Which findings on MRI are characteristic of hepatocellular adenoma (HCA)?

Updated: Feb 21, 2018
  • Author: Bradford A Whitmer, DO; Chief Editor: BS Anand, MD  more...
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Answer

The appearance of hepatocellular adenoma on MRI is variable, owing to the presence or absence of hemorrhage. Hyperintense heterogeneous signals on T1- and T2-weighted imaging are often due to lipids contained within the lesion. [40]  Hemorrhagic HCAs may also have hyperintense T1 imaging with subcapsular hemosiderin rings in 30% of patients.

Kupffer cell–specific MRI agents (superparamagnetic iron oxides [SPIO] and ultra-small superparamagnetic iron oxides [USPIO]) can be administered during the scan. They show no uptake due to a lack of endothelial-reticular cells.

Manganese–dipyridoxal diphosphate (DPDP), gadolinium, or gadobenate dimeglumine (Gd-BOPTA) can be administered during the scan. These show strong uptake due to the presence of hepatocytes. MRI with contrast can differentiate hepatocellular adenoma from FNH in 70% of cases. [41]

Unfortunately, HCC also has a predominance of hepatocytes, which makes these agents unable to differentiate between hepatocellular adenomas and HCC.

In a cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma, investigators using a decision tree model found that although a gadoxetic acid-enhanced MRI (EOB-MRI) strategy was most cost-effective, there was similar effectiveness between the EOB-MRI, conventional MRI, and biopsy strategies in patients with incidentally detected liver lesions in a noncirrhotic liver. [42]


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