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Open Access 01-06-2020 | Magnetic Resonance Imaging | Hepatobiliary-Pancreas

Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?

Authors: Timo Alexander Auer, Uli Fehrenbach, Christian Grieser, Tobias Penzkofer, Dominik Geisel, Moritz Schmelzle, Tobias Müller, Hendrik Bläker, Daniel Seehofer, Timm Denecke

Published in: European Radiology | Issue 6/2020

Abstract

Purpose

To differentiate subtypes of hepatocellular adenoma (HCA) based on enhancement characteristics in gadoxetic acid (Gd-EOB) magnetic resonance imaging (MRI).

Materials and methods

Forty-eight patients with 79 histopathologically proven HCAs who underwent Gd-EOB-enhanced MRI were enrolled (standard of reference: surgical resection). Two blinded radiologists performed quantitative measurements (lesion-to-liver enhancement) and evaluated qualitative imaging features. Inter-reader variability was tested. Advanced texture analysis was used to evaluate lesion heterogeneity three-dimensionally.

Results

Overall, there were 19 (24%) hepatocyte nuclear factor (HNF)-1a-mutated (HHCAs), 37 (47%) inflammatory (IHCAs), 5 (6.5%) b-catenin-activated (bHCA), and 18 (22.5%) unclassified (UHCAs) adenomas. In the hepatobiliary phase (HBP), 49.5% (39/79) of all adenomas were rated as hypointense and 50.5% (40/79) as significantly enhancing (defined as > 25% intralesional GD-EOB uptake). 82.5% (33/40) of significantly enhancing adenomas were IHCAs, while only 4% (1/40) were in the HHCA subgroup (p < 0.001). When Gd-EOB uptake behavior was considered in conjunction with established MRI features (binary regression model), the area under the curve (AUC) increased from 0.785 to 0.953 for differentiation of IHCA (atoll sign + hyperintensity), from 0.859 to 0.903 for bHCA (scar + hyperintensity), and from 0.899 to 0.957 for HHCA (steatosis + hypointensity). Three-dimensional region of interest (3D ROI) analysis showed significantly increased voxel heterogeneity for IHCAs (p = 0.038).

Conclusion

Gd-EOB MRI is of added value for subtype differentiation of HCAs and reliably identifies the typical heterogeneous HBP uptake of IHCAs. Diagnostic accuracy can be improved significantly by the combined analysis of established morphologic MR appearances and intralesional Gd-EOB uptake.

Key Points

• Gd-EOB-enhanced MRI is of added value for subtype differentiation of HCA.

• IHCA and HHCA can be identified reliably based on their typical Gd-EOB uptake patterns, and accuracy increases significantly when additionally taking established MR appearances into account.

• The small numbers of bHCAs and UHCAs remain the source of diagnostic uncertainty.

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Title: Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?
Authors: Timo Alexander Auer
Uli Fehrenbach
Christian Grieser
Tobias Penzkofer
Dominik Geisel
Moritz Schmelzle
Tobias Müller
Hendrik Bläker
Daniel Seehofer
Timm Denecke
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Hepatic Adenoma
Published in: European Radiology / Issue 6/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-06726-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

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