Skip to main content
SpringerLink
Log in

Contrast-enhanced ultrasound of focal nodular hyperplasia: a matter of size

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the contrast-enhanced ultrasound (CEUS) frequencies of centrifugal enhancement, spoke-wheel sign and central scar in focal nodular hyperplasia (FNH) as a function of lesion size.

Methods

Ninety-four FNHs were retrospectively reviewed to assess their largest diameter and enhancement pattern, including centrifugal enhancement from one central artery, spoke-wheel sign, diffuse or centripetal enhancement, central scar and late-phase washout.

Results

Mean FNH-lesion size was 3.7 ± 2.1 cm. Only 43.6 % of FNHs had centrifugal enhancement, with a spoke-wheel pattern (23.4 %) or without (20.2 %), while 56.4 % showed diffuse or centripetal enhancement. Centrifugal enhancement was observed in 73.9 % of FNHs ≤3.1 cm and 14.6 % of FNHs >3.1 cm (P < 10–4). Size and frequency of centrifugal enhancement were negatively correlated (r = –0.57, P < 10–4). The spoke-wheel pattern was also seen more frequently in smaller (37 %) than in larger FNHs (10.4 %) (P < 10–3). Late-phase washout was described in 5.3 % of FNHs and was not size-dependent. Lesions with a central scar were larger than those without, respectively, 5.7 ± 1.7 and 3.6 ± 2.0 cm (P = 0.012).

Conclusions

Typical centrifugal enhancement yielding a confident FNH diagnosis is seen significantly more frequently when the lesion is ≤3.1 cm.

Key Points

• CEUS yields confident diagnoses of FNHs ≤3.1 cm

• The larger the FNH, the lower the diagnostic sensitivity of CEUS

• Final diagnosis of FNHs >3.1 cm should be obtained with MRI not CEUS

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Wanless IR, Mawdsley C, Adams R (1985) On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology 5:1194–1200

    Article  CAS  PubMed  Google Scholar 

  2. Cherqui D, Rahmouni A, Charlotte F et al (1995) Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 22:1674–1681

    Article  CAS  PubMed  Google Scholar 

  3. Herman P, Pugliese V, Machado MA et al (2000) Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment. World J Surg 24:372–376

    Article  CAS  PubMed  Google Scholar 

  4. Vilgrain V, Flejou JF, Arrive L et al (1992) Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology 184:699–703

    Article  CAS  PubMed  Google Scholar 

  5. Bernatik T, Seitz K, Blank W, Schuler A, Dietrich CF, Strobel D (2010) Unclear focal liver lesions in contrast-enhanced ultrasonography—lessons to be learned from the DEGUM multicenter study for the characterization of liver tumors. Ultraschall Med 31:577–581

    Article  CAS  PubMed  Google Scholar 

  6. Bleuzen A, Tranquart F (2004) Incidental liver lesions: diagnostic value of cadence contrast pulse sequencing (CPS) and SonoVue. Eur Radiol 14:P53–P62

    Article  PubMed  Google Scholar 

  7. Tranquart F, Bleuzen A, Tchuenbou J (2004) Contrast ultrasound imaging in focal liver lesions: diagnostic value and guidelines. J Radiol 85:680–689

    Article  CAS  PubMed  Google Scholar 

  8. Kim TK, Jang HJ, Burns PN, Murphy-Lavallee J, Wilson SR (2008) Focal nodular hyperplasia and hepatic adenoma: differentiation with low-mechanical–index contrast-enhanced sonography. AJR Am J Roentgenol 190:58–66

    Article  PubMed  Google Scholar 

  9. Bartolotta TV, Taibbi A, Matranga D, Malizia G, Lagalla R, Midiri M (2010) Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth and liver echogenicity. Eur Radiol 20:2248–2256

    Article  PubMed  Google Scholar 

  10. Ungermann L, Elias P, Zizka J, Ryska P, Klzo L (2007) Focal nodular hyperplasia: spoke-wheel arterial pattern and other signs on dynamic contrast-enhanced ultrasonography. Eur J Radiol 63:290–294

    Article  PubMed  Google Scholar 

  11. Wang W, Chen LD, Lu MD et al (2013) Contrast-enhanced ultrasound features of histologically proven focal nodular hyperplasia: diagnostic performance compared with contrast-enhanced CT. Eur Radiol 23:2546–2554

    Article  PubMed  Google Scholar 

  12. Hussain SM, Terkivatan T, Zondervan PE et al (2004) Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics 24:3–17, discussion 18–19

    Article  PubMed  Google Scholar 

  13. Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update 2008. Ultraschall Med 29:28–44

    Article  CAS  PubMed  Google Scholar 

  14. Westwood M, Joore M, Grutters J et al (2013) Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. Health Technol Assess 17:1–243

    Google Scholar 

  15. Bartolotta TV, Taibbi A, Brancatelli G et al (2014) Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different? Radiol Med 119:222–230

    Article  PubMed  Google Scholar 

  16. Soussan M, Aube C, Bahrami S, Boursier J, Valla DC, Vilgrain V (2010) Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging. Eur Radiol 20:1715–1725

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Oliver Lucidarme. The authors of this manuscript declare a relationship with the following company: Oliver Lucidarme is occasionally paid by Bracco Imaging France (the manufacturer of SonoVue) to organise teaching a session on contrast-enhanced imaging in liver. The other 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. One of the authors has significant statistical expertise (Mathilde Wagner) and no complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because it is a retrospective study concerning the 10 past years. Written informed consent was not required for this study because it is a retrospective study concerning US exams that were regularly performed in clinical routine. In this case, an oral consent given by the patient is only required. None of the study subjects or cohorts has been previously reported.

Methodology: retrospective, diagnostic study/observational, multicentre study.

Author information

Authors and Affiliations

  1. Radiology Department, Hôpital Beaujon APHP, 92118, Clichy, Cedex, France

    Caroline Bertin & Valérie Vilgrain

  2. Radiology Department, Hôpital Pitié–Salpêtrière APHP, 75651, Paris, Cedex, France

    Sophie Egels, Mathilde Wagner, Isabelle Huynh-Charlier & Olivier Lucidarme

  3. INSERM, UMR 1149, Laboratoire IPMA, Centre de Recherche sur l’Inflammation, Faculté de Médecine X Bichat, Université Paris Diderot, 75877, Paris, Cedex, France

    Mathilde Wagner & Valérie Vilgrain

  4. UPMC Univ Paris 06, CNRS UMR 7371, INSERM UMR_S 1146, Laboratoire d’Imagerie Biomédicale, Sorbonne Universités, 75005, Paris, France

    Olivier Lucidarme

  5. Service de Radiologie Polyvalente et Oncologique, Groupe Hospitalier Pitié-Salpêtrière – Charles Foix, 47-83, boulevard de l’Hôpital, 75651, Paris, Cedex, France

    Olivier Lucidarme

Authors
  1. Caroline Bertin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sophie Egels
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathilde Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isabelle Huynh-Charlier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valérie Vilgrain
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olivier Lucidarme
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olivier Lucidarme.

Electronic supplementary material

Below is the link to the electronic supplementary material.

(AVI 15.5 mb)

(MPEG 8.22 mb)

(AVI 8.21 mb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bertin, C., Egels, S., Wagner, M. et al. Contrast-enhanced ultrasound of focal nodular hyperplasia: a matter of size. Eur Radiol 24, 2561–2571 (2014). https://doi.org/10.1007/s00330-014-3280-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3280-0

Keywords

Search

Navigation