Imaging

Hepatic Adenoma

Preliminary Diagnosis: Hepatic Adenoma

I. What imaging technique is first-line for this diagnosis?

Ultrasound of the liver

II. Describe the advantages and disadvantages of this technique for diagnosis of hepatic adenoma.

Advantages

  • Highly portable, relatively quick imaging modality

  • Does not expose patients to ionizing radiation

  • Better adept in detailing the vascularity of a lesion than other imaging modalities

Disadvantages

  • Limited in sensitivity and specificity in detecting, characterizing, and diagnosing hepatic lesions

  • May help guide percutaneous biopsy, treatment, and therapy

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to sonographic imaging exist.

IV. What alternative imaging techniques are available?

  • Triple phase liver protocol CT imaging of the liver

  • Triple phase MR imaging of the abdomen and pelvis with contrast per liver protocol

  • Nuclear medicine technetium-99m sulfur colloid imaging

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hepatic adenoma.

Triple phase liver protocol CT imaging of the liver

Advantages

  • Highly sensitive and specific in diagnosing, characterizing, and detecting liver lesions

  • May help guide percutaneous biopsy, treatment, and therapy

  • Offers exquisite visualization of the surrounding soft tissues , osseous structures, and vasculature

Disadvantages

  • Exposes patients to ionizing radiation

Triple phase MR imaging of the abdomen and pelvis with contrast per liver protocol

Advantages

  • Does not expose patients to ionizing radiation

  • Offers exquisite visualization of the surrounding soft tissues

  • Eovist contrast medium may better delineate biliary versus hepatic pathology

Disadvantages

  • Offers limited evaluation of the surrounding osseous structures

  • May be subject to motion and susceptibility weighted artifact degrading image quality

Nuclear medicine technetium-99m sulfur colloid imaging

Advantages

  • Hepatic adenomas do not demonstrate uptake

Disadvantages

  • Limited in sensitivity and highly specific in diagnosing an hepatic adenoma

  • Offers limited evaluation of the surrounding soft tissues, osseous structures, and vasculature

  • Exposes patients to ionizing radiation

  • Less adept in guiding percutaneous therapy

VI. What are the contraindications for the alternative imaging techniques?

Triple phase liver protocol CT imaging of the liver

  • May be contraindicated in patients who are pregnant

Triple phase MR imaging of the abdomen and pelvis with contrast per liver protocol

  • Contraindicated in patients with non-MR compatible hardware

Nuclear medicine technetium-99m sulfur colloid imaging

  • Contraindicated in breastfeeding and pregnant women

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