Abstract
BackgroundDifferent clinical behaviour influences the importance of differentiating focal nodular hyperplasia (FNH) from other focal liver lesions (FLLs). The aim of this study was to compare the efficacy of contrast-enhanced CT and MRI in the diagnosis of FNH.Methods157 patients with equivocal FLLs detected in ultrasonography subsequently underwent multi-phase CT and MRI with the use of hepatotropic contrast agent (Gd-BOPTA) in a 1.5 T scanner. Examinations were evaluated by three independent readers. Diagnostic efficacy of different radiological signs of FNH in both CT and MRI was compared and AFROC analysis was performed.Results4 hepatocellular adenomas, 95 hepatocellular carcinomas, 98 hemangiomas, 138 metastases and 45 FNHs were diagnosed. In both CT and MRI the radiological sign of the highest accuracy was the presence of the central scar within FNH (0.93 and 0.96 relatively). The sum of two radiological signs in MRI: homogeneous enhancement in hepatic arterial phase (HAP) and enhancing lesion in hepatobiliary phase (HBP) was characterized with high values of sensitivity (0.89), specificity (0.97), PPV (0.82), NPV (0.98) and accuracy (0.96). After inclusion of clinical data into analysis the best discriminating feature in MRI was the presence of enhancing lesion in HBP in patients without cirrhosis. In this regard, efficacy parameters increased to 1.00, 0.99, 0.94, 1.00 and 0.99 accordingly. The area under the curve in AFROC analysis of MRI performance was significantly larger than of CT (p = 0.0145).ConclusionGd-BOPTA-enhanced MRI is a more effective method in the differential diagnosis of FNH than multi-phase CT.
Highlights
Different clinical behaviour influences the importance of differentiating focal nodular hyperplasia (FNH) from other focal liver lesions (FLLs)
Different clinical behaviour and pathological features influence the importance of differentiating FNH from other hypervascular liver lesions such as hepatocellular adenoma (HCA), hepatocellular carcinoma (HCC), and hypervascular metastases as it is critical to ensure proper treatment
The aim of this study is to compare the efficacy of multi-phase multi-detector computed tomography (CT) and magnetic resonance imaging (MRI) with the use of hepatotropic contrast agent Gd-BOPTA in the differentiation of FNH from other focal liver lesions (FLLs) in patients with equivocal foci detected in ultrasonography
Summary
Different clinical behaviour influences the importance of differentiating focal nodular hyperplasia (FNH) from other focal liver lesions (FLLs). FNH is most probably a reactive proliferation of hepatocytes due to preexistent vascular malformation [1]. It is the most frequent benign liver lesion following hemangioma and usually develops in unchanged liver parenchyma [2]. Different clinical behaviour and pathological features influence the importance of differentiating FNH from other hypervascular liver lesions such as hepatocellular adenoma (HCA), hepatocellular carcinoma (HCC), and hypervascular metastases as it is critical to ensure proper treatment.
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