局灶性结节性增生在钆塞酸增强MRI上的自然病史：多中心队列研究
这项多中心回顾性队列研究纳入93例患者共128个FNH病灶，评估基线及随访EOB-MRI的病灶演变。中位随访39.2个月，多数病灶稳定或缩小，仅10.2%增大；最终平均直径较基线略小（3.15 cm vs 3.31 cm，P=0.014）。病灶增大与激素等临床因素无关，支持对典型FNH无症状患者保守管理。
要点
- 典型FNH在EOB-MRI随访中大多稳定或自发缩小，增大者少见。
- HBP分型（A-D型）在增大病灶中可发生转变，需注意随访对比。
- 病灶增大与口服避孕药、妊娠史等激素因素无关。
核心结论
- FNH在长期EOB-MRI随访中呈惰性自然病史，以稳定或自发缩小为主，临床显著增大不常见且与激素等因素无关。
研究设计与样本
- 多中心回顾性队列研究，纳入93例患者共128个FNH病灶，均行基线和随访EOB-MRI，中位随访39.2个月（范围12.1-84.8个月）。
关键影像表现/征象
- 随访中多数病灶稳定（78/128，60.9%）或缩小（37/128，28.9%），仅少数增大（13/128，10.2%）。
- 增大的病灶中观察到HBP分型转变：4例A型转C型，2例D型转C型，1例B型转D型。
- 最终随访平均病灶直径较基线略小（3.15±1.52 cm vs 3.31±1.33 cm；P=0.014），平均相对变化-6.2%，平均年变化-0.05 cm/年。
诊断标准与关键数值
- 病灶演变评估采用三项指标：绝对直径变化阈值≥0.5 cm，相对百分比变化阈值≥10%，以及年直径变化（cm/年）。
- HBP表现采用预定义的四级分类系统（A-D型）评估从基线至最终随访的分型转变。
临床应用与阅片要点
- 对具有典型影像学特征的FNH无症状患者，可考虑保守管理，常规影像监测可能并非必要。
- 随访中若病灶增大，应注意HBP分型可能发生转变，需结合多项指标综合评估。
- 病灶增大与性别、年龄、基线BMI、肝脂肪变、口服避孕药使用、妊娠史及随访时间均无独立关联（均P>0.05）。
局限性
- 回顾性研究设计及多中心队列的固有局限（原文未详细列出具体局限）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To investigate the natural history and longitudinal imaging evolution of focal nodular hyperplasia (FNH) using gadoxetic acid-enhanced MRI (EOB-MRI) in a multicenter cohort.
METHODS: This retrospective multicenter cohort study enrolled patients with FNH who underwent both baseline and follow-up EOB-MRI. Lesion evolution was assessed using three complementary metrics: absolute diameter change (threshold ≥ 0.5 cm), relative percentage change (threshold ≥ 10%), and annual diameter change (cm/year). Hepatobiliary phase (HBP) phenotype transitions from baseline to final follow-up were assessed using a predefined four-tier classification system (types A-D). Multilevel mixed-effects models were applied to evaluate associations between clinical variables and longitudinal changes in lesion size.
RESULTS: A total of 93 patients with 128 FNH lesions were included. Over a median follow-up of 39.2 months (range: 12.1-84.8 months), the majority of lesions remained stable (78/128, 60.9%) or decreased in size (37/128, 28.9%), whereas a minority exhibited interval enlargement (13/128, 10.2%). Among enlarging lesions, longitudinal HBP phenotype transitions were observed, including four from type A to type C, two from type D to type C, and one from type B to type D. At final follow-up, the mean lesion diameter was modestly but significantly smaller than at baseline (3.15 ± 1.52 cm vs. 3.31 ± 1.33 cm; P = 0.014), corresponding to a mean relative change of -6.2% and a mean annual change of -0.05 cm/year. Multilevel mixed-effects models revealed no independent associations between lesion enlargement or continuous diameter changes and any of the evaluated clinical variables, including sex, age, baseline body mass index, hepatic steatosis, oral contraceptive use, pregnancy history, or follow-up duration (all P > 0.05).
CONCLUSION: Longitudinal EOB-MRI follow-up demonstrates that FNH exhibits a largely indolent natural history, with predominant lesion stability or spontaneous regression. Clinically significant enlargement is infrequent and shows no association with hormonal or other clinical factors. These findings support conservative management and indicate that routine imaging surveillance may be unnecessary in asymptomatic patients with typical imaging features.
引用
- Xing F, Lu S, Shi T, et al. Natural history of focal nodular hyperplasia on gadoxetic acid-enhanced MRI: a multicenter cohort study. Abdom Radiol (NY). 2026. PMID: 41995818. doi:10.1007/s00261-026-05518-w
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。