title: Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound.
abstract: The aim of this study was to describe gray-scale appearance of liver parenchyma and focal nodular hyperplasia (FNH) by pulse inversion (PI) ultrasound (US) at baseline and after contrast agent administration in patients with normal and fatty liver. Sixteen consecutive patients (12 women, 4 men) with 29 previously diagnosed FNHs (15 of 29 located in normal liver and 14 of 29 in fatty liver) underwent PI US before and after SH U 508A (Levovist) injection. Signal intensity values were measured within the FNHs and the adjacent liver parenchyma in selected images. Baseline echogenicity of fatty liver was higher (15.19 +/- 2.90 dB +/- SD) than normal liver (10.91 +/- 3.15 dB +/- SD; p<0.001). After Levovist administration, normal livers (7 of 16) showed a statistically significant increase of echogenicity (16.59 +/- 3.81 dB +/- SD; p<0.001) in comparison with fatty livers (9 of 16; 15.75 +/- 3.12 dB +/- SD). The FNHs located in normal liver showed baseline echogenicity higher (12.29 +/- 3.22 dB +/- SD) than that of FNHs arising in fatty liver (7.06 +/- 2.43 dB +/- SD; p<0.001). After Levovist administration, FNHs located in normal liver showed a statistically significant increase of echogenicity (25.30 +/- 4.62 dB +/- SD) in comparison with FNHs located in fatty liver (13.58 +/- 3.54 dB +/- SD; p<0.001); the latter always showed mean values of echogenicity lower than surrounding liver parenchyma. In our series decreased contrast-enhancement pattern of both fatty liver and FNHs located in fatty liver was the most prominent finding when Levovist is administered. Contrast washout was a distinctive feature of FNH arising from the fatty liver.
authors.affiliation: Department of Radiology, University of Palermo, Via Del Vespro 127, 90127 Palermo, Italy. tv_bartolotta@yahoo.com
authors.forename: Tommaso Vincenzo
authors.initials: TV
authors.lastname: Bartolotta
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.forename: Michele
authors.initials: M
authors.lastname: Scialpi
authors.forename: Elio
authors.initials: E
authors.lastname: Sciarrino
authors.forename: Massimo
authors.initials: M
authors.lastname: Galia
authors.forename: Roberto
authors.initials: R
authors.lastname: Lagalla
mesh_terms: D000328:Adult; D003287:Contrast Media; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011134:Polysaccharides; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508