Kim Tae Kyoung, Jang Hyun-Jung, Burns Peter N, Murphy-Lavallee Jessica, Wilson Stephanie R
Department of Medical Imaging, Tornoto General Hospital, University of Tornoto, 585 University Ave., Toronto, ON M5G 2N2, Canada.
AJR Am J Roentgenol. 2008 Jan;190(1):58-66. doi: 10.2214/AJR.07.2493.
The purpose of our study was to determine the differentiating features of focal nodular hyperplasia (FNH) and hepatic adenoma on contrast-enhanced sonography.
Sixty-two patients who underwent contrast-enhanced sonography and were confirmed to have FNH (n = 43) or hepatic adenoma (n = 19) were assessed retrospectively for arterial phase enhancement, filling direction, stellate arteries, and portal phase enhancement. An algorithm was applied to these interpreted features to determine the contrast-enhanced sonography diagnosis.
All lesions were hypervascular in the arterial phase. Centrifugal filling was more common in FNH (39 and 32 of 43, 91% and 74% [reader 1 and reader 2]) than in adenoma (3 and 3 of 19, 16%). Centripetal or mixed filling was more common in adenoma (16 and 16 of 19, 84%) than in FNH (4 and 11 of 43, 9% and 26%) (p < 0.001, kappa = 0.61). Stellate arteries characterized FNH (29 and 26 of 43, 67% and 60%) but not adenoma (3 and 2 of 19, 16% and 11%) (p < 0.001, kappa = 0.36). Sustained portal phase enhancement was more common in FNH (37 and 39 of 43, 86% and 91%) than in adenoma (9 and 12 of 19, 47% and 63%) (p < 0.02, kappa = 0.79). The sensitivity, specificity, positive predictive value, and negative predictive value of sonography for diagnosing FNH were 95% and 86%, 74% and 79%, 89% and 90%, and 88% and 71%, (reader 1 and reader 2, respectively).
FNH is predicted on the basis of arterial phase centrifugal filling and stellate vascularity on contrast-enhanced sonography. Adenoma is less reliably predicted on the basis of centripetal or mixed filling without stellate vascularity. Sustained portal phase enhancement is more common in FNH than in adenoma but contributes less to the differentiation of these lesions.
本研究的目的是确定在超声造影检查中局灶性结节性增生（FNH）和肝腺瘤的鉴别特征。
回顾性评估62例行超声造影检查且确诊为FNH（n = 43）或肝腺瘤（n = 19）的患者的动脉期强化、填充方向、星状动脉及门脉期强化情况。将一种算法应用于这些解读特征以确定超声造影诊断结果。
所有病灶在动脉期均为高血供。离心性填充在FNH中更为常见（43例中的39例和32例，分别为91%和74%[读者1和读者2]），而在腺瘤中较少见（19例中的3例和3例，16%）。向心性或混合性填充在腺瘤中更为常见（19例中的16例和16例，84%），而在FNH中较少见（43例中的4例和11例，分别为9%和26%）（p < 0.001，kappa = 0.61）。星状动脉为FNH的特征表现（43例中的29例和26例，分别为67%和60%），而在腺瘤中不常见（19例中的3例和2例，分别为16%和11%）（p < 0.001，kappa = 0.36）。门脉期持续强化在FNH中更为常见（43例中的37例和39例，分别为86%和91%），而在腺瘤中较少见（19例中的9例和12例，分别为47%和63%）（p < 0.02，kappa = 0.79）。超声诊断FNH的敏感度、特异度、阳性预测值和阴性预测值分别为95%和86%、74%和79%、89%和90%、88%和71%（分别为读者1和读者2）。
基于超声造影检查中动脉期离心性填充和星状血管分布可预测FNH。基于无星状血管分布的向心性或混合性填充对腺瘤的预测可靠性较低。门脉期持续强化在FNH中比在腺瘤中更常见，但对这些病灶的鉴别作用较小。
