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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 28, 2008; 14(28): 4529-4534
Published online Jul 28, 2008. doi: 10.3748/wjg.14.4529
Macro-regenerative nodules in biliary atresia: CT/MRI findings and their pathological relations
Jiun-Lung Liang, Yu-Fan Cheng, Allan M Concejero, Tung-Liang Huang, Tai-Yi Chen, Leo Leung-Chit Tsang, Hsin-You Ou
Jiun-Lung Liang, Yu-Fan Cheng, Tung-Liang Huang, Tai-Yi Chen, Leo Leung-Chit Tsang, Hsin-You Ou, Departments of Diagnostic Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan, China
Allan M Concejero, Departments of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan, China
Author contributions: Liang JL and Chen YF designed the research; Liang JL, Tsang LLC, and Ou HY collected the data; Huang TL and Chen TY interpreted the images; Liang JL wrote the paper; Concejero AM revised the manuscript.
Correspondence to: Dr. Yu-Fan Cheng, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, 123 Tai-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan, China. cheng.yufan@msa.hinet.net
Telephone: +886-7-7317123-3027
Fax: +886-7-7318762
Received: May 20, 2008
Revised: June 23, 2008
Accepted: June 30, 2008
Published online: July 28, 2008
Abstract

AIM: To describe the radiological findings of a macro-regenerative nodule (MRN) in the liver of pre-transplantation biliary atresia (BA) patients and to correlate it with histological findings.

METHODS: Between August 1990 and November 2007, 144 BA patients underwent liver transplantation (LT) at our institution. The pre-transplantation computer tomography (CT) and magnetic resonance imaging (MRI) findings were reviewed and correlated with the post-transplantation pathological findings.

RESULTS: Nine tumor lesions in 7 patients were diagnosed in explanted livers. The post-transplantation pathological findings showed that all the lesions were MRNs without malignant features. No small nodule was detected by either MRI or CT. Of the 8 detectable lesions, 6 (75%) were in the central part of the liver, 5 (63%) were larger than 5 cm, 5 (63%) had intra-tumor tubular structures, 3 (38%) showed enhancing fibrous septa, 3 (38%) had arterial enhancement in CT, one (13%) showed enhancement in MRI, and one (13%) had internal calcifications.

CONCLUSION: Although varied in radiological appearance, MRN can be differentiated from hepatocellular carcinoma (HCC) in most of BA patients awaiting LT. The presence of an arterial-enhancing nodule does not imply that LT is withheld solely on the basis of presumed malignancy by imaging studies. Liver biopsy may be required in aid of diagnostic imaging to exclude malignancy.

Keywords: Biliary atresia; Macro-regenerative nodule; Liver neoplasm; Liver transplantation; Computed tomography; Magnetic resonance imaging