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Liver Adenomatosis: Classification of MR Imaging Features and Comparison with Pathologic Findings¹

¹ From the Departments of Radiology (M.L., L.A., E.B., J.M.T.) and Pathology (D.W., J.F.F.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France; and Departments of Pathology (A.H., V.P.), Hepatic Surgery (J.B.), and Radiology (V.V.), Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France. From the 2003 RSNA Annual Meeting. Received July 25, 2005; revision requested September 27; revision received October 27; accepted November 17; final version accepted February 1, 2006. Address correspondence to M.L. (e-mail: maite.lewin{at}sat.ap-hop-paris.fr).

View larger version (128K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Patient 3. Steatotic form of liver adenomatosis in 30-year-old woman. (a) On transverse T2-weighted MR image (1900/96, 80° flip angle), multiple adenomas (arrows) are slightly hyperintense relative to liver parenchyma. (b) On transverse T1-weighted MR image (174/4, 75° flip angle), adenomas are isointense relative to liver parenchyma. (c) After fat-suppressed imaging (174/4, 75° flip angle), adenomas have signal dropout, which indicates lipid content. (d) Contrast-enhanced T1-weighted image (174/4, 75° flip angle) at portal venous phase shows no enhancement of multiple adenomas. (e) Surgical specimen (one square = 1 x 1 cm) was almost entirely occupied by nonencapsulated tumor that contained several yellow zones. (f) At pathologic examination, these zones consisted of proliferation of hepatocytes showing extensive macro- and microvesicular steatosis. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Patient 3. Steatotic form of liver adenomatosis in 30-year-old woman. (a) On transverse T2-weighted MR image (1900/96, 80° flip angle), multiple adenomas (arrows) are slightly hyperintense relative to liver parenchyma. (b) On transverse T1-weighted MR image (174/4, 75° flip angle), adenomas are isointense relative to liver parenchyma. (c) After fat-suppressed imaging (174/4, 75° flip angle), adenomas have signal dropout, which indicates lipid content. (d) Contrast-enhanced T1-weighted image (174/4, 75° flip angle) at portal venous phase shows no enhancement of multiple adenomas. (e) Surgical specimen (one square = 1 x 1 cm) was almost entirely occupied by nonencapsulated tumor that contained several yellow zones. (f) At pathologic examination, these zones consisted of proliferation of hepatocytes showing extensive macro- and microvesicular steatosis. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (102K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Patient 3. Steatotic form of liver adenomatosis in 30-year-old woman. (a) On transverse T2-weighted MR image (1900/96, 80° flip angle), multiple adenomas (arrows) are slightly hyperintense relative to liver parenchyma. (b) On transverse T1-weighted MR image (174/4, 75° flip angle), adenomas are isointense relative to liver parenchyma. (c) After fat-suppressed imaging (174/4, 75° flip angle), adenomas have signal dropout, which indicates lipid content. (d) Contrast-enhanced T1-weighted image (174/4, 75° flip angle) at portal venous phase shows no enhancement of multiple adenomas. (e) Surgical specimen (one square = 1 x 1 cm) was almost entirely occupied by nonencapsulated tumor that contained several yellow zones. (f) At pathologic examination, these zones consisted of proliferation of hepatocytes showing extensive macro- and microvesicular steatosis. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 1d: Patient 3. Steatotic form of liver adenomatosis in 30-year-old woman. (a) On transverse T2-weighted MR image (1900/96, 80° flip angle), multiple adenomas (arrows) are slightly hyperintense relative to liver parenchyma. (b) On transverse T1-weighted MR image (174/4, 75° flip angle), adenomas are isointense relative to liver parenchyma. (c) After fat-suppressed imaging (174/4, 75° flip angle), adenomas have signal dropout, which indicates lipid content. (d) Contrast-enhanced T1-weighted image (174/4, 75° flip angle) at portal venous phase shows no enhancement of multiple adenomas. (e) Surgical specimen (one square = 1 x 1 cm) was almost entirely occupied by nonencapsulated tumor that contained several yellow zones. (f) At pathologic examination, these zones consisted of proliferation of hepatocytes showing extensive macro- and microvesicular steatosis. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 1e: Patient 3. Steatotic form of liver adenomatosis in 30-year-old woman. (a) On transverse T2-weighted MR image (1900/96, 80° flip angle), multiple adenomas (arrows) are slightly hyperintense relative to liver parenchyma. (b) On transverse T1-weighted MR image (174/4, 75° flip angle), adenomas are isointense relative to liver parenchyma. (c) After fat-suppressed imaging (174/4, 75° flip angle), adenomas have signal dropout, which indicates lipid content. (d) Contrast-enhanced T1-weighted image (174/4, 75° flip angle) at portal venous phase shows no enhancement of multiple adenomas. (e) Surgical specimen (one square = 1 x 1 cm) was almost entirely occupied by nonencapsulated tumor that contained several yellow zones. (f) At pathologic examination, these zones consisted of proliferation of hepatocytes showing extensive macro- and microvesicular steatosis. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (126K): [in this window] [in a new window] [Download PPT slide]   Figure 1f: Patient 3. Steatotic form of liver adenomatosis in 30-year-old woman. (a) On transverse T2-weighted MR image (1900/96, 80° flip angle), multiple adenomas (arrows) are slightly hyperintense relative to liver parenchyma. (b) On transverse T1-weighted MR image (174/4, 75° flip angle), adenomas are isointense relative to liver parenchyma. (c) After fat-suppressed imaging (174/4, 75° flip angle), adenomas have signal dropout, which indicates lipid content. (d) Contrast-enhanced T1-weighted image (174/4, 75° flip angle) at portal venous phase shows no enhancement of multiple adenomas. (e) Surgical specimen (one square = 1 x 1 cm) was almost entirely occupied by nonencapsulated tumor that contained several yellow zones. (f) At pathologic examination, these zones consisted of proliferation of hepatocytes showing extensive macro- and microvesicular steatosis. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (137K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (139K): [in this window] [in a new window] [Download PPT slide]   Figure 2d: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 2e: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 2f: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (135K): [in this window] [in a new window] [Download PPT slide]   Figure 2g: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 2h: Patient 17. Peliotic form of liver adenomatosis in 47-year-old woman. (a) On transverse T2-weighted MR image (1600/70, 90° flip angle), multiple adenomas (arrows) are markedly hyperintense relative to liver parenchyma. (b) On T1-weighted MR image (212/4, 80° flip angle), there was no signal dropout after fat-suppressed imaging. (c, d) MR image from combination of (c) in-phase (148/4.6, 80° flip angle) and (d) opposed-phase (148/2.3, 80° flip angle) sequences show no signal dropout of adenomas. (e, f) Contrast-enhanced T1-weighted MR images (212/4, 80° flip angle) show enhancement of adenomas at (e) arterial phase and (f) portal phase. (g) Resected liver specimen (one square = 1 x 1 cm) shows adenoma in left lobe that measures 5 cm in diameter. Tumor was well delimited, was nonencapsulated (arrows), and contained several hemorrhagic areas. (h) At pathologic examination, these areas corresponded to multifocal peliosis. (Hematoxylin-eosin stain; original magnification, x200.)

View larger version (123K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Patient 1. Mixed form of liver adenomatosis in 22-year-old woman. On (a) T2-weighted MR image (1900/96, 80° flip angle) and (b) T1-weighted MR image (174/4, 75° flip angle), large adenoma (arrow) with intratumoral hemorrhage appears heterogeneously hyperintense. (c, d) Contrast-enhanced T1-weighted MR images (174/4, 75° flip angle) at portal phase show (c) tumor enhancement in large adenoma and (d) multiple adenomas (arrows) with no enhancement at distance from largest nodule. (e) Resected liver specimen (after formol fixation) shows nodule measuring 8 cm in diameter and hemorrhagic and necrotic areas. (f) Several small nodules (white arrows) were observed at distance from largest nodule (black arrow).

View larger version (121K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Patient 1. Mixed form of liver adenomatosis in 22-year-old woman. On (a) T2-weighted MR image (1900/96, 80° flip angle) and (b) T1-weighted MR image (174/4, 75° flip angle), large adenoma (arrow) with intratumoral hemorrhage appears heterogeneously hyperintense. (c, d) Contrast-enhanced T1-weighted MR images (174/4, 75° flip angle) at portal phase show (c) tumor enhancement in large adenoma and (d) multiple adenomas (arrows) with no enhancement at distance from largest nodule. (e) Resected liver specimen (after formol fixation) shows nodule measuring 8 cm in diameter and hemorrhagic and necrotic areas. (f) Several small nodules (white arrows) were observed at distance from largest nodule (black arrow).

View larger version (125K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Patient 1. Mixed form of liver adenomatosis in 22-year-old woman. On (a) T2-weighted MR image (1900/96, 80° flip angle) and (b) T1-weighted MR image (174/4, 75° flip angle), large adenoma (arrow) with intratumoral hemorrhage appears heterogeneously hyperintense. (c, d) Contrast-enhanced T1-weighted MR images (174/4, 75° flip angle) at portal phase show (c) tumor enhancement in large adenoma and (d) multiple adenomas (arrows) with no enhancement at distance from largest nodule. (e) Resected liver specimen (after formol fixation) shows nodule measuring 8 cm in diameter and hemorrhagic and necrotic areas. (f) Several small nodules (white arrows) were observed at distance from largest nodule (black arrow).

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 3d: Patient 1. Mixed form of liver adenomatosis in 22-year-old woman. On (a) T2-weighted MR image (1900/96, 80° flip angle) and (b) T1-weighted MR image (174/4, 75° flip angle), large adenoma (arrow) with intratumoral hemorrhage appears heterogeneously hyperintense. (c, d) Contrast-enhanced T1-weighted MR images (174/4, 75° flip angle) at portal phase show (c) tumor enhancement in large adenoma and (d) multiple adenomas (arrows) with no enhancement at distance from largest nodule. (e) Resected liver specimen (after formol fixation) shows nodule measuring 8 cm in diameter and hemorrhagic and necrotic areas. (f) Several small nodules (white arrows) were observed at distance from largest nodule (black arrow).

View larger version (133K): [in this window] [in a new window] [Download PPT slide]   Figure 3e: Patient 1. Mixed form of liver adenomatosis in 22-year-old woman. On (a) T2-weighted MR image (1900/96, 80° flip angle) and (b) T1-weighted MR image (174/4, 75° flip angle), large adenoma (arrow) with intratumoral hemorrhage appears heterogeneously hyperintense. (c, d) Contrast-enhanced T1-weighted MR images (174/4, 75° flip angle) at portal phase show (c) tumor enhancement in large adenoma and (d) multiple adenomas (arrows) with no enhancement at distance from largest nodule. (e) Resected liver specimen (after formol fixation) shows nodule measuring 8 cm in diameter and hemorrhagic and necrotic areas. (f) Several small nodules (white arrows) were observed at distance from largest nodule (black arrow).

View larger version (133K): [in this window] [in a new window] [Download PPT slide]   Figure 3f: Patient 1. Mixed form of liver adenomatosis in 22-year-old woman. On (a) T2-weighted MR image (1900/96, 80° flip angle) and (b) T1-weighted MR image (174/4, 75° flip angle), large adenoma (arrow) with intratumoral hemorrhage appears heterogeneously hyperintense. (c, d) Contrast-enhanced T1-weighted MR images (174/4, 75° flip angle) at portal phase show (c) tumor enhancement in large adenoma and (d) multiple adenomas (arrows) with no enhancement at distance from largest nodule. (e) Resected liver specimen (after formol fixation) shows nodule measuring 8 cm in diameter and hemorrhagic and necrotic areas. (f) Several small nodules (white arrows) were observed at distance from largest nodule (black arrow).