Focal nodular hyperplasia and hepatic adenoma: comparison of angiography, CT, US, and scintigraphy.

Abstract

The authors reviewed 23 cases of focal nodular hyperplasia and 13 cases of hepatic adenoma, all of which were confirmed pathologically. All solitary masses that exhibited normal or increased uptake of technetium 99m-sulfur colloid were shown to be hyperplasia; while previous criteria such as a central blood supply on angiograms or a central scar on computed tomography (CT) or ultrasound (US) scans were helpful, they were relatively infrequent. A mass that was slightly hypodense and homogeneous on a CT or US scan and highly vascular with an intense capillary stain on an angiogram was almost always hyperplasia. Acute hemorrhage within a focal hepatic tumor was common in adenoma but did not occur in hyperplasia.

Hepatocellular adenoma.

“…Anabolic steroid use, diabetes mellitus, cirrhosis, and type I glycogen storage disease have also been associated with their development [1]. Well-encapsulated neoplasms that consist of a proliferation of normal or nearly normal hepatocytes, hepatocellulan adenomas lack well-defined bile ducts and portal tracks [3]. Usually solitary, they may have fatty and glycogen infiltration, hemorrhage, or necrosis, resulting in a variegated appearance on imaging.…”

“…Usually solitary, they may have fatty and glycogen infiltration, hemorrhage, or necrosis, resulting in a variegated appearance on imaging. CT without IV contrast usually reveals a mass that is less dense than normal liver; hyperdense foci suggest intratumomal bleeding [3]. Following IV contrast administration, they usually enhance with a wide range of densities [3].…”

“…CT without IV contrast usually reveals a mass that is less dense than normal liver; hyperdense foci suggest intratumomal bleeding [3]. Following IV contrast administration, they usually enhance with a wide range of densities [3]. On angiography, they have a peripheral blood supply and are mostly hypervascular with irregular regions of hypovasculanity [3].…”

“…Following IV contrast administration, they usually enhance with a wide range of densities [3]. On angiography, they have a peripheral blood supply and are mostly hypervascular with irregular regions of hypovasculanity [3]. On sonography, they are masses with heterogeneous echogenicity [3].…”

Benign Hepatic Neoplasms

“…Technetium-99-labeled sulfur colloid scintigraphy may prove helpful in demonstrating the presence of Kupffer cells within the FNH lesion, however this finding is not specific enough for definitive diagnosis [1,66,67]. Angiography, though rarely indicated for the diagnosis of FNH, usually demonstrates a hypervascular mass with a single central artery and enlarged peripheral vessels in a "spoken wheel" appearance [66][67][68]. Finally, 18 F-FDG PET can aid in the differentiation between benign and malignant lesions, but it is neither sensitive nor specific enough for diagnosis of FNH [8,38].…”