Dysplastic nodules of the liver: imaging findings

Choi, Byung Ihn; Han, Joon Koo; Hong, Sung Hwan; Kim, T. K.; Song, Chi Sung; Kim, K. W.; Kim, M.-J.; Han, Man Chung

doi:10.1007/s002619900490

Cited by 53 publications

(21 citation statements)

References 28 publications

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“…2) in 40% and mixed echoic in 10% of detected lesions in our study. Choi et al [21] reported a similar incidence of echogenicity. The hyperechoic feature often reflects steatosis of tumor cells (40% of lesions !2 cm) [22], and the hypoechoic property may be due to the presence of homogeneously compacted cells, i.e.…”

Section: Ultrasonographysupporting

confidence: 50%

Imaging of Early Hepatocellular Carcinoma and Adenomatous Hyperplasia (Dysplastic Nodules) with Dynamic CT and a Combination of CT and Angiography: Experience with Resected Liver Specimens

et al. 2004

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Early hepatocellular carcinoma (HCC) as defined by the Liver Cancer Study Group of Japan would correspond to high-grade dysplastic nodules with small foci of HCC in the majority of cases, using the classification system proposed by the International Working Party. A large number of early HCCs were revealed to be hypo- or isovascular in the arterial phase of dynamic CT. Only 5% of the lesions evaluated were hypervascular, which contrasted with advanced small HCCs, of which 94% were hypervascular. CT arterial portography (CTAP) showed hypoattenuation in 66% of early HCCs and isoattenuation in 34%. CT hepatic arteriography (CTHA) demonstrated hypoattenuation in 55% of early HCC, isoattenuation in 30% and hyperattenuation in 15%. These findings suggest that most early HCCs receive equal or reduced blood supply from both portal and arterial flow compared with surrounding noncancerous parenchyma. In contrast, 97% of small HCCs are hypoattenuated on CTAP, and 93% are hyperattenuated on CTHA. For nodule-in-nodule type HCC (advanced HCC within early HCC), the CT attenuation of the central and peripheral portions revealed areas of isolated advanced HCC and isolated early HCC, respectively. Adenomatous hyperplasia (low-grade dysplastic nodules) was not readily differentiated using the various imaging modalities, mainly due to the smaller size of these lesions compared to early HCC and/or a portal and arterial blood supply very similar to that of the surrounding parenchyma. Hemodynamic changes in cirrhotic liver were similarly evaluated using CTAP and CTHA, and the treatment of early HCC is briefly discussed herein.

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Section: Ultrasonographysupporting

confidence: 50%

Imaging of Early Hepatocellular Carcinoma and Adenomatous Hyperplasia (Dysplastic Nodules) with Dynamic CT and a Combination of CT and Angiography: Experience with Resected Liver Specimens

et al. 2004

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“…These findings obtained by CTAP and CTHA are very important clinically, and therefore, they should be applied to noninvasive imaging diagnosis such as Doppler ultrasound, dynamic CT and dynamic MRI [28][29][30][31]. In DNs, hypovascularity (less arterial vascularity) relative to the surrounding liver is usually seen.…”

Section: Correlation Between the Blood Supply And Grade Of Malignancymentioning

confidence: 99%

Imaging of Multistep Human Hepatocarcinogenesis by CT during Intra-Arterial Contrast Injection

Matsui

2004

Intervirology

113

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Various types of hepatocellular nodules are seen in cirrhotic livers. In these nodules, two types of human hepatocarcinogenesis are now considered. One is de novo hepatocarcinogenesis and the other is the stepwise development from high-grade dysplastic nodule (DN), high-grade DN with well-differentiated HCC foci, and overt HCC. According to our analysis by CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) and histological study, in accordance with the elevation of the grade of malignancy of the nodules, the portal tract including normal portal vein (intranodular portal supply) and hepatic artery (intranodular arterial supply through normal hepatic arteries) are decreased. On the other hand, abnormal artery (intranodular arterial supply through newly formed abnormal arteries) gradually increases. Therefore, we can estimate the grade of malignacy of the nodules from intranodular blood supply. To know this blood supply pattern is important for the early detection, characterization and treatment of early stage HCCs. We also revealed that there was a close correlation between the prognosis of the nodules and the blood supply patterns.

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“…However, we wanted to determine the accuracy of imaging techniques as they are performed in routine daily practice in our academic tertiary-care medical center, not in the specific setting of a study in which the radiologist most likely would unintentionally have taken more time and effort to interpret imaging results. Retrospective (re)interpretation of results of imaging examinations by one or more radiologists 19,21,30 includes a similar bias that most likely would lead to greater accuracy than is the case in routine daily practice.…”

Section: Imaging Reports and Radiological-pathological Correlationmentioning

confidence: 99%

“…14,15 Most previous studies have relied on needle biopsies or partial liver resections of focal lesions that were detected by imaging to evaluate the accuracy (sensitivity and specificity) of routine imaging techniques to diagnose HCCs and DNs in cirrhotic liver. [16][17][18][19] However, this type of study cannot correctly determine the accuracy of an imaging technique because patients with (false and true) negative imaging findings are not included, and it sometimes is impossible to distinguish premalignant from malignant lesions on a needle liver biopsy. The true accuracy of an imaging technique can be determined only when imaging data are correlated with the so-called gold standard, which is a detailed pathological examination of complete explant livers with classification of detected focal lesions according to internationally accepted and used criteria.…”

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confidence: 99%

Focal lesions in cirrhotic explant livers: Pathological evaluation and accuracy of pretransplantation imaging examinations

Libbrecht

2002

Liver Transplantation

216

133

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Imaging detection and diagnosis of hepatocellular carcinomas (HCCs) and dysplastic nodules (DNs) in cirrhotic patients is important because the number, size, and type of focal lesions strongly influence patient management. Focal lesions detected by imaging examinations during pretransplantation evaluation were correlated with focal lesions detected during detailed pathological examination of 49 cirrhotic explant livers. Within 6 months before transplantation, color Doppler ultrasonography (US), contrast-enhanced computed tomography (CT), and magnetic resonance (MR) imaging were performed in 94%, 33%, and 55% of patients, respectively. In 2% to 8% of patients, different types of benign focal lesions were present, and a considerable proportion was interpreted as (pre)malignant on imaging examination. US detected only the largest HCCs (patient sensitivity, 40%; specificity, 100%) and no DNs. On a per-patient basis, contrastenhanced CT and MR imaging had poor sensitivity (20% and 27%, respectively) and good specificity (100% and 94%, respectively) for DNs. Patient sensitivity and specificity of both techniques for HCC were reasonable (50% for CT, 70% for MR imaging) and good (79% for CT, 82% for MR imaging), respectively. Neither technique was able to detect smaller (pre)malignant lesions. As a consequence, 10% of patients underwent transplantation, although they exceeded the tumor number limit. Currently used imaging techniques cannot correctly determine the exact tumor burden in some cirrhotic patients. Regular contrast-enhanced MR examination of cirrhotic patients waiting for liver transplantation is the best tool for the early detection of (pre)malignant lesions. (Liver Transpl 2002;8:749-761.)

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Dysplastic nodules of the liver: imaging findings

Abstract: Hepatic dysplastic nodules show diverse imaging characteristics with different imaging techniques; however, common imaging findings of hepatic dysplastic nodules are low echo, low attenuation, and high, low, or homogeneous intensity on T1- and T2-weighted MR, and avascularity.

Cited by 53 publications

References 28 publications

Imaging of Early Hepatocellular Carcinoma and Adenomatous Hyperplasia (Dysplastic Nodules) with Dynamic CT and a Combination of CT and Angiography: Experience with Resected Liver Specimens

Imaging of Early Hepatocellular Carcinoma and Adenomatous Hyperplasia (Dysplastic Nodules) with Dynamic CT and a Combination of CT and Angiography: Experience with Resected Liver Specimens

Imaging of Multistep Human Hepatocarcinogenesis by CT during Intra-Arterial Contrast Injection

Focal lesions in cirrhotic explant livers: Pathological evaluation and accuracy of pretransplantation imaging examinations

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