Transient Homogeneously Enhancing Hepatic Masses: Can Size Predict Benignity?
Fiona Hughes-Cassidy1,2,
Jeffrey Wong1,3,
Diego Aguirre1,4,
Alyssa D. Chavez1,
Tanya Wolfson5,
Anthony Gamst6 and
Claude Sirlin1
1 Liver Imaging Research Group and Department of Radiology, University of
California, San Diego, 408 Dickinson St., San Diego, CA 92103-8226.
2 Department of Radiology, Veterans Affairs Medical Center, San Diego, CA.
3 Present address: Department of Radiology, Tuen Mun Hospital, Hong Kong.
4 Present address: Department of Medical Imaging, Fundacion Santa Fe de Bogota,
University Hospital, Bogota, Colombia.
5 Biostatistics and Bioinformatics Division, Family and Preventive Medicine,
UCSD, San Diego, CA.
6 Neurosciences and Biostatistics and Bioinformatics, UCSD, San Diego, CA.
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Fig. 1B —52-year-old woman with large transient hepatic attenuating
mass. Mass (arrow) enhances homogeneously during hepatic artery phase
(B) and fades to isoattenuation during portal venous phase (C).
Imaging findings are illustrative of transient hepatic attenuating mass. This
mass was stable for 36 months, indicating benignity (presumed diagnosis is
focal nodular hyperplasia).
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Fig. 1C —52-year-old woman with large transient hepatic attenuating
mass. Mass (arrow) enhances homogeneously during hepatic artery phase
(B) and fades to isoattenuation during portal venous phase (C).
Imaging findings are illustrative of transient hepatic attenuating mass. This
mass was stable for 36 months, indicating benignity (presumed diagnosis is
focal nodular hyperplasia).
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Fig. 2 —33-year-old woman with two hyperenhancing liver masses. Axial
CT image of liver during hepatic artery phase shows two hyperenhancing masses:
71 x 55 mm mass in right lobe (black arrow) and 28 x 26
mm mass in left lobe (white arrow). Larger mass contains central scar
(arrowhead) and does not qualify as transient hepatic attenuating
mass. Smaller mass is homogeneous and qualifies as transient hepatic
attenuating mass (high density at periphery of mass is due to arteriovenous
shunting). Both masses faded to isoattenuation on portal venous phase (not
shown) and were stable for 60 months, indicating benignity (presumed
diagnosis, focal nodular hyperplasia).
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Fig. 3A —76-year-old man with neuroendocrine metastasis to liver.
Axial CT image of liver during hepatic artery phase shows 8 x 6 mm
transient hepatic attenuating mass in right lobe of liver (arrow).
Mass faded to isoattenuation on portal venous phase (not shown).
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Fig. 3B —76-year-old man with neuroendocrine metastasis to liver.
Contrast-enhanced CT scan 44 months later shows interval enlargement of mass
(arrows) (now 20 x 15 mm) and change in character from
transient hepatic attenuating mass to heterogeneous mass with ringlike
configuration.
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Fig. 4A —43-year-old man with focal nodular hyperplasia. Axial CT
image of liver during hepatic artery phase shows 15 x 14 mm transient
hepatic attenuating mass (arrow) in left lobe of liver. Mass was
isodense on unenhanced image and faded to isodensity on portal venous phase
(not shown).
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Fig. 4B —43-year-old man with focal nodular hyperplasia. Axial
gadolinium-enhanced MR images of liver obtained 42 months later show interval
enlargement of mass (arrow) (now 23 x 19 mm). Despite its
interval growth, mass has not changed in character; it homogeneously
hyperenhances on arterial phase (B) and fades to isointensity on portal
venous phase (C). Because of its interval growth, biopsy was performed.
Histologic diagnosis was focal nodular hyperplasia. MRI features are
illustrative of transient hepatic intensifying mass.
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Fig. 4C —43-year-old man with focal nodular hyperplasia. Axial
gadolinium-enhanced MR images of liver obtained 42 months later show interval
enlargement of mass (arrow) (now 23 x 19 mm). Despite its
interval growth, mass has not changed in character; it homogeneously
hyperenhances on arterial phase (B) and fades to isointensity on portal
venous phase (C). Because of its interval growth, biopsy was performed.
Histologic diagnosis was focal nodular hyperplasia. MRI features are
illustrative of transient hepatic intensifying mass.
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Fig. 5A —44-year-old woman with transient hepatic attenuating mass in
left lobe of liver. Axial CT image of liver during hepatic artery phase shows
24 x 22 mm hyperenhancing mass (arrow) in left lobe.
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Fig. 5C —44-year-old woman with transient hepatic attenuating mass in
left lobe of liver. Contrast-enhanced transverse sonogram shows spoked-wheel
inside-to-outside enhancement pattern (arrows) characteristic of
focal nodular hyperplasia.
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Fig. 6A —Distribution of lesion sizes. Graphs show distribution of
lesion mean diameters for benign (circles, n = 120) versus
malignant (triangles, n = 107) transient hepatic attenuating
masses (A) and corresponding receiver operator characteristic curves
(B). In plot (A), horizontal line at 22 mm indicates threshold
diameter above which all masses are benign. On ROC curve (B), several
diameter thresholds (in mm) are marked at inflection points. Area under curve
(AUC, 0.676) is significantly higher than uninformative AUC of 0.50 (area
under dashed line).
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Fig. 6B —Distribution of lesion sizes. Graphs show distribution of
lesion mean diameters for benign (circles, n = 120) versus
malignant (triangles, n = 107) transient hepatic attenuating
masses (A) and corresponding receiver operator characteristic curves
(B). In plot (A), horizontal line at 22 mm indicates threshold
diameter above which all masses are benign. On ROC curve (B), several
diameter thresholds (in mm) are marked at inflection points. Area under curve
(AUC, 0.676) is significantly higher than uninformative AUC of 0.50 (area
under dashed line).
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Fig. 7 —Estimated perpatient probability (univariate logistic
regression) of benign (circles, n = 37) versus malignant
(triangles, n = 18) transient hepatic attenuating masses based on
maximum perpatient mass diameter for study sample (solid line) and
for hypothetic populations with varying proportions of benign per-patient
masses (dotted lines).
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Copyright © 2008 by the American Roentgen Ray Society.
