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Volume 65, Issue 2, Pages 386-398 (August 2016) EASL Clinical Practice Guidelines on the management of benign liver tumours Journal of Hepatology Volume 65, Issue 2, Pages 386-398 (August 2016) DOI: 10.1016/j.jhep.2016.04.001 Copyright © 2016 Terms and Conditions

Fig. 1 A typical hemangioma adjacent to FNH on MRI and CEUS. (A and B) The lesion (haemangioma white arrow) is strongly hyperintense on T2 and hypointense on T1. (C–E) On contrast-enhanced images, the lesion shows peripheral and discontinuous enhancement followed by complete fill-in on delayed phase imaging. (F–H) The same enhancement is seen on CEUS. Note that the hemangioma is adjacent to a FNH that does not contain a central element. Journal of Hepatology 2016 65, 386-398DOI: (10.1016/j.jhep.2016.04.001) Copyright © 2016 Terms and Conditions

Fig. 2 A typical example of FNH. (A) Glutamine synthetase expression by immunostaining shows a “map-like” pattern in lesional hepatocytes. The positive hepatocellular areas are usually located around hepatic veins. (B and C) On the MRI, the lesion is barely seen on T2 and on T1. (D and E) On contrast enhanced images, the lesion shows strong and homogeneous enhancement on arterial phase and becomes iso-intense to the liver on portal venous phase. The central element is hyperintense on T2 and enhances on delayed phase imaging using extracellular contrast agents. Journal of Hepatology 2016 65, 386-398DOI: (10.1016/j.jhep.2016.04.001) Copyright © 2016 Terms and Conditions

Fig. 3 Flow chart for the management of FNH; imaging modalities may include US, CEUS, CE-CT and CE-MRI. For large lesions (>3cm), MRI sensitivity is very good. Different imaging modalities can be complementary and for lesions <3cm, where sensitivity and certainty may be less, a second imaging modality such as CEUS is advised. If doubt remains after two imaging modalities, the patients should be referred to a specialist centre, where percutaneous or resection biopsy may be considered. Journal of Hepatology 2016 65, 386-398DOI: (10.1016/j.jhep.2016.04.001) Copyright © 2016 Terms and Conditions

Fig. 4 Recommended management of a presumed HCA. Baseline MRI is necessary to help to confirm a diagnosis of HCA and characterize it. In men, resection is the treatment of choice. In women a period of 6month observation, after lifestyle change, is appropriate. Resection is indicated in lesions persistently greater than 5cm, or increasing in size. In smaller lesions, a conservative approach with interval imaging can be adopted. In specialist centres practising MRI subtyping, longer intervals between scans may be preferred for H-HCA. Biopsy is reserved for those cases where the diagnosis of HCA is uncertain on imaging and malignancy must be ruled out. ∗⩾20% diameter. Journal of Hepatology 2016 65, 386-398DOI: (10.1016/j.jhep.2016.04.001) Copyright © 2016 Terms and Conditions

Journal of Hepatology 2016 65, 386-398DOI: (10. 1016/j. jhep. 2016. 04 Copyright © 2016 Terms and Conditions

Journal of Hepatology 2016 65, 386-398DOI: (10. 1016/j. jhep. 2016. 04 Copyright © 2016 Terms and Conditions

Journal of Hepatology 2016 65, 386-398DOI: (10. 1016/j. jhep. 2016. 04 Copyright © 2016 Terms and Conditions

Journal of Hepatology 2016 65, 386-398DOI: (10. 1016/j. jhep. 2016. 04 Copyright © 2016 Terms and Conditions

Journal of Hepatology 2016 65, 386-398DOI: (10. 1016/j. jhep. 2016. 04 Copyright © 2016 Terms and Conditions