Panayiotou Andreas, Rafailidis Vasileios, Deganello Annamaria, Sellars Maria, Sidhu Paul S
Department of Radiology, King's College Hospital, London, UK.
Ultrasound. 2021 May;29(2):128-134. doi: 10.1177/1742271X20947760. Epub 2020 Aug 9.
Focal nodular hyperplasia, a benign liver tumour, is the second most common focal benign liver lesion, after a cavernous haemangioma. Contrast-enhanced ultrasound is used increasingly for the diagnostic work up and follow-up of focal liver lesions in adults, but is particularly valuable in the paediatric population, with the ability to reduce radiation and the nephrotoxic contrast agents used in computed tomography or magnetic resonance imaging. Confident recognition of focal nodular hyperplasia is important; it is benign, usually asymptomatic, of no clinical significance, of no clinical consequence or malignant potential. We present a case of focal nodular hyperplasia of the liver with its characteristic findings on conventional ultrasound, contrast-enhanced ultrasound with quantitative analysis and correlated with magnetic resonance imaging. A 15-year-old female with right upper quadrant abdominal pain was referred for liver ultrasound. A focal liver lesion was detected on B-mode ultrasound examination, and colour Doppler demonstrated no specific features. Contrast-enhanced ultrasound examination demonstrated early arterial enhancement, with a characteristic spoke-wheel pattern, centrifugal uniform filling of the lesion on the late arterial phase and sustained enhancement on the portal venous phase. Quantitative contrast-enhanced ultrasound has been performed, showing a typical curve of enhancement, as well as characteristic parametric images, supporting the interpretation of contrast-enhanced ultrasound and assisting the diagnosis. Magnetic resonance imaging demonstrated a central T2 hyperintense scar and similar enhancement characteristics as contrast-enhanced ultrasound on T1 gadolinium-enhanced sequences.
Contrast-enhanced ultrasound is a useful technique for the differentiation of benign from malignant liver lesions and has the potential to establish the diagnosis of focal nodular hyperplasia, based on the enhancement pattern, which is similar to that observed on magnetic resonance imaging but can be better appreciated with superior temporal, contrast and spatial resolution of contrast-enhanced ultrasound.
局灶性结节性增生是一种良性肝肿瘤，是仅次于海绵状血管瘤的第二常见的局灶性良性肝病变。超声造影越来越多地用于成人局灶性肝病变的诊断检查和随访，在儿科人群中尤其有价值，因为它能够减少计算机断层扫描或磁共振成像中使用的辐射和肾毒性造影剂。准确识别局灶性结节性增生很重要；它是良性的，通常无症状，无临床意义，无临床后果或恶性潜能。我们报告一例肝脏局灶性结节性增生病例，展示其在传统超声、定量分析超声造影及与磁共振成像相关性方面的特征性表现。一名15岁右上腹疼痛的女性被转诊进行肝脏超声检查。B超检查发现一个局灶性肝病变，彩色多普勒显示无特异性特征。超声造影检查显示早期动脉期强化，具有特征性的辐轮状模式，动脉晚期病变呈离心性均匀填充，门静脉期持续强化。已进行定量超声造影，显示典型的强化曲线以及特征性参数图像，支持超声造影的解读并辅助诊断。磁共振成像显示中央T2高信号瘢痕，在T1钆增强序列上具有与超声造影相似的强化特征。
超声造影是区分肝脏良恶性病变的有用技术，有潜力根据强化模式确立局灶性结节性增生的诊断，其强化模式与磁共振成像观察到的相似，但超声造影具有更好的时间、对比和空间分辨率，能更清晰地显示。
