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Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound

  • Hepatobiliary–Pancreas
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Abstract

The aim of this study was to describe gray-scale appearance of liver parenchyma and focal nodular hyperplasia (FNH) by pulse inversion (PI) ultrasound (US) at baseline and after contrast agent administration in patients with normal and fatty liver. Sixteen consecutive patients (12 women, 4 men) with 29 previously diagnosed FNHs (15 of 29 located in normal liver and 14 of 29 in fatty liver) underwent PI US before and after SH U 508A (Levovist) injection. Signal intensity values were measured within the FNHs and the adjacent liver parenchyma in selected images. Baseline echogenicity of fatty liver was higher (15.19±2.90 dB±SD) than normal liver (10.91±3.15 dB±SD; p<0.001). After Levovist administration, normal livers (7 of 16) showed a statistically significant increase of echogenicity (16.59±3.81 dB±SD; p<0.001) in comparison with fatty livers (9 of 16; 15.75±3.12 dB±SD). The FNHs located in normal liver showed baseline echogenicity higher (12.29±3.22 dB±SD) than that of FNHs arising in fatty liver (7.06±2.43 dB±SD; p<0.001). After Levovist administration, FNHs located in normal liver showed a statistically significant increase of echogenicity (25.30±4.62 dB±SD) in comparison with FNHs located in fatty liver (13.58±3.54 dB±SD; p<0.001); the latter always showed mean values of echogenicity lower than surrounding liver parenchyma. In our series decreased contrast-enhancement pattern of both fatty liver and FNHs located in fatty liver was the most prominent finding when Levovist is administered. Contrast washout was a distinctive feature of FNH arising from the fatty liver.

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References

  1. Ros PR, Menu Y, Vilgrain V et al. (2001) Liver neoplasms and tumor-like conditions. Eur Radiol 11 (Suppl 2):S145–S165

    Article  Google Scholar 

  2. Cherqui D, Rahmouni A, Charlotte F et al. (1995) Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 22:1674–1681

    CAS  PubMed  Google Scholar 

  3. Vilgrain V, Flejou JF, Arrivé L et al. (1992) Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology 184:699–703

    CAS  PubMed  Google Scholar 

  4. Pain JA, Gimson AES, Williams R, Howard ER (1991) Focal nodular hyperplasia of the liver: results of treatment and options in management. Gut 32:524–527

    CAS  PubMed  Google Scholar 

  5. Belghiti J, Pateron D, Panis Y et al. (1993) Resection of presumed benign liver tumours. Br J Surg 80:380–383

    CAS  PubMed  Google Scholar 

  6. Harvey CJ, Albrecht T (2001) Ultrasound of focal liver lesions. Eur Radiol 11:1578–1593

    CAS  PubMed  Google Scholar 

  7. Wang LY, Wang JH, Lin ZY et al. (1997) Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound. Abdom Imaging 22:178–181

    Article  CAS  PubMed  Google Scholar 

  8. Uggowitzer M, Kugler C, Gröll R et al. (1998) Sonographic evaluation of focal nodular hyperplasias (FNH) of the liver with a transpulmonary galactose-based contrast agent (Levovist). Br J Radiol 71:1026–1032

    CAS  PubMed  Google Scholar 

  9. Hosten N, Puls R, Bechstein WO, Felix R (1999) Focal liver lesions: Doppler ultrasound. Eur Radiol 9:428–435

    Article  CAS  PubMed  Google Scholar 

  10. Uggowitzer MM, Kugler C, Mischinger HJ et al. (1999) Echo-enhanced Doppler sonography of focal nodular hyperplasia of the liver. J Ultrasound Med 18:445–451

    CAS  PubMed  Google Scholar 

  11. Burns PN, Wilson SR, Simpson DH (2000) Pulse inversion imaging of liver blood flow: improved method for characterizing focal masses with microbubble contrast. Invest Radiol 35:58–71

    CAS  PubMed  Google Scholar 

  12. Burns PN, Hope Simpson D, Averkiou M (2000) Nonlinear imaging. Ultrasound Med Biol 26:19–22

    Article  Google Scholar 

  13. Dill-Macky MJ, Burns PN, Khalili K, Wilson SR (2002) Focal hepatic masses: enhancement patterns with SH U 508 A and pulse-inversion US. Radiology 222:95–102

    PubMed  Google Scholar 

  14. Bertolotto M, Dalla Palma L, Quaia E, Locatelli M (2000) Characterization of unifocal liver lesions with pulse-inversion harmonic imaging after Levovist injection: preliminary results. Eur Radiol 10:1369–1376

    CAS  PubMed  Google Scholar 

  15. Wilson SR, Burns PN (2001) Liver mass evaluation of ultrasound: the impact of of microbubble contrast agents and pulse-inversion imaging. Semin Liver Dis 21:147–159

    Article  CAS  PubMed  Google Scholar 

  16. Konno K, Ishida H, Sato M et al. (2001) Liver tumors in fatty liver: difficulty in ultrasonographic interpretation. Abdom Imaging 26:487–491

    Article  CAS  PubMed  Google Scholar 

  17. Dalla Palma L, Bertolotto M (1999) Introduction to ultrasound contrast agents: physics overview. Eur Radiol 9 (Suppl 3):S338–S342

    PubMed  Google Scholar 

  18. Foley D, Jochem RJ (1991) Computed tomography: focal and diffuse liver disease. Radiol Clin North Am 29:1213–1222

    CAS  PubMed  Google Scholar 

  19. Blomley MKJ, Albrecth T, Cosgrove DO et al. (1999) Improved imaging of the liver metastases with stimulated acustic emission in the late phase of enhancement with the US contrast agent SH U 508A: early experience. Radiology 210:409–416

    CAS  PubMed  Google Scholar 

  20. Herbay A von, Vogt C, Haussinger D (2002) Late-phase pulse-inversion sonography using the contrast agent Levovist: differentiation between benign and malignant focal lesions of the liver. Am J Roentgenol 179:1273–1279

    PubMed  Google Scholar 

  21. Bartolozzi C, Lencioni R, Paolicchi A et al. (1997) Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography. Eur Radiol 7:1410–1415

    CAS  PubMed  Google Scholar 

  22. Strobel D, Krodel U, Martus P et al. (2000) Clinical evaluation of contrast-enhanced color Doppler sonography in the differential diagnosis of liver tumors. J Clin Ultrasound 28:1–13

    CAS  PubMed  Google Scholar 

  23. Leen E (2001) The role of contrast-enhanced ultrasound in the characterisation of focal liver lesions. Eur Radiol 11 (Suppl 3):S27–S34

    Google Scholar 

  24. Wilson SR, Burns PN, Muradali D et al. (2000) Harmonic hepatic US with microbubble contrast agent: initial experience showing improved characterization of hemangioma, hepatocellular carcinoma, and metastasis. Radiology 215:153–161

    CAS  Google Scholar 

  25. Kim TK, Choi BI, Han JK et al. (2000) Hepatic tumors: contrast agent-enhancement patterns with pulse-inversion harmonic US. Radiology 216:411–417

    CAS  PubMed  Google Scholar 

  26. Tanaka S, Ioka T, Oshikawa O et al. (2001) Dynamic sonography of hepatic tumors. Am J Roentgenol 177:799–805

    CAS  Google Scholar 

  27. Wilson SR, Burns PN (2001) Liver mass evaluation of ultrasound: the impact of of microbubble contrast agents and pulse-inversion imaging. Semin Liver Dis 21:147–159

    Article  CAS  PubMed  Google Scholar 

  28. Quaia E, Bertolotto M, Dalla Palma L (2002) Characterization of liver hemangiomas with pulse-inversion harmonic imaging. Eur Radiol 12:537–544

    PubMed  Google Scholar 

  29. Herbay A von, Vogt C, Haussinger D (2002) Pulse-inversion sonography in the early phase of the sonographic contrast agent Levovist: differentiation between benign and malignant focal liver lesions. J Ultrasound Med 21:1191–2000

    PubMed  Google Scholar 

  30. Lencioni R, Cioni D, Bartolozzi C (2002) Tissue harmonic and contrast agent and contrast-specific imaging: back to gray scale in ultrasound. Eur Radiol 12:151–165

    Article  PubMed  Google Scholar 

  31. Mattrey RF, Kono Y (1999) Parenchymal enhancement on gray-scale in normal and pathologic tissues. Eur Radiol 9 (Suppl 3):S359–S363

    PubMed  Google Scholar 

  32. Buetow PC, Pantongrag-Brown L, Buck JL, Ros P, Goodman ZD (1999) Focal nodular hyperplasia of the liver: radiologic–pathologic correlation. Radiographics 16:369–388

    Google Scholar 

  33. Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK (1999) CT and MR imaging of benign hepatic and biliary tumors. Radiographics 19:431–451

    CAS  PubMed  Google Scholar 

  34. Nino-Murcia M, Olcott EW, Jeffrey RB, Lamm RL, Beaulieu CF, Jain KA (2000) Focal liver lesions: pattern-based classification scheme for enhancement at arterial phase CT. Radiology 215:746–751

    CAS  PubMed  Google Scholar 

  35. Bartolotta TV, Midiri M, Galia M, Carcione A, De Maria M, Lagalla R (2001) Benign hepatic tumors: MRI features before and after superparamagnetic iron oxide administration. Radiol Med 101:219–229

    CAS  Google Scholar 

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Author notes

  1. Tommaso Vincenzo Bartolotta

    Present address: Via Del Carabiniere 32, 90146, Palermo, Italy

Authors and Affiliations

  1. Department of Radiology, University of Palermo, Via Del Vespro 127, 90127, Palermo, Italy

    Tommaso Vincenzo Bartolotta, Massimo Midiri, Massimo Galia & Roberto Lagalla

  2. Department of Radiology, Santissima Annunziata Hospital, Taranto, Italy

    Michele Scialpi

  3. Department of Internal Medicine, Vincenzo Cervello Hospital, Palermo, Italy

    Elio Sciarrino

Authors
  1. Tommaso Vincenzo Bartolotta
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  2. Massimo Midiri
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  3. Michele Scialpi
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  4. Elio Sciarrino
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  5. Massimo Galia
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  6. Roberto Lagalla
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Correspondence to Tommaso Vincenzo Bartolotta.

Additional information

This paper has been accepted for presentation as a scientific paper at the Scientific Assembly and Annual Meeting of the ECR 2003.

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Bartolotta, T.V., Midiri, M., Scialpi, M. et al. Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound. Eur Radiol 14, 583–591 (2004). https://doi.org/10.1007/s00330-003-2089-z

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  • DOI: https://doi.org/10.1007/s00330-003-2089-z

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