scholarly journals Novel Strategy for Diagnosis of Focal Nodular Hyperplasia Using Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid: Enhanced Magnetic Resonance Imaging and Magnetic Resonance Elastography

2021 ◽  
pp. 507-512
Author(s):  
Nobutaka Takeda ◽  
Atsunori Tsuchiya ◽  
Kazuki Natsui ◽  
Yui Ishii ◽  
Yoshihisa Arao ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Liver Biopsy ◽  
Focal Nodular Hyperplasia ◽  
Liver Tumors ◽  
Magnetic Resonance Elastography ◽  
Diethylenetriaminepentaacetic Acid ◽  
Resonance Imaging ◽  
Nodular Hyperplasia ◽  
Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid

Focal nodular hyperplasia (FNH) is the second most frequent benign liver tumor, and it is a fiber-rich stiff lesion. Typically, FNH can be diagnosed by imaging without biopsy. However, liver biopsy and diagnostic resection may be required to differentiate atypical FNH from other liver tumors, such as hepatocellular adenoma (HCA). Therefore, improved noninvasive diagnostic methods are needed. We experienced 2 cases where combination of magnetic resonance elastography (MRE) and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) helped diagnose FNH. A 36-year-old woman and 17-year-old boy with liver tumors measuring 40 mm in diameter each showed hypointense nodule centers, indicating a central scar, surrounded by hyperintense signals during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. To rule out HCA, we performed MRE and liver biopsy. On MRE, the mean stiffness of the mass was 11.6 kPa (mean stiffness of the background liver was 1.7 kPa) and 11.1 kPa (mean stiffness of the background liver was 2.4 kPa) in the first and second patients, respectively. Histological examination of both specimens showed CK7-positive bile-ductular proliferations, abundant fibrous tissue, and few Ki-67-positive cells. Based on these results, we diagnosed these tumors as FNH. Combination of Gd-EOB-DTPA-enhanced MRI and MRE can evaluate the character and stiffness of lesion and help in the diagnosis of FNH.

Liver biopsy for diagnosis of presumed benign hepatocellular lesions lacking magnetic resonance imaging diagnostic features of focal nodular hyperplasia

2016 ◽  
Vol 36 (11) ◽  
pp. 1668-1676 ◽  
Author(s):  
Aurélie Sannier ◽  
Julien Cazejust ◽  
Marie Lequoy ◽  
Pascale Cervera ◽  
Olivier Scatton ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Liver Biopsy ◽  
Focal Nodular Hyperplasia ◽  
Resonance Imaging ◽  
Diagnostic Features ◽  
Nodular Hyperplasia

scholarly journals Laparoscopic Hepatectomy with Selective Hepatic Artery Clamping for A Hyperintense Hepatic Adenoma on Hepatospecific Gadolinium-Enhanced Magnetic Resonance Imaging: The Great Pretender

2019 ◽  
pp. 1-4
Author(s):  
Rodrigo Cañada Trofo Surjan ◽  
Rodrigo Cañada Trofo Surjan ◽  
Andrea Zaidan de Almeida Barros ◽  
Roberto Blasbalg ◽  
Sergio do Prado Silveira ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hepatic Artery ◽  
Focal Nodular Hyperplasia ◽  
Laparoscopic Hepatectomy ◽  
Hepatocellular Adenoma ◽  
Hepatobiliary Phase ◽  
Hepatic Tumors ◽  
Resonance Imaging ◽  
Nodular Hyperplasia

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.

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

Ultrasound ◽  
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.

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