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Furumaya A, Willemssen FEJA, Miclea RL, Haring MPD, de Haas RJ, Feshtali S, Vanhooymissen IJS, Bos D, de Man RA, Ijzermans JNM, Erdmann JI, Verheij J, Doukas MC, van Delden OM, Thomeer MGJ. Lesions hyper- to isointense to surrounding liver in the hepatobiliary phase of gadoxetic acid-enhanced MRI. Eur Radiol 2024:10.1007/s00330-024-10829-x. [PMID: 38900280 DOI: 10.1007/s00330-024-10829-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Hyper- or isointensity in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI has high specificity for focal nodular hyperplasia (FNH) but may be present in hepatocellular adenoma and carcinoma (HCA/HCC). This study aimed to identify imaging characteristics differentiating FNH and HCA/HCC. MATERIALS AND METHODS This multicenter retrospective cohort study included patients with pathology-proven FNH or HCA/HCC, hyper-/isointense in the HBP of gadoxetic acid-enhanced MRI between 2010 and 2020. Diagnostic performance of imaging characteristics for the differentiation between FNH and HCA/HCC were reported. Univariable analyses, multivariable logistic regression analyses, and classification and regression tree (CART) analyses were conducted. Sensitivity analyses evaluated imaging characteristics of B-catenin-activated HCA. RESULTS In total, 124 patients (mean age 40 years, standard deviation 10 years, 108 female) with 128 hyper-/isointense lesions were included. Pathology diagnoses were FNH and HCA/HCC in 64 lesions (50%) and HCA/HCC in 64 lesions (50%). Imaging characteristics observed exclusively in HCA/HCC were raster and atoll fingerprint patterns in the HBP, sinusoidal dilatation on T2-w, hemosiderin, T1-w in-phase hyperintensity, venous washout, and nodule-in-nodule partification in the HBP and T2-w. Multivariable logistic regression and CART additionally found a T2-w scar indicating FNH, less than 50% fat, and a spherical contour indicating HCA/HCC. In our selected cohort, 14/48 (29%) of HCA were B-catenin activated, most (13/14) showed extensive hyper-/isointensity, and some had a T2-w scar (4/14, 29%). CONCLUSION If the aforementioned characteristics typical for HCA/HCC are encountered in lesions extensively hyper- to isointense, further investigation may be warranted to exclude B-catenin-activated HCA. CLINICAL RELEVANCE Hyper- or isointensity in the HBP of gadoxetic acid-enhanced MRI is specific for FNH, but HCA/HCC can also exhibit this feature. Therefore, we described imaging patterns to differentiate these entities. KEY POINTS FNH and HCA/HCC have similar HBP intensities but have different malignant potentials. Six imaging patterns exclusive to HCA/HCC were identified in this lesion population. These features in liver lesions hyper- to isointense in the HBP warrant further evaluation.
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - François E J A Willemssen
- Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Razvan L Miclea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands
| | - Martijn P D Haring
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Shirin Feshtali
- Department of Radiology, Leiden UMC, Leiden University, Leiden, The Netherlands
| | - Inge J S Vanhooymissen
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joanne Verheij
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michail C Doukas
- Department of Pathology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Otto M van Delden
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Shen L, Altmayer S, Tse JR. Beta-Catenin-Mutated Hepatocellular Adenomas at Hepatobiliary Phase MRI: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2024. [PMID: 38465878 DOI: 10.1002/jmri.29279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Beta-catenin-mutated hepatocellular adenomas (β-HCAs) can appear iso- to hyperintense at the hepatobiliary phase (HBP) at magnetic resonance imaging (MRI). Given the relatively lower prevalence of β-HCAs, prior studies had limited power to show statistically significant differences in the HBP signal intensity between different subtypes. PURPOSE To assess the diagnostic performance of HBP MRI to discriminate β-HCA from other subtypes. STUDY TYPE Systemic review and meta-analysis. POPULATION Ten original studies were included, yielding 266 patients with 397 HCAs (9%, 36/397 β-HCAs and 91%, 361/397 non-β-HCAs). FIELD STRENGTH/SEQUENCE 1.5 T and 3.0 T, HBP. ASSESSMENT PubMed, Web of Science, and Embase databases were searched from January 1, 2000, to August 31, 2023, for all articles reporting HBP signal intensity in patients with histopathologically proven HCA subtypes. QUADAS-2 was used to assess risk of bias and concerns regarding applicability. STATISTICAL TESTS Univariate random-effects model was used to calculate pooled estimates. Heterogeneity estimates were assessed with I2 heterogeneity index. Meta-regression (mixed-effect model) was used to test for differences in the prevalence of HBP signal between HCA groups. The threshold for statistical significance was set at P < 0.05. RESULTS HBP iso- to hyperintensity was associated with β-HCAs (pooled prevalence was 72.3% in β-HCAs and 6.3% in non-β-HCAs). Pooled sensitivity and specificity were 72.3% (95% confidence interval 54.1-85.3) and 93.7% (93.8-97.7), respectively. Specificity had substantial heterogeneity with I2 of 83% due to one study, but not for sensitivity (I2 = 0). After excluding this study, pooled sensitivity and specificity were 77.4% (59.6-88.8) and 94.1% (88.9-96.9), with no substantial heterogeneity. One study had high risk of bias for patient selection and two studies were rated unclear for two domains. DATA CONCLUSION Iso- to hyperintensity at HBP MRI may help to distinguish β-HCA subtype from other HCAs with high specificity. However, there was heterogeneity in the pooled estimates. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Luyao Shen
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Stephan Altmayer
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Justin R Tse
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Arian A, Abdullah AD, Taher HJ, Suhail Alareer H, Fotouhi M. Diagnostic Values of the Liver Imaging Reporting and Data System in the Detection and Characterization of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e36082. [PMID: 37065286 PMCID: PMC10097431 DOI: 10.7759/cureus.36082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
This review was undertaken to assess the diagnostic value of the Liver Imaging Reporting and Data System (LI-RADS) in patients with a high risk of hepatocellular carcinoma (HCC). Google Scholar, PubMed, Web of Science, Embase, PROQUEST, and Cochrane Library, as the international databases, were searched with appropriate keywords. Using the binomial distribution formula, the variance of all studies was calculated, and using Stata version 16 (StataCorp LLC, College Station, TX, USA), the obtained data were analyzed. Using a random-effect meta-analysis approach, we determined the pooled sensitivity and specificity. Utilizing the funnel plot and Begg's and Egger's tests, we assessed publication bias. The results exhibited pooled sensitivity and pooled specificity of 0.80% and 0.89%, respectively, with a 95% confidence interval (CI) of 0.76-0.84 and 0.87-0.92, respectively. The 2018 version of LI-RADS showed the greatest sensitivity (0.83%; 95% CI 0.79-0.87; I 2 = 80.6%; P < 0.001 for heterogeneity; T 2 = 0.001). The maximum pooled specificity was detected in LI-RADS version 2014 (American College of Radiology, Reston, VA, USA; 93.0%; 95% CI 89.0-96.0; I 2 = 81.7%; P < 0.001 for heterogeneity; T 2 = 0.001). In this review, the results of estimated sensitivity and specificity were satisfactory. Therefore, this strategy can serve as an appropriate tool for identifying HCC.
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Wakasa Y, Toyoki Y, Kusumi T, Kameyama Y, Odagiri T, Jin H, Nakai M, Aoki K, Kawashima H, Endo M. β-Catenin-activated inflammatory hepatocellular adenoma with pigmentation and atypical features: a case report. Clin J Gastroenterol 2023; 16:237-243. [PMID: 36640247 DOI: 10.1007/s12328-023-01757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
Hepatocellular adenomas are rare diseases, defined as benign liver neoplasms composed of cells with hepatocellular differentiation. Differential diagnosis of hepatocellular adenoma from other lesions, including focal nodular hyperplasia and hepatocellular carcinoma, is crucial to determine treatment strategy. We describe a case of β-catenin-activated inflammatory hepatocellular adenoma with malignant transformation. A 50-year-old man with a suspected liver tumor, based on abdominal ultrasonography findings, was referred to our hospital. Contrast-enhanced computed tomography and magnetic resonance imaging revealed a liver tumor in S2 which was enhanced in the arterial phase to the delayed phase. Based on diagnostic imaging findings, hepatocellular adenoma or focal nodular hyperplasia was suspected. We considered the possibility of malignant potential because of the enlargement of the lesion. Thus, we performed a laparoscopic hepatectomy. Histological examination showed pigment deposition in the hepatocytes, which was determined to be lipofuscin. Mild nuclear swelling and atypia in the tumor area indicated nodular growth. Based on the histological and immunohistochemical findings, the diagnosis was ꞵ-catenin-activated inflammatory hepatocellular adenoma with atypical features. The imaging features of hepatocellular adenoma and focal nodular hyperplasia are similar, but if the tumor tends to grow, surgical treatment should be performed because of the possibility of malignant hepatocellular adenoma.
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Affiliation(s)
- Yusuke Wakasa
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan.
| | - Yoshikazu Toyoki
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
| | - Tomomi Kusumi
- Department of Pathology, Aomori City Hospital, Aomori, Japan
| | - Yuma Kameyama
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
| | - Tadashi Odagiri
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
| | - Hiroyuki Jin
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
| | - Makoto Nakai
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
| | - Kazunori Aoki
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
| | - Hiroaki Kawashima
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
| | - Masaaki Endo
- Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan
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Hepatic Adenoma Subtypes on Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2023; 220:28-38. [PMID: 35920706 DOI: 10.2214/ajr.22.27989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. Accumulating evidence indicates that hepatocellular adenoma (HCA) may have a higher frequency of hepatobiliary phase (HBP) iso- or hyperintensity than previously reported. OBJECTIVE. The purpose of this study was to evaluate the proportion of HCA that shows iso- or hyperintensity in the HBP of gadoxetic acid-enhanced MRI, stratified by HCA subtype (HNF1a-inactivated [H-HCA], inflammatory [I-HCA], β-catenin-activated [B-HCA], and unclassified [U-HCA] HCA), and to assess the diagnostic performance of HBP iso- or hyperintensity for differentiating focal nodular hyperplasia (FNH) from HCA. EVIDENCE ACQUISITION. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched through February 14, 2022, for articles reporting HBP signal intensity on gadoxetic acid-enhanced MRI among pathologically proven HCAs, stratified by subtype. The pooled proportion of HBP iso- or hyperintensity was determined for each subtype and compared using metaregression. Diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from all HCA subtypes combined and from B-HCA and U-HCA combined was assessed using bivariate modeling. EVIDENCE SYNTHESIS. Twenty-eight studies (12 original investigations, 16 case reports or case series) were included, yielding 364 patients with 410 HCAs (112 H-HCAs, 203 I-HCAs, 33 B-HCAs, 62 U-HCAs). Pooled proportion of HBP iso- or hyperintensity was 14% (95% CI, 4-26%) among all HCAs, 0% (95% CI, 0-2%) among H-HCAs, 11% (95% CI, 0-29%) among U-HCAs, 14% (95% CI, 2-31%) among I-HCAs, and 59% (95% CI, 26-88%) among B-HCAs; metaregression showed significant difference among subtypes (p < .001). In four studies reporting diagnostic performance information, HBP iso- or hyperintensity had sensitivity of 99% (95% CI, 57-100%) and specificity of 89% (95% CI, 82-94%) for differentiating FNH from all HCA subtypes and sensitivity of 99% (95% CI, 53-100%) and specificity of 65% (95% CI, 44-80%) for differentiating FNH from B-HCA or U-HCA. CONCLUSION. HCA subtypes other than H-HCA show proportions of HBP iso- or hyperintensity ranging from 11% (U-HCA) to 59% (B-HCA). Low prevalence of B-HCA has contributed to prior reports of high diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from HCA. CLINICAL IMPACT. Radiologists should recognize the low specificity of HBP iso- or hyperintensity on gadoxetic acid-enhanced MRI for differentiating FNH from certain HCA subtypes.
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Fernandes DA, Dal Lago EA, Oliver FA, Loureiro BMC, Martins DL, Penachim TJ, Barros RHDO, Araújo Filho JDAB, Eloy da Costa LB, da Silva ÁMO, de Ataíde EC, Boin IDFSF, Caserta NMG. Hepatobiliary phases in magnetic resonance imaging using liver-specific contrast for focal lesions in clinical practice. World J Hepatol 2022; 14:1459-1469. [PMID: 36158916 PMCID: PMC9376775 DOI: 10.4254/wjh.v14.i7.1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/20/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Challenging lesions, difficult to diagnose through non-invasive methods, constitute an important emotional burden for each patient regarding a still uncertain diagnosis (malignant x benign). In addition, from a therapeutic and prognostic point of view, delay in a definitive diagnosis can lead to worse outcomes. One of the main innovative trends currently is the use of molecular and functional methods to diagnosis. Numerous liver-specific contrast agents have been developed and studied in recent years to improve the performance of liver magnetic resonance imaging (MRI). More recently, one of the contrast agents introduced in clinical practice is gadoxetic acid (gadoxetate disodium).
AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions (FLL) in clinical practice.
METHODS Overall, 302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL. Two radiologists independently reviewed the MRI exams using four stages, and categorized them on a 6-point scale, from 0 (lesion not detected) to 5 (definitely malignant). The stages were: stage 1- images without contrast, stage 2- addition of dynamic phases after contrast (analogous to usual extracellular contrasts), stage 3- addition of hepatobiliary phase after 10 min (HBP 10’), stage 4- hepatobiliary phase after 20 min (HBP 20’) in addition to stage 2.
RESULTS The interobserver agreement was high (weighted Kappa coefficient: 0.81- 1) at all stages in the characterization of benign and malignant FLL. The diagnostic weighted accuracy (Az) was 0.80 in stage 1 and was increased to 0.90 in stage 2. Addition of the hepatobiliary phase increased Az to 0.98 in stage 3, which was also 0.98 in stage 4.
CONCLUSION The hepatobiliary sequences improve diagnostic accuracy. With growing potential in the era of precision medicine, the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.
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Affiliation(s)
- Daniel Alvarenga Fernandes
- Department of Radiology, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | - Eduardo Andreazza Dal Lago
- Department of Radiology, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | - Felipe Aguera Oliver
- Department of Radiology, Medical School, São Paulo State University- UNESP, Botucatu 18618-970, São Paulo, Brazil
| | - Bruna Melo Coelho Loureiro
- Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- InRad/HC-FMUSP, São Paulo 05403-010, SP, Brazil
| | - Daniel Lahan Martins
- Department of Radiology, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | - Thiago José Penachim
- Department of Radiology, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | | | | | - Larissa Bastos Eloy da Costa
- Department of Pathology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | - Áurea Maria Oliveira da Silva
- Liver Transplant Unit, Department of Surgery, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | - Elaine Cristina de Ataíde
- Liver Transplant Unit, Department of Surgery, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | - Ilka de Fátima Santana Ferreira Boin
- Liver Transplant Unit, Department of Surgery, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
| | - Nelson Marcio Gomes Caserta
- Department of Radiology, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
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Katabathina VS, Khanna L, Surabhi VR, Minervini M, Shanbhogue K, Dasyam AK, Prasad SR. Morphomolecular Classification Update on Hepatocellular Adenoma, Hepatocellular Carcinoma, and Intrahepatic Cholangiocarcinoma. Radiographics 2022; 42:1338-1357. [PMID: 35776676 DOI: 10.1148/rg.210206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hepatocellular adenomas (HCAs), hepatocellular carcinomas (HCCs), and intrahepatic cholangiocarcinomas (iCCAs) are a highly heterogeneous group of liver tumors with diverse pathomolecular features and prognoses. High-throughput gene sequencing techniques have allowed discovery of distinct genetic and molecular underpinnings of these tumors and identified distinct subtypes that demonstrate varied clinicobiologic behaviors, imaging findings, and complications. The combination of histopathologic findings and molecular profiling form the basis for the morphomolecular classification of liver tumors. Distinct HCA subtypes with characteristic imaging findings and complications include HNF1A-inactivated, inflammatory, β-catenin-activated, β-catenin-activated inflammatory, and sonic hedgehog HCAs. HCCs can be grouped into proliferative and nonproliferative subtypes. Proliferative HCCs include macrotrabecular-massive, TP53-mutated, scirrhous, clear cell, fibrolamellar, and sarcomatoid HCCs and combined HCC-cholangiocarcinoma. Steatohepatitic and β-catenin-mutated HCCs constitute the nonproliferative subtypes. iCCAs are classified as small-duct and large-duct types on the basis of the level of bile duct involvement, with significant differences in pathogenesis, molecular signatures, imaging findings, and biologic behaviors. Cross-sectional imaging modalities, including multiphase CT and multiparametric MRI, play an essential role in diagnosis, staging, treatment response assessment, and surveillance. Select imaging phenotypes can be correlated with genetic abnormalities, and identification of surrogate imaging markers may help avoid genetic testing. Improved understanding of morphomolecular features of liver tumors has opened new areas of research in the targeted therapeutics and management guidelines. The purpose of this article is to review imaging findings of select morphomolecular subtypes of HCAs, HCCs, and iCCAs and discuss therapeutic and prognostic implications. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Lokesh Khanna
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Venkateswar R Surabhi
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Marta Minervini
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Krishna Shanbhogue
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Anil K Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
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LeGout JD, Bolan CW, Bowman AW, Caserta MP, Chen FK, Cox KL, Sanyal R, Toskich BB, Lewis JT, Alexander LF. Focal Nodular Hyperplasia and Focal Nodular Hyperplasia-like Lesions. Radiographics 2022; 42:1043-1061. [PMID: 35687520 DOI: 10.1148/rg.210156] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Focal nodular hyperplasia (FNH) is a benign lesion occurring in a background of normal liver. FNH is seen most commonly in young women and can often be accurately diagnosed at imaging, including CT, MRI, or contrast-enhanced US. In the normal liver, FNH frequently must be differentiated from hepatocellular adenoma, which although benign, is managed differently because of the risks of hemorrhage and malignant transformation. When lesions that are histologically identical to FNH occur in a background of abnormal liver, they are termed FNH-like lesions. These lesions can be a source of diagnostic confusion and must be differentiated from malignancies. Radiologists' familiarity with the imaging appearance of FNH-like lesions and knowledge of the conditions that predispose a patient to their formation are critical to minimizing the risks of unnecessary intervention for these lesions, which are rarely symptomatic and carry no risk for malignant transformation. FNH is thought to form secondary to an underlying vascular disturbance, a theory supported by the predilection for formation of FNH-like lesions in patients with a variety of hepatic vascular abnormalities. These include abnormalities of hepatic outflow such as Budd-Chiari syndrome, abnormalities of hepatic inflow such as congenital absence of the portal vein, and hepatic microvascular disturbances, such as those that occur after exposure to certain chemotherapeutic agents. Familiarity with the imaging appearances of these varied conditions and knowledge of their association with formation of FNH-like lesions allow radiologists to identify with confidence these benign lesions that require no intervention. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Jordan D LeGout
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Candice W Bolan
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Andrew W Bowman
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Melanie P Caserta
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Frank K Chen
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Kelly L Cox
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Rupan Sanyal
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Beau B Toskich
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Jason T Lewis
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Lauren F Alexander
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
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Kalor A, Girometti R, Maheshwari E, Kierans AS, Pugliesi RA, Buros C, Furlan A. Update on MR Contrast Agents for Liver Imaging. Radiol Clin North Am 2022; 60:679-694. [DOI: 10.1016/j.rcl.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Aziz H, Brown ZJ, Eskander MF, Aquina CT, Baghdadi A, Kamel IR, Pawlik TM. A Scoping Review of the Classification, Diagnosis, and Management of Hepatic Adenomas. J Gastrointest Surg 2022; 26:965-978. [PMID: 35083725 DOI: 10.1007/s11605-022-05246-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/05/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic adenomas (HA), or hepatocellular adenomas, are benign, solid liver lesions that develop in otherwise normal livers, often in the setting of increased estrogen levels. While considered a benign tumor, there is a risk for substantial complications such as hemorrhage and malignant transformation. We review the diagnosis, classification, and potential therapeutic management options for patients with HA. METHODS A scoping narrative review was conducted based on recent literature regarding classification, diagnosis, and management of HA. RESULTS While HAs are typically considered benign, complications such as hemorrhage and malignant transformation may occur in approximately 25% and 5% of patients, respectively. Recent advances in imaging and molecular profiling have allowed for the classification of HAs into subtypes allowing for patient risk stratification that helps guide management. Surgical resection should be considered in asymptomatic patients who are male, have an adenoma ≥5 cm in diameter, or have the β-catenin-activated subtype due to an increased risk of hemorrhage and/or malignant transformation. CONCLUSION Molecular profiling has aided in the stratification of patients relative to the risk of complications to predict better the potential behavior of HAs.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, Tufts University School of Medicine, Boston, MA, USA
| | - Zachary J Brown
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Mariam F Eskander
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Christopher T Aquina
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | | | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
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11
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Liu YH, Fan ZH, Yin SS, Yan K, Sun LQ, Jiang BB. Diagnostic value of color parametric imaging and contrast-enhanced ultrasound in the differentiation of hepatocellular adenoma and well-differentiated hepatocellular carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:216-221. [PMID: 35084048 DOI: 10.1002/jcu.23138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To investigate the differential diagnostic value of computer-aided color parametric imaging (CPI) and contrast-enhanced ultrasound (CEUS) in hepatocellular adenoma (HCA) and well-differentiated hepatocellular carcinoma (wHCC). METHOD A total of 38 patients who underwent CEUS and were pathologically diagnosed with HCA (10 cases) and wHCC (28 cases) were reviewed retrospectively. The differences between the radiological features of HCA and wHCC were compared by two readers, blinded to the final diagnosis. RESULTS (a) Sonographic features: on gray-scale ultrasound, halo sign was more common in wHCC than in HCA (60.7% vs. 10.0%, p = 0.009). On CEUS, hyper- or isoenhancement was more common in HCA in the portal phase (90.0% vs. 50.0%; p = 0.022). On CPI mode, HCA was inclined toward centripetal enhancement (60.0% vs. 14.3% p = 0.010). HCA was characterized by the presence of pseudocapsule enhancement (50.0% vs. 14.3%; p = 0.036). Quantitative analysis showed that the arrival time of HCA was earlier than that of wHCC (12.4 ± 3.7 s vs. 15.9 ± 3.2 s; p = 0.006). (b) Interobserver agreement was improved by using CPI compared with CEUS. The diagnostic sensitivity, specificity, and accuracy of the combination were 80.0%, 85.7%, and 84.2%, respectively. CONCLUSIONS CEUS combined with CPI can provide effective information for the differential diagnosis of HCA and wHCC, especially for the non-experienced radiologists.
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Affiliation(s)
- Yu-Hui Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhi-Hui Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shan-Shan Yin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Li-Qi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bin-Bin Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
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12
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Bilreiro C, Soler JC, Ayuso JR, Caseiro-Alves F, Ayuso C. Diagnostic value of morphological enhancement patterns in the hepatobiliary phase of gadoxetic acid-enhanced MRI to distinguish focal nodular hyperplasia from hepatocellular adenoma. Radiol Med 2021; 126:1379-1387. [PMID: 34287759 DOI: 10.1007/s11547-021-01403-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe the different morphological enhancement patterns of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-DTPA MRI) and to determine their added value in their differential diagnosis. METHODS A retrospective analysis of imaging findings in 185 benign hepatocellular lesions (154 FNH; 31 HCA) in 108 patients who underwent Gd-EOB-DTPA MRI was performed by two independent reviewers. Six patterns on HBP were recorded: 1) homogeneous enhancement; 2) peripheral ring-like enhancement with hypointense central core; 3) peripheral ring-like enhancement with hyperintense central core; 4) central core enhancement with hypointense periphery; 5) heterogeneous enhancement; and 6) the absence of enhancement. RESULTS Peripheral ring-like enhancement with hypointense central core and peripheral ring-like enhancement with hyperintense central core showed the highest specificity for the diagnosis of FNH (100% and 96.8%, respectively). The absence of enhancement and central core enhancement with hypointense periphery were only present in 0.6% and 1.9% of FHN, respectively. All other patterns were observed with similar frequencies in FNH (22.1% to 26.6%). Six HCA showed contrast uptake on the HBP: homogeneous (6.5%), peripheral ring-like enhancement with hyperintense central core (3.2%) and heterogeneous (9.7%). CONCLUSION Both FNH and HCA may demonstrate enhancement in the HBP of Gd-EOB-DTPA MRI, limiting its specificity. A significant improvement in specificity can be achieved by the evaluation of morphological enhancement patterns: Peripheral ring-like enhancement with hypointense or hyperintense central core was highly specific for FNH diagnosis. On the other hand, the absence of HBP enhancement makes the diagnosis of FNH unlikely.
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Affiliation(s)
- Carlos Bilreiro
- Radiology Department, Champalimaud Clinical Centre, Lisbon, Portugal
- Pre-Clinical MRI, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Juan Carlos Soler
- Radiology Department, BCLC Group. Hospital Clínic, c/ Villarroel, 170. Escala 3, Planta 1., 08036, Barcelona, Spain
| | - Juan R Ayuso
- Radiology Department, BCLC Group. Hospital Clínic, c/ Villarroel, 170. Escala 3, Planta 1., 08036, Barcelona, Spain
| | - Filipe Caseiro-Alves
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Carmen Ayuso
- Radiology Department, BCLC Group. Hospital Clínic, c/ Villarroel, 170. Escala 3, Planta 1., 08036, Barcelona, Spain.
- IDIBAPS. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas (CIBERehd), Clinic Liver Cancer Group (BCLC), Barcelona, Spain.
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13
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Katabathina VS, Marji H, Khanna L, Ramani N, Yedururi S, Dasyam A, Menias CO, Prasad SR. Decoding Genes: Current Update on Radiogenomics of Select Abdominal Malignancies. Radiographics 2021; 40:1600-1626. [PMID: 33001791 DOI: 10.1148/rg.2020200042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Technologic advances in chromosomal analysis and DNA sequencing have enabled genome-wide analysis of cancer cells, yielding considerable data on the genetic basis of malignancies. Evolving knowledge of tumor genetics and oncologic pathways has led to a better understanding of histopathologic features, tumor classification, tumor biologic characteristics, and imaging findings and discovery of targeted therapeutic agents. Radiogenomics is a rapidly evolving field of imaging research aimed at correlating imaging features with gene mutations and gene expression patterns, and it may provide surrogate imaging biomarkers that may supplant genetic tests and be used to predict treatment response and prognosis and guide personalized treatment options. Multidetector CT, multiparametric MRI, and PET with use of multiple radiotracers are some of the imaging techniques commonly used to assess radiogenomic associations. Select abdominal malignancies demonstrate characteristic imaging features that correspond to gene mutations. Recent advances have enabled us to understand the genetics of steatotic and nonsteatotic hepatocellular adenomas, a plethora of morphologic-molecular subtypes of hepatic malignancies, a variety of clear cell and non-clear cell renal cell carcinomas, a myriad of hereditary and sporadic exocrine and neuroendocrine tumors of the pancreas, and the development of targeted therapeutic agents for gastrointestinal stromal tumors based on characteristic KIT gene mutations. Mutations associated with aggressive phenotypes of these malignancies can sometimes be predicted on the basis of their imaging characteristics. Radiologists should be familiar with the genetics and pathogenesis of common cancers that have associated imaging biomarkers, which can help them be integral members of the cancer management team and guide clinicians and pathologists. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Luna (pp 1627-1630).
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Affiliation(s)
- Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Haneen Marji
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Lokesh Khanna
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Nisha Ramani
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Sireesha Yedururi
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Anil Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
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14
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Application of Immunohistochemistry in the Pathological Diagnosis of Liver Tumors. Int J Mol Sci 2021; 22:ijms22115780. [PMID: 34071338 PMCID: PMC8198626 DOI: 10.3390/ijms22115780] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 12/17/2022] Open
Abstract
Although radiological diagnostics have been progressing, pathological diagnosis remains the most reliable method for diagnosing liver tumors. In some cases, definite pathological diagnosis cannot be obtained by histological evaluation alone, especially when the sample is a small biopsy; in such cases, immunohistochemical staining is very useful. Immunohistochemistry is the most frequently used technique for molecular pathological diagnosis due to its broad application, ease of performance and evaluation, and reasonable cost. The results occasionally reflect specific genetic mutations. The immunohistochemical markers of hepatocellular carcinoma include those of hepatocellular differentiation—such as hepatocyte paraffin 1 and arginase-1—and those of malignant hepatocytes—such as glypican-3, heat shock protein 70, and glutamine synthetase (GS). To classify the subtypes of hepatocellular adenoma, examination of several immunohistochemical markers, such as liver fatty acid-binding protein, GS, and serum amyloid A, is indispensable. Immunohistochemical staining for GS is also important for the diagnosis of focal nodular hyperplasia. The representative immunohistochemical markers of intrahepatic cholangiocarcinoma include cytokeratin (CK) 7 and CK19. In this article, we provide an overview of the application of immunohistochemistry in the pathological diagnosis of liver tumors referring to the association with genetic alterations. Furthermore, we aimed to explain the practical points in the differential diagnosis of liver tumors by immunohistochemical staining.
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15
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Zhu M, Li H, Wang C, Yang B, Wang X, Hou F, Yang S, Wang Y, Guo X, Qi X. Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases. Drug Discov Ther 2021; 15:112-117. [PMID: 33952777 DOI: 10.5582/ddt.2021.01033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Focal nodular hyperplasia (FNH) is a solid benign tumor of the liver, predominantly in young women. A correct diagnosis of FNH is essential for making appropriate clinical decisions and avoiding unnecessary liver resection. Herein, we reported that two male cases with FNH, who initially presented with persistent abdominal discomfort, were misdiagnosed with hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) on contrast-enhanced magnetic resonance imaging and computed tomography scans, respectively. After surgery, a histological diagnosis of FNH was finally established. In this paper, we also reviewed the knowledge regarding diagnosis and differential diagnosis of FNH on imaging examinations, which are helpful for avoiding misdiagnoses and guiding clinical interventions.
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Affiliation(s)
- Menghua Zhu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Chunhui Wang
- Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xuehan Wang
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Feifei Hou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shengye Yang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yuye Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
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Park HJ, Byun JH, Kang JH, Kang HJ, Yu E, Lee SJ, Kim SY, Won HJ, Shin YM, Kim PN. Value of discrepancy of the central scar-like structure between dynamic CT and gadoxetate disodium-enhanced MRI in differentiation of focal nodular hyperplasia and hepatocellular adenoma. Eur J Radiol 2021; 139:109730. [PMID: 33930719 DOI: 10.1016/j.ejrad.2021.109730] [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: 02/03/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To identify the value of discrepancies in the central scar (CS)-like structure between dynamic CT and gadoxetate disodium-enhanced MRI for differentiating FNH from HCA. METHODS This retrospective study included 113 patients with pathologically-diagnosed FNH (n = 80) or HCA (n = 37). CS-like structures were evaluated on arterial phase (AP) CT and hepatobiliary phase (HBP) MRI. Presence of the CS-like structure, its discrepancy in visibility or size between AP CT and HBP MRI and between AP and HBP MRI, and features of non-scarred tumor portion were evaluated by two radiologists. Inter-observer agreement was evaluated by intraclass correlation coefficients (ICCs) and weighted kappa. Univariable and multivariable logistic regression and ROC analysis were performed to explore features differentiating FNH from HCA. RESULTS Inter-observer agreement was moderate-to-excellent (ICCs≥0.74, kappa≥0.65). On univariable analysis, presence of CS-like structures (P < 0.001), discrepancy of the CS-like structures between AP CT and HBP MRI (73.8 % in FNH; 16.2 % in HCA, P < 0.001) and between AP and HBP MRI (70.0 % in FNH; 16.2 % in HCA, P < 0.001), and the features of non-scarred tumor portion (P ≤ 0.011) were significantly different between FNH and HCA. On multivariable analysis, the discrepancy of CS-like structures between AP CT and HBP MRI, and the absence of low SI of the non-scarred tumor portion on HBP MRI, were suggestive of FNH (P = 0.036 and P < 0.001, respectively; area under the ROC curve, 0.96 [95 % CI, 0.93-0.99]). CONCLUSION Evaluation of discrepancy in the visibility or size of CS-like structures between dynamic CT and gadoxetate disodium-enhanced MRI may facilitate the differentiation of FNH from HCA.
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Affiliation(s)
- Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Ji Hun Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea; Department of Radiology, Hanyang University Gury Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, Republic of Korea
| | - Hyo Jeong Kang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Eunsil Yu
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Pyo Nyun Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Luna A. Invited Commentary: Radiogenomics Applied to Select Abdominal Tumors. Radiographics 2020; 40:1627-1630. [DOI: 10.1148/rg.2020200194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Antonio Luna
- From the Department of Radiology, HT Médica, Clínica Las Nieves, Carmelo Torres 2, 23007 Jaén, Spain
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18
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Moosavi B, Shenoy-Bhangle AS, Tsai LL, Reuf R, Mortele KJ. MRI characterization of focal liver lesions in non-cirrhotic patients: assessment of added value of gadoxetic acid-enhanced hepatobiliary phase imaging. Insights Imaging 2020; 11:101. [PMID: 32960337 PMCID: PMC7509030 DOI: 10.1186/s13244-020-00894-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the added value of the hepatobiliary (HPB) phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) in characterizing newly discovered indeterminate focal liver lesions in non-cirrhotic patients. Results One-hundred and twenty-five non-cirrhotic patients (median age, 46 years; range, 20–85 years; 100 females) underwent gadoxetic acid-enhanced MRI, including the 20-min delayed HPB phase, for characterization of newly discovered focal liver lesions. Images were independently evaluated by two blinded, board-certified abdominal radiologists (R1 and R2) who characterized liver lesions without and with assessment of the HPB phase images in two separate readout sessions. Confidence in diagnosis was scored on a scale from 0 to 3. Inter-observer agreement was assessed using Cohen κ statistics. Change in diagnosis and confidence in diagnosis were evaluated by Wilcoxon signed rank test. There was no significant change in diagnosis before and after evaluation of the HPB phase for both readers (p = 1.0 for R1; p = 0.34 for R2). Confidence in diagnosis decreased from average 2.8 ± 0.45 to 2.6 ± 0.59 for R1 and increased from 2.6 ± 0.83 to 2.8 ± 0.46 for R2. Change in confidence was only statistically significant for R1 (p = 0.003) but not significant for R2 (p = 0.49). Inter-reader agreement in diagnosis was good without (k = 0.66) and with (k = 0.75) inclusion of the HPB phase images. Conclusions The added information obtained from the HPB phase of gadoxetic acid-enhanced MRI does not change the diagnosis or increase confidence in diagnosis when evaluating new indeterminate focal liver lesions in non-cirrhotic patients.
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Affiliation(s)
- Bardia Moosavi
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.
| | - Anuradha S Shenoy-Bhangle
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Leo L Tsai
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Robert Reuf
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.,Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Koenraad J Mortele
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.,Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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Thomas JV, Abou Elkassem AM, Ganeshan B, Smith AD. MR Imaging Texture Analysis in the Abdomen and Pelvis. Magn Reson Imaging Clin N Am 2020; 28:447-456. [PMID: 32624161 DOI: 10.1016/j.mric.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Add "which is a" before "distribution"? Texture analysis (TA) is a form of radiomics that refers to quantitative measurements of the histogram, distribution and/or relationship of pixel intensities or gray scales within a region of interest on an image. TA can be applied to MR images of the abdomen and pelvis, with the main strength quantitative analysis of pixel intensities and heterogeneity rather than subjective/qualitative analysis. There are multiple limitations of MRTA. Despite these limitations, there is a growing body of literature supporting MRTA. This review discusses application of MRTA to the abdomen and pelvis.
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Affiliation(s)
- John V Thomas
- Body Imaging Section, Department of Radiology, University of Alabama at Birmingham, N355 Jefferson Tower, 619 19th Street South, Birmingham, AL 35249-6830, USA.
| | - Asser M Abou Elkassem
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249-6830, USA
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College of London, 5th Floor, Tower, 235 Euston Road, London NW1 2BU, UK
| | - Andrew D Smith
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249-6830, USA
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20
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Wu M, Zhou RH, Xu F, Li XP, Zhao P, Yuan R, Lan YP, Zhou WX. Multi-parameter ultrasound based on the logistic regression model in the differential diagnosis of hepatocellular adenoma and focal nodular hyperplasia. World J Gastrointest Oncol 2019; 11:1193-1205. [PMID: 31908724 PMCID: PMC6937441 DOI: 10.4251/wjgo.v11.i12.1193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/13/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) has very low potential risk, and a tendency to spontaneously resolve. Hepatocellular adenoma (HCA) has a certain malignant tendency, and its prognosis is significantly different from FNH. Accurate identification of HCA and FNH is critical for clinical treatment.
AIM To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.
METHODS Thirty-one patients with HCA were included in the HCA group. Fifty patients with FNH were included in the FNH group. The clinical data were collected and recorded in the two groups. Conventional ultrasound, shear wave elastography, and contrast-enhanced ultrasound were performed, and the lesion location, lesion echo, Young’s modulus (YM) value, YM ratio, and changes of time intense curve (TIC) were recorded. Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH. A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH. The value of the combined indicators for distinguishing HCA and FNH were explored.
RESULTS Multivariate logistic regression analysis showed that lesion echo (P = 0.000), YM value (P = 0.000) and TIC decreasing slope (P = 0.000) were the potential indicators identifying HCA and FNH. In the ROC curve analysis, the accuracy of the YM value distinguishing HCA and FNH was the highest (AUC = 0.891), which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope (P < 0.05). The accuracy of the combined diagnosis was the highest (AUC = 0.938), which was significantly higher than the AUC of the indicators diagnosing HCA individually (P < 0.05). This sensitivity was 91.23%, and the specificity was 83.33%.
CONCLUSION The combination of lesion echo, YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.
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Affiliation(s)
- Meng Wu
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Ru-Hai Zhou
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Feng Xu
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
- Department of Gastroenterology, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Xian-Peng Li
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
- Department of Gastroenterology, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Ping Zhao
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Rui Yuan
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Yu-Peng Lan
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Wei-Xia Zhou
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
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Hamada K, Saitoh S, Nishino N, Fukushima D, Techigawara K, Koyanagi R, Horikawa Y, Shiwa Y, Sakuma H, Kondo F. An elderly man with progressive focal nodular hyperplasia. Clin J Gastroenterol 2019; 13:413-420. [PMID: 31768882 PMCID: PMC7239834 DOI: 10.1007/s12328-019-01072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 11/25/2022]
Abstract
Patients with focal nodular hyperplasia (FNH) develop benign hepatocellular nodules. FNH most frequently occurs in young women. There are no reports of the onset of FNH in elderly men. We report a case of FNH in an elderly man, whose nodules increased in number and size. The patient underwent surgery for carcinoma of the left renal pelvis at 69 years of age; no liver masses were noted on yearly follow-up contrast-enhanced computed tomography (CECT). Ten years later, CECT revealed a hepatic mass, and magnetic resonance imaging suggested FNH. The nodules increased in number and size in subsequent follow-up examinations.
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Affiliation(s)
- Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikariga-oka, Fukushima-shi, Fukushima, 960-1295, Japan. .,Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan.
| | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Daizo Fukushima
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Kae Techigawara
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Ryota Koyanagi
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Hideo Sakuma
- Department of Pathology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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22
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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: 1.2] [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.
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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.
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Renzulli M, Clemente A, Tovoli F, Cappabianca S, Bolondi L, Golfieri R. Hepatocellular adenoma: An unsolved diagnostic enigma. World J Gastroenterol 2019; 25:2442-2449. [PMID: 31171888 PMCID: PMC6543239 DOI: 10.3748/wjg.v25.i20.2442] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/30/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA, β-catenin-mutated HCA, and unclassified HCA. β-catenin-mutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, Bologna 40138, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples 80138, Italy
| | - Francesco Tovoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples 80138, Italy
| | - Luigi Bolondi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, Bologna 40138, Italy
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Tsilimigras DI, Rahnemai-Azar AA, Ntanasis-Stathopoulos I, Gavriatopoulou M, Moris D, Spartalis E, Cloyd JM, Weber SM, Pawlik TM. Current Approaches in the Management of Hepatic Adenomas. J Gastrointest Surg 2019; 23:199-209. [PMID: 30109469 DOI: 10.1007/s11605-018-3917-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/03/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hepatic adenomas (HAs) are a benign and relatively rare type of liver neoplasms. We review the diagnosis, evaluation, and potential therapeutic management options for patients with HA. METHODS A comprehensive review of the English literature was performed utilizing MEDLINE/PubMed and Web of Science databases with end of search date the 30th April of 2018. In PubMed, the terms "hepatocellular," "hepatic," "liver," and "adenoma," "adenomatosis" were searched in the title and/or abstract. RESULTS Recent advances in molecular classification of HA have determined distinct subtypes with specific clinical, pathological, and imaging characteristics. In general, cessation of exogenous hormonal administration or weight loss may lead to HA regression. Surgical resection, either open or laparoscopic, should be considered in patients with symptoms and risk factors for hemorrhage or malignant transformation. These risk factors include tumor diameter greater than 5 cm, β-catenin activated subtype, and/or male gender. The management of acute hemorrhage should primarily aim at achieving hemodynamic stability via angioembolization followed by elective resection, whereas malignant transformation is treated according to oncologic resection principles. Although pregnancy is one of the known risk factors for tumor growth and associated complications, the presence of an HA per se should not be considered a contradiction to pregnancy. CONCLUSION Future genomic-based multicenter studies are required to provide a strong basis for formulating an evidence-based risk-adapted model that guides individualized management strategies for patients with HA.
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Affiliation(s)
- Diamantis I Tsilimigras
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Amir A Rahnemai-Azar
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin Hospital, Madison, WI, USA
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Sharon M Weber
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin Hospital, Madison, WI, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. .,Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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25
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Sciarra A, Schmidt S, Pellegrinelli A, Maggioni M, Dondossola D, Pasquier J, Cigala C, Tosi D, Halkic N, Bulfamante G, Viale G, Bosari S, Balabaud C, Bioulac-Sage P, Sempoux C. OATPB1/B3 and MRP3 expression in hepatocellular adenoma predicts Gd-EOB-DTPA uptake and correlates with risk of malignancy. Liver Int 2019; 39:158-167. [PMID: 30218633 DOI: 10.1111/liv.13964] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Hepatobiliary phase (HBP) Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) has increased the accuracy in differentiating focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). However, the ability of this technique to distinguish HCA subtypes remains controversial. The aim of this study was to investigate the expression of hepatocyte transporters (OATPB1/B3, MRP2, MRP3) in HCA subtypes, hence to understand their MRI signal intensity on HBP Gd-EOB-DTPA-enhanced MRI. METHODS By means of immunohistochemistry (IHC), we scored the expression of OATPB1/B3, MRP2 and MRP3, in resected specimens of FNH (n = 40), subtyped HCA (n = 58) and HCA with focal malignant transformation (HCA-HCC, n = 4). Results were validated on a supplementary set of FNH (n = 6), subtyped HCA (n = 17) and HCA-HCC (n = 1) with Gd-EOB-DTPA MR images. RESULTS All FNH showed a preserved expression of hepatocytes transporters. Beta-catenin-activated HCA (at highest risk of malignant transformation) and HCA-HCC were characterized by preserved/increased OATPB1/B3 expression (predictor of hyperintensity on HBP), as opposed to other HCA subtypes (P < 0.01) that mostly showed OATPB1/B3 absence (predictor of hypointensity on HBP). HCA-HCC showed an additional MRP3 overexpressed profile (P < 0.01). On HBP Gd-EOB-DTPA-enhanced MRI, FNH and HCA signal intensity reflected the profile predicted by their specific OATPB1/B3 tissue expression. The hyperintense vs hypointense HBP signal criterion was able to distinguish all higher risk HCA and HCA-HCC (100% accuracy). CONCLUSIONS OATPB1/B3 and MRP3 IHC and signal intensity on HBP Gd-EOB-DTPA-enhanced MRI can help to stratify HCA according to their risk of malignant transformation.
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Affiliation(s)
- Amedeo Sciarra
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland.,Pathology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Marco Maggioni
- Pathology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Daniele Dondossola
- Liver Transplant and General Surgery Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Jerome Pasquier
- Institute for Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudia Cigala
- Unit of Pathology, San Paolo Hospital Medical School, Department of Health Sciences, University of Milan, Milan, Italy
| | - Delfina Tosi
- Unit of Pathology, San Paolo Hospital Medical School, Department of Health Sciences, University of Milan, Milan, Italy
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Gaetano Bulfamante
- Unit of Pathology, San Paolo Hospital Medical School, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
| | - Silvano Bosari
- Pathology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Charles Balabaud
- Pathology Department, Inserm, UMR-1053, CHU de Bordeaux, Pellegrin Hospital, Bordeaux, France
| | - Paulette Bioulac-Sage
- Pathology Department, Inserm, UMR-1053, CHU de Bordeaux, Pellegrin Hospital, Bordeaux, France
| | - Christine Sempoux
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
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Value of Texture Analysis on Gadoxetic Acid-Enhanced MRI for Differentiating Hepatocellular Adenoma From Focal Nodular Hyperplasia. AJR Am J Roentgenol 2018; 212:538-546. [PMID: 30557050 DOI: 10.2214/ajr.18.20182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of our study was to assess the diagnostic performance of texture analysis (TA) on gadoxetic acid-enhanced MR images for differentiation of hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH). MATERIALS AND METHODS This study included 40 patients (39 women and one man) with 51 HCAs and 28 patients (27 women and one man) with 32 FNH lesions. All lesions were histologically proven with preoperative MRI performed with gadoxetic acid. Two readers reviewed all the imaging sequences to assess the qualitative MRI characteristics. The T2-weighted fast spin-echo, hepatic arterial phase (HAP), and hepatobiliary phase (HBP) sequences were used for TA. Textural features were extracted using commercially available software (TexRAD). The differences in distributions of TA parameters of FNHs and HCAs were assessed using the Mann-Whitney U test. Area under the ROC curve (AUROC) values were calculated for statistically significant features. A logistic regression analysis was conducted to explore the added value of TA. A p value < 0.002 was considered statistically significant after Bonferroni correction for multiple comparisons. RESULTS Multiple TA parameters showed a statistically different distribution in HCA and FNH including skewness on T2-weighted imaging, skewness on HAP imaging, skewness on HBP imaging, and entropy on HBP imaging (p < 0.001). Skewness on HBP imaging showed the largest AUROC (0.869; 95% CI, 0.777-0.933). A skewness value on HBP imaging of greater than -0.06 had a sensitivity of 72.5% and a specificity of 90.6% for the diagnosis of HCA. Six of 51 (11.8%) HCAs lacked hypointensity on HBP imaging. A binary logistic regression analysis including hypointensity on HBP imaging and the statistically significant TA parameters yielded an AUROC of 0.979 for the diagnosis of HCA and correctly predicted 96.4% of the lesions. CONCLUSION TA may be of added value for the diagnosis of atypical HCA presenting without hypointensity on HBP imaging.
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New MRI features improve subtype classification of hepatocellular adenoma. Eur Radiol 2018; 29:2436-2447. [PMID: 30523457 DOI: 10.1007/s00330-018-5784-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/31/2018] [Accepted: 09/20/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE MRI is crucial for the classification of hepatocellular adenomas (HCA) into subtypes. Our objective was to review and increase MRI criteria for subtype classification and define the limits. METHODS Pathological and radiological data of 116 HCAs were retrospectively analyzed to investigate MRI features of HCA pathological subtypes. Risk for complication was also evaluated with regard to subtype and tumor size. RESULTS 38/43 (88%) HNF1α-mutated HCAs (H-HCAs) were discriminated by (i) fatty component (homogeneous or heterogeneous) and (ii) hypovascular pattern, with a sensitivity of 88% and a specificity of 97%. 51/58 (88%) inflammatory HCAs (IHCAs) displayed features of sinusoidal dilatation (SD) including three different patterns (global SD, atoll sign, and a new "crescent sign" corresponding to a partial peripheral rim, hyperintense on T2W and/or arterial phase with persistent delayed enhancement). Sensitivity was 88% and specificity 100%. However, some HCA remained unclassifiable by MRI: HCA remodeled by necrotic/hemorrhagic changes covering > 50% of the lesion, H-HCAs without steatosis, IHCAs without SD, β-catenin-mutated and unclassified HCAs. Regarding malignant transformation (5/116) and bleeding (24/116), none was observed when the HCA diameter was smaller than 5.2 cm and 4.2 cm, respectively. CONCLUSION Based on the largest series evaluated until now, we identified several non-described MRI features and propose new highly sensitive and specific MRI criteria. With the addition of these new features, 88% of the two main HCA subtypes could be identified. KEY POINTS • HNF1α-mutated hepatocellular adenomas (H-HCA) are characterized by the presence of fat and hypovascular pattern in MRI. • Inflammatory hepatocellular adenomas (I-HCA) are characterized by different patterns translating sinusoidal dilatation including the newly described crescent sign. • No MRI specific pattern was identified for β-catenin-mutated HCA (b-HCA).
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Garcovich M, Faccia M, Meloni F, Bertolini E, de Sio I, Calabria G, Francica G, Vidili G, Riccardi L, Zocco MA, Ainora ME, Ponziani FR, De Gaetano AM, Gasbarrini A, Rapaccini GL, Pompili M. Contrast-enhanced ultrasound patterns of hepatocellular adenoma: an Italian multicenter experience. J Ultrasound 2018; 22:157-165. [PMID: 30306412 DOI: 10.1007/s40477-018-0322-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/14/2018] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities. METHODS We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units. RESULTS The study enrolled 19 patients (16 females; 69% with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6-7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89% of these showing centripetal and 11% centrifugal filling pattern, whereas during the portal and late venous phase 58% of HCA showed washout and the remaining 42% displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively. CONCLUSIONS This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.
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Affiliation(s)
- Matteo Garcovich
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Mariella Faccia
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Franca Meloni
- Department of Interventional Ultrasound, Casa di Cura Igea, Milan, Italy.,Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Emanuela Bertolini
- Department of Internal Medicine, Hepatology and Gastroenterology, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Ilario de Sio
- Hepatogastroenterology Unit, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Giosuele Calabria
- IX Interventional Ultrasound Unit for Infectious Diseases, AORN dei Colli, Cotugno Hospital, Naples, Italy
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Gianpaolo Vidili
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Laura Riccardi
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Assunta Zocco
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Elena Ainora
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Francesca Romana Ponziani
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Anna Maria De Gaetano
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Gian Ludovico Rapaccini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maurizio Pompili
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
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Wang H, Yang C, Rao S, Ji Y, Han J, Sheng R, Zeng M. MR imaging of hepatocellular adenomas on genotype-phenotype classification: A report from China. Eur J Radiol 2018; 100:135-141. [PMID: 29496071 DOI: 10.1016/j.ejrad.2018.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate and compare the MR features between hepatocellular adenoma (HCA) subtypes in China, including preliminary observations on diffusion-weighted imaging (DWI). METHODS Thirty-six patients with 39 pathologically proven HCAs underwent gadopentetate dimeglumine enhanced MRI. The morphological and imaging features on T1, T2-weighted, dynamic-enhanced imaging and DWI were retrospectively evaluated and compared between four HCA subtypes, using Kruskal-Wallis test, Fisher's exact test and Dunn-Bonferroni post hoc test. RESULTS HCA frequently occurred in male (n = 19, 52.8%), lacked an association with oral contraceptives (n = 0), and had a relatively high incidence of coexistent Hepatitis B infection (n = 6, 16.7%). Signals on T1 and T2-weighted imaging, enhancement pattern and intensity, lesion heterogeneity, as well as accompanying findings including lesion steatosis, necrosis or cystic component, central scar, and pseudocapsule were different between HCA subtypes (P < .0001 to P = .019). Apparent diffusion coefficient (ADC) values among HCA subtypes were different as a whole (P = .029), within which β-catenin-mutated HCA had the lowest ADCs; but post hoc comparisons demonstrated no significant differences between groups (P = .066-1.000). CONCLUSION Both clinical and MR imaging presentation of HCA in China had some specific characteristics, and a good relationship existed between MR data and genotype-phenotype classification. Furthermore, ADC value may provide a potential indicator of malignant transformation.
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Affiliation(s)
- Heqing Wang
- Shanghai Institute of Medical Imaging, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China; Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
| | - Shengxiang Rao
- Shanghai Institute of Medical Imaging, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China; Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Jing Han
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Ruofan Sheng
- Shanghai Institute of Medical Imaging, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China; Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China; Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
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