Limited added value of contrast-enhanced ultrasound over B-mode for the subtyping of hepatocellular adenomas
April 24, 2020 — European Journal of Radiology
To compare the features of hepatocellular adenoma subtypes (HCAs) in B-mode and contrast-enhanced ultrasound (CEUS).
Thirty-three patients (31 women [94%] and two men [6%], median age [Q1-Q3] 43.5 years old [35-51]) with 44 pathologically proven and subtyped HCAs (including 29 inflammatory HCAs [I-HCA] and 15 HNF1- α inactivated HCAs [H-HCA]) who underwent CEUS were included. The features of HCA on B-mode and CEUS were independently reviewed by two radiologists and compared between HCA subtypes.
I-HCAs were mostly hypoechoic (23/29, 79%) or isoechoic (4/29, 14%) with B-mode. Twelve of them (41%) were heterogeneous. All H-HCAs except one demonstrated homogeneous hyperechogenicity (93%) ( p = 0.001). Moderate or marked liver steatosis was only observed in I-HCAs (12/29, 41%) ( p = 0.001). Arterial hyperenhancement was observed on CEUS in 27/29 (93%) I-HCAs and in 14/15 (93%) H-HCAs (p=0.98). Washout was present in 6/29 (21%) I-HCAs and 1/15 (7%) H-HCAs (p=0.27). A total of 23/29 (79%) I-HCAs and 15/15 (100%) HCAs were homogeneous on portal and delayed phase acquisitions (p=0.04). The specificity for identifying an H-HCA was 100% when the lesion was homogeneous and hyperechoic on B-mode, and the sensibility to rule out an H-HCA was 100% if neither of these two features was present in a liver with obvious steatosis.
Most CEUS features, especially enhancement patterns, do not significantly differ between HCA subtypes. When HCA is suspected on CEUS, B-mode features should be considered, and a combination of lesion hyperechogenicity, homogeneity and the absence of obvious liver steatosis may be useful to distinguish H-HCAs from I-HCAs.
Authors: Jules Gregory, Anita Paisant, Luisa Paulatto, Valérie Paradis, Valérie Vilgrain, Maxime Ronot