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Gastrointestinal
Diagnosis
Liver
Inflammation
Nodular Regenerative Hyperplasia
Nodular Regenerative Hyperplasia
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Abbreviations

          • Nodular regenerative hyperplasia (NRH)

        • Synonyms

          • Nodular transformation, noncirrhotic nodulation

        • Definitions

          • Uncommonly recognized disorder characterized by diffuse micronodular or macronodular transformation of hepatic parenchyma without fibrous septa between nodules
          • Larger focal lesions are called (multiacinar) large regenerative nodules (LRNs)

        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. Vernuccio F et al: Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. Insights Imaging. 12(1):8, 2021
                                          2. Bakshi N et al: Nodular regenerative hyperplasia - an under-recognized vascular disorder of liver. Pathol Res Pract. 216(4):152833, 2020
                                          3. Penrice D et al: Nodular regenerative hyperplasia associated with primary liver malignancies. Hepatology. 71(2):760-1, 2020
                                          4. Navin PJ et al: The utility of MR elastography to differentiate nodular regenerative hyperplasia from cirrhosis. Hepatology. 69(1):452-4, 2019
                                          5. Piao C et al: Noncirrhotic portal hypertension secondary to nodular regenerative hyperplasia postrenal transplant. ACG Case Rep J. 6(12):e00257, 2019
                                          6. Lepelley M et al: Nodular regenerative hyperplasia induced by trastuzumab emtansine: role of emtansine? Ann Hepatol. 17(6):1067-71, 2018
                                          7. Xiang H et al: Liver atoll sign: nodular regenerative hyperplasia. J Med Imaging Radiat Oncol. 62 Suppl 1:88, 2018
                                          8. 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
                                          9. Choe H et al: Nodular regenerative hyperplasia causing portal hypertension in a patient with chronic graft versus host disease: response to sirolimus. Acta Haematol. 132(1):49-52, 2014
                                          10. Morris-Stiff G et al: Nodular regenerative hyperplasia (NRH) complicating oxaliplatin chemotherapy in patients undergoing resection of colorectal liver metastases. Eur J Surg Oncol. 40(8):1016-20, 2014
                                          11. Nodular regenerative hyperplasia. In: LiverTox: clinical and research information on drug-induced liver injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases, 2012
                                          12. Caturelli E et al: Nodular regenerative hyperplasia of the liver: coral atoll-like lesions on ultrasound are characteristic in predisposed patients. Br J Radiol. 84(1003):e129-34, 2011
                                          13. Gouya H et al: Chronic liver disease: systemic and splanchnic venous flow mapping with optimized cine phase-contrast MR imaging validated in a phantom model and prospectively evaluated in patients. Radiology. 261(1):144-55, 2011
                                          14. Hartleb M et al: Nodular regenerative hyperplasia: evolving concepts on underdiagnosed cause of portal hypertension. World J Gastroenterol. 17(11):1400-9, 2011
                                          15. Maganty K et al: Liver transplantation for hepatopulmonary syndrome due to noncirrhotic portal hypertension. Transplant Proc. 43(7):2814-6, 2011
                                          16. Morana G et al: Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol. 46(4):225-39, 2011
                                          17. Schouten JN et al: Idiopathic noncirrhotic portal hypertension. Hepatology. 54(3):1071-81, 2011
                                          18. Ueda T et al: A pictorial review of benign hepatocellular nodular lesions: comprehensive radiological assessment incorporating the concept of anomalous portal tract syndrome. J Hepatobiliary Pancreat Sci. 18(3):386-96, 2011
                                          19. Walldorf J et al: Rapid development of a hepatocellular carcinoma in isolated thrombosis of hepatic veins (classic Budd-Chiari syndrome): case report and review of literature. BMJ Case Rep. 2009, 2009
                                          20. Willatt JM et al: MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology. 247(2):311-30, 2008
                                          21. Qayyum A et al: CT of benign hypervascular liver nodules in autoimmune hepatitis. AJR Am J Roentgenol. 183(6):1573-6, 2004
                                          22. Zeitoun D et al: Congenital hepatic fibrosis: CT findings in 18 adults. Radiology. 231(1):109-16, 2004
                                          23. Brancatelli G et al: Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation. Radiographics. 22(4):847-62, 2002
                                          24. Brancatelli G et al: Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation. AJR Am J Roentgenol. 178(4):877-83, 2002
                                          25. MacSween RNH et al: Pathology of the Liver. 4th ed. London: Churchill Livingston. 755-56, 2002
                                          26. Maetani Y et al: Benign hepatic nodules in Budd-Chiari syndrome: radiologic-pathologic correlation with emphasis on the central scar. AJR Am J Roentgenol. 178(4):869-75, 2002
                                          27. Grazioli L et al: Congenital absence of portal vein with nodular regenerative hyperplasia of the liver. Eur Radiol. 10(5):820-5, 2000
                                          28. Rha SE et al: Nodular regenerative hyperplasia of the liver in Budd-Chiari syndrome: CT and MR features. Abdom Imaging. 25(3):255-8, 2000
                                          29. Soler R et al: Benign regenerative nodules with copper accumulation in a case of chronic Budd-Chiari syndrome: CT and MR findings. Abdom Imaging. 25(5):486-9, 2000
                                          30. Zhou H et al: Multiple macroregenerative nodules in liver cirrhosis due to Budd-Chiari syndrome. Case reports and review of the literature. Hepatogastroenterology. 47(32):522-7, 2000
                                          31. Clouet M et al: Imaging features of nodular regenerative hyperplasia of the liver mimicking hepatic metastases. Abdom Imaging. 24(3):258-61, 1999
                                          32. Vilgrain V et al: Hepatic nodules in Budd-Chiari syndrome: imaging features. Radiology. 210(2):443-50, 1999
                                          33. Casillas C et al: Pseudotumoral presentation of nodular regenerative hyperplasia of the liver: imaging in five patients including MR imaging. Eur Radiol. 7(5):654-8, 1997
                                          34. Wanless IR: Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules. Hepatology. 11(5):787-97, 1990
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Nodular regenerative hyperplasia (NRH)

                                                • Synonyms

                                                  • Nodular transformation, noncirrhotic nodulation

                                                • Definitions

                                                  • Uncommonly recognized disorder characterized by diffuse micronodular or macronodular transformation of hepatic parenchyma without fibrous septa between nodules
                                                  • Larger focal lesions are called (multiacinar) large regenerative nodules (LRNs)

                                                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. Vernuccio F et al: Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. Insights Imaging. 12(1):8, 2021
                                                                                  2. Bakshi N et al: Nodular regenerative hyperplasia - an under-recognized vascular disorder of liver. Pathol Res Pract. 216(4):152833, 2020
                                                                                  3. Penrice D et al: Nodular regenerative hyperplasia associated with primary liver malignancies. Hepatology. 71(2):760-1, 2020
                                                                                  4. Navin PJ et al: The utility of MR elastography to differentiate nodular regenerative hyperplasia from cirrhosis. Hepatology. 69(1):452-4, 2019
                                                                                  5. Piao C et al: Noncirrhotic portal hypertension secondary to nodular regenerative hyperplasia postrenal transplant. ACG Case Rep J. 6(12):e00257, 2019
                                                                                  6. Lepelley M et al: Nodular regenerative hyperplasia induced by trastuzumab emtansine: role of emtansine? Ann Hepatol. 17(6):1067-71, 2018
                                                                                  7. Xiang H et al: Liver atoll sign: nodular regenerative hyperplasia. J Med Imaging Radiat Oncol. 62 Suppl 1:88, 2018
                                                                                  8. 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
                                                                                  9. Choe H et al: Nodular regenerative hyperplasia causing portal hypertension in a patient with chronic graft versus host disease: response to sirolimus. Acta Haematol. 132(1):49-52, 2014
                                                                                  10. Morris-Stiff G et al: Nodular regenerative hyperplasia (NRH) complicating oxaliplatin chemotherapy in patients undergoing resection of colorectal liver metastases. Eur J Surg Oncol. 40(8):1016-20, 2014
                                                                                  11. Nodular regenerative hyperplasia. In: LiverTox: clinical and research information on drug-induced liver injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases, 2012
                                                                                  12. Caturelli E et al: Nodular regenerative hyperplasia of the liver: coral atoll-like lesions on ultrasound are characteristic in predisposed patients. Br J Radiol. 84(1003):e129-34, 2011
                                                                                  13. Gouya H et al: Chronic liver disease: systemic and splanchnic venous flow mapping with optimized cine phase-contrast MR imaging validated in a phantom model and prospectively evaluated in patients. Radiology. 261(1):144-55, 2011
                                                                                  14. Hartleb M et al: Nodular regenerative hyperplasia: evolving concepts on underdiagnosed cause of portal hypertension. World J Gastroenterol. 17(11):1400-9, 2011
                                                                                  15. Maganty K et al: Liver transplantation for hepatopulmonary syndrome due to noncirrhotic portal hypertension. Transplant Proc. 43(7):2814-6, 2011
                                                                                  16. Morana G et al: Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol. 46(4):225-39, 2011
                                                                                  17. Schouten JN et al: Idiopathic noncirrhotic portal hypertension. Hepatology. 54(3):1071-81, 2011
                                                                                  18. Ueda T et al: A pictorial review of benign hepatocellular nodular lesions: comprehensive radiological assessment incorporating the concept of anomalous portal tract syndrome. J Hepatobiliary Pancreat Sci. 18(3):386-96, 2011
                                                                                  19. Walldorf J et al: Rapid development of a hepatocellular carcinoma in isolated thrombosis of hepatic veins (classic Budd-Chiari syndrome): case report and review of literature. BMJ Case Rep. 2009, 2009
                                                                                  20. Willatt JM et al: MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology. 247(2):311-30, 2008
                                                                                  21. Qayyum A et al: CT of benign hypervascular liver nodules in autoimmune hepatitis. AJR Am J Roentgenol. 183(6):1573-6, 2004
                                                                                  22. Zeitoun D et al: Congenital hepatic fibrosis: CT findings in 18 adults. Radiology. 231(1):109-16, 2004
                                                                                  23. Brancatelli G et al: Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation. Radiographics. 22(4):847-62, 2002
                                                                                  24. Brancatelli G et al: Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation. AJR Am J Roentgenol. 178(4):877-83, 2002
                                                                                  25. MacSween RNH et al: Pathology of the Liver. 4th ed. London: Churchill Livingston. 755-56, 2002
                                                                                  26. Maetani Y et al: Benign hepatic nodules in Budd-Chiari syndrome: radiologic-pathologic correlation with emphasis on the central scar. AJR Am J Roentgenol. 178(4):869-75, 2002
                                                                                  27. Grazioli L et al: Congenital absence of portal vein with nodular regenerative hyperplasia of the liver. Eur Radiol. 10(5):820-5, 2000
                                                                                  28. Rha SE et al: Nodular regenerative hyperplasia of the liver in Budd-Chiari syndrome: CT and MR features. Abdom Imaging. 25(3):255-8, 2000
                                                                                  29. Soler R et al: Benign regenerative nodules with copper accumulation in a case of chronic Budd-Chiari syndrome: CT and MR findings. Abdom Imaging. 25(5):486-9, 2000
                                                                                  30. Zhou H et al: Multiple macroregenerative nodules in liver cirrhosis due to Budd-Chiari syndrome. Case reports and review of the literature. Hepatogastroenterology. 47(32):522-7, 2000
                                                                                  31. Clouet M et al: Imaging features of nodular regenerative hyperplasia of the liver mimicking hepatic metastases. Abdom Imaging. 24(3):258-61, 1999
                                                                                  32. Vilgrain V et al: Hepatic nodules in Budd-Chiari syndrome: imaging features. Radiology. 210(2):443-50, 1999
                                                                                  33. Casillas C et al: Pseudotumoral presentation of nodular regenerative hyperplasia of the liver: imaging in five patients including MR imaging. Eur Radiol. 7(5):654-8, 1997
                                                                                  34. Wanless IR: Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules. Hepatology. 11(5):787-97, 1990