The Differential Diagnosis of Hepatocellular Adenoma and Focal Nodular Hyperplasia

Hossein Jadvar, MD, PhD, MPH, MBA


April 18, 2012

Hepatocellular Adenoma and Focal Nodular Hyperplasia: Value of Gadoxetic Acid-Enhanced MR Imaging in Differential Diagnosis

Grazioli L, Bondioni MP, Haradome H, et al
Radiology. 2012;262:520-529


The goal of this project was to retrospectively evaluate the differential imaging features of gadoxetic acid-enhanced MRI in discriminating known hepatocellular adenoma (HCA) in 24 patients from known focal nodular hyperplasia (FNH) in 58 patients. Features that were assessed included signal intensity (SI) on unenhanced, dynamic, and hepatobiliary phase images as well as contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), and SI ratio on dynamic and hepatobiliary phase images. In the arterial phase, the mean CER of FNH was significantly higher than that of HCA (94.3% ± 33.2 vs 59.3% ± 28.1, P < .0001). The mean LLC of FNH in the hepatobiliary phase was also significantly different from that of HCA (0.05 ± 0.01 vs -0.67 ± 0.24, P < .0001). The hepatobiliary phase SI ratio threshold was 0.87, and the sensitivity and specificity for differentiation of the 2 benign hepatic tumors were 92% and 91%, respectively. The authors concluded that gadoxetic acid-enhanced MRI can be useful in the differential diagnosis of FNH from HCA.


The differential discrimination of FNH from HCA is clinically relevant. FNH is probably due to a hyperplastic response by hepatocytes to a preexisting vascular malformation and is typically managed conservatively.[1] HCA, however, is a benign hepatic tumor with potential for malignant transformation and spontaneous hemorrhage. It is typically encountered in women receiving oral contraceptives and is managed with surgical resection.[2] Therefore, the substantial difference in clinical management drives the need for accurate imaging-based differential diagnosis of these benign hepatic lesions. It must be noted, however, that nonconforming situations may occur. In this cohort, for example, FNH lesions with hypointensity during the hepatobiliary phase (secondary to a central scar, fat, or radiating fibrous septa) and HCA lesions with hepatobiliary-phase isointensity (secondary to severe hepatic steatosis) were observed. Despite a few study limitations that are well described in the article, this investigation clearly showed that gadoxetic acid-enhanced MRI may indeed be useful in the important task of discriminating FNH from HCA with high accuracy that can obviate the need for invasive tissue sampling.



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