title: Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI.
abstract: OBJECTIVE
  To determine the value of quantitative analysis of the hepatobiliary phase (HBP) in gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA).
  
  
  METHODS
  Thirty-eight patients bearing 67 lesions (40 FNH; 27 HCA) were retrospectively included in this Institutional Review Board-approved study. The same volumetric interpolated breath-hold examination (VIBE) T1 -weighted sequences were performed before and after contrast injection on a 1.5T MRI, with HBP images acquired with a mean delay of 80 minutes (range 60-120 min). After a visual assessment of lesions enhancement (qualitative HBP analysis), the HBP signal intensity ratio (SIR) and the lesion-to-liver contrast enhancement ratio (LLCER) were calculated for each lesion by two observers (Mann-Whitney test). The sensitivities, specificities (receiver operating characteristic [ROC] curve analysis) and interobserver correlation (intraclass coefficient, ICC) of quantitative HBP analysis were determined.
  
  
  RESULTS
  All FNH and 44.4% of HCA appeared hyper- or isointense relative to the adjacent liver on qualitative HBP analysis. The mean SIR (P < 0.01) and LLCER (P < 0.0001) of FNH were significantly higher than that of HCA. The area under the ROC curve for the differentiation of FNH from HCA with LLCER was 0.98 for both observers. With a cutoff value of -0.3%-observer 1 with highest experience- LLCER assessment provided respective sensitivity and specificity values of 100% and 96.2% for the differentiation of FNH from HCA. The ICC was 0.7 for SIR measurements and 0.8 for LLCER measurements.
  
  
  CONCLUSIONS
  Quantitative LLCER assessment allows an accurate differentiation of FNH from HCA, even in hyper- or isointense HCA on HBP images.
authors: AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.
authors: Marion
authors: M
authors: Roux
authors: AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.
authors: Frederic
authors: F
authors: Pigneur
authors: Paris Est Creteil University, Creteil, France.|AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France.
authors: Julien
authors: J
authors: Calderaro
authors: AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.
authors: Laurence
authors: L
authors: Baranes
authors: AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.|Paris Est Creteil University, Creteil, France.
authors: Mélanie
authors: M
authors: Chiaradia
authors: AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.
authors: Lambros
authors: L
authors: Tselikas
authors: Paris Est Creteil University, Creteil, France.|AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France.
authors: Thomas
authors: T
authors: Decaens
authors: Paris Est Creteil University, Creteil, France.|AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France.
authors: Charlotte
authors: C
authors: Costentin
authors: Paris Est Creteil University, Creteil, France.|AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France.
authors: Alexis
authors: A
authors: Laurent
authors: Paris Est Creteil University, Creteil, France.|AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France.
authors: Daniel
authors: D
authors: Azoulay
authors: Paris Est Creteil University, Creteil, France.|AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France.
authors: Ariane
authors: A
authors: Mallat
authors: Paris Est Creteil University, Creteil, France.|AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France.
authors: Elie-Serge
authors: ES
authors: Zafrani
authors: AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.|Paris Est Creteil University, Creteil, France.
authors: Alain
authors: A
authors: Rahmouni
authors: AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.|Paris Est Creteil University, Creteil, France.|INSERM Unite U 955, Equipe 17, Molecular Mechanisms of Liver Fibrosis, Creteil, France.
authors: Alain
authors: A
authors: Luciani
mesh_terms: D018248:Adenoma, Liver Cell / Q000473:pathology*; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine
keywords: Gd-BOPTA; MRI; focal nodular hyperplasia; hepatocellular adenoma; liver; quantitative analysis