Objective To investigate the value of a new double action MR contrast agent——Gd-BOPTA in the diagnosis of focal nodular hyperplasia (FNH) of the liver with correlation of pathology.
Methods Dedicated MRI scans were performed for 5 patients suspected to have liver FNH on clinical and imaging basis (six lesions). The MR imaging protocol included axial T1W and T2W plain scan, coronal T2 weighted imaging, 3D MRCP, Gd-BOPTA enhanced LAVA dynamic tri-phasic acquisitions (scanning at 15 s, 55 s and 90 s respectively), enhanced 2D T1W scan, enhanced LAVA in delay phase (at 5 and 10 min) and in the hepatobiliary phase (at 40 and 80 min). The imaging features on each MR sequence were compared with surgical and pathological findings.
Results Six lesions in 5 FNH patients were all correctly diagnosed (5 conformed by surgery and 1 by needle biopsy). ①The hemodynamic phase: The parenchyma of 5 lesions were markedly enhanced in the arterial phase, being isointense or slight hypointense in both the portal venous and delay phases, while 1 lesion was isointense in all phases except being slight hyperintense in the arterial phase; The central scar of 5 lesions were not enhanced in the dynamic phase, but showed delayed enhancement. ②The hepatobiliary (excretory) phase: The parenchyma of all 6 lesions were slight hyperintense or isointense, and tree-like bile ducts with hyperintensity were seen within one lesion. The scar showed no enhancement. ③Pathology: The parenchyma was consisted of disarranged normal hepatocytes but with cytoedema, lack of portal tracts and cholestatic change. The central scar showed rich fibrous tissue, a very thick-walled arteriole, proliferative bile ducts, infiltration of inflammatory cells and myxomatous changes.
Conclusion As a dual-phase MR contrast agent capable of depicting both the hemodynamic attributes and hepatobiliary excretion, Gd-BOPTA enhanced MRI can reflect the pathological features of FNH and reach a high diagnostic accuracy.
Citation：
LI Yingchun,SONG Bin,JIANG Lili,TANG Hehan,HE Yanmei,JIANG Xiaozhong,YIN Longlin,WU Junhua. Value of Gd-BOPTA Enhanced MR Imaging in Diagnosing Focal Nodular Hyperplasia of Liver (Report of 5 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(5): 598-604. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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Frohlich JM. MRI of focal nodular hyperplasia (FNH) with gadobenate dimeglumine (Gd-BOPTA) and SPIO (ferumoxides): an intra-individual comparison [Ｊ]. J Magn Reson Imaging， 2004; 19(3)∶375.
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- 1. Hussain SM, Terkivatan T, Zondervan PE, et al. Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis [Ｊ]. Radiographics, 〖JP3〗2004; 24(1)∶3.
- 2. Choi CS, Freeny PC. Triphasic helical CT of hepatic focal nodular hyperplasia: incidence of atypical findings [Ｊ]. AJR Am J Roentgenol, 1998; 170(2)∶391.
- 3. Mortele KJ, Praet M, Van Vlierberghe H, et al. CT and MR imaging findings in focal nodular hyperplasia of the liver: radiologic-pathologic correlation [Ｊ]. AJR Am J Roentgenol, 2000; 175(3)∶687.
- 4. Kamel IR, Liapi E, Fishman EK. Focal nodular hyperplasia: lesion evaluation using 16-MDCT and 3D CT angiography [Ｊ]. AJR Am J Roentgenol, 2006; 186(6)∶1587.
- 5. Morana G, Grazioli L, Testoni M, et al. Contrast agents for hepatic magnetic resonance imaging [Ｊ]. Top Magn Reson Imaging, 2002; 13(3)∶117.
- 6. 林江， 严福华， 李钦. 肝脏局灶性结节增生的MRI诊断 [J]. 复旦学报（医学版）, 2003; 30（5）∶444.
- 7. 黄国鑫， 徐坚民， 孙黎明， 等. 肝脏局灶性增生的CT和MRI表现与病理对照研究 [Ｊ]. 中国医学影像学杂志, 2006; 14（2）∶104.
- 8. 陆建平， 王莉， 王飞， 等. 平扫和动态增强MRI诊断肝脏局灶性结节增生 [Ｊ]. 中华放射学杂志, 2000; 34（11）∶749.
- 9. 郑列， 吴沛宏， 沈静娴， 等. 肝脏局灶性结节增生患者的典型与不典型螺旋CT征像分析 [Ｊ]. 癌症, 2006; 25（7）∶861.
- 10. 杨军， 严福华， 周康荣， 等. 肝局灶性结节增生的MRI表现 [Ｊ]. 临床放射学杂志, 2004; 23（8）∶695.
- 11. Wang C, Ahlstrom H, Ekholm S, et al. Diagnostic efficacy of MnDPDP in MR imaging of the liver. A phase Ⅲ multicentre study [Ｊ]. Acta Radiol, 1997; 38(4 Pt 2)∶643.
- 12. Kirchin MA, Pirovano GP, Spinazzi A. Gadobenate dimeglumine (Gd-BOPTA). An overview [Ｊ]. Invest Radiol, 〖JP4〗1998; 33(11)∶798.
- 13. 徐隽， 李迎春， 宋彬， 等. 新型磁共振造影剂钆贝葡胺诊断肝细胞癌的价值及病理基础 [Ｊ]. 中国普外基础与临床杂志， 2007； 14（4）∶485.
- 14. Frohlich JM. MRI of focal nodular hyperplasia (FNH) with gadobenate dimeglumine (Gd-BOPTA) and SPIO (ferumoxides): an intra-individual comparison [Ｊ]. J Magn Reson Imaging， 2004; 19(3)∶375.
- 15. 武忠弼， 杨光华主编. 中华外科病理学 [M]. 上卷. 第1版. 北京: 人民卫生出版社, 2002∶836~837.
- 16. Grazioli L, Morana G, Federle MP, et al. Focal nodular hyperplasia: morphologic and functional information from MR imaging with gadobenate dimeglumine [Ｊ]. Radiology， 2001; 221(3)∶731.
- 17. 陆伦根. 胆汁淤积的发生机制及诊治策略 [J]. 胃肠病学, 2005; 10(3)∶188.
- 18. 纪元， 朱雄增， 谭云山， 等. 肝局灶性结节性增生的临床病理学研究 [J]. 中华病理学杂志, 2000; 29（5）∶334.
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