New MRI features improve subtype classification of hepatocellular adenoma
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MRI is crucial for the classification of hepatocellular adenomas (HCA) into subtypes. Our objective was to review and increase MRI criteria for subtype classification and define the limits.
Pathological and radiological data of 116 HCAs were retrospectively analyzed to investigate MRI features of HCA pathological subtypes. Risk for complication was also evaluated with regard to subtype and tumor size.
38/43 (88%) HNF1α-mutated HCAs (H-HCAs) were discriminated by (i) fatty component (homogeneous or heterogeneous) and (ii) hypovascular pattern, with a sensitivity of 88% and a specificity of 97%. 51/58 (88%) inflammatory HCAs (IHCAs) displayed features of sinusoidal dilatation (SD) including three different patterns (global SD, atoll sign, and a new “crescent sign” corresponding to a partial peripheral rim, hyperintense on T2W and/or arterial phase with persistent delayed enhancement). Sensitivity was 88% and specificity 100%. However, some HCA remained unclassifiable by MRI: HCA remodeled by necrotic/hemorrhagic changes covering > 50% of the lesion, H-HCAs without steatosis, IHCAs without SD, β-catenin-mutated and unclassified HCAs. Regarding malignant transformation (5/116) and bleeding (24/116), none was observed when the HCA diameter was smaller than 5.2 cm and 4.2 cm, respectively.
Based on the largest series evaluated until now, we identified several non-described MRI features and propose new highly sensitive and specific MRI criteria. With the addition of these new features, 88% of the two main HCA subtypes could be identified.
• HNF1α-mutated hepatocellular adenomas (H-HCA) are characterized by the presence of fat and hypovascular pattern in MRI.
• Inflammatory hepatocellular adenomas (I-HCA) are characterized by different patterns translating sinusoidal dilatation including the newly described crescent sign.
• No MRI specific pattern was identified for β-catenin-mutated HCA (b-HCA).
KeywordsLiver neoplasms Adenoma, liver cell Magnetic resonance imaging Catenins Retrospective studies
Argininosuccinate synthase 1
Area under the receiver operating characteristic
β-catenin-mutated inflammatory HCA
Focal nodular hyperplasia
Liver fatty acid-binding protein
Magnetic resonance imaging
We thank Professors Jean Saric and Laurence Chiche (surgeons); Brigitte Le Bail and Dr. Claire Castain (liver pathologists); and Florent Maire for their clinical contributions to this study.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Frulio Nora.
Conflict of interest
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.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects (30 cases) have been previously reported in Hepatology 2008 by Laumonier et al—Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification.
• Diagnostic or prognostic study
• Performed at one institution
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