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Siderotic nodules at MR imaging: regenerative or dysplastic?
G A Krinsky1, V S Lee, M T Nguyen
1Department of Radiology, New York University Medical Center, NY 10016, USA.
Objective:
To determine if iron containing "siderotic" nodules detected at magnetic resonance (MR) imaging are regenerative (RN) or dysplastic (DN) and to attempt to identify features that may distinguish them.
Material And Methods:
MR imaging (1.5 T) was performed on 77 cirrhotic patients who underwent orthotopic liver transplantation within 0-117 days (mean 30 days) of MR imaging. Two readers retrospectively evaluated breath-hold gradient-echo pulse sequences (echo time > or =9.0 ms, flip angle < or =45 degrees) for the presence of hypointense nodules, which were classified as micronodular (< or =3 mm), macronodular (>3 mm), or mixed. Nodule distribution was classified as focal (<5), scattered (5-20), or diffuse (>20) per slice. Thin section pathologic correlation was available in all cases, and Prussian blue iron stains were performed.
Results:
Of 35 patients with pathologically proven siderotic nodules, 10 (29%) had at least 2 siderotic DN. MR detected siderotic nodules in 10 of 10 (100%) patients with siderotic DN and RN, and in 18 of 25 patients (72%) with siderotic RN only.
Conclusion:
Siderotic RN cannot be reliably distinguished from siderotic DN with MR imaging, and therefore the widely used term "siderotic regenerative nodule" should be avoided and replaced by "siderotic nodule."
Insights
Magnetic resonance (MR) imaging cannot reliably differentiate between siderotic regenerative nodules (RN) and dysplastic nodules (DN) in cirrhotic livers. The study recommends using the general term "siderotic nodule" instead of "siderotic regenerative nodule."
Area of Science:
- Radiology
- Hepatology
- Pathology
Background:
- Siderotic nodules are iron-containing lesions found in cirrhotic livers.
- Distinguishing between regenerative nodules (RN) and dysplastic nodules (DN) is crucial for patient management.
- Magnetic resonance (MR) imaging is a key tool for evaluating liver lesions.
Purpose of the Study:
- To determine if iron-containing siderotic nodules detected by MR imaging are regenerative (RN) or dysplastic (DN).
- To identify specific MR imaging features that can differentiate between siderotic RN and DN.
Main Methods:
- MR imaging (1.5 T) was performed on 77 cirrhotic patients prior to liver transplantation.
- Two readers retrospectively evaluated gradient-echo sequences for hypointense nodules.
- Pathologic correlation with Prussian blue iron stains was performed for all cases.
Main Results:
- MR imaging detected siderotic nodules in 100% of patients with both siderotic DN and RN, and in 72% of patients with siderotic RN only.
- Of 35 patients with pathologically proven siderotic nodules, 10 (29%) had at least 2 siderotic DN.
- Siderotic nodules were classified by size (micronodular, macronodular, mixed) and distribution (focal, scattered, diffuse).
Conclusions:
- Siderotic regenerative nodules (RN) cannot be reliably distinguished from siderotic dysplastic nodules (DN) using current MR imaging techniques.
- The term "siderotic regenerative nodule" is potentially misleading and should be replaced by the broader term "siderotic nodule."