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Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?

Authors: Timo Alexander Auer; Uli Fehrenbach; Christian Grieser; Tobias Penzkofer; Dominik Geisel; Moritz Schmelzle; Tobias Müller; +3 Authors

Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?

Abstract

Abstract Purpose To differentiate subtypes of hepatocellular adenoma (HCA) based on enhancement characteristics in gadoxetic acid (Gd-EOB) magnetic resonance imaging (MRI). Materials and methods Forty-eight patients with 79 histopathologically proven HCAs who underwent Gd-EOB-enhanced MRI were enrolled (standard of reference: surgical resection). Two blinded radiologists performed quantitative measurements (lesion-to-liver enhancement) and evaluated qualitative imaging features. Inter-reader variability was tested. Advanced texture analysis was used to evaluate lesion heterogeneity three-dimensionally. Results Overall, there were 19 (24%) hepatocyte nuclear factor (HNF)-1a-mutated (HHCAs), 37 (47%) inflammatory (IHCAs), 5 (6.5%) b-catenin-activated (bHCA), and 18 (22.5%) unclassified (UHCAs) adenomas. In the hepatobiliary phase (HBP), 49.5% (39/79) of all adenomas were rated as hypointense and 50.5% (40/79) as significantly enhancing (defined as > 25% intralesional GD-EOB uptake). 82.5% (33/40) of significantly enhancing adenomas were IHCAs, while only 4% (1/40) were in the HHCA subgroup (p < 0.001). When Gd-EOB uptake behavior was considered in conjunction with established MRI features (binary regression model), the area under the curve (AUC) increased from 0.785 to 0.953 for differentiation of IHCA (atoll sign + hyperintensity), from 0.859 to 0.903 for bHCA (scar + hyperintensity), and from 0.899 to 0.957 for HHCA (steatosis + hypointensity). Three-dimensional region of interest (3D ROI) analysis showed significantly increased voxel heterogeneity for IHCAs (p = 0.038). Conclusion Gd-EOB MRI is of added value for subtype differentiation of HCAs and reliably identifies the typical heterogeneous HBP uptake of IHCAs. Diagnostic accuracy can be improved significantly by the combined analysis of established morphologic MR appearances and intralesional Gd-EOB uptake. Key Points •Gd-EOB-enhanced MRI is of added value for subtype differentiation of HCA. •IHCA and HHCA can be identified reliably based on their typical Gd-EOB uptake patterns, and accuracy increases significantly when additionally taking established MR appearances into account. •The small numbers of bHCAs and UHCAs remain the source of diagnostic uncertainty.

Country
Germany
Keywords

Adult, Gadolinium DTPA, Male, Adenoma, Liver Cell/metabolism [MeSH] ; Fatty Liver/diagnostic imaging [MeSH] ; Cicatrix/diagnostic imaging [MeSH] ; Gadolinium DTPA [MeSH] ; Contrast Media [MeSH] ; Gd-DTPA ; Adenoma, Liver Cell/pathology [MeSH] ; Liver ; Liver Neoplasms/pathology [MeSH] ; Liver Neoplasms/metabolism [MeSH] ; Male [MeSH] ; Hepatocyte Nuclear Factor 1-alpha/genetics [MeSH] ; Magnetic resonance imaging ; Radiologists [MeSH] ; Fatty Liver/pathology [MeSH] ; Liver Neoplasms/genetics [MeSH] ; Female [MeSH] ; beta Catenin/metabolism [MeSH] ; Liver Neoplasms/diagnostic imaging [MeSH] ; Adult [MeSH] ; Adenoma, Liver Cell/diagnostic imaging [MeSH] ; Humans [MeSH] ; Middle Aged [MeSH] ; Hepatic neoplasms ; Hepatobiliary-Pancreas ; Inflammation/diagnostic imaging [MeSH] ; Inflammation/pathology [MeSH] ; Adenoma, Liver Cell/genetics [MeSH] ; Hepatocellular adenoma ; Magnetic Resonance Imaging/methods [MeSH] ; Cicatrix/pathology [MeSH], Gd-DTPA, 610, Contrast Media, Adenoma, Liver Cell, Cicatrix, Magnetic resonance imaging, Radiologists, Hepatic neoplasms, Humans, Hepatocyte Nuclear Factor 1-alpha, beta Catenin, Inflammation, Liver Neoplasms, Middle Aged, Hepatobiliary-Pancreas, Magnetic Resonance Imaging, Hepatocellular adenoma, Fatty Liver, Liver, Female, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
32
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Top 10%
Top 10%
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