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Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging

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Abstract

Purpose

To investigate magnetic resonance (MR) findings of angiomyolipoma (AML) on gadoxetic acid-enhanced MR imaging, and to identify features that differentiate AML from hepatocellular carcinoma (HCC) in patients with a low risk of HCC development.

Methods

This retrospective study was institutional review board approved, and the requirement for informed consent was waived. Twelve patients with hepatic AML who underwent gadoxetic acid-enhanced MRI with no risk factors for HCC development were recruited. Twenty-seven patients with HCC under the same inclusion criteria were recruited as control. Two radiologists analyzed the images in consensus for morphologic features, enhancement patterns, and hepatobiliary phase (HBP) findings. All results were analyzed using the Mann–Whitney test, two-tailed Fisher exact test, and chi-square test.

Results

Patients with AML were younger than those with HCC (48.8 ± 15 years for AML vs. 62.7 ± 14.2 years for HCC, p = 0.008) with female predominance, while most HCC patients were male (75% (9/12) vs. 15% (4/27), p < 0.001). The most prevalent enhancement pattern was arterial enhancement followed by hypointensity at portal or transitional phases for both AMLs (58% (7/12)) and HCCs (74% (20/27)) (p = 0.455). However, during the HBP, AMLs frequently showed more homogeneous hypointensity than HCCs (83% (10/12) vs. 41% (11/27), p = 0.018). When compared with the signal intensity of the spleen, the mean relative signal intensity of the AML was 91.2 ± 15.4%, while in HCCs, it was 128.7 ± 40% (p < 0.001).

Conclusions

Although AMLs showed similar enhancement patterns to HCCs during the dynamic phases of gadoxetic acid-enhanced MRI, using characteristic MR features of AML during the HBP and demographic differences, one can better differentiate AML from HCC.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Korea

    Rihyeon Kim, Jeong Min Lee, Ijin Joo, Dong Ho Lee, Sungmin Woo, Joon Koo Han & Byung Ihn Choi

  2. Institute of Radiation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Korea

    Jeong Min Lee, Joon Koo Han & Byung Ihn Choi

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  1. Rihyeon Kim
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Correspondence to Jeong Min Lee.

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Kim, R., Lee, J.M., Joo, I. et al. Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Abdom Imaging 40, 531–541 (2015). https://doi.org/10.1007/s00261-014-0244-4

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