Part 1: <scp>MRI</scp> features of focal nodular hyperplasia with an emphasis on hepatobiliary contrast agents

Sutherland, Tom; Seale, Melanie; Yap, Kelvin

doi:10.1111/1754-9485.12130

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…The SI of both FNH and MRN seen on high b-value DWI were furthermore similar to the surrounding liver parenchyma. [27][28][29] Concerning the CE-MR study, both categories of nodules behave similarly with brisk transitory enhancement in the late arterial phase and a predominant lack of washout in the subsequent phases. The hypervascular behaviour reflecting its increased arterial supply may be problematic for the distinction between MRN and HCC in the context of cirrhosis or, more rarely, with hypervascular liver metastases in the setting of oncologic follow-up.…”

Section: Discussionmentioning

confidence: 95%

Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

Donato¹,

Andrade²,

Bastati

et al. 2018

Acta Med Port

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RESUMOIntrodução: Nódulos regenerativos multiacinares são nódulos hepatocelulares benignos relacionados com alterações vasculares hepáticas. São muito semelhantes à hiperplasia nodular focal mas ocorrem num contexto diferente de doença hepática crónica. O objectivo deste trabalho foi descrever os achados imagiológicos principais destes nódulos e compará-los com um grupo controlo de hiperplasia nodular focal. Material e Métodos: Foi efectuada uma revisão cega de estudos por ressonância magnética de 26 casos de nódulos regenerativos multiacinares e 25 de hiperplasia nodular focal, sendo os dois grupos comparados quanto à dimensão das lesões, morfologia, margens, estrutura, aspecto em T1, T2, difusão e após contraste (incluindo na fase hepatobiliar), presença de cicatriz central e halo hipointenso. Resultados: Foram encontradas diferenças significativas entre nódulos regenerativos multiacinares e hiperplasia nodular focal quanto às dimensões das lesões (mediana 2,35 cm AIQ: 2,13 vs 6,00 cm AIQ: 5,20 respectivamente, p < 0,001), presença de halo hipointenso após contraste (n = 9 vs n = 2, p = 0,038) e de cicatriz central (n = 9 vs n = 20, p = 0,002). Não se observaram outras diferenças significativas. Discussão: Nódulos regenerativos multiacinares e hiperplasia nodular focal são globalmente muito semelhantes mas a ausência de cicatriz central e a presença de halo hipointenso deve sugerir o diagnóstico de nódulos regenerativos multiacinares. Conclusão: O reconhecimento dos achados imagiológicos de nódulos regenerativos multiacinares pode explicar alguns dos casos atípicos de hiperplasia nodular focal e prevenir biopsias desnecessárias. Pode também desencadear uma investigação mais aprofundada de anomalias vasculares hepáticas subjacentes eventualmente desconhecidas.ABSTRACT Introduction: Multiacinar regenerative nodules are benign hepatocellular nodules related to vascular disturbances of the liver. They strongly resemble conventional focal nodular hyperplasia but are connected to different clinical settings, typically chronic liver disease.The purpose of the present study was to describe the key imaging features of these lesions and compare them with a control arm of focal nodular hyperplasia. Material and Methods: A blinded consensus review of liver magnetic resonance consisting of 26 cases of multiacinar regenerative nodules and 25 cases of focal nodular hyperplasia was performed. Lesion size, shape, margins, structure, T1 and T2 signal intensity, diffusion and contrast-enhanced features (including hepatobiliary phase), presence of a central scar and of a peripheral hypointense rim were compared between the two groups. Results: Significant differences between multiacinar regenerative nodules and focal nodular hyperplasia included size (median 2.35 cm, IQR: 2.13, vs 6.00 cm, IQR: 5.20, respectively, p < 0.001), presence of a peripheral hypointense rim after contrast (n = 9 vs n = 2 cases, p = 0.038) and of a central scar (n = 9 vs n = 20, p = 0.002). There were no other significant differences. Discussion: Overall m...

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Section: Discussionmentioning

confidence: 95%

Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

Donato¹,

Andrade²,

Bastati

et al. 2018

Acta Med Port

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“…An enlarged feeding artery has also been described in FNH as has the presence of draining veins, although the draining vein is typically seen during the portal venous phase rather than during the arterial dominant phase as it is secondary to increased blood flow rather than due to shunting. A prominent and early draining vein has also been described in HCC, but the drainage of HCC is typically to the portal venous system, rather than to the hepatic veins.…”

Section: Discussionmentioning

confidence: 99%

Contrast‐enhanced sonographic appearances of two primary hepatic epithelioid angiomyolipomas

Chai

Fox

Chong

et al. 2020

J of Clinical Ultrasound

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Epithelioid hepatic angiomyolipoma (Epi-HAML) is a rare hepatic tumor frequently misdiagnosed as hepatocellular carcinoma (HCC). Unlike conventional angiomyolipoma (AML), Epi-HAML contains minimal amount of adipose tissue, which is a radiological distinguishing feature between AML and HCC. Two patients were referred for management of incidentally found hepatic lesions confirmed to be Epi-HAML on post-resection tissue analysis. CT and MRI findings were suggestive of HCC. Contrast-enhanced ultrasound demonstrated intratumoral shunting, a feeding artery, and early draining hepatic vein. These findings should alert radiologists to the possibility of Epi-HAML. Furthermore, these features may be better assessed by contrast-enhanced ultrasound due to its superior dynamic temporal resolution. K E Y W O R D S angiomyolipoma, contrast-enhanced ultrasound, epithelioid angiomyolipoma, liver, ultrasound

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“…La diferencia entre HNF y adenoma en la fase hepatobiliar consiste en que la HNF presenta una retención del contraste hasta en el 96% de los casos, a diferencia del adenoma que no lo retiene. 10,27,36,[38][39][40] Por lo tanto, el ácido gadoxético es útil para su diferenciación, con una sensibilidad entre 91-100% y una especificidad entre 87-100%. 33 Sin embargo, algunos adenomas, principalmente los de tipo inflamatorio, pueden tener mínimo realce en esa fase.…”

Section: Utilidades Y Controversiasunclassified

“…El ácido gadoxético es de gran utilidad en la detección y caracterización de lesiones focales hepáticas y en la valoración de la vía biliar, suministrando información adicional a las secuencias convencionales. [10][11][12][13][14][15][16][17] Debido a su estructura molecular, que contiene una parte hidrosoluble y otra lipofílica (EOB-etoxibencil), muestra un mecanismo de acción bifásico. Inicialmente presenta una distribución en el espacio extracelular que permite la adquisición de imágenes dinámicas (arterial, portal y transicional).…”

Section: Introductionunclassified

Agentes hepatoespecíficos, usos actuales: más allá de la caracterización de lesiones focales

et al. 2018

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Palabras Clave► hígado ► medio de contraste ► resonancia magnética Resumen Con el ácido gadoxético, el realce dinámico de las lesiones focales es igual a los demás medios de contraste extracelulares, por lo que su utilidad principal está en la obtención de una fase hepatobiliar que permita diferenciar y caracterizar lesiones que contienen hepatocitos como en el caso de la hiperplasia nodular focal (HNF) y los nódulos regenerativos. Las lesiones que no tienen hepatocitos o que son carentes de conductos biliares, demuestran baja señal con respecto al parénquima hepático en esa fase, lo que ocurre con los adenomas hepatocelulares (AHC), nódulos displásicos de alto grado, carcinoma hepatocelular (CHC) y metástasis entre otras. Hacer esta diferenciación cambia el manejo de la lesión focal, permitiendo en la mayoría de los casos caracterizar las lesiones que contienen hepatocitos que no requieren biopsia, como las benignas, de aquellas que si pudieran requerir la confirmación histológica. Otros usos de estos medios de contraste órgano específicos es la evaluación de la integridad de la vía biliar especialmente en pacientes posquirúrgicos y la diferenciación de quistes que tienen comunicación con la vía biliar de aquellos que son quistes hepáticos simples. El objetivo de este artículo es realizar una revisión sobre la evidencia actual del papel emergente de los contrastes órgano específicos, incluyendo no solo la evaluación de las lesiones focales hepáticas, sino también otras utilidades como el análisis de la patología biliar.

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Part 1: MRI features of focal nodular hyperplasia with an emphasis on hepatobiliary contrast agents

Cited by 9 publications

References 19 publications

Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

Contrast‐enhanced sonographic appearances of two primary hepatic epithelioid angiomyolipomas

Agentes hepatoespecíficos, usos actuales: más allá de la caracterización de lesiones focales

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