Background and aims: Focal nodular hyperplasia with major sinusoidal dilatation (FNH-sd) is a misleading entity, with some features resembling inflammatory hepatocellular adenoma (HCA). We aimed to assess the performance of contrast-enhanced ultrasound (CEUS) for the diagnosis of FNH-sd.
Methods: Four histologically proven FNH-sd nodules in four patients were investigated with both MRI and CEUS imaging. Sinusoidal dilatation was focally visible in all cases in histology.
Results: In MRI, in all the four cases, lesions were hypervascular in arterial phase, with high intensity in T2-weighted sequence imaging and persistent enhancement in the delayed gadolinium-enhanced phase. These MRI features were more indicative of HCA than FNH. On the other hand, CEUS showed a very specific centrifugal filling followed by a strong, homogeneous enhancement of the whole lesion.
Conclusion: CEUS seems to be an essential step for the diagnosis of non-typical FNH, such as FNH-sd. This small series highlights the interest of performing both CEUS and MRI for the diagnosis of atypical focal liver lesions, such as FNH-sd.
Keywords: Contrast-enhanced ultrasound; Focal nodular hyperplasia; Glutamine synthetase; Inflammatory hepatocellular adenoma; Sinusoidal dilatation.
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