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Rofo 2000; 172(9): 727-738
DOI: 10.1055/s-2000-7227
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© Georg Thieme Verlag Stuttgart · New York

Aktueller Stand der bildgebenden Diagnostik der fokalen nodulären Hyperplasie der Leber

M. M. Uggowitzer, C. Kugler, A. Ruppert-Kohlmayr, R. Groell, J. Raith, H. Schreyer
  • Univ. Klinik für Radiologie, Karl-Franzens-Universität Graz
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung.

Fokale noduläre Hyperplasien (FNH) sind nach Hämangiomen die zweithäufigsten benignen fokalen soliden Leberläsionen. Betroffen sind hauptsächlich Frauen zwischen dem 20. und 50. Lebensjahr, in seltenen Fällen auch Kinder. Als Ursache wird eine arteriovenöse Gefäßmissbildung der Leber diskutiert, die ein pseudotumoröses Wachstum des umliegenden Lebergewebes induziert.

Charakteristische morphologische Merkmale sind die Ausbildung einer zentralen Narbe sowie die in der Narbe verlaufenden tumorversorgenden Arterien (sog. „feeder”), von denen die radiär angeordneten intratumoralen Gefäße ihren Ausgang nehmen. Bildgebenden Verfahren, mit denen die pathognomonisch über die radspeichenartig verlaufenden Gefäße zentrifugale Blutversorgung von FNH, die arterielle Kontrastierung des Tumorparenchyms, das Fehlen von Verkalkungen und einer Tumorkapsel sowie die charakteristische Kontrastmittelaufnahme der zentralen Narbe dargestellt werden können, kommt eine besondere Bedeutung zu. Die Kenntnis dieser Besonderheiten ist für die Unterscheidung der FNH von anderen hypervaskularisierten fokalen Leberläsionen mit Tendenz zur Narbenbildung wie Leberzelladenomen, großen kavernösen Hämangiomen, hepatozellulären und fibrolamellären Karzinomen sowie Metastasen, von Bedeutung.

Die Diagnose und Differenzialdiagnose der FNH erfolgt durch den kombinierten Einsatz von (Doppler-)Sonographie und triphasischer Computertomographie (CT). Eine Absicherung der Diagnose kann mit der dynamischen MRT erreicht werden. Der Angiographie kommt wegen der Invasivität, den verschiedenen szintigraphischen Verfahren wegen ihrer eingeschränkten Sensitivität und räumlichen Auflösung für die Diagnose der FNH keine Bedeutung mehr zu. Läsionen, bei denen das typische Erscheinungsbild einer FNH nicht ausgebildet ist, müssen weiterhin biopsiert und histologisch untersucht werden.

Imaging of focal nodular hyperplasia of the liver - Current status.

Ranging behind hemangiomas, focal nodular hyperplasias (FNH) are the second most common benign solid liver lesions. Women between the age of 20 and 50 years are predominantly affected. In rare cases FNH may occur in children. Etiologically, an arteriovenous vascular malformation of the liver is discussed, which causes pseudotumorous growth of the surrounding liver parenchyma. Morphological features such as the presence of a radial vascular architecture and feeding arteries within a central scar are characteristic for the presence of FNH. Imaging techniques which enable the depiction of the arterial blood supply with a characteristic centrifugal filling pattern, the contrast enhancement in the early arterial phase, the absence of calcifications and of a tumour capsule and the typical enhancement of the central scar, are of particular importance. Knowledge of these features is important in order to differentiate FNH from other hypervascular focal liver lesions with tendency of scar formation, such as hepatic adenomas, giant hemangiomas, hepatocellular and fibrolamellar carcinomas, and metastases. Diagnosis and differential diagnosis of FNH will be enabled by a combined modality approach consisting of (Doppler) sonography and triphasic CT. To confirm the diagnosis of FNH, dynamic MRI is advisable. Because of the invasiveness of angiography as well as the limited sensitivity and spatial resolution of the various scintigraphic methods, these modalities no longer play a role in the diagnostic work-up of FNH. Lesions lacking typical features diagnostic for FNH remain subjects for biopsy and histological examination.

Schlüsselwörter:

Fokale noduläre Hyperplasie (FNH) - Hypervaskularisierte fokale Leberläsionen - Gefäßmissbildung - Bildgebende Verfahren

Key words:

Focal nodular hyperplasia (FNH) - Hypervascular focal liver lesions - Vascular malformation - Imaging modalities

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ao. Univ. Prof. Dr. Martin-Michael Uggowitzer

Klinische Abteilung für Spezielle radiologische und sonstige bildgebende Verfahren Univ. Klinik für Radiologie Karl-Franzens-Universität Graz

Auenbruggerplatz 9

8036 Graz

Österreich

Phone: + 43-316-385-2219

Fax: + 43-316-385-4149

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