Top

Published in:

01-06-2014 | Magnetic Resonance

Gadoxetic acid enhanced MRI for differentiation of FNH and HCA: a single centre experience

Authors: Christian Grieser, Ingo G. Steffen, Incken-Birthe Kramme, Hendrik Bläker, Ergin Kilic, Carmen Maria Perez Fernandez, Daniel Seehofer, Eckart Schott, Bernd Hamm, Timm Denecke

Published in: European Radiology | Issue 6/2014

Abstract

Objectives

Evaluation of enhancement characteristics of histopathologically confirmed focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HCAs) with gadoxetic acid-enhanced MRI.

Methods

Sixty-eight patients with 115 histopathologically proven lesions (FNHs, n = 44; HCAs, n = 71) examined with gadoxetic acid-enhanced MRI were retrospectively enrolled (standard of reference: surgical resection, n = 53 patients (lesions: FNHs, n = 37; HCAs, n = 53); biopsy, n = 15 (lesions: FNHs, n = 7; HCAs, n = 18)). Two radiologists evaluated all MR images regarding morphological features as well as the vascular and hepatocyte-specific enhancement in consensus.

Results

For the hepatobiliary phase, relative enhancement of the lesions and lesion to liver enhancement were significantly lower for HCAs (mean, 48.7 (±48.4) % and 49.4 (±33.9) %) compared to FNHs (159.3 (±92.5) %; and 151.7 (±79) %; accuracy of 89 % and 90 %, respectively; P < 0.001). Visual strong uptake of FNHs vs. hypointensity of HCAs in the hepatobiliary phase resulted in an accuracy of 92 %. This parameter was superior to all other morphological and dynamic vascular criteria alone and in combination (accuracy, 54–85 %).

Conclusions

For differentiation of FNHs and HCAs by means of MRI, gadoxetic acid uptake in the hepatobiliary phase was found to be superior to all other criteria alone and in combination.

Key Points

• EOB-MRI is well suited to differentiate FNHs and hepatocellular adenomas.

• For this purpose hepatobiliary phase is superior to unenhanced and dynamic imaging.

• Hepatobiliary phase (peripheral) hyper- or isointensity is typical for FNH.

• Hepatobiliary phase hypointensity is typical for hepatocellular adenomas.

• EOB-MRI helps to avoid misinterpretations of benign hepatocellular lesions.

van den Esschert JW, van Gulik TM, Phoa SS (2010) Imaging modalities for focal nodular hyperplasia and hepatocellular adenoma. Dig Surg 27:46–55PubMedCrossRef

Grazioli L, Bondioni MP, Haradome H, Motosugi U, Tinti R, Frittoli B et al (2012) Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 262:520–529PubMedCrossRef

Barthelmes L, Tait IS (2005) Liver cell adenoma and liver cell adenomatosis. HPB (Oxford) 7:186–196CrossRef

Stoot JH, Coelen RJ, De Jong MC, Dejong CH (2010) Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases. HPB (Oxford) 12:509–522CrossRef

Bioulac-Sage P, Cubel G, Taouji S, Scoazec JY, Leteurtre E, Paradis V et al (2012) Immunohistochemical markers on needle biopsies are helpful for the diagnosis of focal nodular hyperplasia and hepatocellular adenoma subtypes. Am J Surg Pathol 36:1691–1699PubMedCrossRef

Buscarini L, Fornari F, Bolondi L, Colombo P, Livraghi T, Magnolfi F et al (1990) Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications. A retrospective study on 2091 biopsies. J Hepatol 11:344–348PubMedCrossRef

Fornari F, Civardi G, Cavanna L, Di Stasi M, Rossi S, Sbolli G et al (1989) Complications of ultrasonically guided fine-needle abdominal biopsy. Results of a multicenter Italian study and review of the literature. The Cooperative Italian Study Group. Scand J Gastroenterol 24:949–955PubMedCrossRef

Tsai JH, Jeng YM, Pan CC, Lu SW, Kuo YJ (2012) Immunostaining of glutamine synthetase is a sensitive and specific marker for diagnosing focal nodular hyperplasia in needle biopsy. Pathology 44:605–610PubMedCrossRef

Friedrich-Rust M, Klopffleisch T, Nierhoff J, Herrmann E, Vermehren J, Schneider MD et al (2013) Contrast-enhanced ultrasound for the differentiation of benign and malignant focal liver lesions: a meta-analysis. Liver Int 33:739–755PubMedCrossRef

10.

Hussain SM, van den Bos IC, Dwarkasing RS, Kuiper JW, den Hollander J (2006) Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis. Eur Radiol 16:1873–1886PubMedCrossRef

11.

van Aalten SM, Thomeer MG, Terkivatan T, Dwarkasing RS, Verheij J, de Man RA et al (2011) Hepatocellular adenomas: correlation of MR imaging findings with pathologic subtype classification. Radiology 261:172–181PubMedCrossRef

12.

Grazioli L, Morana G, Kirchin MA, Schneider G (2005) Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-enhanced MR imaging: prospective study. Radiology 236:166–177PubMedCrossRef

13.

Morana G, Grazioli L, Kirchin MA, Bondioni MP, Faccioli N, Guarise A et al (2011) Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol 46:225–239PubMedCrossRef

14.

Bioulac-Sage P, Laumonier H, Couchy G, Le Bail B, Sa Cunha A, Rullier A et al (2009) Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology 50:481–489PubMedCrossRef

15.

Bieze M, van den Esschert JW, Nio CY, Verheij J, Reitsma JB, Terpstra V et al (2012) Diagnostic accuracy of MRI in differentiating hepatocellular adenoma from focal nodular hyperplasia: prospective study of the additional value of gadoxetate disodium. AJR Am J Roentgenol 199:26–34PubMedCrossRef

16.

Huppertz A, Haraida S, Kraus A, Zech CJ, Scheidler J, Breuer J et al (2005) Enhancement of focal liver lesions at gadoxetic acid-enhanced MR imaging: correlation with histopathologic findings and spiral CT–initial observations. Radiology 234:468–478PubMedCrossRef

17.

Mohajer K, Frydrychowicz A, Robbins JB, Loeffler AG, Reed TD, Reeder SB (2012) Characterization of hepatic adenoma and focal nodular hyperplasia with gadoxetic acid. J Magn Reson Imaging 36:686–696PubMedCentralPubMedCrossRef

18.

Purysko AS, Remer EM, Coppa CP, Obuchowski NA, Schneider E, Veniero JC (2012) Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. AJR Am J Roentgenol 198:115–123PubMedCrossRef

19.

Bioulac-Sage P, Blanc JF, Rebouissou S, Balabaud C, Zucman-Rossi J (2007) Genotype phenotype classification of hepatocellular adenoma. World J Gastroenterol 13:2649–2654PubMed

20.

Bioulac-Sage P, Laumonier H, Laurent C, Zucman-Rossi J, Balabaud C (2008) Hepatocellular adenoma: what is new in 2008. Hepatol Int 2:316–321PubMedCentralPubMedCrossRef

21.

Grieser C, Steffen I, Seehofer D, Kramme I, Uktolseya R, Scheurig-Muenkler C et al (2012) Histopathologically confirmed focal nodular hyperplasia of the liver: gadoxetic acid enhanced MRI characteristics. Magn Reson Imaging 31:755–760PubMedCrossRef

22.

Arrive L, Flejou JF, Vilgrain V, Belghiti J, Najmark D, Zins M et al (1994) Hepatic adenoma: MR findings in 51 pathologically proved lesions. Radiology 193:507–512PubMed

23.

Ba-Ssalamah A, Uffmann M, Saini S, Bastati N, Herold C, Schima W (2009) Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions. Eur Radiol 19:342–357PubMedCrossRef

24.

Chung KY, Mayo-Smith WW, Saini S, Rahmouni A, Golli M, Mathieu D (1995) Hepatocellular adenoma: MR imaging features with pathologic correlation. AJR Am J Roentgenol 165:303–308PubMedCrossRef

25.

Kim MJ, Rhee HJ, Jeong HT (2012) Hyperintense lesions on gadoxetate disodium-enhanced hepatobiliary phase imaging. AJR Am J Roentgenol 199:W575–W586PubMedCrossRef

26.

Paulson EK, McClellan JS, Washington K, Spritzer CE, Meyers WC, Baker ME (1994) Hepatic adenoma: MR characteristics and correlation with pathologic findings. AJR Am J Roentgenol 163:113–116PubMedCrossRef

27.

Ronot M, Paradis V, Duran R, Kerbaol A, Vullierme MP, Belghiti J et al (2013) MR findings of steatotic focal nodular hyperplasia and comparison with other fatty tumours. Eur Radiol 23:914–923PubMedCrossRef

28.

Kacl GM, Hagspiel KD, Marincek B (1997) Focal nodular hyperplasia of the liver: serial MRI with Gd-DOTA, superparamagnetic iron oxide, and Gd-EOB-DTPA. Abdom Imaging 22:264–267PubMedCrossRef

29.

Bioulac-Sage P, Rebouissou S, Thomas C, Blanc JF, Saric J, Sa Cunha A et al (2007) Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology 46:740–748PubMedCrossRef

30.

van Aalten SM, Verheij J, Terkivatan T, Dwarkasing RS, de Man RA, Ijzermans JN (2011) Validation of a liver adenoma classification system in a tertiary referral centre: implications for clinical practice. J Hepatol 55:120–125PubMedCrossRef

31.

Zucman-Rossi J, Jeannot E, Nhieu JT, Scoazec JY, Guettier C, Rebouissou S et al (2006) Genotype-phenotype correlation in hepatocellular adenoma: new classification and relationship with HCC. Hepatology 43:515–524PubMedCrossRef

32.

Silva AC, Evans JM, McCullough AE, Jatoi MA, Vargas HE, Hara AK (2009) MR imaging of hypervascular liver masses: a review of current techniques. Radiographics 29:385–402PubMedCrossRef

33.

Marin D, Galluzzo A, Plessier A, Brancatelli G, Valla D, Vilgrain V (2011) Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. Eur Radiol 21:2074–2082PubMedCrossRef

34.

Fujiwara H, Sekine S, Onaya H, Shimada K, Mikata R, Arai Y (2011) Ring-like enhancement of focal nodular hyperplasia with hepatobiliary-phase Gd-EOB-DTPA-enhanced magnetic resonance imaging: radiological-pathological correlation. Jpn J Radiol 29:739–743PubMedCrossRef

35.

Eisenberg LB, Warshauer DM, Woosley JT, Cance WG, Bunzendahl H, Semelka RC (1995) CT and MRI of hepatic focal nodular hyperplasia with peripheral steatosis. J Comput Assist Tomogr 19:498–500PubMedCrossRef

36.

Huppertz A, Breuer J, Fels LM, Schultze-Mosgau M, Sutter G, Klein S et al (2011) Evaluation of possible drug-drug interaction between gadoxetic acid and erythromycin as an inhibitor of organic anion transporting peptides (OATP). J Magn Reson Imaging 33:409–416PubMedCrossRef

37.

Vander Borght S, Libbrecht L, Blokzijl H, Faber KN, Moshage H, Aerts R et al (2005) Diagnostic and pathogenetic implications of the expression of hepatic transporters in focal lesions occurring in normal liver. J Pathol 207:471–482PubMedCrossRef

38.

Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W et al (2012) Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images. Jpn J Radiol 30:499–508PubMedCrossRef

39.

Denecke T, Steffen IG, Agarwal S, Seehofer D, Kroncke T, Hanninen EL et al (2012) Appearance of hepatocellular adenomas on gadoxetic acid-enhanced MRI. Eur Radiol 22:1769–1775PubMedCrossRef

40.

Gupta RT, Iseman CM, Leyendecker JR, Shyknevsky I, Merkle EM, Taouli B (2012) Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium. AJR Am J Roentgenol 199:35–43PubMedCrossRef

41.

Holzapfel K, Eiber MJ, Fingerle AA, Bruegel M, Rummeny EJ, Gaa J (2012) Detection, classification, and characterization of focal liver lesions: value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods. Abdom Imaging 37:74–82PubMedCrossRef

42.

Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO (2008) Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol 43:504–511PubMedCrossRef

43.

Laumonier H, Bioulac-Sage P, Laurent C, Zucman-Rossi J, Balabaud C, Trillaud H (2008) Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology 48:808–818PubMedCrossRef

44.

Ronot M, Bahrami S, Calderaro J, Valla DC, Bedossa P, Belghiti J et al (2011) Hepatocellular adenomas: accuracy of magnetic resonance imaging and liver biopsy in subtype classification. Hepatology 53:1182–1191PubMedCrossRef

45.

Thomeer MG, Willemssen FE, Biermann KK, El Addouli H, de Man RA, Ijzermans JN et al (2013) MRI features of inflammatory hepatocellular adenomas on hepatocyte phase imaging with liver-specific contrast agents. J Magn Reson Imaging. doi:10.1002/jmri.24281 PubMed

Title: Gadoxetic acid enhanced MRI for differentiation of FNH and HCA: a single centre experience
Authors: Christian Grieser
Ingo G. Steffen
Incken-Birthe Kramme
Hendrik Bläker
Ergin Kilic
Carmen Maria Perez Fernandez
Daniel Seehofer
Eckart Schott
Bernd Hamm
Timm Denecke
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3144-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Gadoxetic acid enhanced MRI for differentiation of FNH and HCA: a single centre experience

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 6/2014

Effective dose to patient measurements in flat-detector and multislice computed tomography: a comparison of applications in neuroradiology

Application of the diffusion kurtosis model for the study of breast lesions

Influence of Calcium on Choline Measurements by 1H MR Spectroscopy of Thigh Muscles

Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time

CT halo sign as an imaging marker for response to adoptive cell therapy in metastatic melanoma with pulmonary metastases

Short interval follow-up after a benign concordant MR-guided vacuum assisted breast biopsy – is it worthwhile?