To retrospectively investigate the prevalence, MR findings, natural history, and association with other hepatic lesions of focal nodular hyperplasia (FNH)-like lesions in a cohort of consecutive patients with cavernous transformation of the portal vein (CTPV).
Materials and methods
This retrospective IRB-approved study comprised 58 patients (32 men, 26 women; average age, 50 years) with CTPV who underwent liver MR imaging between 2000 and 2008. MR images were assessed by two radiologists in consensus for the presence of (a) FNH-like lesions and other liver lesions, and (b) other imaging findings. Patients were assigned to a stable or progressive clinical course based on lesion characteristics at follow-up.
Twelve of 58 patients (21%) had 38 FNH-like lesions (average size, 1.3 cm). Common findings of FNH-like lesions were isointensity on T2-weighted images (82%), intense and homogeneous enhancement during the arterial phase, and lack of washout during the hepatic venous and interstitial phases (100%). FNH-like lesions were found with other benign liver lesions (1 hemangioma, 1 adenoma) in two patients. Three (25%) patients with FNH-like lesions showed a progressive clinical course.
FNH-like lesions are commonly detected in patients with CTPV. Most lesions demonstrate benign imaging findings and stable clinical course.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Webster GJ, Burroughs AK, Riordan SM (2005) Review article: portal vein thrombosis—new insights into aetiology and management. Aliment Pharmacol Ther 21:1–9
Vilgrain V, Condat B, Bureau C et al (2006) Atrophy-hypertrophy complex in patients with cavernous transformation of the portal vein: CT evaluation. Radiology 241:149–155
Tublin ME, Towbin AJ, Federle MP, Nalesnik MA (2008) Altered liver morphology after portal vein thrombosis: not always cirrhosis. Dig Dis Sci 53:2784–2788
Mathieu D, Vasile N, Dibie C, Grenier P (1985) Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation. Radiology 154:743–748
Choi SH, Lee JM, Lee KH et al (2004) Relationship between various patterns of transient increased hepatic attenuation on CT and portal vein thrombosis related to acute cholecystitis. AJR 183:437–442
Condat B, Vilgrain V, Asselah T et al (2003) Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study. Hepatology 37:1302–1308
Ribera Cano A, Debette-Gratien M, Descottes B, Languepin J (2007) Focal nodular hyperplasia involving portal cavernoma. Arch Pediatr 14:1315–1317
Bureau C, Péron JM, Sirach E, Selves J, Otal P, Vinel JP (2004) Liver nodules resembling focal nodular hyperplasia after portal vein thrombosis. J Hepatol 41:499–500
Tanaka M, Wanless IR (1998) Pathology of the liver in Budd-Chiari syndrome: portal vein thrombosis and the histogenesis of veno-centric cirrhosis, veno-portal cirrhosis, and large regenerative nodules. Hepatology 27:488–496
Kondo F (2001) Benign nodular hepatocellular lesions caused by abnormal hepatic circulation: etiological analysis and introduction of a new concept. J Gastroenterol Hepatol 16:1319–1328
Ames JT, Federle MP, Chopra K (2009) Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver. Clin Radiol 64:1190–1195
Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002) Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation. Radiographics 22:847–862
Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002) Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation. AJR 178:877–883
Vilgrain V, Lewin M, Vons C et al (1999) Hepatic nodules in Budd-Chiari syndrome: imaging features. Radiology 210:443–450
Soyer P, Lacheheb D, Caudron C, Levesque M (1993) MRI of adenomatous hyperplastic nodules of the liver in Budd-Chiari syndrome. J Comput Assist Tomogr 17:86–89
Rha SE, Lee MG, Lee YS et al (2000) Nodular regenerative hyperplasia of the liver in Budd-Chiari syndrome: CT and MR features. Abdom Imaging 25:255–258
Van Gansbeke D, Avni EF, Delcour C, Engelholm L, Struyven J (1985) Sonographic features of portal vein thrombosis. AJR 144:749–752
Ros PR, Viamonte M Jr, Soila K, Sheldon JJ, Tobias J, Cohen B (1986) Demonstration of cavernomatous transformation of the portal vein by magnetic resonance imaging. Gastrointest Radiol 11:90–92
Wang L, Li ZS, Lu JP, Wang F, Liu Q, Tian JM (2008) Cavernous transformation of the portal vein: three-dimensional dynamic contrast-enhanced MR angiography. Abdom Imaging 33:463–468
Couinaud C (1957) Le foie: études anatomiques et chirurgicales. Masson, Paris, pp 9–12
Bismuth H (1982) Surgical anatomy and anatomical surgery of the liver. World J Surg 6:3–8
Minami M, Ohtomo K, Itai Y (2002) In: Itai Y (ed). Central zoneT and peripheral zone T in the liver: analysis by radiologic imaging. Tokyo, Japan7 Medical Tribune Inc.; pp. 6–14
(1995) Terminology of nodular hepatocellular lesions: international working party. Hepatology 22: 983–993
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
Kim TK, Choi BI, Han JK, Chung JW, Park JH, Han MC (1998) Nontumorous arterioportal shunt in cirrhotic liver mimicking hypervascular tumor: two-phase spiral CT findings. Radiology 208:597–603
Semelka RC, Brown ED, Ascher SM et al (1994) Hepatic hemangiomas: a multiinstitutional study of appearance on T2-weighted and serial gadolinium-enhanced gradient-echo MR images. Radiology 192:401–406
Arrive L, Flejou JF, Vilgrain V et al (1994) Hepatic adenoma: MR findings in 51 pathologically proved lesions. Radiology 193:507–512
Matsui O, Kadoya M, Kameyama T et al (1991) Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology 178:493–497
Choi BI, Takayasu K, Han MC (1993) Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis and imaging findings. AJR 160:1177–1187
Ishigami K, Yoshimitsu K, Nishihara Y et al (2009) Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings. Radiology 250:435–443
Bioulac-Sage P, Balabaud C, Wanless IR (2001) Diagnosis of focal nodular hyperplasia: not so easy. Am J Surg Pathol 25:1322–1325
Brancatelli G, Federle MP, Grazioli L, Blachar A, Peterson MS, Thaete L (2001) Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Radiology 219:61–68
Choi CS, Freeny PC (1998) Triphasic helical CT of hepatic focal nodular hyperplasia: incidence of atypical findings. AJR 170:391–395
Itai Y, Moss AA, Goldberg HI (1982) Transient hepatic attenuation difference of lobar or segmental distribution detected by dynamic computed tomography. Radiology 144:835–839
Begg CB, McNeil BJ (1988) Assessment of radiologic tests: control of bias and other design considerations. Radiology 167:565–569
About this article
Cite this article
Marin, D., Galluzzo, A., Plessier, A. et al. Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. Eur Radiol 21, 2074 (2011). https://doi.org/10.1007/s00330-011-2161-z
- Cavernous transformation of the portal vein
- Benign liver neoplasms
- Magnetic resonance imaging