Klinik Für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, 10178, Germany.
BMC Med Imaging. 2021 Feb 15;21(1):28. doi: 10.1186/s12880-021-00552-0.
Recent studies provide evidence that hepatocellular adenomas (HCAs) frequently take up gadoxetic acid (Gd-EOB) during the hepatobiliary phase (HBP). The purpose of our study was to investigate how to differentiate between Gd-EOB-enhancing HCAs and focal nodular hyperplasias (FNHs). We therefore retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection). Two readers (experienced abdominal radiologists blinded to clinical data) reviewed the images evaluating morphologic features and subjectively scoring Gd-EOB uptake (25-50%, 50-75% and 75-100%) for each lesion. Quantitative lesion-to-liver enhancement was measured in arterial, portal venous (PV), transitional and HBP. Additionally, multivariate regression analyses were performed.
Subjective scoring of intralesional Gd-EOB uptake showed the highest discriminatory accuracies (AUC: 0.848 (R#1); 0.920 (R#2)-p < 0.001) with significantly higher uptake scores assigned to FNHs (Cut-off: 75%-100%). Typical lobulation and presence of a central scar in FNH achieved an accuracy of 0.750 or higher in at least one reader (lobulation-AUC: 0.809 (R#1); 0.736 (R#2); central scar-AUC: 0.595 (R#1); 0.784 (R#2)). The multivariate regression emphasized the discriminatory power of the Gd-EOB scoring (p = 0.001/OR:22.15 (R#1) and p < 0.001/OR:99.12 (R#2). The lesion-to-liver ratio differed significantly between FNH and HCA in the PV phase and HBP (PV: 132.9 (FNH) and 110.2 (HCA), p = 0.048 and HBP: 110.3 (FNH) and 39.2 (HCA), p < 0.001)), while the difference was not significant in arterial and transitional contrast phases (p > 0.05).
Even in HBP-enhancing HCA, characterization of Gd-EOB uptake was found to provide the strongest discriminatory power in differentiating HCA from FNH. Furthermore, a lobulated appearance and a central scar are more frequently seen in FNH than in HCA.
最近的研究表明，肝细胞腺瘤（HCA）在肝胆期（HBP）经常摄取钆塞酸（Gd-EOB）。我们的研究目的是探讨如何区分 Gd-EOB 增强的 HCA 和局灶性结节增生（FNH）。因此，我们回顾性地纳入了 40 例 HCA，这些 HCA 在 65 例经病理证实的 100 例 HCA 中被归类为 HBP Gd-EOB 增强病变。这些增强的 HCA 与 28 例 FNH 病变（标准参考：手术切除）进行了回顾性匹配。两名（经验丰富的腹部放射科医生，对临床数据不知情）读者评估了图像的形态特征，并对每个病变的 Gd-EOB 摄取进行主观评分（25-50%、50-75%和 75-100%）。在动脉、门静脉（PV）、过渡和 HBP 期测量病变与肝脏的增强。此外，还进行了多变量回归分析。
病变内 Gd-EOB 摄取的主观评分显示出最高的鉴别准确率（AUC：0.848（R#1）；0.920（R#2）-p<0.001），FNH 的摄取评分明显更高（截断值：75%-100%）。FNH 中典型的分叶和中央瘢痕的存在在至少一名读者中达到了 0.750 或更高的准确率（分叶 AUC：0.809（R#1）；0.736（R#2）；中央瘢痕 AUC：0.595（R#1）；0.784（R#2））。多变量回归强调了 Gd-EOB 评分的鉴别能力（p=0.001/OR：22.15（R#1）和 p<0.001/OR：99.12（R#2））。在门静脉期和 HBP 期，FNH 和 HCA 之间的病变与肝脏比值差异有统计学意义（PV：132.9（FNH）和 110.2（HCA），p=0.048 和 HBP：110.3（FNH）和 39.2（HCA），p<0.001）），而在动脉期和过渡期差异无统计学意义（p>0.05）。
即使在 HBP 增强的 HCA 中，Gd-EOB 摄取的特征也被发现是区分 HCA 和 FNH 的最强鉴别力。此外，FNH 比 HCA 更常出现分叶状外观和中央瘢痕。
