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Diagnosis of Hepatic Angiomyolipoma by Combination of Baseline and Contrast-Enhanced Ultrasound--A Prospective Study in Non-Cirrhotic Patients.

Li R, Tang CL, Zhang Y, Ma KS, Zhang XH, Guo DY, Yan XC - PLoS ONE (2015)

Bottom Line: The diagnostic criteria were fulfilled in 31 HAMLs, 1 hepatocellular adenoma and 1 hemangioma.Ten HAMLs were misdiagnosed as other liver tumors because they did not meet the diagnostic criteria mentioned above and consequently yielded a sensitivity, specificity, positive predictive values, negative predictive values and Youden index of 75.61%, 99.88%, 93.94%, 99.42%, and 0.75 respectively.The combination of baseline US and CEUS may lead to the correct diagnosis noninvasively in the majority of HAMLs in non-cirrhotic patients with normal AFP level.

View Article: PubMed Central - PubMed

Affiliation: Dept. Hepato-biliary-Pancreatic Surgery, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.

ABSTRACT

Objectives: Hepatic angiomyolipoma (HAML) is a rare, benign mesenchymal tumor of the liver and its diagnosis has been considered challenging. The aim of this study was to investigate prospectively the diagnostic efficacy of the incorporation of both baseline ultrasound (US) and contrast-enhanced ultrasound (CEUS) features of HAML in patients without cirrhosis.

Materials and methods: Consecutive 1748 non-cirrhotic patients with focal liver lesions (FLLs) were prospectively enrolled. Baseline US and CEUS were performed before resection or biopsy. Ultrasound imaging diagnosis of FLLs was compared with the pathological results.

Results: Final diagnoses were established in 41 patients with HAML (2.3%) with normal alpha fetal protein (AFP) level and in 1707 patients with FLL other than HAML. Diagnostic criteria for HAML was based on the combination of baseline US and CEUS appearance of the nodule: (1) Well-defined, marked hyper-echoic nodule without surrounding hypo-echoic halo on baseline US; (2) hyper-enhancement in the arterial phase (exclude initial peripheral nodular enhancement and spoke-wheel arteries) and remains hyper-enhancement or iso-enhancement in the late phase. The diagnostic criteria were fulfilled in 31 HAMLs, 1 hepatocellular adenoma and 1 hemangioma. Ten HAMLs were misdiagnosed as other liver tumors because they did not meet the diagnostic criteria mentioned above and consequently yielded a sensitivity, specificity, positive predictive values, negative predictive values and Youden index of 75.61%, 99.88%, 93.94%, 99.42%, and 0.75 respectively.

Conclusion: The combination of baseline US and CEUS may lead to the correct diagnosis noninvasively in the majority of HAMLs in non-cirrhotic patients with normal AFP level.

No MeSH data available.


Related in: MedlinePlus

Typical appearance of HAML on baseline US and CEUS.There is a well-defined, marked heterogeneous hyper-echoic nodule of 44 mm×31mm in size without surrounding hypo-echoic halo on baseline US in the left lobe of liver (white arrow) in a 39 year female patient (A). The nodule shows heterogeneous hyper-enhancement in the arterial phase (13 seconds after injection of contrast agent) without initial peripheral nodular enhancement or spoke-wheel arteries (B). The nodule shows heterogeneous hyper-enhancement in the portal phase (1 minute and 21 seconds after injection of contrast agent) and sustained heterogeneous hyper-enhancement in the late phase. (3 minutes and 17 seconds after injection of contrast agent,) (C,D).
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pone.0132290.g002: Typical appearance of HAML on baseline US and CEUS.There is a well-defined, marked heterogeneous hyper-echoic nodule of 44 mm×31mm in size without surrounding hypo-echoic halo on baseline US in the left lobe of liver (white arrow) in a 39 year female patient (A). The nodule shows heterogeneous hyper-enhancement in the arterial phase (13 seconds after injection of contrast agent) without initial peripheral nodular enhancement or spoke-wheel arteries (B). The nodule shows heterogeneous hyper-enhancement in the portal phase (1 minute and 21 seconds after injection of contrast agent) and sustained heterogeneous hyper-enhancement in the late phase. (3 minutes and 17 seconds after injection of contrast agent,) (C,D).

Mentions: Thirty three well-defined lesions showing marked hyper-echogenicity on baseline US and sustained enhancement pattern without initial peripheral nodular enhancement or spoke-wheel arteries on CEUS had been diagnosed as HAML before liver resection or biopsy (Fig 2). Subsequent pathological analysis turned out to be HAML in 31 patients, hepatocellular adenoma in one patient and hemangioma in another patient. Ten HAMLs were misdiagnosed as other liver tumors because they did not fulfill the diagnostic criteria mentioned above: 5 lesions (4 hypoechoic and 1 hyperechoic on baseline US) showing wash out enhancement pattern were diagnosed as malignant tumors, 1 large cystic lesion and 1 inhomogeneous hypoechoic lesion showing rim-like enhancement pattern were interpreted as benign liver tumor with internal haemorrhage and necrosis, 1 isoechoic lesion and 1 hypoechoic lesion showing sustained enhancement pattern were characterized as benign liver tumor, and 1 marked hyperechoic lesion showing hypoenhancement during all the three vascular phases was interpreted as hypovascular tumor with indeterminate diagnosis. Other 1705 focal liver lesions (99.88%) that did not meet the diagnostic criteria of HAML were correctly interpreted as non-HAML lesions.


Diagnosis of Hepatic Angiomyolipoma by Combination of Baseline and Contrast-Enhanced Ultrasound--A Prospective Study in Non-Cirrhotic Patients.

Li R, Tang CL, Zhang Y, Ma KS, Zhang XH, Guo DY, Yan XC - PLoS ONE (2015)

Typical appearance of HAML on baseline US and CEUS.There is a well-defined, marked heterogeneous hyper-echoic nodule of 44 mm×31mm in size without surrounding hypo-echoic halo on baseline US in the left lobe of liver (white arrow) in a 39 year female patient (A). The nodule shows heterogeneous hyper-enhancement in the arterial phase (13 seconds after injection of contrast agent) without initial peripheral nodular enhancement or spoke-wheel arteries (B). The nodule shows heterogeneous hyper-enhancement in the portal phase (1 minute and 21 seconds after injection of contrast agent) and sustained heterogeneous hyper-enhancement in the late phase. (3 minutes and 17 seconds after injection of contrast agent,) (C,D).
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4492985&req=5

pone.0132290.g002: Typical appearance of HAML on baseline US and CEUS.There is a well-defined, marked heterogeneous hyper-echoic nodule of 44 mm×31mm in size without surrounding hypo-echoic halo on baseline US in the left lobe of liver (white arrow) in a 39 year female patient (A). The nodule shows heterogeneous hyper-enhancement in the arterial phase (13 seconds after injection of contrast agent) without initial peripheral nodular enhancement or spoke-wheel arteries (B). The nodule shows heterogeneous hyper-enhancement in the portal phase (1 minute and 21 seconds after injection of contrast agent) and sustained heterogeneous hyper-enhancement in the late phase. (3 minutes and 17 seconds after injection of contrast agent,) (C,D).
Mentions: Thirty three well-defined lesions showing marked hyper-echogenicity on baseline US and sustained enhancement pattern without initial peripheral nodular enhancement or spoke-wheel arteries on CEUS had been diagnosed as HAML before liver resection or biopsy (Fig 2). Subsequent pathological analysis turned out to be HAML in 31 patients, hepatocellular adenoma in one patient and hemangioma in another patient. Ten HAMLs were misdiagnosed as other liver tumors because they did not fulfill the diagnostic criteria mentioned above: 5 lesions (4 hypoechoic and 1 hyperechoic on baseline US) showing wash out enhancement pattern were diagnosed as malignant tumors, 1 large cystic lesion and 1 inhomogeneous hypoechoic lesion showing rim-like enhancement pattern were interpreted as benign liver tumor with internal haemorrhage and necrosis, 1 isoechoic lesion and 1 hypoechoic lesion showing sustained enhancement pattern were characterized as benign liver tumor, and 1 marked hyperechoic lesion showing hypoenhancement during all the three vascular phases was interpreted as hypovascular tumor with indeterminate diagnosis. Other 1705 focal liver lesions (99.88%) that did not meet the diagnostic criteria of HAML were correctly interpreted as non-HAML lesions.

Bottom Line: The diagnostic criteria were fulfilled in 31 HAMLs, 1 hepatocellular adenoma and 1 hemangioma.Ten HAMLs were misdiagnosed as other liver tumors because they did not meet the diagnostic criteria mentioned above and consequently yielded a sensitivity, specificity, positive predictive values, negative predictive values and Youden index of 75.61%, 99.88%, 93.94%, 99.42%, and 0.75 respectively.The combination of baseline US and CEUS may lead to the correct diagnosis noninvasively in the majority of HAMLs in non-cirrhotic patients with normal AFP level.

View Article: PubMed Central - PubMed

Affiliation: Dept. Hepato-biliary-Pancreatic Surgery, Southwest Hospital Affiliated to Third Military Medical University, Chongqing, China.

ABSTRACT

Objectives: Hepatic angiomyolipoma (HAML) is a rare, benign mesenchymal tumor of the liver and its diagnosis has been considered challenging. The aim of this study was to investigate prospectively the diagnostic efficacy of the incorporation of both baseline ultrasound (US) and contrast-enhanced ultrasound (CEUS) features of HAML in patients without cirrhosis.

Materials and methods: Consecutive 1748 non-cirrhotic patients with focal liver lesions (FLLs) were prospectively enrolled. Baseline US and CEUS were performed before resection or biopsy. Ultrasound imaging diagnosis of FLLs was compared with the pathological results.

Results: Final diagnoses were established in 41 patients with HAML (2.3%) with normal alpha fetal protein (AFP) level and in 1707 patients with FLL other than HAML. Diagnostic criteria for HAML was based on the combination of baseline US and CEUS appearance of the nodule: (1) Well-defined, marked hyper-echoic nodule without surrounding hypo-echoic halo on baseline US; (2) hyper-enhancement in the arterial phase (exclude initial peripheral nodular enhancement and spoke-wheel arteries) and remains hyper-enhancement or iso-enhancement in the late phase. The diagnostic criteria were fulfilled in 31 HAMLs, 1 hepatocellular adenoma and 1 hemangioma. Ten HAMLs were misdiagnosed as other liver tumors because they did not meet the diagnostic criteria mentioned above and consequently yielded a sensitivity, specificity, positive predictive values, negative predictive values and Youden index of 75.61%, 99.88%, 93.94%, 99.42%, and 0.75 respectively.

Conclusion: The combination of baseline US and CEUS may lead to the correct diagnosis noninvasively in the majority of HAMLs in non-cirrhotic patients with normal AFP level.

No MeSH data available.


Related in: MedlinePlus