Atypical focal nodular hyperplasia of the liver: imaging features of nonspecific and liver-specific MR contrast agents.
OBJECTIVE
The objective of our study was to describe the functional and differential uptake features of atypical focal nodular hyperplasia using different MR contrast agents and to evaluate their potential role in the diagnosis and characterization of focal nodular hyperplasia.


METHODS
Contrast-enhanced MR images of 45 patients with 85 focal nodular hyperplasia lesions were retrospectively reviewed. In these patients, sonographic findings were nonspecific (n = 37), or CT features were inconclusive (n = 8). Non-liver specific gadolinium chelates were used in 18 patients (48 lesions) suspected of having either focal nodular hyperplasia or hemangioma. The following liver-specific agents were used in patients with suspected focal nodular hyperplasia or metastases: mangafodipir trisodium, 30 patients (55 lesions); ferumoxides, six patients (16 lesions); and SHU 555 A, six patients (six lesions). Individual lesions were quantified by signal intensity and assessed qualitatively by homogeneity, contrast enhancement, and presence of a central scar.


RESULTS
At unenhanced MR imaging, the triad of homogeneity, isointensity, and central scar was found in 22% of the focal nodular hyperplasia lesions. On mangafodipir trisodium-enhanced T1-weighted images, all focal nodular hyperplasia lesions showed contrast uptake: in 64% of the lesions, uptake was equal to parenchyma; 25%, greater than the parenchyma; and 11%, less than the parenchyma. On iron oxide-enhanced T2-weighted images, all focal nodular hyperplasia lesions showed uptake of the contrast agent, but contrast uptake in the lesions was less than in the surrounding parenchyma. Dynamic gadolinium chelate-enhanced MR imaging showed early and vigorous enhancement of focal nodular hyperplasia lesions with rapid washout in 88%. Atypical imaging features of the lesions included hyperintensity on T1-weighted images, necrosis and hemorrhage, and inhomogeneous or only minimal contrast uptake.


CONCLUSIONS
For patients in whom the diagnosis of focal nodular hyperplasia cannot be established on unenhanced or gadolinium-enhanced MR imaging, homogeneous uptake of liver-specific contrast agent with better delineation of central scar may help to make a confident diagnosis of focal nodular hyperplasia.
Ba-Ssalamah
Ahmed
A
Department of Radiology, University of Vienna, Waehringer Gürtel 18-20, A-1090 Vienna, Austria.
Schima
Wolfgang
W
Schmook
Maria T
MT
Linnau
Ken F
KF
Schibany
Nadja
N
Helbich
Thomas
T
Reimer
Peter
P
Laengle
Friedrich
F
Wrba
Friedrich
F
Kurtaran
Amir
A
Ryan
Mark
M
Mann
Frederick A
FA
D000328:Adult; D003287:Contrast Media; D003911:Dextrans; D004492:Edetic Acid / Q000031:analogs & derivatives; D005260:Female; D052203:Ferrosoferric Oxide; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis*; D019786:Gadolinium DTPA; D006801:Humans; D007501:Iron; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D011732:Pyridoxal Phosphate / Q000031:analogs & derivatives; D012189:Retrospective Studies
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D011732:Pyridoxal Phosphate; C064925:gadodiamide; D004492:Edetic Acid; D007501:Iron; C065507:ferumoxides; D019786:Gadolinium DTPA; C060076:N,N'-bis(pyridoxal-5-phosphate)ethylenediamine-N,N'-diacetic acid; D052203:Ferrosoferric Oxide