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Imagerie des lésions hépatiques bénignes

Imaging of benign liver lesions

  • Published:
Acta Endoscopica

Résumé

La multiplication des examens échographiques du foie a eu pour conséquence la découverte de plus en plus fréquente de tumeurs bénignes dont on ne soupçonnait pas la prévalence come par exemple les hémangiomes et les hyperplasies nodulaires focales. Le diagnostic de ces lésions bénignes s'est affiné par l'amélioration des techniques (scanner spiralé, IRM) et par l'utilisation de produtis de contraste spécifiques, notamment en IRM, ou non spécifiques. Le diagnostic histologique n'est souvent plus requis si une sémiologie rigoureuse est adoptée. La base de ce travail est la connaissance de signes simples qui permettent une non multiplication des examens d'imagerie. Seront envisagés successivement les signes de l'hémangiome, des lésions kystiques, et de la stéatose hépatique qui pose des problèmes diagnostiques, notamment dans ses formes nodulaires. Enfin, il est fondamental de distinguer hyperplasie nodulaire nodulaire focale d'un adénome hépatocellulaire en raison des implications thérapeutiques, notamment chirugicales s'il s'gait d'un adénome hépatocellulaire, du fait de ses complications potentielles comme l'hémorragie et la possible transformation maligne.

Summary

The multiplication of ultrasound inverstigations has led to the discovery of more and more frequent benign tumours the prevalence of which was not even suspected, such as haemangioma or focal nodular hyperplasia. The diagnosis of these benign lesions became more accurate (spiraled scan, IRM) with the progress of the techniques and by the use of specifc or non specific contrast products especially in IRM. Most often, the histological diagnosis is no longer required when a rigourous semeiology is adopted. The basis of this work is the recognition of simple signs allowing not to repeat imaging investigations. We will describe the signs of haemangioma, cystic lesions and hepatic steatosis with its diagnostic problems, especially in the nodular aspects. At least, it is fundamental to distinguish focal nodular hyperplaisa from hepatocellular adenoma because of their therapeutic implications, especially surgical in presence of a hepatocellualar adenoma considering possible complications such as hemorrhage or malignant transformation.

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  1. Départment de Radiologie, Centre Hospitalier Henri Mondor, Université Paris 12, 51, avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, (France)

    D. Mathieu

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Mathieu, D. Imagerie des lésions hépatiques bénignes. Acta Endosc 30, 439–452 (2000). https://doi.org/10.1007/BF03015795

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