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Focal nodular hyperplasia: hepatobiliary enhancement patterns on gadoxetic-acid contrast-enhanced MRI.

van Kessel CS, de Boer E, ten Kate FJ, Brosens LA, Veldhuis WB, van Leeuwen MS - Abdom Imaging (2013)

Bottom Line: Available histological specimens of FNHs (surgical resection or histological biopsy), were re-evaluated to correlate histological features with observed enhancement patterns. 26 FNHs in 20 patients were included; histology was available in six lesions (four resections, two biopsies).The following histological features associated with gadoxetic-acid uptake were identified: number and type of bile-ducts (pre-existent bile-ducts, proliferation, and metaplasia), extent of fibrosis, the presence of inflammation and extent of vascular proliferation.FNH lesions can be categorized into different hepatobiliary enhancement patterns on Gadoxetic-acid-enhanced MRI, which appear to be associated with histological differences in number and type of bile-ducts, and varying the presence of fibrous tissue, inflammation, and vascularization.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands. c.s.vankessel@umcutrecht.nl

ABSTRACT

Objectives: To assess the range of hepatobiliary enhancement patterns of focal nodular hyperplasia (FNH) after gadoxetic-acid injection, and to correlate these patterns to specific histological features.

Materials and methods: FNH lesions, imaged with Gadoxetic-acid-enhanced MRI, with either typical imaging findings on T1, T2 and dynamic-enhanced sequences or histologically proven, were evaluated for hepatobiliary enhancement patterns and categorized as homogeneously hyperintense, inhomogeneously hyperintense, iso-intense, or hypo-intense-with-ring. Available histological specimens of FNHs (surgical resection or histological biopsy), were re-evaluated to correlate histological features with observed enhancement patterns.

Results: 26 FNHs in 20 patients were included; histology was available in six lesions (four resections, two biopsies). The following distribution of enhancement patterns was observed: 10/26 homogeneously hyperintense, 4/26 inhomogeneously hyperintense, 5/26 iso-intense, 6/26 hypointense-with-ring, and 1/26 hypointense, but without enhancing ring. The following histological features associated with gadoxetic-acid uptake were identified: number and type of bile-ducts (pre-existent bile-ducts, proliferation, and metaplasia), extent of fibrosis, the presence of inflammation and extent of vascular proliferation.

Conclusion: FNH lesions can be categorized into different hepatobiliary enhancement patterns on Gadoxetic-acid-enhanced MRI, which appear to be associated with histological differences in number and type of bile-ducts, and varying the presence of fibrous tissue, inflammation, and vascularization.

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Flowchart of FNH identification
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Fig1: Flowchart of FNH identification

Mentions: On pre-contrast and early dynamic MRI, a total of 21 typical FNH’s were identified in 15 patients. Although presenting with a typical appearance on MRI, histopathology was acquired in one of these lesions. This lesion occurred in a patient referred with a presumed colorectal liver metastasis and for that reason surgical resection was performed. Histopathology was available in another 5 FNH’s in 5 patients (3 surgically treated, 2 histological biopsies), in whom the MRI appearance and enhancement pattern were not pathognomonic for FNH. This resulted in a total of 26 FNH’s, varying in size between 0.5 and 11.9 cm (mean 3.1 cm) in 20 patients (15 women, 5 men; mean age 46.1 years, range 28.8–60.9 years). 15 lesions were less than or equal to 3 cm in diameter and 11 lesions were larger than 3 cm in diameter. Four patients presented with more than one FNH (range 1–4), the other 16 patients presented with a solitary lesion. For further details see Fig. 1.Fig. 1


Focal nodular hyperplasia: hepatobiliary enhancement patterns on gadoxetic-acid contrast-enhanced MRI.

van Kessel CS, de Boer E, ten Kate FJ, Brosens LA, Veldhuis WB, van Leeuwen MS - Abdom Imaging (2013)

Flowchart of FNH identification
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672515&req=5

Fig1: Flowchart of FNH identification
Mentions: On pre-contrast and early dynamic MRI, a total of 21 typical FNH’s were identified in 15 patients. Although presenting with a typical appearance on MRI, histopathology was acquired in one of these lesions. This lesion occurred in a patient referred with a presumed colorectal liver metastasis and for that reason surgical resection was performed. Histopathology was available in another 5 FNH’s in 5 patients (3 surgically treated, 2 histological biopsies), in whom the MRI appearance and enhancement pattern were not pathognomonic for FNH. This resulted in a total of 26 FNH’s, varying in size between 0.5 and 11.9 cm (mean 3.1 cm) in 20 patients (15 women, 5 men; mean age 46.1 years, range 28.8–60.9 years). 15 lesions were less than or equal to 3 cm in diameter and 11 lesions were larger than 3 cm in diameter. Four patients presented with more than one FNH (range 1–4), the other 16 patients presented with a solitary lesion. For further details see Fig. 1.Fig. 1

Bottom Line: Available histological specimens of FNHs (surgical resection or histological biopsy), were re-evaluated to correlate histological features with observed enhancement patterns. 26 FNHs in 20 patients were included; histology was available in six lesions (four resections, two biopsies).The following histological features associated with gadoxetic-acid uptake were identified: number and type of bile-ducts (pre-existent bile-ducts, proliferation, and metaplasia), extent of fibrosis, the presence of inflammation and extent of vascular proliferation.FNH lesions can be categorized into different hepatobiliary enhancement patterns on Gadoxetic-acid-enhanced MRI, which appear to be associated with histological differences in number and type of bile-ducts, and varying the presence of fibrous tissue, inflammation, and vascularization.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands. c.s.vankessel@umcutrecht.nl

ABSTRACT

Objectives: To assess the range of hepatobiliary enhancement patterns of focal nodular hyperplasia (FNH) after gadoxetic-acid injection, and to correlate these patterns to specific histological features.

Materials and methods: FNH lesions, imaged with Gadoxetic-acid-enhanced MRI, with either typical imaging findings on T1, T2 and dynamic-enhanced sequences or histologically proven, were evaluated for hepatobiliary enhancement patterns and categorized as homogeneously hyperintense, inhomogeneously hyperintense, iso-intense, or hypo-intense-with-ring. Available histological specimens of FNHs (surgical resection or histological biopsy), were re-evaluated to correlate histological features with observed enhancement patterns.

Results: 26 FNHs in 20 patients were included; histology was available in six lesions (four resections, two biopsies). The following distribution of enhancement patterns was observed: 10/26 homogeneously hyperintense, 4/26 inhomogeneously hyperintense, 5/26 iso-intense, 6/26 hypointense-with-ring, and 1/26 hypointense, but without enhancing ring. The following histological features associated with gadoxetic-acid uptake were identified: number and type of bile-ducts (pre-existent bile-ducts, proliferation, and metaplasia), extent of fibrosis, the presence of inflammation and extent of vascular proliferation.

Conclusion: FNH lesions can be categorized into different hepatobiliary enhancement patterns on Gadoxetic-acid-enhanced MRI, which appear to be associated with histological differences in number and type of bile-ducts, and varying the presence of fibrous tissue, inflammation, and vascularization.

Show MeSH
Related in: MedlinePlus