Evidence map›Paper›PMID 40369264›Full record

ArticleEuropean radiology2025

Qualitative and quantitative assessment of gadoxetic acid MRI in distinguishing atypical focal nodular hyperplasia from hepatocellular adenoma subtypes.

Khaled Y Elbanna, Korosh Khalili, May AlMoharb, Ankur Goel, Sandra Fischer, Tae Kyoung Kim

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Article in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2 citing papers in PubMed.

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5 · Who and what money

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6 authors.

Khaled Y ElbannaUniversity Medical Imaging Toronto, University Health Network, University of Toronto, Toronto, ON, Canada. khaled.elbanna@uhn.ca.ORCID http://orcid.org/0000-0001-6499-9261
Korosh KhaliliUniversity Medical Imaging Toronto, University Health Network, University of Toronto, Toronto, ON, Canada.
May AlMoharbDepartment of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Ankur GoelUniversity Medical Imaging Toronto, University Health Network, University of Toronto, Toronto, ON, Canada.
Sandra FischerLaboratory Medicine Program, Princess Margaret Cancer Centre Research Institute, University Health Network. University of Toronto, Toronto, ON, Canada.
Tae Kyoung KimUniversity Medical Imaging Toronto, University Health Network, University of Toronto, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess qualitative and quantitative imaging features, including lesion-to-liver contrast enhancement ratio (LLCER), on gadoxetic acid-enhanced MRI for differentiating atypical focal nodular hyperplasia (aFNH) from hepatocellular adenoma (HCA) subtypes. MATERIALS AND

methodsThis retrospective study included patients with histopathologically-confirmed aFNH and HCA who underwent gadoxetic acid-enhanced MRI between January 2010 and December 2020. Two radiologists assessed qualitative imaging features and calculated LLCERs for quantitative evaluation of HBP enhancement. Statistical analyses included ROC curves, sensitivity, specificity, and a decision tree.

results86 patients (41 ± 11 years; 64 women) had 29 aFNHs and 90 HCAs. HBP iso-/hyperintensity was observed in 72.4% (21/29) of aFNH compared to 28.8% (15/52) of U-HCA, 35% (7/20) of I-HCA, and 0% (0/11) of H-HCA. β-HCA showed 71.4% (5/7) iso-/hyperintensity, overlapping with aFNH (p = 0.17). Homogeneous iso-/hyperintensity and rim-like enhancement were present in 48.3% (14/29) and 20.7% (6/29) of aFNH but absent in β-HCA (p = 0.004). LLCER demonstrated high diagnostic performance, differentiating aFNH from U-HCA, H-HCA, and I-HCA(AUCs 0.91-0.99, sensitivities 82.8-96.6%, specificities 90.0-100%). For β-HCA, LLCER showed overlap with aFNH; AUCs (0.62-0.64) and specificities (57.1%). Among HCAs with HBP iso-/hyperintensity, 74.1% had negative LLCER values, while 25.9% (mostly β-HCA/U-HCA) showed positive values (true enhancement). Combined decision trees selected LLCER as the primary node, with downstream HBP features variably incorporated, except β-HCA, which solely used qualitative features.

conclusionHBP iso-/hyperintensity and LLCER reliably differentiated aFNH from most HCA subtypes, except β-HCA, validated by decision tree analyses. Homogeneous iso-/hyperintensity or rim-like enhancement was absent in β-HCA, aiding differentiation. KEY POINTS: Question Variability in hepatobiliary phase (HBP) enhancement among hepatocellular adenoma (HCA) subtypes and atypical FNH (aFNH) poses diagnostic challenges. Findings Despite HBP enhancement overlap in aFNH/β-HCA, "homogeneous" and rim-like enhancement aided aFNH differentiation from HCAs. LLCER separated HCAs lacking true HBP uptake from aFNH. Clinical relevance This study explored challenges in differentiating aFNH from HCA subtypes, especially overlapping β-HCA, highlighting discriminatory qualitative markers and quantitative assessment to distinguish true HBP enhancement, an approach validated by decision tree analysis.

Indexed as

Adenoma, Liver CellFocal Nodular HyperplasiaGadolinium DTPALiver NeoplasmsMagnetic Resonance ImagingAdultContrast MediaDiagnosis, DifferentialFemaleHumansImage EnhancementLiverMaleMiddle AgedRetrospective StudiesSensitivity and SpecificityContrast MediaGadolinium DTPAgadolinium ethoxybenzyl DTPAAdenoma (liver cell)Focal nodular hyperplasiaHepatobiliary contrast agentsLiver neoplasmsMagnetic resonance imaging

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PMID40369264

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.