, the unique characteristics of imaging non-cooperative patients and discuss the role of hepatocyte-specific contrast agents. A review of the imaging features of the most common benign and malignant FLL is presented, supplemented by a schematic representation of a simplistic practical approach on MRI.
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Affiliation(s)
- António P Matos
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Fernanda Velloni
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Miguel Ramalho
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Mamdoh AlObaidy
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Aruna Rajapaksha
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Richard C Semelka
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
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12
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Brunel T, Guibal A, Boularan C, Ducerf C, Mabrut JY, Bancel B, Boussel L, Rode A. Focal nodular hyperplasia and hepatocellular adenoma: The value of shear wave elastography for differential diagnosis. Eur J Radiol 2015; 84:2059-64. [PMID: 26299323 DOI: 10.1016/j.ejrad.2015.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/15/2015] [Accepted: 07/27/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study assessed the clinical usefulness of shear wave elastography (SWE) during ultrasound for differentiating between focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HAs). MATERIALS AND METHODS SWE was performed on 56 patients presenting with 76 liver lesions (57 FNHs and 19HAs) that were confirmed by MRI and contrast-enhanced ultrasound (CEUS) (n=55) or by histology (n=21). A mean elasticity value was obtained for each lesion. The ratios of the elasticity of the lesions to the elasticity of the surrounding liver were determined. The optimal elasticity cut-off value for distinguishing between the two lesion types was determined using ROC analysis. All lesions that were classified as "undetermined" after CEUS were reclassified using the elasticity values. RESULTS The mean elasticity value was 46.99 ± 31.15 kPa for FNHs and 12.08 ± 10.68 kPa for HAs (p<0.0001). The mean relative elasticity ratio values were 7.94 ± 6.43 and 1.91 ± 1.70, respectively (p<0.0001). The ROC analysis showed a maximal accuracy of 95% for identification with a cut-off of 18.8 kPa for lesion elasticity (accuracy of 96% with a cut-off of 1.98 for the relative elasticity ratio). A total of 68 CEUS were performed, and 17 lesions (25%) were classified as "undetermined" after CEUS. With these cut-off values 16 lesions (94.1%) were correctly reclassified as FNHs. CONCLUSION SWE is a useful adjunctive tool for differentiation between FNH and HA during ultrasound examination.
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Affiliation(s)
- Thomas Brunel
- Service de Radiologie, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - Aymeric Guibal
- Service d'imagerie abdominale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon cedex 03, France.
| | - Camille Boularan
- Service d'imagerie abdominale, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon cedex 03, France.
| | - Christian Ducerf
- Service de Chirurgie Digestive, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - Jean-Yves Mabrut
- Service de Chirurgie Digestive, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - Brigitte Bancel
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - Loïc Boussel
- Service de Radiologie, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - Agnès Rode
- Service de Radiologie, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
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Current updates on the molecular genetics and magnetic resonance imaging of focal nodular hyperplasia and hepatocellular adenoma. Insights Imaging 2015; 6:347-62. [PMID: 25790815 PMCID: PMC4444792 DOI: 10.1007/s13244-015-0399-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Focal nodular hyperplasia (FNH) and hepatocellular adenomas (HCAs) constitute benign hepatic neoplasms in adults. HCAs are monoclonal neoplasms characterised by an increased predilection to haemorrhage and also malignant transformation. On the other hand, FNH is a polyclonal tumour-like lesion that occurs in response to increased perfusion and has an uneventful clinical course. Recent advances in molecular genetics and genotype-phenotype correlation in these hepatocellular neoplasms have enabled a new classification system. FNHs are classified into the typical and atypical types based on histomorphological and imaging features. HCAs have been categorised into four subtypes: (1) HCAs with HNF-1α mutations are diffusely steatotic, do not undergo malignant transformation, and are associated with familial diabetes or adenomatosis. (2) Inflammatory HCAs are hypervascular with marked peliosis and a tendency to bleed. They are associated with obesity, alcohol and hepatic steatosis. (3) HCAs with β-catenin mutations are associated with male hormone administration and glycogen storage disease, frequently undergo malignant transformation and may simulate hepatocellular carcinoma on imaging. (4) The final type is unclassified HCAs. Each of these except the unclassified subtype has a few distinct imaging features, often enabling reasonably accurate diagnosis. Biopsy with immunohistochemical analysis is helpful in difficult cases and has strong implications for patient management. TEACHING POINTS • FNHs are benign polyclonal neoplasms with no risk of haemorrhage or malignancy. • HCAs are benign monoclonal neoplasms classified into four subtypes based on immunohistochemistry. • Inflammatory HCAs show an atoll sign with a risk of bleeding and malignant transformation. • HNF-1α HCAs are steatotic HCAs with minimal complications and the best prognosis. • β-Catenin HCA shows variable MRI features and a high risk of malignancy.
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Diffusion-weighted imaging of the liver in patients with chronic liver disease: comparison of monopolar and bipolar diffusion gradients for image quality and lesion detection. AJR Am J Roentgenol 2015; 204:59-68. [PMID: 25539238 DOI: 10.2214/ajr.13.11695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of our study was to compare diffusion-weighted imaging (DWI) sequences using a bipolar versus a monopolar single-shot echo-planar imaging (EPI) gradient design for image quality and for lesion detection and characterization in patients with liver disease. MATERIALS AND METHODS In this retrospective study, 77 patients with chronic liver disease who underwent MRI including bipolar and monopolar DWI at 1.5 T were assessed. Two independent observers reviewed the DWI studies for image quality and the detection and characterization of liver lesions. The reference standard for diagnosis was established by consensus review of two different observers using imaging characteristics on conventional MRI sequences, lesion stability over time, pathologic correlation, or a combination of these findings. The estimated signal-to-noise ratio (SNR) of liver parenchyma and apparent diffusion coefficients (ADCs) of the liver and lesions were calculated for both sequences. ROC analysis was conducted to evaluate the performance of ADC for the diagnosis of hepatocellular carcinoma (HCC). RESULTS Eighty-five lesions, 50 HCCs and 35 benign lesions, were detected with the reference standard in 38 patients. There was equivalent image quality for the bipolar and monopolar sequences (p = 0.24-0.42). The HCC detection rate for observers 1 and 2 was slightly better with bipolar DWI (50.0% and 52.0%, respectively) compared with monopolar DWI (44.0% and 46.0%); however, this difference did not reach statistical significance. The estimated SNR was higher with the monopolar sequence than with the bipolar sequence (p ≤ 0.001). The AUC for the ROC curve was 0.691 for bipolar DWI and 0.649 for monopolar DWI when ADC was used for the characterization of HCC, which is not a statistically significant difference (p = 0.59). CONCLUSION The higher estimated SNR yielded by the monopolar DWI sequence did not translate into better HCC detection compared with the bipolar DWI sequence. ADC has a limited role for HCC characterization in patients with liver disease.
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Immunostaining of glutamine synthetase is a sensitive and specific marker for diagnosing focal nodular hyperplasia in needle biopsy. Pathology 2014; 44:605-10. [PMID: 22990279 DOI: 10.1097/pat.0b013e32835817c6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Focal nodular hyperplasia (FNH) has characteristic histological features which may not be seen in needle biopsy specimens. We investigate the diagnostic role of glutamine synthetase (GS) in needle biopsy specimens. METHODS Sixty-one hepatic tumours were categorised into 20 'definite' FNHs, 13 'probable' FNHs, and 28 cases without specific diagnosis. Needle biopsy specimens of 92 non-tumourous lesions, 25 well-differentiated hepatocellular carcinomas (WDHCCs), and 4 high-grade dysplastic nodules (HGDNs) and resection specimens of 10 macroregenerative nodules were also selected for immunohistochemical stain of GS for comparison. RESULTS All 20 'definite' FNHs, nine 'probable' FNHs, and five cases without specific diagnosis expressed typical map-like staining pattern of GS. The demographic data of these five cases were similar to those of FNH. All cases of chronic hepatitis B and C, cirrhosis, macroregenerative nodule and peritumourous liver tissue showed normal pericentral/periseptal pattern. Fifteen of 25 WDHCCs and one HGDN showed diffuse pattern. Ten WDHCCs and two HGDNs showed negative staining. One HGDN showed mosaic pattern. CONCLUSIONS Immunohistochemical staining of GS increases the diagnostic sensitivity of FNH in needle biopsy, especially in those without typical morphology. It also helps in differentiating FNH from other tumourous and non-tumourous lesions.
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Abstract
Focal liver lesions (FLLs) are commonly encountered on routine imaging studies. Most lesions detected are benign, but many are indeterminate at the time of initial imaging. This article reviews the important role of MR imaging for the detection and characterization of various benign FLLs while illustrating typical imaging appearances and potential pitfalls in interpretation. The utility of diffusion-weighted imaging and hepatocyte-specific contrast agents is also discussed.
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Affiliation(s)
- Jonathan R Cogley
- Section of Body Imaging, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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Dohan A, Soyer P, Guerrache Y, Hoeffel C, Gavini JP, Kaci R, Boudiaf M. Focal nodular hyperplasia of the liver: diffusion-weighted magnetic resonance imaging characteristics using high b values. J Comput Assist Tomogr 2014; 38:96-104. [PMID: 24424559 DOI: 10.1097/rct.0b013e3182a91006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To qualitatively and quantitatively assess the presentation of hepatic focal nodular hyperplasia (FNH) at diffusion-weighted magnetic resonance imaging (DWMRI) using multiple high b values. MATERIALS AND METHODS Twenty-five patients with 27 FNHs had liver DWMRI at 1.5 T using free-breathing acquisition and 3 b values (0, 600, 1000 s/mm). Focal nodular hyperplasias were evaluated qualitatively using visual analysis of diffusion-weighted magnetic resonance (DWMR) images and quantitatively using conventional apparent diffusion coefficient (ADC) and normalized ADC measurements. RESULTS All FNHs (100%) were visible on b0 DWMR images; 26 of the 27 FNHs (96%), on b600 DWMR images; and 21 of the 27 FNHs (78%), on b1000 DWMR images. A total of 18 of the 27 FNHs (67%) exhibited a hyperintense central scar on the b0 DWMR images that remained visible on the b600 and b1000 DWMR images in 6 of the 27 FNHs (22%). Conventional ADC value of FNHs (1.318 × 10 mm/±0.208) was significantly lower than that of adjacent hepatic parenchyma (1.414 × 10 mm/s ± 1.95) (P = 0.0003), although a substantial overlap was found. The use of normalized ADC using the liver as reference organ resulted in a more restricted distribution of ADC values (variation coefficient, 5.3%). CONCLUSIONS Focal nodular hyperplasias show a wide range of morphological features at DWMRI using high b values. Further studies are needed to fully investigate as to what extent normalized ADC may result in better lesion characterization.
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Affiliation(s)
- Anthony Dohan
- From the *Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; †Université Paris-Diderot, Sorbonne Paris Cité; ‡UMR INSERM 965-Paris 7 "Angiogenèse et recherche translationnelle"; §Department of Radiology, Hôpital Robert Debré, Reims Cedex; and ∥Department of Pathology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
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18
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Use of magnetic resonance imaging contrast agents in the liver and biliary tract. Magn Reson Imaging Clin N Am 2012; 20:715-37. [PMID: 23088947 DOI: 10.1016/j.mric.2012.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article presents an overview of liver and biliary contrast agents including their mechanisms of action, dosage and elimination, current clinical indications, and potential future uses.
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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. AJR Am J Roentgenol 2012; 199:26-34. [PMID: 22733890 DOI: 10.2214/ajr.11.7750] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to prospectively determine the sensitivity of hepatobiliary phase gadoxetate disodium-enhanced MRI combined with standard MRI in differentiating focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). SUBJECTS AND METHODS Patients suspected of having FNH or HCA larger than 2 cm underwent gadoxetate disodium-enhanced MRI. Standard MRI was evaluated separately from the additional hepatobiliary phase by two blinded radiologists. For the largest lesion in each patient, findings were compared with histologic diagnosis. Sensitivity, positive predictive value (PPV), and distinctive features were analyzed using McNemar and analysis of variance tests. RESULTS Fifty-two patients completed the study. Histologic diagnosis revealed 24 HCAs and 28 FNHs. Characterization on standard MRI was inconclusive in 40% (21/52) and conclusive in 60% (31/52) of lesions. The sensitivity of standard MRI for HCA was 50% (12/24) with a PPV of 100% (12/12). The sensitivity for FNH was 68% (19/28) with a PPV of 95% (18/19). After review of hepatobiliary phase, the sensitivity for HCA improved to 96% (23/24) with a PPV of 96% (23/24). The sensitivity for FNH improved to 96% (27/28) with a PPV of 96% (27/28). Features with significant predictive value for diagnosis in HCA included bleeding (p < 0.001), fat (p = 0.010), and glycogen (p = 0.024). The presence of a central scar was predictive for FNH (p < 0.001). CONCLUSION 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.
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Incidence and etiology of new liver lesions in pediatric patients previously treated for malignancy. AJR Am J Roentgenol 2012; 199:186-91. [PMID: 22733911 DOI: 10.2214/ajr.11.7690] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the time course, cause, and imaging characteristics of all new liver lesions in pediatric patients with a previously treated malignancy. MATERIALS AND METHODS Our hospital cancer registry was used to identify patients between 1980 and 2005 who met the following criteria: solid tumor, survival > 2 years after diagnosis, no liver lesions at a posttreatment baseline, and cross-sectional imaging follow-up of > 2 years. Final dictated reports of all cross-sectional imaging examinations including the abdomen were reviewed for any mention of new liver lesions. Positive reports were followed by consensus review of the images and clinical data. Patients were divided into three groups: those with suspected or proven focal nodular hyperplasia (FNH), those with suspected or proven metastases, and those with other lesions. An exact Wilcoxon test was used to evaluate the differences between the groups. RESULTS Of 967 patients who met the initial inclusion criteria, 273 had adequate follow-up to be included in the study. Forty-six patients (16.8%) developed new liver lesions during the study period, and 14 of those 46 were classified into the FNH group (30.4%) and seven were classified into the metastasis group (15.2%). A significant difference was found in the median time to the development of FNH versus metastasis and other lesions (FNH, 92.9 months; metastasis, 43.2 months; other lesions, 18.5 months; p < 0.0001). A significant difference was also seen in the median length of follow-up between the groups (FNH, 115.6 months; metastasis, 57 months; other lesions, 50.8 months; p = 0.002). The imaging features of the groups also differed. CONCLUSION The most common liver lesion encountered in pediatric patients previously treated for malignancy was FNH, which occurred farther from the time of diagnosis and had different imaging characteristics from both metastases and other liver lesions.
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Hanaoka J, Shimada M, Utsunomiya T, Imura S, Morine Y, Ikemoto T, Mori H. Huge focal nodular hyperplasia difficult to distinguish from well-differentiated hepatocellular carcinoma. Hepatol Res 2012; 42:727-31. [PMID: 22686861 DOI: 10.1111/j.1872-034x.2012.00974.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We present a 43-year-old man with huge focal nodular hyperplasia (FNH) that was difficult to distinguish from well-differentiated hepatocellular carcinoma (HCC). He previously had abnormal portal vein circulation due to hypoplasia of the intrahepatic portal vein, which was treated with a superior mesenteric vein-inferior vena cava shunt. Laboratory findings included predominantly indirect hyperbilirubinemia with concomitant elevation in aspartate aminotransferase (AST), alanine aminotransferase (ALT), and ammonia. Serum α-fetoprotein and des-γ-carboxy prothrombin were slightly elevated. Multidetector-row computed tomography detected the primary tumor in the left liver lobe, which partially showed a central stellate scar. Gd ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging showed some low-intensity areas in the tumor in the hepatocyte phase. 99mTc-galactosyl human serum albumin scintigraphy showed normal intake of agent in the tumor. We could not rule out well-differentiated HCC. Extended left hepatectomy was performed. Final histopathological findings showed that most of the tumor was FNH against a background of portal vein hypoplasia with moderate atypia and hemorrhage. And immunohistochemical analysis revealed high expression of organic anion transporter (OATP) 1B3 and low expression of multidrug resistance-associated protein (MRP) 2 in a part of the tumor. The patient has remained alive with no hepatic lesion for 1 year after surgery. We describe a case of huge FNH that was difficult to distinguish from well-differentiated HCC even by current fully preoperative imaging technology and demonstrate the effectiveness of curative surgical resection.
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Affiliation(s)
- Jun Hanaoka
- Department of Surgery, University of Tokushima, Tokushima, Japan
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Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. AJR Am J Roentgenol 2012; 198:115-23. [PMID: 22194486 DOI: 10.2214/ajr.11.6836] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the performance of gadoxetate disodium-enhanced MRI in the characterization of focal nodular hyperplasia (FNH) and hepatocellular adenoma and to assess potential advantages of hepatocyte phase imaging in identifying features that distinguish FNH from hepatocellular adenoma. MATERIALS AND METHODS Gadoxetate disodium-enhanced MRI examinations of 12 patients with hepatocellular adenoma and 35 patients with FNH were retrospectively evaluated by three blinded readers. Diagnoses and confidence scores were recorded before and after disclosure of hepatocyte phase images. The data obtained were combined to create receiver operating characteristic curves, and the areas under the curves were compared. Imaging characteristics, including signal intensity, were recorded. Lesion-to-liver enhancement ratio was calculated for each contrast-enhanced phase. RESULTS The readers' average receiver operating characteristic area was significantly higher after disclosure of hepatocyte phase images (p=0.024). FNHs were correctly diagnosed in 74.3-97.1% of cases before and 97.1-100% of cases after the disclosure of hepatocyte phase images; hepatocellular adenoma was correctly diagnosed in 83-100% and 91.7-100% of cases (p>0.05). The presence of a central scar in FNH and fat on hepatocellular adenoma were the only morphologic features that were statistically significantly different (p<0.05). FNH had greater average contrast-enhanced signal intensity and enhancement ratio in all phases (p<0.001). A hepatocyte phase enhancement ratio of less than 0.7 was 100% specific and 91.6% sensitive for hepatocellular adenoma, with accuracy of 97.1% for these data. CONCLUSION Gadoxetate disodium-enhanced MRI had high accuracy in diagnosis of FNH and hepatocellular adenoma, and the hepatocyte phase improved their distinction. FNH enhances significantly more than hepatocellular adenoma. An enhancement ratio, particularly in the hepatocyte phase, can be potentially used as an additional distinguishing feature.
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Agnello F, Ronot M, Valla DC, Sinkus R, Van Beers BE, Vilgrain V. High-b-value diffusion-weighted MR imaging of benign hepatocellular lesions: quantitative and qualitative analysis. Radiology 2011; 262:511-9. [PMID: 22143926 DOI: 10.1148/radiol.11110922] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the signal intensity (SI) of benign hepatocellular lesions in high-b-value diffusion-weighted (DW) magnetic resonance (MR) images and to compare the apparent diffusion coefficient (ADC) values of focal nodular hyperplasias (FNHs) with those of hepatocellular adenomas (HCAs). MATERIALS AND METHODS This retrospective study was approved by institutional review board, with waiver of informed consent. Inclusion criteria were consecutive patients with diagnosed FNH or HCA who underwent MR imaging with a DW sequence of the liver at three b values, 0, 150, and 600 sec/mm2. The final study population included 67 patients (seven men, 60 women) with 90 hepatocellular lesions (54 FNHs, 36 HCAs). The mean ADC was compared between the lesions and the liver. Receiver operating characteristic analysis was performed to evaluate the diagnostic value of ADC for differentiating HCAs and FNHs. RESULTS The mean ADC value of all FNHs and HCAs was significantly lower than that of the liver (P=.004). An ADC ratio below 15% was observed in 50 of 54 (93%) FNHs and in 29 of 36 (81%) HCAs. The mean ADC value of FNHs was significantly higher than that of HCAs (P<.001). The area under the receiver operating characteristic curve was 0.760. With a cutoff value of 1.37×10(-3) mm2/sec, the sensitivity and specificity for differentiating HCA from FNH were 70% and 76%, respectively. There was no significant difference in ADC values between HCA subtypes. The SI of most FNHs and HCAs (78 of 90, 87%) increased with increasing b values, whereas none showed a decrease in SI with increasing b values. When the DW MR criteria for benign and malignant liver tumors were applied, 44 of 90 (49%) lesions would have been considered malignant lesions, whereas the other lesions (46 of 90, 51%) would have been considered indeterminate. CONCLUSION On DW MR images, benign hepatocellular lesions often show findings that suggest restricted diffusion.
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Affiliation(s)
- Francesco Agnello
- Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP, Hôpital Beaujon, 100 bd du Général Leclerc, 92110 Clichy, France
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Fowler KJ, Brown JJ, Narra VR. Magnetic resonance imaging of focal liver lesions: approach to imaging diagnosis. Hepatology 2011; 54:2227-37. [PMID: 21932400 DOI: 10.1002/hep.24679] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article is a review of magnetic resonance imaging (MRI) of incidental focal liver lesions. This review provides an overview of liver MRI protocol, diffusion-weighted imaging, and contrast agents. Additionally, the most commonly encountered benign and malignant lesions are discussed with emphasis on imaging appearance and the diagnostic performance of MRI based on a review of the literature.
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Affiliation(s)
- Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA.
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Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol 2011; 46:225-39. [PMID: 21102346 DOI: 10.1097/rli.0b013e3181feee3a] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate hepatobiliary phase magnetic resonance imaging with gadobenate dimeglumine for differentiation of benign hypervascular liver lesions from malignant or high-risk lesions. METHODS AND MATERIALS Retrospective assessment was performed of 550 patients with 910 hypervascular lesions (302 focal nodular hyperplasia [FNH], 82 nodular regenerative hyperplasia [NRH], 59 hepatic adenoma or liver adenomatosis [HA/LA], 329 hepatocellular carcinomas [HCC], 12 fibrolamellar-HCC [FL-HCC], 21 peripheral cholangiocarcinomas [PCC], 105 metastases). Imaging was performed before and during the arterial, portal-venous, equilibrium, and hepatobiliary phases after gadobenate dimeglumine administration (0.05 mmol/kg). Histologic confirmation was available for ≥1 lesion per patient, except for patients with suspected FNH (diagnosis based on characteristic enhancement/follow-up). Lesion differentiation (benign/malignant) on the basis of contrast washout and lesion enhancement (hypo-/iso-/hyperintensity) was assessed (sensitivity, specificity, accuracy, PPV, and NPV) relative to histology or final diagnosis. RESULTS On portal-venous or equilibrium phase images, washout was not seen for 208 of 526 (39.5%) malignant (HCC, FL-HCC, PCC, metastases) and high-risk (HA/LA) lesions. Conversely, only 5 of 384 (1.3%) true benign lesions (FNH/NRH) showed washout. Taking washout as indicating malignancy, the sensitivity, specificity, and accuracy for malignant lesion identification during these phases was 61.8%, 98.7%, and 77.4%. On hepatobiliary phase images, 289 of 302 FNH, 82 of 82 NRH, 1 of 59 HA or LA, 62 of 341 HCC or FL-HCC, and 2 of 105 metastases were hyperintense or isointense. Taking iso- or hyperintensity as an indication for lesion benignity, the sensitivity, specificity, accuracy, PPV, and NPV for benign lesion identification was 96.6%, 87.6%, 91.4%, 85.1%, and 97.3%, respectively. CONCLUSIONS Hepatobiliary phase imaging with gadobenate dimeglumine is accurate for distinguishing benign lesions from malignant or high-risk lesions. Biopsy should be considered for hypointense lesions on hepatobiliary phase images after gadobenate dimeglumine.
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Focal liver lesion detection and characterization with GD-EOB-DTPA. Clin Radiol 2011; 66:673-84. [PMID: 21524416 DOI: 10.1016/j.crad.2011.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 01/19/2011] [Accepted: 01/31/2011] [Indexed: 12/13/2022]
Abstract
Superior soft-tissue contrast affords magnetic resonance imaging (MRI) some advantages compared to computed tomography (CT) in both detection and characterization of focal liver lesions. Because of its relatively recently introduction into clinical practice, a growing number of articles in the literature have demonstrated the usefulness of the hepatobiliary-specific MRI contrast agent gadoxetic acid disodium (Gd-EOB-DTPA) in liver imaging. The purpose of this review is to demonstrate the typical enhancement patterns of the most common liver lesions using Gd-EOB-DTPA in daily clinical scenarios and briefly describe its mechanism of action. Radiologists interpreting liver MRI studies with this agent must be familiar with the appearance of focal lesions in the hepatocyte phase to avoid misinterpretation.
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27
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Variable MR imaging appearances of focal nodular hyperplasia in pediatric cancer patients. Pediatr Radiol 2011; 41:335-40. [PMID: 21170523 DOI: 10.1007/s00247-010-1956-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/05/2010] [Accepted: 11/12/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is rare in the general pediatric population but is increasingly found in treated pediatric cancer patients. FNH can be incidentally found on CT and MRI and can be misdiagnosed as liver metastasis in patients with an oncological history. OBJECTIVE To describe the MR imaging findings of FNH in pediatric cancer patients. MATERIALS AND METHODS Ten children who had been treated for a primary malignancy and who were diagnosed with FNH from 2003 to 2010 were identified from a search for FNH in our pathology and radiology databases. Patients were included if they were treated for a primary malignancy and had undergone MR imaging of the liver including T1-weighted, T2-weighted and dynamic contrast-enhanced T1-weighted sequences. RESULTS FNH from all patients (n=10) demonstrated typical homogeneous arterial enhancement on MRI. The FNH was often multiple and small (7/10 patients), lacking a central scar, with variable imaging characteristics including signal hyperintensity on both T1- and T2-weighted images (4/10 patients), especially in the setting of hepatic hemosiderosis. CONCLUSION FNH has a variable MR appearance in pediatric cancer patients and should be considered in the differential diagnosis of hypervascular liver lesions.
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Laumonier H, Frulio N, Laurent C, Balabaud C, Zucman-Rossi J, Bioulac-Sage P. Focal nodular hyperplasia with major sinusoidal dilatation: a misleading entity. BMJ Case Rep 2010; 2010:2010/nov30_1/bcr0920103311. [PMID: 22798311 DOI: 10.1136/bcr.09.2010.3311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is a benign liver lesion thought to be a non-specific response to locally increased blood flow. Although the diagnosis of FNH and hepatocellular adenoma (HCA) has made great progress over the last few years using modern imaging techniques, there are still in daily practice some difficulties concerning some atypical nodules. Here, the authors report the case of a 47-year-old woman with a single liver lesion thought to be, by imaging, an inflammatory HCA with major sinusoidal congestion. This nodule was revealed to be, at the microscopical level and after specific immunostaining and molecular analysis, an FNH with sinusoidal dilatation (so-called telangiectatic focal nodular hyperplasia).
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Affiliation(s)
- Hervé Laumonier
- Radiology Department, Hôpital St André CHU Bordeaux, Bordeaux, France.
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Karam AR, Shankar S, Surapaneni P, Kim YH, Hussain S. Focal nodular hyperplasia: central scar enhancement pattern using Gadoxetate Disodium. J Magn Reson Imaging 2010; 32:341-4. [PMID: 20677260 DOI: 10.1002/jmri.22262] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To illustrate the unusual enhancement pattern of the focal nodular hyperplasia central scar using Gadoxetate Disodium. MATERIALS AND METHODS Over a 10-month period, six patients, with a total of seven focal nodular hyperplasia lesions with typical central scar, had MRI of the liver using Gadoxetate Disodium (Eovist, Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ). Four of the six patients had a prior Gadobenate Dimeglumine (Multihance, Bracco Diagnostics Inc., Princeton, NJ) -enhanced MRI of the liver performed within the previous year. The dynamic enhancement pattern of the central scar on the 10 liver MRIs was independently analyzed by two abdominal imaging radiologists who were blinded to the contrast agent used. RESULTS On the Gadoxetate Disodium-enhanced MRIs and during the arterial phase, 1-min, 2-min, and 3-min delay, none of the central scars demonstrated enhancement. However, all four of the lesions that were previously scanned using Gadobenate Dimeglumine demonstrated typical enhancement after a 3-min delay. CONCLUSION On Gadoxetate Disodium-enhanced MRIs of the liver, the central scar of focal nodular hyperplasia lesions does not typically demonstrate delayed enhancement.
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Affiliation(s)
- Adib R Karam
- Radiology Department, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Gadoxetate disodium-enhanced MRI of the liver: part 1, protocol optimization and lesion appearance in the noncirrhotic liver. AJR Am J Roentgenol 2010; 195:13-28. [PMID: 20566794 DOI: 10.2214/ajr.10.4392] [Citation(s) in RCA: 250] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this article is to review the pharmacokinetic and pharmacodynamic properties of gadoxetate disodium (Gd-EOB-DTPA), to describe a workflow-optimized pulse sequence protocol, and to illustrate the imaging appearance of focal lesions in the noncirrhotic liver. CONCLUSION Gd-EOB-DTPA allows a comprehensive evaluation of the liver with the acquisition of both dynamic and hepatocyte phase images. This provides potential additional information, especially for the detection and characterization of small liver lesions. However, protocol optimization is necessary for improved image quality and workflow.
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Abstract
Abstract
Background: Liver is the most common distant metastasized organ in advanced colon cancer. Surgical resection of metastatic lesions would offer the best chance of a long-term survival. An accurate diagnosis and evaluation of extent of disease is crucial in the management of liver metastasis. Objective: Report a benign hepatic condition mimicking liver metastasis in a colon cancer patient. Case presentation: A 53-year-old male with an early stage sigmoid colon cancer was treated with sigmoidectomy followed by adjuvant chemotherapy consisting of 5-FU, leucovorin, and oxaliplatin for six months. Annual computerized tomography of abdomen at two years after the surgery revealed three hypervascular nodules in the liver. Investigations including MRI of the liver and whole body FDG-F18 PET/CT demonstrated evidence consistent with non-metastatic liver nodules. Liver biopsy of one of the lesions led to the diagnosis of “focal nodular hyperplasia”. Conclusion: The possible etiology, diagnosis, and further management of this benign liver tumor, the focal nodular hyperplasia became clear.
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Sakiani S, Koh C, Heller T. Glowing in the dark: not always a bad thing. Gastroenterology 2010; 138:e7-8. [PMID: 20123140 PMCID: PMC2945228 DOI: 10.1053/j.gastro.2009.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 05/27/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Sasan Sakiani
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland 20892, USA
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland 20892, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland 20892, USA
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