Behavior of Hepatocellular Adenoma on Real-time Low-Mechanical Index Contrast-Enhanced Ultrasonography With a Second-Generation Contrast Agent

Abstract

Objective. The purpose of this study was to describe the behavior of histologically proven hepatocellular adenoma (HCA) on low-mechanical index (MI) contrastenhanced ultrasonography (CEUS). Methods. A review of the databases from 4 academic hospitals revealed 18 patients (15 female and 3 male; mean age, 40 years; range, 25-71 years) with 25 histologically proven HCA lesions who were studied with CEUS at a low MI (0.04-0.1). Results. Twenty-four of 25 lesions (96%; 95% confidence interval [CI], 80.5%-99.3%) showed high-intensity enhancement, scored as 3 on a scale of 0 to 3, whereas only 1 lesion (4%; 95% CI, 0.7%-19.5%) was scored as 2. The time of peak enhancement ranged between 10 and 19 seconds (average, 13 seconds). All but 1 of the 25 lesions (96%; 95% CI, 80.5%-99.3%) showed early homogeneous and centripetal enhancement during the hepatic arterial phase. No portal venous phase enhancement was observed in any lesion because all showed rapid wash-out (100%; 95% CI, 86.7%-100%). Twenty lesions (80%; 95% CI, 60.9%-91.1%) were found to be isoechoic to slightly hypoechoic during the portal phase, and 19 (76%; 95% CI, 56.6%-88.5%) were isoechoic to mildly hypoechoic, whereas 7 (24%; 95% CI, 11.5%-43.4%) were hypoechoic during the late phase. Conclusions. Contrast-enhanced ultrasonography is an effective technique for identifying the microvascular and macrovascular characteristics of HCA. Typically, HCA shows early (10-19 seconds) and centripetal enhancement during the arterial phase and isoechogenicity or mild hypoechogenicity during the portal phase, remaining slightly hypoechoic or isoechoic during the late phase in most cases.

Appearance of hepatocellular adenomas on gadoxetic acid-enhanced MRI

“…In our study, mean relative enhancement of portal venous and venous phase was rather uniform. However, 13 HCAs presented a "wash-out" of contrast in the venous phase compared to the arterial phase in the quantitative analysis, which is not an uncommon finding in dynamic imaging of HCAs [31]. To differentiate this true "wash-out" from a visual impression of hypointensity because of early onset of hepatocyte-selective uptake in case of gadoxetic acid, quantification in comparison to unenhanced images is necessary.…”

Clinical Application of Contrast-Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

“…One of the most common applications of CEUS is in diagnostic imaging of focal liver lesions. 11,12 Many clinical works have determined that CEUS is superior to computed tomography and equivalent to magnetic resonance imaging for characterizing solid liver masses. [13][14][15] However, reports on the use of CEUS for diagnosis of superficial lymphadenopathy are less common.…”

Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver?

“…CEUS findings of HCA were described in previous studies [5][6][7][8]18] . In one study which investigated 18 lesions, which were iso-hypoechoic in 9, hyper-enhancing in all in the arterial phase, and iso or hypo-enhancement in all in the late phase [18] .…”

“…Although contrast-enhanced ultrasonographic features of HCA have been reported in several literatures till now [5][6][7] , there have been little studies that described those of each type of HCA [8] . HCAs usually arise in the liver without steatosis, because a nodule arising in fibrotic/cirrhotic liver was not to be a HCA according to World Health Organization classification 2010 [1] .…”