Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2014

Open Access 01-12-2014 | Case report

Split-bolus versus triphasic multidetector-row computed tomography technique in the diagnosis of hepatic focal nodular hyperplasia: a case report

Published in: Journal of Medical Case Reports | Issue 1/2014

Login to get access

Abstract

Introduction

Computed tomography and magnetic resonance imaging are able to demonstrate and to diagnose hepatic focal nodular hyperplasia when a typical pattern of a well-circumscribed lesion with a central scar is present.
Our aim is to propose the split-bolus multidetector-row computed tomography technique as an alternative to the conventional triphasic technique in the detection and characterization of focal nodular hyperplasia to reduce the radiation dose to the patient.
To the best of our knowledge, this is the first report regarding the application of the split-bolus computed tomography technique in the evaluation of hepatic focal nodular hyperplasia.

Case presentation

We describe a case of focal nodular hyperplasia of the liver in a 53-year-old Caucasian woman (weight 75Kg) with a colorectal adenocarcinoma histologically confirmed. An innovative split-bolus multidetector-row computed tomography technique was used that, by splitting intravenous contrast material in two boli, combined two phases (hepatic arterial phase and portal venous phase) in a single pass; a delayed (5 minutes) phase was obtained to compare the findings with that of triphasic multidetector-row computed tomography.

Conclusions

Split-bolus multidetector-row computed tomography was able to show the same appearance of the lesion as the triphasic multidetector-row computed tomography technique.
This is the first case demonstrating the effectiveness of the split-bolus multidetector-row computed tomography technique in the detection and characterization of focal nodular hyperplasia with a significant reduction in radiation dose to the patient with respect to triphasic multidetector-row computed tomography technique.
Appendix
Available only for authorised users
Literature
1.
go back to reference Craig JR, Peters RL, Edmondson HA: Tumors of the Liver and Intrahepatic Bile Ducts. Fasc 26, 2nd Serv. 1989, Washington, DC: Armed Forces Institute of Pathology Craig JR, Peters RL, Edmondson HA: Tumors of the Liver and Intrahepatic Bile Ducts. Fasc 26, 2nd Serv. 1989, Washington, DC: Armed Forces Institute of Pathology
2.
go back to reference Wanless IR, Albrecht S, Bilbao J, Frei JV, Heathcote EJ, Roberts EA: Multiple focal nodular hyperplasia of the liver associated with vascular malformations of various organs and neoplasia of the brain: a new syndrome. Mod Pathol. 1989, 2: 456-462.PubMed Wanless IR, Albrecht S, Bilbao J, Frei JV, Heathcote EJ, Roberts EA: Multiple focal nodular hyperplasia of the liver associated with vascular malformations of various organs and neoplasia of the brain: a new syndrome. Mod Pathol. 1989, 2: 456-462.PubMed
3.
go back to reference Carlson SK, Johnson CD, Bender CE, Welch TJ: CT of focal nodular hyperplasia of the liver. AJR Am J Roentgenol. 2000, 174 (3): 705-712. 10.2214/ajr.174.3.1740705.CrossRefPubMed Carlson SK, Johnson CD, Bender CE, Welch TJ: CT of focal nodular hyperplasia of the liver. AJR Am J Roentgenol. 2000, 174 (3): 705-712. 10.2214/ajr.174.3.1740705.CrossRefPubMed
4.
go back to reference Van Leeuwen MS, Noordzij J, Feldeberg MA, Hennipman AH, Doornewaard H: Focal liver lesions: characterization with triphasic spiral CT. Radiology. 1996, 201 (2): 327-336. 10.1148/radiology.201.2.8888219.CrossRefPubMed Van Leeuwen MS, Noordzij J, Feldeberg MA, Hennipman AH, Doornewaard H: Focal liver lesions: characterization with triphasic spiral CT. Radiology. 1996, 201 (2): 327-336. 10.1148/radiology.201.2.8888219.CrossRefPubMed
5.
go back to reference Brook OR, Gourtsoyianni S, Brook A, Siewert B, Kent T, Raptopoulos V: Spectral multidetector CT of the pancreas: assessment of radiation dose and tumor conspicuity. Radiology. 2013, 269 (1): 139-148. 10.1148/radiol.13121409.CrossRefPubMed Brook OR, Gourtsoyianni S, Brook A, Siewert B, Kent T, Raptopoulos V: Spectral multidetector CT of the pancreas: assessment of radiation dose and tumor conspicuity. Radiology. 2013, 269 (1): 139-148. 10.1148/radiol.13121409.CrossRefPubMed
6.
go back to reference Scialpi M, Piscioli I, Magli M, D’Andrea A: Split-bolus spectral multidetector CT of the pancreas: problem solving in the detection of “isoattenuating” pancreatic cancer?. Radiology. 2014, 270 (3): 936-937.CrossRefPubMed Scialpi M, Piscioli I, Magli M, D’Andrea A: Split-bolus spectral multidetector CT of the pancreas: problem solving in the detection of “isoattenuating” pancreatic cancer?. Radiology. 2014, 270 (3): 936-937.CrossRefPubMed
7.
go back to reference Van der Molen AJ, Veldkamp WJ, Geleijns J: 16-slice CT: achievable effective doses of common protocols in comparison with recent CT dose surveys. Br J Radiol. 2007, 80: 248-255. 10.1259/bjr/52356535.CrossRefPubMed Van der Molen AJ, Veldkamp WJ, Geleijns J: 16-slice CT: achievable effective doses of common protocols in comparison with recent CT dose surveys. Br J Radiol. 2007, 80: 248-255. 10.1259/bjr/52356535.CrossRefPubMed
8.
go back to reference Choi B, Nguyen M: The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol. 2005, 39 (5): 401-412. 10.1097/01.mcg.0000159226.63037.a2.CrossRefPubMed Choi B, Nguyen M: The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol. 2005, 39 (5): 401-412. 10.1097/01.mcg.0000159226.63037.a2.CrossRefPubMed
9.
go back to reference Mortelé KJ, Praet M, Van Vlierberghe H, Kunnen M, Ros PR: CT and MR imaging findings in focal nodular hyperplasia of the liver: radiologic-pathologic correlation. AJR Am J Roentgenol. 2000, 175: 687-692. 10.2214/ajr.175.3.1750687.CrossRefPubMed Mortelé KJ, Praet M, Van Vlierberghe H, Kunnen M, Ros PR: CT and MR imaging findings in focal nodular hyperplasia of the liver: radiologic-pathologic correlation. AJR Am J Roentgenol. 2000, 175: 687-692. 10.2214/ajr.175.3.1750687.CrossRefPubMed
10.
go back to reference Kim T, Hori M, Onishi H: Liver masses with central or eccentric scar. Semin Ultrasound CT MR. 2009, 30 (5): 418-425. 10.1053/j.sult.2009.07.004.CrossRefPubMed Kim T, Hori M, Onishi H: Liver masses with central or eccentric scar. Semin Ultrasound CT MR. 2009, 30 (5): 418-425. 10.1053/j.sult.2009.07.004.CrossRefPubMed
11.
go back to reference Bartolotta TV, Taibbi A, Brancatelli G, Matranga D, Tumbarello M, Midiri M, Lagalla R: Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different?. Radiol Med. 2014, 119: 222-230. 10.1007/s11547-013-0333-4.CrossRefPubMed Bartolotta TV, Taibbi A, Brancatelli G, Matranga D, Tumbarello M, Midiri M, Lagalla R: Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different?. Radiol Med. 2014, 119: 222-230. 10.1007/s11547-013-0333-4.CrossRefPubMed
12.
go back to reference Mathieu D, Vilgrain V, Mahfouz AE, Anglade MC, Vullierme MP, Denys A: Benign liver tumors. Magn Reson Imaging Clin N Am. 1997, 5: 255-288.PubMed Mathieu D, Vilgrain V, Mahfouz AE, Anglade MC, Vullierme MP, Denys A: Benign liver tumors. Magn Reson Imaging Clin N Am. 1997, 5: 255-288.PubMed
13.
go back to reference Shirkhoda A, Farah MC, Bernacki E, Madrazo B, Roberts J: Hepatic focal nodular hyperplasia: CT and sonographic spectrum. Abdom Imaging. 1994, 19: 34-38. 10.1007/BF02165858.CrossRefPubMed Shirkhoda A, Farah MC, Bernacki E, Madrazo B, Roberts J: Hepatic focal nodular hyperplasia: CT and sonographic spectrum. Abdom Imaging. 1994, 19: 34-38. 10.1007/BF02165858.CrossRefPubMed
14.
go back to reference Shamsi K, De Schepper A, Degryse H, Deckers F: Focal nodular hyperplasia of the liver: radiologic findings. Abdom Imaging. 1993, 18: 32-38. 10.1007/BF00201698.CrossRefPubMed Shamsi K, De Schepper A, Degryse H, Deckers F: Focal nodular hyperplasia of the liver: radiologic findings. Abdom Imaging. 1993, 18: 32-38. 10.1007/BF00201698.CrossRefPubMed
15.
go back to reference Gupta RT, Iseman CM, Leyendecker JR, Shyknevsky I, Merkle EM, Taouli B: Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium. AJR Am J Roentgenol. 2012, 199 (1): 35-43. 10.2214/AJR.11.7757.CrossRefPubMed Gupta RT, Iseman CM, Leyendecker JR, Shyknevsky I, Merkle EM, Taouli B: Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium. AJR Am J Roentgenol. 2012, 199 (1): 35-43. 10.2214/AJR.11.7757.CrossRefPubMed
16.
go back to reference Bieze M, van den Esschert JW, Nio CY, Verheij J, Reitsma JB, Terpstra V, van Gulik TM, Phoa SS: 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. 2012, 199: 26-34. 10.2214/AJR.11.7750.CrossRefPubMed Bieze M, van den Esschert JW, Nio CY, Verheij J, Reitsma JB, Terpstra V, van Gulik TM, Phoa SS: 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. 2012, 199: 26-34. 10.2214/AJR.11.7750.CrossRefPubMed
17.
go back to reference Scialpi M, Palumbo B, Pierotti L, Gravante S, Piunno A, Rebonato A, D’Andrea A, Reginelli A, Piscioli I, Brunese L, Rotondo A: Detection and characterization of focal liver lesions by split-bolus multidetector-row CT: diagnostic accuracy and radiation dose in oncologic patients. Anticancer Res. 2014, 34 (8): 4335-4344.PubMed Scialpi M, Palumbo B, Pierotti L, Gravante S, Piunno A, Rebonato A, D’Andrea A, Reginelli A, Piscioli I, Brunese L, Rotondo A: Detection and characterization of focal liver lesions by split-bolus multidetector-row CT: diagnostic accuracy and radiation dose in oncologic patients. Anticancer Res. 2014, 34 (8): 4335-4344.PubMed
18.
go back to reference Portnoy O, Guranda L, Apter S, Eiss D, Amitai MM, Konen E: Optimization of 64-MDCT urography: effect of dual-phase imaging with furosemide on collecting system opacification and radiation dose. AJR Am J Roentgenol. 2011, 197 (5): 882-886. 10.2214/AJR.11.6965.CrossRef Portnoy O, Guranda L, Apter S, Eiss D, Amitai MM, Konen E: Optimization of 64-MDCT urography: effect of dual-phase imaging with furosemide on collecting system opacification and radiation dose. AJR Am J Roentgenol. 2011, 197 (5): 882-886. 10.2214/AJR.11.6965.CrossRef
19.
go back to reference Brenner DJ, Hall EJ: Computed tomography – an increasing source of radiation exposure. N Engl J Med. 2007, 357 (22): 2277-2284. 10.1056/NEJMra072149.CrossRefPubMed Brenner DJ, Hall EJ: Computed tomography – an increasing source of radiation exposure. N Engl J Med. 2007, 357 (22): 2277-2284. 10.1056/NEJMra072149.CrossRefPubMed
20.
go back to reference Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington De González A, Miglioretti DL: Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009, 169 (22): 2078-2086. 10.1001/archinternmed.2009.427.CrossRefPubMedPubMedCentral Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington De González A, Miglioretti DL: Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009, 169 (22): 2078-2086. 10.1001/archinternmed.2009.427.CrossRefPubMedPubMedCentral
21.
go back to reference Erturk SM, Ichikawa T, Sou H, Tsukamoto T, Motosugi U, Araki T: Effect of duration of contrast material injection on peak enhancement times and values of the aorta, main portal vein, and liver at dynamic MDCT with the dose of contrast medium tailored to patient weight. Clin Radiol. 2008, 63 (3): 263-271. 10.1016/j.crad.2007.02.024.CrossRefPubMed Erturk SM, Ichikawa T, Sou H, Tsukamoto T, Motosugi U, Araki T: Effect of duration of contrast material injection on peak enhancement times and values of the aorta, main portal vein, and liver at dynamic MDCT with the dose of contrast medium tailored to patient weight. Clin Radiol. 2008, 63 (3): 263-271. 10.1016/j.crad.2007.02.024.CrossRefPubMed
22.
go back to reference Heiken JP, Brink JA, McClennan BL, Sagel SS, Crowe TM, Gaines MV: Dynamic incremental CT: effect of volume and concentration of contrast material and patient weight on hepatic enhancement. Radiology. 1995, 195 (2): 353-357. 10.1148/radiology.195.2.7724752.CrossRefPubMed Heiken JP, Brink JA, McClennan BL, Sagel SS, Crowe TM, Gaines MV: Dynamic incremental CT: effect of volume and concentration of contrast material and patient weight on hepatic enhancement. Radiology. 1995, 195 (2): 353-357. 10.1148/radiology.195.2.7724752.CrossRefPubMed
23.
go back to reference Yamashita Y, Komohara Y, Takahashi M, Uchida M, Hayabuchi N, Shimizu T, Narabayashi I: Abdominal helical CT: evaluation of optimal doses of intravenous contrast material – a prospective randomized study. Radiology. 2000, 216: 718-723. 10.1148/radiology.216.3.r00se26718.CrossRefPubMed Yamashita Y, Komohara Y, Takahashi M, Uchida M, Hayabuchi N, Shimizu T, Narabayashi I: Abdominal helical CT: evaluation of optimal doses of intravenous contrast material – a prospective randomized study. Radiology. 2000, 216: 718-723. 10.1148/radiology.216.3.r00se26718.CrossRefPubMed
Metadata
Title
Split-bolus versus triphasic multidetector-row computed tomography technique in the diagnosis of hepatic focal nodular hyperplasia: a case report
Publication date
01-12-2014
Published in
Journal of Medical Case Reports / Issue 1/2014
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-8-425

Other articles of this Issue 1/2014

Journal of Medical Case Reports 1/2014 Go to the issue