Hepatic Adenoma Subtypes on Hepatobiliary Phase of Gadoxetic Acid–Enhanced MRI: Systematic Review and Meta-Analysis

Kim, Tae-Hyung; Woo, Sungmin; Ebrahimzadeh, Sanam; Mclnnes, Matthew D F; Gerst, Scott R.; Richard, K. G.

doi:10.2214/ajr.22.27989

Cited by 24 publications

(7 citation statements)

References 55 publications

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“…12). [39][40][41][42] However, it has been reported that 14% of HCAs show isointensity or hyperintensity in the HBP. 42 Other Potential or Investigational Applications…”

Section: Diagnosis Of Liver Metastasesmentioning

confidence: 99%

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Gadoxetic Acid–Enhanced Liver MRI

Ichikawa

Goshima

2023

Invest Radiol

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Since its introduction in the worldwide medical market, gadoxetic acid has attracted considerable interest. The year 2023 marks the 15th anniversary of the introduction of gadoxetic acid in Japan. Gadoxetic acid–enhanced magnetic resonance imaging (GA-MRI) is the predominantly performed contrast MRI examination for the liver. Its most essential characteristic, namely, the hepatobiliary phase, revolutionized the clinical management of liver disease. Gadoxetic acid–enhanced MRI is currently the most efficient method for focal liver lesion detection and analysis. Meta-analyses demonstrated its excellent effectiveness for the diagnosis of hepatocellular carcinoma and liver metastases. Owing to the extensive usage of gadoxetic acid, a hepatobiliary phase hypointense nodule without arterial phase hyperenhancement is well documented. The existence of such nodules may be a sign of hypervascular hepatocellular carcinoma in nodules and other areas in the liver. Apart from its role in tumor identification and characterization, GA-MRI can help assess response to therapy and liver fibrosis. Therefore, it is proposed to use gadoxetic acid as the first option for MRI of the liver in the majority of patients. The efficacy of gadoxetic acid surpasses its disadvantages, rendering this contrast agent the preferred choice for routine MRI of the liver. The clinical use of GA-MRI is discussed in this review article.

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“…12). [39][40][41][42] However, it has been reported that 14% of HCAs show isointensity or hyperintensity in the HBP. 42 Other Potential or Investigational Applications…”

Section: Diagnosis Of Liver Metastasesmentioning

confidence: 99%

“…12). 39–42 However, it has been reported that 14% of HCAs show isointensity or hyperintensity in the HBP 42 …”

Section: Clinical Significance Of Focal Liver Lesionsmentioning

confidence: 99%

Gadoxetic Acid–Enhanced Liver MRI

Ichikawa

Goshima

2023

Invest Radiol

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“…The incidence of HCA is approximately 1–3 million cases per year in Europe and North America but is lower in Asia. Four subtypes of HCA are recognized: hepatocyte nuclear factor 1α (HNF-1α)-inactivated type, β-catenin-activated type, inflammatory type, and unclassified type [ 28 , 29 ]. Additionally, HCAs with β-catenin mutations frequently undergo malignant change and inflammatory HCAs (i-HCA) commonly bleed.…”

Section: Dynamics Of Contrast Enhancementmentioning

confidence: 99%

“…These can demonstrate strong arterial enhancement with portal venous washout. Especially, pooled proportion of iso- or hyper-intensity in the HBP on MRI was 14% among all HCAs, 0% among H-HCAs, 11% among unclassified HCAs, 14% among i-HCAs, and 59% among β-catenin-activated HCAs [ 29 ].…”

Section: Dynamics Of Contrast Enhancementmentioning

confidence: 99%

Imaging Diagnosis of Various Hepatocellular Carcinoma Subtypes and Its Hypervascular Mimics: Differential Diagnosis Based on Conventional Interpretation and Artificial Intelligence

Minami

Nishida

Kudo³

2022

Liver Cancer

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Background. Hepatocellular carcinoma (HCC) is unique among malignancies, and its characteristics on contrast imaging modalities allow for a highly accurate diagnosis. The radiological differentiation of focal liver lesions is playing an increasingly important role, and the Liver Imaging Reporting and Data System (LI-RADS) adopts a combination of major features including arterial phase hyperenhancement (APHE) and washout pattern. Summary. Specific HCCs such as well or poorly differentiated type, subtypes including fibrolamellar or sarcomatoid and combined hepatocellular-cholangiocarcinoma does not often demonstrate APHE and washout appearance. Meanwhile, hypervascular liver metastases and hypervascular intrahepatic cholangiocarcinoma (ICC) can demonstrate APHE and washout. There are still other hypervascular malignant liver tumors (i.e., angiosarcoma, epithelioid hemangioendothelioma) and hypervascular benign liver lesions (i.e., adenoma, focal nodular hyperplasia, angiomyolipoma, flash filling hemangioma, reactive lymphoid hyperplasia, inflammatory lesion, arterioportal shunt), which need to be distinguished from HCC. When a patient has chronic liver disease, differential diagnosis of hypervascular liver lesions can be even more complicated. Meanwhile, artificial intelligence (AI) in medicine has been widely explored, and recent advancement in the field of deep learning has provided promising performance for the analysis of medical images. Especially, radiological imaging data contain diagnostic, prognostic, and predictive information which AI can extract. The AI researches have demonstrated high accuracy (over 90% accuracy) for classifying lesions with typical imaging features from some hepatic lesions. AI system has a potential to implement in clinical routine as decision support tools. However, for the differential diagnosis of many types of hypervascular liver lesions, further large-scale clinical validation still is required. Key Messages. Clinicians should be aware of the histopathological features, imaging characteristics and differential diagnoses of hypervascular liver lesions to a precise diagnosis and the more valuable treatment plan. We need to be familiar with such atypical cases to prevent a diagnostic delay, but AI based tools also need to lean a large number of typical and atypical cases.

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“…In recent years, MRI with specific contrast agents has been proven to be the most accurate and specific radiological tool for diagnosing benign liver tumors. More importantly, imaging features can indicate molecular subtypes of HCA (4)(5)(6). Imaging follow-up for benign liver tumors appears to be increasingly feasible and reasonable (2,7).…”

Section: Introductionmentioning

confidence: 99%

Surgical indications for solid hepatic benign tumors: An updated literature review

Zhang,

Ji,

Qiu

et al. 2023

BST

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Hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma are the most common benign solid liver tumors. However, their surgical indications have been the subject of debate. Minimally invasive liver resection reduces the cost of surgery and may lead to overtreatment of benign liver tumors. Recently, there has been a growing understanding of the etiology, pathogenesis, and natural history of these tumors. Great progress has also been made in imaging. The use of MRI and contrast agents has improved the accuracy of non-invasive diagnosis of these tumors, and especially in the identification of specific molecular subtypes of liver adenoma. These factors have resulted in alterations of surgical indications for these tumors. This article examines recent literature and it discusses the surgical indications for hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma while summarizing modifications in clinical management.

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Hepatic Adenoma Subtypes on Hepatobiliary Phase of Gadoxetic Acid–Enhanced MRI: Systematic Review and Meta-Analysis

Cited by 24 publications

References 55 publications

Gadoxetic Acid–Enhanced Liver MRI

Gadoxetic Acid–Enhanced Liver MRI

Imaging Diagnosis of Various Hepatocellular Carcinoma Subtypes and Its Hypervascular Mimics: Differential Diagnosis Based on Conventional Interpretation and Artificial Intelligence

Surgical indications for solid hepatic benign tumors: An updated literature review

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