Ronot Maxime, Vilgrain Valérie
Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France; INSERM Centre de recherche Biomédicale Bichat-Beaujon, université Paris-Diderot, Sorbonne-Paris-Cité, CRB3 U773, 75018 Paris, France.
Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France; INSERM Centre de recherche Biomédicale Bichat-Beaujon, université Paris-Diderot, Sorbonne-Paris-Cité, CRB3 U773, 75018 Paris, France.
Clin Res Hepatol Gastroenterol. 2014 Dec;38(6):681-8. doi: 10.1016/j.clinre.2014.01.014. Epub 2014 Mar 11.
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are a variety of solid lesions mostly found in the absence of underlying chronic liver disease in young patients. HCA is no longer to be considered as a unique lesion but as a recollection of different entities sharing common points but most of all separated by different typical morphological aspects. Accurate diagnosis is of clinical importance as the management is most of the time conservative for FNH, whereas HCAs expose patients to hemorrhage and malignant transformation, and may lead to a more invasive treatment, mainly surgical resection. Moreover, the different HCA subtypes expose to different risks of complication. The best imaging techniques for the differentiation between FNH and HCAs and for the subtyping of HCAs are contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI), as specific combinations of imaging features have been associated with the different lesions. They should be considered as complementary examinations. Atypical or multiple lesions, lesions containing fat or presence of an associated steatosis represent diagnostic challenges. Recently, MR hepatospecific contrast agents have been shown to be useful. Emergent elastography techniques might also be helpful in the near future. Biopsy should always be performed in case of uncertain diagnosis to reach a final diagnosis and avoid unnecessary invasive treatment.
局灶性结节性增生（FNH）和肝细胞腺瘤（HCA）是多种实性病变，多见于年轻患者，且无潜在慢性肝病。HCA不再被视为一种单一病变，而是不同实体的集合，这些实体有共同点，但最重要的是通过不同的典型形态学特征区分开来。准确诊断具有临床重要性，因为对于FNH，大多数情况下治疗是保守的，而HCA会使患者面临出血和恶变风险，并可能导致更具侵入性的治疗，主要是手术切除。此外，不同的HCA亚型面临不同的并发症风险。用于区分FNH和HCA以及对HCA进行亚型分类的最佳成像技术是对比增强超声（CEUS）和磁共振成像（MRI），因为特定的成像特征组合与不同病变相关。它们应被视为互补检查。非典型或多发病变、含脂肪病变或存在相关脂肪变性代表诊断挑战。最近，已证明磁共振肝脏特异性对比剂有用。新兴的弹性成像技术在不久的将来可能也会有帮助。诊断不确定时应始终进行活检以达成最终诊断并避免不必要的侵入性治疗。
