Dysplastic liver nodules
Updates to Article Attributes
Body
was changed:
Dysplastic liver nodules are focal nodular regions (≥1 mm) without definite evidence of malignancy.
Epidemiology
They have been found in cirrhotic patients with a prevalence of 14% (size >1.0 cm) to 37% (size >0.5 cm) 2.
Associations
Pathology
Dysplasia indicates:
- nuclear atypia
- increased fat or glycogen in the cluster of dysplastic cells
Classification
They are broadly divided asdepending on the presence of cytologic and architectural atypia 2,4:
- low
grade-grade:imaging appearance closer toresemble regenerative nodule - high
grade: imaging appearance closer to-grade: resemble well-differentiated hepatocellular carcinoma (HCC)- atypia is insufficient to establish a diagnosis of HCC
- may exhibit clonelike features
Radiographic features
Ultrasound
Cirrhotic changes are present but the nodules may not be visualised on ultrasound. Few cases have shown hypo- and hyperechoic nodules and the echogenicity relates to the fat content in the nodule.
CT
Usually hypoattenuating, however, they may be iso- or hyperattenuating to the hepatic parenchyma.
-
contrastmultiphase contrasted images: they may show early arterial uptake but the contrast does not wash out on delayed phase (unlike HCC)
MRI
-
T1:
highalthough the signal intensity may vary broadly,low, or homogeneous intensitymost of them have high T1 signal -
in and out phaseIP-OOP: shows fat accumulation characterised by signal drop on the out-of-phase sequence - T2: iso- to hypointense
- DWI: no restricted diffusion
- T1 C+ (Gd)
- high
grade-grade nodules show early contrast enhancement without washout on delayed phase
- high
-
T2* C+ (SPIO)
- low
grade-grade nodules appear hypointense 13
- low
Treatment and prognosis
They are considered premalignant and hence follow-up is necessary. Percutaneous ablation therapy can be considered 9.
Differential diagnosis
There can be some imaging overlap with
- regenerative nodule
-
early hepatocellular carcinoma
.See also- increased T2 signal
-
regenerative liver nodules - washout on multiphase postcontrast imaging
-</ul><h5>Classification</h5><p>They are broadly divided as <sup>2,4</sup>:</p><ul>-<li>low grade: imaging appearance closer to <a href="/articles/regenerative-liver-nodule">regenerative nodule</a>- +</ul><h5>Classification</h5><p>They are broadly divided depending on the presence of cytologic and architectural atypia <sup>2,4</sup>:</p><ul>
- +<li>low-grade: resemble <a href="/articles/regenerative-liver-nodule">regenerative nodule</a>
-<li>high grade: imaging appearance closer to <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a> (HCC)</li>-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Cirrhotic changes are present but the nodules may not be visualised on ultrasound. Few cases have shown hypo- and hyperechoic nodules and the echogenicity relates to the fat content in the nodule.</p><h5>CT</h5><p>Usually hypoattenuating, however they may be iso- or hyperattenuating to the hepatic parenchyma.</p><ul><li>-<strong>contrast:</strong> they may show early arterial uptake but the contrast does not wash out on delayed phase (unlike HCC)</li></ul><h5>MRI</h5><ul>- +<li>high-grade: resemble well-differentiated <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a> (HCC)<ul>
- +<li>atypia is insufficient to establish a diagnosis of HCC</li>
- +<li>may exhibit clonelike features</li>
- +</ul>
- +</li>
- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Cirrhotic changes are present but the nodules may not be visualised on ultrasound. Few cases have shown hypo- and hyperechoic nodules and the echogenicity relates to the fat content in the nodule.</p><h5>CT</h5><p>Usually hypoattenuating, however, they may be iso- or hyperattenuating to the hepatic parenchyma.</p><ul><li>multiphase contrasted images: they may show early arterial uptake but the contrast does not wash out on delayed phase (unlike HCC)</li></ul><h5>MRI</h5><ul>
-<strong>T1:</strong> high, low, or homogeneous intensity</li>- +<strong>T1:</strong> although the signal intensity may vary broadly, most of them have high T1 signal </li>
-<strong>in and out phase:</strong> shows fat accumulation</li>- +<strong>IP-OOP:</strong> shows fat accumulation characterised by signal drop on the out-of-phase sequence</li>
-<strong>contrast studies</strong><ul>-<li><strong>T1 C+ (Gd)</strong><ul><li>high grade nodules show early contrast enhancement without washout on delayed phase</li></ul>- +<strong>DWI: </strong><!--?xml version="1.0" encoding="UTF-8"?-->no restricted diffusion</li>
- +<li><strong>T1 C+ (Gd)</strong><ul><li>high-grade nodules show early contrast enhancement without washout on delayed phase</li></ul>
-<strong>T2* C+ (SPIO)</strong><ul><li>low grade nodules appear hypointense <sup>13</sup>- +<strong>T2* C+ (SPIO)</strong><ul><li>low-grade nodules appear hypointense <sup>13</sup>
- +</ul><h4>Treatment and prognosis</h4><p>They are considered premalignant and hence follow-up is necessary. Percutaneous ablation therapy can be considered <sup>9</sup>.</p><h4>Differential diagnosis</h4><ul>
- +<li><a href="/articles/regenerative-liver-nodule">regenerative nodule</a></li>
- +<li>early <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a><ul>
- +<li>increased T2 signal</li>
- +<li>restricted diffusion </li>
- +<li>washout on multiphase postcontrast imaging </li>
-</ul><h4>Treatment and prognosis</h4><p>They are considered premalignant and hence follow-up is necessary. Percutaneous ablation therapy can be considered <sup>9</sup>.</p><h4>Differential diagnosis</h4><p>There can be some imaging overlap with <a href="/articles/hepatocellular-carcinoma">hepatocellular carcinoma</a>.</p><h4>See also</h4><ul><li><a href="/articles/regenerative-liver-nodules">regenerative liver nodules</a></li></ul>- +</ul>
Unable to process the form. Check for errors and try again.