Gravitational 3D Magnetic Resonance Elastography for Differentiating Focal Nodular Hyperplasia and Hepatic Adenoma

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—stiffness, shear wave speed (Cs), wave attenuation, and phase angle—were quantified for lesions and background parenchyma. Δ-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 (Δ 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, Δ stiffness and Δ 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 Δ 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.