{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:22:23Z","timestamp":1785424943209,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001665","name":"French National Research Agency","doi-asserted-by":"crossref","award":["ANR-21-RHUS-0012"],"award-info":[{"award-number":["ANR-21-RHUS-0012"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"crossref"}]},{"award":["ANR-21-RHUS-0012"],"award-info":[{"award-number":["ANR-21-RHUS-0012"]}],"id":[{"id":"https:\/\/ror.org\/00rbzpz17","id-type":"ROR","asserted-by":"publisher"}]},{"name":"SiRIC InsiTu: Insights into cancer: From inflammation to tumor","award":["INCa-DGOS-INSERM-ITMO Cancer_18008"],"award-info":[{"award-number":["INCa-DGOS-INSERM-ITMO Cancer_18008"]}]},{"name":"French FHU MOSAIC2"},{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Forschung, Technologie und Raumfahrt","doi-asserted-by":"crossref","award":["ANR-21-RHUS-0012"],"award-info":[{"award-number":["ANR-21-RHUS-0012"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"crossref"}]},{"award":["ANR-21-RHUS-0012"],"award-info":[{"award-number":["ANR-21-RHUS-0012"]}],"id":[{"id":"https:\/\/ror.org\/04pz7b180","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014276","name":"Doktor Robert Pfleger Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014276","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Wilhelm Vaillant Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Differentiating focal nodular hyperplasia (FNH) from hepatic adenoma (HA) remains challenging, as FNH is benign whereas HA carries risks of hemorrhage and malignant transformation. This prospective single-center pilot study evaluated the diagnostic performance of three-dimensional magnetic resonance elastography (3D-MRE) using a gravitational transducer for non-invasive differentiation of FNH and HA. Methods: Thirty-three participants (23 FNH, 10 HA) underwent 3D-MRE using the gravitational transducer. Viscoelastic parameters\u2014stiffness, shear wave speed (Cs), wave attenuation, and phase angle\u2014were quantified for lesions and background parenchyma. \u0394-values were calculated by subtracting background liver measurements from lesion values. Results: FNH demonstrated significantly higher stiffness than HA (median 3.16 vs. 2.58 kPa; p = 0.02) and higher Cs (median 1.81 vs. 1.64 m\/s; p = 0.001). Normalized stiffness differences (\u0394 stiffness) were significantly greater in FNH than HA (median 0.83 vs. 0.10 kPa; p = 0.001). Generalized additive models revealed divergent volume-dependent stiffening behaviors. In ROC analysis, \u0394 stiffness and \u0394 Cs each achieved an AUC of 0.87, indicating that single background-normalized viscoelastic parameters carry the principal diagnostic signal. An exploratory multivariable combination of \u0394 stiffness with patient age produced an apparent AUC of 0.93 with wide odds-ratio confidence intervals, and is presented as hypothesis-generating rather than as a clinical prediction model. Conclusions: In this pilot cohort, 3D-MRE using the gravitational transducer showed encouraging parameter-level separation between FNH and HA, with background normalization enhancing discrimination. Wave attenuation and phase angle did not differ significantly between lesion types. Given the small sample size (particularly the HA subgroup of ten patients), the mixed reference standard (histological confirmation in only 14 of 33 lesions; definitive hepatobiliary-phase MRI criteria in 19 of 33), the single-slice ROI used for lesion measurement, and the incomplete characterization of background liver parenchyma, these findings should be regarded as hypothesis-generating and require external validation in larger, multicenter cohorts before any clinical application.<\/jats:p>","DOI":"10.3390\/diagnostics16101569","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:06:07Z","timestamp":1779365167000},"page":"1569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gravitational 3D Magnetic Resonance Elastography for Differentiating Focal Nodular Hyperplasia and Hepatic Adenoma"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7959-5008","authenticated-orcid":false,"given":"Leon David","family":"Gruenewald","sequence":"first","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayan","family":"Mansouri","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Booz","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0524-6574","authenticated-orcid":false,"given":"Jennifer","family":"Gotta","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9123-7581","authenticated-orcid":false,"given":"Philipp","family":"Reschke","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0004-6378","authenticated-orcid":false,"given":"Tommaso","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Alrahmoun","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scherwin","family":"Mahmoudi","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon S.","family":"Martin","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Eichler","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Gruber-Rouh","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Zeuzem","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"G\u00f6rg\u00fcl\u00fc","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melis","family":"Onay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0662-6675","authenticated-orcid":false,"given":"Eva","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Mathematical Modeling, Faculty of Medicine, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Johanna Gobertina Tetuanui","family":"Vehreschild","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Infectious Diseases, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Schregel","sequence":"additional","affiliation":[{"name":"Section Neuroradiology, Institute of Diagnostic and Interventional Radiology, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Ciesek","sequence":"additional","affiliation":[{"name":"Institute of Medical Virology, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3100-2167","authenticated-orcid":false,"given":"Sebastian","family":"Haberkorn","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5218-1075","authenticated-orcid":false,"given":"Thomas Joseph","family":"Vogl","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Sinkus","sequence":"additional","affiliation":[{"name":"Team \u201cFrom Micro to Macro in Cancer Development\u201d, Center for Research on Inflammation, UMR 1149 National Institute for Health and Medical Research (INSERM), Universit\u00e9 de Paris, 75013 Paris, France"},{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, London WC2R 2LS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6915-5906","authenticated-orcid":false,"given":"Vitali","family":"Koch","sequence":"additional","affiliation":[{"name":"Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1148\/rg.210156","article-title":"Focal Nodular Hyperplasia and Focal Nodular Hyperplasia-like Lesions","volume":"42","author":"LeGout","year":"2022","journal-title":"Radiographics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e000592","DOI":"10.1136\/bmjgast-2020-000592","article-title":"Scoping review of clinical practice guidelines on the management of benign liver 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