Differentiation of Focal Nodular Hyperplasia From Hepatocellular Adenoma on Contrast-Enhanced US With Perfluorobutane...

The study aimed to investigate the diagnostic performance of contrast-enhanced US (CEUS), especially perfluorobutane (PFB)-enhanced US, in differentiating focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA).

This retrospective study included patients with FNH or HCA, all of whom underwent either PFB-enhanced US or sulfur hexafluoride-enhanced US. For the entire cohort and PFB-enhanced US subgroup, logistic regression analyses were performed to identify independent predictors that help distinguish FNH from HCA, then diagnostic performance of the final multivariate model was calculated.

A total of 135 patients with 135 observations (97 FNH and 38 HCA) were included. In the entire cohort, the final multivariate model, incorporating centrifugal filling in the arterial phase (odds ratio [OR] = 48.96, p < 0.001), central scar (OR = 55.21, p = 0.002), hyperechogenicity (OR = 0.14, p = 0.03) and hypo-enhancement in the late phase (OR = 0.17, p = 0.002), yielded an area under the curve (AUC) of 0.92 (95% CI: 0.88-0.97). In the PFB-enhanced US subgroup (n = 68), the multivariate model identified that centrifugal filling in the arterial phase (OR = 61.68, p < 0.001), central artery (OR = 3.23, p = 0.02) were independent predictors supporting FNH, while hypo-enhancement in the Kupffer-phase (OR = 0.06, p < 0.001) was a strong independent feature indicative of HCA; the multivariate model achieved an AUC of 0.94 (95% CI: 0.89-0.99).

CEUS could serve as a reliable imaging modality for differentiating FNH from HCA. Kupffer-phase findings on PFB-enhanced US might provide certain diagnostic value.