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Hepatic Adenomas More Common, Numerous in Patients With Liver Steatosis

December 21, 2008
Written by: , Filed in: Uncategorized
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The objective of a recent study was to examine the relationship between hepatic adenomas and fatty liver.

This retrospective analysis has concluded that hepatic adenomas are more common and more numerous in patients with fatty liver.

Participants/Methodology

This study was comprised of 24 patients (2 men and 22 women) with a histologically confirmed diagnosis of hepatic adenoma. Nine patients were symptomatic, including right upper-quadrant abdominal pain or discomfort, or acute or recent hemorrhage.
Routine follow-up in three patients for glycogen storage disease type I discovered hepatic adenomas.

A control group of individuals with known hepatic hemangiomas was chosen. CT was performed in
23 study patients and 22 control subjects. Eight study patients and 2 control subjects had undergone MRI performed on a 1.5-T system.

Images were reviewed independently by two abdominal radiologists. Fatty liver was present on CT if the liver attenuation value was at least 10 HU lower than that of the spleen on unenhanced images, and at least 30 HU lower on portal venous phase images. On MRI, fatty liver was determined by the subjective assessment of signal loss on T1-weighted out-of-phase gradient echo images.

The objective of a recent study was to examine the relationship between hepatic adenomas and fatty liver. This retrospective analysis has concluded that hepatic adenomas are more common and more numerous in patients with fatty liver. Participants/Methodology This study was comprised of 24 patients (2 men and 22 women) with a histologically confirmed diagnosis of hepatic adenoma. Nine patients were symptomatic, including right upper-quadrant abdominal pain or discomfort, or acute or recent hemorrhage. Routine follow-up in three patients for glycogen storage disease type I discovered hepatic adenomas. A control group of individuals with known hepatic hemangiomas was chosen. CT was performed in 23 study patients and 22 control subjects. Eight study patients and 2 control subjects had undergone MRI performed on a 1.5-T system. Images were reviewed independently by two abdominal radiologists. Fatty liver was present on CT if the liver attenuation value was at least 10 HU lower than that of the spleen on unenhanced images, and at least 30 HU lower on portal venous phase images. On MRI, fatty liver was determined by the subjective assessment of signal loss on T1-weighted out-of-phase gradient echo images. [text_ad] Results There were 14 of 24 patients in the study group with steatosis; 13 of these 24 had a single adenoma, and 11 had multiple adenomas. There were 7 of 24 patients in the control group with steatosis; 15 of these 24 had a single hemangioma, and 9 had multiple hemangiomas. Of patients with multiple adenomas, 82% had liver steatosis, while this was present in only 38% with a single adenoma. Therefore, hepatic adenomas occur more frequently in patients with hepatic steatosis; 82% to 83% of patients with adenomas had a history of oral contraceptive use. All patients with glycogen storage disease type I had multiple adenomas. Reviewer's Comments The results of this study are helpful in demonstrating that hepatic adenomas were more common and more numerous in patients with liver steatosis. Therefore, liver steatosis may predispose patients to development of multiple hepatic adenomas. One of the limitations reported in this study was that small adenomas were not likely to be biopsied or resected. Consequently, this led to under representation of these smaller lesions. Author: John C. Sabatino, MD, MSD Reference: Furlan A, van der Windt DJ, et al. Multiple Hepatic Adenomas Associated With Liver Steatosis at CT and MRI: A Case-Control Study. AJR; 2008;191 (November): 1430-1435: [text_ad]

Results
There were 14 of 24 patients in the study group with steatosis; 13 of these 24 had a single adenoma, and 11 had multiple adenomas. There were 7 of 24 patients in the control group with steatosis; 15 of these 24 had a single hemangioma, and 9 had multiple hemangiomas. Of patients with multiple adenomas, 82% had liver steatosis, while this was present in only 38% with a single adenoma.

Therefore, hepatic adenomas occur more frequently in patients with hepatic steatosis; 82% to 83% of patients with adenomas had a history of oral contraceptive use. All patients with glycogen storage disease type I had multiple adenomas.

Reviewer’s
Comments

The results of this study are helpful in demonstrating that hepatic adenomas were more common and more numerous in patients with liver steatosis. Therefore, liver steatosis may predispose patients to development of multiple hepatic adenomas.

One of the limitations reported in this study was that small adenomas were not likely to be biopsied or resected. Consequently, this led to under representation of these smaller lesions.

Author:
John C. Sabatino, MD, MSD

Reference:
Furlan A, van der Windt DJ, et al. Multiple Hepatic Adenomas Associated With Liver Steatosis at CT and MRI: A Case-Control Study. AJR; 2008;191 (November): 1430-1435:

The objective of a recent study was to examine the relationship between hepatic adenomas and fatty liver. This retrospective analysis has concluded that hepatic adenomas are more common and more numerous in patients with fatty liver. Participants/Methodology This study was comprised of 24 patients (2 men and 22 women) with a histologically confirmed diagnosis of hepatic adenoma. Nine patients were symptomatic, including right upper-quadrant abdominal pain or discomfort, or acute or recent hemorrhage. Routine follow-up in three patients for glycogen storage disease type I discovered hepatic adenomas. A control group of individuals with known hepatic hemangiomas was chosen. CT was performed in 23 study patients and 22 control subjects. Eight study patients and 2 control subjects had undergone MRI performed on a 1.5-T system. Images were reviewed independently by two abdominal radiologists. Fatty liver was present on CT if the liver attenuation value was at least 10 HU lower than that of the spleen on unenhanced images, and at least 30 HU lower on portal venous phase images. On MRI, fatty liver was determined by the subjective assessment of signal loss on T1-weighted out-of-phase gradient echo images. [text_ad] Results There were 14 of 24 patients in the study group with steatosis; 13 of these 24 had a single adenoma, and 11 had multiple adenomas. There were 7 of 24 patients in the control group with steatosis; 15 of these 24 had a single hemangioma, and 9 had multiple hemangiomas. Of patients with multiple adenomas, 82% had liver steatosis, while this was present in only 38% with a single adenoma. Therefore, hepatic adenomas occur more frequently in patients with hepatic steatosis; 82% to 83% of patients with adenomas had a history of oral contraceptive use. All patients with glycogen storage disease type I had multiple adenomas. Reviewer's Comments The results of this study are helpful in demonstrating that hepatic adenomas were more common and more numerous in patients with liver steatosis. Therefore, liver steatosis may predispose patients to development of multiple hepatic adenomas. One of the limitations reported in this study was that small adenomas were not likely to be biopsied or resected. Consequently, this led to under representation of these smaller lesions. Author: John C. Sabatino, MD, MSD Reference: Furlan A, van der Windt DJ, et al. Multiple Hepatic Adenomas Associated With Liver Steatosis at CT and MRI: A Case-Control Study. AJR; 2008;191 (November): 1430-1435: [text_ad]
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