Hepatocellular Adenomas: Molecular Basis and Multimodality Imaging Update.

Area of Science:

• Hepatobiliary Imaging and Intervention
• Gastroenterology and Hepatology
• Oncology

Background:

• Hepatocellular adenomas (HCAs) are benign liver tumors with diverse prognoses and eight molecularly defined subtypes.
• Understanding HCA subtypes is crucial as they exhibit unique biologic behaviors and potential for malignant transformation or bleeding.
• Multiphasic MRI with hepatobiliary contrast agents is the gold standard for noninvasive HCA detection, characterization, and surveillance.

Approach:

• Review of radiologic-pathologic correlations for HCA subtypes across various imaging modalities.
• Analysis of HCA complications, including bleeding and malignant transformation to hepatocellular carcinoma.
• Evaluation of current management strategies, including surgical resection, thermal ablation, and transarterial embolization.

Key Points:

• HCAs typically appear hypointense on hepatobiliary MRI, with exceptions including beta-catenin mutated exon 3 and some inflammatory subtypes.
• Risk of bleeding and malignant transformation is linked to HCA size, subtype, and patient factors.
• Surgical resection is recommended for HCAs >5 cm, all sizes in men, and beta-catenin mutated exon 3 subtypes.

Conclusions:

• Accurate HCA classification and subtype identification are essential for predicting clinical course and guiding management.
• Multimodality imaging plays a critical role in the diagnosis, characterization, and monitoring of HCAs.
• Personalized management strategies, considering tumor characteristics and patient factors, are key to optimizing outcomes for hepatocellular adenomas.