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Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?
Timo Alexander Auer1, Uli Fehrenbach2, Christian Grieser2
1Klinik für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 13353, Berlin, Germany. timo-alexander.auer@charite.de.
European Radiology
|February 23, 2020
Summary
Gadoxetic acid-enhanced MRI aids in differentiating hepatocellular adenoma subtypes. Combining imaging features with Gd-EOB uptake patterns improves diagnostic accuracy for inflammatory and HNF-1a-mutated adenomas.
Area of Science:
- Hepatobiliary imaging
- Gastrointestinal radiology
- Medical imaging analysis
Background:
- Hepatocellular adenomas (HCAs) are benign liver tumors with diverse subtypes.
- Accurate subtyping of HCAs is crucial for management and predicting malignant transformation risk.
- Gadoxetic acid (Gd-EOB) enhanced magnetic resonance imaging (MRI) offers unique hepatobiliary phase (HBP) information.
Purpose of the Study:
- To evaluate the efficacy of Gd-EOB-enhanced MRI in differentiating HCA subtypes.
- To assess the added value of combining HBP enhancement patterns with conventional MRI features for HCA subtyping.
Main Methods:
- Retrospective analysis of 79 histopathologically proven HCAs in 48 patients who underwent Gd-EOB-enhanced MRI.
- Two radiologists assessed qualitative and quantitative imaging features, including HBP enhancement.
- Advanced 3D texture analysis was employed to evaluate lesion heterogeneity.
Main Results:
- HCA subtypes included HNF-1a-mutated (HHCA), inflammatory (IHCA), b-catenin-activated (bHCA), and unclassified (UHCA).
- Significantly enhancing lesions in the HBP were predominantly IHCAs (82.5%), while only 4% were HHCAs (p < 0.001).
- Combined analysis of HBP uptake and morphologic features significantly improved diagnostic accuracy for IHCA, bHCA, and HHCA differentiation (AUC up to 0.957).
- IHCA demonstrated significantly increased voxel heterogeneity on 3D ROI analysis (p=0.038).
Conclusions:
- Gd-EOB-enhanced MRI is valuable for HCA subtype differentiation.
- Reliable identification of IHCA and HHCA is achievable using characteristic Gd-EOB uptake patterns.
- Integrating established MR appearances with intralesional Gd-EOB uptake substantially enhances diagnostic accuracy.
