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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 with a histologically proven FNH presenting as an inhomogenously hyperintense lesion on hepatobiliary phases (Tumor C). 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 black arrows). Initially, the lesion presents as a hyperintense lesion with a non-enhancing central scar during arterial phase, but over time the lesion characteristics change resulting in an inhomogeneous appearance during hepatobiliary phase. G CD34 immunohistochemistry shows diffuse positivity throughout the lesion (brown staining at arrows). H Hematoxylin and eosin staining showing an abnormal, enlarged vessel with thickened vessel wall (arrow). The inhomogeneous appearance on hepatobiliary phase is presumably related to areas with ischemic injury and ductular metaplasia due to vascular abnormalities, which are alternated by areas with ductular proliferation.
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Fig3: A patient with a histologically proven FNH presenting as an inhomogenously hyperintense lesion on hepatobiliary phases (Tumor C). 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 black arrows). Initially, the lesion presents as a hyperintense lesion with a non-enhancing central scar during arterial phase, but over time the lesion characteristics change resulting in an inhomogeneous appearance during hepatobiliary phase. G CD34 immunohistochemistry shows diffuse positivity throughout the lesion (brown staining at arrows). H Hematoxylin and eosin staining showing an abnormal, enlarged vessel with thickened vessel wall (arrow). The inhomogeneous appearance on hepatobiliary phase is presumably related to areas with ischemic injury and ductular metaplasia due to vascular abnormalities, which are alternated by areas with ductular proliferation.

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 with a histologically proven FNH presenting as an inhomogenously hyperintense lesion on hepatobiliary phases (Tumor C). 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 black arrows). Initially, the lesion presents as a hyperintense lesion with a non-enhancing central scar during arterial phase, but over time the lesion characteristics change resulting in an inhomogeneous appearance during hepatobiliary phase. G CD34 immunohistochemistry shows diffuse positivity throughout the lesion (brown staining at arrows). H Hematoxylin and eosin staining showing an abnormal, enlarged vessel with thickened vessel wall (arrow). The inhomogeneous appearance on hepatobiliary phase is presumably related to areas with ischemic injury and ductular metaplasia due to vascular abnormalities, which are alternated by areas with ductular proliferation.
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Fig3: A patient with a histologically proven FNH presenting as an inhomogenously hyperintense lesion on hepatobiliary phases (Tumor C). 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 black arrows). Initially, the lesion presents as a hyperintense lesion with a non-enhancing central scar during arterial phase, but over time the lesion characteristics change resulting in an inhomogeneous appearance during hepatobiliary phase. G CD34 immunohistochemistry shows diffuse positivity throughout the lesion (brown staining at arrows). H Hematoxylin and eosin staining showing an abnormal, enlarged vessel with thickened vessel wall (arrow). The inhomogeneous appearance on hepatobiliary phase is presumably related to areas with ischemic injury and ductular metaplasia due to vascular abnormalities, which are alternated by areas with ductular proliferation.
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