Focal nodular hyperplasia (FNH) is the second most frequent benign liver tumor, and it is a fiber-rich stiff lesion. Typically, FNH can be diagnosed by imaging without biopsy. However, liver biopsy and diagnostic resection may be required to differentiate atypical FNH from other liver tumors, such as hepatocellular adenoma (HCA). Therefore, improved noninvasive diagnostic methods are needed. We experienced 2 cases where combination of magnetic resonance elastography (MRE) and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) helped diagnose FNH. A 36-year-old woman and 17-year-old boy with liver tumors measuring 40 mm in diameter each showed hypointense nodule centers, indicating a central scar, surrounded by hyperintense signals during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. To rule out HCA, we performed MRE and liver biopsy. On MRE, the mean stiffness of the mass was 11.6 kPa (mean stiffness of the background liver was 1.7 kPa) and 11.1 kPa (mean stiffness of the background liver was 2.4 kPa) in the first and second patients, respectively. Histological examination of both specimens showed CK7-positive bile-ductular proliferations, abundant fibrous tissue, and few Ki-67-positive cells. Based on these results, we diagnosed these tumors as FNH. Combination of Gd-EOB-DTPA-enhanced MRI and MRE can evaluate the character and stiffness of lesion and help in the diagnosis of FNH.
Case Rep Gastroenterol 2021;15:507–512

中文翻译：

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使用钆乙氧基苄基二亚乙基三胺五乙酸诊断局灶性结节性增生的新策略：增强型磁共振成像和磁共振弹性成像

局灶性结节增生 (FNH) 是第二常见的良性肝脏肿瘤，它是一种富含纤维的僵硬病变。通常，FNH 可以通过成像诊断，无需活检。然而，可能需要肝活检和诊断性切除才能将非典型 FNH 与其他肝脏肿瘤（如肝细胞腺瘤 (HCA)）区分开来。因此，需要改进的无创诊断方法。我们经历了 2 个案例，其中结合磁共振弹性成像 (MRE) 和钆乙氧基苄基二亚乙基三胺五乙酸 (Gd-EOB-DTPA) 增强磁共振成像 (MRI) 有助于诊断 FNH。一名 36 岁妇女和一名 17 岁男孩患有直径 40 毫米的肝脏肿瘤，均显示低信号结节中心，表明有中央疤痕，在 Gd-EOB-DTPA 增强 MRI 的肝胆相期间被高信号包围。为了排除 HCA，我们进行了 MRE 和肝活检。在 MRE 上，第一和第二名患者的肿块平均硬度分别为 11.6 kPa（背景肝脏的平均硬度为 1.7 kPa）和 11.1 kPa（背景肝脏的平均硬度为 2.4 kPa）。两个标本的组织学检查均显示 CK7 阳性胆管增生、丰富的纤维组织和少量 Ki-67 阳性细胞。基于这些结果，我们将这些肿瘤诊断为 FNH。Gd-EOB-DTPA增强MRI与MRE联合可评估病灶的性质和僵硬程度，有助于FNH的诊断。第一名和第二名患者分别为 6 kPa（背景肝脏的平均硬度为 1.7 kPa）和 11.1 kPa（背景肝脏的平均硬度为 2.4 kPa）。两个标本的组织学检查均显示 CK7 阳性胆管增生、丰富的纤维组织和少量 Ki-67 阳性细胞。基于这些结果，我们将这些肿瘤诊断为 FNH。Gd-EOB-DTPA增强MRI与MRE联合可评估病灶的性质和僵硬程度，有助于FNH的诊断。第一名和第二名患者分别为 6 kPa（背景肝脏的平均硬度为 1.7 kPa）和 11.1 kPa（背景肝脏的平均硬度为 2.4 kPa）。两个标本的组织学检查均显示 CK7 阳性胆管增生、丰富的纤维组织和少量 Ki-67 阳性细胞。基于这些结果，我们将这些肿瘤诊断为 FNH。Gd-EOB-DTPA增强MRI与MRE联合可评估病灶的性质和僵硬程度，有助于FNH的诊断。
Case Rep Gastroenterol 2021；15:507–512