Interest of contrast-enhanced sonography to identify focal nodular hyperplasia with sinusoidal dilatation

Abstract Background and aims Focal nodular hyperplasia with major sinusoidal dilatation (FNH-sd) is a misleading entity, with some features resembling inflammatory hepatocellular adenoma (HCA). We aimed to assess the performance of contrast-enhanced ultrasound (CEUS) for the diagnosis of FNH-sd. Met...

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Bibliographic Details
Published in:Diagnostic and interventional imaging 2014-01, Vol.95 (1), p.77-83
Main Authors: Alberti, N, Frulio, N, Bioulac-Sage, P, Laumonier, H, Balabaud, C, Perez, J.-T, Teixeira, F.R, Harbonnier, N, Trillaud, H
Format: Article
Language:English
Subjects:
Adult
Biopsy, Needle
Cell Proliferation
Contrast Media
Contrast-enhanced ultrasound
Dilatation, Pathologic - diagnostic imaging
Dilatation, Pathologic - pathology
Female
Focal nodular hyperplasia
Focal Nodular Hyperplasia - diagnostic imaging
Focal Nodular Hyperplasia - pathology
Glutamine synthetase
Hepatocytes - pathology
Humans
Image Enhancement
Incidental Findings
Inflammatory hepatocellular adenoma
Liver - blood supply
Liver - diagnostic imaging
Liver - pathology
Magnetic Resonance Imaging
Middle Aged
Phospholipids
Radiology
Retrospective Studies
Sensitivity and Specificity
Sinusoidal dilatation
Sulfur Hexafluoride
Ultrasonography, Interventional
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Summary:Abstract Background and aims Focal nodular hyperplasia with major sinusoidal dilatation (FNH-sd) is a misleading entity, with some features resembling inflammatory hepatocellular adenoma (HCA). We aimed to assess the performance of contrast-enhanced ultrasound (CEUS) for the diagnosis of FNH-sd. Methods Four histologically proven FNH-sd nodules in four patients were investigated with both MRI and CEUS imaging. Sinusoidal dilatation was focally visible in all cases in histology. Results In MRI, in all the four cases, lesions were hypervascular in arterial phase, with high intensity in T2-weighted sequence imaging and persistent enhancement in the delayed gadolinium-enhanced phase. These MRI features were more indicative of HCA than FNH. On the other hand, CEUS showed a very specific centrifugal filling followed by a strong, homogeneous enhancement of the whole lesion. Conclusion CEUS seems to be an essential step for the diagnosis of non-typical FNH, such as FNH-sd. This small series highlights the interest of performing both CEUS and MRI for the diagnosis of atypical focal liver lesions, such as FNH-sd.
ISSN:2211-5684
2211-5684
DOI:10.1016/j.diii.2013.09.002