Lesions hyper- to isointense to surrounding liver in the hepatobiliary phase of gadoxetic acid-enhanced MRI.

Autor: Furumaya A; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. a.furumaya@amsterdamumc.nl.; Cancer Center Amsterdam, Amsterdam, The Netherlands. a.furumaya@amsterdamumc.nl., Willemssen FEJA; Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands., Miclea RL; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands., Haring MPD; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., de Haas RJ; Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Feshtali S; Department of Radiology, Leiden UMC, Leiden University, Leiden, The Netherlands., Vanhooymissen IJS; Cancer Center Amsterdam, Amsterdam, The Netherlands.; Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bos D; 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., de Man RA; Department of Gastroenterology and Hepatology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands., Ijzermans JNM; Department of Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands., Erdmann JI; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Amsterdam, The Netherlands., Verheij J; Cancer Center Amsterdam, Amsterdam, The Netherlands.; Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Doukas MC; Department of Pathology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands., van Delden OM; Cancer Center Amsterdam, Amsterdam, The Netherlands.; Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Thomeer MGJ; Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Dec; Vol. 34 (12), pp. 7661-7672. Date of Electronic Publication: 2024 Jun 20.
DOI: 10.1007/s00330-024-10829-x
Abstrakt: 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.
Competing Interests: Compliance with ethical standards Guarantor The scientific guarantor of this publication is Dr. MGJ Thomeer. Conflict of interest The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry One of the authors has significant statistical expertise. Informed consent Written informed consent was not required for this study because an opt-out procedure was applied. Ethical approval Institutional Review Board approval was not required because the study was beyond the Dutch Medical Research Involving Human Subjects Act (WMO). Methodology RetrospectiveDiagnostic or prognostic studyMulticenter study
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: