Urase A, Tsurusaki M, Kozuki R, Kono A, Sofue K, Ishii K. Imaging characteristics of hypervascular focal nodular hyperplasia-like lesions in patients with chronic alcoholic liver disease. World J Gastroenterol 2025; 31(2): 98031 [DOI: 10.3748/wjg.v31.i2.98031]
Corresponding Author of This Article
Masakatsu Tsurusaki, MD, PhD, Professor, Department of Radiology, Kindai University, Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama 589-8511, Osaka, Japan. mtsuru@dk2.so-net.ne.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Atsushi Urase, Masakatsu Tsurusaki, Ryohei Kozuki, Atsushi Kono, Kazunari Ishii, Department of Radiology, Kindai University, Faculty of Medicine, Osakasayama 589-8511, Osaka, Japan
Masakatsu Tsurusaki, Department of Radiology, Kansai Medical University Medical Center, Moriguchi 570-8507, Osaka, Japan
Keitaro Sofue, Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
Author contributions: Urase A, Tsurusaki M, Sofue K, Kozuki R, Kono A, Ishii K wrote the paper; Urase A and Tsurusaki M designed research; Tsurusaki M performed research; Urase A, Tsurusaki M, Sofue K, Kozuki R, Kono A contributed new reagents or analytic tools; Tsurusaki M analyzed data.
Institutional review board statement: This retrospective study was performed with the approval of the institutional ethics committee of Kindai University, Faculty of Medicine.
Informed consent statement: Informed consent for using their computed tomography and magnetic resonance images and biopsy specimens was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Raw data used in this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masakatsu Tsurusaki, MD, PhD, Professor, Department of Radiology, Kindai University, Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama 589-8511, Osaka, Japan. mtsuru@dk2.so-net.ne.jp
Received: June 15, 2024 Revised: October 25, 2024 Accepted: November 18, 2024 Published online: January 14, 2025 Processing time: 185 Days and 16.2 Hours
Abstract
BACKGROUND
Focal nodular hyperplasia (FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse. Although pathologically similar to hepatocellular carcinoma (HCC) lesions, they are benign. As such, it is important to develop methods to distinguish between FNH-like lesions and HCC.
AIM
To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC.
METHODS
We studied pathologically confirmed FNH-like lesions in 13 patients with alcoholic cirrhosis [10 men and 3 women; mean age: 54.5 ± 12.5 (33-72) years] who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography (CT) and magnetic resonance imaging (MRI), including superparamagnetic iron oxide (SPIO) and/or gadoxetic acid-enhanced MRI. Seven patients also underwent angiography-assisted CT.
RESULTS
The evaluated lesion features included arterial enhancement pattern, washout appearance (low density compared with that of surrounding liver parenchyma), signal intensity on T1-weighted image (T1WI) and T2-weighted image (T2WI), central scar presence, chemical shift on in- and out-of-phase images, and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI. Eleven patients had multiple small lesions (< 1.5 cm). Radiological features of FNH-like lesions included hypervascularity despite small lesions, lack of “corona-like” enhancement in the late phase on CT during hepatic angiography (CTHA), high-intensity on T1WI, slightly high- or iso-intensity on T2WI, no signal decrease in out-of-phase images, and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid. Pathologically, similar to HCC, FNH-like lesions showed many unpaired arteries and sinusoidal capillarization.
CONCLUSION
Overall, the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis. Specifically, SPIO- and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.
Core Tip: Two enhancement patterns were observed for the hepatobiliary phase on gadoxetic acid-enhanced magnetic resonance imaging (MRI): Heterogeneous hyperintense (43%) and ring-like enhancement (57%), and all lesions exhibited a marked homogeneous uptake pattern on superparamagnetic iron oxide-enhanced MRI in patients with focal nodular hyperplasia-like lesions. This finding is of clinical relevance because it is useful for the differential diagnosis of hypervascular liver nodules in patients with chronic liver disease.
