Focal nodular hyperplasia: Spoke-wheel arterial pattern and other signs on dynamic contrast-enhanced ultrasonography

Ungermann, Leoš; Eliás, P; Žižka, Ján; Ryška, Pavel; Klzo, Luděk

doi:10.1016/j.ejrad.2007.01.026

Cited by 64 publications

(35 citation statements)

References 18 publications

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“…The presence of a hypoechoic non-enhancing central scar and an arterial feeding vessel are other features suggestive of FNH on CEUS [4]. According to the small series reported in the literature, the above-described signs may not always be easily identifiable in FNH on CEUS, especially in lesions smaller than 3 cm [9,10]. Furthermore, some studies reported that FNHs deeply located in fatty liver may present some washout in the portal-venous and delayed phases, thus making choosing the right diagnosis challenging [11,12].…”

Section: Introductionmentioning

confidence: 92%

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Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth and liver echogenicity

et al. 2010

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Section: Introductionmentioning

confidence: 92%

“…In particular, for each lesion, the two readers were asked to detect at baseline US and CEUS the presence of three signs suggestive of FNH defined as follows by means of literature data [4,9,10]:…”

Section: Image Analysismentioning

confidence: 99%

Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth and liver echogenicity

et al. 2010

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“…During the portal venous and delayed phases, FNH appears hyper- or isoechoic in comparison with surrounding liver parenchyma. The presence of a non-enhancing central scar was found to be a distinctive feature of FNH [15,16,17,18,19,20,21,22,23]. HCA shows subcapsular feeding arteries with mixed or centripetal filling.…”

Section: Resultsmentioning

confidence: 99%

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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“…The female to male ratio of FNH is approximately 13–15:1 based on non-epidemiological studies, but ratios between 2 and 26:1 have been reported [3,24,25]. This makes FNH typically a condition found in females.…”

Section: Focal Nodular Hyperplasiamentioning

confidence: 99%

Focal Nodular Hyperplasia and Hepatic Adenoma: Epidemiology and Pathology

Wenniger

Terpstra²,

Beuers³

2010

Dig Surg

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Focal nodular hyperplasia (FNH) and hepatic adenoma (HA) represent the most frequent non-vascular benign liver tumors. They are often asymptomatic. The widespread use of high-resolution imaging modalities leads to an increase of incidental detection of FNH and HA. Physicians are thus increasingly confronted with these formerly rarely recognized conditions, stressing the need for concise but adequate information on the optimal clinical strategies for these patients. FNH is the most common non-vascular benign tumor of the liver. It probably arises as a polyclonal, hyperplastic response to a locally disturbed blood flow. It is typically found in asymptomatic women. Histologically, FNH can be described as a focal form of cirrhosis. Complications of FNH are extremely rare and surgical resection is generally not advised. HA is a rare monoclonal, but benign liver tumor primarily found in young females using estrogen-containing contraceptives. Although its exact etiology is unknown, a direct link between sex steroid exposure and the uncontrolled hepatocellular growth is suspected. Complications of HA are spontaneous bleeding and malignant transformation. Withdrawal of estrogen treatment and excision of large tumors (>5 cm) are established therapeutic strategies. In conclusion, although FNH and HA are reasonably well-described clinical and histopathological entities, their epidemiology and pathophysiology need to be further unraveled.

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Focal nodular hyperplasia: Spoke-wheel arterial pattern and other signs on dynamic contrast-enhanced ultrasonography

Cited by 64 publications

References 18 publications

Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth and liver echogenicity

Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth and liver echogenicity

Imaging Modalities for Focal Nodular Hyperplasia and Hepatocellular Adenoma

Focal Nodular Hyperplasia and Hepatic Adenoma: Epidemiology and Pathology

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