MRI of Hepatic Adenomatosis: Initial Observations with Gadoxetic Acid Contrast Agent in Three Patients

Giovanoli, O; Heim, Markus H.; Terracciano, Luigi; Bongartz, G.; Ledermann, Hans Peter

doi:10.2214/ajr.07.3198

Cited by 40 publications

(33 citation statements)

References 10 publications

(21 reference statements)

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“…imaging to distinguish between these subgroups was described in some recent publications on the basis of specific features and contrast agent-enhancement pattern (1,4,11,12). In particular, in the hepatobiliary phase (HBP) of MR imaging after administration of the contrast agent (ie, 20 minutes after the administration of gadoxetic acid [Primovist or Eovist; Bayer Healthcare, Berlin, Germany]), the majority of HCAs show washout and appear hypointense to the surrounding liver tissue (13,14). Increasingly, the literature (15-18) contains reports of HCA nodules that show incomplete washout or even retention of gadoxetic acid during the HBP.…”

Section: Advances In Knowledgementioning

confidence: 99%

Morphologic and Molecular Features of Hepatocellular Adenoma with Gadoxetic Acid–enhanced MR Imaging

Ba‐Ssalamah¹,

Antunes

Feier³

et al. 2015

Radiology

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Purpose:To evaluate the diagnostic performance of imaging features of gadoxetic acid-enhanced magnetic resonance (MR) imaging to differentiate among hepatocellular adenoma (HCA) subtypes by using the histopathologic results of the new immunophenotype and genotype classification and to correlate the enhancement pattern on the hepatobiliary phase (HBP) with the degrees of expression of organic anion transporting polypeptide (OATP1B1/3), multidrug resistance-associated protein 2 (MRP) (MRP2), and MRP 3 (MRP3) transporters. Materials and Methods:This retrospective study was approved by the institutional review board, and the requirement for informed consent waived. MR imaging findings of 29 patients with 43 HCAs were assessed by two radiologists independently then compared with the histopathologic analysis as the standard of reference. Receiver operating characteristic curves and Spearman rank correlation coefficient were used to test the diagnostic performance of gadoxetic acid-enhanced MR imaging features, which included the retention or washout at HBP and degree of transporter expression. Interreader agreement was assessed by using the k statistic with 95% confidence interval. Results:The area under the curve for the diagnosis of inflammatory HCA was 0.79 (95% confidence interval: 0.64, 0.90); for the steatotic type, it was 0.90 (95% confidence interval: 0.77, 0.97); and for the b-catenin type, it was 0.87 (95% confidence interval: 0.74, 0.95). There were no imaging features that showed a significant statistical correlation for the diagnosis of unclassified HCAs. On immunohistochemical staining, OATP1B1/3 expression was the main determinant for the retention, whereas MRP3 was the key determinant for washout of gadoxetic acid at HBP (P , .001). MRP2 appeared to have no role. Conclusion:Gadoxetic acid-enhanced MR imaging features may suggest the subtype of HCA. The degree of OATP1B1/3 and MRP3 expression correlated statistically with gadoxetic acid retention and washout, respectively, in the HBP.q RSNA, 2015

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Section: Advances In Knowledgementioning

confidence: 99%

Morphologic and Molecular Features of Hepatocellular Adenoma with Gadoxetic Acid–enhanced MR Imaging

Ba‐Ssalamah¹,

Antunes

Feier³

et al. 2015

Radiology

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“…Giovanoli and colleagues reported all lesions of hepatic adenomatosis to be hypointense compared with surrounding normal liver parenchyma in the hepatobiliary phase. 2 Huppertz and associates reported 2 hyperintense adenomas in the hepatobiliary phase. 4 Our case demonstrated the center of the lesion as isointense and its peripheral region as hypointense compared with the surrounding normal liver parenchyma in the hepatobiliary phase.…”

Section: Discussionmentioning

confidence: 98%

“…Use of a recently available liverspeciˆc contrast medium for magnetic resonance (MR) imaging, gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), has become common in the evaluation of hepatocellular lesions. [1][2][3][4][5] The medium accumulates in partially benign hepatocellular nodules. 5 However, few reports describe theˆndings of Gd-EOB-DTPA-enhanced MR imaging for hepatocellular adenoma, 2 and to the best of our knowledge, no reports detail their correlation with pathologicalˆndings.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] The medium accumulates in partially benign hepatocellular nodules. 5 However, few reports describe theˆndings of Gd-EOB-DTPA-enhanced MR imaging for hepatocellular adenoma, 2 and to the best of our knowledge, no reports detail their correlation with pathologicalˆndings. We report a case of hepatocellular adenoma, focusing on the correlation ofˆndings from radiology and pathology.…”

Section: Introductionmentioning

confidence: 99%

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Gd-EOB-DTPA-enhanced MR Imaging Findings of Hepatocellular Adenoma: Correlation with Pathological Findings

et al. 2011

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We report a case of a 28-year-old woman with hepatocellular adenoma and correlatê ndings of pathology and magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) enhancement. In the hepatobiliary phase, the peripheral region of the tumor that corresponded with proliferating hepatocytes with steatosis showed slight hypointensity compared with the surrounding liver parenchyma, and the central region of the tumor that corresponded with cellular areas showed isointensity.

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“…gadoxetic acid disodium, allows delayed imaging of functional liver tissue because of its highly specific uptake by hepatocytes. Benign lesions containing well-differentiated hepatocytes haven been shown to take up and metabolize gadoxetic acid, whereas malignant tumors generally show no uptake (12).…”

Section: Discussionmentioning

confidence: 99%

Hepatic adenomatosis: MR Imaging Features

Kock

Smet

et al. 2014

Journal of the Belgian Society of Radiology

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Hepatic adenomatosis occurs predominantly in women during the 4 th and 5 th decades of life (1). Hepatic adenomatosis is rare, although its real frequency could be underestimated because many patients are asymptomatic. Hepatic adenomatosis is defined as the presence of multiple adenomas (arbitrarily > 10) involving both lobes of the liver. Patients with glycogen storage disease or with a history of steroid intake are not considered to have liver adenomatosis (1, 2).Although the exact aetiology of hepatic adenomatosis is still unclear, congenital or acquired hepatic vascular abnormalities, mutations of the hepatocyte nuclear factor 1alpha (HNF1A) gene, and non-alcoholic fatty liver disease have been proposed as potential causes for the development of hepatic adenomatosis (1, 2). Hepatocellular adenomas in patients with hepatic adenomatosis may be of the inflammatory, HNF-1alpha-mutated, or beta-catenin-mutated subtypes, and as a consequence may show variable imaging findings.We describe the magnetic resonance imaging (MRI) findings in a 39-year-old woman presenting with non-alcoholic fatty liver disease and hepatic adenomatosis characterized by the inflammatory subtype of hepatic adenomas. minimal or no signal drop-off on chemical shift sequences. On T1-weighted in-phase images, lesions were isointense or mildly hyperintense compared to liver parenchyma (Fig. 1). On fat suppressed T1-weighed images, due to liver steatosis, lesions were markedly hyperintense (Fig. 2). One lesion measuring 8 cm demonstrated an irregular central T1-and T2-weighted hypointense area. Case reportA 39-year-old female with unremarkable previous medical history was referred for MRI after detecting a large liver mass during routine ultrasound examination. Patient had taken oral contraceptives for 12 years. Physical examination showed slight overweight (body mass index 29). The laboratory evaluations and blood biochemistry profile showed elevated C-reactive protein (11,4 mg/dl; normal value < 0,5), alkaline phosphatase (417 U/L, normal values 27-126) and γ-glutamyltransferase (101 U/L, normal values 5-43) levels. Hepatitis B surface antigen, anti-hepatitis B surface antibody and anti-hepatitis C antibody were negative.Serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and carbohydrate antigenic determinant (CA) 19-9 were normal. On MRI, liver parenchyma showed marked signal drop-off on T1-weighted out-ofphase images and corresponded to steatosis of the liver parenchyma. Multiple, approximately 14, well-delineated focal liver lesions with variable size (1-10 cm diameter) involving both liver lobes were noted. Lesions were diffusely hyperintense on T2-weighted images, with higher signal intensity in the periphery of the lesion (Fig. 1) We report a case with the inflammatory subtype of hepatic adenomatosis in a 39-year-old woman with liver steatosis. the magnetic resonance imaging features using extracellular gadolinium chelates and hepatocytetargeted contrast agents are described.

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MRI of Hepatic Adenomatosis: Initial Observations with Gadoxetic Acid Contrast Agent in Three Patients

Cited by 40 publications

References 10 publications

Morphologic and Molecular Features of Hepatocellular Adenoma with Gadoxetic Acid–enhanced MR Imaging

Morphologic and Molecular Features of Hepatocellular Adenoma with Gadoxetic Acid–enhanced MR Imaging

Gd-EOB-DTPA-enhanced MR Imaging Findings of Hepatocellular Adenoma: Correlation with Pathological Findings

Hepatic adenomatosis: MR Imaging Features

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