title: Interest of contrast-enhanced sonography to identify focal nodular hyperplasia with sinusoidal dilatation.
abstract: OBJECTIVE
  Focal nodular hyperplasia with major sinusoidal dilatation (FNH-sd) is a misleading entity, with some features resembling inflammatory hepatocellular adenoma (HCA). We aimed to assess the performance of contrast-enhanced ultrasound (CEUS) for the diagnosis of FNH-sd.
  
  
  METHODS
  Four histologically proven FNH-sd nodules in four patients were investigated with both MRI and CEUS imaging. Sinusoidal dilatation was focally visible in all cases in histology.
  
  
  RESULTS
  In MRI, in all the four cases, lesions were hypervascular in arterial phase, with high intensity in T2-weighted sequence imaging and persistent enhancement in the delayed gadolinium-enhanced phase. These MRI features were more indicative of HCA than FNH. On the other hand, CEUS showed a very specific centrifugal filling followed by a strong, homogeneous enhancement of the whole lesion.
  
  
  CONCLUSIONS
  CEUS seems to be an essential step for the diagnosis of non-typical FNH, such as FNH-sd. This small series highlights the interest of performing both CEUS and MRI for the diagnosis of atypical focal liver lesions, such as FNH-sd.
authors.affiliation: Service d'imagerie diagnostique et interventionnelle, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France. Electronic address: nicolasalberti@aol.com.
authors.forename: N
authors.initials: N
authors.lastname: Alberti
authors.affiliation: Service d'imagerie diagnostique et interventionnelle, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
authors.forename: N
authors.initials: N
authors.lastname: Frulio
authors.affiliation: Inserm U1053, université Bordeaux Segalen, 33076 Bordeaux, France; Pathology Department, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, Bordeaux, France.
authors.forename: P
authors.initials: P
authors.lastname: Bioulac-Sage
authors.affiliation: Service d'imagerie diagnostique et interventionnelle, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
authors.forename: H
authors.initials: H
authors.lastname: Laumonier
authors.affiliation: Inserm U1053, université Bordeaux Segalen, 33076 Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Balabaud
authors.affiliation: Service d'imagerie diagnostique et interventionnelle, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
authors.forename: J-T
authors.initials: JT
authors.lastname: Perez
authors.affiliation: Radiology Department, Institut Bergonié, Regional Cancer Center, 33076 Bordeaux cedex, France.
authors.forename: F R
authors.initials: FR
authors.lastname: Teixeira
authors.affiliation: Service d'imagerie, Hôpital d'Instruction des Armées Robert Picqué, 351, route de Toulouse, 33140 Villenave-d'Ornon, France.
authors.forename: N
authors.initials: N
authors.lastname: Harbonnier
authors.affiliation: Service d'imagerie diagnostique et interventionnelle, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
authors.forename: H
authors.initials: H
authors.lastname: Trillaud
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D049109:Cell Proliferation; D003287:Contrast Media; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D033162:Incidental Findings; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010743:Phospholipids; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast-enhanced ultrasound; Focal nodular hyperplasia; Glutamine synthetase; Inflammatory hepatocellular adenoma; Sinusoidal dilatation