Atypical CT and MRI Features of Focal Nodular Hyperplasia of Liver: A Study with Radiologic-Pathologic Correlation

Narendra Darai¹, Rongbao Shu², Rajkumar Gurung², Xiaojuan Zhang², Gaojun Teng^2*

¹Department of Radiology, Zhong Da Hospital, Southeast University, Nanjing, China.
²Medical School, Southeast University, Nanjing, China.

DOI: 10.4236/ojrad.2015.53020                

Abstract

Focal Nodular Hyperplasia (FNH) is the second most hepatic tumor next to hemangioma predominantly affecting women. It is a benign regenerative nodule having an unencapsulated well-defined mass with fibrovascular septae and proliferating bile ductules. Gadoxetic acid is a hepatocyte specific MR contrast agent which is known to be specific for the identifying FNH. Congenital vascular malformation and enlargement due to hormone stimulation is being considered as the main cause of FNH. The central stellate fibrovascular scar is a typical diagnostic imaging feature of FNH and the atypical pathological findings of FNH include large lesions multiple in number, internal necrosis, haemorrhagic foci and fatty infiltration. The atypical imaging features include non-enhancement of the central scar, calcification of the lesion, nonvisualized central scar and pseudocapsular enhancement on delayed imaging. For the accurate diagnosis of FNH, study of atypical radiologic features of FNH in correlation with pathological findings is the most essential. The macroscopic and the microscopic pathognomic changes should be taken as helpful points in the diagnosis of FNH. The main objective of this study is to recognize and understand the typical and atypical imaging patterns observed in CT and MR imaging of FNH with pathological correlation which avoids the necessity of biopsy and further investigations.

Keywords

Focal Nodular Hyperplasia (FNH), Atypical Imaging and Pathological Features, CT, MRI, Differential Diagnosis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mathieu, D., Vilgrain, V., Mahfouz, A.E., Anglade, M.C., Vullierme, M.P. and Denys, A. (1997) Benign Liver Tumors. Magnetic Resonance Imaging Clinics of North America, 5, 255-288.
[2]	Shirkhoda, A., Farah, M.C., Bernacki, E., Madrazo, B. and Roberts, J. (1994) Hepatic Focal Nodular Hyperplasia: CT and Sonographic Spectrum. Abdominal Imaging, 19, 34-38. http://dx.doi.org/10.1007/BF02165858
[3]	Reymond, D., Plaschkes, J., Luthy, A.R., Leibundgut, K., Hirt, A. and Wagner, H.P. (1995) Focal Nodular Hyperplasia of the Liver in Children: Review of Follow-Up and Outcome. Journal of Pediatric Surgery, 30, 1590-1593. http://dx.doi.org/10.1016/0022-3468(95)90162-0
[4]	Grazioli, L., Morana, G., Federle, M.P., Brancatelli, G., Testoni, M., Kirchin, M.A., et al. (2001) Focal Nodular Hyperplasia: Morphologic and Functional Information from MR Imaging with Gadobenate Dimeglumine. Radiology, 221, 731-739. http://dx.doi.org/10.1148/radiol.2213010139
[5]	Huppertz, A., Haraida, S., Kraus, A., Zech, C.J., Scheidler, J., Breuer, J., et al. (2005) Enhancement of Focal Liver Lesions at Gadoxetic Acid-Enhanced MR Imaging: Correlation with Histopathologic Findings and Spiral CT—Initial Observations. Radiology, 234, 468-478. http://dx.doi.org/10.1148/radiol.2342040278
[6]	Ko, K.R., Lee, D.H., Park, J.S., Yi, B.H., Lim, J.W., Ko, Y.T., et al. (2003) Focal Nodular Hyperplasia with Retraction of Liver Capsule: A Case Report. Korean Journal of Radiology, 4, 66-69. http://dx.doi.org/10.3348/kjr.2003.4.1.66
[7]	Wanless, I.R., Mawdsley, C. and Adams, R. (1985) On the Pathogenesis of Focal Nodular Hyperplasia of the Liver. Hepatology, 5, 1194-1200. http://dx.doi.org/10.1002/hep.1840050622
[8]	Choi, J.Y., Lee, H.C., Yim, J.H., Shim, J.H., Lim, Y.S., Shin, Y.M., et al. (2011) Focal Nodular Hyperplasia or Focal Nodular Hyperplasia-Like Lesions of the Liver: A Special Emphasis on Diagnosis. Journal of Gastroenterology and Hepatology, 26, 1004-1009. http://dx.doi.org/10.1111/j.1440-1746.2011.06659.x
[9]	Rummeny, E., Weissleder, R., Sironi, S., et al. (1989) Central Scars in Primary Liver Tumors: MR Features, Specificity and Pathologic Correlation. Radiology, 171, 323-326. http://dx.doi.org/10.1148/radiology.171.2.2539605
[10]	Shamsi, K., de Schepper, A., Degryse, H. and Deckers, F. (1993) Focal Nodular Hyperplasia of the Liver: Radiologic Findings. Abdominal Imaging, 18, 32-38. http://dx.doi.org/10.1007/BF00201698
[11]	Grandin, C.B., Van Beers, B.E., Pauwels, S., Demeure, R., Jamart, J. and Pringot, J. (1997) Ferumoxides and Tc-99m Sulfur Colloid: Comparison of the Tumor-to-Liver Uptake in Focal Nodular Hyperplasia. Journal of Magnetic Resonance Imaging, 7, 125-129. http://dx.doi.org/10.1002/jmri.1880070117
[12]	Vilgrain, V., Flejou, J.F., Arrive, L., Belghiti, J., Najmark, D., Menu, Y., et al. (1992) Focal Nodular Hyperplasia of the Liver: MR Imaging and Pathologic Correlation in 37 Patients. Radiology, 184, 699-703. http://dx.doi.org/10.1148/radiology.184.3.1509052
[13]	Shortell, C.K. and Schwartz, S.I. (1991) Hepatic Adenoma and Focal Nodular Hyperplasia. Surgery, Gynecology, and Obstetrics, 173, 426-431.
[14]	Mergo, P.J. and Ros, P.R. (1998) Benign Lesions of the Liver. Radiologic Clinics of North America, 36, 319-331. http://dx.doi.org/10.1016/S0033-8389(05)70025-7
[15]	Ishak, K.G. and Rabin, L. (1975) Benign Tumors of the Liver. Medical Clinics of North America, 59, 995-1013.
[16]	Brunt, E.M. and Flye, M.W. (1991) Infraction in Focal Nodular Hyperplasia of the Liver: A Case Report. American Journal of Clinical Pathology, 95, 503-506.
[17]	Federle, M.P. and Brancatelli, G. (2001) Imaging of Benign Hepatic Masses. Seminars in Liver Disease, 21, 237-249. http://dx.doi.org/10.1055/s-2001-15344
[18]	Trotter, J.F. and Everson, G.T. (2001) Benign Focal Lesions of the Liver. Clinics in Liver Disease, 5, 17-42. http://dx.doi.org/10.1016/S1089-3261(05)70152-5
[19]	Chaoui, A., Mergo, P.J. and Lauwers, G.Y. (1998) Unusual Appearance of Focal Nodular Hyperplasia with Fatty Change. American Journal of Roentgenology, 171, 1433-1434. http://dx.doi.org/10.2214/ajr.171.5.9798902
[20]	Choi, C.S. and Frenny, P.C. (1998) Triphasic Helical CT of Hepatic Focal Nodular Hyperplasia: Incidence of Atypical Findings. American Journal of Roentgenology, 170, 391-395. http://dx.doi.org/10.2214/ajr.170.2.9456952
[21]	Mortelé, K.J., Praet, M., Van Vlierberghe, H., Kunnen, M. and Ros, P.R. (2000) CT and MR Imaging Findings in Focal Nodular Hyperplasia of the Liver: Radiologic-Pathologic Correlation. American Journal of Roentgenology, 175, 687-692.