title: Differentiation of focal nodular hyperplasia from hepatocellular adenomas with low-mechanical-index contrast-enhanced sonography (CEUS): effect of size on diagnostic confidence.
abstract: OBJECTIVE
  The purpose of this study was to assess the diagnostic performance of contrast-enhanced sonography (CEUS) for the differentiation of focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) according to lesion size.
  
  
  METHODS
  Forty patients with a definite diagnosis of FNH or HCA who underwent CEUS were included in this institutional review board (IRB)-approved study. A total of 43 FNHs and 20 HCAs, including 15 inflammatory HCAs and five unclassified HCAs, were analysed. Two radiologists reviewed the diagnostic CEUS parameters separately and in consensus, including the presence or absence of centrifugal filling and central vessels. The sensitivity (Se), specificity (Sp), and inter-observer confidence (Kappa) of CEUS diagnostic parameters were assessed.
  
  
  RESULTS
  Inter-observer agreement of CEUS for FNH diagnosis was high (kappa = 0.81) with an overall Se of 67.4% [29/43 (CI 95%: 51.4-80.1 %)] and an Sp of 100% [20/20 (CI 95%: 81-100%)]. Significantly higher Se figures were found for lesions ≤ 35 mm than for lesions > 35 mm [respectively, 93 % (28/30) (CI 95%: 77.6-99.2) vs. 7.7% (1/13) (CI 95%: 0.2-36%), p = 0.002] with unchanged specificity.
  
  
  CONCLUSIONS
  CEUS is highly specific for the diagnosis of FNH, with very good inter-observer agreement, whatever the size, but its sensitivity is significantly reduced in diagnosing lesions larger than 35 mm.
  
  
  CONCLUSIONS
  • CEUS is highly specific for the diagnosis of FNH, regardless of lesion size • CEUS shows reduced sensitivity in diagnosing FNH lesions larger than 35 mm • The filling patterns of hepatocellular adenomas are not affected by lesion size.
authors.affiliation: Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, Creteil, 94010, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Roche
authors.forename: Frederic
authors.initials: F
authors.lastname: Pigneur
authors.forename: Lambros
authors.initials: L
authors.lastname: Tselikas
authors.forename: Marion
authors.initials: M
authors.lastname: Roux
authors.forename: Laurence
authors.initials: L
authors.lastname: Baranes
authors.forename: Marjane
authors.initials: M
authors.lastname: Djabbari
authors.forename: Charlotte
authors.initials: C
authors.lastname: Costentin
authors.forename: Julien
authors.initials: J
authors.lastname: Calderaro
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
mesh_terms: D018248:Adenoma, Liver Cell / Q000150:complications / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media