European Radiology

, Volume 29, Issue 5, pp 2436–2447 | Cite as

New MRI features improve subtype classification of hepatocellular adenoma

  • Sylvain Bise
  • Nora FrulioEmail author
  • Arnaud Hocquelet
  • Nicolas Alberti
  • Jean-Frederic Blanc
  • Christophe Laurent
  • Hervé Laumonier
  • Charles Balabaud
  • Paulette Bioulac-Sage
  • Hervé Trillaud



MRI is crucial for the classification of hepatocellular adenomas (HCA) into subtypes. Our objective was to review and increase MRI criteria for subtype classification and define the limits.


Pathological and radiological data of 116 HCAs were retrospectively analyzed to investigate MRI features of HCA pathological subtypes. Risk for complication was also evaluated with regard to subtype and tumor size.


38/43 (88%) HNF1α-mutated HCAs (H-HCAs) were discriminated by (i) fatty component (homogeneous or heterogeneous) and (ii) hypovascular pattern, with a sensitivity of 88% and a specificity of 97%. 51/58 (88%) inflammatory HCAs (IHCAs) displayed features of sinusoidal dilatation (SD) including three different patterns (global SD, atoll sign, and a new “crescent sign” corresponding to a partial peripheral rim, hyperintense on T2W and/or arterial phase with persistent delayed enhancement). Sensitivity was 88% and specificity 100%. However, some HCA remained unclassifiable by MRI: HCA remodeled by necrotic/hemorrhagic changes covering > 50% of the lesion, H-HCAs without steatosis, IHCAs without SD, β-catenin-mutated and unclassified HCAs. Regarding malignant transformation (5/116) and bleeding (24/116), none was observed when the HCA diameter was smaller than 5.2 cm and 4.2 cm, respectively.


Based on the largest series evaluated until now, we identified several non-described MRI features and propose new highly sensitive and specific MRI criteria. With the addition of these new features, 88% of the two main HCA subtypes could be identified.

Key Points

• HNF1α-mutated hepatocellular adenomas (H-HCA) are characterized by the presence of fat and hypovascular pattern in MRI.

• Inflammatory hepatocellular adenomas (I-HCA) are characterized by different patterns translating sinusoidal dilatation including the newly described crescent sign.

• No MRI specific pattern was identified for β-catenin-mutated HCA (b-HCA).


Liver neoplasms Adenoma, liver cell Magnetic resonance imaging Catenins Retrospective studies 



Argininosuccinate synthase 1


Area under the receiver operating characteristic


β-catenin-mutated HCA


β-catenin-mutated inflammatory HCA


C-reactive protein


Focal nodular hyperplasia


HNF1α-mutated HCAs


Hepatobiliary phase


Hepatocellular adenoma


Hepatocellular carcinoma


Inflammatory HCA


Liver fatty acid-binding protein


Magnetic resonance imaging


Sinusoidal dilatation


T2-weighted sequence


Unclassified HCA



We thank Professors Jean Saric and Laurence Chiche (surgeons); Brigitte Le Bail and Dr. Claire Castain (liver pathologists); and Florent Maire for their clinical contributions to this study.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Frulio Nora.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects (30 cases) have been previously reported in Hepatology 2008 by Laumonier et al—Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

Supplementary material

330_2018_5784_MOESM1_ESM.xls (50 kb)
ESM 1 (XLS 49 kb)
330_2018_5784_MOESM2_ESM.doc (32 kb)
ESM 2 (DOC 31 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Sylvain Bise
    • 1
  • Nora Frulio
    • 1
    Email author
  • Arnaud Hocquelet
    • 1
  • Nicolas Alberti
    • 1
  • Jean-Frederic Blanc
    • 2
  • Christophe Laurent
    • 3
  • Hervé Laumonier
    • 1
  • Charles Balabaud
    • 4
  • Paulette Bioulac-Sage
    • 4
    • 5
  • Hervé Trillaud
    • 1
    • 6
  1. 1.CHU de Bordeaux, Service d’imagerie diagnostique et interventionnelleHôpital Haut-LévêquePessacFrance
  2. 2.CHU de Bordeaux, Service d’hépato-gastroentérologie et oncologie digestiveHôpital Haut-LévêquePessacFrance
  3. 3.CHU de Bordeaux, Service de Chirurgie hépato-biliaire et transplantation hépatiqueHôpital Haut-LévêquePessacFrance
  4. 4.Université de BordeauxINSERM, UMR 1053BordeauxFrance
  5. 5.CHU de Bordeaux, Service de PathologieHopital PellegrinBordeauxFrance
  6. 6.EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie)Université de BordeauxBordeauxFrance

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