Advertisement

Der Radiologe

, 51:688 | Cite as

Benigne fokale Leberläsionen

  • S. Baroud
  • N. Bastati
  • H. Prosch
  • W. Schima
  • A. Ba-Ssalamah
Leitthema

Zusammenfassung

Eine genaue Kenntnis des breiten Spektrums benigner fokaler Leberläsionen und der geeigneten radiologischen Untersuchungsmethode ist essenziell, um eine sichere Diagnose bzgl. der Dignität und damit das weitere Vorgehen bestimmen zu können. Damit wird eine unnötige Verunsicherung des Patienten und des behandelnden Arztes vermieden, und invasive, eventuell mit Komplikationen assoziierte Biopsien sowie zeit- und kostenintensive Verlaufskontrollen können reduziert werden.

Der folgende Artikel erläutert die häufigsten und klinisch wichtigsten benignen fokalen Leberläsionen und deren typisches und atypisches Erscheinen in den 3 häufig verwendeten bildgebenden Verfahren Sonographie, Computertomographie und Magnetresonanztomographie.

Schlüsselwörter

Benigne fokale Leberläsionen MRT CT Ultraschall Kontrastmittelverstärkt 

Abkürzungen

KM

Kontrastmittel

CEUS

„Contrast-enhanced ultrasound“, kontrastmittelverstärkter Ultraschall

DWI

„Diffusion-weighted imaging“, diffusionsgewichtete Sequenzen

ADC

„Apparent diffusion coefficient“

HU

Hounsfield Units

MRCP

Magnetresonanzcholangiopankreatikographie

FNH

Fokale noduläre Hyperplasie

SNN

„Solitary necrotic nodule“, solitäre nekrotische Knoten

FLC

Fibrolamelläres Karzinom

Benign focal hepatic lesions

Abstract

A profound knowledge of the various benign focal hepatic lesions and selection of the most suitable radiological examination modality is essential for achieving an accurate characterization of a hepatic lesion and in turn will determine the further patient management. This will avoid unnecessary agitation to both patient and the referring clinician and limits time-consuming, costly and risky biopsies to an absolute minimum.

The following article will discuss the typical and atypical appearances of the most frequent and clinically relevant benign focal hepatic lesions with ultrasound, computed tomography and magnetic resonance imaging.

Keywords

Benign focal hepatic lesions MRI CT Sonography Contrast-enhanced 

Notes

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Ba-Ssalamah A, Baroud S, Bastati N et al (2010) MR imaging of benign focal liver lesions. Magn Reson Imaging Clin North Am 18:403–419CrossRefGoogle Scholar
  2. 2.
    Ba-Ssalamah A, Happel B, Kettenbach J et al (2004) MRT of the liver. Clinical significance of nonspecific and liver-specific MRT contrast agents. Radiologe 44:1170–1184PubMedCrossRefGoogle Scholar
  3. 3.
    Ba-Ssalamah A, Schima W, Schmook Mt et al (2002) Atypical focal nodular hyperplasia of the liver: imaging features of nonspecific and liver-specific MR contrast agents. AJR Am J Roentgenol 179:1447–1456PubMedGoogle Scholar
  4. 4.
    Ba-Ssalamah A, Uffmann M, Saini S et al (2009) Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions. Eur Radiol 19:342–357PubMedCrossRefGoogle Scholar
  5. 5.
    Bae KT, Tao C, Zhu F et al (2009) MRI-based kidney volume measurements in ADPKD: reliability and effect of gadolinium enhancement. Clin J Am Soc Nephrol 4:719–725PubMedCrossRefGoogle Scholar
  6. 6.
    Bioulac-Sage P, Laumonier H, Couchy G et al (2009) Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology 50:481–489PubMedCrossRefGoogle Scholar
  7. 7.
    Brannigan M, Burns PN, Wilson SR (2004) Blood flow patterns in focal liver lesions at microbubble-enhanced US1. Radiographics 24:921–935PubMedCrossRefGoogle Scholar
  8. 8.
    Bruegel M, Holzapfel K, Gaa J et al (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18:477–485PubMedCrossRefGoogle Scholar
  9. 9.
    Buell JF, Tranchart H, Cannon R et al (2010) Management of benign hepatic tumors. Surg Clin North Am 90:719–735PubMedCrossRefGoogle Scholar
  10. 10.
    Caseiro-Alves F, Brito J, Araujo Ae et al (2007) Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis. Eur Radiol 17:1544–1554PubMedCrossRefGoogle Scholar
  11. 11.
    Deniz K, Çoban G (2010) Solitary necrotic nodule of the liver: always benign? J Gastrointest Surg 14:536–540PubMedCrossRefGoogle Scholar
  12. 12.
    Elsayes KM, Narra VR, Yin Y et al (2005) Focal hepatic lesions: diagnostic value of enhancement pattern approach with contrast-enhanced 3D gradient-echo MR imaging. Radiographics 25:1299–1320PubMedCrossRefGoogle Scholar
  13. 13.
    Fruehwald-Pallamar J, Bastati-Huber N, Fakhrai N et al (2011) Confident non-invasive diagnosis of pseudolesions of the liver using diffusion-weighted imaging at 3T MRI. Eur J Radiol (Corrected Proof)Google Scholar
  14. 14.
    Geng L, Lin C, Huang B et al (2011) Solitary necrotic nodule of the liver: MR findings in 33 pathologically proved lesions. Eur J Radiol (Corrected Proof)Google Scholar
  15. 15.
    Giannitrapani L, Soresi M, La Spada E et al (2006) Sex hormones and risk of liver tumor. Ann N Y Acad Sci 1089:228–236PubMedCrossRefGoogle Scholar
  16. 16.
    Goshima S, Kanematsu M, Watanabe H et al (2010) Hepatic hemangioma and metastasis: differentiation with gadoxetate disodium-enhanced 3T MRI. AJR Am J Roentgenol 195:941–946PubMedCrossRefGoogle Scholar
  17. 17.
    Grazioli L, Federle MP, Ichikawa T et al (2000) Liver adenomatosis: clinical, histopathologic, and imaging findings in 15 patients. Radiology 216:395–402PubMedGoogle Scholar
  18. 18.
    Kapp N, Curtis KM (2009) Hormonal contraceptive use among women with liver tumors: a systematic review. Contraception 80:387–390PubMedCrossRefGoogle Scholar
  19. 19.
    Kim T, Hori M, Onishi H (2009) Liver masses with central or eccentric scar. Semin Ultrasound CT MR 30:418–425PubMedCrossRefGoogle Scholar
  20. 20.
    Kim TK, Jang HJ, Burns PN et al (2008) Focal nodular hyperplasia and hepatic adenoma: differentiation with low-mechanical-index contrast-enhanced sonography. AJR Am J Roentgenol 190:58–66PubMedCrossRefGoogle Scholar
  21. 21.
    Koea J, Taylor G, Miller M et al (2003) Solitary necrotic nodule of the liver: a riddle that is difficult to answer. J Gastrointest Surg 7:627–630PubMedCrossRefGoogle Scholar
  22. 22.
    Koike N, Cho A, Nasu K et al (2009) Role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of focal hepatic lesions. World J Gastroenterol 15:5805–5812PubMedCrossRefGoogle Scholar
  23. 23.
    Mariss J, Gaa J, Wörtler K et al (2009) Multiple biliäre Hamartome (von-Meyenburg-Komplexe). Radiologie up2date 9:199–202CrossRefGoogle Scholar
  24. 24.
    Montet X, Lazeyras F, Howarth N et al (2004) Specificity of SPIO particles for characterization of liver hemangiomas using MRI. Abdom Imaging 29:60–70PubMedCrossRefGoogle Scholar
  25. 25.
    Powers C, Ros PR, Stoupis C et al (1994) Primary liver neoplasms: MR imaging with pathologic correlation. Radiographics 14:459–482PubMedGoogle Scholar
  26. 26.
    Prasanna PM, Fredericks SE, Winn SS et al (2010) Best cases from the AFIP: giant cavernous hemangioma. Radiographics 30:1139–1144PubMedCrossRefGoogle Scholar
  27. 27.
    Qayyum A (2009) Diffusion-weighted imaging in the abdomen and pelvis: concepts and applications. Radiographics 29:1797–1810PubMedCrossRefGoogle Scholar
  28. 28.
    Rummeny E, Weissleder R, Sironi S et al (1989) Central scars in primary liver tumors: MR features, specificity, and pathologic correlation. Radiology 171:323–326PubMedGoogle Scholar
  29. 29.
    Schwartz LH, Gandras EJ, Colangelo SM et al (1999) Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology 210:71–74PubMedGoogle Scholar
  30. 30.
    Silva AC, Evans JM, Mccullough AE et al (2009) MR imaging of hypervascular liver masses: a review of current techniques. Radiographics 29:385–402PubMedCrossRefGoogle Scholar
  31. 31.
    Soussan M, Aube C, Bahrami S et al (2010) Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging. Eur Radiol 20:1715–1725PubMedCrossRefGoogle Scholar
  32. 32.
    Termanini B, Gibril F, Doppman JL et al (1997) Distinguishing small hepatic hemangiomas from vascular liver metastases in gastrinoma: use of a somatostatin-receptor scintigraphic agent. Radiology 202:151–158PubMedGoogle Scholar
  33. 33.
    Tsuboyama T, Onishi H, Kim T et al (2010) Hepatocellular carcinoma: hepatocyte-selective enhancement at gadoxetic acid, enhanced MR imaging, correlation with expression of sinusoidal and canalicular transporters and bile accumulation. Radiology 255:824–833PubMedCrossRefGoogle Scholar
  34. 34.
    Volk M, Strotzer M, Lenhart M et al (2001) Frequency of benign hepatic lesions incidentally detected with contrast-enhanced thin-section portal venous phase spiral CT. Acta Radiol 42:172–175PubMedGoogle Scholar
  35. 35.
    Wanless IR, Mawdsley C, Adams R (1985) On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology 5:1194–1200PubMedCrossRefGoogle Scholar
  36. 36.
    Winterer JT, Kotter E, Ghanem N et al (2006) Detection and characterization of benign focal liver lesions with multislice CT. Eur Radiol 16:2427–2443PubMedCrossRefGoogle Scholar
  37. 37.
    Zech CJ, Grazioli L, Breuer J et al (2008) Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol 43:504–511PubMedCrossRefGoogle Scholar
  38. 38.
    Zucman-Rossi J, Jeannot E, Nhieu JT et al (2006) Genotype-phenotype correlation in hepatocellular adenoma: new classification and relationship with HCC. Hepatology 43:515–524PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • S. Baroud
    • 1
  • N. Bastati
    • 1
  • H. Prosch
    • 1
  • W. Schima
    • 2
  • A. Ba-Ssalamah
    • 1
  1. 1.Universitätsklinik für RadiodiagnostikAKH, Medizinische Universität WienWienÖsterreich
  2. 2.Abteilung für Radiologie und Bildgebende DiagnostikKrankenhaus Göttlicher Heiland, WienWienÖsterreich

Personalised recommendations