Contrast-enhanced ultrasound patterns of hepatocellular adenoma: an Italian multicenter experience

  • Matteo GarcovichEmail author
  • Mariella Faccia
  • Franca Meloni
  • Emanuela Bertolini
  • Ilario de Sio
  • Giosuele Calabria
  • Giampiero Francica
  • Gianpaolo Vidili
  • Laura Riccardi
  • Maria Assunta Zocco
  • Maria Elena Ainora
  • Francesca Romana Ponziani
  • Anna Maria De Gaetano
  • Antonio Gasbarrini
  • Gian Ludovico Rapaccini
  • Maurizio Pompili
Original Article



Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities.


We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units.


The study enrolled 19 patients (16 females; 69% with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6–7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89% of these showing centripetal and 11% centrifugal filling pattern, whereas during the portal and late venous phase 58% of HCA showed washout and the remaining 42% displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively.


This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.


Contrast-enhanced ultrasound Hepatocellular adenoma Phenotype classification Benign liver lesion Magnetic resonance imaging 



L′adenoma epatico (HCA) rappresenta una rara neoplasia primitiva del fegato, recentemente classificata in quattro diversi sottotipi sulla base delle caratteristiche istopatologiche e del comportamento biologico. In considerazione dell’ampio e diffuso utilizzo dell’ecografia con mezzo di contrasto ecografico (CEUS) nella valutazione non-invasiva delle lesioni focali epatiche l’obiettivo di questo studio è stato quello di documentare in una casistica multicentrica le caratteristiche CEUS di lesioni focali epatiche già caratterizzate come HCA e di valutare le eventuali correlazioni con i diversi sottotipi istologici e con altre metodiche di imaging (CT/MRI).


Sono stati raccolti retrospettivamente le informazioni su pazienti con diagnosi istologica di HCA sottoposti a CEUS e CT ± MR in sette diversi centri italiani di ecografia.


Sono stati inclusi nello studio 19 pazienti con diagnosi istologica di HCA (16 donne; 69% con storia attuale e/o pregressa di utilizzo di farmaci estroprogestinici): 14/19 adenomi sottotipo “infiammatori” (IHCA), 1/19 β-catenin-activated HCA e i restanti erano HCA non classificabili. L’esame CEUS ha mostrato nella quasi totalità dei casi (18/19) un rapido enhancement arterioso di tipo centripeto (89%) o centrifugo (11%). Durante la fase portale e tardiva si è dimostrato un wash-out contrastografico rispettivamente nel 58% degli HCA; invece nel 42% dei rimanenti casi non è stato osservato wash-out in nessuna delle fasi contrastografiche. In particolare è stato evidenziato che nel sottotipo I-HCA 7/14 non presentavano washout in nessuna delle fasi contrastografiche, mentre 3/14 e 4/14 mostravano rispettivamente un washout nelle fasi portali o tardive.


La nostra casistica rappresenta una delle poche esperienze italiane presenti in letteratura riguardo all’utilizzo della CEUS negli adenomi epatici, confermando l’aspetto di ipervascolarizzazione nella fase arteriosa (soprattutto con un flusso centripeto) ed il comportamento eterogeneo nelle fasi portali e tardive. In particolare, nel caso di I-HCA un comportamento contrastografico caratterizzato da washout in fase tardiva è frequente con l’utilizzo della CEUS ma non con l’utilizzo della MRI.



All authors received no specific funding for this work.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of the Catholic University of Sacred Heart. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2018

Authors and Affiliations

  • Matteo Garcovich
    • 1
    Email author
  • Mariella Faccia
    • 1
  • Franca Meloni
    • 2
    • 3
  • Emanuela Bertolini
    • 4
  • Ilario de Sio
    • 5
  • Giosuele Calabria
    • 6
  • Giampiero Francica
    • 7
  • Gianpaolo Vidili
    • 8
  • Laura Riccardi
    • 1
  • Maria Assunta Zocco
    • 1
  • Maria Elena Ainora
    • 1
  • Francesca Romana Ponziani
    • 1
  • Anna Maria De Gaetano
    • 9
  • Antonio Gasbarrini
    • 1
  • Gian Ludovico Rapaccini
    • 1
  • Maurizio Pompili
    • 1
  1. 1.Department of Internal Medicine and GastroenterologyFondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred HeartRomeItaly
  2. 2.Department of Interventional UltrasoundCasa di Cura IgeaMilanItaly
  3. 3.Department of RadiologyUniversity of Wisconsin-MadisonMadisonUSA
  4. 4.Department of Internal Medicine, Hepatology and GastroenterologySan Paolo Hospital, Università degli Studi di MilanoMilanItaly
  5. 5.Hepatogastroenterology UnitUniversità degli Studi della Campania Luigi VanvitelliNaplesItaly
  6. 6.IX Interventional Ultrasound Unit for Infectious DiseasesAORN dei Colli, Cotugno HospitalNaplesItaly
  7. 7.Interventional Ultrasound UnitPineta Grande HospitalCastel VolturnoItaly
  8. 8.Department of Clinical and Experimental MedicineUniversity of SassariSassariItaly
  9. 9.Department of RadiologyFondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred HeartRomeItaly

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