Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Dig Surg. 2010;27(1):46-55. doi: 10.1159/000268407. Epub 2010 Apr 1.
BACKGROUND/AIMS: There are several imaging modalities available for the detection of focal liver lesions. Differentiation between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) is important because of the consequences for management. However, differentiation based on imaging alone still shows limitations.
We reviewed the literature for typical features of FNH and HCA on radiologic and nuclear imaging with emphasis on differentiation of both lesions.
Seven articles describe the performance of an imaging modality for the differentiation between FNH and HCA. Limitations of these studies are the small sample size and/or the lack of comparison with the 'gold standard', i.e. histological diagnosis. No studies are available that compare the accuracy of several imaging modalities in the differentiation of FNH and HCA. Conventional ultrasound (US) is not useful in the differentiation because of the non-specific features. On contrast-enhanced US, the arterial filling direction of FNH is centrifugal and centripetal in case of HCA. The parenchymal enhancement of FNH is sustained in the portal venous and delayed phases, but shows rapid washout in case of HCA. Multiphase CT scan can differentiate FNH from HCA when there is a central scar. FNH may have a slightly higher relative enhancement in the arterial phase. On MRI with hepatocyte-specific contrast agents, HCA does not show contrast uptake in the hepatobiliary phase in contrast to FNH.
We conclude that there is limited evidence of the diagnostic performance of currently used imaging modalities for the differentiation of FNH and HCA. We therefore propose a prospective study (DiFA trial) to determine the accuracy of several radiologic and nuclear imaging studies in differentiating FNH and HCA.
背景/目的：有几种成像方式可用于检测局灶性肝病变。由于管理方面的原因，区分局灶性结节增生（FNH）和肝细胞腺瘤（HCA）非常重要。然而，仅基于影像学的区分仍然存在局限性。
我们回顾了影像学和核医学成像中 FNH 和 HCA 典型特征的文献，重点在于区分这两种病变。
有 7 篇文章描述了一种成像方式在 FNH 和 HCA 鉴别中的性能。这些研究的局限性在于样本量小和/或缺乏与“金标准”（即组织学诊断）的比较。没有比较几种成像方式在 FNH 和 HCA 鉴别中的准确性的研究。由于非特异性特征，常规超声（US）在鉴别诊断中用处不大。在对比增强超声中，FNH 的动脉充盈方向为离心性和向心性，而 HCA 的动脉充盈方向为向心性和离心性。FNH 的实质增强在门静脉期和延迟期持续，但在 HCA 中表现为快速洗脱。多期 CT 扫描在存在中央瘢痕时可区分 FNH 和 HCA。FNH 在动脉期的相对增强可能略高。在具有肝细胞特异性对比剂的 MRI 上，HCA 在肝胆期没有显示对比摄取，而 FNH 则显示对比摄取。
我们得出结论，目前用于区分 FNH 和 HCA 的成像方式的诊断性能证据有限。因此，我们建议进行一项前瞻性研究（DiFA 试验），以确定几种放射学和核医学成像研究在区分 FNH 和 HCA 中的准确性。
