Hepatic focal nodular hyperplasia of the CT and MR diagnosis of_4161

By Karen Hawkins,2014-10-30 14:09
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Hepatic focal nodular hyperplasia of the CT and MR diagnosis of_4161

    Hepatic focal nodular hyperplasia of the CT and MR diagnosis of

     Abstract Objective To analyze the hepatic focal nodular hyperplasia (FNH) of the CT, MR performance levels, aimed at improving the diagnosis of FNH. Methods pathological examination confirmed FNH 8 cases underwent

    CT examination in 7 cases, line MR examination in 2 cases, while row CT and MR examination in 1 case, and review the literature to explore its CT, MR manifestations. The results of CT scan lesions showed homogeneous or

    inhomogeneous low-density, enhanced scan arterial phase except for central scar, all lesions were markedly enhanced, portal venous phase was slightly higher density, latency period of four lesions was slightly higher or equal density, 3 lesions showed slightly low density; three lesions were

    delayed enhanced central scar. Unenhanced MR lesion was slightly longer or equal to T1, T2 signal; enhancing lesions showed markedly enhanced arterial phase, portal venous phase and the extension of the period was slightly higher or equal to signal the central scar lesions enhance delay. Conclusion CT, MRI, in particular, dynamic contrast-enhanced scanning in

    the diagnosis of FNH of great value.

     Key words X-ray computed MRI focal nodular hyperplasia

     Abstract Objective To evaluate the MR imaging and CT appearance of focal nodular hyperplasia (FNH) of the liver and improve the accuracy of diagnosis in FNH. Methods The CT and MRI findings of 8 patients pathologically confirmed FNH were studied retrospectively. 7 patients were

    examined by CT and 2 patients were examined by MRI. 1 patient had both CT and MRI examination. Results On plain CT, the lesions showed heterogeneous or homogeneous hypodensity. On postcontrast CT, the lesions showed intense and homogeneous enhancement during arterial phase, except for 3 lesions with the central scar. During portal vein phase, the lesions showed moderate hyperdensity. During delayed phase, 4 leisons remained mild hyperdensity or isodensity and 3 leisons showed hypodensity. 3 lesions

    with central scars demonstrated delayed enhancement. On MR imageing, the lesion showed slightly long or iso-T1 and T2 signal intensity,

    demonstrating intense arterial enchancement and moderate portal and delayed enhancement on Gd-DTPA contrast studies. Central scar delayed

    enhancement. Conclusion MR and CT especially dynamic contrast enhancement is of great value to the diagnosis of FNH.

     Key words X-ray computed Magnetic resonance imaging Focal nodular hyperplasia

     Hepatic focal nodular hyperplasia (focal nodular hyperplsia, FNH) is a rare benign nodular lesions of the liver, the incidence rate of the solid space-occupying lesions of liver 2.7%, female patients (about 79%) . Onset age from 3 months to 64 years old, more common 20 to 50 years old. The vast majority of patients had no obvious clinical symptoms, rather than accidentally discovered during physical examination, only about 15%

    can cause symptoms, often in upper abdominal pain and mass, a rare spontaneous rupture and abdominal bleeding. This disease is not malignant potential, long-term follow-up are reduced and the self-healing tendency,

    generally do not need treatment, with clinical symptoms of possible


     A clinical data

     1.1 General Information

     Collected from May 1995 to October 2005 in our hospital CT and / or MR examination and pathologically confirmed FNH 8 Li (CT examination in 7 cases, MR examination in 2 cases, 1 case at the same time-line CT and MR

    examination), in which men 3 cases and 5 females, aged 32 to 42 years (mean 38 years). Lesions were found on physical examination or accidentally, no chronic hepatitis, cirrhosis of the history of alpha-

    fetoprotein (AFP) negative.

     1.2 Methods

     Using siemens sensation 16 row CT, pitch of 1.0, from top to bottom row, after a one-time breath-hold scan, scan range from the diaphragm to the liver under the top edge, 5mm reconstruction, underwent arterial

    phase, portal phase, delayed phase ? phase scanning, contrast agent 60%

    of the security radio Lectra, 80 ~ 100ml, 3ml / s intravenous bolus injection, delay 30s (arterial phase), 30s (portal phase), 60s (late period) after the scan.

     Using siemens symphony 1.5T MRI, intravenous bolus injection Gd-DTPA

    dynamic contrast-enhanced scans in stage ?, slice thickness 5 ~ 8mm,

spacing 2 ~ 3mm.

     2 Results

     The patients, CT scan lesions showed homogeneous or inhomogeneous

    low-density, enhanced scan arterial phase except for central scar, all lesions were markedly enhanced, portal venous phase was slightly higher density, latency period of four lesions was slightly higher or equal to density, three lesions showed slightly low density; three lesions of the

    central scar were delayed enhanced arterial phase enhancing lesions showed markedly enhanced portal venous phase and delayed phase showed slightly higher or equal to signal the central scar lesions enhance delay. Figure 1

    ~ 3.

     3 Discussion

     3.1 Pathogenesis

     Hepatic focal nodular hyperplasia (FNH) of unknown etiology, most scholars believe that this disease is a hamartoma, or a vascular malformation of the liver response to sexual expression, rather than

    authenticity tumor. Wanles so that the lesion artery diameter larger and portal vein branches, suggesting that sinusoidal blood supply due to arterial or blood flow increased, which led to nodular hyperplasia of liver cells. Some scholars believe that FNH is basically is a kind of

    arteriovenous anastomosis of vascular malformations and local ingredients for all the excessive proliferation of liver tissue. FNH has been reported abroad, accompanied by a cerebral vascular malformation, meningioma, and

    astrocytoma syndrome.

     Pathological changes of 3.2

     FNH often as a single sharp eyes, good hair in the liver capsule, the diameter of about 1 ~ 20cm, in order to <6cm more common, the surface of umbilical-like depression, the aspect nodule with the surrounding liver

    tissue showed a clear boundary, but no capsule, lesions are generally brown or light brown. Nodule-like scar tissue between the Astral, fiber

    intervals from the central to the surrounding radiation, showing cirrhosis of the liver is not completely separated. Mirror view of Nguyen et al [1] the FNH is divided into classical and non-classical categories. Classic

    FNH microscopic features: the proliferation of fiber spacing will be divided into liver nodules, nodules and normal liver cell shape, size

    consistent, single or double rows, is no different-type nature of hepatic

    lobule structure, normal; fiber interval shows thick-walled blood vessels

    and proliferation of small bile ducts, and have inflammatory cell infiltration. Non-classical FNH lesions in the non-proliferation of fiber

    spacing but the congestion of the blood vessel expansion chamber, also known as blood vessels dilated FNH. Reposted elsewhere in the paper for free download http://

     3.3 CT manifestations

     CT diagnosis of FNH poor sensitivity and specificity, reported in the literature only 30% to 50% of patients can have a more typical changes in [2 ~ 4]: the realm of clear and plain isodense or slightly low density central scar tissue showed low density; dynamic contrast-enhanced arterial

    phase and portal performance is significantly enhanced early rapid homogeneous significantly enhanced, portal and delayed phase enhanced degree of advanced rapidly or gradually decreased, while the drainage of blood vessels around the edge of FNH portal venous phase and delayed phase was not complete thin rim enhancement, central scar tissue delayed

    enhancement. FNH of dynamic contrast-enhanced performance is closely

    related to its hemodynamic basis, FNH is characterized by a typical centrifugal blood supply of the blood supply, one or more feeding arteries from the central scar given to the distribution of spokes-like radiation

    to the edges. FNH drainage ways very unique in the lesion and normal liver at the junction area and the central scar seen in the thick of the large veins. 7 patients in this group are the typical CT manifestations. FNH has

    been reported there are two drainage paths, one through the draining vein into the hepatic vein, another one through the lesions within the cavernous sinus into the adjacent liver tissue. The individual reported in the literature, FNH within the copper-binding protein can cause excessive

    deposition of CT scan showed a high density. Are reported in the literature FNH may appear uneven strengthened, considering the possibility of its growth over the blood supply, causing lesions related to changes in

    homogeneity, or oral contraceptives related to changes in its blood supply. FNH no real capsule, close to a rare liver fibrosis pressure, it is reported the formation of FNH Pathologic see the fibrous capsule may be due to large lesions, slow growth, thickening of the surrounding liver

    caused by a passive matrix.

     3.4 MR performance

     Most scholars believe that MR is the best way to diagnosis of FNH, the sensitivity and specificity respectively "70%" 90%, but only 1 / 3 of the patients had typical MR manifestations [2 ~ 5]. Generally considered typical of FNH of the MR showed T1WI showed equal or slightly lower than the signal; T2WI showed equal or slightly higher than the signal; central scar tissue was T1WI low signal, T2WI, and PDWI for the high signal,

signal uniformity, MR can show diameter

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