IMAGERIE DES LESIONS HEPATOCYTAIRES BENIGNES · 2019-09-30 · AlberM N et al. Interest of...

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Nicolas ALBERTI Centre Hospitalier Alpes Leman Contact : [email protected] IMAGERIE DES LESIONS HEPATOCYTAIRES BENIGNES

Transcript of IMAGERIE DES LESIONS HEPATOCYTAIRES BENIGNES · 2019-09-30 · AlberM N et al. Interest of...

Page 1: IMAGERIE DES LESIONS HEPATOCYTAIRES BENIGNES · 2019-09-30 · AlberM N et al. Interest of contrast-enhanced sonography to idenMfy focal nodular hyperplasia with sinusoidal dilataMon.

NicolasALBERTICentreHospitalierAlpesLeman

Contact:[email protected]

IMAGERIEDESLESIONSHEPATOCYTAIRESBENIGNES

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Jedéclarenepasavoirdeconflitd’intérêtenrela4onaveccetravail.Lesdossiersprésentésproviennentsoitdelali@érature,ducentrehospitalierAlpesLemanoudel’hopitalSaintAndré(CHUBordeaux).

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•  Deuxfamillesdis4nctes:HNFvsHCA•  Intérêtdelesdifférencier(risqueshémorragiques

etdedégénérescence)•  GoldStandard:IRM+/-CEUS(combinaison)

•  Challengediagnos4que

Principauxconcepts

RonotM,VilgrainV.Imagingofbenignhepatocellularlesions:Currentconceptsandrecentupdates.ClinResHepatolGastroenterol(2014)

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•  Lésionrégénéra4ve•  0,8%(sérieautopsique)/0,6-3%(popula4ongénérale)

•  F/H:9/1

•  Pasdelienaveclescontracep4fsoraux

•  Solitairedans2/3descas

•  DONOTTOUCHLESION

HyperplasienodulairefocaleEpidemiologie

BalabaudCetal.FocalNodularHyperplasiaandHepatocellularAdenomaaroundtheWorldViewedthroughtheScopeoftheImmunopathologicalClassificaMon.InternaMonalJournalofHepatology(2013)

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HyperplasienodulairefocaleIRM

•  Foiedanslefoie•  Lésionhomogène,hypervasculaireàlaphase

artérielle,s’homogenéisantautempsportaletlorsdephasesplustardives,sanslavage

•  Cicatricestellaire:40%

•  Signesimportants:aspectlobulé/pasdedysmorphiehépa4que

HussainSetal.FocalNodularHyperplasia:FindingsatState-of-the-ArtMRImaging,US,CT,andPathologicAnalysisRadiographics(2004).RonotM,VilgrainV.Imagingofbenignhepatocellularlesions:Currentconceptsandrecentupdates.ClinResHepatolGastroenterol(2014)

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FORMETYPIQUESe:70%,Spe:98%

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HyperplasienodulairefocalePhaseHepato-biliaire

•  Gadobénatedediméglumine(Mul4hance,BRACCO)•  Plusieurspa@ernpossibles:*isosignal*hypersignalhomogène*couronneenhypersignalT1

FujiwaraHetal.Ring-likeenhancementoffocalnodularhyperplasiawithhepatobiliary-phase-enhancedmagneMcresonanceimaging:radiological-pathologicalcorrelaMon.JpnJRadiol(2011).

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HyperplasienodulairefocaleECUS

•  SulphurHexafluoride(Sonovue,BRACCO)•  Deuxpa@ernautempsartériel(25s):

*Remplissagecentrifuge(lésiondemoinsde3cm)*Rayonderoue(20%)

•  Absencedelavageautempsportal

WangWetal.:Contrast-enhancedultrasoundfeaturesofhistologicallyprovenfocalnodularhyperplasia:diagnosMcperformancecomparedwithcontrast-enhancedCT.EurRadiol(2013)

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CourtesyofDRHANSPETERWESKOTT-Germany

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DioguardiBurgioMetal.ImagingofHepaMcFocalNodularHyperplasia:pictorialreviewanddiagnosMcstrategy.Seminarsinultrasound,CTandMRI(2017)

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AlberMNetal.Interestofcontrast-enhancedsonographytoidenMfyfocalnodularhyperplasiawithsinusoidaldilataMon.DII(2014)

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D’OnofrioMetal.Contrast-EnhancedUltrasoundofFocalLiverLesions.AJR(2015)

HyperplasienodulairefocaleECUS

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HyperplasienodulairefocaleAtypiesetphénotypespar4culiers

•  Varia4ondetaille(20-30%)etévolu4onfibreuse

•  Lésionpédiculée•  Calcifica4onsougraisse

•  Dilata4onsinusoïdaleHussainSetal.FocalNodularHyperplasia:FindingsatState-of-the-ArtMRImaging,US,CT,andPathologicAnalysisRadiographics(2004).RonotM,VilgrainV.Imagingofbenignhepatocellularlesions:Currentconceptsandrecentupdates.ClinResHepatolGastroenterol(2014)

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HyperplasienodulairefocaleEvolu4onfibreuse

CrombeAetal.FromatypicalfocalnodularhyperplasiatoafibroMcbandwithcapsularretracMon:Acasereport.DII(2014)

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HyperplasienodulairefocaleDispari4on

MamoneGetal.Completespontaneousregressionofgiantfocalnodularhyperplasiaoftheliver:MagneMcresonanceimagingevaluaMonwithhepatobiliarycontrastmedia.WJG(2016)

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HyperplasienodulairefocaleFormepédiculée

HussainSetal.FocalNodularHyperplasia:FindingsatState-of-the-ArtMRImaging,US,CT,andPathologicAnalysisRadiographics(2004).RonotM,VilgrainV.Imagingofbenignhepatocellularlesions:Currentconceptsandrecentupdates.ClinResHepatolGastroenterol(2014)

•  Deuxièmetypedelésionpédiculéeenfréquenceaprèsangiome(9%)•  Asymptoma4quedans80%descas

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HyperplasienodulairefocaleFormepédiculée

•  Deuxièmetypedelésionpédiculéeenfréquenceaprèsangiome(9%)•  Asymptoma4quedans80%descas

HussainSetal.FocalNodularHyperplasia:FindingsatState-of-the-ArtMRImaging,US,CT,andPathologicAnalysisRadiographics(2004).RonotM,VilgrainV.Imagingofbenignhepatocellularlesions:Currentconceptsandrecentupdates.ClinResHepatolGastroenterol(2014)

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HyperplasienodulairefocaleFormepédiculée

•  Deuxièmetypedelésionpédiculéeenfréquenceaprèsangiome(9%)•  Asymptoma4quedans80%descas

VilgrainVetal.Pi_allsinLiverImaging.Radiology(2016)

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HyperplasienodulairefocaleCalcifica4ons

CarlsonSKetal.CToffocalnodularhyperplasiaoftheliver.AJR(2000).BrancatelliGetal.Focalnodularhyperplasia:CTfindingswithemphasisonmulMphasichelicalCTin78paMents.Radiology(2001)

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HyperplasienodulairefocaleGraisse

RonotMetal.MRfindingsofsteatoMcfocalnodularhyperplasiaandcomparisonwithotherfabytumours.EuropeanRadiology(2013)

•  Pourcentageimportantd’HNFstéatosiques(jusqu’à50et85%)danscertainesséries.

•  Li@ératureconfuse!(graissesuspectéesurlaprésenced’unhypersignalspontanéT1parcertainsauteurs)

•  Graisseintra-lésionnelle=chutedesignalsurlesséquencesenopposi4ondephase.

•  Associa4onsta4s4que:stéatosehépa4que/HNFàcontenugraisseux

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HyperplasienodulairefocaleGraisse

RonotMetal.MRfindingsofsteatoMcfocalnodularhyperplasiaandcomparisonwithotherfabytumours.EuropeanRadiology(2013)

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HyperplasienodulairefocaleGraisse:Formeatypique

BIOPSIE!

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HyperplasienodulairefocaleDilata4onsinusoïdale

AlberMNetal.Interestofcontrast-enhancedsonographytoidenMfyfocalnodularhyperplasiawithsinusoidaldilataMon.DII(2014)

•  Dilata4onsinusoïdale,plusoumoinsétendue,auseind’unnoduled’HNF.

•  Ancienterme:HNFtélangiectasique(termenonapproprié).

•  Caractéris4quemajeuredesHCAdetypeinflammatoire

•  Intérêtdel’ECUS!!

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HyperplasienodulairefocaleDilata4onsinusoïdale

LaumonierHetal.FocalnodularhyperplasiawithmajorsinusoidaldilataMon:amisleadingenMty.BMJ(2010)

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HyperplasienodulairefocaleDilata4onsinusoïdale

AlberMNetal.Interestofcontrast-enhancedsonographytoidenMfyfocalnodularhyperplasiawithsinusoidaldilataMon.DII(2014)

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HyperplasienodulairefocaleRecommanda4onsactuelles

EASLClinicalPracMceGuidelinesonthemanagementofbenignlivertumours.JHepatol(2016)

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•  Lésionnéoplasique•  1/1000

•  Femme+++

•  Lienaveclescontracep4fsoraux

•  Associa4onavecdesmaladiesmétaboliques(glycogénose,galactosémie….)

•  Symptoma4quedans20%descas

AdénomeHépatocellulaireEpidemiologie

BalabaudCetal.FocalNodularHyperplasiaandHepatocellularAdenomaaroundtheWorldViewedthroughtheScopeoftheImmunopathologicalClassificaMon.InternaMonalJournalofHepatology(2013)

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AdénomeHépatocellulaireSoustypes

BalabaudCetal.FocalNodularHyperplasiaandHepatocellularAdenomaaroundtheWorldViewedthroughtheScopeoftheImmunopathologicalClassificaMon.InternaMonalJournalofHepatology(2013)

INFLAMMATOIRE(50%)

HNF1ALPHA(35%)

BETACATENIN(10%)

INCLASSE(5%)

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AdénomeHépatocellulaireInflammatoire

Bioulac-SagePetal.HepatocellularAdenomaManagementandPhenotypicClassificaMon:theBordeauxExperience.Hepatology(2009).LaumonierHetal.HepatocellularAdenomas:MagneMcResonanceImagingFeaturesAsaFuncMonofMolecularPathologicalClassificaMon.Hepatology(2008).

•  Muta4onIL6(chromosome5q11)•  Obésité+++

•  Anémieetsyndromeinflammatoire

•  Associa4onàlamuta4onBetaCatenindans10%descas

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AdénomeHépatocellulaireInflammatoire

LaumonierHetal.HepatocellularAdenomas:MagneMcResonanceImagingFeaturesAsaFuncMonofMolecularPathologicalClassificaMon.Hepatology(2008).

HypersignalT2,hyperartérialiséRehaussementporto-tardifpersistant(Se86.7%,Sp87.5%)

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AdénomeHépatocellulaireInflammatoire

GrieserCetal.GadoxeMcacidenhancedMRIfordifferenMaMonofFNHandHCA:asinglecentreexperience.EurRadiol(2014)

HYPOSIGNALSURLAPHASEHEPATO-BILIAIRE

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AdénomeHépatocellulaireInflammatoire

VanAaltenetal.HepatocellularAdenomas:CorrelaMonofMRImagingFindingswithPathologicSubtypeClassificaMon.Radiology(2011)

ATOLLSIGNSPECIFICITE:100%

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LaumonierHetal.RoleofContrast-EnhancedSonographyinDifferenMaMonofSubtypesofHepatocellularAdenoma:CorrelaMonwithMRIFindings.AJR(2011).ManichonAFetal.HepatocellularAdenoma:EvaluaMonwithContrast-EnhancedUltrasoundandMRIandCorrelaMonwithPathologicandPhenotypicClassificaMonin26Lesions.HPBsurgery(2012)

AdénomeHépatocellulaireInflammatoire

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AdénomeHépatocellulaireInflammatoire

DharmanaH,etal.,Hepatocellularadenoma:imagingreviewofthevariousmolecularsubtypes.ClinicalRadiology(2017).

RUPTUREHEMORRAGIQUE

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AdénomeHépatocellulaireInflammatoire

DarnisB,etal.Managementofbleedinglivertumors.JournalofVisceralSurgery(2014).

RUPTUREHEMORRAGIQUE

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AdénomeHépatocellulaireInflammatoire

DharmanaH,etal.,Hepatocellularadenoma:imagingreviewofthevariousmolecularsubtypes.ClinicalRadiology(2017).

RUPTUREHEMORRAGIQUE

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AdénomeHépatocellulaireInflammatoire

T130sT2FS

GST2DEGENERESCENCE

AlberMNetal.SteatoMchepatocellularadenomaswithdifferentphenotypicsubtypes:Acasereport.CLINRE(2015)

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AdénomeHépatocellulaireHNF1ALPHA

Bioulac-SagePetal.HepatocellularAdenomaManagementandPhenotypicClassificaMon:theBordeauxExperience.Hepatology(2009).LaumonierHetal.HepatocellularAdenomas:MagneMcResonanceImagingFeaturesAsaFuncMonofMolecularPathologicalClassificaMon.Hepatology(2008).

•  Muta4onTCF1(chromosome12q24)

•  MODY3

•  Dégénérescenceexcep4onnelle

•  Asymptoma4que

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AdénomeHépatocellulaireHNF1ALPHA

DharmanaH,etal.,Hepatocellularadenoma:imagingreviewofthevariousmolecularsubtypes.ClinicalRadiology(2017)

ChutehomogèneetdiffusedusignalenOutPhase(Se86.7%,Sp100%)

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LaumonierHetal.RoleofContrast-EnhancedSonographyinDifferenMaMonofSubtypesofHepatocellularAdenoma:CorrelaMonwithMRIFindings.AJR(2011)

AdénomeHépatocellulaireHNF1ALPHA

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AdénomeHépatocellulaireBetaCatenin

DharmanaH,etal.,Hepatocellularadenoma:imagingreviewofthevariousmolecularsubtypes.ClinicalRadiology(2017).

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AlberMNetal.SteatoMchepatocellularadenomaswithdifferentphenotypicsubtypes:Acasereport.CLINRE(2015)

A@en4onautermed’adénomestéatosique!

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AlberMNetal.SteatoMchepatocellularadenomaswithdifferentphenotypicsubtypes:Acasereport.CLINRE(2015)

A@en4onautermed’adénomestéatosique!

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FrulioNetal.Hepatocellularadenomatosis:whatshouldthetermstandfor!CLINRE(2014)

IP

OP

IP

OP

IP

OP

AdénomatoseHNF1ALPHA

+de10adénomes

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AdénomatoseInflammatoire

+de10adénomes

FrulioNetal.Hepatocellularadenomatosis:whatshouldthetermstandfor!CLINRE(2014)

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AdénomeHépatocellulaireRecommanda4onsactuelles

EASLClinicalPracMceGuidelinesonthemanagementofbenignlivertumours.JHepatol(2016)

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CommentdifférencierHNFetHCA?Phasehepato-biliaire

CamposJetal.FocalhepaMclesionsinGd-EOB-DTPAenhancedMRI:theatlas.InsightsImaging(2012)

HYPERPLASIENODULAIREFOCALE

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CommentdifférencierHNFetHCA?Phasehepato-biliaire

ADENOMEINFLAMMATOIRE

CamposJetal.FocalhepaMclesionsinGd-EOB-DTPAenhancedMRI:theatlas.InsightsImaging(2012)

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CommentdifférencierHNFetHCA?Phasehepato-biliaire

CARCINOMEFIBRO-LAMELLAIRE

CamposJetal.FocalhepaMclesionsinGd-EOB-DTPAenhancedMRI:theatlas.InsightsImaging(2012)

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CommentdifférencierHNFetHCA?Echographiedecontraste

D’OnofrioMetal.Contrast-EnhancedUltrasoundofFocalLiverLesions.AJR(2015)ChioreanL,etal.Focalmassesinanon-cirrhoMcliver:TheaddiMonalbenefitofCEUSoverbaselineimaging.EurJRadiol(2015)

HYPERPLASIENODULAIREFOCALE

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CommentdifférencierHNFetHCA?Echographiedecontraste

ChioreanL,etal.Focalmassesinanon-cirrhoMcliver:TheaddiMonalbenefitofCEUSoverbaselineimaging.EurJRadiol(2015).LaumonierHetal.RoleofContrast-EnhancedSonographyinDifferenMaMonofSubtypesofHepatocellularAdenoma:CorrelaMonwithMRIFindings.AJR(2011)

ADENOMEHNF1ALPHA

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CommentdifférencierHNFetHCA?Autrestechniques:Elastographie

BrunelTetal.Focalnodularhyperplasiaandhepatocellularadenoma:ThevalueofshearwaveelastographyfordifferenMaldiagnosis.EurJRadiol(2015)

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CommentdifférencierHNFetHCA?Autrestechniques:PETCT

VanDenEsschertJetal.DifferenMaMonofhepatocellularadenomaandfocalnodularhyperplasiausing18F-fluorocholinePET/CT.EurJNuclMedMolImaging(2011)

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