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Eur Radiol. 2019 Jul;29(7):3791-3801. doi: 10.1007/s00330-019-06150-7. Epub 2019 Apr 1.

Iso- or hyperintensity of hepatocellular adenomas on hepatobiliary phase does not always correspond to hepatospecific contrast-agent uptake: importance for tumor subtyping.

Author information

1
Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.
2
Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France.
3
Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France. maxime.ronot@aphp.fr.
4
University Paris Diderot, Sorbonne Paris Cité, Paris, France. maxime.ronot@aphp.fr.
5
INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. maxime.ronot@aphp.fr.
6
Department of Pathology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.
7
Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France.
8
INSERM Unit U 955, Equipe 18, 94010, Creteil, France.
9
Department of Hepatology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.
10
Department of Liver Surgery, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.
11
University Paris Diderot, Sorbonne Paris Cité, Paris, France.
12
INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.

Abstract

PURPOSE:

This study was conducted in order to evaluate if iso- or hyperintensity of HCAs on HBP is systematically related to a high uptake of hepatospecific contrast agent, using a quantitative approach.

METHODS:

This bicentric retrospective study included all patients with histologically confirmed and subtyped HCA from 2009 to 2017 who underwent MRI with HBP after Gd-BOPTA injection and who showed iso- or hyperintensity on HBP. The signal intensity of tumors on pre- and postcontrast images and the presence of hepatic steatosis were noted. Contrast uptake on HBP was quantified using the liver-to-lesion contrast enhancement ratio (LLCER) and compared between HCA subtypes (Wilcoxon signed-rank test). Categorical variables were compared using chi-square tests.

RESULTS:

Twenty-four HCAs showed iso- or hyperintensity on HBP, specifically 17 inflammatory (IHCAs) and 7 β-catenin HCAs (BHCAs). Eighteen HCAs (75%) (17 IHCAs and 1 BHCAs) had a LLCER < 0% (median - 13.6%, group 1), of which 94% were hyperintense on precontrast T1-W images, with background hepatic steatosis. Six HCAs (25%) had LLCER ≥ 0% (median 2.9%, group 2), and all were BHCAs. A LLCER ≥ 1.6% was associated with the diagnosis of BHCA with a sensitivity of 86% and a specificity of 100%.

CONCLUSION:

In conclusion, iso- or hyperintensity of hepatocellular adenomas on HBP does not necessarily correspond to an increased hepatospecific contrast-agent uptake. In IHCA, tumor hyperintensity on precontrast images and the underlying steatosis likely explain such iso- or hyperintensity, which do show reduced HBP contrast-agent uptake. On the other hand, marked contrast uptake can be observed, especially in BHCA.

KEY POINTS:

• Iso- or hyperintensity on HBP does not necessarily reflect a high uptake of hepatospecific contrast agent. • Discrepancies between qualitative signal intensity and quantitative hepatospecific contrast uptake can be explained in IHCA by a combination of tumor hyperintensity on precontrast images and underlying hepatic steatosis. • In BHCA, iso- or hyperintensity on HBP does actually correspond to a greater contrast uptake than that of the liver, demonstrated by an increased lesion-to-liver contrast enhancement ratio (LLCER).

KEYWORDS:

Adenoma; Contrast media; Liver neoplasms; Magnetic resonance imaging

PMID:
30937584
DOI:
10.1007/s00330-019-06150-7
[Indexed for MEDLINE]

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