A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma

Abstract

• The effectiveness of the three strategies was similar. • The cost of the EOB-MRI strategy was lowest. • EOB-MRI strategy is the most cost-effective for differentiating FNH from HCA.

Hepatocellular adenoma: An unsolved diagnostic enigma

“…The combination of low signal intensity in the hepatobiliary phase with routine MRI features and risk factors of liver disease, could substantially improve the diagnosis of HCAs[24]. In addition, MRI performed with gadoxetic acid was demonstrated to be the most cost-effective strategy for differentiating FNH from HCA in patients with incidentally detected focal liver lesions in a non-cirrhotic liver[25,26].…”

Evaluation and Management of Hepatocellular Adenomas

“…Specifically, it can be difficult to distinguish HCA from focal nodular hyperplasia in some cases. A cost‐effectiveness analysis of diagnostic strategies in this case found that gadoxetic acid–enhanced MRI was likely the most cost‐effective approach 3 . Although most adenomas have a benign natural history, potential serious complications include rupture, hemorrhage, and malignant transformation into hepatocellular carcinoma.…”

“…review approach. 3 Although most adenomas have a benign natural history, potential serious complications include rupture, hemorrhage, and malignant transformation into hepatocellular carcinoma. Hemorrhage and malignant transformation have been reported in 27.2% and 4.2% of patients with HCA, respectively, although both are significantly less likely in lesions smaller than 5 cm in maximum diameter.…”

Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases

“…First, central scar is of great significance for the diagnosis of FNH, but it is only observed in approximately 50% of FNH cases and is usually present in FNH lesions larger than 3 cm. If such a typical sign is missing, it is difficult to obtain a confident diagnosis of FNH on conventional MRI (18,19). The case 1 with a small hepatic lesion did not have any signal intensity symbolizing the central scar on CE-MRI.…”

“…By comparison, on hepatobiliary phase of CE-MRI with novel hepatocyteselective contrast agents, such as gadoxetate disodium and gadobenate dimeglumine, there is a difference in signal intensity between FNH and HCA. The former often presents as iso-/hyperintensity, but the latter as hypointensity (4,18,21). Of course, some contrasting situations should not be neglected (21)(22)(23), which may be related to different expression levels of organic anion transporting polypeptide (OATP) on hepatocyte membrane (24).…”