Bastati-Huber N, Pötter-Lang S, Ba-Ssalamah A
Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Allgemeine Radiologie und Kinderradiologie, Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich,
Radiologe. 2015 Jan;55(1):18-26. doi: 10.1007/s00117-014-2704-9.
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are liver lesions of hepatocellular origin. The FNH is a commonly occurring hepatic lesion whereas HCA is very rare. Non-invasive differentiation between HCA subtypes and atypical FNH may pose a diagnostic challenge as both entities predominantly occur in middle-aged female patients.
The conventional imaging modalities include ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Distinguishing FNH from HCA is of great importance clinically as FNH is considered to be a benign lesion and needs no further management. In contrast HCA is considered to be a borderline tumor due to the risk of hemorrhage, growth and even malignant transformation and requires individualized management.
The above mentioned radiological procedures usually enable an accurate and certain diagnosis of a typical FNH to be achieved. In cases of atypical FNH, particularly in patients with a clinical history of malignancy, these imaging modalities are insufficient to establish a clear diagnosis. In this scenario, the use of modern hepatobiliary contrast-enhanced MRI will enable a differentiation between FNH and metastasis with a high sensitivity and specificity. Furthermore, it allows a differentiation of FNH from 90 % of adenoma subtypes.
This article describes the histopathological and radiological features of these lesions and explains the advantages and limitations of various imaging modalities used for the diagnosis and differentiation of these entities.
The new classification of HCAs according to phenotype and genotype and their imaging features, as well as different enhancement patterns, are described. The correlation between HCA subtypes and their individual management are also discussed.
局灶性结节性增生（FNH）和肝细胞腺瘤（HCA）是肝细胞起源的肝脏病变。FNH是一种常见的肝脏病变，而HCA非常罕见。HCA亚型与非典型FNH之间的无创鉴别可能构成诊断挑战，因为这两种病变主要发生在中年女性患者中。
传统的成像方式包括超声（US）、计算机断层扫描（CT）和磁共振成像（MRI）。在临床上，区分FNH和HCA非常重要，因为FNH被认为是良性病变，无需进一步处理。相比之下，HCA由于有出血、生长甚至恶变的风险，被认为是一种临界肿瘤，需要个体化处理。
上述放射学检查通常能够准确、肯定地诊断典型的FNH。对于非典型FNH，特别是有恶性肿瘤临床病史的患者，这些成像方式不足以明确诊断。在这种情况下，使用现代肝胆对比增强MRI能够以高灵敏度和特异性区分FNH和转移瘤。此外，它还能区分FNH与90%的腺瘤亚型。
本文描述了这些病变的组织病理学和放射学特征，并解释了用于诊断和区分这些病变的各种成像方式的优缺点。
描述了根据表型和基因型对HCA的新分类及其成像特征，以及不同的强化模式。还讨论了HCA亚型与其个体化处理之间的相关性。
