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Gastrointestinal
Diagnosis
Liver
Inflammation
Regenerative and Dysplastic Nodules
Regenerative and Dysplastic Nodules
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Regenerative nodule (RN)
              • Dysplastic nodule (DN)

            • Synonyms

              • Cirrhotic nodule

            • Definitions

              • Localized proliferation of liver parenchyma within cirrhotic liver in response to liver injury
                • May progress to become dysplastic or even malignant

            IMAGING

            • General Features

              • Imaging Recommendations

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Li S et al: Diagnostic efficacy of contrast-enhanced ultrasound versus MRI Liver Imaging Reporting and Data System (LI-RADS) for categorising hepatic observations in patients at risk of hepatocellular carcinoma. Clin Radiol. 76(2):161.e1-10, 2021
                                          2. Joo I et al: Radiologic-pathologic correlation of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement at gadoxetic acid-enhanced mri: a multicenter study. Radiology. 296(2):335-45, 2020
                                          3. Inchingolo R et al: MR with Gd-EOB-DTPA in assessment of liver nodules in cirrhotic patients. World J Hepatol. 10(7):462-73, 2018
                                          4. Sato T et al: Natural history of large regenerative nodules and dysplastic nodules in liver cirrhosis: 28-year follow-up study. Hepatol Int. 9(2):330-6, 2015
                                          5. Rich N et al: Hepatocellular carcinoma tumour markers: current role and expectations. Best Pract Res Clin Gastroenterol. 28(5):843-53, 2014
                                          6. Ronot M et al: Hepatocellular carcinoma: diagnostic criteria by imaging techniques. Best Pract Res Clin Gastroenterol. 28(5):795-812, 2014
                                          7. Bartolozzi C et al: Contrast-enhanced magnetic resonance imaging of 102 nodules in cirrhosis: correlation with histological findings on explanted livers. Abdom Imaging. 38(2):290-6, 2013
                                          8. Nakamura S et al: The diagnosis of hypovascular hepatic lesions showing hypo-intensity in the hepatobiliary phase of Gd-EOB- DTPA-enhanced MR imaging in high-risk patients for hepatocellular carcinoma. Acta Med Okayama. 67(4):239-44, 2013
                                          9. Quaia E et al: Predictors of dysplastic nodule diagnosis in patients with liver cirrhosis on unenhanced and gadobenate dimeglumine-enhanced MRI with dynamic and hepatobiliary phase. AJR Am J Roentgenol. 200(3):553-62, 2013
                                          10. Giorgio A et al: Characterization of dysplastic nodules, early hepatocellular carcinoma and progressed hepatocellular carcinoma in cirrhosis with contrast-enhanced ultrasound. Anticancer Res. 31(11):3977-82, 2011
                                          11. Kudo M: Diagnostic imaging of hepatocellular carcinoma: recent progress. Oncology. 81 Suppl 1:73-85, 2011
                                          12. Lee JM et al: Hepatocellular nodules in liver cirrhosis: MR evaluation. Abdom Imaging. 36(3):282-9, 2011
                                          13. Ouedraogo NA et al: Dysplastic hepatic nodules: radiological abnormalities and histopathological correlations. Eur J Radiol. 79(2):232-6, 2011
                                          14. Chou CT et al: Characterization of cirrhotic nodules with gadoxetic acid-enhanced magnetic resonance imaging: the efficacy of hepatocyte-phase imaging. J Magn Reson Imaging. 32(4):895-902, 2010
                                          15. Hanna RF et al: Cirrhosis-associated hepatocellular nodules: correlation of histopathologic and MR imaging features. Radiographics. 28(3):747-69, 2008
                                          16. Lencioni R et al: Guidelines for imaging focal lesions in liver cirrhosis. Expert Rev Gastroenterol Hepatol. 2(5):697-703, 2008
                                          17. Lupescu IG et al: Tissue specific MR contrast media role in the differential diagnosis of cirrhotic liver nodules. J Gastrointestin Liver Dis. 17(3):341-6, 2008
                                          18. Robinson P: Hepatocellular carcinoma: development and early detection. Cancer Imaging. 8 Suppl A:S128-31, 2008
                                          19. Roncalli M et al: Hepatocellular dysplastic nodules. Ann Ital Chir. 79(2):81-9, 2008
                                          20. Krinsky GA et al: Nondysplastic nodules that are hyperintense on T1-weighted gradient-echo MR imaging: frequency in cirrhotic patients undergoing transplantation. AJR Am J Roentgenol. 180(4):1023-7, 2003
                                          21. Hussain SM et al: Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation. Radiographics. 22(5):1023-36; discussion 1037-9, 2002
                                          22. Krinsky GA et al: Siderotic nodules in the cirrhotic liver at MR imaging with explant correlation: no increased frequency of dysplastic nodules and hepatocellular carcinoma. Radiology. 218(1):47-53, 2001
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Regenerative nodule (RN)
                                                      • Dysplastic nodule (DN)

                                                    • Synonyms

                                                      • Cirrhotic nodule

                                                    • Definitions

                                                      • Localized proliferation of liver parenchyma within cirrhotic liver in response to liver injury
                                                        • May progress to become dysplastic or even malignant

                                                    IMAGING

                                                    • General Features

                                                      • Imaging Recommendations

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Li S et al: Diagnostic efficacy of contrast-enhanced ultrasound versus MRI Liver Imaging Reporting and Data System (LI-RADS) for categorising hepatic observations in patients at risk of hepatocellular carcinoma. Clin Radiol. 76(2):161.e1-10, 2021
                                                                                  2. Joo I et al: Radiologic-pathologic correlation of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement at gadoxetic acid-enhanced mri: a multicenter study. Radiology. 296(2):335-45, 2020
                                                                                  3. Inchingolo R et al: MR with Gd-EOB-DTPA in assessment of liver nodules in cirrhotic patients. World J Hepatol. 10(7):462-73, 2018
                                                                                  4. Sato T et al: Natural history of large regenerative nodules and dysplastic nodules in liver cirrhosis: 28-year follow-up study. Hepatol Int. 9(2):330-6, 2015
                                                                                  5. Rich N et al: Hepatocellular carcinoma tumour markers: current role and expectations. Best Pract Res Clin Gastroenterol. 28(5):843-53, 2014
                                                                                  6. Ronot M et al: Hepatocellular carcinoma: diagnostic criteria by imaging techniques. Best Pract Res Clin Gastroenterol. 28(5):795-812, 2014
                                                                                  7. Bartolozzi C et al: Contrast-enhanced magnetic resonance imaging of 102 nodules in cirrhosis: correlation with histological findings on explanted livers. Abdom Imaging. 38(2):290-6, 2013
                                                                                  8. Nakamura S et al: The diagnosis of hypovascular hepatic lesions showing hypo-intensity in the hepatobiliary phase of Gd-EOB- DTPA-enhanced MR imaging in high-risk patients for hepatocellular carcinoma. Acta Med Okayama. 67(4):239-44, 2013
                                                                                  9. Quaia E et al: Predictors of dysplastic nodule diagnosis in patients with liver cirrhosis on unenhanced and gadobenate dimeglumine-enhanced MRI with dynamic and hepatobiliary phase. AJR Am J Roentgenol. 200(3):553-62, 2013
                                                                                  10. Giorgio A et al: Characterization of dysplastic nodules, early hepatocellular carcinoma and progressed hepatocellular carcinoma in cirrhosis with contrast-enhanced ultrasound. Anticancer Res. 31(11):3977-82, 2011
                                                                                  11. Kudo M: Diagnostic imaging of hepatocellular carcinoma: recent progress. Oncology. 81 Suppl 1:73-85, 2011
                                                                                  12. Lee JM et al: Hepatocellular nodules in liver cirrhosis: MR evaluation. Abdom Imaging. 36(3):282-9, 2011
                                                                                  13. Ouedraogo NA et al: Dysplastic hepatic nodules: radiological abnormalities and histopathological correlations. Eur J Radiol. 79(2):232-6, 2011
                                                                                  14. Chou CT et al: Characterization of cirrhotic nodules with gadoxetic acid-enhanced magnetic resonance imaging: the efficacy of hepatocyte-phase imaging. J Magn Reson Imaging. 32(4):895-902, 2010
                                                                                  15. Hanna RF et al: Cirrhosis-associated hepatocellular nodules: correlation of histopathologic and MR imaging features. Radiographics. 28(3):747-69, 2008
                                                                                  16. Lencioni R et al: Guidelines for imaging focal lesions in liver cirrhosis. Expert Rev Gastroenterol Hepatol. 2(5):697-703, 2008
                                                                                  17. Lupescu IG et al: Tissue specific MR contrast media role in the differential diagnosis of cirrhotic liver nodules. J Gastrointestin Liver Dis. 17(3):341-6, 2008
                                                                                  18. Robinson P: Hepatocellular carcinoma: development and early detection. Cancer Imaging. 8 Suppl A:S128-31, 2008
                                                                                  19. Roncalli M et al: Hepatocellular dysplastic nodules. Ann Ital Chir. 79(2):81-9, 2008
                                                                                  20. Krinsky GA et al: Nondysplastic nodules that are hyperintense on T1-weighted gradient-echo MR imaging: frequency in cirrhotic patients undergoing transplantation. AJR Am J Roentgenol. 180(4):1023-7, 2003
                                                                                  21. Hussain SM et al: Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation. Radiographics. 22(5):1023-36; discussion 1037-9, 2002
                                                                                  22. Krinsky GA et al: Siderotic nodules in the cirrhotic liver at MR imaging with explant correlation: no increased frequency of dysplastic nodules and hepatocellular carcinoma. Radiology. 218(1):47-53, 2001