Contrast-enhanced ultrasound patterns of hepatocellular adenoma: an Italian multicenter experience

Matteo Garcovich, Mariella Faccia, Franca Meloni, Emanuela Bertolini, Ilario de Sio, Giosuele Calabria, Giampiero Francica, Gianpaolo Vidili, Laura Riccardi, Maria Assunta Zocco, Maria Elena Ainora, Francesca Romana Ponziani, Anna Maria De Gaetano, Antonio Gasbarrini, Gian Ludovico Rapaccini, Maurizio Pompili

Research output: Contribution to journalArticle

Abstract

PURPOSE: Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities.

METHODS: We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units.

RESULTS: The study enrolled 19 patients (16 females; 69% with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6-7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89% of these showing centripetal and 11% centrifugal filling pattern, whereas during the portal and late venous phase 58% of HCA showed washout and the remaining 42% displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively.

CONCLUSIONS: This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.

Original languageEnglish
JournalJournal of Ultrasound
DOIs
Publication statusE-pub ahead of print - Oct 10 2018

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Liver Cell Adenoma
Ultrasonography
Magnetic Resonance Imaging
Catenins
Oral Contraceptives
Italy
Histology
Tomography
Liver

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Contrast-enhanced ultrasound patterns of hepatocellular adenoma : an Italian multicenter experience. / Garcovich, Matteo; Faccia, Mariella; Meloni, Franca; Bertolini, Emanuela; de Sio, Ilario; Calabria, Giosuele; Francica, Giampiero; Vidili, Gianpaolo; Riccardi, Laura; Zocco, Maria Assunta; Ainora, Maria Elena; Ponziani, Francesca Romana; De Gaetano, Anna Maria; Gasbarrini, Antonio; Rapaccini, Gian Ludovico; Pompili, Maurizio.

In: Journal of Ultrasound, 10.10.2018.

Research output: Contribution to journalArticle

Garcovich, M, Faccia, M, Meloni, F, Bertolini, E, de Sio, I, Calabria, G, Francica, G, Vidili, G, Riccardi, L, Zocco, MA, Ainora, ME, Ponziani, FR, De Gaetano, AM, Gasbarrini, A, Rapaccini, GL & Pompili, M 2018, 'Contrast-enhanced ultrasound patterns of hepatocellular adenoma: an Italian multicenter experience', Journal of Ultrasound. https://doi.org/10.1007/s40477-018-0322-5
Garcovich, Matteo ; Faccia, Mariella ; Meloni, Franca ; Bertolini, Emanuela ; de Sio, Ilario ; Calabria, Giosuele ; Francica, Giampiero ; Vidili, Gianpaolo ; Riccardi, Laura ; Zocco, Maria Assunta ; Ainora, Maria Elena ; Ponziani, Francesca Romana ; De Gaetano, Anna Maria ; Gasbarrini, Antonio ; Rapaccini, Gian Ludovico ; Pompili, Maurizio. / Contrast-enhanced ultrasound patterns of hepatocellular adenoma : an Italian multicenter experience. In: Journal of Ultrasound. 2018.
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title = "Contrast-enhanced ultrasound patterns of hepatocellular adenoma: an Italian multicenter experience",
abstract = "PURPOSE: Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities.METHODS: We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units.RESULTS: The study enrolled 19 patients (16 females; 69{\%} with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6-7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89{\%} of these showing centripetal and 11{\%} centrifugal filling pattern, whereas during the portal and late venous phase 58{\%} of HCA showed washout and the remaining 42{\%} displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively.CONCLUSIONS: This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.",
author = "Matteo Garcovich and Mariella Faccia and Franca Meloni and Emanuela Bertolini and {de Sio}, Ilario and Giosuele Calabria and Giampiero Francica and Gianpaolo Vidili and Laura Riccardi and Zocco, {Maria Assunta} and Ainora, {Maria Elena} and Ponziani, {Francesca Romana} and {De Gaetano}, {Anna Maria} and Antonio Gasbarrini and Rapaccini, {Gian Ludovico} and Maurizio Pompili",
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TY - JOUR

T1 - Contrast-enhanced ultrasound patterns of hepatocellular adenoma

T2 - an Italian multicenter experience

AU - Garcovich, Matteo

AU - Faccia, Mariella

AU - Meloni, Franca

AU - Bertolini, Emanuela

AU - de Sio, Ilario

AU - Calabria, Giosuele

AU - Francica, Giampiero

AU - Vidili, Gianpaolo

AU - Riccardi, Laura

AU - Zocco, Maria Assunta

AU - Ainora, Maria Elena

AU - Ponziani, Francesca Romana

AU - De Gaetano, Anna Maria

AU - Gasbarrini, Antonio

AU - Rapaccini, Gian Ludovico

AU - Pompili, Maurizio

PY - 2018/10/10

Y1 - 2018/10/10

N2 - PURPOSE: Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities.METHODS: We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units.RESULTS: The study enrolled 19 patients (16 females; 69% with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6-7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89% of these showing centripetal and 11% centrifugal filling pattern, whereas during the portal and late venous phase 58% of HCA showed washout and the remaining 42% displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively.CONCLUSIONS: This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.

AB - PURPOSE: Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities.METHODS: We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units.RESULTS: The study enrolled 19 patients (16 females; 69% with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6-7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89% of these showing centripetal and 11% centrifugal filling pattern, whereas during the portal and late venous phase 58% of HCA showed washout and the remaining 42% displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively.CONCLUSIONS: This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.

U2 - 10.1007/s40477-018-0322-5

DO - 10.1007/s40477-018-0322-5

M3 - Article

C2 - 30306412

JO - Journal of Ultrasound

JF - Journal of Ultrasound

SN - 1971-3495

ER -