Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China.
World J Gastroenterol. 2012 Dec 21;18(47):7048-55. doi: 10.3748/wjg.v18.i47.7048.
To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia (FNH) in children on dynamic contrast-enhanced multi-slice computed tomography (MSCT) and computed tomography angiography (CTA) images.
From September 1999 to April 2012, a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University, including 12 cases (5.5%) of FNH in children (age ≤ 18 years old). All the 12 pediatric patients underwent MSCT. We retrospectively analyzed the imaging features of FNH lesions, including the number, location, size, margin, density of FNH demonstrated on pre-contrast and contrast-enhanced computed tomography (CT) scanning, central scar, fibrous septa, pseudocapsule, the morphology of the feeding arteries and the presence of draining vessels (portal vein or hepatic vein).
All the 12 pediatric cases of FNH had solitary lesion. The maximum diameter of the lesions was 4.0-12.9 cm, with an average diameter of 5.5 ± 2.5 cm. The majority of the FNH lesions (10/12, 83.3%) had well-defined margins. Central scar (10/12, 83.3%) and fibrous septa (11/12, 91.7%) were commonly found in children with FNH. Central scar was either isodense (n = 7) or hypodense (n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase. Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases. Pseudocapsule was very rare (1/12, 8.3%) in pediatric FNH. With the exception of central scars and fibrous septa within the lesions, all 12 cases of pediatric FNH were homogeneously enhanced on the contrast-enhanced CT images, significantly hyperdense in the arterial phase (12/12, 100.0%), and isodense in the portal venous phase (7/12, 58.3%) and equilibrium phase (11/12, 91.7%). Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH, whereas no neovascularization of malignant tumors was noted. In 9 cases (75.0%), there was a spoke-wheel shaped centrifugal blood supply inside the tumors. The draining hepatic vein was detected in 8 cases of pediatric FNH. However, the draining vessels in the other 4 cases could not be detected. No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.
The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH. Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.
回顾性分析儿童肝脏局灶性结节性增生（FNH）在多层螺旋 CT（MSCT）和 CT 血管造影（CTA）动态增强图像上的影像学特征。
自 1999 年 9 月至 2012 年 4 月，中山大学孙逸仙纪念医院和中山大学肿瘤防治中心共经手术切除或活检证实 218 例 FNH，其中儿童 FNH 12 例（5.5%）（年龄≤18 岁）。所有 12 例儿科患者均行 MSCT 检查。我们回顾性分析了 FNH 病变的影像学特征，包括平扫和增强 CT 扫描显示的 FNH 病灶的数量、位置、大小、边缘、密度、中央瘢痕、纤维间隔、假包膜、供血动脉的形态以及引流血管（门静脉或肝静脉）的存在。
所有 12 例儿科 FNH 均为单发病变。病灶最大直径为 4.0-12.9cm，平均直径为 5.5±2.5cm。大多数 FNH 病灶（10/12，83.3%）边界清楚。儿童 FNH 中常见中央瘢痕（10/12，83.3%）和纤维间隔（11/12，91.7%）。中央瘢痕在平扫 CT 图像上呈等密度（n=7）或低密度（n=3），8 例在平衡期呈渐进性增强。纤维间隔在动脉期呈线性低密度，在门静脉期和平衡期呈等密度。儿童 FNH 中假包膜非常罕见（1/12，8.3%）。除病灶内的中央瘢痕和纤维间隔外，所有 12 例儿科 FNH 在增强 CT 图像上均呈均匀强化，动脉期明显高密度（12/12，100.0%），门静脉期（7/12，58.3%）和平衡期（11/12，91.7%）呈等密度。所有 12 例 FNH 均在 CTA 图像上观察到肿瘤内的中央供血动脉，而未见恶性肿瘤新生血管。9 例（75.0%）肿瘤内可见辐轮状离心性供血。8 例儿科 FNH 检测到引流肝静脉。然而，在另外 4 例中未检测到引流血管。在 12 例儿科患者的肝脏中未发现相关的肝腺瘤或肝血管瘤。
MSCT 和 CTA 的特征性影像学表现可能反映了儿童 FNH 的病理和血液动力学特征。动态多期 MSCT 和 CTA 成像可有效诊断儿童 FNH。
