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Published in: European Radiology 5/2019

01-05-2019 | Hepatobiliary-Pancreas

New MRI features improve subtype classification of hepatocellular adenoma

Authors: Sylvain Bise, Nora Frulio, Arnaud Hocquelet, Nicolas Alberti, Jean-Frederic Blanc, Christophe Laurent, Hervé Laumonier, Charles Balabaud, Paulette Bioulac-Sage, Hervé Trillaud

Published in: European Radiology | Issue 5/2019

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Abstract

Objective

MRI is crucial for the classification of hepatocellular adenomas (HCA) into subtypes. Our objective was to review and increase MRI criteria for subtype classification and define the limits.

Methods

Pathological and radiological data of 116 HCAs were retrospectively analyzed to investigate MRI features of HCA pathological subtypes. Risk for complication was also evaluated with regard to subtype and tumor size.

Results

38/43 (88%) HNF1α-mutated HCAs (H-HCAs) were discriminated by (i) fatty component (homogeneous or heterogeneous) and (ii) hypovascular pattern, with a sensitivity of 88% and a specificity of 97%. 51/58 (88%) inflammatory HCAs (IHCAs) displayed features of sinusoidal dilatation (SD) including three different patterns (global SD, atoll sign, and a new “crescent sign” corresponding to a partial peripheral rim, hyperintense on T2W and/or arterial phase with persistent delayed enhancement). Sensitivity was 88% and specificity 100%. However, some HCA remained unclassifiable by MRI: HCA remodeled by necrotic/hemorrhagic changes covering > 50% of the lesion, H-HCAs without steatosis, IHCAs without SD, β-catenin-mutated and unclassified HCAs. Regarding malignant transformation (5/116) and bleeding (24/116), none was observed when the HCA diameter was smaller than 5.2 cm and 4.2 cm, respectively.

Conclusion

Based on the largest series evaluated until now, we identified several non-described MRI features and propose new highly sensitive and specific MRI criteria. With the addition of these new features, 88% of the two main HCA subtypes could be identified.

Key Points

• HNF1α-mutated hepatocellular adenomas (H-HCA) are characterized by the presence of fat and hypovascular pattern in MRI.
• Inflammatory hepatocellular adenomas (I-HCA) are characterized by different patterns translating sinusoidal dilatation including the newly described crescent sign.
• No MRI specific pattern was identified for β-catenin-mutated HCA (b-HCA).
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Metadata
Title
New MRI features improve subtype classification of hepatocellular adenoma
Authors
Sylvain Bise
Nora Frulio
Arnaud Hocquelet
Nicolas Alberti
Jean-Frederic Blanc
Christophe Laurent
Hervé Laumonier
Charles Balabaud
Paulette Bioulac-Sage
Hervé Trillaud
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5784-5

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