Abstract
The accurate diagnosis of benign lesions in a cirrhotic liver is clearly important to avoid misdiagnosis of hepatocellular carcinoma (HCC) or other malignancies and to direct the patient toward the most appropriate management. In this chapter we review the appearance of the most common benign lesions encountered on CT and MR imaging of a cirrhotic liver. The lesions are divided into two main groups depending on the histological composition as non-hepatocellular lesions (i.e., cysts and peribiliary cysts, hemangiomas, pseudolesions) and hepatocellular lesions (i.e., nonmalignant cirrhosis-associated nodules, focal nodular hyperplasia like nodules, and hepatobiliary hypointense nodules without arterial phase hyperenhancement).
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References
American College of Radiology. Liver imaging reporting and data system. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS. Accessed July 2018
Baron RL, Campbell WL, Dodd GD 3rd (1994) Peribiliary cysts associated with severe liver disease: imaging-pathologic correlation. AJR Am J Roentgenol 3:631–636
Bazerbachi F, Haffar S, Sugihara T et al (2018) Peribiliary cysts: a systematic review and proposal of a classification framework. BMJ Open Gastroenterol 5(1):e000204
Brancatelli G, Federle MP, Blachar A, Grazioli L (2001) Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology 219(1):69–74
Chernyak V, Fowler KJ, Heiken JP, Sirlin CB (2019) Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI-RADS). J Magn Reson Imaging 49(5):1236–1252
Choi JY, Lee HC, Yim JH et al (2011) Focal nodular hyperplasia or focal nodular hyperplasia-like lesions of the liver: a special emphasis on diagnosis. J Gastroenterol Hepatol 26(6):1004–1009
Choi BI, Lee JM, Kim TK et al (2015) Diagnosing borderline hepatic nodules in hepatocarcinogenesis: imaging performance. AJR Am J Roentgenol 205(1):10–21
Dodd GD 3rd, Baron RL, Oliver JH 3rd, Federle MP (1999) Spectrum of imaging findings of the liver in end-stage cirrhosis: Part II, focal abnormalities. AJR Am J Roentgenol 173(5):1185–1192
Doo KW, Lee CH, Choi JW et al (2009) “Pseudo washout” sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR Am J Roentgenol 193(6):W490–W496
Duran R, Ronot M, Di Renzo S et al (2015) Is magnetic resonance imaging of hepatic hemangioma any different in liver fibrosis and cirrhosis compared to normal liver? Eur J Radiol 84(5):816–822
Elsayes KM, Chernyak V, Morshid AI et al (2018) Spectrum of pitfalls, pseudolesions, and potential misdiagnoses in cirrhosis. AJR Am J Roentgenol 211(1):87–96
Golfieri R, Renzulli M, Lucidi V et al (2011) Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to dynamic MRI in the detection of hypovascular small (≤ 2 cm) HCC in cirrhosis. Eur Radiol J 6:1233–1242
Joo I, Lee JM, Lee DH et al (2015) Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout? Eur Radiol 25(10):2859–2868
Kim JW, Lee CH, Kim SB et al (2017) Washout appearance in Gd-EOB-DTPA-enhanced MR imaging: a differentiating feature between hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase and focal nodular hyperplasia-like nodules. J Magn Reson Imaging 45(6):1599–1608
Kitao A, Matsui O, Yoneda N et al (2018) Differentiation between hepatocellular carcinoma showing hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI and focal nodular hyperplasia by CT and MRI. AJR Am J Roentgenol 21(2):347–357
Komatsu N, Motosugi U, Maekawa S et al (2014) Hepatocellular carcinoma risk assessment using gadoxetic acid-enhanced hepatocyte phase magnetic resonance imaging. Hepatol Res 44(13):1339–1346
Libbrecht L, Cassiman D, Verslype C et al (2006) Clinicopathological features of focal nodular hyperplasia-like nodules in 130 cirrhotic explant livers. Am J Gastroenterol 101(10):2341–2346
Motosugi U, Bannas P, Sano K, Reeder SB (2015) Hepatobiliary MR contrast agents in hypovascular hepatocellular carcinoma. J Magn Reson Imaging 41(2):251–265
Motosugi U, Murakami T, Lee JM et al (2018) LI-RADS HBA Working Group. Recommendation for terminology: nodules without arterial phase hyperenhancement and with hepatobiliary phase hypointensity in chronic liver disease. J Magn Reson Imaging 5:1169–1171
Murakami T, Tsurusaki M (2014) Hypervascular benign and malignant liver tumors that require differentiation from hepatocellular carcinoma: key points of imaging diagnosis. Liver Cancer 3(2):85–96
Nakashima O, Kurogi M, Yamaguchi R et al (2004) Unique hypervascular nodules in alcoholic liver cirrhosis: identical to focal nodular hyperplasia-like nodules? J Hepatol 41(6):992–998
Ohtomo K, Baron RL, Dodd GD 3rd et al (1993) Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT. Radiology 188(1):31–35
Papadatos D, Fowler KJ, Kielar AZ et al (2018) Cirrhosis and LI-RADS. Abdom Radiol (NY) 43(1):26–40
Quaglia A, Tibballs J, Grasso A et al (2003) Focal nodular hyperplasia-like areas in cirrhosis. Histopathology 42(1):14–21
Ronot M, Dioguardi Burgio M, Purcell Y et al (2017) Focal lesions in cirrhosis: not always HCC. Eur J Radiol 93:157–168. https://doi.org/10.1016/j.ejrad.2017.05.040
Sasaki M, Yoneda N, Sawai Y et al (2015) Clinicopathological characteristics of serum amyloid A-positive hepatocellular neoplasms/nodules arising in alcoholic cirrhosis. Histopathology 66(6):836–845
Suh CH, Kim KW, Pyo J et al (2017) Hypervascular transformation of hypovascular hypointense nodules in the hepatobiliary phase of gadoxetic acid-enhanced MRI: a systematic review and meta-analysis. AJR Am J Roentgenol 209(4):781–789
The International Consensus Group for Hepatocellular Neoplasia (2009) Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 49(2):658–664
Toyoda H, Kumada T, Tada T et al (2013) Non-hypervascular hypointense nodules detected by Gd-EOB-DTPA-enhanced MRI are a risk factor for recurrence of HCC after hepatectomy. J Hepatol 58(6):1174–1180
Vilgrain V, Fléjou JF, Arrivé L et al (1992) Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology 184(3):699–703
Vilgrain V (2006) Focal nodular hyperplasia. Eur J Radiol 2:236–245
Wanless IR, Wong F, Blendis LM (1995) Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology. Hepatic and portal vein thrombosis in cirrhosis: possible role in development of parenchymal extinction and portal hypertension. Hepatology 5:1238–1247
Yoneda N, Matsui O, Kitao A et al (2016) Benign hepatocellular nodules: hepatobiliary phase of gadoxetic acid-enhanced MR imaging based on molecular background. Radiographics 36(7):2010–2027
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Catania, R., Borhani, A.A., Furlan, A. (2021). Benign Lesions in Cirrhosis. In: Quaia, E. (eds) Imaging of the Liver and Intra-hepatic Biliary Tract. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-39021-1_10
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