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Dysplastic hepatic nodules: Radiological abnormalities and histopathological correlations
European Journal of Radiology 79 (2011) 232–236
Contents lists available at ScienceDirect
European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad
Dysplastic hepatic nodules: Radiological abnormalities and histopathological correlations Nina Astrid Ouedraogo a,∗ , Marie Danjoux-de-Volontat b,2 , Julien Auriol a,1 , Jean-Marie Peron c,3 , Hervé Rousseau a,4 , Philippe Otal a,4 a
Service de Radiologie, Centre Hospitalier Universitaire Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France Service d’Anatomie et de Cytologie pathologique, Centre Hospitalier Universitaire Purpan, TSA 40031, 31059 Toulouse Cedex 9, France c Service de Gastroentérologie, Centre Hospitalier Universitaire Purpan, TSA 40031, 31059 Toulouse Cedex 9, France b
a r t i c l e
i n f o
Article history: Received 1 November 2009 Received in revised form 28 March 2010 Accepted 16 June 2010 Keywords: Dysplastic nodule Liver cirrhosis Hepatocellular carcinoma CT MRI
a b s t r a c t Pathological studies of explanted cirrhotic livers have made it possible to define precisely the principal morphological characteristics of the transitional stages of the regenerative nodule to dysplastic nodule to hepatocellular carcinoma. The aim of our study was to examine the imaging features of histologically proven dysplastic nodules and to compare them with their histopathological features. A large majority (63%) of the dysplastic nodules in our series was hypervascular and 16% had the classic appearance of hepatocellular carcinoma. Even if the management of a high-grade dysplastic nodule differs little from that of a hepatocellular carcinoma, it is important to remember that not all hypervascular nodules in a cirrhotic liver are necessarily a hepatocellular carcinoma or a high-grade dysplastic nodule. © 2010 Elsevier Ireland Ltd. All rights reserved.
1. Conclusion In spite of the good performances of the Barcelona criteria in the diagnosis of HCC, the classic combination of signs consisting of hypervascularity and portal washout is neither perfectly sensitive nor entirely specific. A large majority (63%) of
∗ Corresponding author. Tel.: +33 614955007; fax: +33 561322492. E-mail addresses: [email protected] (N.A. Ouedraogo), [email protected] (M. Danjoux-de-Volontat), [email protected] (J. Auriol), [email protected] (J.-M. Peron), [email protected] (H. Rousseau), [email protected] (P. Otal). 1 Tel.: +33 561323546; fax: +33 561322492. 2 Tel.: +33 561772108; fax: +33 561777603. 3 Tel.: +33 561779483; fax: +33 561779015. 4 Tel.: +33 561323351; fax: +33 561322492. 0720-048X/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2010.06.028
the DN in our series were hypervascular and 16% had the classic appearance of HCC. Even if the management of a high-grade dysplastic nodule differs little from that of an HCC, it is important to remember that all hypervascular nodules in a cirrhotic liver are not necessarily either an HCC or a high-grade DN (Figs. 1–8).
N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
Fig. 1. Typical appearance of a dysplastic nodule on CT scan: hypodense nodule without enhancement (a), in the arterial phase (b) and in the portal phase (c).
Fig. 2. Abnormal appearance on CT scan: isodense nodule without enhancement (a), and hyperdense in the arterial and portal phases (b and c).
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N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
Fig. 3. Abnormal appearance on CT scan: hypodense nodule without enhancement (a), hyperdense in the arterial phase (b) and isodense in the portal phase (c).
Fig. 4. Typical appearance of a dysplastic nodule on MRI: hyperintense on T1-weighted sequences (a), isointense on T2-weighted sequences (b), hypointense in the arterial phase (c) and isointense in the portal phase (d).
N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
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Fig. 5. Abnormal appearance on MRI: decreased signal intensity on T1-weighted sequences (a) and increased signal intensity on T2-weighted sequences (b). Hypervascularity in the arterial and portal phases (c and d).
Fig. 6. Abnormalities on MRI: nodule with homogeneous signal intensity on T1-weighted sequences (a) and T2-weighted sequences (b), increased signal intensity in arterial phase(c) and decreased signal intensity in the portal phases (d).
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N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
Fig. 7. Low-grade DN: cell density is moderately increased with regular cytology.
Fig. 8. High-grade DN: trabecular architecture is irregular, with compact and slightly thickened trabeculae. Cell density is markedly increased. Cytological abnormalities are observed: nucleus are slightly or not atypical, but with a high nuclear-cytoplasmic ratio.
Acknowledgement The authors thank Nina Crowte for translation of the manuscript.
Contents lists available at ScienceDirect
European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad
Dysplastic hepatic nodules: Radiological abnormalities and histopathological correlations Nina Astrid Ouedraogo a,∗ , Marie Danjoux-de-Volontat b,2 , Julien Auriol a,1 , Jean-Marie Peron c,3 , Hervé Rousseau a,4 , Philippe Otal a,4 a
Service de Radiologie, Centre Hospitalier Universitaire Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France Service d’Anatomie et de Cytologie pathologique, Centre Hospitalier Universitaire Purpan, TSA 40031, 31059 Toulouse Cedex 9, France c Service de Gastroentérologie, Centre Hospitalier Universitaire Purpan, TSA 40031, 31059 Toulouse Cedex 9, France b
a r t i c l e
i n f o
Article history: Received 1 November 2009 Received in revised form 28 March 2010 Accepted 16 June 2010 Keywords: Dysplastic nodule Liver cirrhosis Hepatocellular carcinoma CT MRI
a b s t r a c t Pathological studies of explanted cirrhotic livers have made it possible to define precisely the principal morphological characteristics of the transitional stages of the regenerative nodule to dysplastic nodule to hepatocellular carcinoma. The aim of our study was to examine the imaging features of histologically proven dysplastic nodules and to compare them with their histopathological features. A large majority (63%) of the dysplastic nodules in our series was hypervascular and 16% had the classic appearance of hepatocellular carcinoma. Even if the management of a high-grade dysplastic nodule differs little from that of a hepatocellular carcinoma, it is important to remember that not all hypervascular nodules in a cirrhotic liver are necessarily a hepatocellular carcinoma or a high-grade dysplastic nodule. © 2010 Elsevier Ireland Ltd. All rights reserved.
1. Conclusion In spite of the good performances of the Barcelona criteria in the diagnosis of HCC, the classic combination of signs consisting of hypervascularity and portal washout is neither perfectly sensitive nor entirely specific. A large majority (63%) of
∗ Corresponding author. Tel.: +33 614955007; fax: +33 561322492. E-mail addresses: [email protected] (N.A. Ouedraogo), [email protected] (M. Danjoux-de-Volontat), [email protected] (J. Auriol), [email protected] (J.-M. Peron), [email protected] (H. Rousseau), [email protected] (P. Otal). 1 Tel.: +33 561323546; fax: +33 561322492. 2 Tel.: +33 561772108; fax: +33 561777603. 3 Tel.: +33 561779483; fax: +33 561779015. 4 Tel.: +33 561323351; fax: +33 561322492. 0720-048X/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2010.06.028
the DN in our series were hypervascular and 16% had the classic appearance of HCC. Even if the management of a high-grade dysplastic nodule differs little from that of an HCC, it is important to remember that all hypervascular nodules in a cirrhotic liver are not necessarily either an HCC or a high-grade DN (Figs. 1–8).
N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
Fig. 1. Typical appearance of a dysplastic nodule on CT scan: hypodense nodule without enhancement (a), in the arterial phase (b) and in the portal phase (c).
Fig. 2. Abnormal appearance on CT scan: isodense nodule without enhancement (a), and hyperdense in the arterial and portal phases (b and c).
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N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
Fig. 3. Abnormal appearance on CT scan: hypodense nodule without enhancement (a), hyperdense in the arterial phase (b) and isodense in the portal phase (c).
Fig. 4. Typical appearance of a dysplastic nodule on MRI: hyperintense on T1-weighted sequences (a), isointense on T2-weighted sequences (b), hypointense in the arterial phase (c) and isointense in the portal phase (d).
N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
235
Fig. 5. Abnormal appearance on MRI: decreased signal intensity on T1-weighted sequences (a) and increased signal intensity on T2-weighted sequences (b). Hypervascularity in the arterial and portal phases (c and d).
Fig. 6. Abnormalities on MRI: nodule with homogeneous signal intensity on T1-weighted sequences (a) and T2-weighted sequences (b), increased signal intensity in arterial phase(c) and decreased signal intensity in the portal phases (d).
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N.A. Ouedraogo et al. / European Journal of Radiology 79 (2011) 232–236
Fig. 7. Low-grade DN: cell density is moderately increased with regular cytology.
Fig. 8. High-grade DN: trabecular architecture is irregular, with compact and slightly thickened trabeculae. Cell density is markedly increased. Cytological abnormalities are observed: nucleus are slightly or not atypical, but with a high nuclear-cytoplasmic ratio.
Acknowledgement The authors thank Nina Crowte for translation of the manuscript.