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Analysis of contrast-enhanced ultrasound features of hepatocellular adenoma according to different pathological
Kailing Chen1, Yi Dong1, Weibin Zhang1
1Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
Contrast-enhanced ultrasound (CEUS) reveals distinct imaging features for hepatocellular adenoma (HCA) molecular subtypes. These unique CEUS characteristics may aid in the preoperative differentiation of various HCA molecular classifications.
Area of Science:
- Hepatobiliary imaging
- Molecular subtyping of liver tumors
- Contrast-enhanced ultrasound (CEUS)
Background:
- Hepatocellular adenomas (HCAs) are benign liver tumors with diverse molecular classifications.
- Accurate preoperative subtyping of HCAs is crucial for appropriate management and risk stratification.
- Contrast-enhanced ultrasound (CEUS) offers dynamic imaging capabilities for characterizing liver lesions.
Purpose of the Study:
- To investigate the specific contrast-enhanced ultrasound (CEUS) features of hepatocellular adenomas (HCAs).
- To correlate CEUS findings with the established pathological molecular classifications of HCAs.
- To assess the diagnostic performance of CEUS in differentiating HCA molecular subtypes.
Main Methods:
- Retrospective analysis of 53 histopathologically confirmed HCA lesions.
- CEUS imaging features were analyzed and compared across four WHO 2019 molecular subgroups: HNF-1α inactivated (H-HCA), β-catenin activated (B-HCA), inflammatory (I-HCA), and unclassified (U-HCA).
- Statistical analysis included ANOVA and Fisher's exact test; sensitivity, specificity, and accuracy were calculated.
Main Results:
- All HCAs demonstrated hyperenhancement during the arterial phase.
- Distinct enhancement patterns were observed: complete hyperenhancement in H-HCAs and B-HCAs, and centripetal filling in I-HCAs (P=0.016).
- Sustained hyper-/iso-enhancement was noted in H-HCAs during later phases, while I-HCAs and B-HCAs predominantly showed hypoenhancement (P=0.000). Hyper-enhanced subcapsular arteries were frequent in I-HCAs (64.5%). Central unenhanced areas were more common in I-HCAs (29.0%, P=0.034).
Conclusions:
- CEUS exhibits unique imaging features, including enhancement patterns, subcapsular arteries, and washout characteristics.
- These CEUS findings may assist in the preoperative prediction of different HCA molecular subtypes.
- CEUS can provide valuable diagnostic information for guiding the management of hepatocellular adenomas.
Objective:
To explore the specific contrast-enhanced ultrasound (CEUS) features of hepatocellular adenomas (HCA) according to their pathological molecular classifications.
Methods & Materials:
In this retrospective study, fifty-three histopathologically proved HCA lesions (mean size, 39.7±24.9 mm) were included. Final histopathological diagnosis of HCA lesions were identified by surgical resection (n = 51) or biopsy (n = 2) specimens. CEUS imaging features were compared among four subgroups according to World Health Organization (WHO) 2019 pathological molecular classifications standards. Analysis of variance (ANOVA) were used for statistical analysis of continuous variables. Fisher's exact test were used for categorical variables. The sensitivity (SE), specificity (SP), and accuracy of CEUS feature in diagnosis of each HCA subtype were calculated and compared.
Results:
Final histopathological diagnosis included HNF-1α inactivated HCAs (H-HCA, n = 12), β-catenin activated HCAs (B-HCA, n = 8), inflammatory HCAs (I-HCA, n = 31), and unclassified HCAs (U-HCA, n = 2). During arterial phase of CEUS, all HCAs were hyper-enhanced, 66.6% (8/12) of H-HCAs and 50% (4/8) of B-HCAs displayed complete hyperenhancement, whereas 58.0% (18/31) of I-HCAs showed centripetal filling hyperenhancement pattern (P = 0.016). Hyper-enhanced subcapsular arteries could be detected in 64.5% (20/31) I-HCAs during early arterial phase. During portal venous and late phase, sustained hyper- or iso-enhancement were observed in 91.7% (11/12) of H-HCAs, while most of I-HCAs (61.3%, 19/31) and B-HCAs (7/8, 87.5%) were hypo-enhanced (P = 0.000). Central unenhanced areas were most commonly observed in I-HCAs (29.0%, 9/31) (P = 0.034).
Conclusion:
Depending on its unique imaging features including enhancement filling pattern, hyper-enhanced subcapsular artery and presence of washout, CEUS might provide helpful diagnostic information for preoperative prediction of various HCA molecular subtypes.
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