CT and MR Imaging Findings in Focal Nodular Hyperplasia of the Liver

Mortelé, Koenraad J.; Praet, Marleen; Vlierberghe, Hans Van; Kunnen, Marc; Ros, Pablo R.

doi:10.2214/ajr.175.3.1750687

Cited by 180 publications

(90 citation statements)

References 9 publications

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“…26 On CT scans, the classic FNH lesion is reported to be a homogeneous, hypoattenuated mass. This lesion (except for the central scar) is enhanced rapidly and dramatically during the arterial phase of contrast-enhanced CT. 13,18,24,25 On MRI scans, as is the case on CT scans, dense enhancement of the lesion (except for the central scar) is observed; MRI signal enhancement is observed after the injection of gadolinium. 19 -21 In contrast with FNH, fibrolamellar carcinoma may demonstrate a central scar with low signal intensity on T2-weighted images.…”

Section: Discussionmentioning

confidence: 88%

“…There is general agreement that specific imaging criteria indicate a definitive diagnosis of FNH. 3,4,[17][18][19][20][21][22][23][24][25] It is only in patients with clinical, biochemical, or imaging features that are not typical of FNH that histologic diagnosis is necessary to exclude the possibility of other diseases or, above all, a malignant tumor. 26 On CT scans, the classic FNH lesion is reported to be a homogeneous, hypoattenuated mass.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

Bouyn

Leclère

Raimondo

et al. 2003

Cancer

127

126

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BACKGROUNDThe detection of hepatic nodules, particularly in patients treated for a previous malignancy, raises a diagnostic dilemma. Focal nodular hyperplasia (FNH) of the liver is an uncommon, benign tumor in children and must be differentiated from malignant hepatic lesions. The etiology of FNH is obscure, and its pathogenesis is poorly understood. FNH may be a reaction to localized vascular abnormalities and circulatory disturbances. The goal of the current study was to identify risk factors for the occurrence of FNH in children who had received prior treatment for a malignant tumor.METHODSThe current retrospective study examined 14 cases of FNH in pediatric patients who previously had been treated for a malignancy. Diagnosis was based on clinical and radiologic findings and was proven histologically in four cases.RESULTSFNH lesions were discovered by chance during routine examination in 78% of patients. The incidence of FNH was particularly high in the current series (0.45%) compared with the incidence in the general pediatric population. High doses of alkylating agents (e.g., busulfan or melphalan), venoocclusive disease, and liver radiotherapy may be responsible for injury to the vascular endothelium and subsequent localized circulatory disturbances. FNH is characterized by the absence of complications after its detection; therefore, only close follow‐up is recommended.CONCLUSIONSFNH appears to be a late complication of an iatrogenic vascular disease in children with a history of malignancy. Cancer 2003;97:3107–13. © 2003 American Cancer Society.DOI 10.1002/cncr.11452

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

Bouyn

Leclère

Raimondo

et al. 2003

Cancer

127

126

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“…The central scar can be identified in 50e70% of moderate-to-large-sized nodules and a much lower percentage of small lesions (<3 cm). It appears hypointense in T1 and hyperintense in T2 due to the presence of blood vessels, bile ducts, and edema-inducing phenomena [66,75], and these findings clearly differentiate it from the lesional tissue around it. When the MRI study is performed with a conventional vascular contrast agent like gadolinium, the nodule displays intense, uniform enhancement in the arterial phase followed by isointensity in the late phase [59,76].…”

Section: Radiologic Imaging Techniquesmentioning

confidence: 96%

Diagnosis and management of hepatic focal nodular hyperplasia

Venturi

Piscaglia

Vidili

et al. 2007

Journal of Ultrasound

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Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.Sommario L'iperplasia nodosa focale (FNH) è il tumore epatico benigno più frequente dopo l'angioma. E' di solito rilevata in modo occasionale, per lo più nelle donne in età fertile, anche se si può riscontrare in entrambi i sessi e ad ogni età. I soggetti portatori raramente sono sintomatici, nonostante l'FNH possa essere causa di dolore ai quadranti addominali superiori. Nella gestione dell'FNH il problema clinico principale è rappresentato dalla difficoltà di differenziarla dalle altre lesioni epatiche ipervascolarizzate, come l'adenoma, l'epatocarcinoma o le metastasi ipervascolari, tuttavia utilizzando le opportune tecniche diagnostiche è oggi possibile evitare il ricorso ad esami invasivi. La Risonanza Magnetica (RM) ha una sensibilità e una specificità superiori rispetto a quelle dell'ecografia convenzionale e della Tomografia Assiale Computerizzata (TC) per la diagnosi di FNH. L'uso dell'angioecografia perfusionale (CEUS) e dell'eco-Doppler può tuttavia aumentare in modo significativo la confidenza diagnostica

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“…1) (5,6). However, in our experience these imaging features alone are not diagnostic for FNH, and can be observed in a number of benign and malignant lesions (7,8).…”

mentioning

confidence: 99%

“…Atypically, FNH may present as a large lesion, which is sometimes multiple in localization (5). Rare imaging features include nonvisualization or nonenhancement of the central scar, and pseudocapsular enhancement on delayed images (9).…”

mentioning

confidence: 99%

Focal nodular hyperplasia: Lesion characteristics on state‐of‐the‐art MRI including dynamic gadolinium‐enhanced and superparamagnetic iron‐oxide‐uptake sequences in a prospective study

Terkivatan

Bos

Hussain

et al. 2006

Magnetic Resonance Imaging

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Purpose: To image a cohort of patients with pathologyproven focal nodular hyperplasia (FNH) to assess which characteristics of state-of-the-art magnetic resonance imaging (MRI) of the liver are the most useful for improving the detection and characterization of FNH. Materials and Methods:In 14 patients, pathology-proven FNH (N ϭ 33) were prospectively examined using gadolinium (Gd) and superparamagnetic iron-oxide (SPIO) contrast media. All lesions were evaluated for signal intensity (SI), fatty infiltration, central scar, mode of enhancement with Gd, and uptake of SPIO. The percentage of dynamic contrast enhancement in the arterial, portal, and delayed phases was assessed. The contrast-to-noise ratio (CNR) before and after administration of SPIO contrast was calculated. Results:The SI of the lesions was low to isointense on T1-weighted (T1W) images, and intermediate to isointense on T2W images. Fatty infiltration of the lesions was present in 6%. The percentages of enhancement in the liver and lesion were 110%, 115%, and 95%, and 151%, 182%, and 160%, respectively (P Ͻ 0.0001). All lesions showed uptake of SPIO with improved conspicuity of the central scar and septa. The CNR values precontrast and post-Gd/SPIO were significantly different for T1 in-and opposed-phase and black-blood echo-planar imaging (BBEPI). Conclusion:Combining dynamic Gd-enhanced imaging with T1W and T2W sequences after administration of SPIO facilitates comprehensive evaluation of FNH.

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CT and MR Imaging Findings in Focal Nodular Hyperplasia of the Liver

Cited by 180 publications

References 9 publications

Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

Diagnosis and management of hepatic focal nodular hyperplasia

Focal nodular hyperplasia: Lesion characteristics on state‐of‐the‐art MRI including dynamic gadolinium‐enhanced and superparamagnetic iron‐oxide‐uptake sequences in a prospective study

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