Focal Nodular Hyperplasia and Hepatocellular Adenoma of the  Liver

Ruppert-Kohlmayr, A.; Uggowitzer, M.; Kügler, Christian; Zebedin, D.; Schaffler-Schaden, Dagmar; Ruppert, Georg S.

doi:10.2214/ajr.176.6.1761493

Cited by 70 publications

(22 citation statements)

References 16 publications

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“…In the portal venous and delayed phase, the FNH becomes isodense and may be difficult to detect. The central scar and septations typically show late enhancement due to diffusion of the contrast material into the stroma of the lesion [4,27,28,30,32,33,34,35,36,37]. A central scar is seen on CT in approximately 50% of the lesions.…”

Section: Resultsmentioning

confidence: 99%

“…Ruppert et al [36] performed a study in 45 histologically proven FNHs and 27 HCAs to evaluate the use of triphasic CT imaging for differentiating FNH and HCA. They found a central scar in 65% of all FNHs (29% in FNH <3 cm and 82% in FNH >3 cm) and none in case of a HCA.…”

Section: Resultsmentioning

confidence: 99%

“…Bartolozzi et al [13], Dietrich et al [25] and Ruppert et al [36] performed a performance study of Doppler-, contrast-enhanced US and multiphase helical CT scan, respectively, in patients with histology proven FNH or HCA. The sample sizes, especially for HCA, were however small.…”

Section: Discussionmentioning

confidence: 99%

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Imaging Modalities for Focal Nodular Hyperplasia and Hepatocellular Adenoma

Esschert¹,

Gulik²,

Phoa

2010

Dig Surg

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Background/Aims: There are several imaging modalities available for the detection of focal liver lesions. Differentiation between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) is important because of the consequences for management. However, differentiation based on imaging alone still shows limitations. Methods: We reviewed the literature for typical features of FNH and HCA on radiologic and nuclear imaging with emphasis on differentiation of both lesions. Results: Seven articles describe the performance of an imaging modality for the differentiation between FNH and HCA. Limitations of these studies are the small sample size and/or the lack of comparison with the ‘gold standard’, i.e. histological diagnosis. No studies are available that compare the accuracy of several imaging modalities in the differentiation of FNH and HCA. Conventional ultrasound (US) is not useful in the differentiation because of the non-specific features. On contrast-enhanced US, the arterial filling direction of FNH is centrifugal and centripetal in case of HCA. The parenchymal enhancement of FNH is sustained in the portal venous and delayed phases, but shows rapid washout in case of HCA. Multiphase CT scan can differentiate FNH from HCA when there is a central scar. FNH may have a slightly higher relative enhancement in the arterial phase. On MRI with hepatocyte-specific contrast agents, HCA does not show contrast uptake in the hepatobiliary phase in contrast to FNH. Conclusion: We conclude that there is limited evidence of the diagnostic performance of currently used imaging modalities for the differentiation of FNH and HCA. We therefore propose a prospective study (DiFA trial) to determine the accuracy of several radiologic and nuclear imaging studies in differentiating FNH and HCA.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Imaging Modalities for Focal Nodular Hyperplasia and Hepatocellular Adenoma

Esschert¹,

Gulik²,

Phoa

2010

Dig Surg

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“…Using these techniques it is usually possible to differentiate adenomas from other benign lesions such as focal nodular hyperplasia and haemangioma as well as from malignancies [10,11,12]. No strict consensus for the optimal imaging work-up of liver lesions was found.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Hepatocellular Adenoma in the Netherlands: Similarities and Differences

Aalten¹,

Terkivatan²,

Man

et al. 2010

Dig Surg

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Background: The diagnosis of hepatocellular adenoma (HA) has a great impact on the lives of young women and may pose clinical dilemmas to the clinician since there are no standardized protocols to follow. We aimed to establish expert opinions on diagnosis and treatment of HA by collecting data from a nationwide questionnaire in the Netherlands. Methods: A questionnaire was sent to 20 Dutch hospitals known to offer hepatologic and surgical experience on liver tumours. Results: 17 hospitals (85%) responded to the questionnaire. Annually, a median of 52 patients presented with a solid liver tumour. In 15 (88%) hospitals, hepatic adenomas were diagnosed with contrast-enhanced, multiphase spiral CT or MRI. In 2 (12%) hospitals, histology was required as part of a management protocol. Surveillance after withdrawal of oral contraceptives was the initial policy in all clinics. MRI, CT or ultrasound was used for follow-up. Criteria for surgical resection were a tumour size >5 cm and abdominal complaints. In 5 (29%) hospitals, patients were dismissed from follow-up after surgery. In complex cases (e.g. large, multiple or centrally localized lesions, a wish for pregnancy), the treatment policy was highly variable. Pregnancy was not discouraged in 15 hospitals, but in 11 (65%) of these, strictly defined conditions were noted: frequent follow-up, peripheral tumour localization that makes surgery easier if necessary, stable tumour size, and a good informed consent. Conclusion: The management of HAs in the Netherlands is rather uniform, except in complex cases in which multiple factors may influence policy.

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“…to be significantly higher than in HCA whereas results in unenhanced scans and the hepatic vein phase were ambiguous [77]. Using a 1.6 cut-off for relative enhancement in the early arterial phase provided an accuracy of 96%.…”

Section: Mdct Of Benign Focal Liver Lesionsmentioning

confidence: 91%

Detection and characterization of benign focal liver lesions with multislice CT

et al. 2006

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MDCT is a rapidly evolving technique that significantly improves CT imaging for several indications including depiction of focal benign lesions. Imaging mainly profits from improved longitudinal spatial resolution allowing high-quality non-axial reformations and 3D reconstructions and CT angiography as well as rapid accurate multiphase imaging with short breath-holding periods. This review provides an overview of the current status of MDCT with respect to liver imaging and the implications for characterizing benign focal liver lesions. MDCT currently allows the acquisition of thin slices in daily routine diagnostics providing an improved detection rate of small liver lesions. Whereas large benign focal liver lesions exhibit typical patterns of morphology, attenuation and perfusion, which also may be assessed with single-slice scanners, small lesions remain challenging even with MDCT, since the specific criteria for confident diagnosis become more ambiguous. Here, MR imaging provides more detailed information about tissue components and the availability of liver-specific contrast agents, adding further impact to this technique. With respect to dose considerations, the number of necessary multiphase scans as well as the application of very thin collimation should be strictly checked for each patient undergoing MDCT based on the individual clinical situation and question.

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Focal Nodular Hyperplasia and Hepatocellular Adenoma of the Liver

Cited by 70 publications

References 16 publications

Imaging Modalities for Focal Nodular Hyperplasia and Hepatocellular Adenoma

Imaging Modalities for Focal Nodular Hyperplasia and Hepatocellular Adenoma

Diagnosis and Treatment of Hepatocellular Adenoma in the Netherlands: Similarities and Differences

Detection and characterization of benign focal liver lesions with multislice CT

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