Elbanna Khaled Y, Khalili Korosh, AlMoharb May, Goel Ankur, Fischer Sandra, Kim Tae Kyoung
University Medical Imaging Toronto, University Health Network, University of Toronto, Toronto, ON, Canada.
Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Eur Radiol. 2025 May 14. doi: 10.1007/s00330-025-11679-x.
To assess qualitative and quantitative imaging features, including lesion-to-liver contrast enhancement ratio (LLCER), on gadoxetic acid-enhanced MRI for differentiating atypical focal nodular hyperplasia (aFNH) from hepatocellular adenoma (HCA) subtypes.
This retrospective study included patients with histopathologically-confirmed aFNH and HCA who underwent gadoxetic acid-enhanced MRI between January 2010 and December 2020. Two radiologists assessed qualitative imaging features and calculated LLCERs for quantitative evaluation of HBP enhancement. Statistical analyses included ROC curves, sensitivity, specificity, and a decision tree.
86 patients (41 ± 11 years; 64 women) had 29 aFNHs and 90 HCAs. HBP iso-/hyperintensity was observed in 72.4% (21/29) of aFNH compared to 28.8% (15/52) of U-HCA, 35% (7/20) of I-HCA, and 0% (0/11) of H-HCA. β-HCA showed 71.4% (5/7) iso-/hyperintensity, overlapping with aFNH (p = 0.17). Homogeneous iso-/hyperintensity and rim-like enhancement were present in 48.3% (14/29) and 20.7% (6/29) of aFNH but absent in β-HCA (p = 0.004). LLCER demonstrated high diagnostic performance, differentiating aFNH from U-HCA, H-HCA, and I-HCA(AUCs 0.91-0.99, sensitivities 82.8-96.6%, specificities 90.0-100%). For β-HCA, LLCER showed overlap with aFNH; AUCs (0.62-0.64) and specificities (57.1%). Among HCAs with HBP iso-/hyperintensity, 74.1% had negative LLCER values, while 25.9% (mostly β-HCA/U-HCA) showed positive values (true enhancement). Combined decision trees selected LLCER as the primary node, with downstream HBP features variably incorporated, except β-HCA, which solely used qualitative features.
HBP iso-/hyperintensity and LLCER reliably differentiated aFNH from most HCA subtypes, except β-HCA, validated by decision tree analyses. Homogeneous iso-/hyperintensity or rim-like enhancement was absent in β-HCA, aiding differentiation.
Question Variability in hepatobiliary phase (HBP) enhancement among hepatocellular adenoma (HCA) subtypes and atypical FNH (aFNH) poses diagnostic challenges. Findings Despite HBP enhancement overlap in aFNH/β-HCA, "homogeneous" and rim-like enhancement aided aFNH differentiation from HCAs. LLCER separated HCAs lacking true HBP uptake from aFNH. Clinical relevance This study explored challenges in differentiating aFNH from HCA subtypes, especially overlapping β-HCA, highlighting discriminatory qualitative markers and quantitative assessment to distinguish true HBP enhancement, an approach validated by decision tree analysis.
评估钆塞酸增强磁共振成像（MRI）上的定性和定量成像特征，包括病灶与肝脏对比增强率（LLCER），以鉴别非典型性局灶性结节性增生（aFNH）与肝细胞腺瘤（HCA）亚型。
这项回顾性研究纳入了2010年1月至2020年12月期间接受钆塞酸增强MRI检查且组织病理学确诊为aFNH和HCA的患者。两名放射科医生评估定性成像特征并计算LLCERs，用于肝细胞期（HBP）强化的定量评估。统计分析包括ROC曲线、敏感性、特异性和决策树。
86例患者（41±11岁；64名女性）有29个aFNH和90个HCA。aFNH中72.4%（21/29）在HBP期呈等/高信号，而未分类HCA（U-HCA）中为28.8%（15/52），炎症性HCA（I-HCA）中为35%（7/20），高分化HCA（H-HCA）中为0%（0/11）。β-HCA中71.4%（5/7）呈等/高信号，与aFNH重叠（p=0.17）。aFNH中48.3%（14/29）呈均匀等/高信号且有边缘样强化，20.7%（6/29）有边缘样强化，但β-HCA中无（p=0.004）。LLCER显示出较高的诊断性能，可区分aFNH与U-HCA、H-HCA和I-HCA（AUCs为0.91-0.99，敏感性为82.8-96.6%，特异性为90.0-100%）。对于β-HCA，LLCER与aFNH有重叠；AUCs（0.62-0.64）和特异性（57.1%）。在HBP期呈等/高信号的HCA中，74.1%的LLCER值为阴性，而25.9%（大多为β-HCA/U-HCA）为阳性值（真正强化）。联合决策树选择LLCER作为主要节点，下游结合不同的HBP特征，β-HCA除外，其仅使用定性特征。
通过决策树分析验证，HBP期等/高信号和LLCER可可靠地区分aFNH与大多数HCA亚型，但β-HCA除外。β-HCA中无均匀等/高信号或边缘样强化，有助于鉴别。
问题肝细胞腺瘤（HCA）亚型和非典型性局灶性结节性增生（aFNH）在肝胆期（HBP）强化的变异性带来诊断挑战。发现尽管aFNH/β-HCA在HBP期强化有重叠，但“均匀”和边缘样强化有助于aFNH与HCA的鉴别。LLCER可区分缺乏真正HBP摄取的HCA与aFNH。临床意义本研究探讨了鉴别aFNH与HCA亚型的挑战，尤其是重叠的β-HCA，强调了鉴别性定性标志物和定量评估以区分真正的HBP强化，该方法经决策树分析验证。
