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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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Another patient presenting with a hypo-intense type FNH in segment 5 (Tumor B). 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). The FNH is visible during all phases and initially presents as a hypervascular lesion on arterial phase without a central scar. During hepatobiliary phases, the lesion signal is less intense compared to the surrounding parenchyma, resulting in a slightly hypointense aspect. G CK 19 immunohistochemistry showing weakly CK 19 positive ductular proliferation in the lesion periphery (arrows), while the lesion centre is almost completely negative. H CK7 immunohistochemistry shows diffuse positivity in the lesion representing both ductular proliferation and ductular metaplasia (black arrows); the bile-ducts that are positive for CK19 (G) are positive for CK7 as well (red arrows). The ductular metaplasia is more pronounced than the ductular proliferation and is visible both in the lesion centre as in the lesion periphery. J CD34 immunohistochemistry shows expression around the fibrous tissue (arrows). K Azan staining demonstrates the presence of fibrous tissue throughout the lesion (black arrows pointing out blue areas), although a central scar cannot be identified.
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Fig6: Another patient presenting with a hypo-intense type FNH in segment 5 (Tumor B). 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). The FNH is visible during all phases and initially presents as a hypervascular lesion on arterial phase without a central scar. During hepatobiliary phases, the lesion signal is less intense compared to the surrounding parenchyma, resulting in a slightly hypointense aspect. G CK 19 immunohistochemistry showing weakly CK 19 positive ductular proliferation in the lesion periphery (arrows), while the lesion centre is almost completely negative. H CK7 immunohistochemistry shows diffuse positivity in the lesion representing both ductular proliferation and ductular metaplasia (black arrows); the bile-ducts that are positive for CK19 (G) are positive for CK7 as well (red arrows). The ductular metaplasia is more pronounced than the ductular proliferation and is visible both in the lesion centre as in the lesion periphery. J CD34 immunohistochemistry shows expression around the fibrous tissue (arrows). K Azan staining demonstrates the presence of fibrous tissue throughout the lesion (black arrows pointing out blue areas), although a central scar cannot be identified.

Mentions: One lesion could not be categorized into one of these four patterns. This lesion (5.5 cm) appeared hyperintense during early dynamic phases, but signal intensity decreased during hepatobiliary phases, resulting in a slightly hypo-intense signal compared to the surrounding parenchyma. This lesion was homogeneously hypo-intense, and did not show a peripheral rim like the “hypo-intense-with-ring” type FNH’s (Fig. 6a–f).Fig. 6


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)

Another patient presenting with a hypo-intense type FNH in segment 5 (Tumor B). 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). The FNH is visible during all phases and initially presents as a hypervascular lesion on arterial phase without a central scar. During hepatobiliary phases, the lesion signal is less intense compared to the surrounding parenchyma, resulting in a slightly hypointense aspect. G CK 19 immunohistochemistry showing weakly CK 19 positive ductular proliferation in the lesion periphery (arrows), while the lesion centre is almost completely negative. H CK7 immunohistochemistry shows diffuse positivity in the lesion representing both ductular proliferation and ductular metaplasia (black arrows); the bile-ducts that are positive for CK19 (G) are positive for CK7 as well (red arrows). The ductular metaplasia is more pronounced than the ductular proliferation and is visible both in the lesion centre as in the lesion periphery. J CD34 immunohistochemistry shows expression around the fibrous tissue (arrows). K Azan staining demonstrates the presence of fibrous tissue throughout the lesion (black arrows pointing out blue areas), although a central scar cannot be identified.
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Fig6: Another patient presenting with a hypo-intense type FNH in segment 5 (Tumor B). 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). The FNH is visible during all phases and initially presents as a hypervascular lesion on arterial phase without a central scar. During hepatobiliary phases, the lesion signal is less intense compared to the surrounding parenchyma, resulting in a slightly hypointense aspect. G CK 19 immunohistochemistry showing weakly CK 19 positive ductular proliferation in the lesion periphery (arrows), while the lesion centre is almost completely negative. H CK7 immunohistochemistry shows diffuse positivity in the lesion representing both ductular proliferation and ductular metaplasia (black arrows); the bile-ducts that are positive for CK19 (G) are positive for CK7 as well (red arrows). The ductular metaplasia is more pronounced than the ductular proliferation and is visible both in the lesion centre as in the lesion periphery. J CD34 immunohistochemistry shows expression around the fibrous tissue (arrows). K Azan staining demonstrates the presence of fibrous tissue throughout the lesion (black arrows pointing out blue areas), although a central scar cannot be identified.
Mentions: One lesion could not be categorized into one of these four patterns. This lesion (5.5 cm) appeared hyperintense during early dynamic phases, but signal intensity decreased during hepatobiliary phases, resulting in a slightly hypo-intense signal compared to the surrounding parenchyma. This lesion was homogeneously hypo-intense, and did not show a peripheral rim like the “hypo-intense-with-ring” type FNH’s (Fig. 6a–f).Fig. 6

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