Hepatocellular adenoma CT: Difference between revisions

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{{Hepatocellular adenoma}}
{{Hepatocellular adenoma}}
{{CMG}}; {{AOEIC}} {{CZ}}
{{CMG}}; {{AOEIC}} {{CZ}}{{Sab}}


==Overview==
==Overview==
The [[Computed tomography|CT scan]] findings of hepatocellular adenoma are usually variable and characteristic [[Lesion|lesions]] are best seen with multiphase helical [[Computed tomography|CT scanning]]. The [[Computed tomography|CT scan]] findings include non-lobulated and well-marginated mass that can be encapsulated and is rarely [[Calcification|calcified]]. A [[heterogeneous]] hypo-attenuating area within the [[tumor]] may be seen in cases of [[necrosis]] or old [[hemorrhage]]. Large hepatocellular adenomas may be more [[heterogeneous]] than smaller [[Lesion|lesions]] and their [[Computed tomography|CT scan]] appearance is less specific.


==CT==
==CT scan==
* The [[Computed tomography|CT scan]] findings of hepatocellular adenoma are usually variable.<ref>{{cite journal|doi=10.1594/ecr2013/C-2620}}</ref>
*Classical characteristic [[Lesion|lesions]] of [[adenoma]] are best seen with multi-phase helical [[Computed tomography|CT scan]].
* The [[Computed tomography|CT scan]] findings of hepatocellular adenoma include the following:<ref>{{Cite journal
| author = [[Bipin Valchandji Daga]], [[Vaibhav R. Shah]] & [[Rahul B. More]]
| title = CT scan diagnosis of hepatic adenoma in a case of von Gierke disease
| journal = [[The Indian journal of radiology & imaging]]
| volume = 22
| issue = 1
| pages = 54–57
| year = 2012
| month = January
| doi = 10.4103/0971-3026.95405
| pmid = 22623817
}}</ref><ref>{{Cite journal
| author = [[Ludger Barthelmes]] & [[Iain S. Tait]]
| title = Liver cell adenoma and liver cell adenomatosis
| journal = [[HPB : the official journal of the International Hepato Pancreato Biliary Association]]
| volume = 7
| issue = 3
| pages = 186–196
| year = 2005
| month =
| doi = 10.1080/13651820510028954
| pmid = 18333188
}}</ref><ref>{{Cite journal
| author = [[T. J. Welch]], [[P. F. 2nd Sheedy]], [[C. M. Johnson]], [[D. H. Stephens]], [[J. W. Charboneau]], [[M. L. Brown]], [[G. R. May]], [[M. A. Adson]] & [[D. B. McGill]]
| title = Focal nodular hyperplasia and hepatic adenoma: comparison of angiography, CT, US, and scintigraphy
| journal = [[Radiology]]
| volume = 156
| issue = 3
| pages = 593–595
| year = 1985
| month = September
| doi = 10.1148/radiology.156.3.3895291
| pmid = 3895291
}}</ref><ref>{{Cite journal
| author = [[H. Dharmana]], [[S. Saravana-Bawan]], [[S. Girgis]] & [[G. Low]]
| title = Hepatocellular adenoma: imaging review of the various molecular subtypes
| journal = [[Clinical radiology]]
| volume = 72
| issue = 4
| pages = 276–285
| year = 2017
| month = April
| doi = 10.1016/j.crad.2016.12.020
| pmid = 28126185
}}</ref><ref name="DhingraFiel2014">{{cite journal|last1=Dhingra|first1=Sadhna|last2=Fiel|first2=M. Isabel|title=Update on the New Classification of Hepatic Adenomas: Clinical, Molecular, and Pathologic Characteristics|journal=Archives of Pathology & Laboratory Medicine|volume=138|issue=8|year=2014|pages=1090–1097|issn=0003-9985|doi=10.5858/arpa.2013-0183-RA}}</ref>
** Non-lobulated and well-marginated [[mass]] that can be encapsulated and is rarely [[Calcification|calcified]].
**[[Homogeneous]] enhancement in the [[Artery|arterial]] phase.
**The [[homogeneous]] enhancement is usually [[Attenuation|isoattenuating]] but sometimes mildly [[Attenuation|hypo-attenuating]] relative to normal [[liver]] on unenhanced [[Portal vein|portal venous]] phase and delayed phase images.
** Presence of [[Tumoral|intratumoral]] [[fat]] can reveal a [[Attenuation|hypoattenuating]] mass, if it is surrounded by a [[fatty liver]] it appears [[Attenuation|hyperattenuating]] on all [[contrast]] phases and unenhanced images.
** A [[heterogeneous]], [[Attenuation|hypo-attenuating]] area within the [[tumor]] is seen in cases of [[necrosis]] or old [[hemorrhage]].
** Large hepatocellular adenomas may be more [[heterogeneous]] than smaller [[Lesion|lesions]] and their [[Computed tomography|CT scan]] appearance is less specific.


* [[Fat]] or [[hemorrhage]] can easily be identified on unenhanced images, and delayed-phase images demonstrate the tendency for fibrotic components to enhance and retain contrast material.
==Images==
 
[[File:Hepatic Adenoma CT (arterial phase).jpg|300px|left|thumb|Axial C+ arterial phase. [https://radiopaedia.org/articles/hepatic-adenoma?lang=us Source: Case courtesy of Dr Natalie Yang, Radiopaedia.org, rID: 6951]]]
* Because [[adenoma]]s consist almost entirely of uniform [[hepatocyte]]s and a variable number of [[Kupffer cell]]s, most [[adenoma]]s are nearly isoattenuating relative to normal liver on unenhanced, portal venous–phase, and delayed-phase images.
[[File:Hepatic Adenoma CT (portal venous phase).jpg|300px|center|thumb|Axial C+ portal venous phase. [https://radiopaedia.org/articles/hepatic-adenoma?lang=us Source: Case courtesy of Dr Natalie Yang, Radiopaedia.org, rID: 6951]]]
 
[[File:Hepatic Adenoma CT 2.png|300px|left|thumb|Axial C+ portal venous phase. [https://radiopaedia.org/articles/hepatic-adenoma?lang=us Source: Case courtesy of Dr Praveen Jha, Radiopaedia.org, rID: 16678]]]
* In patients with [[fatty liver]], adenomas are hyperattenuating at all phases of contrast enhancement and on unenhanced images as well.
<br style="clear:left">
 
* Small hepatocellular adenomas enhance rapidly and are hyperattenuating relative to the liver.
 
* Excluding lesions with acute or old tumor hemorrhage and fat deposition, hepatocellular adenoma demonstrated homogeneous or nearly homogeneous enhancement in approx 80% of cases.
 
:* The enhancement usually does not persist in adenomas because of arteriovenous shunting.
 
* Larger hepatocellular adenomas may be more heterogeneous than smaller lesions, and their [[CT]] appearance is less specific.


==References==
==References==
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Latest revision as of 14:41, 21 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]Sabawoon Mirwais, M.B.B.S, M.D.[3]

Overview

The CT scan findings of hepatocellular adenoma are usually variable and characteristic lesions are best seen with multiphase helical CT scanning. The CT scan findings include non-lobulated and well-marginated mass that can be encapsulated and is rarely calcified. A heterogeneous hypo-attenuating area within the tumor may be seen in cases of necrosis or old hemorrhage. Large hepatocellular adenomas may be more heterogeneous than smaller lesions and their CT scan appearance is less specific.

CT scan

Images

Axial C+ arterial phase. Source: Case courtesy of Dr Natalie Yang, Radiopaedia.org, rID: 6951
Axial C+ portal venous phase. Source: Case courtesy of Dr Natalie Yang, Radiopaedia.org, rID: 6951
Axial C+ portal venous phase. Source: Case courtesy of Dr Praveen Jha, Radiopaedia.org, rID: 16678


References

  1. . doi:10.1594/ecr2013/C-2620. Missing or empty |title= (help)
  2. Bipin Valchandji Daga, Vaibhav R. Shah & Rahul B. More (2012). "CT scan diagnosis of hepatic adenoma in a case of von Gierke disease". The Indian journal of radiology & imaging. 22 (1): 54–57. doi:10.4103/0971-3026.95405. PMID 22623817. Unknown parameter |month= ignored (help)
  3. Ludger Barthelmes & Iain S. Tait (2005). "Liver cell adenoma and liver cell adenomatosis". HPB : the official journal of the International Hepato Pancreato Biliary Association. 7 (3): 186–196. doi:10.1080/13651820510028954. PMID 18333188.
  4. T. J. Welch, P. F. 2nd Sheedy, C. M. Johnson, D. H. Stephens, J. W. Charboneau, M. L. Brown, G. R. May, M. A. Adson & D. B. McGill (1985). "Focal nodular hyperplasia and hepatic adenoma: comparison of angiography, CT, US, and scintigraphy". Radiology. 156 (3): 593–595. doi:10.1148/radiology.156.3.3895291. PMID 3895291. Unknown parameter |month= ignored (help)
  5. H. Dharmana, S. Saravana-Bawan, S. Girgis & G. Low (2017). "Hepatocellular adenoma: imaging review of the various molecular subtypes". Clinical radiology. 72 (4): 276–285. doi:10.1016/j.crad.2016.12.020. PMID 28126185. Unknown parameter |month= ignored (help)
  6. Dhingra, Sadhna; Fiel, M. Isabel (2014). "Update on the New Classification of Hepatic Adenomas: Clinical, Molecular, and Pathologic Characteristics". Archives of Pathology & Laboratory Medicine. 138 (8): 1090–1097. doi:10.5858/arpa.2013-0183-RA. ISSN 0003-9985.


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