Gd-EOB-DTPA MRI for focal nodular hyperplasia-like lesions in pediatric cancer survivors

Objectives To investigate the hepatobiliary enhancement patterns of gadoxetic acid (Gd-EOB-DTPA) MRI and the temporal evolution of focal nodular hyperplasia (FNH)–like lesions in pediatric cancer survivors. Methods We retrospectively included pediatric cancer survivors who had new liver lesions detected during surveillance imaging and who were diagnosed with FNH-like lesions by Gd-EOB-DTPA MRI without the aid of a hepatobiliary phase. The hepatobiliary enhancement patterns of FNH-like lesions were categorized as homogeneous hyperintense/isointense, heterogeneous hyperintense, and ring-like enhancement. Temporal changes in the FNH-like lesions were evaluated by follow-up Gd-EOB-DTPA MRI. Statistical analyses included one-way analysis of variance and Spearman’s rank correlation test. Results A total of 132 radiologically diagnosed FNH-like lesions in 18 patients showed the three different hepatobiliary enhancement patterns: homogeneous hyperintense/isointense ( n = 65, 49%), heterogeneous hyperintense ( n = 24, 18%), and ring-like enhancement ( n = 43, 33%). A weak positive correlation was found between the lesion size and the hepatobiliary enhancement pattern ( p = 0.015). Follow-up MRI showed alterations in the size and number of 55 FNHs in 8 patients, including stable size ( n = 15, 27%), increased size ( n = 17, 31%), decreased size ( n = 11, 20%), disappearance ( n = 12, 22%), and 74 new lesions (5 patients, 63%). Conclusions FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns and various temporal changes. Recognition of the radiological characteristics of FNH-like lesions may avoid unnecessary invasive procedures and reduce patients/parents’ anxiety. Key Points • FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns. The most common was homogeneous hyperintense/isointense, followed by heterogeneous hyperintense, and ring-like enhancement. • FNH-like lesions in pediatric cancer survivors can show various temporal changes during follow-up.