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Reizine E, Meurgey A, Amaddeo G, Laurent A, Calderaro J, Mule S, Luciani A. Fat in mass in primary liver lesions: are usual MRI diagnostic criteria of both malignant and benign liver lesions still applicable? Abdom Radiol (NY) 2022; 47:2347-2355. [PMID: 35672475 DOI: 10.1007/s00261-022-03561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the accuracy of the usual MRI diagnostic patterns of primary liver lesions applied to the diagnosis of pathologically proven fat-containing liver lesions. MATERIALS AND METHODS This monocentric IRB approved retrospective study included all patients with pathologically proven focal liver lesions and documented intra-tumoral fat on pathology and who underwent preoperative liver MRI for characterization. Both liver morphology and usual lesion MRI features were analyzed and their distribution correlated to the final pathological result (Khi-2 or Fisher exact tests, Student t-test or Mann-Whitney U test, as appropriate). The Sensitivity (Se) and Specificity (Sp) of MRI patterns known to be associated to both Hepatocellular Carcinoma (HCC), Focal Nodular Hyperplasia (FNH), and Hepatocellular Adenoma (HCA) subtypes were evaluated. RESULTS Between March 2014 and November 2021, 66 lesions were included, corresponding to: 26 HCC, 32 HCA, 6 FNH and 2 hepatic angiomyolipoma (HAML). All lesions developed on a dysmorphic liver were HCC. A non-rim arterial phase hyperenhancement with a washout and an enhancing capsule had a 98% specificity for HCC diagnosis; A homogeneous dropout of signal on the opposed phase had a sensitivity of 92% and a specificity of 89% for the diagnosis of HNF1alpha inactivated subtype of HCA (HHCA). The FNH pattern was specific at 100% for the diagnosis of FNH with a 40% Se. Finally, the accuracy of inflammatory hepatocellular adenoma (IHCA) pattern had a low 60% Se but a high 89% Sp for IHCA diagnosis. CONCLUSION Known MRI patterns remain reliable for the accurate diagnosis of primary liver tumors on MRI even in fat-containing lesions.
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Affiliation(s)
- Edouard Reizine
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France.
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France.
| | - Azure Meurgey
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Giuliana Amaddeo
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Department of Hepatology, APHP, HU Henri Mondor, Créteil, France
| | - Alexis Laurent
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Departement of Liver Surgery, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Julien Calderaro
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Department of Pathology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Sebastien Mule
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
| | - Alain Luciani
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
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Matondang SBRE, Karismaputri KS, Suharlim E, Yonathan IWM. Hepatocellular Carcinoma with Macroscopic Fat Metamorphosis: A Case Series. J Clin Imaging Sci 2021; 11:36. [PMID: 34345526 PMCID: PMC8326146 DOI: 10.25259/jcis_221_2020] [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: 12/13/2020] [Accepted: 06/16/2021] [Indexed: 12/03/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related deaths in the world, with hepatitis B and C as its main causes. HCC can have fat metamorphosis which leads to a better prognosis, though this is more commonly found in lesions smaller than 3 cm in diameter, and usually contains intravoxel fat. In this case series, we present three cases of HCC with macroscopic fat metamorphosis as examined using CT scan and MRI. Macroscopic fat is seen using CT as a hypodense mass with attenuation of −10 to −100 HU, or MRI using fat-saturation technique. Intravoxel fat can be seen on MRI using fat saturation chemical shift technique, appearing as signal loss during opposed phase and increased signal during in-phase. The differential diagnoses of HCC with fat metamorphosis are angiomyolipoma, hepatic adenoma, nodular steatosis, focal nodular hyperplasia, dysplastic nodule, liposarcoma, and hepatic metastasis. Enhancement patterns of the fat and non-fat component; intra-tumoral fat distribution; the presence of cirrhosis; the presence of atoll sign; and history of viral hepatitis are useful clues for differentiation of HCC with other differential diagnoses.
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Affiliation(s)
| | - Komang Shary Karismaputri
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Central Jakarta, Jakarta, Indonesia
| | - Edwin Suharlim
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Central Jakarta, Jakarta, Indonesia
| | - I Wayan Murna Yonathan
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Central Jakarta, Jakarta, Indonesia
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Mengna HMDPHD, Lu ZMD, Tianan JMDPHD. Findings of Fat Containing Hepatocellular Carcinoma on Contrast-enhanced Ultrasound with Sonazoid: A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Mamone G, Di Piazza A, Carollo V, Crinò F, Vella S, Cortis K, Miraglia R. Imaging of primary malignant tumors in non-cirrhotic liver. Diagn Interv Imaging 2020; 101:519-535. [DOI: 10.1016/j.diii.2020.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
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Valero González MÁ, Núñez Delgado Y, Milena Muñoz A. Hepatic epithelioid angiomyolipoma: contribution of a new case. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 112:76-77. [PMID: 31755279 DOI: 10.17235/reed.2019.6388/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In relation to the article published by Ortiz S et al. (1), we have recently seen a 37-year-old female who presented to the Emergency Department with pain in right hypochondrium and a mild increase in transaminase levels. An ultrasound was performed that showed a large 13-cm tumor in the right hepatic lobe, which was heterogeneous with hyperechogenic and anechoic areas.
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Affiliation(s)
| | | | - Ana Milena Muñoz
- Servicio de Radiodiagnóstico, Hospital Universitario San Cecilio, España
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Lopes CV, Goldoni MB, Barra MB, Hartmann AA, Artifon ELA. Pedunculated hepatic angiomyolipoma: A rare entity. Presse Med 2019; 48:1189-1190. [PMID: 31653540 DOI: 10.1016/j.lpm.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/03/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- César V Lopes
- Santa Casa Hospital, Department of Gastroenterology and Digestive Endoscopy, Rua Prof. Cristiano Fischer 668/1001, C.E.P. 91.410-000 Porto Alegre-RS, Brazil.
| | - Marcos B Goldoni
- Santa Casa Hospital/Federal University of Health Sciences of Porto Alegre (UFCSPA), Department of Gastrointestinal Surgery, Porto Alegre, Brazil.
| | - Marinez B Barra
- Santa Casa Hospital, Department of Pathology, Porto Alegre, Brazil.
| | | | - Everson L A Artifon
- University of São Paulo Medical School, Department of Surgery, São Paulo, Brazil.
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Ding H, Wei H, Liu H, Chen Y, Xue X, Weng H. The Histopathological Features and CT/MRI Imaging Performances in Hepatic Angiomyolipoma Patients. Ann Hepatol 2018; 16:759-764. [PMID: 28809731 DOI: 10.5604/01.3001.0010.2769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To evaluate the diagnostic value of dynamic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in the differential diagnosis of hepatic angiomyolipoma (HAML) and hepatocellular carcinoma (HCC) and to clarify the relationship between histopathological features and CT or MRI imaging performances in HAML. MATERIAL AND METHODS Six HAML and 33 non-cirrhotic HCC patients confirmed by histopathology were retrospectively analyzed. The serum biomarkers, CT and MRI examinations were conventionally performed before the confirmatory histological diagnosis. The clinical data from their medical records was also analyzed. RESULTS Six HAML patients were annotated as two types according to CT and MRI imaging characteristics, including hypovascular type (n = 1) and hypervascular type (n = 5). The imaging performances of the 33 HCC patients were hypervascular type. Moreover, all the 5 hypervascular type HAML patients were misdiagnosed as HCC by CT or MRI. We also found that the hypervascular type of HAML patients contained more vessels and less fatty tissues in histopathology than hypovascular type of HAML patients. However, the clinical features included HCC high risk factors (hepatitis B or C), non-specific symptoms, male and increased serum alpha fetoprotein (AFP) were more common in HCC patients than HAML patients (P < 0.05, respectively). CONCLUSIONS The CT or MRI imaging performances of HAML patients containing more vessels and less fatty tissues in histopathology resemble the imaging performance of HCC patients. These clinical features may be of great help in the differential diagnosis in the current clinical practices.
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Affiliation(s)
- Huiguo Ding
- Capital Medical University, Beijing, China Department of Gastroenterology and Hepatology, Beijing You'an Hospital Center for Collaborative Innovation in Critical Infectious Diseases, Beijing, China
| | - Hongtao Wei
- Capital Medical University, Beijing, China Department of Gastroenterology and Hepatology, Beijing You'an Hospital Center for Collaborative Innovation in Critical Infectious Diseases, Beijing, China
| | - Hui Liu
- Capital Medical University, Beijing, China Department of Pathology, Beijing You'an Hospital
| | - Yuhan Chen
- Capital Medical University, Beijing, China Department of Gastroenterology and Hepatology, Beijing You'an Hospital Center for Collaborative Innovation in Critical Infectious Diseases, Beijing, China
| | - Xiaowei Xue
- Chinese Academy of Medical Sciences, Beijing, China Department of Pathology, Peking Union Medical College Hospital
| | - Honglei Weng
- Heidelberg University, Mannheim, Germany Department of Medicine II, Section Molecular Hepatology, Medical Faculty Mannheim
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Lafitte M, Laurent V, Soyer P, Ayav A, Balaj C, Petit I, Hossu G. MDCT features of hepatocellular carcinoma (HCC) in non-cirrhotic liver. Diagn Interv Imaging 2015; 97:355-60. [PMID: 26546291 DOI: 10.1016/j.diii.2015.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 09/20/2015] [Accepted: 09/22/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe the multidetector row computed tomography (MDCT) imaging features of HCC that develops in patients who are free from underlying liver cirrhosis and to determine if the MDCT presentation of this specific tumor differs from that of the more common HCC that develops in patients with liver cirrhosis using a retrospective case-control study. PATIENTS AND METHODS The MDCT examinations of 38 patients with HCC in non-cirrhotic liver (group 1) were quantitatively and qualitatively analyzed and compared to those obtained in 38 patients with HCC in cirrhotic liver (group 2) matched for age and gender. Quantitative and qualitative characteristics of HCC of both groups were compared using univariate analysis. RESULTS HCCs were significantly larger in group 1 (81.5mm±55.5) than in group 2 (44.5mm±39.1 SD; P=0.0015). In group 1, HCCs were more frequently single tumors (87%) than in group 2 (37%) (P<0.0001), encapsulated (92% vs. 47% respectively; P<0.0001), had more frequently fatty component (24% vs. 8%, respectively; P=0.0279) and internal hemorrhage (29% vs. 3%, respectively; P=0.0033). No significant differences were found between the two groups for location, hyperenhancement of HCC during the arterial phase, washout during the portal phase, endoluminal portal involvement by HCC, endoportal cruoric thrombus, invasion of adjacent organs and underlying liver steatosis. CONCLUSION HCC in non-cirrhotic liver are larger than those observed in cirrhotic liver and more frequently present as a single encapsulated tumor. They have the same patterns of enhancement than HCC that develops in cirrhotic liver.
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Affiliation(s)
- M Lafitte
- Service de radiologie, hôpital Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - V Laurent
- Service de radiologie, hôpital Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - P Soyer
- Université Sorbonne Paris-Cité-Diderot Paris 7, 10, avenue de Verdun, 75010 Paris, France
| | - A Ayav
- Service de radiologie, hôpital Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - C Balaj
- Service de radiologie, hôpital Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - I Petit
- Service de radiologie, hôpital Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - G Hossu
- Service de radiologie, hôpital Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy, France
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