Usefulness of noninvasive tests in nodular regenerative hyperplasia of the liver.

BACKGROUND: The only way to diagnose nodular regenerative hyperplasia (NRH) is liver biopsy. AIM: To evaluate in a prospective study the performance of noninvasive liver investigations in patients with NRH. METHODS: All consecutive patients with NRH who were being followed up in our unit from 2004 to 2007 were included. All biopsy specimens were reanalysed independently to confirm the diagnosis of NRH (classified as certain or probable) and to assess portal or sinusoidal associated fibrosis. All patients had liver stiffness (using FibroScan) and FibroTest measurements. Magnetic resonance imaging (MRI) was performed using two contrast agents (gadolinium-chelate and ferucarbotran). RESULTS: Thirty patients were included (mean age: 53 years). Median liver stiffness value was 7.9 kPa (range: 3.5-16.8), with 63% of the patients having more than 7.1 kPa. No relationship was found between NRH with or without portal hypertension and liver stiffness or Fibrotest. No correlation was found between liver stiffness and portal and/or sinusoidal fibrosis. In patients studied with MRI, 55% had portal hypertension and 9% a diffuse fine-nodular loss of iron uptake after ferucarbotran injection. CONCLUSION: Liver stiffness and FibroTest values may be increased in NRH patients, with no correlation with portal hypertension or portal and sinusoidal fibrosis. Contrast-enhanced MRI is disappointing in NRH.

Quadruple-phase MDCT of the liver in patients with suspected hepatocellular carcinoma: effect of contrast material flow rate.

OBJECTIVE: The purposes of this study were to evaluate the effect of contrast material flow rate (3 mL/sec vs 5 mL/sec) on the detection and visualization of hepatocellular carcinoma (HCC) with MDCT and the safety profile of iodixanol at different injection rates. SUBJECTS AND METHODS: In a prospective, randomized multicenter trial, 97 patients (83 men and 14 women, with a mean age of 64 years) suspected of having HCC underwent quadruple-phase (double arterial, portal venous, delayed phase) 4-16-MDCT. Patients were randomized to receive iodixanol, 320 mg I/mL (1.5 mL/kg body weight), at a flow rate of 3 mL/sec (48 patients) or 5 mL/sec (49 patients). Qualitative (lesion detection, image quality) and quantitative (liver and aortic enhancement, tumor-liver contrast) analyses and safety assessment were performed. RESULTS: Overall, 145 HCCs were detected in the 5 mL/sec group and 100 HCCs in the 3 mL/sec group (p < 0.05). More lesions equal to or less than 1 cm were detected at 5 mL/sec (33 vs 16 lesions). The late arterial phase showed significantly more lesions than the early, arterial phase (133 vs 100 and 96 vs 67 lesions, respectively, p < 0.0001). Hyperattenuating HCCs were better visualized in the late arterial phase at 5 mL/sec (excellent visualization: 54% vs 27%). Using a flow of 5 mL/sec did not increase the rate of patient discomfort or contrast media-related adverse events. Most discomfort in both groups was of mild intensity and there was no severe discomfort. CONCLUSION: For detection of HCC with MDCT, a higher flow rate of 5 mL/sec is recommended. Visualization of hyperattenuating HCC is improved with no greater discomfort or adverse events.

Paroxysmal nocturnal hemoglobinuria and Budd-Chiari syndrome: therapeutic challenge with bone marrow transplantation, transjugular intrahepatic portosystemic shunt, and vena cava stent.

Stenosis of inferior vena cava can be a cause of or a consequence of Budd-Chiari syndrome (BCS). However, its occurrence after transjugular intrahepatic portosystemic shunt (TIPS) insertion has only been twice reported. We report the case of a 23-year-old man who presented BCS of the three suprahepatic veins. The cause of BCS was paroxysmal nocturnal hemoglobinuria, which was treated by bone marrow transplantation. A few months later, it was necessary to insert a TIPS because of refractory ascites and severe denutrition. However, refractory ascites was persistent and esophageal varices bleeding occurred. A TIPS desobstruction was needed, and during this angiography a stenosis of the suprahepatic vena cava was found and was treated with dilatation and stent. In a few weeks, the patient's clinical and nutritional state improved and, after 9 months hospitalization, the patient was discharged. One year later, this patient had no symptoms with an excellent permeability of TIPS and vena cava stent. This case report confirms that TIPS is a good treatment for BCS, but stenosis of inferior vena cava can occur after such a treatment.

Detection of nodules in liver cirrhosis: spiral computed tomography or magnetic resonance imaging? A prospective study of 88 nodules in 34 patients.

Detection and characterization of all focal lesions in the liver are critical for screening patients with chronic liver disease. The aim of this prospective study was to investigate the accuracy of magnetic resonance imaging (MRI) and spiral computed tomography for the diagnosis of hepatic nodules in cirrhotic patients when compared with pathological findings of the explanted liver. From February 1997 to July 1999, 34 cirrhotic patients waiting for orthotopic liver transplantation (OLT) (mean age, 53.5 +/- 9.3 years; 24 males) were included. All patients had MRI and spiral computed tomography examinations, and findings were matched with the histological findings. Data analyses were made using the McNemar chi-square test. Mean time between radiological examination (MRI or spiral computed tomography) and OLT was 43.8 +/- 39 days. A total of 88 nodules were found in the 34 patients: 54 hepatocellular carcinoma (HCC) (mean size, 18 +/- 10 mm) in 21 patients, 22 dysplastic nodules (mean size, 10.7 +/- 4.3 mm) in 11 patients, and 12 macroregenerative nodules in 13 patients. Lesion-by-lesion analyses showed that sensitivity of MRI and spiral computed tomography for nodule, HCC or dysplastic nodule diagnosis was 44.3 and 31.8% (P = 0.02), 61.1 and 51.9% (P = 0.2), and 27.3 and 0% (P = 0.04), respectively. Patient-by-patient analyses showed no statistical difference between spiral computed tomography and MRI for nodule diagnosis. In conclusion, in patients with liver cirrhosis, MRI is more accurate than spiral computed tomography for the detection of liver nodules and dysplastic nodules. However, tumour size is always a restricting factor for these two techniques, which are unable to detect small HCC in more than 60% of cases.