目的:gadoxetic酸增强MRI在肝胆阶段(HBP)的高强度或等强度对局灶性结节增生(FNH)具有很高的特异性,但可能存在于肝细胞腺瘤和肝癌(HCA/HCC)中。本研究旨在确定FNH和HCA/HCC的影像学特征。
方法:这项多中心回顾性队列研究包括病理证实为FNH或HCA/HCC的患者,2010年至2020年间,gadoxetic酸增强MRI的HBP高/等强度。报告了FNH和HCA/HCC之间鉴别的影像学特征的诊断性能。单变量分析,多变量逻辑回归分析,并进行了分类和回归树(CART)分析。敏感性分析评估了B-连环蛋白激活的HCA的成像特征。
结果:总计,124例患者(平均年龄40岁,标准偏差10年,108名女性),包括128个高/等强度病变。病理诊断为FNH和HCA/HCC64个病灶(50%),HCA/HCC64个病灶(50%)。仅在HCA/HCC中观察到的成像特征是HBP中的光栅和环礁指纹模式,T2-w上的正弦膨胀,含铁血黄素,T1-w同相高强度,静脉冲洗,以及HBP和T2-w中的结节中的结节分割。多变量逻辑回归和CART还发现T2-w瘢痕表明FNH,脂肪含量低于50%,和指示HCA/HCC的球形轮廓。在我们选定的队列中,14/48(29%)的HCA被B-catenin激活,大多数(13/14)显示广泛的超/等强度,和一些有T2-w疤痕(4/14,29%)。
结论:如果上述HCA/HCC的典型特征出现在病变中,可能需要进一步研究以排除B-catenin激活的HCA.
结论:gadoxetic酸增强MRI的HBP中的高强度或等强度对FNH具有特异性,但HCA/HCC也可以表现出这一特征。因此,我们描述了区分这些实体的成像模式.
结论:FNH和HCA/HCC具有相似的HBP强度,但具有不同的恶性潜能。在该病变人群中确定了HCA/HCC特有的六种成像模式。HBP中肝脏病变的这些特征-高-等强度值得进一步评估。
OBJECTIVE: Hyper- or isointensity in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI has high specificity for focal nodular hyperplasia (FNH) but may be present in hepatocellular adenoma and carcinoma (HCA/HCC). This study aimed to identify imaging characteristics differentiating FNH and HCA/HCC.
METHODS: This multicenter retrospective cohort study included patients with pathology-proven FNH or HCA/HCC, hyper-/isointense in the HBP of gadoxetic acid-enhanced MRI between 2010 and 2020. Diagnostic performance of imaging characteristics for the differentiation between FNH and HCA/HCC were reported. Univariable analyses, multivariable logistic regression analyses, and classification and regression tree (CART) analyses were conducted. Sensitivity analyses evaluated imaging characteristics of B-catenin-activated HCA.
RESULTS: In total, 124 patients (mean age 40 years, standard deviation 10 years, 108 female) with 128 hyper-/isointense lesions were included. Pathology diagnoses were FNH and HCA/HCC in 64 lesions (50%) and HCA/HCC in 64 lesions (50%). Imaging characteristics observed exclusively in HCA/HCC were raster and atoll fingerprint patterns in the HBP, sinusoidal dilatation on T2-w, hemosiderin, T1-w in-phase hyperintensity, venous washout, and nodule-in-nodule partification in the HBP and T2-w. Multivariable logistic regression and CART additionally found a T2-w scar indicating FNH, less than 50% fat, and a spherical contour indicating HCA/HCC. In our selected cohort, 14/48 (29%) of HCA were B-catenin activated, most (13/14) showed extensive hyper-/isointensity, and some had a T2-w scar (4/14, 29%).
CONCLUSIONS: If the aforementioned characteristics typical for HCA/HCC are encountered in lesions extensively hyper- to isointense, further investigation may be warranted to exclude B-catenin-activated HCA.
CONCLUSIONS: Hyper- or isointensity in the HBP of gadoxetic acid-enhanced MRI is specific for FNH, but HCA/HCC can also exhibit this feature. Therefore, we described imaging patterns to differentiate these entities.
CONCLUSIONS: FNH and HCA/HCC have similar HBP intensities but have different malignant potentials. Six imaging patterns exclusive to HCA/HCC were identified in this lesion population. These features in liver lesions hyper- to isointense in the HBP warrant further evaluation.