Focal nodular hyperplasia: spoke-wheel arterial pattern and other signs on dynamic contrast-enhanced ultrasonography

To evaluate the prevalence of spoke-wheel pattern and typical symptoms of focal nodular hyperplasia (FNH) by means of dynamic contrast-enhanced ultrasonography (CEUS) in relation to lesion size.

Twenty-eight patients were included in the trial, in whom, based on the CEUS, we raised suspicion of hypervascularized liver lesion; there were 30 lesions altogether. The final diagnosis of FNH was verified by means of CT, MRI or lesion biopsy. Majority of patients (26) were females, compared to 2 male, with average age of 33.3 years. Average lesion size was 45.6 mm. Besides the ultrasound examination, we used also "blood pool" ultrasound contrast agent of second generation, sulphur hexafluoride (BR1); we evaluated enhancement of the lesion until the late stage-within 5 min from application.

In lesions larger than 3 cm (n=20), stellate vascular enhancement was found in 19 cases (95.0%) early in arterial phase. As for lesions smaller than 3 cm (n=10), spoke-wheel pattern was observed only in 3 cases (30%) and lesions smaller than 2 cm practically did not show this phenomenon at all (n=1; 17%). Generally, symptom of spoke-wheel pattern was observed in 22 cases, i.e. in 73.3%. In total, central scar was present in 63.3% (n=19) of cases. In lesions larger than 3 cm, it was present in 85.0% (n=17), in lesions smaller than 3 cm in 20% (n=2).

Contrast-enhanced ultrasonography can be the final diagnostic method for FNH larger than 3 cm which has typical spoke-wheel vessel structure on CEUS. If this phenomenon is not present and the central scar is not visible, specific diagnosis of FNH cannot be based solely on CEUS findings.