Difference between revisions of "Hepatocellular adenoma MRI"

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__NOTOC__
 
__NOTOC__
 
{{Hepatocellular adenoma}}
 
{{Hepatocellular adenoma}}
{{CMG}}; {{AOEIC}} {{CZ}}
+
{{CMG}}; {{AOEIC}} {{CZ}}{{ZAS}}{{Sab}}
  
 
==Overview==
 
==Overview==
 +
The [[Magnetic resonance imaging|MRI]] findings of hepatocellular adenoma range from hyperintense to mildly hypointense relative to the [[liver]] [[Tissue (biology)|tissue]] on T1 weighted images. On T2 weighted images, the findings are predominantly hyperintense relative to the [[liver]], whereas in the presence of [[necrosis]] and [[hemorrhage]] they can be [[heterogeneous]] with hyper- or hypo-[[Attenuation|attenuating]] signal. The central [[scar]] on [[gadolinium]] is not seen in hepatocellular adenoma. There is usually no significant uptake with [[Injection (medicine)|injection]] of [[Hepatocyte|hepatocellular]] specific [[contrast|contrast agent]], gadolinium benzoyloxy propionic tetraacetate (Gd-BOTA).
  
 
==MRI==
 
==MRI==
 +
* The [[magnetic resonance imaging|MR imgaing]] findings of [[hepatocellualar adenoma]] include:<ref>{{cite journal|doi=10.1594/ecr2013/C-2620}}</ref><ref name="DhingraFiel2014">{{cite journal|last1=Dhingra|first1=Sadhna|last2=Fiel|first2=M. Isabel|title=Update on the New Classification of Hepatic Adenomas: Clinical, Molecular, and Pathologic Characteristics|journal=Archives of Pathology & Laboratory Medicine|volume=138|issue=8|year=2014|pages=1090–1097|issn=0003-9985|doi=10.5858/arpa.2013-0183-RA}}</ref><ref name="NaultParadis2017">{{cite journal|last1=Nault|first1=Jean-Charles|last2=Paradis|first2=Valérie|last3=Cherqui|first3=Daniel|last4=Vilgrain|first4=Valérie|last5=Zucman-Rossi|first5=Jessica|title=Molecular classification of hepatocellular adenoma in clinical practice|journal=Journal of Hepatology|volume=67|issue=5|year=2017|pages=1074–1083|issn=01688278|doi=10.1016/j.jhep.2017.07.009}}</ref><ref>{{Cite journal
 +
| author = [[Maarten G. Thomeer]], [[Mirelle Broker]], [[Joanne Verheij]], [[Michael Doukas]], [[Turkan Terkivatan]], [[Diederick Bijdevaate]], [[Robert A. De Man]], [[Adriaan Moelker]] & [[Jan N. IJzermans]]
 +
| title = Hepatocellular adenoma: when and how to treat? Update of current evidence
 +
| journal = [[Therapeutic advances in gastroenterology]]
 +
| volume = 9
 +
| issue = 6
 +
| pages = 898–912
 +
| year = 2016
 +
| month = November
 +
| doi = 10.1177/1756283X16663882
 +
| pmid = 27803743
 +
}}</ref><ref>{{Cite journal
 +
| author = [[L. Arrive]], [[J. F. Flejou]], [[V. Vilgrain]], [[J. Belghiti]], [[D. Najmark]], [[M. Zins]], [[Y. Menu]], [[J. M. Tubiana]] & [[H. Nahum]]
 +
| title = Hepatic adenoma: MR findings in 51 pathologically proved lesions
 +
| journal = [[Radiology]]
 +
| volume = 193
 +
| issue = 2
 +
| pages = 507–512
 +
| year = 1994
 +
| month = November
 +
| doi = 10.1148/radiology.193.2.7972769
 +
| pmid = 7972769
 +
}}</ref><ref>{{Cite journal
 +
| author = [[Massimo Roncalli]], [[Amedeo Sciarra]] & [[Luca Di Tommaso]]
 +
| title = Benign hepatocellular nodules of healthy liver: focal nodular hyperplasia and hepatocellular adenoma
 +
| journal = [[Clinical and molecular hepatology]]
 +
| volume = 22
 +
| issue = 2
 +
| pages = 199–211
 +
| year = 2016
 +
| month = June
 +
| doi = 10.3350/cmh.2016.0101
 +
| pmid = 27189732
 +
}}</ref><ref>{{Cite journal
 +
| author = [[Matthanja Bieze]], [[Jacomina W. van den Esschert]], [[C. Yung Nio]], [[Joanne Verheij]], [[Johannes B. Reitsma]], [[Valeska Terpstra]], [[Thomas M. van Gulik]] & [[Saffire S. K. S. Phoa]]
 +
| title = Diagnostic accuracy of MRI in differentiating hepatocellular adenoma from focal nodular hyperplasia: prospective study of the additional value of gadoxetate disodium
 +
| journal = [[AJR. American journal of roentgenology]]
 +
| volume = 199
 +
| issue = 1
 +
| pages = 26–34
 +
| year = 2012
 +
| month = July
 +
| doi = 10.2214/AJR.11.7750
 +
| pmid = 22733890
 +
}}</ref><ref>{{Cite journal
 +
| author = [[Andrei S. Purysko]], [[Erick M. Remer]], [[Christopher P. Coppa]], [[Nancy A. Obuchowski]], [[Erika Schneider]] & [[Joseph C. Veniero]]
 +
| title = Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI
 +
| journal = [[AJR. American journal of roentgenology]]
 +
| volume = 198
 +
| issue = 1
 +
| pages = 115–123
 +
| year = 2012
 +
| month = January
 +
| doi = 10.2214/AJR.11.6836
 +
| pmid = 22194486
 +
}}</ref><ref>{{Cite journal
 +
| author = [[Sheela Agarwal]], [[Jorge M. Fuentes-Orrego]], [[Thomas Arnason]], [[Joseph Misdraji]], [[Kartik S. Jhaveri]], [[Mukesh Harisinghani]] & [[Peter F. Hahn]]
 +
| title = Inflammatory hepatocellular adenomas can mimic focal nodular hyperplasia on gadoxetic acid-enhanced MRI
 +
| journal = [[AJR. American journal of roentgenology]]
 +
| volume = 203
 +
| issue = 4
 +
| pages = W408–W414
 +
| year = 2014
 +
| month = October
 +
| doi = 10.2214/AJR.13.12251
 +
| pmid = 25055198
 +
}}</ref><ref>{{Cite journal
 +
| author = [[Maarten G. Thomeer]], [[Francois E. Willemssen]], [[Katharina K. Biermann]], [[Haroun El Addouli]], [[Rob A. de Man]], [[Jan N. Ijzermans]] & [[Roy S. Dwarkasing]]
 +
| title = MRI features of inflammatory hepatocellular adenomas on hepatocyte phase imaging with liver-specific contrast agents
 +
| journal = [[Journal of magnetic resonance imaging : JMRI]]
 +
| volume = 39
 +
| issue = 5
 +
| pages = 1259–1264
 +
| year = 2014
 +
| month = May
 +
| doi = 10.1002/jmri.24281
 +
| pmid = 23897798
 +
}}</ref><ref>{{Cite journal
 +
| author = [[Heqing Wang]], [[Chun Yang]], [[Shengxiang Rao]], [[Yuan Ji]], [[Jing Han]], [[Ruofan Sheng]] & [[Mengsu Zeng]]
 +
| title = MR imaging of hepatocellular adenomas on genotype-phenotype classification: A report from China
 +
| journal = [[European journal of radiology]]
 +
| volume = 100
 +
| pages = 135–141
 +
| year = 2018
 +
| month = March
 +
| doi = 10.1016/j.ejrad.2018.01.023
 +
| pmid = 29496071
 +
}}</ref><ref name="DharmanaSaravana-Bawan2017">{{cite journal|last1=Dharmana|first1=H.|last2=Saravana-Bawan|first2=S.|last3=Girgis|first3=S.|last4=Low|first4=G.|title=Hepatocellular adenoma: imaging review of the various molecular subtypes|journal=Clinical Radiology|volume=72|issue=4|year=2017|pages=276–285|issn=00099260|doi=10.1016/j.crad.2016.12.020}}</ref>
  
* On T1-weighted MR images, hepatocellular adenomas have been variously described as hyperintense, isointense, and hypointense lesions.
+
* Signals range from hyperintense to mildly hypointense relative to [[liver]] [[tissue]] on T1 weighted images. This [[heterogeneous]] appearance results from areas of high intensity due to [[fat]] and acute [[hemorrhage]] and low signal intensity area corresponding to [[necrosis]] or old [[hemorrhage]] or [[calcification|calcifications]].
 +
* The hepatocellular adenoma in T2 weighted images is predominantly hyperintense relative to [[liver]], although in the presence of [[necrosis]] and [[hemorrhage]] they can be [[heterogeneous]] with hyper- and hypo-[[attenuation|attenuating]] signal.
 +
* Dynamic post-[[gadolinium]] show intense [[artery|arterial]] phase enhancement with iso-intensity on [[portal]] phase and delayed images.
 +
* Hepatocellular adenoma does not have a central [[scar]] so if a central [[scar]] enhances after gadolinium is administered, the [[diagnosis]] of [[focal nodular hyperplasia]] is strongly favored.
 +
* With the [[Injection (medicine)|injection]] of [[hepatocyte|hepatocellular]] specific [[contrast|contrast agent]], gadolinium benzyloxy propionic tetraacetate (Gd-BOTA), there is usually no significant uptake.
  
* It has been reported that 47%–74% of hepatocellular adenomas are predominantly hyperintense relative to liver on T2-weighted images; this is due to prolonged T2 and is consistent with findings in other hepatic tumors.
+
==Images==
 
+
[[File:Hepatic Adenoma MRI.jpg|300px|left|thumb|MRI showing multiple hepatocellular adenomas (yellow arrows). [https://radiopaedia.org/articles/hepatic-adenoma?lang=us Case courtesy of Dr Chris O'Donnell, Radiopaedia.org, rID: 26904]]]
* Some lesions are hypointense and isointense on T2-weighted images.
+
<br style="clear:left">
 
 
* Most lesions are heterogeneous, demonstrating a combination of hyper- and hypointensity on T2-weighted images relative to hemorrhage and necrosis.
 
 
 
*Dynamic gadolinium-enhanced gradient-echo MR imaging, like dynamic CT, can be used to demonstrate early arterial enhancement that reflects the presence of subcapsular feeding vessels.
 
 
 
*Adenomas usually do not show uptake of superparamagnetic iron oxide particles, resulting in decreased signal intensity on T2-weighted images.
 
 
 
*After injection of a hepatocellular-specific contrast agent such as gadolinium benzyloxypropionictetraacetate (Gd-BOPTA) there is usually no substantial uptake.
 
  
 
==References==
 
==References==
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Latest revision as of 17:44, 21 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Zahir Ali Shaikh, MD[3]Sabawoon Mirwais, M.B.B.S, M.D.[4]

Overview

The MRI findings of hepatocellular adenoma range from hyperintense to mildly hypointense relative to the liver tissue on T1 weighted images. On T2 weighted images, the findings are predominantly hyperintense relative to the liver, whereas in the presence of necrosis and hemorrhage they can be heterogeneous with hyper- or hypo-attenuating signal. The central scar on gadolinium is not seen in hepatocellular adenoma. There is usually no significant uptake with injection of hepatocellular specific contrast agent, gadolinium benzoyloxy propionic tetraacetate (Gd-BOTA).

MRI

Images

MRI showing multiple hepatocellular adenomas (yellow arrows). Case courtesy of Dr Chris O'Donnell, Radiopaedia.org, rID: 26904


References

  1. . doi:10.1594/ecr2013/C-2620. Missing or empty |title= (help)
  2. Dhingra, Sadhna; Fiel, M. Isabel (2014). "Update on the New Classification of Hepatic Adenomas: Clinical, Molecular, and Pathologic Characteristics". Archives of Pathology & Laboratory Medicine. 138 (8): 1090–1097. doi:10.5858/arpa.2013-0183-RA. ISSN 0003-9985.
  3. Nault, Jean-Charles; Paradis, Valérie; Cherqui, Daniel; Vilgrain, Valérie; Zucman-Rossi, Jessica (2017). "Molecular classification of hepatocellular adenoma in clinical practice". Journal of Hepatology. 67 (5): 1074–1083. doi:10.1016/j.jhep.2017.07.009. ISSN 0168-8278.
  4. Maarten G. Thomeer, Mirelle Broker, Joanne Verheij, Michael Doukas, Turkan Terkivatan, Diederick Bijdevaate, Robert A. De Man, Adriaan Moelker & Jan N. IJzermans (2016). "Hepatocellular adenoma: when and how to treat? Update of current evidence". Therapeutic advances in gastroenterology. 9 (6): 898–912. doi:10.1177/1756283X16663882. PMID 27803743. Unknown parameter |month= ignored (help)
  5. L. Arrive, J. F. Flejou, V. Vilgrain, J. Belghiti, D. Najmark, M. Zins, Y. Menu, J. M. Tubiana & H. Nahum (1994). "Hepatic adenoma: MR findings in 51 pathologically proved lesions". Radiology. 193 (2): 507–512. doi:10.1148/radiology.193.2.7972769. PMID 7972769. Unknown parameter |month= ignored (help)
  6. Massimo Roncalli, Amedeo Sciarra & Luca Di Tommaso (2016). "Benign hepatocellular nodules of healthy liver: focal nodular hyperplasia and hepatocellular adenoma". Clinical and molecular hepatology. 22 (2): 199–211. doi:10.3350/cmh.2016.0101. PMID 27189732. Unknown parameter |month= ignored (help)
  7. Matthanja Bieze, Jacomina W. van den Esschert, C. Yung Nio, Joanne Verheij, Johannes B. Reitsma, Valeska Terpstra, Thomas M. van Gulik & Saffire S. K. S. Phoa (2012). "Diagnostic accuracy of MRI in differentiating hepatocellular adenoma from focal nodular hyperplasia: prospective study of the additional value of gadoxetate disodium". AJR. American journal of roentgenology. 199 (1): 26–34. doi:10.2214/AJR.11.7750. PMID 22733890. Unknown parameter |month= ignored (help)
  8. Andrei S. Purysko, Erick M. Remer, Christopher P. Coppa, Nancy A. Obuchowski, Erika Schneider & Joseph C. Veniero (2012). "Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI". AJR. American journal of roentgenology. 198 (1): 115–123. doi:10.2214/AJR.11.6836. PMID 22194486. Unknown parameter |month= ignored (help)
  9. Sheela Agarwal, Jorge M. Fuentes-Orrego, Thomas Arnason, Joseph Misdraji, Kartik S. Jhaveri, Mukesh Harisinghani & Peter F. Hahn (2014). "Inflammatory hepatocellular adenomas can mimic focal nodular hyperplasia on gadoxetic acid-enhanced MRI". AJR. American journal of roentgenology. 203 (4): W408–W414. doi:10.2214/AJR.13.12251. PMID 25055198. Unknown parameter |month= ignored (help)
  10. Maarten G. Thomeer, Francois E. Willemssen, Katharina K. Biermann, Haroun El Addouli, Rob A. de Man, Jan N. Ijzermans & Roy S. Dwarkasing (2014). "MRI features of inflammatory hepatocellular adenomas on hepatocyte phase imaging with liver-specific contrast agents". Journal of magnetic resonance imaging : JMRI. 39 (5): 1259–1264. doi:10.1002/jmri.24281. PMID 23897798. Unknown parameter |month= ignored (help)
  11. Heqing Wang, Chun Yang, Shengxiang Rao, Yuan Ji, Jing Han, Ruofan Sheng & Mengsu Zeng (2018). "MR imaging of hepatocellular adenomas on genotype-phenotype classification: A report from China". European journal of radiology. 100: 135–141. doi:10.1016/j.ejrad.2018.01.023. PMID 29496071. Unknown parameter |month= ignored (help)
  12. Dharmana, H.; Saravana-Bawan, S.; Girgis, S.; Low, G. (2017). "Hepatocellular adenoma: imaging review of the various molecular subtypes". Clinical Radiology. 72 (4): 276–285. doi:10.1016/j.crad.2016.12.020. ISSN 0009-9260.

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