Focal nodular hyperplasia: Intraindividual comparison of dynamic gadobenate dimeglumine- and ferucarbotran-enhanced magnetic resonance imaging

Introduction: Focal nodular hyperplasia and hepatocellular adenoma are benign hepatic tumors and differential diagnosis is important as hepatic adenomas may complicate with hemorrhage and malignant transformation. Magnetic resonance imaging with gadolinium-enhanced contrast agents is the best noninvasive diagnostic tool for benign hepatic tumors. Nevertheless, atypical radiological findings can make differential diagnosis a challenge. Presentation of case: We report a young female patient with large hepatic benign tumor with intralesional hemorrhage that disclosed hyper-intensity on hepatobiliary phase on a gadolinium-enhanced magnetic resonance imaging study, suggestive of focal nodular hyperplasia. As this type of tumor usually do not complicate with bleeding, surgical resection was proposed and a laparoscopic right posterior hepatic sectionectomy with selective hepatic artery clamping was performed. Pathology disclosed an inflammatory hepatic adenoma. Discussion: Hepatic adenomas may present as hyper-intense tumors on hepatobiliary phase of gadoliniumenhanced magnetic resonance imaging. Surgical resection still has a role on the treatment of benign hepatic tumors. Laparoscopic liver resections must be considered, even when a major hepatectomy is planned, as this approach has proved safe and effective. Selective hepatic artery clamping during minimally invasive liver surgery may be an option to reduce intraoperative bleeding, remnant liver ischemia and postoperative hepatic failure. Conclusion: We reported a young female patient with a benign hepatic tumor complicated with hemorrhage suggestive of a focal nodular hyperplasia on gadolinium-enhanced magnetic resonance imaging study. A laparoscopic hepatectomy was performed and final pathology disclosed an inflammatory hepatocellular adenoma.

Download Full-text

USEFULNESS OF POWER DOPPLER ULTRASONOGRAPHY AND SUPERPARAMAGNETIC IRON OXIDE ENHANCED MAGNETIC RESONANCE IMAGING FOR DIAGNOSIS OF FOCAL NODULAR HYPERPLASIA OF THE LIVER AFTER TREATMENT OF NEUROBLASTOMA

Pediatric Hematology and Oncology ◽

10.3109/08880010903464206 ◽

2010 ◽

Vol 27 (3) ◽

pp. 250-256 ◽

Cited By ~ 2

Author(s):

Kiminobu Sugito ◽

Takeshi Kusafuka ◽

Hiroyuki Kawashima ◽

Shota Uekusa ◽

Takeshi Furuya ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Iron Oxide ◽

Magnetic Resonance ◽

Focal Nodular Hyperplasia ◽

Doppler Ultrasonography ◽

Power Doppler ◽

Superparamagnetic Iron Oxide ◽

Power Doppler Ultrasonography ◽

Resonance Imaging ◽

Nodular Hyperplasia

Download Full-text

Paediatric focal nodular hyperplasia: A case study of typical contrast-enhanced ultrasound findings with quantitative analysis and correlated with magnetic resonance imaging

Ultrasound ◽

10.1177/1742271x20947760 ◽

2020 ◽

pp. 1742271X2094776

Author(s):

Andreas Panayiotou ◽

Vasileios Rafailidis ◽

Annamaria Deganello ◽

Maria Sellars ◽

Paul S Sidhu

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Focal Nodular Hyperplasia ◽

Ultrasound Examination ◽

Liver Lesion ◽

Contrast Enhanced Ultrasound ◽

Resonance Imaging ◽

Contrast Enhanced ◽

Nodular Hyperplasia ◽

Benign Liver

Introduction Focal nodular hyperplasia, a benign liver tumour, is the second most common focal benign liver lesion, after a cavernous haemangioma. Contrast-enhanced ultrasound is used increasingly for the diagnostic work up and follow-up of focal liver lesions in adults, but is particularly valuable in the paediatric population, with the ability to reduce radiation and the nephrotoxic contrast agents used in computed tomography or magnetic resonance imaging. Confident recognition of focal nodular hyperplasia is important; it is benign, usually asymptomatic, of no clinical significance, of no clinical consequence or malignant potential. We present a case of focal nodular hyperplasia of the liver with its characteristic findings on conventional ultrasound, contrast-enhanced ultrasound with quantitative analysis and correlated with magnetic resonance imaging. Case presentation: A 15-year-old female with right upper quadrant abdominal pain was referred for liver ultrasound. A focal liver lesion was detected on B-mode ultrasound examination, and colour Doppler demonstrated no specific features. Contrast-enhanced ultrasound examination demonstrated early arterial enhancement, with a characteristic spoke-wheel pattern, centrifugal uniform filling of the lesion on the late arterial phase and sustained enhancement on the portal venous phase. Quantitative contrast-enhanced ultrasound has been performed, showing a typical curve of enhancement, as well as characteristic parametric images, supporting the interpretation of contrast-enhanced ultrasound and assisting the diagnosis. Magnetic resonance imaging demonstrated a central T2 hyperintense scar and similar enhancement characteristics as contrast-enhanced ultrasound on T1 gadolinium-enhanced sequences. Conclusion Contrast-enhanced ultrasound is a useful technique for the differentiation of benign from malignant liver lesions and has the potential to establish the diagnosis of focal nodular hyperplasia, based on the enhancement pattern, which is similar to that observed on magnetic resonance imaging but can be better appreciated with superior temporal, contrast and spatial resolution of contrast-enhanced ultrasound.

Download Full-text