Sonic hedgehog hepatocellular adenoma: magnetic resonance imaging features and correlation with histology.

Details

Serval ID
serval:BIB_E936B5043A8A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Sonic hedgehog hepatocellular adenoma: magnetic resonance imaging features and correlation with histology.
Journal
European radiology
Author(s)
Ducatel A., Trillaud H., Reizine E., Vilgrain V., Sempoux C., Schmidt-Kobbe S., Gouw ASH, de Haas R.J., Julien C., Paradis V., Blanc J.F., Chiche L., Balabaud C., Bioulac-Sage P., Frulio N.
ISSN
1432-1084 (Electronic)
ISSN-L
0938-7994
Publication state
Published
Issued date
07/2024
Peer-reviewed
Oui
Volume
34
Number
7
Pages
4649-4662
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Sonic hedgehog hepatocellular adenoma (shHCA) is a new hepatocellular adenoma (HCA) subgroup characterized by high risk of hemorrhage. ShHCA account for below 10% of all HCA cases and are often associated with female gender, obesity, and non-alcoholic steatohepatitis. No specific MRI characteristics have been described to date. The objective of this study was to assess the value of using MRI to identify shHCA, and correlate MRI findings with histology.
We retrospectively collected MRI scans of 29 patients with shHCA from our center and from different liver referral centers to include 35 lesions. Diagnosis of shHCA was assessed by immunohistochemical overexpression of argininosuccinate synthase 1 or prostaglandin D2 synthase, then confirmed by molecular analysis of sonic hedgehog pathway activation and/or by proteomic analysis.
In 46% (n = 16/35) of shHCA cases, we detected intralesional fluid-filled cavities defined on MR images as fluid-like foci markedly hyperintense on T2-weighted sequences, and hypointense on T1-weighted sequences, with or without delayed enhancement. Pathologically, these cavities were observed in 54% of cases as vacuoles filled with blood at different stages of degradation. Hemorrhage and/or necrosis were detected among 71% of cases by MRI analysis (n = 25/35) versus 82% pathologically. Seventeen percent of shHCA cases (n = 6/35) were completely homogeneous via MRI and pathological analysis. No MRI criteria was found in favor of focal nodular hyperplasia, HNF1A-mutated HCA, or typical inflammatory HCA.
We reveal the presence of intralesional fluid-filled cavities among 46% of our shHCA cases that represent a new MRI finding possibly helpful for shHCA diagnosis.
This multicenter study is the first clinical study about the radiological aspect of this new hepatocellular adenoma subgroup. This highlights a strong correlation between MRI and histological analysis, with a specific pattern emerging for diagnosis.
• Sonic hedgehog hepatocellular adenoma is a new hepatocellular adenoma subgroup associated with high risk of hemorrhage, but imaging features of this subgroup remain unknown. • Analysis of MR images and correlation with pathology revealed intralesional fluid-filled cavities and necrotic-hemorrhagic changes. • Intralesional fluid-filled cavities have not yet been described in other adenoma subtypes and represent a new MRI finding for sonic hedgehog hepatocellular adenoma.
Keywords
Humans, Female, Male, Liver Neoplasms/diagnostic imaging, Liver Neoplasms/pathology, Magnetic Resonance Imaging/methods, Adenoma, Liver Cell/diagnostic imaging, Adenoma, Liver Cell/pathology, Middle Aged, Hedgehog Proteins/metabolism, Retrospective Studies, Adult, Aged, Hemorrhage, Hepatocellular adenoma, Magnetic resonance imaging, Pathology, Sonic hedgehog protein
Pubmed
Web of science
Create date
01/12/2023 9:40
Last modification date
02/07/2024 8:38
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