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Differentiation of focal nodular hyperplasia from hepatocellular adenomas with low-mecanical-index contrast-enhanced sonography (CEUS): effect of size on diagnostic confidence

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Purpose

The purpose of this study was to assess the diagnostic performance of contrast-enhanced sonography (CEUS) for the differentiation of focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) according to lesion size.

Materials and methods

Forty patients with a definite diagnosis of FNH or HCA who underwent CEUS were included in this institutional review board (IRB)-approved study. A total of 43 FNHs and 20 HCAs, including 15 inflammatory HCAs and five unclassified HCAs, were analysed. Two radiologists reviewed the diagnostic CEUS parameters separately and in consensus, including the presence or absence of centrifugal filling and central vessels. The sensitivity (Se), specificity (Sp), and inter-observer confidence (Kappa) of CEUS diagnostic parameters were assessed.

Results

Inter-observer agreement of CEUS for FNH diagnosis was high (kappa = 0.81) with an overall Se of 67.4 % [29/43 (CI 95 %: 51.4–80.1 %)] and an Sp of 100 % [20/20 (CI 95 %: 81–100 %)]. Significantly higher Se figures were found for lesions ≤ 35 mm than for lesions > 35 mm [respectively, 93 % (28/30) (CI 95 %: 77.6–99.2) vs. 7.7 % (1/13) (CI 95 %: 0.2–36 %), p = 0.002] with unchanged specificity.

Conclusion

CEUS is highly specific for the diagnosis of FNH, with very good inter-observer agreement, whatever the size, but its sensitivity is significantly reduced in diagnosing lesions larger than 35 mm.

Key Points

• CEUS is highly specific for the diagnosis of FNH, regardless of lesion size

• CEUS shows reduced sensitivity in diagnosing FNH lesions larger than 35 mm

• The filling patterns of hepatocellular adenomas are not affected by lesion size

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Abbreviations

FNH:

Focal nodular hyperplasia

HCA:

Hepatocellular adenoma

CEUS:

Contrast-enhanced ultrasound

Gd-BOPTA:

Gadobenate dimeglumine

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Acknowledgements

The scientific guarantor of this publication is Dr. Vincent Roche. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, Creteil, 94010, France

    Vincent Roche, Frederic Pigneur, Lambros Tselikas, Marion Roux, Laurence Baranes, Marjane Djabbari, Alain Rahmouni & Alain Luciani

  2. Faculté de Médecine Creteil, Universite Paris Est, Creteil, 94010, France

    Lambros Tselikas, Marion Roux, Julien Calderaro, Alexis Laurent, Alain Rahmouni & Alain Luciani

  3. Hépato-Gasto-entérologie, AP-HP, Groupe Henri Mondor Albert Chenevier, Creteil, 94010, France

    Charlotte Costentin

  4. Anatomopathologie, AP-HP, Groupe Henri Mondor Albert Chenevier, Creteil, 94010, France

    Julien Calderaro

  5. Chirurgie Viscérale, AP-HP, Groupe Henri Mondor Albert Chenevier, Creteil, 94010, France

    Alexis Laurent

  6. INSERM, U 955, Equipe 18, Creteil, 94010, France

    Alain Luciani

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  1. Vincent Roche
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Correspondence to Alain Luciani.

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Roche, V., Pigneur, F., Tselikas, L. et al. Differentiation of focal nodular hyperplasia from hepatocellular adenomas with low-mecanical-index contrast-enhanced sonography (CEUS): effect of size on diagnostic confidence. Eur Radiol 25, 186–195 (2015). https://doi.org/10.1007/s00330-014-3363-y

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  • DOI: https://doi.org/10.1007/s00330-014-3363-y

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