Abstract
BackgroundRecent studies provide evidence that hepatocellular adenomas (HCAs) frequently take up gadoxetic acid (Gd-EOB) during the hepatobiliary phase (HBP). The purpose of our study was to investigate how to differentiate between Gd-EOB-enhancing HCAs and focal nodular hyperplasias (FNHs). We therefore retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection). Two readers (experienced abdominal radiologists blinded to clinical data) reviewed the images evaluating morphologic features and subjectively scoring Gd-EOB uptake (25–50%, 50–75% and 75–100%) for each lesion. Quantitative lesion-to-liver enhancement was measured in arterial, portal venous (PV), transitional and HBP. Additionally, multivariate regression analyses were performed.ResultsSubjective scoring of intralesional Gd-EOB uptake showed the highest discriminatory accuracies (AUC: 0.848 (R#1); 0.920 (R#2)—p < 0.001) with significantly higher uptake scores assigned to FNHs (Cut-off: 75%-100%). Typical lobulation and presence of a central scar in FNH achieved an accuracy of 0.750 or higher in at least one reader (lobulation—AUC: 0.809 (R#1); 0.736 (R#2); central scar—AUC: 0.595 (R#1); 0.784 (R#2)). The multivariate regression emphasized the discriminatory power of the Gd-EOB scoring (p = 0.001/OR:22.15 (R#1) and p < 0.001/OR:99.12 (R#2). The lesion-to-liver ratio differed significantly between FNH and HCA in the PV phase and HBP (PV: 132.9 (FNH) and 110.2 (HCA), p = 0.048 and HBP: 110.3 (FNH) and 39.2 (HCA), p < 0.001)), while the difference was not significant in arterial and transitional contrast phases (p > 0.05).ConclusionEven in HBP-enhancing HCA, characterization of Gd-EOB uptake was found to provide the strongest discriminatory power in differentiating HCA from FNH. Furthermore, a lobulated appearance and a central scar are more frequently seen in FNH than in HCA.
Highlights
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are among the most benign solid neoplasms of the liver and have the highest incidence in young adolescent to middle aged women [1]
HCAs were classified into the four major molecular subgroups based on their genetic and phenotypic characteristics according to the Bordeaux classification from 2006 (HNF-1a-mutated adenoma (HHCA), inflammatory adenoma (IHCA—formerly telangiectatic FNH), β-catenin-activated adenoma, and unclassified adenoma (UHCA)) [11, 27,28,29]
Patients During enrollment, we identified 36 patients with a total of 68 pathologically proven FNH or HCA lesions with at least 25% intralesional Gd-EOB uptake
Summary
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are among the most benign solid neoplasms of the liver and have the highest incidence in young adolescent to middle aged women [1]. Evidence is high for differentiation of benign liver lesions (especially HCA and FNH) using liver-specific contrast agents such as gadoxetic acid (Gd-EOB; Primovist or Eovist, Bayer Pharma, Berlin, Germany) or gadobenate dimeglumine (Gd-BOPTA; Multihance, Bracco Imaging, Italy) [5, 12, 14,15,16,17,18,19]. We retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection).
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