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Gastrointestinal
Diagnosis
Liver
Benign Neoplasms and Tumor-like Conditionas
Focal Nodular Hyperplasia
Focal Nodular Hyperplasia
Atif Zaheer, MD; Gabriela Gayer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Focal nodular hyperplasia (FNH)

          • Definitions

            • Benign tumor of liver caused by hyperplastic response to localized vascular abnormality

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Bröker MEE et al: Performance of contrast-enhanced sonography versus MRI with a liver-specific contrast agent for diagnosis of hepatocellular adenoma and focal nodular hyperplasia. AJR Am J Roentgenol. 214(1):81-9, 2020
                                            2. Fujita N et al: Hyperintense liver masses at hepatobiliary phase gadoxetic acid-enhanced MRI: imaging appearances and clinical importance. Radiographics. 40(1):72-94, 2020
                                            3. Gatti M et al: Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia. Radiol Med. 125(4):348-55, 2020
                                            4. Nie P et al: A CT-based radiomics nomogram for differentiation of focal nodular hyperplasia from hepatocellular carcinoma in the non-cirrhotic liver. Cancer Imaging. 20(1):20, 2020
                                            5. Patacsil SJ et al: A review of benign hepatic tumors and their imaging characteristics. Cureus. 12(1):e6813, 2020
                                            6. Wang DC et al: Characterization of indeterminate liver lesions on CT and MRI with contrast-enhanced ultrasound: what is the evidence? AJR Am J Roentgenol. 1-10, 2020
                                            7. Zarfati A et al: Management of focal nodular hyperplasia of the liver: experience of 50 pediatric patients in a tertiary center. J Pediatr Surg. 55(9):1885-91, 2020
                                            8. Campos Amico E et al: Should focal nodular hyperplasia still be operated upon? Analysis of a case series. Dig Dis. 37(4):309-14, 2019
                                            9. Cannella R et al: Evaluation of texture analysis for the differential diagnosis of focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced CT images. Abdom Radiol (NY). 44(4):1323-30, 2019
                                            10. Fang C et al: Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability. Pediatr Radiol. 49(1):82-90, 2019
                                            11. Kim MJ et al: Problematic lesions in cirrhotic liver mimicking hepatocellular carcinoma. Eur Radiol. 29(9):5101-10, 2019
                                            12. Kozaka K et al: Doughnut-like hyperintense nodules on hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: imaging and clinicopathological features. Eur Radiol. 29(12):6489-98, 2019
                                            13. Laino ME et al: Treatment-related focal nodular hyperplasia mimicking liver metastases. J Pediatr Hematol Oncol. 41(2):138-9, 2019
                                            14. Taibbi A et al: Focal nodular hyperplasia: a weight-based, intraindividual comparison of gadobenate dimeglumine and gadoxetate disodium-enhanced MRI. Diagn Interv Radiol. 25(2):95-101, 2019
                                            15. Vanhooymissen IJSML et al: Intrapatient Comparison of the hepatobiliary phase of Gd-BOPTA and Gd-EOB-DTPA in the differentiation of hepatocellular adenoma from focal nodular hyperplasia. J Magn Reson Imaging. 49(3):700-10, 2019
                                            16. Bröker MEE et al: Growth of focal nodular hyperplasia is not a reason for surgical intervention, but patients should be referred to a tertiary referral centre. World J Surg. 42(5):1506-13, 2018
                                            17. Kitao A et al: Differentiation Between Hepatocellular Carcinoma Showing Hyperintensity On The Hepatobiliary Phase Of Gadoxetic Acid-enhanced MRI and focal nodular hyperplasia by CT and MRI. AJR Am J Roentgenol. 211(2):347-57, 2018
                                            18. Burrowes DP et al: Contrast-enhanced US approach to the diagnosis of focal liver masses. Radiographics. 37(5):1388-400, 2017
                                            19. Chavhan GB et al: Liver Mr imaging in children: current concepts and technique. Radiographics. 36(5):1517-32, 2016
                                            20. Dioguardi Burgio M et al: Imaging of hepatic focal nodular hyperplasia: pictorial review and diagnostic strategy. Semin Ultrasound CT MR. 37(6):511-24, 2016
                                            21. Yoneda N et al: Benign Hepatocellular nodules: hepatobiliary phase of gadoxetic acid-enhanced MR imaging based on molecular background. Radiographics. 36(7):2010-27, 2016
                                            22. Cogley JR et al: MR imaging of benign focal liver lesions. Radiol Clin North Am. 52(4):657-82, 2014
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Focal nodular hyperplasia (FNH)

                                                    • Definitions

                                                      • Benign tumor of liver caused by hyperplastic response to localized vascular abnormality

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Angiographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Bröker MEE et al: Performance of contrast-enhanced sonography versus MRI with a liver-specific contrast agent for diagnosis of hepatocellular adenoma and focal nodular hyperplasia. AJR Am J Roentgenol. 214(1):81-9, 2020
                                                                                      2. Fujita N et al: Hyperintense liver masses at hepatobiliary phase gadoxetic acid-enhanced MRI: imaging appearances and clinical importance. Radiographics. 40(1):72-94, 2020
                                                                                      3. Gatti M et al: Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia. Radiol Med. 125(4):348-55, 2020
                                                                                      4. Nie P et al: A CT-based radiomics nomogram for differentiation of focal nodular hyperplasia from hepatocellular carcinoma in the non-cirrhotic liver. Cancer Imaging. 20(1):20, 2020
                                                                                      5. Patacsil SJ et al: A review of benign hepatic tumors and their imaging characteristics. Cureus. 12(1):e6813, 2020
                                                                                      6. Wang DC et al: Characterization of indeterminate liver lesions on CT and MRI with contrast-enhanced ultrasound: what is the evidence? AJR Am J Roentgenol. 1-10, 2020
                                                                                      7. Zarfati A et al: Management of focal nodular hyperplasia of the liver: experience of 50 pediatric patients in a tertiary center. J Pediatr Surg. 55(9):1885-91, 2020
                                                                                      8. Campos Amico E et al: Should focal nodular hyperplasia still be operated upon? Analysis of a case series. Dig Dis. 37(4):309-14, 2019
                                                                                      9. Cannella R et al: Evaluation of texture analysis for the differential diagnosis of focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced CT images. Abdom Radiol (NY). 44(4):1323-30, 2019
                                                                                      10. Fang C et al: Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability. Pediatr Radiol. 49(1):82-90, 2019
                                                                                      11. Kim MJ et al: Problematic lesions in cirrhotic liver mimicking hepatocellular carcinoma. Eur Radiol. 29(9):5101-10, 2019
                                                                                      12. Kozaka K et al: Doughnut-like hyperintense nodules on hepatobiliary phase without arterial-phase hyperenhancement in cirrhotic liver: imaging and clinicopathological features. Eur Radiol. 29(12):6489-98, 2019
                                                                                      13. Laino ME et al: Treatment-related focal nodular hyperplasia mimicking liver metastases. J Pediatr Hematol Oncol. 41(2):138-9, 2019
                                                                                      14. Taibbi A et al: Focal nodular hyperplasia: a weight-based, intraindividual comparison of gadobenate dimeglumine and gadoxetate disodium-enhanced MRI. Diagn Interv Radiol. 25(2):95-101, 2019
                                                                                      15. Vanhooymissen IJSML et al: Intrapatient Comparison of the hepatobiliary phase of Gd-BOPTA and Gd-EOB-DTPA in the differentiation of hepatocellular adenoma from focal nodular hyperplasia. J Magn Reson Imaging. 49(3):700-10, 2019
                                                                                      16. Bröker MEE et al: Growth of focal nodular hyperplasia is not a reason for surgical intervention, but patients should be referred to a tertiary referral centre. World J Surg. 42(5):1506-13, 2018
                                                                                      17. Kitao A et al: Differentiation Between Hepatocellular Carcinoma Showing Hyperintensity On The Hepatobiliary Phase Of Gadoxetic Acid-enhanced MRI and focal nodular hyperplasia by CT and MRI. AJR Am J Roentgenol. 211(2):347-57, 2018
                                                                                      18. Burrowes DP et al: Contrast-enhanced US approach to the diagnosis of focal liver masses. Radiographics. 37(5):1388-400, 2017
                                                                                      19. Chavhan GB et al: Liver Mr imaging in children: current concepts and technique. Radiographics. 36(5):1517-32, 2016
                                                                                      20. Dioguardi Burgio M et al: Imaging of hepatic focal nodular hyperplasia: pictorial review and diagnostic strategy. Semin Ultrasound CT MR. 37(6):511-24, 2016
                                                                                      21. Yoneda N et al: Benign Hepatocellular nodules: hepatobiliary phase of gadoxetic acid-enhanced MR imaging based on molecular background. Radiographics. 36(7):2010-27, 2016
                                                                                      22. Cogley JR et al: MR imaging of benign focal liver lesions. Radiol Clin North Am. 52(4):657-82, 2014