The online version of this article (https://doi.org/10.1186/s12876-017-0719-1) contains supplementary material, which is available to authorized users.
Different clinical behaviour influences the importance of differentiating focal nodular hyperplasia (FNH) from other focal liver lesions (FLLs). The aim of this study was to compare the efficacy of contrast-enhanced CT and MRI in the diagnosis of FNH.
157 patients with equivocal FLLs detected in ultrasonography subsequently underwent multi-phase CT and MRI with the use of hepatotropic contrast agent (Gd-BOPTA) in a 1.5 T scanner. Examinations were evaluated by three independent readers. Diagnostic efficacy of different radiological signs of FNH in both CT and MRI was compared and AFROC analysis was performed.
4 hepatocellular adenomas, 95 hepatocellular carcinomas, 98 hemangiomas, 138 metastases and 45 FNHs were diagnosed. In both CT and MRI the radiological sign of the highest accuracy was the presence of the central scar within FNH (0.93 and 0.96 relatively). The sum of two radiological signs in MRI: homogeneous enhancement in hepatic arterial phase (HAP) and enhancing lesion in hepatobiliary phase (HBP) was characterized with high values of sensitivity (0.89), specificity (0.97), PPV (0.82), NPV (0.98) and accuracy (0.96). After inclusion of clinical data into analysis the best discriminating feature in MRI was the presence of enhancing lesion in HBP in patients without cirrhosis. In this regard, efficacy parameters increased to 1.00, 0.99, 0.94, 1.00 and 0.99 accordingly. The area under the curve in AFROC analysis of MRI performance was significantly larger than of CT (p = 0.0145).
Gd-BOPTA-enhanced MRI is a more effective method in the differential diagnosis of FNH than multi-phase CT.
Additional file 1: The microscopic image of FNH with characteristic central scar (×20). (TIFF 5111 kb)12876_2017_719_MOESM1_ESM.tif
Additional file 2: CT and MRI images of FNH in segment IVB of the liver. Fig. a. Axial CT image in hepatic arterial phase shows typical intensive homogeneous enhancement of the lesion with characteristic hypodense central scar (arrow). The lesion is isodense to normal liver parenchyma in the non-contrast examination (Fig. b) and in equilibrium phase (fig. c), but slightly hyperdense in portal venous phase (Fig. d). Fig. e. T1-weighted contrasted-enhanced MRI in hepatic arterial phase shows typical enhancement pattern of FNH - intensive homogeneous enhancement and hypointensive central scar (arrow). Fig. f. Hepatobiliary phase confirms the diagnosis of FNH presenting stronger enhancement of FNH than the surrounding liver parenchyma. This lesion is isointense to the liver parenchyma in non-enhanced T1- (Fig. g) and T2-weighted MRI (Fig. h). (TIFF 528 kb)12876_2017_719_MOESM2_ESM.tif
Additional file 3: MRI of FNH in segment VI of the liver. Fig. a. Axial T1-weighted non-enhanced MRI shows slightly hypointense focal liver lesion with clearly visible hypointense central scar (arrow). Fig. b. Spin echo sequence, T1-weighted non-enhanced sagittal image presents hypointensive lesion with a central scar. Fig. c. The axial T1-weighted contrast-enhanced image in hepatic arterial phase shows typical intensive homogeneous enhancement of the lesion with a characteristic hypointense central scar. Fig. d. Axial T1-weighted contrast-enhanced MR image: lesion is isointense to the normal liver parenchyma in portal venous phase, the hypointensive central scar is visible (arrow). Fig. e,f. Axial and sagittal images in hepatobiliary phase: lesion is isointense to the surrounding liver parenchyma, the central scar is clearly visible. (TIFF 3002 kb)12876_2017_719_MOESM3_ESM.tif
Additional file 4: CT and MRI images of FNH in segment V of the liver. Fig. a,b. CT image in hepatic arterial phase shows typical intensive homogeneous enhancement of the lesion with discreetly visible central scar (arrow). This lesion is hypointense in the non-enhanced T1-weighted image (fig. c) and isointense in the T2-weighted image (fig. d). Fig. e. Axial T1-weighted contrast-enhanced MRI in hepatic arterial phase presents a homogeneous enhancement of the lesion with subtle central scar (arrow). (TIFF 909 kb)12876_2017_719_MOESM4_ESM.tif
Additional file 5: Results of multiple comparisons of radiological signs in CT by means of McNemar’s test. P values presented after Bonferroni-Hochberg’s correction. (PDF 108 kb)12876_2017_719_MOESM5_ESM.pdf
Additional file 6: Results of multiple comparisons of radiological signs in MRI by means of McNemar’s test. P values presented after Bonferroni-Hochberg’s correction. (PDF 108 kb)12876_2017_719_MOESM6_ESM.pdf
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- Efficacy comparison of multi-phase CT and hepatotropic contrast-enhanced MRI in the differential diagnosis of focal nodular hyperplasia: a prospective cohort study
Tomasz K. Nowicki
- BioMed Central
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