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Hepatocellular adenoma: MR imaging features with pathologic correlation
K Y Chung1, W W Mayo-Smith, S Saini
1Department of Radiology, Massachusetts General Hospital, Boston 02114, USA.
Objective:
The purpose of this study was to describe the MR imaging characteristics of hepatic adenomas and to correlate these features with pathologic findings.
Materials And Methods:
Sixteen patients from four institutions who had 31 hepatocellular adenomas underwent MR imaging with T1- and T2-weighted pulse sequences at 1.5 T. Dynamic gadolinium-chelate-enhanced gradient-recalled-echo (GRE) MR imaging was done in eight patients with 15 lesions. Twenty-three lesions in 15 patients were confirmed by surgical excision. MR images were retrospectively reviewed by three experienced radiologists for signal intensity of lesions relative to liver, heterogeneity, contrast enhancement, and presence of signs of histopathologic correlates. These imaging findings were then compared with histopathologic findings.
Results:
Nearly all (29 of 31 lesions) hepatocellular adenomas showed heterogeneous signal intensity on MR images. Most (19/31) were predominantly hyperintense on proton density- or T2-weighted images; the predominant signal intensity on T1-weighted images varied. Thirteen of 15 lesions showed early arterial enhancement relative to liver on dynamic GRE MR images. MR imaging was most successful in showing intratumoral hemorrhage (10 of 12 histopathologically proven lesions), large intratumoral vessels (five of five), fatty change (three of six), and peliosis (three of three cases). In two lesions, capsules (one of five) and central scars (one of three) were detected.
Conclusion:
Hepatocellular adenomas have a highly variable appearance on MR images because of their varied histologic appearances. Although no definitive MR imaging signal or structural characteristics can be identified, tumor heterogeneity, particularly when related to hemorrhage, and early arterial enhancement can suggest a diagnosis of hepatocellular adenoma in the proper patient population.
Insights
Magnetic resonance (MR) imaging reveals variable features of hepatic adenomas. Tumor heterogeneity, especially with hemorrhage, and early arterial enhancement on MR imaging can suggest this diagnosis.
Area of Science:
- Radiology
- Hepatology
- Oncology
Background:
- Hepatic adenomas are benign liver tumors.
- Accurate diagnosis is crucial for management.
- MR imaging is a key modality for characterizing liver lesions.
Purpose of the Study:
- To describe MR imaging characteristics of hepatic adenomas.
- To correlate MR imaging findings with histopathologic features.
Main Methods:
- Retrospective review of MR images (T1/T2-weighted, dynamic GRE) from 16 patients with 31 hepatic adenomas.
- Correlation of imaging findings with histopathologic results from 23 lesions.
Main Results:
- Most hepatic adenomas (29/31) showed heterogeneous signal intensity.
- Early arterial enhancement was observed in 13/15 lesions.
- MR imaging effectively detected hemorrhage, intratumoral vessels, fatty change, and peliosis.
Conclusions:
- Hepatic adenomas exhibit diverse MR imaging appearances due to varied histology.
- No single MR imaging feature is definitive.
- Tumor heterogeneity, hemorrhage, and early arterial enhancement suggest hepatic adenoma in appropriate clinical contexts.