|
1
|
Kim JH, Yoon JH, Joo I, Lee JM. Evaluation of Primary Liver Cancers Using Hepatocyte-Specific Contrast-Enhanced MRI: Pitfalls and Potential Tips. J Magn Reson Imaging 2020; 53:655-675. [PMID: 32700807 DOI: 10.1002/jmri.27213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
When radiologists interpret hepatic focal lesions seen on dynamic magnetic resonance imaging (MRI) scans, it is important not only to distinguish malignant lesions from benign ones but also to distinguish nonhepatocellular carcinoma (HCC) malignancies from HCCs. In addition, most major guidelines, including those of the American Association for the Study of Liver Disease, European Association for the Study of the Liver, and Korean Liver Cancer Association and National Cancer Center, allow for the noninvasive imaging diagnosis of HCC in at-risk patients. However, ~40% of HCC cases show atypical imaging features mimicking non-HCC malignancies. Furthermore, several benign and malignant lesions, such as flash-filling hemangioma and intrahepatic mass-forming cholangiocarcinoma, frequently look like HCC. In contrast, although multiparametric MRI options, including hepatobiliary phase and diffusion-weighted imaging, provide useful information that could help address these challenges, there remain several unresolved issues with regard to the noninvasive diagnostic criteria characterizing HCC. In this article, we discuss the typical imaging features and challenging situations related to primary liver cancers in MRI, while considering how to make a correct diagnosis. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
Collapse
Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| |
Collapse
|
|
2
|
Kim JH, Joo I, Lee JM. Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging. Korean J Radiol 2020; 20:1019-1041. [PMID: 31270973 PMCID: PMC6609440 DOI: 10.3348/kjr.2018.0636] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.
Collapse
Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| |
Collapse
|
|
3
|
Zulfiqar M, Sirlin CB, Yoneda N, Ronot M, Hecht EM, Chernyak V, Matsui O, Bastati N, Ba‐Ssalamah A, Chatterjee D, Bashir M, Fowler KJ. Hepatocellular adenomas: Understanding the pathomolecular lexicon, MRI features, terminology, and pitfalls to inform a standardized approach. J Magn Reson Imaging 2019; 51:1630-1640. [DOI: 10.1002/jmri.26902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Maria Zulfiqar
- Mallinckrodt Institute of RadiologyWashington University School of Medicine St Louis Missouri USA
| | - Claude B. Sirlin
- Department of RadiologyUniversity of California San Diego San Diego California USA
| | | | - Maxime Ronot
- Department of RadiologyHôpitaux Universitaires Paris Nord Val de Seine, Cinchy France
| | | | - Victoria Chernyak
- Department of Radiology, Montefiore Medical CenterAlbert Einstein College of Medicine New York New York USA
| | - Osamu Matsui
- Department of RadiologyKanazawa University Japan
| | - Nina Bastati
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Ahmed Ba‐Ssalamah
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Deyali Chatterjee
- Department of PathologyWashington University School of Medicine St Louis Missouri USA
| | - Mustafa Bashir
- Department of RadiologyDuke University Durham North Carolina USA
| | - Kathryn J. Fowler
- Department of RadiologyUniversity of California San Diego San Diego California USA
| |
Collapse
|
|
4
|
Cannella R, Brancatelli G, Rangaswamy B, Minervini MI, Borhani AA, Furlan A. Enhancement pattern of hepatocellular adenoma (HCA) on MR imaging performed with Gd-EOB-DTPA versus other Gd-based contrast agents (GBCAs): An intraindividual comparison. Eur J Radiol 2019; 119:108633. [PMID: 31437747 DOI: 10.1016/j.ejrad.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE To conduct an intraindividual comparison of the enhancement pattern of hepatocellular adenoma (HCA) on dynamic MRI study obtained following the injection of Gadoxetic acid (Gd-EOB-DTPA) and other gadolinium-based contrast agents (GBCAs). METHOD This is a retrospective, Institutional Review Board-approved study conducted in a single institution. A search of medical records between 2008 and 2017 revealed 17 patients (all females) with at least one pathologically-proven HCA who underwent liver MRI with Gd-EOB-DTPA and another GBCA within 1 year. Enhancement of each lesion on hepatic arterial (HAP), portal venous (PVP), 2 min and 4-5 minutes phases was subjectively evaluated by two abdominal radiologists. Lesions were categorized as hyper-, iso- or hypointense compared to the surrounding liver parenchyma. The presence of a peripheral pseudocapsule was also recorded. The differences in lesion enhancement were assessed using the McNemar Test. A p-value <0.05 was considered statistically significant. RESULTS The final population included 35 HCAs (83% inflammatory subtype). There was no significant difference in lesion size (P = 0.708) and enhancement on HAP (P = 0.625) or PVP (P = 0.125). HCAs showed more frequently hypointensity on 2 min (13/35 vs. 1/35, P < 0.001) and 4-5 minutes (P < 0.001) images obtained after injection of Gd-EOB-DTPA compared to those obtained after other GBCAs. A pseudocapsule was more frequently noted after administration of Gd-EOB-DTPA (13/35 vs 1/35, P = 0.002). CONCLUSIONS Enhancement pattern of HCA differs significantly after the injection of Gd-EOB-DTPA compared to other GBCAs. Lesion hypointensity on 2 min and 4-5 minutes images is more frequent when using Gd-EOB-DTPA.
Collapse
Affiliation(s)
- Roberto Cannella
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA; Section of Radiology - BiND., University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiology - BiND., University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Balasubramanya Rangaswamy
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marta I Minervini
- Division of Transplant Pathology, Department of Pathology, UPMC Montefiore, University of Pittsburgh, PA, United States
| | - Amir A Borhani
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
|
5
|
Hull NC, Schooler GR, Lee EY. Hepatobiliary MR Imaging in Children:. Magn Reson Imaging Clin N Am 2019; 27:263-278. [DOI: 10.1016/j.mric.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
|
6
|
Shao N, Pandey A, Ghasabeh MA, Khoshpouri P, Pandey P, Varzaneh FN, Zarghampour M, Fouladi D, Pawlik TM, Anders RA, Kamel IR. Long-term follow-up of hepatic adenoma and adenomatosis: analysis of size change on imaging with histopathological correlation. Clin Radiol 2018; 73:958-965. [PMID: 30031588 DOI: 10.1016/j.crad.2018.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/21/2018] [Indexed: 01/01/2023]
Abstract
AIM To analyse the change in size on follow-up of hepatic adenomas (HAs) and adenomatosis, and to investigate the relationship of imaging features with size change. MATERIALS AND METHODS The study included 44 patients (142 lesions) who underwent magnetic resonance imaging (MRI) or computed tomography (CT) for diagnosis and follow-up of HA. The imaging features and percentage change in maximum tumour dimension were observed over a follow-up duration of up to 139 months. RESULTS With an average follow-up of 43 months, 37% lesions decreased in size, 58% were stable, 4% increased; one lesion regressed completely. Adenomas were stratified into size groups (<3, 3-5, and ≥5 cm). Size change among the three groups was similar (p>0.05). Percent size change was different for lesions followed for ≤12 months (-7.2%) compared with lesions followed for 13-60 months (-20.5%), and those followed for ≥60 months (-23.5%; p<0.05); there was no difference between lesions followed for 13-60 months and ≥60 months (p=0.523). Baseline size and percent size change was similar between the hepatocyte nuclear factor 1α-inactivated HA (HA-H) and inflammatory HA (HA-I) subtype (p>0.05). CONCLUSION Most adenomas were either stable or regressed on follow-up. Size change was independent of baseline size. After an initial size decrease within 5 years, no further size reduction was noted on extended follow-up. The percent size change in the HA-H and HA-I subtype was similar.
Collapse
Affiliation(s)
- N Shao
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - A Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - M A Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - P Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - P Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - F N Varzaneh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - M Zarghampour
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - D Fouladi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA
| | - T M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Suite 670 395 W. 12th Avenue, Suite 670, Columbus, OH 43210-1267, USA
| | - R A Anders
- Department of Pathology, Johns Hopkins Medical Institutions, 1550 Orleans Street, Baltimore, MD 21231, USA
| | - I R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD 21287, USA.
| |
Collapse
|
|
7
|
A First Report of Synchronous Intracapsular and Extracapsular Hepatic Adenoma. Case Rep Surg 2018; 2017:9053568. [PMID: 29410930 PMCID: PMC5749273 DOI: 10.1155/2017/9053568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023] Open
Abstract
Although the gallbladder is the most common site of ectopic liver, it has been reported in many other organs, such as kidney, adrenal glands, pancreas, omentum, stomach, esophagus, mediastinum, lungs, and heart. Hepatocytes in an ectopic liver behave like normal hepatocytes; furthermore, they can be associated with the same pathological findings as those in the main liver. Ectopic liver in the gallbladder can undergo fatty change, hemosiderosis, cholestasis, cirrhosis, hemangioma, focal nodular hyperplasia, adenoma, and even carcinogenesis. The incidence of extracapsular hepatic adenoma is not known, but only two cases have been reported. Here, we provide the first case report of synchronous multiple intracapsular and extracapsular hepatic adenomas. A 60-year-old woman with multiple hepatic adenomas and one 7 × 5 × 5 cm ectopic hepatic adenoma attached to the gallbladder fundus complicated with abdominal pain is presented.
Collapse
|
|
8
|
Hennedige TP, Hallinan JTPD, Leung FP, Teo LLS, Iyer S, Wang G, Chang S, Madhavan KK, Wee A, Venkatesh SK. Comparison of magnetic resonance elastography and diffusion-weighted imaging for differentiating benign and malignant liver lesions. Eur Radiol 2016; 26:398-406. [PMID: 26032879 DOI: 10.1007/s00330-015-3835-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 04/23/2015] [Accepted: 05/07/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Comparison of magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) for differentiating malignant and benign focal liver lesions (FLLs). METHODS Seventy-nine subjects with 124 FLLs (44 benign and 80 malignant) underwent both MRE and DWI. MRE was performed with a modified gradient-echo sequence and DWI with a free breathing technique (b = 0.500). Apparent diffusion coefficient (ADC) maps and stiffness maps were generated. FLL mean stiffness and ADC values were obtained by placing regions of interest over the FLLs on stiffness and ADC maps. The accuracy of MRE and DWI for differentiation of benign and malignant FLL was compared using receiver operating curve (ROC) analysis. RESULTS There was a significant negative correlation between stiffness and ADC (r = -0.54, p < 0.0001) of FLLs. Malignant FLLs had significantly higher mean stiffness (7.9kPa vs. 3.1kPa, p < 0.001) and lower mean ADC (129 vs. 200 × 10(-3)mm(2)/s, p < 0.001) than benign FLLs. The sensitivity/specificity/positive predictive value/negative predictive value for differentiating malignant from benign FLLs with MRE (cut-off, >4.54kPa) and DWI (cut-off, <151 × 10(-3)mm(2)/s) were 96.3/95.5/97.5/93.3% (p < 0.001) and 85/81.8/88.3/75% (p < 0.001), respectively. ROC analysis showed significantly higher accuracy for MRE than DWI (0.986 vs. 0.82, p = 0.0016). CONCLUSION MRE is significantly more accurate than DWI for differentiating benign and malignant FLLs. KEY POINTS • MRE is superior to DWI for differentiating benign and malignant focal liver lesions. • Benign lesions with large fibrous components may have higher stiffness with MRE. • Cholangiocarcinomas tend to have higher stiffness than hepatocellular carcinomas. • Hepatocellular adenomas tend to have lower stiffness than focal nodular hyperplasia. • MRE is superior to conventional MRI in differentiating benign and malignant liver lesions.
Collapse
Affiliation(s)
- Tiffany P Hennedige
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore
| | | | - Fiona P Leung
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore
- South West Radiology, Liverpool, NSW, Australia
| | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore
| | - Sridhar Iyer
- Department of Surgery, National University Health System, Singapore, Singapore
| | - Gang Wang
- Department of Diagnostic Imaging, National University Hospital, National University Health System, Singapore, Singapore
- University of Calgary, Alberta, Canada
| | - Stephen Chang
- Department of Surgery, National University Health System, Singapore, Singapore
| | | | - Aileen Wee
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
|
9
|
Tse JR, Naini BV, Lu DSK, Raman SS. Qualitative and Quantitative Gadoxetic Acid-enhanced MR Imaging Helps Subtype Hepatocellular Adenomas. Radiology 2015; 279:118-27. [PMID: 26505921 DOI: 10.1148/radiol.2015142449] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine which clinical variables and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging features are associated with histologically proved hepatocellular adenoma (HCA) genotypic subtypes. MATERIALS AND METHODS In this institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study, clinical information and MR images of 49 histologically proved HCAs from January 2002 to December 2013 (21 patients; mean age, 39 years; age range, 15-59 years) were retrospectively reviewed by two radiologists. Qualitative and quantitative imaging features, including the signal intensity ratio relative to liver in each phase, were studied. HCA tissues were stained with subtype-specific markers and subclassified by a pathologist. Clinical and imaging data were correlated with pathologic findings and compared by using Fisher exact or t test, with a Bonferroni correction for multiple comparisons. RESULTS Forty-nine HCAs were subclassified into 14 inflammatory, 20 hepatocyte nuclear factor (HNF)-1α-mutated, one β-catenin-activated, and 14 unclassified lesions. Intralesional steatosis was exclusively seen in HNF-1α-mutated lesions. Marked hyperintensity on T2-weighted images was seen in 12 of 14 (86%) inflammatory lesions compared with four of 21 (19%) HNF-1α-mutated, seven of 14 (50%) unclassified, and zero of one (0%) β-catenin-activated lesion. Two large lesions (one β-catenin-activated and one unclassified) transformed into hepatocellular carcinomas and were the only lesions to enhance with marked heterogeneity. In the hepatobiliary phase, all HCA subtypes were hypoenhancing compared with surrounding liver parenchyma, and they reached their nadir signal intensity by 10 minutes after the administration of contrast material before plateauing. HNF-1α-mutated lesions had the lowest lesion signal intensity ratio of 0.47 ± 0.09, compared with 0.73 ± 0.18 for inflammatory lesions (P = .0004), 0.82 for the β-catenin-activated lesion, and 0.73 ± 0.06 for the unclassified lesion (P = .00002). CONCLUSION In this study, all HCA subtypes were hypoenhancing at Gd-EOB-DTPA-enhanced MR imaging in the hepatobiliary phase and reached their nadir signal intensity at 10 minutes. HNF-1α-mutated lesions could be distinguished from other subtypes by having the lowest lesion signal intensity ratio.
Collapse
Affiliation(s)
- Justin R Tse
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
| | - Bita V Naini
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
| | - David S K Lu
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
| | - Steven S Raman
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
| |
Collapse
|
|
10
|
Chiorean L, Cui XW, Tannapfel A, Franke D, Stenzel M, Kosiak W, Schreiber-Dietrich D, Jüngert J, Chang JM, Dietrich CF. Benign liver tumors in pediatric patients - Review with emphasis on imaging features. World J Gastroenterol 2015; 21:8541-8561. [PMID: 26229397 PMCID: PMC4515836 DOI: 10.3748/wjg.v21.i28.8541] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023] Open
Abstract
Benign hepatic tumors are commonly observed in adults, but rarely reported in children. The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking. Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors. In pediatric patients, most benign focal liver lesions are inborn and may grow like the rest of the body. Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis. Selection of the appropriate imaging test is challenging, since it depends on a number of age-related factors. This paper will discuss the most frequently encountered benign liver tumors in children (infantile hepatic hemangioendothelioma, mesenchymal hamartoma, focal nodular hyperplasia, nodular regenerative hyperplasia, and hepatocellular adenoma), as well as a comparison to the current knowledge regarding such tumors in adult patients. The current emphasis is on imaging features, which are helpful not only for the initial diagnosis, but also for pre- and post-treatment evaluation and follow-up. In addition, future perspectives of contrast-enhanced ultrasound (CEUS) in pediatric patients are highlighted, with descriptions of enhancement patterns for each lesion being discussed. The role of advanced imaging tests such as CEUS and magnetic resonance imaging, which allow for non-invasive assessment of liver tumors, is of utmost importance in pediatric patients, especially when repeated imaging tests are needed and radiation exposure should be avoided.
Collapse
|
|
11
|
Solbach P, Potthoff A, Raatschen HJ, Soudah B, Lehmann U, Schneider A, Gebel MJ, Manns MP, Vogel A. Testosterone-receptor positive hepatocellular carcinoma in a 29-year old bodybuilder with a history of anabolic androgenic steroid abuse: a case report. BMC Gastroenterol 2015; 15:60. [PMID: 25986067 PMCID: PMC4461943 DOI: 10.1186/s12876-015-0288-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/08/2015] [Indexed: 12/21/2022] Open
Abstract
Background Continuous use of anabolic androgenic steroid in high-doses is associated with substantial health risks, including hepatocellular adenoma. Malignant transformation from hepatocellular adenoma to hepatocellular carcinoma after anabolic androgenic steroid abuse has been rarely reported. The morphological distinction of adenoma from well-differentiated hepatocellular carcinoma is challenging and requires elaborated imaging techniques and histology. Case presentation We report about a 29-year old male professional bodybuilder who presented with mid-epigastric pain at the emergency unit. Ultrasound showed a severe hepatomegaly with multiple lesions. Contrast-enhanced ultrasound revealed a heterogeneous pattern with signs of hepatocellular carcinoma. CT scan of the abdomen confirmed multiple hypervascular lesions and central areas of necrosis without contrast enhancement. Subsequent diagnostics included fine needle aspiration (FNA) of suspicious lesions and mini-laparoscopy to establish the diagnosis of a β-catenin and testosterone-receptor positive hepatocellular carcinoma embedded in multiple adenomas. The patient was subsequently treated by liver transplantation and remains tumor-free 27 month after surgery. Conclusion Hepatocellular carcinoma occurring in association with anabolic androgenic steroid abuse should sensitize physicians and especially professional bodybuilders for the harmful use of high doses of steroids.
Collapse
Affiliation(s)
- Philipp Solbach
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Hans-Jürgen Raatschen
- Department of Diagnostic and Interventional Radiology, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Bisharah Soudah
- Department of Pathology, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Ulrich Lehmann
- Department of Pathology, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Michael J Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| |
Collapse
|
|
12
|
Donato M, Hamidian Jahromi A, Andrade AI, Kim R, Chaudhery SI, Sangster G. Hepatic adenomatosis: a rare but important liver disease with severe clinical implications. Int Surg 2015; 100:903-7. [PMID: 26011213 PMCID: PMC4452981 DOI: 10.9738/intsurg-d-14-00161.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 56-year-old white female presented to the emergency room (ER) with acute onset of right upper quadrant abdominal pain, nausea, and vomiting, and she was found to have a sudden drop in hemoglobin. Abdominal computed tomography (CT) with and without intravenous contrast revealed multiple bilobar focal hepatic hypervascular lesions, one of them demonstrating spontaneous rupture with active intraperitoneal bleeding. A moderate hemoperitoneum was present. The patient underwent exploratory laparotomy for right hepatic posterior segmentectomy (right posterior sectionectomy) and peritoneal lavage. The histopathology evaluation revealed multiple liver adenomas. Hepatic adenomatosis is a clinical entity characterized by 10 or more hepatic adenomas. It must be distinguished from isolated hepatic adenoma as it bears a much higher risk of complications, such as spontaneous rupture, hemorrhage and malignant transformation. Here we discuss the radiologic and histopathologic findings of the current case along with a review of the English language medical literature.
Collapse
Affiliation(s)
- Maren Donato
- 1 Department of Radiology, CIMED, La Plata, Buenos Aires, Argentina
| | | | | | | | | | | |
Collapse
|
|
13
|
|
|
14
|
Darnell A, Forner A, Rimola J, Reig M, García-Criado Á, Ayuso C, Bruix J. Liver Imaging Reporting and Data System with MR Imaging: Evaluation in Nodules 20 mm or Smaller Detected in Cirrhosis at Screening US. Radiology 2015; 275:698-707. [PMID: 25658038 DOI: 10.1148/radiol.15141132] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) with magnetic resonance (MR) imaging for hepatic nodules 20 mm or smaller detected during ultrasonographic (US) surveillance in patients with cirrhosis. MATERIALS AND METHODS Between November 2003 and January 2010, patients with cirrhosis with a newly US-detected solitary hepatic nodule 20 mm or smaller were included in this institutional ethics committee-approved study. All patients provided written informed consent before the study; the need to obtain consent for reanalysis of the data was waived. Patients underwent MR imaging and fine-needle biopsy (the reference standard). Nodules without pathologic confirmation were followed up with MR imaging every 6 months. A LI-RADS category was retrospectively assigned to nodules seen at MR imaging. The diagnostic accuracy for each LI-RADS category was described by sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals. RESULTS Final diagnoses of 133 nodules in 159 patients were as follows: 102 hepatocellular carcinomas (HCCs), three intrahepatic cholangiocarcinomas (ICCs), one neuroendocrine metastasis, and 27 benign lesions (median MR imaging follow-up, 95 months). None (0%) of five LI-RADS category 1 lesions, three (25%) of 12 category 2 lesions, 29 (69%) of 42 category 3 lesions, 24 (96%) of 25 category 4 lesions, and 44 (98%) of 45 category 5 lesions were HCCs. One category 3 lesion was ICC, one category 5 lesion was a neuroendocrine metastasis, and two (50%) of four lesions categorized as other malignancies were HCCs. In patients with nodules detected at surveillance US, LI-RADS category 4 criteria were as effective as category 5 criteria for HCC diagnosis. Combining both categories would improve sensitivity without impairing specificity or positive or negative predictive value for HCC diagnosis (42.3%, 98.2%, 97.8%, and 47.4% vs 65.4%, 96.4%, 97.1%, and 59.6%, respectively). CONCLUSION In patients with cirrhosis with US-detected nodules 20 mm or smaller, both LI-RADS category 4 and category 5 have high specificity for HCC. In addition, a relevant proportion of lesions categorized as LI-RADS category 2 or 3 or as other malignancies were HCCs. Thus, active diagnostic work-up, including biopsy to allow prompt treatment, is recommended in such patients. Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Anna Darnell
- From the Department of Radiology, Barcelona Clinic Liver Cancer group, Hospital Clinic Barcelona, University of Barcelona, Spain (A.D., J.R., A.G.C., C.A.); Liver Unit, Barcelona Clinic Liver Cancer Group, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, c/Villarroel 170, Escala 7, Planta 3, 08036 Barcelona, Spain (A.F., M.R., J.B.); and Networked Biomedical Research Center in Hepatic and Liver Diseases, Barcelona, Spain (A.F., J.R., M.R., C.A., J.B.)
| | | | | | | | | | | | | |
Collapse
|
|
15
|
Grieser C, Steffen IG, Kramme IB, Bläker H, Kilic E, Perez Fernandez CM, Seehofer D, Schott E, Hamm B, Denecke T. Gadoxetic acid enhanced MRI for differentiation of FNH and HCA: a single centre experience. Eur Radiol 2014; 24:1339-48. [PMID: 24658870 DOI: 10.1007/s00330-014-3144-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/04/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Evaluation of enhancement characteristics of histopathologically confirmed focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HCAs) with gadoxetic acid-enhanced MRI. METHODS Sixty-eight patients with 115 histopathologically proven lesions (FNHs, n=44; HCAs, n=71) examined with gadoxetic acid-enhanced MRI were retrospectively enrolled (standard of reference: surgical resection, n=53 patients (lesions: FNHs, n=37; HCAs, n=53); biopsy, n=15 (lesions: FNHs, n=7; HCAs, n=18)). Two radiologists evaluated all MR images regarding morphological features as well as the vascular and hepatocyte-specific enhancement in consensus. RESULTS For the hepatobiliary phase, relative enhancement of the lesions and lesion to liver enhancement were significantly lower for HCAs (mean, 48.7 (±48.4)%and 49.4 (±33.9) %) compared to FNHs (159.3 (±92.5) %; and 151.7 (±79) %; accuracy of 89%and 90 %, respectively; P<0.001). Visual strong uptake of FNHs vs. hypointensity of HCAs in the hepatobiliary phase resulted in an accuracy of 92 %. This parameter was superior to all other morphological and dynamic vascular criteria alone and in combination (accuracy, 54–85 %). CONCLUSIONS For differentiation of FNHs and HCAs by means of MRI, gadoxetic acid uptake in the hepatobiliary phase was found to be superior to all other criteria alone and in combination. KEY POINTS EOB-MRI is well suited to differentiate FNHs and hepatocellular adenomas. For this purpose hepatobiliary phase is superior to unenhanced and dynamic imaging. Hepatobiliary phase (peripheral) hyper- or isointensity is typical for FNH. Hepatobiliary phase hypointensity is typical for hepatocellular adenomas. EOB-MRI helps to avoid misinterpretations of benign hepatocellular lesions.
Collapse
|
|
16
|
Qian LJ, Zhu J, Zhuang ZG, Xia Q, Liu Q, Xu JR. Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation. Radiographics 2014; 33:1419-33. [PMID: 24025933 DOI: 10.1148/rg.335125063] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A multilocular cystic hepatic lesion detected at computed tomography (CT) and magnetic resonance (MR) imaging is a common but nonspecific radiologic finding that can cause potential challenges for differential diagnosis. This imaging pattern may be observed in a wide spectrum of common and uncommon neoplastic or nonneoplastic entities. Neoplastic lesions include cystadenoma, cystadenocarcinoma, hepatocellular carcinoma (HCC), metastases, mesenchymal hamartoma, and inflammatory myofibroblastic tumor. Nonneoplastic lesions include hepatic abscess, echinococcal cyst, intrahepatic hematoma, and biloma. The multiple coalescent cysts seen in polycystic liver disease may exhibit an imaging pattern similar to that of a multilocular cystic lesion. Mural nodularity, irregular thickness of the septa, ragged inner surface, and typical enhancement pattern in the solid portion of the lesion are often indicative of malignancy, although multilocular primary or secondary malignant tumors are uncommon. Recognition of the more common necrosis or cystic change of HCC and metastases induced by locoregional or systemic treatment also is important. The nonenhanced cystic component may be composed of different types of fluids (eg, serous, mucinous, proteinaceous, hemorrhagic, bilious, or mixed) or spontaneous or treatment-related necrosis, whereas the septa may be formed by a wide range of tissues depending on the lesion type. An understanding of the CT and MR imaging findings of these lesions and their respective pathologic correlation aids in accurate diagnosis.
Collapse
Affiliation(s)
- Li Jun Qian
- Departments of Radiology, Hepatic Surgery, and Pathology, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Pudong, Shanghai 200127, P.R. China
| | | | | | | | | | | |
Collapse
|
|
17
|
|
|
18
|
Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management. Updates Surg 2013; 66:9-21. [DOI: 10.1007/s13304-013-0222-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/16/2013] [Indexed: 12/25/2022]
|
|
19
|
Abstract
Hepatic adenoma is a rare, benign tumor (with potential for malignant degeneration) and its diagnosis is difficult because its presentation is highly variable in medical imaging, particularly with MRI. In such cases, the use of a hepatic biopsy is usually recommended. (18)FDG-PET/CT provides a very significant predictive value for malignant hepatic lesions. In addition, the occurrence of an (18)FDG-avid benign tumor is a rare event. We hereby present the case of a patient with advanced breast cancer for whom an (18)FDG-PET/CT showed a focal hepatic uptake. A subsequent biopsy provided a diagnosis of a hepatic adenoma.
Collapse
|
|
20
|
Schmid-Tannwald C, Jiang Y, Dahi F, Rist C, Sethi I, Oto A. Diffusion-weighted MR imaging of focal liver lesions in the left and right lobes: is there a difference in ADC values? Acad Radiol 2013; 20:440-5. [PMID: 23498984 DOI: 10.1016/j.acra.2012.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 10/27/2012] [Accepted: 10/27/2012] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To determine possible differences between the left and right hepatic lobes in apparent diffusion coefficient (ADC) values of benign and malignant focal liver lesions (FLLs) and normal liver parenchyma. MATERIALS AND METHODS Thirty-six patients (16 males, 20 females; mean age 56.8 years) with FLLs of the same etiology in both the left and right hepatic lobes (13 patients with 26 benign FLLs and 23 patients with 46 malignant FLLs) who underwent 1.5T magnetic resonance imaging (MRI) including diffusion-weighted MRI (b values: 0 and 800 seconds/mm) with respiratory gating and without cardiac gating were included in this Health Insurance Portability and Accountability Act-compliant and institutional review board-approved study. ADC values of normal liver parenchyma and FLLs in each hepatic lobe were calculated and compared by using Student's t-test and Wilcoxon signed-rank test, respectively. RESULTS The mean ADC values of normal liver parenchyma, benign FLLs, and malignant FLLs were significantly higher (P < .001, P = .003, and P = .005, respectively) in the left hepatic lobe (1.74 × 10(-3), 1.81 × 10(-3), and 1.48 × 10(-3) mm²/second, respectively) than in the right hepatic lobe (1.48 × 10(-3), 1.54 × 10(-3), and 1.24 × 10(-3) mm²/second, respectively). CONCLUSION ADC values of benign and malignant FLLs calculated from noncardiac-gated DW-MRI are significantly higher in the left hepatic lobe compared with the right hepatic lobe. This may be a limitation for characterization of FLLs based on ADC measurements.
Collapse
|
|
21
|
Denecke T, Steffen IG, Agarwal S, Seehofer D, Kröncke T, Hänninen EL, Kramme IB, Neuhaus P, Saini S, Hamm B, Grieser C. Appearance of hepatocellular adenomas on gadoxetic acid-enhanced MRI. Eur Radiol 2012; 22:1769-75. [PMID: 22437921 DOI: 10.1007/s00330-012-2422-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/12/2012] [Accepted: 01/21/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate enhancement characteristics of hepatocellular adenomas (HCAs) using gadoxetic acid as a hepatocyte-specific MR contrast agent. METHODS Twenty-four patients with histopathologically proven HCAs were retrospectively identified. MRI consisted of T1- and T2-weighted (w) sequences with and without fat saturation (fs), multiphase dynamic T1-w images, and fs T1-w images during the hepatobiliary phase. Standard of reference was surgical resection (n = 19) or biopsy (n = 5). Images were analysed for morphology and contrast behaviour including signal intensity (SI) measurement on T1-w images normalised to the pre-contrast base line. RESULTS In total 34 HCAs were evaluated. All HCAs showed enhancement in the arterial phase; 38 % of HCAs showed reduced contrast enhancement ("wash-out") in the venous phase. All HCAs showed enhancement (SI increase, 56 ± 53 %; P <0.001) in the hepatobiliary phase, although liver uptake was stronger (96 ± 58 %). Thus, 31 of all HCAs (91 %) appeared hypointense to the surrounding liver in the hepatobiliary phase, while 3 out of 34 lesions were iso-/hyperintense. CONCLUSIONS Gadoxetic acid accumulates in HCAs in the hepatobiliary phase, although significantly less than in surrounding liver. Thus, HCA appears in the vast majority of cases as a hypointense lesion on hepatobiliary phase images. KEY POINTS • Magnetic resonance-specific contrast agents are now available for hepatic imaging. • Hepatocellular adenomas enhance with gadoxetic acid as in previous CT/MRI experience. • Enhancement during the hepatobiliary phase is less in HCAs than in liver. • Typical HCAs appear as hypointense lesions on T1-w hepatobiliary phase images. • True hyperintense HCA enhancement can occasionally occur during the hepatobiliary phase.
Collapse
Affiliation(s)
- Timm Denecke
- Klinik für Radiologie, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
22
|
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: 5.5] [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.
Collapse
|
|
23
|
Kim TY, Kim BS, Hyun CL, Song BC. [Hepatocellular adenoma treated with radiofrequency ablation in young male]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:384-7. [PMID: 21694493 DOI: 10.4166/kjg.2011.57.6.384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Tae Yun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | | | | | | |
Collapse
|
|
24
|
Fernández-Rey C, Gavela-Ramón R, Brañanova-López P, Valerdiz-Casasola S. Solución del caso 34. Adenoma hepático. RADIOLOGIA 2011; 53:480-2. [DOI: 10.1016/j.rx.2010.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 10/01/2010] [Indexed: 10/16/2022]
|
|
25
|
van Aalten SM, Thomeer MGJ, Terkivatan T, Dwarkasing RS, Verheij J, de Man RA, Ijzermans JNM. Hepatocellular adenomas: correlation of MR imaging findings with pathologic subtype classification. Radiology 2011; 261:172-81. [PMID: 21875850 DOI: 10.1148/radiol.11110023] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the correlation between magnetic resonance (MR) imaging findings and pathologic subtype classification of hepatocellular adenoma (HCA). MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. MR imaging studies of 61 lesions (48 patients; median age, 36 years) were available and were independently reviewed by two radiologists. Consensus readings on all morphologic and signal-intensity imaging features were obtained. Previously, these lesions had been classified on the basis of pathologic findings and immunohistochemical analysis. Fisher exact and χ² tests were performed to compare the results between the different subtypes. A Bonferroni correction was applied to correct for multiple testing (α < .0033). RESULTS MR imaging signs of diffuse intratumoral fat deposition were present in seven (78%) of nine liver-fatty acid binding protein (L-FABP)-negative HCAs compared with five (17%) of 29 inflammatory HCAs (P = .001). Steatosis within the nontumoral liver was present in 11 (38%) of 29 inflammatory HCAs compared with none of the L-FABP-negative HCAs (P = .038). A characteristic atoll sign was only seen in the inflammatory group (P = .027). Presence of a typical vaguely defined type of scar was seen in five (71%) of seven β-catenin-positive HCAs (P = .003). No specific MR imaging features were identified for the unclassified cases. CONCLUSION L-FABP-negative, inflammatory, and β-catenin-positive HCAs were related to MR imaging signs of diffuse intratumoral fat deposition, an atoll sign, and a typical vaguely defined scar, respectively. Since β-catenin-positive HCAs are considered premalignant, closer follow-up with MR imaging or resection may be preferred.
Collapse
Affiliation(s)
- Susanna M van Aalten
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
|
26
|
Marin D, Galluzzo A, Plessier A, Brancatelli G, Valla D, Vilgrain V. Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. Eur Radiol 2011; 21:2074-82. [DOI: 10.1007/s00330-011-2161-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/09/2011] [Indexed: 01/02/2023]
|
|
27
|
Abstract
Recent advances in multidetector-row computed tomography, magnetic resonance imaging, and ultrasonography have led to the detection of incidental hepatic lesions in both the oncology and nononcology patient population that in the past remained undiscovered. These incidental hepatic lesions have created a management dilemma for both clinicians and radiologists. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidentalomas are presented.
Collapse
|
|
28
|
Lewis RB, Lattin GE, Makhlouf HR, Levy AD. Tumors of the liver and intrahepatic bile ducts: radiologic-pathologic correlation. Magn Reson Imaging Clin N Am 2011; 18:587-609, xii. [PMID: 21094457 DOI: 10.1016/j.mric.2010.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary tumors of the liver can be classified pathologically based on their cell of origin into epithelial tumors, arising from hepatocytes or biliary epithelium, and nonepithelial tumors, including mesenchymal tumors and lymphoma. Characteristic findings on MR imaging can be seen in many cases. This article reviews the MR imaging appearance of these tumors with pathologic correlation.
Collapse
Affiliation(s)
- Rachel B Lewis
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th Street NW, Washington, DC 20306-6000, USA.
| | | | | | | |
Collapse
|
|
29
|
Ronot M, Bahrami S, Calderaro J, Valla DC, Bedossa P, Belghiti J, Vilgrain V, Paradis V, Paradis V. Hepatocellular adenomas: accuracy of magnetic resonance imaging and liver biopsy in subtype classification. Hepatology 2011; 53:1182-91. [PMID: 21480324 DOI: 10.1002/hep.24147] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED Hepatocellular adenomas (HCAs) are divided into genotype/phenotype subgroups associated with different evolutive profiles. Therefore, recognition of subtype is of clinical importance in patient management. Magnetic resonance imaging (MRI) is considered the most informative imaging modality and liver biopsy a key diagnostic tool whose role in HCA subtyping has never been extensively studied. The purpose of our study was to evaluate the diagnostic performance of MRI and liver biopsy with and without immunohistochemistry and to assess the interobserver agreement for MR classification in a consecutive series of resected HCAs. Forty-seven HCAs with preoperative MRI and biopsy were retrospectively included. MRI data were reviewed independently by two abdominal radiologists blind to the pathological results and classification. Subtyping of HCAs on liver biopsy was made blindly to clinical, biological, and imaging data and to final classification. Routine histological analysis was based on morphological criteria and immunohistochemistry was systematically performed when enough tissue was available. Final subtyping of HCA was based on the examination of the surgical specimen. Radiologists correctly classified HCAs in 85%. The interobserver kappa correlation coefficient was 0.86. Routine histological analysis led to 76.6% of correct classification and 81.6% when immunophenotypical characteristics were available. The additional value of immunophenotypical markers is best in HCAs containing steatosis. Agreement between MRI findings and routine histological analysis was observed in 74.5%, leading to a likelihood ratio of subtype diagnosis higher than 20. CONCLUSION MRI and biopsy analysis are two efficient methods in subtyping HCAs and their association increases the diagnosis confidence. Interobserver variability in MRI criteria is very low.
Collapse
Affiliation(s)
- Maxime Ronot
- Department of Radiology, Hôpital Beaujon Clichy, France; INSERM U773, centre de recherche biomédicale Bichat-Beaujon, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
|
30
|
Jauregui G, El Mouhadi S, Rosmorduc O, Wendum D, Menu Y, Arrivé L. [Hepatocellular adenoma. Answer to December e-quid]. ACTA ACUST UNITED AC 2011; 92:82-5. [PMID: 21352735 DOI: 10.1016/j.jradio.2010.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Jauregui
- Service de radiologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | | | | | | | | | | |
Collapse
|
|
31
|
Grazioli L, Bondioni MP, Faccioli N, Gambarini S, Tinti R, Schneider G, Kirchin M. Solid focal liver lesions: dynamic and late enhancement patterns with the dual phase contrast agent gadobenate dimeglumine. J Gastrointest Cancer 2011; 41:221-32. [PMID: 20405242 DOI: 10.1007/s12029-010-9145-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The purpose of this paper is to illustrate contrast enhancement patterns of solid focal liver lesions on dynamic and late phase imaging with gadobenate dimeglumine (Gd-BOPTA). IMAGING FINDINGS Unenhanced T2- and T1-weighted, dynamic T1-weighted (arterial, portal-venous, and equilibrium) and late phase (1-3 h) Gd-BOPTA-enhanced MR imaging of different focal liver lesions (nodular regenerative hyperplasia, hepatic adenoma, liver adenomatosis, hepatocellular carcinoma, peripheral cholangiocarcinoma, hypervascular metastases, and hypovascular metastases) are shown. Dynamic imaging was performed using GRE T1-w sequences after the bolus injection of 0.1 mmol/kg Gd-BOPTA; late-phase imaging was obtained at 1-3 h after contrast injection. CONCLUSIONS Dynamic imaging with Gd-BOPTA provides the same information as with conventional gadolinium-based extracellular contrast agents, while late-phase imaging gives additional information for lesion identification and characterization.
Collapse
Affiliation(s)
- Luigi Grazioli
- Department of Radiology, University of Brescia, Brescia, Italy.
| | | | | | | | | | | | | |
Collapse
|
|
32
|
Miller FH, Hammond N, Siddiqi AJ, Shroff S, Khatri G, Wang Y, Merrick LB, Nikolaidis P. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 2010; 32:138-47. [PMID: 20578020 DOI: 10.1002/jmri.22235] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate apparent diffusion coefficient (ADC) values for characterization of a variety of focal liver lesions and specifically for differentiation of solid benign lesions (focal nodular hyperplasia [FNH] and adenomas) from solid malignant neoplasms (metastases and hepatocellular carcinoma [HCC]) in a large case series. MATERIALS AND METHODS A total of 542 lesions in 382 patients were evaluated. ADC values were measured in 166 hemangiomas, 112 hepatomas, 107 metastases, 95 cysts, 10 abscesses, 43 FNH, and nine adenomas. ADCs of 1.5 and 1.6 (x10(-3) mm(2)/second) were selected as threshold values to separate benign and malignant lesions. Sensitivity, specificity, positive, and negative predictive values (PPV, NPV) were calculated. Comparisons were carried out with studentized range test. RESULTS There was high interobserver agreement in ADC measurements for all lesion types. The mean ADCs for cysts was 3.40 (x10 (-3) mm(2)/second), hemangiomas 2.26, FNH 1.79, adenomas 1.49, abscesses 1.97, HCC 1.53, and metastases 1.50. The mean ADC for benign lesions was 2.50 and for malignant lesions was 1.52. Cysts were easily distinguished from other lesions. There was, however, overlap between solid benign and malignant lesions. CONCLUSION Benign lesions have higher mean ADC values than malignant lesions. However, ADC values of solid benign lesions (FNH and adenomas) are similar to malignant lesions (metastases, HCC) limiting the value of diffusion weighted imaging (DWI) for differentiating solid liver masses.
Collapse
Affiliation(s)
- Frank H Miller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
| | | | | | | | | | | | | | | |
Collapse
|
|
33
|
Stoot JHMB, Coelen RJS, de Jong MC, Dejong CHC. Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases. HPB (Oxford) 2010; 12:509-22. [PMID: 20887318 PMCID: PMC2997656 DOI: 10.1111/j.1477-2574.2010.00222.x] [Citation(s) in RCA: 242] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malignant transformation of hepatocellular adenomas (HCAs) into hepatocellular carcinomas (HCCs) has been reported repeatedly and is considered to be one of the main reasons for surgical treatment. However, its actual risk is currently unknown. OBJECTIVE To provide an estimation of the frequency of malignant transformation of HCAs and to discuss its clinical implications. METHODS A systematic literature search was conducted using the following databases: The Cochrane Hepatobiliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE and EMBASE. RESULTS One hundred and fifty-seven relevant series and 17 case reports (a total of 1635 HCAs) were retrieved, reporting an overall frequency of malignant transformation of 4.2%. Only three cases (4.4%) of malignant alteration were reported in a tumour smaller than 5 cm in diameter. DISCUSSION Malignant transformation of HCAs into HCCs remains a rare phenomenon with a reported frequency of 4.2%. A better selection of exactly those patients presenting with an HCA with an amplified risk of malignant degeneration is advocated in order to reduce the number of liver resections and thus reducing the operative risk for these predominantly young patients. The Bordeaux adenoma tumour markers are a promising method of identifying these high-risk adenomas.
Collapse
Affiliation(s)
- Jan HMB Stoot
- Department of Surgery, Maastricht University Medical CentreSittard,Department of Surgery, Orbis Medical CentreSittard
| | - Robert JS Coelen
- Department of Surgery, Maastricht University Medical CentreSittard,Department of Surgery, Orbis Medical CentreSittard
| | | | - Cornelis HC Dejong
- Department of Surgery, Maastricht University Medical CentreSittard,Maastricht University, Nutrim School for Nutrition, Toxicology and MetabolismMaastricht, the Netherlands
| |
Collapse
|
|
34
|
Chung EM, Cube R, Lewis RB, Conran RM. From the archives of the AFIP: Pediatric liver masses: radiologic-pathologic correlation part 1. Benign tumors. Radiographics 2010; 30:801-26. [PMID: 20462995 DOI: 10.1148/rg.303095173] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Benign hepatic tumors in children include lesions that are unique to the pediatric age group and others that are more common in adults. Infantile hemangioendothelioma, or infantile hepatic hemangioma, is a benign vascular tumor that may cause serious clinical complications. It is composed of vascular channels lined by endothelial cells. At imaging, large feeding arteries and draining veins and early, intense, peripheral nodular enhancement with centripetal filling on delayed images are characteristic features. Mesenchymal hamartoma of the liver occurs in young children and is characterized pathologically by mesenchymal proliferation with fluid-containing cysts of varying size and number. The mesenchymal component or cystic component may predominate; this predominance determines the imaging appearance of the tumor. Benign epithelial tumors that are common in adults may infrequently occur in childhood. These include focal nodular hyperplasia (FNH), hepatocellular adenoma, and nodular regenerative hyperplasia. All are composed of hyperplastic hepatocytes similar to surrounding liver parenchyma and may be difficult to discern at imaging. Preferential hepatic arterial phase enhancement helps distinguish FNH and hepatic adenoma from uninvolved liver. Hepatic adenoma often has intracellular fat and a propensity for intratumoral hemorrhage, neither of which are seen in FNH. Unlike adenoma, FNH often contains enough Kupffer cells to show uptake at sulfur colloid scintigraphy. Nodular regenerative hyperplasia is often associated with portal hypertension, which may be evident at imaging. Knowledge of how the pathologic features of these tumors affect their imaging appearances helps radiologists offer an appropriate differential diagnosis and management plan.
Collapse
Affiliation(s)
- Ellen M Chung
- Department of Radiology and Radiological Sciences, Edward F. Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
| | | | | | | |
Collapse
|
|
35
|
Hardie AD, Naik M, Hecht EM, Chandarana H, Mannelli L, Babb JS, Taouli B. Diagnosis of liver metastases: value of diffusion-weighted MRI compared with gadolinium-enhanced MRI. Eur Radiol 2010; 20:1431-1441. [PMID: 20148251 DOI: 10.1007/s00330-009-1695-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 10/20/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The full diagnostic value of diffusion-weighted (DW) MRI in the evaluation of liver metastases remains uncertain. The aim of the present study was to assess the diagnostic accuracy of DW-MRI and contrast-enhanced MRI (CE-MRI) using extracellular gadolinium chelates, with the reference standard established by consensus interpretation of confirmatory imaging and histopathologic data. METHODS MR examinations of 51 patients with extrahepatic malignancies were retrospectively reviewed by two independent observers who assessed DW-MRI and CE-MRI for detection of liver metastases. RESULTS By reference standard, 93 liver lesions (49 metastases and 44 benign lesions) were identified in 27 patients, 11 patients had no liver lesions, and 13 patients had innumerable metastatic and/or benign lesions. There was no difference in diagnostic performance between the two methods for either observer for the diagnosis of metastatic lesions per patient. For per-lesion analysis, sensitivity of DW-MRI was equivalent to CE-MRI for observer 1 (67.3% vs. 63.3%, p = 0.67), but lower for observer 2 (65.3% vs. 83.7%, p = 0.007). By pooling data from both observers, the sensitivity of DW-MRI was 66.3% (65/98) and 73.5% (72/98) for CE-MRI, with no significant difference (p = 0.171). CONCLUSION DW-MRI is a reasonable alternative to CE-MRI for the detection of liver metastases.
Collapse
Affiliation(s)
- Andrew D Hardie
- Department of Radiology, NYU Langone Medical Center, 560 First Avenue, New York, NY 10016, USA
| | | | | | | | | | | | | |
Collapse
|
|
36
|
Soussan M, Aubé C, Bahrami S, Boursier J, Valla DC, Vilgrain V. Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging. Eur Radiol 2010; 20:1715-25. [PMID: 20069427 DOI: 10.1007/s00330-009-1700-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/14/2009] [Accepted: 11/20/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To prospectively assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) and MR imaging in incidental solid focal liver lesions not characterised on ultrasound. MATERIALS AND METHODS Forty-seven patients with 50 lesions underwent MR imaging and CEUS: 24 focal nodular hyperplasias (FNH), 11 adenomas, 10 haemangiomas, 1 focal fatty change and 4 malignant lesions were identified. Two experienced radiologists randomly reviewed contrast-enhanced MR imaging and CEUS data, and provided the most likely diagnosis. Sensitivity (Se), specificity (Sp), likelihood ratios (LR) and kappa value were calculated. RESULTS A histotype diagnosis was obtained in 66-52% with MR imaging and 52-53% with CEUS, respectively, for both readers. Se, Sp and LR for haemangioma were 100-100, 100-100 and 78-78 with MR imaging and 89-89, 100-100 and 68-70 with CEUS; for FNH with MR imaging they were 88-63, 96-100 and 23-34 and 74-67, 88-96 and 6-17 with CEUS. If the diagnosis of haemangioma was uncertain with CEUS, MR imaging always confirmed the diagnosis. If the diagnosis of FNH was uncertain with either CEUS or MR imaging, the other imaging technique confirmed the diagnosis in approximately half the cases. CONCLUSION Both CEUS and MR imaging have a high diagnostic performance in incidental focal liver lesions and are complementary when diagnosis is uncertain.
Collapse
Affiliation(s)
- Michael Soussan
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, APHP, Hôpital Beaujon, Clichy, France
| | | | | | | | | | | |
Collapse
|
|
37
|
Multiple echogenic liver masses from multifocal nodular steatosis in a 55-year-old male with chronic hepatitis C. Radiol Case Rep 2010; 5:399. [PMID: 27307868 PMCID: PMC4898294 DOI: 10.2484/rcr.v5i3.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hepatic steatosis is often seen in patients with hepatitis on screening ultrasound as generalized increased liver echogenecity. However, its nodular form can present as multiple echogenic masses, which can mimic hepatocellular carcinoma or metastasis by ultrasound and computed tomography. Small hepatocellular carcinomas are often hyperechoic and have a trend towards lower alpha-fetoprotein levels. Magnetic resonance imaging can accurately identify microscopic fat within the lesions and demonstrate lack of associated enhancing soft tissue. If this entity is not appropriately characterized using magnetic resonance imaging, it can lead to additional imaging workup and unnecessary biopsy.
Collapse
|
|
38
|
Furlan A, Marin D, Bae KT, Lagalla R, Agnello F, Bazzocchi M, Brancatelli G. Focal liver lesions hyperintense on T1-weighted magnetic resonance images. Semin Ultrasound CT MR 2009; 30:436-49. [PMID: 19842568 DOI: 10.1053/j.sult.2009.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article reviews focal liver lesions hyperintense on T1-weighted magnetic resonance (MR) images and describes the underlying etiologies associated with their T1 signal intensity. Although focal liver lesions are commonly detected because of their iso- or hypointensity on T1-weighted images, lesions (benign or malignant) may present with T1 hyperintensity when they contain T1 shortening elements--such as fat, hemorrhage, copper, melanin, and highly concentrated proteins. Our discussion includes the description of state-of-the-art T1-weighted MR sequences and the imaging features of lesions on pre- and postcontrast MR images that are characteristic for lesion composition and useful for making accurate diagnosis.
Collapse
Affiliation(s)
- Alessandro Furlan
- University of Pittsburgh Medical Center, Department of Radiology, 3362 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | | | |
Collapse
|
|
39
|
Dokmak S, Paradis V, Vilgrain V, Sauvanet A, Farges O, Valla D, Bedossa P, Belghiti J. A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology 2009; 137:1698-705. [PMID: 19664629 DOI: 10.1053/j.gastro.2009.07.061] [Citation(s) in RCA: 258] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 07/24/2009] [Accepted: 07/29/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Hepatocellular adenoma (HA) is associated with risk of bleeding and malignancy, justifying resection. Patients with multiple forms of HA are difficult to manage. We evaluated the characteristics and outcome of 122 patients with single and multiple HAs after surgery. METHODS From 1990 to 2004, 122 patients (14 male) underwent surgical resection. Complications (hemorrhage and malignancy) were assessed according to size, number, and histologic subtype (steatotic, telangiectatic, and unclassified), with a mean follow-up period of 70 months. RESULTS Hemorrhagic HA occurred in 21% of cases and malignant HA occurred in 8%. Risk of complications was not related to the number of HAs but was associated with size (>5 cm), especially of telangiectatic and unclassified subtypes. Patients with steatotic HA had a low risk of complications. Malignant HA was more frequent in men (43%); all patients treated by partial resection survived, without recurrent malignancy, after a mean follow-up period of 78 months. After 109 patients with benign HA revealed recurrence or progression of HA in 8% and regression in 9% of cases. No complications were observed in 11 women who became pregnant during the follow-up period. CONCLUSIONS Patients with HAs greater than 5 cm, telangiectatic or unclassified subtypes, and men have an increased risk of complicated disease; resection should be restricted to these patients. The risk of complications was not related to the number of HAs, so patients with multiple HAs do not need liver transplantation.
Collapse
Affiliation(s)
- Safi Dokmak
- Department of HepatoBilioPancreatic Surgery, University of Paris 7 and Beaujon Hospital, Clichy, France
| | | | | | | | | | | | | | | |
Collapse
|
|
40
|
Kamaya A, Maturen KE, Tye GA, Liu YI, Parti NN, Desser TS. Hypervascular Liver Lesions. Semin Ultrasound CT MR 2009; 30:387-407. [DOI: 10.1053/j.sult.2009.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
|
41
|
Nguyen AT, Bressenot A, Manolé S, Galloy MA, Bronowicki JP, Vidailhet M, Feillet F, Claudon M. Contrast-enhanced ultrasonography in patients with glycogen storage disease type Ia and adenomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:497-505. [PMID: 19321677 DOI: 10.7863/jum.2009.28.4.497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this series was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the characterization of focal liver lesions (FLLs) in patients with glycogen storage diseases (GSDs). METHODS Contrast-enhanced ultrasonographic data obtained for characterization of 8 FLLs (size, 0.9-10.2 cm) in 2 patients with GSD type Ia (GSD-Ia) and lesion growth or recurrent abdominal pain were reviewed and compared with computed tomographic (CT) and magnetic resonance imaging (MRI) data. After total and left hepatectomy, pathologic examination confirmed benign adenomas in 6 of the evaluated lesions. Follow-up confirmed benignity in the 2 remaining lesions. RESULTS In all FLLs, CEUS showed marked hypervascularity in the early arterial phase. Centripetal filling was shown in only 1 lesion, and diffuse enhancement without any clear direction was shown in all other lesions. During the portal and late phases, 6 of the 8 lesions showed sustained enhancement, including 2 lesions that appeared heterogeneous during all phases of CT and MRI. In an aspect of 1 of these 6 large adenomas, late wash-out could be explained by sinusoid compression. The other 2 adenomas showed moderate wash-out but remained homogeneous. CONCLUSIONS Focal liver lesions found in patients with GSD-Ia have similar patterns on CEUS compared with incidental adenomas. Global or partial hypoenhancement observed in the late phase did not indicate a transition to hepatocellular carcinoma but may have been related to ischemia.
Collapse
Affiliation(s)
- Anh T Nguyen
- Department of Pediatric Radiology, Children's Hospital, Institut National de la Santé et de la Recherche Médicale, Vandoeuvre, France
| | | | | | | | | | | | | | | |
Collapse
|
|
42
|
Radiological and histopathological manifestations of hepatocellular nodular lesions concomitant with various congenital and acquired hepatic hemodynamic abnormalities. Jpn J Radiol 2009; 27:53-68. [PMID: 19373534 DOI: 10.1007/s11604-008-0299-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 10/31/2008] [Indexed: 12/25/2022]
Abstract
Congenital and acquired hepatic hemodynamic abnormalities are classified into four categories: hepatic arterial inflow disorder, portal vein inflow disorder, hepatic vein outflow disorder, and presence of a third inflow to the liver. Although their detailed etiology is not fully understood, these hepatic hemodynamic abnormalities may cause the formation of hepatocellular nodules. Recent advances in imaging modalities now enable visualization of these hepatocellular nodules concomitantly with the identification of various congenital and acquired hemodynamic abnormalities. Most of these nodular lesions are benign hyperplastic nodules, such as focal nodular hyperplasia, nodular regenerative hyperplasia, and other types of regenerative nodules. However, neoplastic nodules such as hepatic adenoma and hepatocellular carcinoma may also occur in conjunction with hepatic hemodynamic abnormalities. Distinguishing neoplastic nodules, especially malignant liver tumors, from hyperplastic nodules is important. Detection of intranodular Kupffer cells with superparamagnetic iron oxide enhanced magnetic resonance imaging is a key indicator that a nodule is regenerative rather than neoplastic.
Collapse
|
|
43
|
|
|
44
|
Laumonier H, Bioulac-Sage P, Laurent C, Zucman-Rossi J, Balabaud C, Trillaud H. Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology 2008; 48:808-18. [PMID: 18688875 DOI: 10.1002/hep.22417] [Citation(s) in RCA: 194] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED Hepatocellular adenomas (HCAs) are a group of benign tumors forming three molecular pathological subgroups: (1) hepatocyte nuclear factor 1alpha (HNF-1alpha)-inactivated, (2) beta-catenin-activated, and (3) inflammatory. Some HCAs present both beta-catenin activation and inflammation. We analyzed magnetic resonance imaging (MRI) data for correlations between features on imaging and pathological classification of HCAs. We included 50 cases for which pathology specimens were classified into three groups based on immunohistochemical staining. Two characteristic MRI profiles were identified corresponding to HNF-1alpha-inactivated and inflammatory HCAs. Fifteen HCAs were HNF-1alpha-inactivated. The corresponding lesions showed (1) diffuse signal dropout on T1-weighted chemical shift sequence due to steatosis, (2) isosignal or slight hypersignal on T2-weighted (T2W) images, and (3) moderate enhancement in the arterial phase, with no persistent enhancement in the portal venous and delayed phases. For the diagnosis of HNF-1alpha-inactivated HCA, the positive predictive value of homogeneous signal dropout on chemical shift images was 100%, the negative predictive value was 94.7%, the sensitivity was 86.7%, and the specificity was 100%. Twenty-three HCAs were inflammatory and showed (1) an absence or only focal signal dropout on chemical shift sequence; (2) marked hypersignal on T2W sequences, with a stronger signal in the outer part of the lesions, correlating with sinusoidal dilatation areas; and (3) strong arterial enhancement, with persistent enhancement in the portal venous and delayed phases. Marked hypersignal on T2W sequences associated with delayed persistent enhancement had a positive predictive value of 88.5%, a negative predictive value of 84%, a sensitivity of 85.2%, and a specificity of 87.5% for the diagnosis of inflammatory HCA. CONCLUSION HNF-1alpha-mutated HCAs and inflammatory HCAs were associated with specific MRI patterns related to diffuse fat repartition and sinusoidal dilatation, respectively.
Collapse
Affiliation(s)
- Hervé Laumonier
- Department of Radiology, CHU de Bordeaux, Hopital Saint-André, Bordeaux, France
| | | | | | | | | | | |
Collapse
|
|
45
|
Cho SW, Marsh JW, Steel J, Holloway SE, Heckman JT, Ochoa ER, Geller DA, Gamblin TC. Surgical management of hepatocellular adenoma: take it or leave it? Ann Surg Oncol 2008; 15:2795-803. [PMID: 18696154 DOI: 10.1245/s10434-008-0090-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatocellular adenoma (HA) is a rare benign tumor of the liver. Surgical resection is generally indicated to reduce risks of hemorrhage and malignant transformation. We sought to evaluate clinical presentation, surgical management, and outcomes of patients with HA at our institution. METHODS We performed a retrospective review of 41 patients who underwent surgical resection for HA between 1988 and 2007. RESULTS Thirty-eight patients were women, and the median age at presentation was 36 years (range, 19-65 years). The most common clinical presentation was abdominal pain (70%) followed by incidental radiological finding (17%). Twenty-two patients had a history of oral contraceptive use. Median number of HA was one (range, 1-3). There were 32 open cases (3 trisectionectomy, 15 hemihepatectomy, 7 sectionectomy, 4 segmentectomy, and 3 wedge resection), and 9 laparoscopic cases (1 hemihepatectomy, 5 sectionectomy, 1 segmentectomy, and 2 wedge resection). The median estimated blood loss was 225 mL (range, 0-3400 mL). The median length of stay was 6 days (range, 1-15 days). Surgical morbidities included pleural effusion requiring percutaneous drainage (n = 2), pneumonia (n = 1), and wound infection (n = 1). There was no perioperative mortality. Twelve patients had hemorrhage from HA. Hepatocellular carcinoma was observed in two patients with HA. Median follow-up was 23 months (range, 1-194 months), at which time all patients were alive. CONCLUSION In view of 29% hemorrhagic and 5% malignant complication rates, we recommend surgical resection over observation if patient comorbidities and anatomic location of HA are favorable. A laparoscopic approach can be safely used in selected cases.
Collapse
Affiliation(s)
- Sung W Cho
- Division of Transplantation, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | | | | | | | | | | | | | | |
Collapse
|
|
46
|
Low SCS, Peh WCG, Muttarak M, Cheung HS, Ng IOL. Imaging features of hepatic angiomyolipomas. J Med Imaging Radiat Oncol 2008; 52:118-23. [PMID: 18373801 DOI: 10.1111/j.1440-1673.2008.01927.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We review the imaging appearances of hepatic angiomyolipomas in patients with and without tuberous sclerosis. Sporadic hepatic angiomyolipomas have a varied appearance because of the inconstant proportion of fat, making confident imaging diagnosis difficult and necessitating biopsy in many cases. In patients with tuberous sclerosis, hepatic angiomyolipomas have a more consistent imaging appearance and, together with other features of the syndrome, can be more easily diagnosed. Preoperative diagnosis helps obviate unnecessary surgery.
Collapse
Affiliation(s)
- S C S Low
- Department of Diagnostic Radiology, KK Women's and Children's Hospital, Singapore
| | | | | | | | | |
Collapse
|
|
47
|
Abstract
Uma grande variedade de tumores benignos e malignos ocorre no fígado. Embora a caracterização de lesões hepáticas focais possa ser um desafio para o radiologista, a maioria das lesões se apresenta com características de imagem que permitem o seu diagnóstico. O objetivo deste trabalho é o de rever os principais aspectos de imagem dos tumores hepáticos benignos e malignos mais comumente encontrados no fígado adulto.
Collapse
|
|
48
|
Lewin M, Vilgrain V. [Radiological diagnosis of benign liver cell tumors]. ACTA ACUST UNITED AC 2008; 32:304-9; quiz 293, 314. [PMID: 18367357 DOI: 10.1016/j.gcb.2008.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M Lewin
- Département de radiologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | | |
Collapse
|
|
49
|
Parikh T, Drew SJ, Lee VS, Wong S, Hecht EM, Babb JS, Taouli B. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 2008; 246:812-22. [PMID: 18223123 DOI: 10.1148/radiol.2463070432] [Citation(s) in RCA: 414] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To retrospectively compare diffusion-weighted (DW) magnetic resonance (MR) imaging with standard breath-hold T2-weighted MR imaging for focal liver lesion (FLL) detection and characterization, by using consensus evaluation and other findings as the reference standard. MATERIALS AND METHODS Approval for this retrospective HIPAA-compliant study was obtained from the institutional review board; informed consent was waived. Fifty-three consecutive patients (30 men, 23 women; mean age, 60.7 years) with at least one FLL of 1 cm or greater in diameter were evaluated. Two independent observers reviewed DW (b values of 0, 50, and 500 sec/mm(2)) and T2-weighted images for FLL detection and characterization. Reference standard for diagnosis was obtained from consensus review by the two observers of DW, T2-weighted, and dynamic contrast material-enhanced images, pathologic data, and follow-up imaging results. Apparent diffusion coefficient (ADC) was measured for FLLs identified at consensus review. DW and T2-weighted images were compared for FLL detection and characterization by using a binary logistic regression model. Receiver operating characteristic curve analyses were conducted to evaluate the utility of ADC for diagnosis of malignancy. RESULTS Two hundred eleven FLLs (136 malignant, 75 benign) were detected at consensus review. Overall detection rate (averaged for two observers) was significantly higher for DW (87.7%) versus T2-weighted (70.1%) imaging (P < .001). FLL characterization was not significantly different between DW (89.1%) and T2-weighted (86.8%) imaging (P = .51). ADCs of malignant FLLs were significantly lower than those of benign FLLs (P < .001). The area under the curve for diagnosis of malignancy was 0.839, with sensitivity of 74.2%, specificity of 77.3%, positive predictive value of 85.5%, negative predictive value of 62.3%, and accuracy of 75.3%, by using a threshold ADC of less than 1.60 x 10(-3) mm(2)/sec. CONCLUSION DW MR imaging was better than standard breath-hold T2-weighted imaging for FLL detection and was equal to breath-hold T2-weighted imaging for FLL characterization.
Collapse
Affiliation(s)
- Tejas Parikh
- Department of Radiology, New York University Medical Center, 530 First Ave, MRI, New York, NY 10016, USA
| | | | | | | | | | | | | |
Collapse
|
|
50
|
Abstract
Liver masses are very common and most are benign. It is therefore important to avoid unnecessary interventions for benign lesions, while at the same time ensuring accurate diagnosis of hepatic malignancies. Many cancer patients, like the general population, have incidental benign liver lesions. In planning treatment for cancer patients, it is critical to avoid inappropriate treatment decisions based on misdiagnosis of a benign lesion as a metastasis or primary liver malignancy. This article describes the salient imaging features of the common benign liver masses and outlines a general approach to distinguishing between benign and malignant hepatic lesions.
Collapse
Affiliation(s)
- Jay P Heiken
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
| |
Collapse
|