Knowles DM II, Wolff M: Focal nodular hyperplasia of the liver: a clinicopathologic study and review of the literature.Hum Pathol 1976;7: 533–545.

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Mathieu D, Bruneton JN, Drouillard J, et al: Hepatic adenoma and focal nodular hyperplasia: dynamic CT study.Radiology 1986;160: 53–58.

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Miura, Y., Kondo, K., Oikawa, J. et al. Contrast-enhanced ultrasonography using levovist: Usefulness of diagnosis of small focal nodular hyperplasia lesions. J Med Ultrasonics 29, 99–104 (2002). https://doi.org/10.1007/BF02481231

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Differential diagnosis of focal nodular hyperplasia and hepatocellular carcinoma is clinically important because, while both are hypervascular tumors, they have vastly different prognoses. Because the spoke-wheel appearance is the primary characteristic of focal nodular hyperplasia, we attempted to detect this pattern in nodules smaller than 3 cm in diameter with contrast-enhanced ultrasonography using a contrast agent (Levovist). Four patients were examined with contrast-enhanced US: two of the patients were examined with Coded Harmonic Angio; the other two patients were examined with contrast-enhanced color and power Doppler US without harmonic imaging. Although the hepatic arteriogram showed the spoke-wheel appearance in only one tumor (diameter, 3 cm), contrast-enhanced US clearly demonstrated this characteristic in all four tumors, including three tumors that were less than 2 cm in diameter. Because it is noninvasive and can be carried out in an outpatient clinic, contrast-enhanced US is extremely useful for diagnosing small focal noduler hyperplasia lesions at sites that can be observed with US.

Ding H, Kudo M, Onda H, et al: Evaluation of posttreatment response of hepatocellular carcinoma with contrast-enhanced coded phase-inversion harmonic US: comparison with dynamic CT.Radiology 2001;221: 721–730.

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Lencioni R, Pinto F, Armillotta N, et al: Assessment of tumor vascularity in hepatocellular carcinoma: comparison of power Doppler US and color Doppler US.Radiology 1996;201: 353–358.

Takayasu K, Muramatsu Y, Moriyama N, et al: Focal nodular hyperplasia of the liver: arterial angio-CT and microangiography.J Comput Assist Tomogr 1992;16: 212–215.

Kudo M, Tomita S, Tochio H, et al: Hepatic focal nodular hyperplasia: specific findings at dynamic contrast-enhanced US with carbon dioxide microbubbles.Radiology 1991;179: 377–382.

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Wanless IR, Mawdsley C, Adams R: On the pathogenesis of focal nodular hyperplasia of the liver.Hepatology 1985;5: 1194–1200.

Kim AY, Choi BI, Kim TK, et al: Hepatocellular carcinoma: power Doppler US with a contrast agent-preliminary results.Radiology 1998;209: 135–140.

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Kudo M: Contrast harmonic ultrasound is a breakthrough technology in the diagnosis and treatment of hepatocellular carcinoma. J Med Ultrasonics 2001;28: 79–81.

Tanaka S, Kitamura T, Fujita M, et al: Value of contrast-enhanced color Doppler sonography in diagnosing hepatocellular carcinoma with special attention to “color-filled pattern”.J Clin Ultrasound 1998;26: 207–212.

Uggowitzer M, Kugler C, Groll R, et al: Sonographic evaluation of focal nodular hyperplasias (FNH) of the liver with a transpulmonary galactose-based contrast agent (Levivist).Br J Radiol 1998;71: 1026–1032.

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Fechner RE, Roehm JOF Jr: Angiographic and pathologic correlations of hepatic focal nodular hyperplasia.Am J Surg Pathol 1977;1: 217–224.

Miyayama S, Matsui O, Ueda K, et al: Hemodynamics of small hepatic focal nodular hyperplasia: evaluation with single-level dynamic CT during hepatic arteriography.AJR Am J Roentgenol 2000;174: 1567–1569.

Rogers JV, Mack LA, Freeny PC, et al: Hepatic focal nodular hyperplasia: angiography, CT, sonography, and scintigraphy.AJR Am J Roentgenol 1981;137: 983–990.