How to differentiate macro-regenerative nodules from hepato-carcinoma?

BA, the congenital absence or destruction of intra- or extra-hepatic biliary system, affects about 5 - 10/100 000 live births. End stage liver cirrhosis developed in some BA patients later in life. As a result of liver cirrhosis, regenerative nodules may develop in cirrhotic liver including a specific type termed MRN. The clinical significance and pathological features of MRN have been discussed in some articles. However, the image features of MRN and how to differentiate them from HCC have yet to be elucidated.

A research article to be published on July 28, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Yu-Fan Cheng from Chang-Gung memorial hospital- Kaohsiung medical center found that MRN developed in about 5% BA patients and there was no malignant change within them based on the histopathological finding of 144 extracted livers. The authors also reviewed pre-transplantation image surveys including CT and MRI.

They found that the MRN may have typical and atypical images features in CT/MRI. Typical MRN which are found in about 5/8 are hyperdense on pre-contrast CT and hypointense on T2WI MRI as compared with surrounding liver parenchyma. They had intra-tumoral tubular vascular bundles and showed no enhancement. These features can be used to differentiate from HCC. Atypical MRN which are found in 3/8 showed arterial enhancement and may be interpreted as signs of malignant change. Liver biopsy may aid in making a decision before liver transplantation (LT).

LT should not be withheld in BA patients based solely on images because benign lesions may also have images which look like HCC. The combined use of alfa-feto-protein , images and sometimes liver biopsy are still helpful in pre-transplant survey. The result of this article implies that liver biopsy can be avoided if supported by the typical images of MRN and repeated biopsy is not necessary if the AFP value is incongruent with radiographic findings.

Reference: Liang JL, Cheng YF, Concejero AM, Huang TL, Chen TY, Tsang LCL, Ou HY. Macro-regenerative nodule in biliary atresia: The CT/MRI findings and their pathological relations. World J Gastroenterol 2008; 14(28): 4529-4534 http://www.wjgnet.com/1007-9327/14/4529.asp

Correspondence to: Dr. Yu-Fan Cheng, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, 123 Tai-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan，China.cheng.yufan@msa.hinet.net Telephone: +886-7-7317123-3027 Fax: +886-7-7318762

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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