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Cirrhosis-associated Hepatocellular Nodules: Correlation of Histopathologic and MR Imaging Features¹

¹ From the Department of Radiology, Division of Body Imaging (R.F.H., D.A.A., N.K., C.B.S.), and Department of Pathology (S.C.E., M.R.P.), University of California, San Diego, UCSD Liver Center, 200 W Arbor Dr, San Diego, CA 92103-8756. Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received May 2, 2005; revision requested September 13; final revision received August 7, 2007; accepted August 21. The authors discuss an investigational or unlabeled use of a commercial product, device, or pharmaceutical that has not been approved for such purpose by the FDA. C.B.S. has received research grants from Bayer and General Electric; all remaining authors have no financial relationships to disclose. Address correspondence to C.B.S. (e-mail: csirlin{at}ucsd.edu).

Cirrhotic livers are characterized by advanced fibrosis and the formation of hepatocellular nodules, which are classified histologically as either (a) regenerative lesions (eg, regenerative nodules, lobar or segmental hyperplasia, focal nodular hyperplasia) or (b) dysplastic or neoplastic lesions (eg, dysplastic foci and nodules, hepatocellular carcinomas). The differentiation of these lesions is important because regenerative nodules are benign, whereas dysplastic and neoplastic nodules are premalignant and malignant, respectively. However, their accurate characterization may be difficult even at histopathologic analysis. Differential diagnosis may be facilitated by comparing the clinical and pathologic findings with radiologic imaging features; in particular, nodule size, vascularity, hepatocellular function, and Kupffer cell density assessed at magnetic resonance (MR) imaging are suggestive of the correct diagnosis. MR imaging is more useful than computed tomography for such assessments because it provides better soft-tissue contrast and a more nuanced depiction of different tissue properties. Moreover, a wider variety of contrast agents is available for use in MR imaging. Familiarity with the MR imaging characteristics of cirrhosis-associated hepatocellular nodules is therefore important for optimal diagnosis and management of cirrhotic disease.

© RSNA, 2008