Department of Radiology, Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
Radiology. 2012 Feb;262(2):520-9. doi: 10.1148/radiol.11101742.
To retrospectively evaluate the utility of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the differential diagnosis of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH).
This study had institutional review board approval; the requirement for informed consent was waived. Eighty-two patients (58 patients with FNH and 24 patients with HCAs) with 111 lesions were included in the study. There were 74 female patients and eight male patients (mean age, 41.9 years±13.2 [standard deviation]; age range, 11-78 years). Two readers reviewed all images in terms of signal intensity (SI) features on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), and SI ratio on dynamic and hepatobiliary phase images were calculated.
The CER of FNH in the arterial phase (mean, 94.3%±33.2) was significantly higher than that of HCAs (mean, 59.3%±28.1) (P<.0001). During the hepatobiliary phase, the LLC of FNH showed minimally positive values (mean, 0.05±0.01) and that of HCAs demonstrated strong negative values (mean, -0.67±0.24) (P<.0001). The area under the receiver operating characteristic curve of the hepatobiliary phase SI ratio for differentiation of the two tumors was 0.97, and a sensitivity of 92% and specificity of 91% were found with a cutoff value of 0.87. Among six FNH lesions that showed atypical hypointensity during the hepatobiliary phase, four had a large central scar, one contained a substantial fat component, and one had abundant radiating fibrous septa. Three HCAs were isointense during the hepatobiliary phase owing to severe hepatic steatosis.
Gadoxetic acid-enhanced MR imaging facilitates the differentiation of FNH from HCA.
回顾性评价钆塞酸增强磁共振成像（MR）在肝细胞腺瘤（HCA）和局灶性结节性增生（FNH）鉴别诊断中的应用价值。
本研究经机构审查委员会批准，豁免了知情同意书的要求。共纳入 82 例患者（58 例 FNH 和 24 例 HCA）共 111 个病灶，其中 74 例为女性，8 例为男性（平均年龄 41.9 岁±13.2[标准差]；年龄范围 11-78 岁）。两位读者根据平扫、动态及肝胆期图像上的信号强度（SI）特征评估所有图像。进行定量分析时，计算了动脉期的对比增强率（CER）、病灶与肝脏对比（LLC）和动态及肝胆期图像上的 SI 比值。
FNH 的动脉期 CER（平均 94.3%±33.2）明显高于 HCA（平均 59.3%±28.1）（P<.0001）。在肝胆期，FNH 的 LLC 表现为轻微阳性（平均 0.05±0.01），而 HCA 则表现为强烈的阴性（平均 -0.67±0.24）（P<.0001）。两种肿瘤鉴别诊断的肝胆期 SI 比值的受试者工作特征曲线下面积为 0.97，当截断值为 0.87 时，灵敏度为 92%，特异性为 91%。在肝胆期呈非典型低信号的 6 个 FNH 病变中，有 4 个有大的中央瘢痕，1 个含有大量脂肪成分，1 个有丰富的放射状纤维间隔。由于严重的肝脂肪变性，3 个 HCA 在肝胆期呈等信号。
钆塞酸增强 MR 成像有助于 FNH 和 HCA 的鉴别诊断。
