scholarly journals Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Federica Vernuccio ◽  
Domenico Salvatore Gagliano ◽  
Roberto Cannella ◽  
Ahmed Ba-Ssalamah ◽  
An Tang ◽  
...  
Keyword(s):  
Contrast Agents ◽  
Focal Nodular Hyperplasia ◽  
Mri Contrast Agents ◽  
Focal Liver Lesions ◽  
Liver Imaging ◽  
Hepatobiliary Phase ◽  
Liver Lesions ◽  
Oncologic Patients ◽  
Nodular Hyperplasia ◽  
Cirrhotic Patients

AbstractHepatobiliary MRI contrast agents are increasingly being used for liver imaging. In clinical practice, most focal liver lesions do not uptake hepatobiliary contrast agents. Less commonly, hepatic lesions may show variable signal characteristics on hepatobiliary phase. This pictorial essay reviews a broad spectrum of benign and malignant focal hepatic observations that may show hyperintensity on hepatobiliary phase in various clinical settings. In non-cirrhotic patients, focal hepatic observations that show hyperintensity in the hepatobiliary phase are usually benign and typically include focal nodular hyperplasia. In patients with primary or secondary vascular disorders, focal nodular hyperplasia-like lesions arise as a local hyperplastic response to vascular alterations and tend to be iso- or hyperintense in the hepatobiliary phase. In oncologic patients, metastases and cholangiocarcinoma are hypointense lesions in the hepatobiliary phase; however, occasionally they may show a diffuse, central and inhomogeneous hepatobiliary paradoxical uptake with peripheral rim hypointensity. Post-chemotherapy focal nodular hyperplasia-like lesions may be tricky, and their typical hyperintense rim in the hepatobiliary phase is very helpful for the differential diagnosis with metastases. In cirrhotic patients, hepatocellular carcinoma may occasionally appear hyperintense on hepatobiliary phase.

scholarly journals MRI characterization of focal liver lesions in non-cirrhotic patients: assessment of added value of gadoxetic acid-enhanced hepatobiliary phase imaging

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Bardia Moosavi ◽  
Anuradha S. Shenoy-Bhangle ◽  
Leo L. Tsai ◽  
Robert Reuf ◽  
Koenraad J. Mortele
Keyword(s):  
Gadoxetic Acid ◽  
Added Value ◽  
Rank Test ◽  
Focal Liver Lesions ◽  
Hepatobiliary Phase ◽  
Liver Lesions ◽  
Enhanced Mri ◽  
Phase Images ◽  
Cirrhotic Patients

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.

Evaluation of 2D- Shear Wave Elastography for Characterisation of Focal Liver Lesions

2017 ◽  
Vol 26 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Ludmila Gerber ◽  
Daniel Fitting ◽  
Kajana Srikantharajah ◽  
Nina Weiler ◽  
Georgia Kyriakidou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Shear Wave ◽  
Focal Nodular Hyperplasia ◽  
Shear Wave Elastography ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Nodular Hyperplasia ◽  
Glutamyl Transferase

Background & Aim: This is a prospective study for evaluation of 2D-shear wave elastography (2D-SWE) for characterisation and differentiation of benign und malignant focal liver lesions (FLLs).Methods: The patients referred to our ultrasound unit were prospectively included. B-mode ultrasound and 2D-SWE (Aixplorer® France) were performed for one FLL in each patient. Liver histology and/or contrast-enhanced imaging were used as a reference method.Results: 140 patients with FLL were included. SWE acquisitions failed in 24% of them. Therefore, 106 patients with FLL could be analysed, 42/106 with benign and 64/106 with malignant FLLs. The median stiffness for benign FLLs was 16.4 (2.1-71.9) kPa: 16.55 kPa for 18 focal nodular hyperplasia (FNH), 16.35 kPa for 18 hemangioma, 9.8 kPa for 3 focal fatty sparings (FFS), 8.9 kPa for 1 adenoma, 20 kPa for one regenerative node and 29 kPa for one cholangiofibroma, and for the malignant FLLs 36 (4.1-142.9) kPa: 44.8 kPa for 16 hepatocellular carcinoma (HCC), 70.7 kPa for 7 cholangiocarcinoma (CCC) and 29.5 kPa for the 41 metastasis (p<0.001). Malignant FLLs were significantly stiffer than benign FLLs (p<0.0001). Cholangiocarcinomas were the stiffest malignant FFLs with significantly higher values as compared to HCCs and metastases (p=0.033 and p=0.0079, respectively). No significant difference in stiffness could be observed between the different benign FLL entities. No significant difference was observed whether 2D-SWE included the whole FLL, the periphery or only the hardest area of the FLL.Conclusions: 2D-SWE provides further characterising information for interpretation of FLLs and may be useful at least in differentiation of CCCs and HCCs.Abbreviations: ALT: alanine aminotransaminase; AST: aspartate aminotransaminase; AUROC: area under the ROC; ARFI: acoustic radiation force impulse; CCC: cholangiocarcinoma; CECT: contrast-enhanced CT; CEMRI: contrast-enhanced MRI; CEUS: contrast-enhanced ultrasound; FFS: focal fatty sparing; FLL: focal liver lesion; FNH: focal nodular hyperplasia; GGT: gamma-glutamyl-transferase; HCC: hepatocellular carcinoma; NASH: nonalcoholic steatohepatitis; pSWE: point shear wave elastography; ROC: receiver-operating-characteristic; ROI: region of interest; 2D-SWE: 2D-shear wave elastography; TE: transient elastography.

Intrapatient Comparison of the Hepatobiliary Phase of Gd-BOPTA and Gd-EOB-DTPA in the Differentiation of Hepatocellular Adenoma From Focal Nodular Hyperplasia

2018 ◽  
Vol 49 (3) ◽  
pp. 700-710 ◽  
Author(s):  
Inge J.S.M.L. Vanhooymissen ◽  
Maarten G. Thomeer ◽  
Loes M.M. Braun ◽  
Bibiche Gest ◽  
Sebastiaan van Koeverden ◽  
...  
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Hepatocellular Adenoma ◽  
Hepatobiliary Phase ◽  
Nodular Hyperplasia

scholarly journals Challenging liver lesions in noncirrhotic patients: Report of three cases

2019 ◽  
Vol 12 ◽  
pp. 263177451984494
Author(s):  
Tania Franceschini ◽  
Deborah Malvi ◽  
Lorenzo Maroni ◽  
Matteo Ravaioli ◽  
Matteo Cescon ◽  
...  
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Hepatocellular Adenoma ◽  
Epithelioid Cell ◽  
Cell Tumor ◽  
Liver Lesions ◽  
Diagnostic Challenge ◽  
Radiological Features ◽  
Perivascular Epithelioid Cell ◽  
Nodular Hyperplasia ◽  
Final Histological Diagnosis

We describe three cases of liver lesions, characterized by a discrepancy between presurgical imaging and histological features, in which the final histological diagnosis was quite different from what the surgeons expected. We present (1) a case of primary liver angiomyolipoma associated with focal nodular hyperplasia, (2) a case of perivascular epithelioid cell tumor, and (3) a case of liver splenosis associated with focal nodular hyperplasia. In all cases, a presurgical diagnosis of hepatocellular adenoma was made. Due to nonspecific clinical and radiological features, these rare liver lesions are often presurgically misdiagnosed, especially in young noncirrhotic patients. The association among different lesions represents one additional diagnostic challenge.

scholarly journals Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

2018 ◽  
Vol 31 (9) ◽  
pp. 470 ◽  
Author(s):  
Henrique Donato ◽  
Luísa Andrade ◽  
Nina Bastati ◽  
Augusta Cipriano ◽  
Ahmed Ba-Ssalamah ◽  
...  
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Lesion Size ◽  
Clinical Settings ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Imaging Findings ◽  
Vascular Abnormality ◽  
Central Scar ◽  
Nodular Hyperplasia ◽  
Regenerative Nodules

Introduction: Multiacinar regenerative nodules are benign hepatocellular nodules related to vascular disturbances of the liver. They strongly resemble conventional focal nodular hyperplasia but are connected to different clinical settings, typically chronic liver disease. The purpose of the present study was to describe the key imaging features of these lesions and compare them with a control arm of focal nodular hyperplasia.Material and Methods: A blinded consensus review of liver magnetic resonance consisting of 26 cases of multiacinar regenerative nodules and 25 cases of focal nodular hyperplasia was performed. Lesion size, shape, margins, structure, T1 and T2 signal intensity, diffusion and contrast-enhanced features (including hepatobiliary phase), presence of a central scar and of a peripheral hypointense rim were compared between the two groups.Results: Significant differences between multiacinar regenerative nodules and focal nodular hyperplasia included size (median 2.35 cm, IQR: 2.13, vs 6.00 cm, IQR: 5.20, respectively, p < 0.001), presence of a peripheral hypointense rim after contrast (n = 9 vs n = 2 cases, p = 0.038) and of a central scar (n = 9 vs n = 20, p = 0.002). There were no other significant differences.Discussion: Overall multiacinar regenerative nodules and focal nodular hyperplasia have very similar imaging features but lack of a central scar and presence of a hypointense rim should suggest a diagnosis of multiacinar regenerative nodules.Conclusions: Recognition of the imaging findings of multiacinar regenerative nodules can explain some atypical cases of focal nodular hyperplasia, avoiding unnecessary biopsies. They may also be the trigger to investigate an unsuspected underlying liver vascular abnormality.

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