Van Wettere Morgane, Paulatto Luisa, Raynaud Lucas, Bruno Onorina, Payancé Audrey, Plessier Aurélie, Rautou Pierre-Emmanuel, Paradis Valérie, Cazals-Hatem Dominique, Valla Dominique, Vilgrain Valérie, Ronot Maxime
Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France.
Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France.
JHEP Rep. 2020 Mar 9;2(3):100097. doi: 10.1016/j.jhepr.2020.100097. eCollection 2020 Jun.
BACKGROUND & AIMS: Hepatobiliary phase (HBP) images can discriminate between benign and malignant liver lesions, but it is unclear if this approach can be used in patients with Budd-Chiari syndrome (BCS). Thus, we aimed to assess the diagnostic utility of HBP images in patients with BCS.
This retrospective study included all patients admitted to our institution with a diagnosis of BCS and focal liver lesions on hepatobiliary contrast agent-enhanced MR imaging (HBCA-MRI) from 2000 to 2019. MR images were reviewed by 2 radiologists blinded to the diagnosis of the lesions. Patient and lesion characteristics were recorded, focusing on HBP imaging features.
Twenty-six patients (mean 35 ± 11 years old [13-65]; 21 women [81%] 35 ± 12 years old [13-65]; 5 men [19%] 36 ± 10 years old [19-44]) with 99 benign liver lesions and 12 hepatocellular carcinomas (HCCs) were analyzed. Patients with HCC were significantly older than those with benign lesions (mean 50 ± 10 33 ± 9 years old, = 0.003), with higher alpha-fetoprotein (AFP) levels (3/4 [75%] 1/22 [5%] with AFP >15 ng/ml, <0.001). Homogeneous hypointense signals were identified on HBP in 14 lesions, including 12/12 (100%) HCCs, and 2/99 (2%) benign lesions ( <0.001). Most benign liver lesions showed either peripheral (n = 52/99 [53%]) or homogeneous hyperintensity (n = 23/99 [23%]) on HBP. Lesions with signal hypointensity on HBP in patients with AFP serum levels >15 ng/ml were all HCCs.
Most benign lesions showed homogeneous or peripheral hyperintensity on HBP images while all HCCs were homogeneously hypointense. HBP images are helpful to differentiate between benign lesions and HCCs and outperform other sequences. They should be systematically acquired for the characterization of focal lesions in patients with BCS.
Hepatobiliary phase imaging is an approach that has recently been shown to discriminate between benign and malignant lesions in the liver. However, it was not known whether this imaging approach could be used effectively in patients with Budd-Chiari syndrome. Herein, we have shown that hepatobiliary phase imaging appears to be useful for differentiating between benign and malignant liver lesions in patients with Budd-Chiari syndrome.
肝胆期（HBP）图像可鉴别肝脏良恶性病变，但尚不清楚该方法能否用于布加综合征（BCS）患者。因此，我们旨在评估HBP图像在BCS患者中的诊断效用。
这项回顾性研究纳入了2000年至2019年间因BCS诊断并在肝胆对比剂增强磁共振成像（HBCA-MRI）上发现肝脏局灶性病变而入住我院的所有患者。由2名对病变诊断不知情的放射科医生对磁共振图像进行评估。记录患者和病变特征，重点关注HBP成像特征。
分析了26例患者（平均年龄35±11岁[13 - 65岁]；21名女性[81%]，年龄35±12岁[13 - 65岁]；5名男性[19%]，年龄36±10岁[19 - 44岁]），共99个肝脏良性病变和12例肝细胞癌（HCC）。HCC患者的年龄显著大于良性病变患者（平均50±10岁对33±9岁，P = 0.003），甲胎蛋白（AFP）水平更高（AFP>15 ng/ml者，3/4 [75%]对1/22 [5%]，P<0.001）。14个病变在HBP上表现为均匀低信号，其中包括12/12（100%）例HCC和2/99（2%）个良性病变（P<0.001）。大多数肝脏良性病变在HBP上表现为周边（n = 52/99 [53%]）或均匀高信号（n = 23/99 [23%]）。血清AFP水平>15 ng/ml的患者中，HBP上信号为低信号的病变均为HCC。
大多数良性病变在HBP图像上表现为均匀或周边高信号，而所有HCC均为均匀低信号。HBP图像有助于鉴别良性病变与HCC，且优于其他序列。对于BCS患者的局灶性病变特征描述，应系统地获取HBP图像。
肝胆期成像最近被证明是一种可鉴别肝脏良恶性病变的方法。然而，尚不清楚这种成像方法能否在布加综合征患者中有效应用。在此，我们表明肝胆期成像似乎有助于鉴别布加综合征患者的肝脏良恶性病变。
