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Focal Nodular Hyperplasia and Hepatic Adenoma: Differentiation with Low-Mechanical-Index Contrast-Enhanced Sonography

Tae Kyoung Kim1, Hyun-Jung Jang1, Peter N. Burns2, Jessica Murphy-Lavallee1 and Stephanie R. Wilson1,3

1 Department of Medical Imaging, Tornoto General Hospital, University of Tornoto, 585 University Ave., Toronto, ON M5G 2N2, Canada.
2 Imaging Research, Sunnybrook Health Sciences Centre and Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, ON, Canada.
3 Present address: Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.


Figure 1
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  		Fig. 1A —Focal nodular hyperplasia in 37-year-old asymptomatic woman. Oblique contrast-enhanced sonograms at 12 (A), 14 (B), and 20 (C) seconds after microbubble contrast injection show mass with central stellate arteries and centrifugal filling followed by strong, homogeneous enhancement of mass.

 

Figure 2
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  		Fig. 1B —Focal nodular hyperplasia in 37-year-old asymptomatic woman. Oblique contrast-enhanced sonograms at 12 (A), 14 (B), and 20 (C) seconds after microbubble contrast injection show mass with central stellate arteries and centrifugal filling followed by strong, homogeneous enhancement of mass.

 

Figure 3
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  		Fig. 1C —Focal nodular hyperplasia in 37-year-old asymptomatic woman. Oblique contrast-enhanced sonograms at 12 (A), 14 (B), and 20 (C) seconds after microbubble contrast injection show mass with central stellate arteries and centrifugal filling followed by strong, homogeneous enhancement of mass.

 

Figure 4
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  		Fig. 1D —Focal nodular hyperplasia in 37-year-old asymptomatic woman. Contrast-enhanced sonogram 240 seconds after injection shows sustained positive enhancement of mass relative to normal liver and central nonenhancing area representing central scar (arrow).

 

Figure 5
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  		Fig. 2A —Focal nodular hyperplasia in 33-year-old man with abdominal pain. Oblique contrast-enhanced sonogram 7 seconds after microbubble contrast injection shows mass with central stellate arteries (arrow).

 

Figure 6
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  		Fig. 2B —Focal nodular hyperplasia in 33-year-old man with abdominal pain. Contrast-enhanced sonograms 8 (B) and 9 (C) seconds after injection show centrifugal progression of enhancement and subsequent homogeneous enhancement of mass. Transient peripheral unenhanced zone (arrows, B) is visualized in periphery of lesion that gradually disappears as enhancement fills entire mass.

 

Figure 7
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  		Fig. 2C —Focal nodular hyperplasia in 33-year-old man with abdominal pain. Contrast-enhanced sonograms 8 (B) and 9 (C) seconds after injection show centrifugal progression of enhancement and subsequent homogeneous enhancement of mass. Transient peripheral unenhanced zone (arrows, B) is visualized in periphery of lesion that gradually disappears as enhancement fills entire mass.

 

Figure 8
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  		Fig. 3A —Hepatic adenoma in 40-year-old woman with lightheadedness. Transverse contrast-enhanced sonograms 9 (A), 11 (B), and 12 (C) seconds after microbubble contrast injection show large mass (arrows, A) that virtually fills field of view. Note peripheral arteries feeding mass and subsequent centripetal progression of intratumoral enhancement.

 

Figure 9
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  		Fig. 3B —Hepatic adenoma in 40-year-old woman with lightheadedness. Transverse contrast-enhanced sonograms 9 (A), 11 (B), and 12 (C) seconds after microbubble contrast injection show large mass (arrows, A) that virtually fills field of view. Note peripheral arteries feeding mass and subsequent centripetal progression of intratumoral enhancement.

 

Figure 10
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  		Fig. 3C —Hepatic adenoma in 40-year-old woman with lightheadedness. Transverse contrast-enhanced sonograms 9 (A), 11 (B), and 12 (C) seconds after microbubble contrast injection show large mass (arrows, A) that virtually fills field of view. Note peripheral arteries feeding mass and subsequent centripetal progression of intratumoral enhancement.

 

Figure 11
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  		Fig. 3D —Hepatic adenoma in 40-year-old woman with lightheadedness. Contrast-enhanced sonogram 233 seconds after injection shows sustained enhancement and isoechogenicity of mass (arrows) relative to normal liver.

 

Figure 12
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  		Fig. 4A —Hepatic adenoma in 47-year-old man with mass detected in abdomen during exercise. Oblique contrast-enhanced sonograms 6 (A), 8 (B), and 11 (C) seconds after microbubble contrast injection show mass with mixed filling of arterial enhancement.

 

Figure 13
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  		Fig. 4B —Hepatic adenoma in 47-year-old man with mass detected in abdomen during exercise. Oblique contrast-enhanced sonograms 6 (A), 8 (B), and 11 (C) seconds after microbubble contrast injection show mass with mixed filling of arterial enhancement.

 

Figure 14
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  		Fig. 4C —Hepatic adenoma in 47-year-old man with mass detected in abdomen during exercise. Oblique contrast-enhanced sonograms 6 (A), 8 (B), and 11 (C) seconds after microbubble contrast injection show mass with mixed filling of arterial enhancement.

 

Figure 15
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  		Fig. 4D —Hepatic adenoma in 47-year-old man with mass detected in abdomen during exercise. Contrast-enhanced sonogram 116 seconds after injection shows washout of mass relative to normal liver. Biopsy was recommended.

 

Figure 16
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  		Fig. 5A —Differentiating focal nodular hyperplasia from adenoma on contrast-enhanced sonography. Graphs show results of receiver operating characteristic (ROC) analysis for readers 1 (A) and 2 (B). Solid line shows fitted ROC curve and dotted lines show 95% CI of fitted curve.

 

Figure 17
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  		Fig. 5B —Differentiating focal nodular hyperplasia from adenoma on contrast-enhanced sonography. Graphs show results of receiver operating characteristic (ROC) analysis for readers 1 (A) and 2 (B). Solid line shows fitted ROC curve and dotted lines show 95% CI of fitted curve.

 

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