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New MRI features improve subtype classification of hepatocellular adenoma

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objective

MRI is crucial for the classification of hepatocellular adenomas (HCA) into subtypes. Our objective was to review and increase MRI criteria for subtype classification and define the limits.

Methods

Pathological and radiological data of 116 HCAs were retrospectively analyzed to investigate MRI features of HCA pathological subtypes. Risk for complication was also evaluated with regard to subtype and tumor size.

Results

38/43 (88%) HNF1α-mutated HCAs (H-HCAs) were discriminated by (i) fatty component (homogeneous or heterogeneous) and (ii) hypovascular pattern, with a sensitivity of 88% and a specificity of 97%. 51/58 (88%) inflammatory HCAs (IHCAs) displayed features of sinusoidal dilatation (SD) including three different patterns (global SD, atoll sign, and a new “crescent sign” corresponding to a partial peripheral rim, hyperintense on T2W and/or arterial phase with persistent delayed enhancement). Sensitivity was 88% and specificity 100%. However, some HCA remained unclassifiable by MRI: HCA remodeled by necrotic/hemorrhagic changes covering > 50% of the lesion, H-HCAs without steatosis, IHCAs without SD, β-catenin-mutated and unclassified HCAs. Regarding malignant transformation (5/116) and bleeding (24/116), none was observed when the HCA diameter was smaller than 5.2 cm and 4.2 cm, respectively.

Conclusion

Based on the largest series evaluated until now, we identified several non-described MRI features and propose new highly sensitive and specific MRI criteria. With the addition of these new features, 88% of the two main HCA subtypes could be identified.

Key Points

• HNF1α-mutated hepatocellular adenomas (H-HCA) are characterized by the presence of fat and hypovascular pattern in MRI.

• Inflammatory hepatocellular adenomas (I-HCA) are characterized by different patterns translating sinusoidal dilatation including the newly described crescent sign.

• No MRI specific pattern was identified for β-catenin-mutated HCA (b-HCA).

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Abbreviations

Ass1:

Argininosuccinate synthase 1

AUROC:

Area under the receiver operating characteristic

b-HCA:

β-catenin-mutated HCA

b-IHCA:

β-catenin-mutated inflammatory HCA

CRP:

C-reactive protein

FNH:

Focal nodular hyperplasia

H-HCA:

HNF1α-mutated HCAs

HBP:

Hepatobiliary phase

HCA:

Hepatocellular adenoma

HCC:

Hepatocellular carcinoma

IHCA:

Inflammatory HCA

LFABP:

Liver fatty acid-binding protein

MRI:

Magnetic resonance imaging

SD:

Sinusoidal dilatation

T2W:

T2-weighted sequence

UHCA:

Unclassified HCA

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Acknowledgments

We thank Professors Jean Saric and Laurence Chiche (surgeons); Brigitte Le Bail and Dr. Claire Castain (liver pathologists); and Florent Maire for their clinical contributions to this study.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Sylvain Bise and Nora Frulio contributed equally to this work.

Authors and Affiliations

  1. CHU de Bordeaux, Service d’imagerie diagnostique et interventionnelle, Hôpital Haut-Lévêque, F-33604, Pessac, France

    Sylvain Bise, Nora Frulio, Arnaud Hocquelet, Nicolas Alberti, Hervé Laumonier & Hervé Trillaud

  2. CHU de Bordeaux, Service d’hépato-gastroentérologie et oncologie digestive, Hôpital Haut-Lévêque, F-33604, Pessac, France

    Jean-Frederic Blanc

  3. CHU de Bordeaux, Service de Chirurgie hépato-biliaire et transplantation hépatique, Hôpital Haut-Lévêque, F-33604, Pessac, France

    Christophe Laurent

  4. Université de Bordeaux, INSERM, UMR 1053, F-33076, Bordeaux, France

    Charles Balabaud & Paulette Bioulac-Sage

  5. CHU de Bordeaux, Service de Pathologie, Hopital Pellegrin, F-33076, Bordeaux, France

    Paulette Bioulac-Sage

  6. EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie), Université de Bordeaux, F-33076, Bordeaux, France

    Hervé Trillaud

Authors
  1. Sylvain Bise
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  2. Nora Frulio
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  3. Arnaud Hocquelet
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  4. Nicolas Alberti
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  5. Jean-Frederic Blanc
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  6. Christophe Laurent
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  7. Hervé Laumonier
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  8. Charles Balabaud
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  9. Paulette Bioulac-Sage
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Corresponding author

Correspondence to Nora Frulio.

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Guarantor

The scientific guarantor of this publication is Dr. Frulio Nora.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects (30 cases) have been previously reported in Hepatology 2008 by Laumonier et al—Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Bise, S., Frulio, N., Hocquelet, A. et al. New MRI features improve subtype classification of hepatocellular adenoma. Eur Radiol 29, 2436–2447 (2019). https://doi.org/10.1007/s00330-018-5784-5

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  • DOI: https://doi.org/10.1007/s00330-018-5784-5

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