Transarterial embolization of symptomatic focal nodular hyperplasia

To evaluate the effectiveness of small size trisacryl gelatin microsphere embolization as a minimally invasive treatment option for patients with symptomatic focal nodular hyperplasia (FNH).

A retrospective review was performed of experience with transarterial bland embolization of FNH during the period 2006-2011 in 12 patients (10 women and 2 men; age range, 18-61 y) with a total of 17 lesions presenting with symptoms of pain. FNH was pathologically proven in 11 lesions from 10 patients; the remaining lesions exhibited the classic imaging appearance for FNH. All patients underwent superselective embolization with 100-300 μm trisacryl gelatin microspheres. Lesion size and contrast enhancement before and after treatment were compared to determine success of the procedure. Clinical response was determined by review of the electronic medical record.

After embolization, seven patients showed complete resolution and five patients showed partial resolution of symptoms. Compared with imaging performed before the procedure, mean decrease in lesion size after embolization was 61% (range, 26%-90%) on cross-sectional imaging obtained 4-10 weeks after embolization and 87% (range, 54%-98%) on subsequent imaging. Diminished contrast enhancement was universally noted, with 5 of 17 lesions showing complete lack of residual enhancement.

Transarterial bland embolization of FNH with trisacryl gelatin microspheres in symptomatic patients is a suitable treatment alternative to surgical resection.