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Iso- or hyperintensity of hepatocellular adenomas on hepatobiliary phase does not always correspond to hepatospecific contrast-agent uptake: importance for tumor subtyping

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study was conducted in order to evaluate if iso- or hyperintensity of HCAs on HBP is systematically related to a high uptake of hepatospecific contrast agent, using a quantitative approach.

Methods

This bicentric retrospective study included all patients with histologically confirmed and subtyped HCA from 2009 to 2017 who underwent MRI with HBP after Gd-BOPTA injection and who showed iso- or hyperintensity on HBP. The signal intensity of tumors on pre- and postcontrast images and the presence of hepatic steatosis were noted. Contrast uptake on HBP was quantified using the liver-to-lesion contrast enhancement ratio (LLCER) and compared between HCA subtypes (Wilcoxon signed-rank test). Categorical variables were compared using chi-square tests.

Results

Twenty-four HCAs showed iso- or hyperintensity on HBP, specifically 17 inflammatory (IHCAs) and 7 β-catenin HCAs (BHCAs). Eighteen HCAs (75%) (17 IHCAs and 1 BHCAs) had a LLCER < 0% (median − 13.6%, group 1), of which 94% were hyperintense on precontrast T1-W images, with background hepatic steatosis. Six HCAs (25%) had LLCER ≥ 0% (median 2.9%, group 2), and all were BHCAs. A LLCER ≥ 1.6% was associated with the diagnosis of BHCA with a sensitivity of 86% and a specificity of 100%.

Conclusion

In conclusion, iso- or hyperintensity of hepatocellular adenomas on HBP does not necessarily correspond to an increased hepatospecific contrast-agent uptake. In IHCA, tumor hyperintensity on precontrast images and the underlying steatosis likely explain such iso- or hyperintensity, which do show reduced HBP contrast-agent uptake. On the other hand, marked contrast uptake can be observed, especially in BHCA.

Key Points

• Iso- or hyperintensity on HBP does not necessarily reflect a high uptake of hepatospecific contrast agent.

• Discrepancies between qualitative signal intensity and quantitative hepatospecific contrast uptake can be explained in IHCA by a combination of tumor hyperintensity on precontrast images and underlying hepatic steatosis.

• In BHCA, iso- or hyperintensity on HBP does actually correspond to a greater contrast uptake than that of the liver, demonstrated by an increased lesion-to-liver contrast enhancement ratio (LLCER).

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Abbreviations

BHCA:

β-Catenin-mutated hepatocellular adenoma

FNH:

Focal nodular hyperplasia

HBP:

Hepatobiliary phase

HCA:

Hepatocellular adenoma

HHCA:

HNF1-α-inactivated HCA

IHCA:

Inflammatory HCA

LLCER:

Liver-to-lesion contrast enhancement ratio

OATP:

Organic anion transporting polypeptide

SI:

Signal intensity

SIR:

Signal intensity ratio

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France

    Edouard Reizine, Frederic Pigneur, Sebastien Mulé & Alain Luciani

  2. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, 100 Boulevard du Général Leclerc, 92118, Clichy, Hauts-de-Seine, France

    Edouard Reizine, Maxime Ronot, Yvonne Purcell, Marco Dioguardi Burgio & Valérie Vilgrain

  3. University Paris Diderot, Sorbonne Paris Cité, Paris, France

    Maxime Ronot & Valérie Vilgrain

  4. INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France

    Maxime Ronot & Valérie Vilgrain

  5. Department of Pathology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France

    Julien Calderaro

  6. Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France

    Julien Calderaro, Giuliana Amaddeo, Alexis Laurent & Alain Luciani

  7. INSERM Unit U 955, Equipe 18, 94010, Creteil, France

    Julien Calderaro, Giuliana Amaddeo & Alain Luciani

  8. Department of Hepatology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France

    Giuliana Amaddeo

  9. Department of Liver Surgery, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France

    Alexis Laurent

Authors
  1. Edouard Reizine
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  2. Maxime Ronot
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Correspondence to Maxime Ronot.

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Guarantor

The scientific guarantor of this publication is Maxime Ronot.

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The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in a previous manuscript in the European Radiology focusing on a correlation between the quantitative analysis of benign hepatocellular tumor uptake on HBP imaging and the quantitative level of OATP expression [28].

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• retrospective

• diagnostic or prognostic study

• multicenter study

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Reizine, E., Ronot, M., Pigneur, F. et al. Iso- or hyperintensity of hepatocellular adenomas on hepatobiliary phase does not always correspond to hepatospecific contrast-agent uptake: importance for tumor subtyping. Eur Radiol 29, 3791–3801 (2019). https://doi.org/10.1007/s00330-019-06150-7

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  • DOI: https://doi.org/10.1007/s00330-019-06150-7

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