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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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A patient presenting with a typical FNH on conventional FNH, which appeared homogeneously hyperintense to the surrounding parenchyma during hepatobiliary phases. A–F The FNH is visible on T1, T2, and during arterial phase, portal-venous phase, and 5 and 10 min hepatobiliary phase, respectively (white and blackarrows).
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Fig2: A patient presenting with a typical FNH on conventional FNH, which appeared homogeneously hyperintense to the surrounding parenchyma during hepatobiliary phases. A–F The FNH is visible on T1, T2, and during arterial phase, portal-venous phase, and 5 and 10 min hepatobiliary phase, respectively (white and blackarrows).

Mentions: Ten lesions (10/26, 38 %) demonstrated a homogeneously hyperintense pattern (mean size 2.3 cm, range 0.5–6.4 cm; 3 lesions >3 cm, 7 lesions <3 cm) (Fig. 2a–f). A thin, stellar or linear hypodensity, interpreted as the central scar on early dynamic sequences, was visible during the hepatobiliary phases in all 3 lesions larger than 3 cm and in none of the lesions smaller than 3 cm. Four lesions (4/26, 15 %) showed an inhomogeneously hyperintense pattern (Fig. 3a–f), where 1–5 mm nodular areas of hypo-intense signal were scattered throughout the enhancing lesion without the presence of a typical scar (mean size 5.9, range 2.5–11.9 cm, one lesion <3 cm, 3 lesions >3 cm). Six lesions (6/26, 23 %) demonstrated a “hypointense-with-ring” pattern (mean size 1.9 cm, range 1.0–2.6 cm, all lesions <3 cm) (Fig. 4a–f). Five lesions (5/26, 19 %) showed an iso-intense pattern with mass effect (mean size 3.5 cm, range 1.7–5.3 cm; 2 lesions <3 cm, 3 lesions >3 cm) (Fig. 5a–f), with a scar present in all three lesions larger than 3 cm.Fig. 2


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)

A patient presenting with a typical FNH on conventional FNH, which appeared homogeneously hyperintense to the surrounding parenchyma during hepatobiliary phases. A–F The FNH is visible on T1, T2, and during arterial phase, portal-venous phase, and 5 and 10 min hepatobiliary phase, respectively (white and blackarrows).
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Related In: Results  -  Collection

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

Fig2: A patient presenting with a typical FNH on conventional FNH, which appeared homogeneously hyperintense to the surrounding parenchyma during hepatobiliary phases. A–F The FNH is visible on T1, T2, and during arterial phase, portal-venous phase, and 5 and 10 min hepatobiliary phase, respectively (white and blackarrows).
Mentions: Ten lesions (10/26, 38 %) demonstrated a homogeneously hyperintense pattern (mean size 2.3 cm, range 0.5–6.4 cm; 3 lesions >3 cm, 7 lesions <3 cm) (Fig. 2a–f). A thin, stellar or linear hypodensity, interpreted as the central scar on early dynamic sequences, was visible during the hepatobiliary phases in all 3 lesions larger than 3 cm and in none of the lesions smaller than 3 cm. Four lesions (4/26, 15 %) showed an inhomogeneously hyperintense pattern (Fig. 3a–f), where 1–5 mm nodular areas of hypo-intense signal were scattered throughout the enhancing lesion without the presence of a typical scar (mean size 5.9, range 2.5–11.9 cm, one lesion <3 cm, 3 lesions >3 cm). Six lesions (6/26, 23 %) demonstrated a “hypointense-with-ring” pattern (mean size 1.9 cm, range 1.0–2.6 cm, all lesions <3 cm) (Fig. 4a–f). Five lesions (5/26, 19 %) showed an iso-intense pattern with mass effect (mean size 3.5 cm, range 1.7–5.3 cm; 2 lesions <3 cm, 3 lesions >3 cm) (Fig. 5a–f), with a scar present in all three lesions larger than 3 cm.Fig. 2

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