Abstract：
BACKGROUND. The classification of hepatocellular adenomas (HCAs) was updated in 2017 on the basis of genetic and molecular analysis. OBJECTIVE. The purpose of this article was to evaluate features on gadoxetate disodium-enhanced MRI of HCA subtypes on the basis of the 2017 classification and to propose a diagnostic algorithm for determining subtype using these features. METHODS. This retrospective study included 56 patients (49 women, seven men; mean age, 37 ± 13 [SD] years) with histologically confirmed HCA evaluated by gadoxetate disodium-enhanced MRI from January 2010 to January 2021. Subtypes were reclassified using 2017 criteria: hepatocyte nuclear factor-1α mutated HCA (HHCA), inflammatory HCA (IHCA), β-catenin exon 3 activated HCA (β-HCA), mixed inflammatory and β-HCA (β-IHCA), sonic hedgehog HCA (shHCA), and unclassified HCA (UHCA). Qualitative MRI features were assessed. Liver-to-lesion contrast enhancement ratios (LLCERs) were measured. Subtypes were compared, and a diagnostic algorithm was proposed. RESULTS. The analysis included 65 HCAs: 16 HHCAs, 31 IHCAs, six β-HCA, four β-IHCA, five shHCA, and three UHCAs. HHCAs showed homogeneous diffuse intralesional steatosis in 94%, whereas all other HCAs showed this finding in 0% (p < .001). IHCAs showed the \"atoll\" sign in 58%, whereas all other HCAs showed this finding in 12% (p < .001). IHCAs showed moderate T2 hyperintensity in 52%, whereas all other HCAs showed this finding in 12% (p < .001). The β-HCAs and β-IHCAs occurred in men in 63%, whereas all other HCAs occurred in men in 4% (p < .001). The β-HCAs and β-IHCAs had a mean size of 10.1 ± 6.8 cm, whereas all other HCAs had a mean size of 5.1 ± 2.9 cm (p = .03). The β-HCAs and β-IHCAs showed fluid components in 60%, whereas all other HCAs showed this finding in 5% (p < .001). Hepatobiliary phase iso- or hyperintensity was observed in 80% of β-HCAs and β-IHCAs versus 5% of all other HCAs (p < .001). Hepatobiliary phase LLCER was positive in nine HCAs (eight β-HCAs and β-IHCAs; one IHCA). The shHCA and UHCA did not show distinguishing features. The proposed diagnostic algorithm had accuracy of 98% for HHCAs, 83% for IHCAs, and 95% for β-HCAs or β-IHCAs. CONCLUSION. Findings on gadoxetate disodium-enhanced MRI, including hepatobiliary phase characteristics, were associated with HCA subtypes using the 2017 classification. CLINICAL IMPACT. The algorithm identified common HCA subtypes with high accuracy, including those with β-catenin exon 3 mutations.
摘要：
背景。在遗传和分子分析的基础上，2017年更新了肝细胞腺瘤（HCA）的分类。目标。本文的目的是在2017年分类的基础上评估HCA亚型gadoxetate二钠增强MRI的特征，并提出一种使用这些特征确定亚型的诊断算法。方法。这项回顾性研究包括56例患者(49例女性，七个男人；平均年龄，37±13[SD]年），2010年1月至2021年1月通过gadoxetate二钠增强MRI评估了组织学证实的HCA。亚型使用2017年标准重新分类：肝细胞核因子-1α突变的HCA（HHCA），炎症性HCA（IHCA），β-连环蛋白外显子3激活的HCA（β-HCA），混合炎症和β-HCA（β-IHCA），声波刺猬HCA(shHCA)，和未分类的HCA（UHCA）。评估定性MRI特征。测量肝脏与病变的对比增强比（LLCERs）。比较了亚型，并提出了一种诊断算法。结果。分析包括65个HCA：16个HCA，31IHCA,六β-HCA,四β-IHCA，五个shHCA，和三个UHCA。HHCA显示94％的均匀弥漫性病灶内脂肪变性，而所有其他HCA显示这一发现为0%(p<.001)。IHCA显示了58%的“环礁”标志，而所有其他HCA显示这一发现为12%(p<.001)。IHCA显示52％的中等T2高强度，而所有其他HCA显示这一发现为12%(p<.001)。男性中β-HCAs和β-IHCAs发生率为63%,而所有其他HCA在男性中的发生率为4%(p<.001)。β-HCA和β-IHCA的平均大小为10.1±6.8厘米，而所有其他HCA的平均大小为5.1±2.9cm（p=0.03）。β-HCA和β-IHCA显示流体成分占60％，而所有其他HCA显示这一发现为5%(p<.001)。在80％的β-HCA和β-IHCA中观察到肝胆相等或高强度，而在所有其他HCA中观察到5％（p<.001）。9种HCA（8种β-HCA和β-IHCA；1种IHCA）的肝胆相LLCER阳性。shHCA和UHCA没有显示出区别特征。所提出的诊断算法对HHCA的准确率为98%，IHCA的83%，和95%的β-HCAs或β-IHCAs。结论。gadoxetate二钠增强MRI的发现，包括肝胆相特征，使用2017年分类与HCA亚型相关。临床影响。该算法识别出常见的HCA亚型,具有较高的准确率,包括具有β-连环蛋白外显子3突变的那些。
