Diagnosis and management of hepatic focal nodular hyperplasia

Venturi, A.; Piscaglia, Fabio; Vidili, Gianpaolo; Flori, S.; Righini, R.; Golfieri, Rita; Bolondi, Luigi

doi:10.1016/j.jus.2007.06.001

Cited by 29 publications

(76 citation statements)

References 81 publications

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“…Cirrhosis due to congenital hepatic fibrosis or vascular disorders (Budd‐Chiari syndrome, chronic portal vein occlusion, cardiac congestion, diffuse nodular regenerative hyperplasia, or hereditary hemorrhagic telangiectasia) (Fig. ) is associated with the formation of benign hypervascularized observations that can mimic HCC on imaging . Application of LI‐RADS is disallowed in patients with cirrhosis due to these conditions to prevent an unacceptably high number of false‐positive cases.…”

Section: User Pitfallsmentioning

confidence: 99%

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User and system pitfalls in liver imaging with LI‐RADS

Elsayes

Fowler

Chernyak

et al. 2019

Magnetic Resonance Imaging

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The Liver Imaging Reporting and Data System (LI‐RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging, created specifically for patients at risk for hepatocellular carcinoma. Over the past years, LI‐RADS has been progressively implemented into clinical practice, but pitfalls remain related to user error and inherent limitations of the system. User pitfalls include the inappropriate application of LI‐RADS to a low‐risk patient population, incorrect measurement techniques, inaccurate assumptions about LI‐RADS requirements, and improper usage of LI‐RADS terminology and categories. System pitfalls include areas of discordance with the Organ Procurement and Transplantation Network (OPTN) as well as pitfalls related to rare ancillary features. This article reviews common user pitfalls in applying LI‐RADS v2018 and how to avoid preventable errors and also highlights deficiencies of the current version of LI‐RADS and how it might be improved in the future. Level of Evidence:3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2019;50:1673–1686.

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Section: User Pitfallsmentioning

confidence: 99%

“…1) is associated with the formation of benign hypervascularized observations that can mimic HCC on imaging. 13,14 Application of LI-RADS is disallowed in patients with cirrhosis due to these conditions to prevent an unacceptably high number of false-positive cases.…”

Section: User Pitfallsmentioning

confidence: 99%

User and system pitfalls in liver imaging with LI‐RADS

Elsayes

Fowler

Chernyak

et al. 2019

Magnetic Resonance Imaging

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“…Most patients with FNH are asymptomatic and FNH are mostly incidentally detected. Symptoms of vague abdominal pain or discomfort may arise when an FNH is large ([ 5 cm) or subcapsular in location [9,10]. In 70% of cases, FNH is a solitary lesion, with multiple lesions seen in remainder of the cases [10].…”

Section: Focal Nodular Hyperplasiamentioning

confidence: 99%

“…Malignant transformation to HCC is considered an extremely rare scenario, and to date, only 22 cases of pathologically proven malignant degeneration of FNHs have been reported [16]. For asymptomatic lesions less than 4 cm in size, imaging surveillance and conservative management is probably appropriate [9,16]. A definitive imaging surveillance interval has not been reported in the literature but larger lesions can be followed at 6-month intervals [11].…”

Section: Focal Nodular Hyperplasiamentioning

confidence: 99%

“…Beta-catenin-activated subtype adenomas occur primarily in the setting of androgenic steroid exposure, typically exogenous; this is the most common subtype identified in men with hepatocellular adenomas [18]. While adenomas are benign lesions, the risk of intralesional or perilesional hemorrhage increases when an adenoma grows larger than 5 cm in size [9,10]. Additionally, malignant transformation to hepatocellular carcinoma (HCC) has been reported with beta-catenin subtype lesions, particularly in men [18,19].…”

Section: Hepatocellular Adenomamentioning

confidence: 99%

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Abdominal and pelvic imaging findings associated with sex hormone abnormalities

et al. 2018

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Hormones are substances that serve as chemical communication between cells. They are unique biological molecules that affect multiple organ systems and play a key role in maintaining homoeostasis. In this role, they are usually produced from a single organ and have defined target organs. However, hormones can affect non-target organs as well. As such, biochemical and hormonal abnormalities can be associated with anatomic changes in multiple target as well as non-target organs. Hormone-related changes may take the form of an organ parenchymal abnormality, benign neoplasm, or even malignancy. Given the multifocal action of hormones, the observed imaging findings may be remote from the site of production, and may actually be multi-organ in nature. Anatomic findings related to hormone level abnormalities and/or laboratory biomarker changes may be identified with imaging. The purpose of this image-rich review is to sensitize radiologists to imaging findings in the abdomen and pelvis that may occur in the context of hormone abnormalities, focusing primarily on sex hormones and their influence on these organs.

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The Early‐Enhancing Hepatic Vein: Differentiating Focal Nodular Hyperplasia and Hepatic Adenoma With Pathologic Validation in MRI

Kania

Dave

Guglielmo

et al. 2023

Magnetic Resonance Imaging

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BackgroundFocal nodular hyperplasia (FNH) and hepatic adenoma (HA) are two common benign liver lesions with different management options. In particular, resection is considered for large HA lesions to avoid possible bleeding complications or rarely malignant degeneration.PurposeTo determine whether early enhancement of a draining hepatic vein (EDHV) and absence of perilesional enhancement (PLE) on arterial phase MR images are useful for distinguishing FNH from HA.Study TypeRetrospective.PopulationA total of 34 patients: 16 with FNH and 18 with HA lesions.Field Strength/SequenceA1.5 T, axial T1 fat‐suppressed arterial postcontrast.AssesmentFour abdominal radiologists blinded to pathologic diagnosis assessed for the presence or absence of EDHV in association with the lesion, definitively characterized by pathology. This was considered present if contrast could be identified in a hepatic vein contiguous with the lesion in question. Secondarily, PLE was evaluated.Statistical TestsFleiss's multirater kappa statistic, Chi‐squared statistic, Phi‐coefficient. Significance level P < 0.05.ResultsConsidering all observations obtained from the four readers, an EDHV was identified with FNH 48.5% of the time. EDHV was seen with HA in 8.8% of cases. PLE was seen with significantly greater frequency in HA. The presence of an EDHV was associated with the absence of PLE.Data ConclusionIn a lesion that may be either an FNH or HA, confident identification on arterial phase images of an EDHV should lead the reader to favor FNH, while the presence PLE should dissuade the reader from FNH.Evidence Level4.Technical EfficacyStage 2.

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Diagnosis and management of hepatic focal nodular hyperplasia

Cited by 29 publications

References 81 publications

User and system pitfalls in liver imaging with LI‐RADS

User and system pitfalls in liver imaging with LI‐RADS

Abdominal and pelvic imaging findings associated with sex hormone abnormalities

The Early‐Enhancing Hepatic Vein: Differentiating Focal Nodular Hyperplasia and Hepatic Adenoma With Pathologic Validation in MRI

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