J Korean Radiol Soc.  2006 Feb;54(2):113-119. 10.3348/jkrs.2006.54.2.113.

Hypervascular Hyperplastic Nodules Appearing in Chronic Alcoholic Liver Disease: Benign Intrahepatic Nodules Mimicking Hepatocellular Carcinoma

• Park WK
• Chang JC
• Kim JW
• Cho JH
• Lee JK
• Lee HZ
• Yun SS
• Lee DS
• Choi JH
• Hwang TY
• Eun JR

• KMID: 1577164
• DOI: http://doi.org/10.3348/jkrs.2006.54.2.113

Abstract

PURPOSE: Hypervascular hyperplastic nodules in those patients with chronic alcoholic liver disease and who are hepatitis B and C negative have recently been reported on. The purpose of this study was to correlate the radiologic and pathologic findings with the clinical significance of these hypervascular hyperplastic nodules in chronic alcoholic liver disease.
MATERIALS AND METHODS
The study included eight hypervascular nodules of seven patients with chronic alcoholic liver disease, and these patients had abused alcohol for more than 20 years. Eight hypervascular nodules were seen on the arterial phase of dynamic CT scans, but the possibility of HCC was excluded pathologically (n=4) or clinically. The radiologic and pathologic findings, and the changes of these nodules on follow up CT scans were retrospectively analyzed.
RESULTS
All nodules showed good enhancement on the arterial phase. The tissue equilibrium phase of the dynamic CT scans showed isodensity in seven patients and low density in one patient. Ultrasound scans revealed hypoechoic findings for three nodules, isoechoic findings for two nodules, hyperechoic findings for one nodule, and two nodules were not detected. Angiograms (n=6) showed late incremental tumor staining, and all the nodules were well seen on the sinusoidal phase. CT during hepatic angiography (n=4) showed well stained tumor. CT during arterial portography (n=4) showed no defect in three nodules and nodular defect in one nodule. The MR images (n=3) showed low signal intensity in two nodules and iso-signal intensity in one nodule on T2WI. Five of six cases for which follow up CT scans were performed showed decrease in size and one was disappeared.
CONCLUSION
Radiologically, it is often difficult to differentiate the hypervascular hyperplastic nodules seen in the chronic alcoholic liver disease from hepatocellular carcinoma, and histological confirmation is needed for excluded hepatocellular carcinoma. However, late tumor staining during the sinusoidal phase without any blood supply by feeding vessels or any arterioportal shunt on the angiogram, isodensity during the tissue equilibrium phase of dynamic CT and low signal intensity on T2WI may suggest the presence of hypervascular hyperplastic nodule.

Keyword

Liver, CT ; Liver, angiography; Liver neoplasms ; Liver neoplasms, angiography ; Liver neoplasms, MR

MeSH Terms

Alcoholics*
Angiography
Carcinoma, Hepatocellular*
Follow-Up Studies
Hepatitis B
Humans
Liver Diseases, Alcoholic*
Liver Neoplasms
Portography
Retrospective Studies
Tomography, X-Ray Computed
Ultrasonography