Hepatic focal nodular hyperplasia: the "star sign" on gadolinium-enhanced magnetic resonance angiography.
OBJECTIVE
This study aimed at presenting the three-dimensional gadolinium-enhanced magnetic resonance angiography findings of hepatic focal nodular hyperplasia with angiographic correlation.


METHODS
Three patients (one had abdominal pain, two were asymptomatic) with liver mass or nodules in the liver revealed on ultrasound underwent three-dimensional gadolinium-enhanced magnetic resonance angiography. Catheter angiography was available for correlation in all three cases. Other imaging studies including conventional magnetic resonance imaging in three patients, computed tomography in two and scintigraphy scan in one were reviewed. Surgical resection and biopsy were performed in one and two patients respectively.


RESULTS
The ultrasound, computed tomography, magnetic resonance and scintigraphy findings were non-specific for focal nodular hyperplasia in all three patients. However, gadolinium-enhanced magnetic resonance angiography demonstrated tumor vessels radiating from its center to the periphery, which corresponded to the spokes of the characteristic "spoke-wheel" pattern on catheter angiography, producing the so called "star sign," that may suggest the diagnosis of focal nodular hyperplasia. Histopathologic examinations revealed focal nodular hyperplasia.


CONCLUSIONS
This report highlights the usefulness of gadolinium-enhanced magnetic resonance angiography in the diagnosis of hepatic focal nodular hyperplasia by demonstrating the "star sign" and that computed tomography, scintigraphy, and catheter angiography may thus be obviated in such instances.
Ko
Sheung-Fat
SF
Department of Radiology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan. sfatko@admcgmh.com.tw
Ng
Shu-Hang
SH
Lee
Tze-Yu
TY
Wan
Yung-Liang
YL
Lin
Jui-Wei
JW
Chen
Chao-Long
CL
D000293:Adolescent; D000328:Adult; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D005682:Gadolinium