Abstract
Objective
We aimed to systematically review the gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) findings of focal nodular hyperplasia (FNH) and its diagnostic value.
Methods
A thorough literature search was conducted in Ovid-MEDLINE and EMBASE databases to identify studies evaluating Gd-EOB-DTPA-MRI findings of FNH. To evaluate the frequency of characteristic imaging findings on Gd-EOB-DTPA-MRI, pooled proportions of high/iso signal intensity (SI) on the hepatobiliary phase (HBP), arterial enhancement, high/iso SI on the portal-venous phase (PVP) or equilibrium phase (EP), and the central scar were calculated. Meta-analysis was performed to evaluate the diagnostic accuracy of high/iso SI on HBP for distinguishing FNH from hepatocellular adenoma.
Results
A review of 96 articles identified ten eligible articles with 304 patients with FNHs for meta-analysis. Pooled proportion of the Gd-EOB-DTPA-MRI findings showed that high/iso SI on the HBP, arterial enhancement, and high/iso SI on the PVP/EP were observed in 93% (95% CI, 90–97%), 99% (95% CI, 97–100%), and 97% (95% CI, 95–99%) of FNHs, respectively, while a central scar was observed in 61% of FNHs (95% CI, 47–74%). High/iso SI on the HBP was highly accurate for distinguishing FNH from hepatocellular adenoma, with a summary sensitivity of 93.9% (95% CI, 89.1–97.1%) and a specificity of 95.3% (95% CI, 88.4–98.7%).
Conclusions
High/iso SI on the HBP of Gd-EOB-DTPA-MRI is characteristic and a prevalent finding of FNHs and can be helpful in the management of patients with FNH.
Key Points
• The vast majority (94–97 %) of FNHs show high/iso SI on HBP.
• High/iso SI on HBP was accurate for distinguishing FNH from hepatocellular adenoma.
• HBP of Gd-EOB-DTPA-MRI can reduce unnecessary biopsies for the diagnosis of FNHs.
Similar content being viewed by others
References
Charny CK, Jarnagin WR, Schwartz LH et al (2001) Management of 155 patients with benign liver tumours. Br J Surg 88:808–813
Weimann A, Ringe B, Klempnauer J et al (1997) Benign liver tumors: differential diagnosis and indications for surgery. World J Surg 21:983–990, discussion 990-981
Bioulac-Sage P, Balabaud C, Bedossa P et al (2007) Pathological diagnosis of liver cell adenoma and focal nodular hyperplasia: Bordeaux update. J Hepatol 46:521–527
Bluemke DA, Sahani D, Amendola M et al (2005) Efficacy and safety of MR imaging with liver-specific contrast agent: U.S. multicenter phase III study. Radiology 237:89–98
Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV (2009) Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiogr Rev Publ Radiol Soc N Am Inc 29:1725–1748
Vilgrain V, Uzan F, Brancatelli G, Federle MP, Zappa M, Menu Y (2003) Prevalence of hepatic hemangioma in patients with focal nodular hyperplasia: MR imaging analysis. Radiology 229:75–79
Vogl TJ, Kummel S, Hammerstingl R et al (1996) Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 200:59–67
An HS, Park HS, Kim YJ, Jung SI, Jeon HJ (2013) Focal nodular hyperplasia: characterisation at gadoxetic acid-enhanced MRI and diffusion-weighted MRI. Br J Radiol 86:20130299
Bieze M, van den Esschert JW, Nio CY et al (2012) Diagnostic accuracy of MRI in differentiating hepatocellular adenoma from focal nodular hyperplasia: prospective study of the additional value of gadoxetate disodium. AJR Am J Roentgenol 199:26–34
Grazioli L, Bondioni MP, Haradome H et al (2012) Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 262:520–529
Grieser C, Steffen IG, Seehofer D et al (2013) Histopathologically confirmed focal nodular hyperplasia of the liver: Gadoxetic acid-enhanced MRI characteristics. Magn Reson Imaging 31:755–760
Gupta RT, Iseman CM, Leyendecker JR, Shyknevsky I, Merkle EM, Taouli B (2012) Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium. AJR Am J Roentgenol 199:35–43
Haimerl M, Wachtler M, Platzek I et al (2013) Added value of Gd-EOB-DTPA-enhanced Hepatobiliary phase MR imaging in evaluation of focal solid hepatic lesions. BMC Med Imaging 13:41
Mohajer K, Frydrychowicz A, Robbins JB, Loeffler AG, Reed TD, Reeder SB (2012) Characterization of hepatic adenoma and focal nodular hyperplasia with gadoxetic acid. J Magn Reson Imaging JMRI 36:686–696
Purysko AS, Remer EM, Coppa CP, Obuchowski NA, Schneider E, Veniero JC (2012) Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. AJR Am J Roentgenol 198:115–123
Van Kessel CS, De Boer E, Ten Kate FJW, Brosens LAA, Veldhuis WB, Van Leeuwen MS (2013) Focal nodular hyperplasia: Hepatobiliary enhancement patterns on gadoxetic-acid contrast-enhanced MRI. Abdom Imaging 38:490–501
Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO (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. Investig Radiol 43:504–511
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25
Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12:1293–1316
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634
Duval S, Tweedie R (2000) Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463
Bieze M, Phoa S, Busch O, Verheij J, Gouma D, Van Gulik T (2012) Outcomes of liver resection for hepatocellular adenoma and focal nodular hyperplasia; results of a prospective trial. HPB 14:277
Chung YE, Kim MJ, Kim YE, Park MS, Choi JY, Kim KW (2013) Characterization of Incidental Liver Lesions: Comparison of Multidetector CT versus Gd-EOB-DTPA-Enhanced MR Imaging. PLoS One 8:e66141
Holzapfel K, Eiber MJ, Fingerle AA, Bruegel M, Rummeny EJ, Gaa J (2012) Detection, classification, and characterization of focal liver lesions: Value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods. Abdom Imaging 37:74–82
Hope TA, Saranathan M, Petkovska I, Hargreaves BA, Herfkens RJ, Vasanawala SS (2013) Improvement of gadoxetate arterial phase capture with a high spatio-temporal resolution multiphase three-dimensional SPGR-dixon sequence. J Magn Reson Imaging 38:938–945
Rhee H, Kim MJ, Park MS, Kim KA (2012) Differentiation of early hepatocellular carcinoma from benign hepatocellular nodules on gadoxetic acid-enhanced MRI. Br J Radiol 85:e837–e844
Saito K, Yoshimura N, Saguchi T et al (2012) MR characterization of focal nodular hyperplasia: gadoxetic acid versus superparamagnetic iron oxide imaging. Magn Reson Med Sci MRMS Off J Jpn Soc Magn Reson Med 11:163–169
Jaeschke R, Guyatt GH, Sackett DL (1994) Users′ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA J Am Med Assoc 271:703–707
Grazioli L, Morana G, Federle MP et al (2001) Focal nodular hyperplasia: morphologic and functional information from MR imaging with gadobenate dimeglumine. Radiology 221:731–739
Halavaara J, Breuer J, Ayuso C et al (2006) Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT–a multicenter trial. J Comput Assist Tomogr 30:345–354
American College of Radiology. ACR Appropriateness Criteria: Liver Lesion - Initial Characterization.
De Carlis L, Pirotta V, Rondinara GF et al (1997) Hepatic adenoma and focal nodular hyperplasia: diagnosis and criteria for treatment. Liver Transpl Surg 3:160–165
Herman P, Pugliese V, Machado MA et al (2000) Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment. World J Surg 24:372–376
Leese T, Farges O, Bismuth H (1988) Liver cell adenomas. A 12-year surgical experience from a specialist hepato-biliary unit. Ann Surg 208:558–564
Morana G, Grazioli L, Kirchin MA et al (2011) Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Investig Radiol 46:225–239
Brismar TB, Dahlstrom N, Edsborg N, Persson A, Smedby O, Albiin N (2009) Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA: a comparison in healthy volunteers. Acta Radiol (Stockholm, Sweden : 1987) 50:709–715
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100
Acknowledgments
The scientific guarantor of this publication is Hyun Kwon Ha. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Kyung Won Kim) has significant statistical expertise. Institutional Review Board approval was obtained. Neither Institutional Review Board approval nor written informed consent were required required for this study, because of the nature of our study, which was a systemic review and meta-analysis. Methodology: Meta-analysis, performed at one institution.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suh, C.H., Kim, K.W., Kim, G.Y. et al. The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis. Eur Radiol 25, 950–960 (2015). https://doi.org/10.1007/s00330-014-3499-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-014-3499-9