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Hepatic focal nodular hyperplasia: CT and sonographic spectrum
A Shirkhoda1, M C Farah, E Bernacki
1Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, MI 48073.
Abdominal Imaging
|January 1, 1994
Summary
Focal nodular hyperplasia (FNH) of the liver presents varied imaging features on CT and ultrasound, often mimicking other liver lesions. A central scar aids diagnosis, but caution is advised in cancer patients.
Area of Science:
- Radiology
- Hepatology
- Medical Imaging
Background:
- Focal nodular hyperplasia (FNH) is a common benign liver lesion.
- Distinguishing FNH from malignant neoplasms like metastasis is clinically important.
- Incidental detection of FNH occurs during investigations for other conditions.
Purpose of the Study:
- To evaluate the computed tomography (CT) and ultrasound imaging characteristics of focal nodular hyperplasia (FNH).
- To assess the diagnostic challenges posed by FNH, particularly in differentiating it from hemangioma or metastasis.
- To highlight the utility of imaging features and pathological confirmation in FNH diagnosis.
Main Methods:
- Retrospective analysis of abdominal computed tomography (CT) scans (n=15) and ultrasound (US) (n=11) in patients with pathologically proven FNH.
- Review of unenhanced and contrast-enhanced CT findings, including lesion density and enhancement patterns.
- Correlation of imaging findings with pathological diagnoses obtained via needle aspiration or surgical resection.
Main Results:
- FNH lesions exhibited variable appearances on unenhanced CT (isodense/hypodense) and contrast-enhanced CT (isodense, hypodense, or hyperdense).
- Seven hypodense lesions on unenhanced CT became isodense after contrast administration.
- Ultrasound findings included hypoechoic, echogenic, and isoechoic lesions relative to the liver parenchyma. Central scars were identified in three cases on both CT and US.
Conclusions:
- Focal nodular hyperplasia (FNH) demonstrates diverse CT and sonographic features that can mimic other liver pathologies, including hemangioma and metastasis.
- The presence of a central scar increases diagnostic specificity for FNH.
- In cancer patients, imaging findings suggestive of FNH require careful interpretation, and needle aspiration may be necessary for definitive diagnosis.