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Colli A, Nadarevic T, Miletic D, Giljaca V, Fraquelli M, Štimac D, Casazza G. Abdominal ultrasound and alpha-foetoprotein for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev 2021; 4:CD013346. [PMID: 33855699 PMCID: PMC8078581 DOI: 10.1002/14651858.cd013346.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) occurs mostly in people with chronic liver disease and ranks sixth in terms of global instances of cancer, and fourth in terms of cancer deaths for men. Despite that abdominal ultrasound (US) is used as an initial test to exclude the presence of focal liver lesions and serum alpha-foetoprotein (AFP) measurement may raise suspicion of HCC occurrence, further testing to confirm diagnosis as well as staging of HCC is required. Current guidelines recommend surveillance programme using US, with or without AFP, to detect HCC in high-risk populations despite the lack of clear benefits on overall survival. Assessing the diagnostic accuracy of US and AFP may clarify whether the absence of benefit in surveillance programmes could be related to under-diagnosis. Therefore, assessment of the accuracy of these two tests for diagnosing HCC in people with chronic liver disease, not included in surveillance programmes, is needed. OBJECTIVES Primary: the diagnostic accuracy of US and AFP, alone or in combination, for the diagnosis of HCC of any size and at any stage in adults with chronic liver disease, either in a surveillance programme or in a clinical setting. Secondary: to assess the diagnostic accuracy of abdominal US and AFP, alone or in combination, for the diagnosis of resectable HCC; to compare the diagnostic accuracy of the individual tests versus the combination of both tests; to investigate sources of heterogeneity in the results. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic-Test-Accuracy Studies Register, Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, until 5 June 2020. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of US and AFP, independently or in combination, for the diagnosis of HCC in adults with chronic liver disease, with cross-sectional and case-control designs, using one of the acceptable reference standards, such as pathology of the explanted liver, histology of resected or biopsied focal liver lesion, or typical characteristics on computed tomography, or magnetic resonance imaging, all with a six-months follow-up. DATA COLLECTION AND ANALYSIS We independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest-plots, and tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 373 studies. The index-test was AFP (326 studies, 144,570 participants); US (39 studies, 18,792 participants); and a combination of AFP and US (eight studies, 5454 participants). We judged at high-risk of bias all but one study. Most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time-interval between the index test and the reference standard was rarely defined. Most studies with AFP had a case-control design. We also had major concerns for the applicability due to the characteristics of the participants. As the primary studies with AFP used different cut-offs, we performed a meta-analysis using the hierarchical-summary-receiver-operating-characteristic model, then we carried out two meta-analyses including only studies reporting the most used cut-offs: around 20 ng/mL or 200 ng/mL. AFP cut-off 20 ng/mL: for HCC (147 studies) sensitivity 60% (95% CI 58% to 62%), specificity 84% (95% CI 82% to 86%); for resectable HCC (six studies) sensitivity 65% (95% CI 62% to 68%), specificity 80% (95% CI 59% to 91%). AFP cut-off 200 ng/mL: for HCC (56 studies) sensitivity 36% (95% CI 31% to 41%), specificity 99% (95% CI 98% to 99%); for resectable HCC (two studies) one with sensitivity 4% (95% CI 0% to 19%), specificity 100% (95% CI 96% to 100%), and one with sensitivity 8% (95% CI 3% to 18%), specificity 100% (95% CI 97% to 100%). US: for HCC (39 studies) sensitivity 72% (95% CI 63% to 79%), specificity 94% (95% CI 91% to 96%); for resectable HCC (seven studies) sensitivity 53% (95% CI 38% to 67%), specificity 96% (95% CI 94% to 97%). Combination of AFP (cut-off of 20 ng/mL) and US: for HCC (six studies) sensitivity 96% (95% CI 88% to 98%), specificity 85% (95% CI 73% to 93%); for resectable HCC (two studies) one with sensitivity 89% (95% CI 73% to 97%), specificity of 83% (95% CI 76% to 88%), and one with sensitivity 79% (95% CI 54% to 94%), specificity 87% (95% CI 79% to 94%). The observed heterogeneity in the results remains mostly unexplained, and only in part referable to different cut-offs or settings (surveillance programme compared to clinical series). The sensitivity analyses, excluding studies published as abstracts, or with case-control design, showed no variation in the results. We compared the accuracy obtained from studies with AFP (cut-off around 20 ng/mL) and US: a direct comparison in 11 studies (6674 participants) showed a higher sensitivity of US (81%, 95% CI 66% to 90%) versus AFP (64%, 95% CI 56% to 71%) with similar specificity: US 92% (95% CI 83% to 97%) versus AFP 89% (95% CI 79% to 94%). A direct comparison of six studies (5044 participants) showed a higher sensitivity (96%, 95% CI 88% to 98%) of the combination of AFP and US versus US (76%, 95% CI 56% to 89%) with similar specificity: AFP and US 85% (95% CI 73% to 92%) versus US 93% (95% CI 80% to 98%). AUTHORS' CONCLUSIONS In the clinical pathway for the diagnosis of HCC in adults, AFP and US, singularly or in combination, have the role of triage-tests. We found that using AFP, with 20 ng/mL as a cut-off, about 40% of HCC occurrences would be missed, and with US alone, more than a quarter. The combination of the two tests showed the highest sensitivity and less than 5% of HCC occurrences would be missed with about 15% of false-positive results. The uncertainty resulting from the poor study quality and the heterogeneity of included studies limit our ability to confidently draw conclusions based on our results.
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Affiliation(s)
- Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tin Nadarevic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Damir Miletic
- Department of Radiology , Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Vanja Giljaca
- Department of Gastroenterology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
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Fan K, Lu C, Shu G, Lv XL, Qiao E, Zhang N, Chen M, Song J, Wu F, Zhao Z, Xu X, Xu M, Chen C, Yang W, Sun J, Du Y, Ji J. Sialic acid-engineered mesoporous polydopamine dual loaded with ferritin gene and SPIO for achieving endogenous and exogenous synergistic T2-weighted magnetic resonance imaging of HCC. J Nanobiotechnology 2021; 19:76. [PMID: 33731140 PMCID: PMC7968241 DOI: 10.1186/s12951-021-00821-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a common malignant tumor with poor prognosis. Magnetic resonance imaging (MRI) is one of the most effective imaging methods for the early diagnosis of HCC. However, the current MR contrast agents are still facing challenges in the early diagnosis of HCC due to their relatively low sensitivity and biosafety. Thus, the development of effective MR agents is highly needed for the early diagnosis of HCC. Results Herein, we fabricated an HCC-targeted nanocomplexes containing SPIO-loaded mesoporous polydopamine (MPDA@SPIO), sialic acid (SA)-modified polyethyleneimine (SA-PEI), and alpha-fetoprotein regulated ferritin gene (AFP-Fth) which was developed for the early diagnosis of HCC. It was found that the prepared nanocomplexes (MPDA@SPIO/SA-PEI/AFP-Fth) has an excellent biocompatibility towards the liver cells. In vivo and in vivo studies revealed that the transfection of AFP-Fth gene in hepatic cells significantly upregulated the expression level of ferritin, thereby resulting in an enhanced contrast on T2-weighted images via the formed endogenous MR contrast. Conclusions The results suggested that MPDA@SPIO/SA-PEI/AFP-Fth had a superior ability to enhance the MR contrast of T2-weighted images of tumor region than the other preparations, which was due to its HCC-targeted ability and the combined T2 contrast effect of endogenous ferritin and exogenous SPIO. Our study proved that MPDA@SPIO/SA-PEI/AFP-Fth nanocomplexes could be used as an effective MR contrast agent to detect HCC in the early stage.![]() Supplementary Information The online version contains supplementary material available at 10.1186/s12951-021-00821-8.
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Affiliation(s)
- Kai Fan
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China.,Department of Radiology, Sir Run Shaw Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Chengying Lu
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Gaofeng Shu
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China.,Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China
| | - Xiu-Ling Lv
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Enqi Qiao
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China.,Department of Radiology, Sir Run Shaw Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Nannan Zhang
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Minjiang Chen
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China.,Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China
| | - Jingjing Song
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Fazong Wu
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Zhongwei Zhao
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Xiaoling Xu
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China
| | - Min Xu
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Chunmiao Chen
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Weibin Yang
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China
| | - Jihong Sun
- Department of Radiology, Sir Run Shaw Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Yongzhong Du
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China.
| | - Jiansong Ji
- Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, School of Medicine, Lishui Hospital of Zhejiang University, Lishui, 323000, Zhejiang, China.
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Zaki IH, Shropshire E, Zhang S, Xiao D, Wildman-Tobriner B, Marin D, Gupta RT, Erkanli A, Nelson RC, Bashir MR. How frequently does hepatocellular carcinoma develop in at-risk patients with a negative liver MRI examination with intravenous Gadobenate dimeglumine? Abdom Radiol (NY) 2021; 46:969-978. [PMID: 32951065 DOI: 10.1007/s00261-020-02771-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the rate of development of clinically significant liver nodules (LR-4, LR-5, LR-M) after a negative MRI in an HCC screening population. METHODS This retrospective study included patients at risk of developing HCC requiring imaging surveillance who had undergone multiphase Gadobenate dimeglumine-enhanced MRI that was negative and had follow up LI-RADS compliant multiphase CTs or MRIs for at least 12 months or positive follow-up within 12 months. Follow-up examinations were classified as negative (no nodules or only LR-1 nodules) or positive (nodule other than LR-1). Time-to-first positive examination, types of nodules, and cumulative incidence of nodule development were recorded. RESULTS 204 patients (mean age 58.9 ± 10.2 years, 128 women), including 172 with cirrhosis, were included. Based CT/MRI follow-up (median 35 months, range 12-80 months), the overall cumulative incidence of developing a nodule was 10.5%. Cumulative incidence of nodule development was: 0.5% at 6-9 months and 2.1% at 12 ± 3 months, including one LR-4 nodule, one LR-M nodule, and two LR-3 nodules. The cumulative incidence of clinically significant nodule development was 1.1% at 9-15 months. 70% (143/204) of patients also underwent at least one US follow-up, and no patient developed a positive US examination following index negative MRI. CONCLUSION Clinically significant liver nodules develop in 1.1% of at-risk patients in the first year following negative MRI. While ongoing surveillance is necessary for at-risk patients, our study suggests than longer surveillance intervals after a negative MRI may be reasonable and that further research is needed to explore this possibility.
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Affiliation(s)
- Islam H Zaki
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
- Center for Advanced Magnetic Resonance Development (CAMRD), Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Erin Shropshire
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Shuaiqi Zhang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC, 27710, USA
| | - Dong Xiao
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC, 27710, USA
| | | | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC, 27710, USA
| | - Redon C Nelson
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
- Center for Advanced Magnetic Resonance Development (CAMRD), Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
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Sparchez Z, Craciun R, Caraiani C, Horhat A, Nenu I, Procopet B, Sparchez M, Stefanescu H, Mocan T. Ultrasound or Sectional Imaging Techniques as Screening Tools for Hepatocellular Carcinoma: Fall Forward or Move Forward? J Clin Med 2021; 10:903. [PMID: 33668839 PMCID: PMC7956684 DOI: 10.3390/jcm10050903] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is probably the epitome of a screening target, with a well-defined high-risk population, accessible screening methods, and multiple curative-intent treatments available for early disease. Per major societies guideline consensus, biannual ultrasound (US) surveillance of the at-risk patients is the current standard of care worldwide. Yet, despite its documented success in the past decades, this standard is far from perfect. While the whole community is working to further tighten the knots, a worrying number of cases still slip through this safety net. Consequently, these patients lose their chance to a curative solution which leads to a high disease burden with disproportionate mortality. While US will probably remain the fundamental staple in the screening strategy, key questions are seeking better answers. How can its caveats be addressed, and the technique be improved? When are further steps needed? How to increase accuracy without giving up on accessibility? This narrative review discusses the place of US surveillance in the bigger HCC picture, trying to navigate through its strengths and limits based on the most recent available evidence.
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Affiliation(s)
- Zeno Sparchez
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (Z.S.); (A.H.); (I.N.); (B.P.); (T.M.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Rares Craciun
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (Z.S.); (A.H.); (I.N.); (B.P.); (T.M.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Cosmin Caraiani
- Department of Medical Imaging, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Adelina Horhat
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (Z.S.); (A.H.); (I.N.); (B.P.); (T.M.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Iuliana Nenu
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (Z.S.); (A.H.); (I.N.); (B.P.); (T.M.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Bogdan Procopet
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (Z.S.); (A.H.); (I.N.); (B.P.); (T.M.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Mihaela Sparchez
- Paediatric Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Horia Stefanescu
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Tudor Mocan
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (Z.S.); (A.H.); (I.N.); (B.P.); (T.M.)
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
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Alunni-Fabbroni M, Weber S, Öcal O, Seidensticker M, Mayerle J, Malfertheiner P, Ricke J. Circulating Cell-Free DNA Combined to Magnetic Resonance Imaging for Early Detection of HCC in Patients with Liver Cirrhosis. Cancers (Basel) 2021; 13:cancers13030521. [PMID: 33572923 PMCID: PMC7866376 DOI: 10.3390/cancers13030521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Liver cirrhosis can develop into malignant disease over time. Frequent monitoring would be advisable to detect the earliest signs of HCC progress resulting in a possible earlier treatment of the patient. Our study showed that the combination of genetic analysis of DNA freely circulating in the blood of the cirrhotic patients with MRI can represent a powerful strategy to timely identify suspect lesions, which can then be followed up more closely and thus potentially be treated earlier. In this way, personalized medicine can be applied to liver diseases such as cirrhosis. Abstract Liquid biopsy based on circulating cell-free DNA (cfDNA) is a promising non-invasive tool for the prognosis of hepatocellular cancer (HCC). In this exploratory study we investigated whether cfDNA and gene variants associated with HCC may be found in patients with liver cirrhosis (LC) and thus identify those at an increased risk for HCC. A cohort of 40 LC patients with no suspect neoplastic lesions was included in this study. Next generation sequencing (NGS) of cfDNA isolated from plasma was performed on a panel of 597 selected genes. Images of the patients who underwent MRI with hepatospecific contrast media during the study period were retrospectively re-evaluated (imaging was not part of the prospective study). cfDNA was detected in the plasma of 36 patients with LC. NGS-based analyses identified 20 variants in different combinations. Re-evaluation of the MRI images that were available for a proportion of the patients (n = 27) confirmed the absence of lesions in 8 cases carrying cfDNA without variants. In 6 of 19 patients with identified variants and MRI images available, MRI revealed a precursor lesion compatible with HCC and new lesions were discovered at follow-up in two patients. These precursor lesions were amenable for curative treatments. Mutation analysis revealed selective HCC related gene mutations in a subset of patients with LC, raising the suspect that these patients were at an increased risk for HCC development. MRI findings confirmed suspect nodular lesions of early stage HCC not detected with current standard screening procedures, which were only seen in patients carrying cfDNA variants. This opens a perspective for an HCC screening strategy combining both liquid biopsy and MRI in patients with LC.
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Affiliation(s)
- Marianna Alunni-Fabbroni
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (O.Ö.); (M.S.); (P.M.); (J.R.)
- Correspondence: ; Tel.: +49-89-4400-77605
| | - Sabine Weber
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (S.W.); (J.M.)
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (O.Ö.); (M.S.); (P.M.); (J.R.)
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (O.Ö.); (M.S.); (P.M.); (J.R.)
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (S.W.); (J.M.)
| | - Peter Malfertheiner
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (O.Ö.); (M.S.); (P.M.); (J.R.)
- Department of Medicine II, University Hospital, LMU Munich, 81377 Munich, Germany; (S.W.); (J.M.)
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (O.Ö.); (M.S.); (P.M.); (J.R.)
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Role of N-acetyl Cysteine in Post-transarterial Chemoembolization Transaminitis in Hepatocellular Carcinoma: A Single-center Experience. J Clin Exp Hepatol 2021; 11:299-304. [PMID: 33994712 PMCID: PMC8103334 DOI: 10.1016/j.jceh.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is the most common locoregional therapy for hepatocellular carcinoma (HCC). Postembolization syndrome is not an uncommon complication. At present, there is no specific treatment for management of this complication. We aimed to study the role of N-acetyl cysteine (NAC), an antioxidant, in management of this complication. METHODS In a prospective observational study, consecutive patients with HCC undergoing TACE from January 2016 to January 2017 were included. Patients with postembolization syndrome, defined as an elevation of transaminase levels more than 3-4 times the upper limit of normal, were administered intravenous NAC for 72 h (150 mg/kg for 1 h, then 12.5 mg/kg/h for 4 h, and continuous infusion 6.25 mg/h for the remaining 67 h). The other group received only supportive standard of care. The primary end point was reduction in post-TACE transaminitis. RESULTS Of 112 patients with HCC, 53 (47.3%) received NAC. The majority were cirrhotics in both the groups. Both groups were well matched in demographic, laboratory, and tumor characteristics. In the NAC group, there was significant reduction in Aspartate transaminase (AST) and Alanine transaminase (ALT) levels from day 1 to day 3 (p = 0.000) compared with the non-NAC group, with no significant change in bilirubin or international normalized ratio levels. The duration of hospital stay was similar in both the groups. None had any major adverse events to NAC. CONCLUSION This is a prospective, single-center experience, showing that early initiation of N-acetyl cysteine in those with post-TACE embolization syndrome reduces the transaminase level significantly.
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Key Words
- AFP, alpha-fetoprotein
- ANOVA, analysis of variance
- BCLC, Barcelona Clinic Liver Cancer
- CT, computed tomography
- HCC, hepatocellular carcinoma
- IL, interleukin
- INR, international normalized ratio
- LT, liver transplantation
- NAC, N-acetyl cysteine
- PES, postembolization syndrome
- TACE, Transarterial chemoembolization
- chronic liver disease
- liver cancer
- liver transplant
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Evaluation of diagnostic accuracy of serum calcium channel α2δ1 subunit in hepatocellular carcinoma-related cirrhosis. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Hepatocellular carcinoma (HCC) is one of the commonest malignancies worldwide that carries a bad prognosis particularly in Egypt due to the high prevalence of HCV burden. Late diagnosis of HCC especially in cirrhosis suffering-liver is one of the causes that worsen HCC outcome. Identification of molecular pathways of HCC will open the gate for early diagnosis and effective management. Oscillation of calcium controlled by the α2δ1 subunit has been proposed as one of the mechanisms in tumor-initiating cell properties of HCC. In this study, we aim to evaluate the serum α2δ1 subunit level as a biological marker for HCC. A total of 90 participants were enrolled, 40 patients with HCC, 40 patients with cirrhosis, and 10 healthy volunteers; serum level of α2δ1 was assessed in all participants with ELISA
Results
The mean serum levels of α2δ1 were significantly higher in HCC group (19.53 ± 6.87 ng/dL) than cirrhotic (6.24 ± 2.64 ng/dL) and control groups (0.67 ± 0.48 ng/dL) (P = 0.001). There was no significance between α2δ1 and etiology of liver disease as viral (HCV, HBV) or non-viral (P = 0.14).
Conclusion
α2δ1 subunit may serve as a potential non-invasive marker with excellent sensitivity for diagnosis of HCC regardless of the etiology of liver disease.
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Lin ZY, Fang Y, Chen J, Lin QF, Yan Y, Chen J, Li YL. Feasibility and efficacy study of microwave ablation of recurrent small HCC guided by enhanced liver-specific magnetic resonance imaging contrast agent. Int J Hyperthermia 2020; 37:1330-1335. [PMID: 33243050 DOI: 10.1080/02656736.2020.1850886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To investigate the feasibility and efficacy of liver-specific magnetic resonance imaging (MRI) with gadolinium-containing contrast agent guidance for microwave ablation (MWA) of recurrent small hepatocellular carcinoma (HCC). MATERIALS AND METHODS The Ethics Committee of the First Affiliated Hospital of Fujian Medical University approved this study. Eighteen patients presented with 30 recurrent small HCCs, at least one lesion per patient was undetectable on unenhanced MRI, but this was clearly demonstrated in the hepatobiliary phase after liver-specific MRI contrast agent administration. Gd-BOPTA (16 cases) or Gd-EOB-DTPA (2 cases) were injected half an hour before the procedure, and MWA was performed by percutaneous puncture of the target lesion with a magnetic resonance-compatible microwave antenna under 1.5 T MRI guidance. RESULTS The technical success rate was 100%. The mean maximum diameter of the lesions was 9.7 ± 2.8 mm (5.0-15.4 mm). The mean follow-up time was 11.6 ± 4.7 months (range, 4-19 months), and no local recurrence was observed. CONCLUSIONS MWA of small HCCs guided by enhanced liver-specific MRI contrast agent is a safe and effective technique.
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Affiliation(s)
- Zheng-Yu Lin
- The Department of Interventional Radiology, Molecular Oncology Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan Fang
- Nursing Department, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin Chen
- The Department of Interventional Radiology, Molecular Oncology Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing-Feng Lin
- The Department of Interventional Radiology, Molecular Oncology Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan Yan
- The Department of Interventional Radiology, Molecular Oncology Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Chen
- The Department of Interventional Radiology, Molecular Oncology Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu-Liang Li
- The Department of Interventional Radiology, Molecular Oncology Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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An JY, Peña MA, Cunha GM, Booker MT, Taouli B, Yokoo T, Sirlin CB, Fowler KJ. Abbreviated MRI for Hepatocellular Carcinoma Screening and Surveillance. Radiographics 2020; 40:1916-1931. [PMID: 33136476 PMCID: PMC7714535 DOI: 10.1148/rg.2020200104] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
To detect potentially curable hepatocellular carcinoma (HCC), clinical practice guidelines recommend semiannual surveillance US of the liver in adult patients at risk for developing this malignancy, such as those with cirrhosis and some patients with chronic hepatitis B infection. However, cirrhosis and a large body habitus, both of which are increasingly prevalent in the United States and the rest of the world, may impair US visualization of liver lesions and reduce the sensitivity of surveillance with this modality. The low sensitivity of US for detection of early-stage HCC contributes to delayed diagnosis and increased mortality. Abbreviated MRI, a shortened MRI protocol tailored for early-stage detection of HCC, has been proposed as an alternative surveillance option that provides high sensitivity and specificity. Abbreviated MRI protocols include fewer sequences than a complete multiphase MRI examination and are specifically designed to identify small potentially curable HCCs that may be missed at US. Three abbreviated MRI strategies have been studied: (a) nonenhanced, (b) dynamic contrast material-enhanced, and (c) hepatobiliary phase contrast-enhanced abbreviated MRI. Retrospective studies have shown that simulated abbreviated MRI provides high sensitivity and specificity for early-stage HCC, mostly in nonsurveillance cohorts. If it is supported by scientific evidence in surveillance populations, adoption of abbreviated MRI could advance clinical practice by increasing early detection of HCC, allowing effective treatment and potentially prolonging life in the growing number of individuals with this cancer. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
| | | | - Guilherme M. Cunha
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Michael T. Booker
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Bachir Taouli
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Takeshi Yokoo
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Claude B. Sirlin
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
| | - Kathryn J. Fowler
- From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.)
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60
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Chen J, Lin Z, Lin Q, Lin R, Yan Y, Chen J. Percutaneous radiofrequency ablation for small hepatocellular carcinoma in hepatic dome under MR-guidance: clinical safety and efficacy. Int J Hyperthermia 2020; 37:192-201. [PMID: 32066293 DOI: 10.1080/02656736.2020.1728397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: To evaluate the clinical safety and efficacy of percutaneous radiofrequency ablation (RFA) using multitined expandable electrodes under magnetic resonance imaging (MRI) guidance in the treatment of small hepatocellular carcinomas (HCCs) in the hepatic dome.Materials and methods: The data of 49 patients with 50 HCC lesions in the hepatic dome who underwent MRI-guided RFA from April 2010 to January 2018 were retrospectively analyzed. Planning, targeting, and controlling were performed under MR-guidance during the procedure. The complications after RFA were observed. Follow-up MRI was performed to evaluate the curative effect. The local progression-free survival, recurrence-free survival, and overall survival rates were calculated using the Kaplan-Meier survival curve.Results: The procedures were successfully accomplished in all patients without major complications. The mean follow-up time was 36.9 ± 25.8 months (range, 3-99 months). Technical success was 100% after one RFA session with MRI assessment after 1 month. Local tumor progression was observed in one patient (2%) with the lesion located in the hepatic dome at 4 months on a subsequent follow-up MRI. The progression-free survival time was 25.0 ± 22.7 months (median, 17.0 months). The 1-,3-, and 5-year local tumor progression-free survival rates were all 98.0%. The 1-,3-, and 5-year recurrence-free survival rates were 68.1%, 39.9%, and 28.5%, respectively, and the estimated overall survival rates were 93.7%, 76.3%, and 54.3%, respectively.Conclusion: Planning, targeting, and controlling of RFA were well supported by MRI with acceptable time. MRI-guided RFA for small HCCs in the hepatic dome is safe and effective with fewer RF sessions.
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Affiliation(s)
- Jin Chen
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhengyu Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingfeng Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ruixiang Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan Yan
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Chen
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Chiang MF, Tseng TK, Shih CW, Yang TH, Wu SY. Clinical and contrast-enhanced image features in the prediction model for the detection of small hepatocellular carcinomas. J Cancer 2020; 11:7166-7175. [PMID: 33193879 PMCID: PMC7646160 DOI: 10.7150/jca.47245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose: To identify novel radiological features and clinical characteristics to improve diagnostic criteria for early detection of small hepatocellular carcinoma (HCC). Patients and Methods: We retrospectively recruited asymptomatic patients with no history of HCC but a high risk of HCC in whom a new, solitary, well-defined, solid nodule between 10 and 20 mm was detected through a screening ultrasound. We retrospectively collected all clinical data, and patients were examined using dynamic contrast-enhanced computed tomography or magnetic resonance imaging; subsequently, fine-needle biopsy was performed. A multivariate analysis of the predictors of small HCCs was performed by fitting a multiple logistic regression model with the stepwise variable selection method. Results: In total, 392 and 347 patients with a small liver nodule received a final pathologic confirmation of HCC and non-HCC, respectively. The estimated odds ratios and 95% confidence intervals of tumor size > 12.45 mm, age > 56.61 years, liver cirrhosis, hepatitis C virus (HCV) carrier status, ln alpha-fetoprotein (AFP) > 1.954, arterial phase enhancement, and portal or venous phase washout appearance without arterial phase enhancement were 2.0735 (1.4746-2.9155), 1.8878 (1.2949-2.7521), 1.6927 (1.1294-2.5369), 1.6186 (1.0347-2.5321), 2.0297 (1.3342-3.0876), 3.7451 (2.3845-5.8821), and 2.0327 (1.3500-3.0608), respectively. The area under the receiver operating characteristic curves for the diagnosis of small HCCs was 0.79 for arterial phase enhancement and 0.75 for portal or venous phase washout appearance without arterial phase enhancement. Conclusion: Clinical and contrast-enhanced image features are valuable in the prediction model for the detection and early diagnosis of small HCCs in patients with a high risk of HCC. In addition to negative portal or venous washout and negative arterial enhancement in images, age > 56.61 years, tumor size > 12.45 mm, HCV carrier status, and ln(AFP) > 1.954, are useful indicators for the early detection of small HCCs.
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Affiliation(s)
- Ming-Feng Chiang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Tse-Kai Tseng
- Department of Radiology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Lotung, Taiwan
| | - Chia-Wen Shih
- Department of Pathology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Lotung, Taiwan
| | - Tzeng-Huey Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Szu-Yuan Wu
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.,Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
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Vernuccio F, Porrello G, Cannella R, Vernuccio L, Midiri M, Giannitrapani L, Soresi M, Brancatelli G. Benign and malignant mimickers of infiltrative hepatocellular carcinoma: tips and tricks for differential diagnosis on CT and MRI. Clin Imaging 2020; 70:33-45. [PMID: 33120287 DOI: 10.1016/j.clinimag.2020.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/23/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) may have an infiltrative appearance in about 8-20% of cases. Infiltrative HCC can be a challenging diagnosis and it is associated with the worst overall survival among HCC patients. Infiltrative HCC is characterized by the spread of multiple minute nodules throughout the liver, without a dominant one, ultimately resulting into macrovascular invasion. On CT and MRI, infiltrative HCC appears as an ill-defined, large mass, with variable degree of enhancement, and satellite neoplastic nodules in up to 52% of patients. On MRI, it may show restriction on diffusion weighted imaging, hyperintensity on T2- and hypointensity on T1-weighted images, and, if hepatobiliary agent is used, hypointensity on hepatobiliary phase. Infiltrative HCC must be differentiated from other liver diseases, such as focal confluent fibrosis, steatosis, amyloidosis, vascular disorders of the liver, cholangiocarcinoma, and diffuse metastatic disease. In cirrhotic patients, the identification of vascular tumor invasion of the portal vein and its differentiation from bland thrombosis is of utmost importance for patient management. On contrast enhanced CT and MRI, portal vein tumor thrombosis appears as an enhancing thrombus within the portal vein, close to the main tumor and results into vein enlargement. The aim of this pictorial review is to show CT and MRI features that allow the diagnosis of infiltrative HCC and portal vein tumor thrombosis. A particular point of interest includes the tips and tricks for differential diagnosis with potential mimickers of infiltrative HCC.
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Affiliation(s)
- Federica Vernuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy; University Paris Diderot, Sorbonne Paris Cité, Paris, France; I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124 Messina, Italy; Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy.
| | - Giorgia Porrello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Roberto Cannella
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy; Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Laura Vernuccio
- U.O.C. Geriatria e Lungodegenza, AOUP University Hospital Palermo, CDCD Geriatria, Palermo, Italy
| | - Massimo Midiri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Lydia Giannitrapani
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Maurizio Soresi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Kim JH, Kang SH, Lee M, Choi HS, Jun BG, Kim TS, Choi DH, Suk KT, Kim MY, Kim YD, Cheon GJ, Baik SK, Kim DJ. Improved detection of hepatocellular carcinoma by dynamic computed tomography in cirrhotic patients with chronic hepatitis B: A multicenter study. J Gastroenterol Hepatol 2020; 35:1795-1803. [PMID: 32222111 DOI: 10.1111/jgh.15046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Current guidelines for chronic hepatitis B (CHB) patients are to undergo surveillance for hepatocellular carcinoma (HCC) with 6-monthly ultrasonography (US). However, sensitivities of US to detect early-stage HCC in cirrhotic patients are suboptimal. We aimed to compare overall survival and detection rates of very-early-stage HCC in two groups: group A, undergoing 6-monthly US versus group B, undergoing 6-monthly US alternating with dynamic computed tomography (CT). METHODS This retrospective multicenter study assessed 1235 cirrhotic patients with CHB under entecavir/tenofovir therapy from 2007 to 2016. The primary endpoint was overall survival rates between the two groups. The Cox proportional hazards model and propensity score matching analyses were used to assess the effect of surveillance modalities on overall survival and detection of Barcelona Clinic Liver Cancer stage 0 HCC after balancing. RESULTS During a median follow-up of 4.5 years, 10-year cumulative HCC incidence rates of 16.3% were significantly higher in group B (n = 576) than 13.7% in group A (n = 659; P < 0.001). However, in patients with HCC, 10-year overall survival rates of 85.1% were significantly higher in group B than 65.6% in group A (P = 0.001 by log-rank test). CT exam alternating with US was independently associated with reduced overall mortality (hazard ratio 0.47, P = 0.02). Cumulative incidence of Barcelona Clinic Liver Cancer stage 0 HCC was significantly higher in group B than in group A (hazard ratio 2.82, P < 0.001). CONCLUSION In cirrhotic patients with CHB, dynamic CT exam alternating with US led to higher detection rates of very-early-stage HCC and benefit of overall survival than did US exams.
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Affiliation(s)
- Ji Hyun Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Minjong Lee
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.,Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Baek Gyu Jun
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Tae Suk Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Dae Hee Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ki Tae Suk
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Don Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gab Jin Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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Quantitative proteomics identifies a plasma multi-protein model for detection of hepatocellular carcinoma. Sci Rep 2020; 10:15552. [PMID: 32968147 PMCID: PMC7511324 DOI: 10.1038/s41598-020-72510-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022] Open
Abstract
More efficient biomarkers are needed to facilitate the early detection of hepatocellular carcinoma (HCC). We aimed to identify candidate biomarkers for HCC detection by proteomic analysis. First, we performed a global proteomic analysis of 10 paired HCC and non-tumor tissues. Then, we validated the top-ranked proteins by targeted proteomic analyses in another tissue cohort. At last, we used enzyme-linked immunosorbent assays to validate the candidate biomarkers in multiple serum cohorts including HCC cases (HCCs), cirrhosis cases (LCs), and normal controls (NCs). We identified and validated 33 up-regulated proteins in HCC tissues. Among them, eight secretory or membrane proteins were further evaluated in serum, revealing that aldo-keto reductase family 1 member B10 (AKR1B10) and cathepsin A (CTSA) can distinguish HCCs from LCs and NCs. The area under the curves (AUCs) were 0.891 and 0.894 for AKR1B10 and CTSA, respectively, greater than that of alpha-fetoprotein (AFP; 0.831). Notably, combining the three proteins reached an AUC of 0.969, which outperformed AFP alone (P < 0.05). Furthermore, the serum AKR1B10 levels dramatically decreased after surgery. AKR1B10 and CTSA are potential serum biomarkers for HCC detection. The combination of AKR1B10, CTSA, and AFP may improve the HCC diagnostic efficacy.
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65
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Prognostic role of spleen volume measurement using computed tomography in patients with compensated chronic liver disease from hepatitis B viral infection. Eur Radiol 2020; 31:1432-1442. [PMID: 32880698 DOI: 10.1007/s00330-020-07209-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/09/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To determine the prognostic value of CT-based splenic volume measurement in patients with compensated chronic liver disease (cCLD) from chronic hepatitis B (CHB). METHODS A total of 584 patients having multiphasic liver CT scans between January and December 2011 were retrospectively reviewed. Spleen volume was measured using a semi-automated three-dimensional volumetric software program. Electronic medical records and national registry data were reviewed to determine the diagnosis of hepatocellular carcinoma (HCC), hepatic decompensation, or death. The cumulative incidence (CI) of the development of decompensation, HCC occurrence, and overall survival (OS) were estimated by the Kaplan-Meier method. The Cox proportional hazard regression model was used to evaluate prognostic factors. The optimal cutoff spleen volume to predict each outcome was obtained using a minimal p value approach method. RESULTS After a median follow-up of 92 months, 114 patients developed HCC with a 7-year CI of 17.2%. A larger spleen volume was a significant predictor of HCC occurrence (HR = 2.13, p = 0.009). Decompensation occurred in 30 patients with a 7-year CI of 5.0%, and a larger spleen volume was also significantly associated with the development of decompensation (HR = 4.66, p = 0.005). Twenty-three patients died, and their estimated 7-year OS was 96.4%. A larger spleen volume also significantly affected OS (HR = 6.15, p = 0.007). The optimal cutoff spleen volume was set at 532 mL for HCC occurrence, 656.9 mL for the development of decompensation, and 741.1 mL for OS. CONCLUSIONS A larger spleen volume was significantly associated with HCC occurrence, development of decompensation, and poor OS in patients with cCLD from CHB. KEY POINTS • Spleen volume could be easily acquired from routine multiphasic liver CT scan using a semi-automated 3D volumetric software program with excellent inter-observer agreement. • A larger spleen volume was significantly associated with a higher rate of hepatocellular carcinoma occurrence, the development of decompensation, and poor overall survival in patients with compensated chronic liver disease from chronic hepatitis B.
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Yoon JH, Lee JM, Lee DH, Joo I, Jeon JH, Ahn SJ, Kim ST, Cho EJ, Lee JH, Yu SJ, Kim YJ, Yoon JH. A Comparison of Biannual Two-Phase Low-Dose Liver CT and US for HCC Surveillance in a Group at High Risk of HCC Development. Liver Cancer 2020; 9:503-517. [PMID: 33083277 PMCID: PMC7548851 DOI: 10.1159/000506834] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/26/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Biannual ultrasonography (US) is a current recommendation for hepatocellular carcinoma (HCC) surveillance in a high-risk group. The sensitivity of US, however, has been low in patients with a high risk of developing HCC. We aimed to compare sensitivity for HCC of biannual US and two-phase low-dose computed tomography (LDCT) in patients with a high risk of HCC. METHODS In this prospective single-arm study, participants with an annual risk of HCC greater than 5% (based on a risk index of ≥2.33) and who did not have a history of HCC were enrolled from November 2014 to July 2016. Participants underwent paired biannual US and two-phase LDCT 1-3 times. Two-phase LDCT included arterial and 3-min delayed phases. The sensitivity, specificity, and positive predictive value of HCC detection using US and two-phase LDCT were compared using a composite algorithm as a standard of reference. RESULTS Of the 139 enrolled participants, 137 underwent both the biannual US and two-phase LDCT at least once and had follow-up images. Among them, 27 cases of HCC (mean size: 14 ± 4 mm) developed in 24 participants over 1.5 years. Two-phase LDCT showed a significantly higher sensitivity (83.3% [20/24] vs. 29.2% [7/24], p < 0.001) and specificity (95.6% [108/113] vs. 87.7% [99/113], p =0.03) than US. A false-positive result was reported in 14 participants at US and 5 participants at two-phase LDCT, resulting in a significantly higher positive predictive value of two-phase LDCT (33.3% [7/21] vs. 80% [20/25], p < 0.001). CONCLUSIONS Patients with a risk index ≥2.33 showed a high annual incidence of HCC development in our study, and two-phase LDCT showed significantly higher sensitivity and specificity for HCC detection than US.
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Affiliation(s)
- Jeong Hee Yoon
- Radiology, Seoul National University Hospital, Seoul, Republic of Korea,College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Radiology, Seoul National University Hospital, Seoul, Republic of Korea,College of Medicine, Seoul, Republic of Korea,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea,*Jeong Min Lee, Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080 (Republic of Korea),
| | - Dong Ho Lee
- Radiology, Seoul National University Hospital, Seoul, Republic of Korea,College of Medicine, Seoul, Republic of Korea
| | - Ijin Joo
- Radiology, Seoul National University Hospital, Seoul, Republic of Korea,College of Medicine, Seoul, Republic of Korea
| | - Ju Hyun Jeon
- Radiology, Seoul National University Hospital, Seoul, Republic of Korea,College of Medicine, Seoul, Republic of Korea
| | - Su Joa Ahn
- Radiology, Seoul National University Hospital, Seoul, Republic of Korea,College of Medicine, Seoul, Republic of Korea
| | - Seung-taek Kim
- Radiology, Seoul National University Hospital, Seoul, Republic of Korea,College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Cho
- Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Jong Yu
- Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Brunsing RL, Fowler KJ, Yokoo T, Cunha GM, Sirlin CB, Marks RM. Alternative approach of hepatocellular carcinoma surveillance: abbreviated MRI. HEPATOMA RESEARCH 2020; 6:59. [PMID: 33381651 PMCID: PMC7771881 DOI: 10.20517/2394-5079.2020.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review focuses on emerging abbreviated magnetic resonance imaging (AMRI) surveillance of patients with chronic liver disease for hepatocellular carcinoma (HCC). This surveillance strategy has been proposed as a high-sensitivity alternative to ultrasound for identification of patients with early-stage HCC, particularly in patients with cirrhosis or obesity, in whom sonographic visualization of small tumors may be compromised. Three general AMRI approaches have been developed and studied in the literature - non-contrast AMRI, dynamic contrast-enhanced AMRI, and hepatobiliary phase contrast-enhanced AMRI - each comprising a small number of selected sequences specifically tailored for HCC detection. The rationale, general technique, advantages and disadvantages, and diagnostic performance of each AMRI approach is explained. Additionally, current gaps in knowledge and future directions are discussed. Based on emerging evidence, we cautiously recommend the use of AMRI for HCC surveillance in situations where ultrasound is compromised.
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Affiliation(s)
- Ryan L. Brunsing
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Kathryn J. Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Guilherme Moura Cunha
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA 92093, USA
| | - Robert M. Marks
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20892, USA
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Park HJ, Kim SY. Imaging Modalities for Hepatocellular Carcinoma Surveillance: Expanding Horizons beyond Ultrasound. JOURNAL OF LIVER CANCER 2020; 20:99-105. [PMID: 37384318 PMCID: PMC10035675 DOI: 10.17998/jlc.20.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 06/30/2023]
Abstract
In Asian countries favoring loco-regional treatment such as surgical resection or ablation, very early-stage hepatocellular carcinoma (HCC) should be the main target for surveillance. Even though ultrasound (US) has been accepted as a primary imaging modality for HCC surveillance, its performance in detecting very early-stage HCCs is insufficient. Moreover, in more than 20% of patients at high risk for HCC, visualization of the liver on US may be limited owing to the advanced distortion and heterogeneity of the liver parenchyma. Recently revised HCC clinical guidelines allow the use of alternative surveillance tools including computed tomography or magnetic resonance imaging in patients with inadequate US exams. This paper summarizes the findings of recent studies using imaging modalities other than US as surveillance tools for HCC as well as strengths and limitations of these modalities.
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Affiliation(s)
- Hyo Jung Park
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Possner M, Gordon-Walker T, Egbe AC, Poterucha JT, Warnes CA, Connolly HM, Ginde S, Clift P, Kogon B, Book WM, Walker N, Wagenaar LJ, Moe T, Oechslin E, Kay WA, Norris M, Dillman JR, Trout AT, Anwar N, Hoskoppal A, Broering DC, Bzeizi K, Veldtman G. Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes. Int J Cardiol 2020; 322:142-148. [PMID: 32828959 DOI: 10.1016/j.ijcard.2020.08.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fontan-associated liver disease (FALD) is universal in patients with a Fontan circulation. Hepatocellular carcinoma (HCC) is one of its severe expressions, and, though rare, frequently fatal. The purpose of this study was to describe the clinical presentation, risk factors, and outcomes of HCC in patients with a Fontan circulation. METHODS A multicenter case series of Fontan patients with a diagnosis of HCC formed the basis of this study. The case series was extended by published cases and case reports. Clinical presentation, tumor characteristics, laboratory and hemodynamic findings as well as treatment types and outcomes, were described. RESULTS Fifty-four Fontan patients (50% female) with a diagnosis of HCC were included. Mean age at HCC diagnosis was 30 ± 9.4 years and mean duration from Fontan surgery to HCC diagnosis was 21.6 ± 7.4 years. Median HCC size at the time of diagnosis was 4 cm with a range of 1 to 22 cm. The tumor was located in the right hepatic lobe in 65% of the patients. Fifty-one percent had liver cirrhosis at the time of HCC diagnosis. Fifty percent of the patients had no symptoms related to HCC and alpha-fetoprotein was normal in 26% of the cases. Twenty-six patients (48%) died during a median follow-up duration of 10.6 (range 1-50) months. CONCLUSIONS HCC in Fontan patients occurs at a young age with a 1-year survival rate of only 50%. Meticulous liver surveillance is crucial to detect small tumors in the early stage.
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Affiliation(s)
- Mathias Possner
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Timothy Gordon-Walker
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; The University of Edinburgh, Edinburgh, United Kingdom
| | - Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Carole A Warnes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Salil Ginde
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul Clift
- Department of Cardiology, New Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Brian Kogon
- Department of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Egleston, Emory University, Atlanta, GA, USA
| | - Wendy M Book
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA, USA
| | - Niki Walker
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Lodewijk J Wagenaar
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente Hospital, Enschede, the Netherlands
| | - Tabitha Moe
- Division of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, University Health Network / Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
| | - W Aaron Kay
- Section of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA; Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark Norris
- Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nadeem Anwar
- Division of Gastroenterology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Arvind Hoskoppal
- Department of Pediatrics, University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Dieter C Broering
- Department of Liver Transplantation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Bzeizi
- Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Gruschen Veldtman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Yamada A. Deep learning promotes B-mode ultrasound screening for focal liver lesions. EBioMedicine 2020; 56:102814. [PMID: 32512516 PMCID: PMC7276510 DOI: 10.1016/j.ebiom.2020.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Akira Yamada
- Shinshu University School of Medicine, Radiology, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan.
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Yan J, Man Z, Lu Q, Ma K. Long-Term Survival in Patients Receiving Combination Therapy with Resection and Radiofrequency Ablation for Multi-Focal Hepatocellular Carcinoma Classified as Barcelona Clinic Liver Cancer Stage B: A Retrospective Controlled Study. Cancer Manag Res 2020; 12:2613-2621. [PMID: 32368139 PMCID: PMC7173838 DOI: 10.2147/cmar.s237635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/18/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the survival outcomes of combined liver resection (LR) and radiofrequency ablation (RFA) on multi-focal hepatocellular carcinoma (HCC) in patients with Barcelona clinic liver cancer (BCLC) stage B. Methods A total of 210 cases of HCC were included in this study. In 42 cases, patients were treated with combination therapy using LR and RFA (LRCRFA). In 84 cases, patients underwent transarterial chemoembolization (TACE), and in another 84 cases, patients underwent LR; both the TACE and LR groups served as controls. It both categorized as BCLC stage B for LRCRFA and TACE groups but as BCLC stage A for LR group. Results The overall survival (OS) rate of the LRCRFA group was significantly higher than that of the TACE group (P<0.001) but was not significantly different when compared with the LR group (P=0.544). The disease-free survival (DFS) rate of the LRCRFA group was significantly lower than that of the LR group (P=0.029). Patients with ≤4 tumors or those with ≤5 tumors no larger than 6 cm in diameter experienced better long-term outcomes than other patients in the same LRCRFA group. The OS rates and DFS rates were not significantly different from those of patients in the LR group (P>0.05). Having more than 2 existing tumors was an independent risk factor for OS rate. Conclusion Combination therapy using LR and RFA can more effectively improve the prognosis of these patients than TACE. Patients with BCLC stage B HCC with ≤4 tumors or ≤5 tumors smaller than 6 cm in diameter are the ideal candidates for the application of LRCRFA.
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Affiliation(s)
- Jun Yan
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing, People's Republic of China.,The Institute of Hepatobiliary Surgery, The First Hospital Affiliated of Army Medical University, Chongqing, People's Republic of China.,Center of Hepatobiliary Pancreatic Disease, Xuzhou Central Hospital, Jiangsu, People's Republic of China
| | - Zhongsong Man
- Center of Hepatobiliary Pancreatic Disease, Xuzhou Central Hospital, Jiangsu, People's Republic of China
| | - Qian Lu
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Kuansheng Ma
- The Institute of Hepatobiliary Surgery, The First Hospital Affiliated of Army Medical University, Chongqing, People's Republic of China
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Hepatocellular Carcinoma in a Patient With Hepatic Steatosis. ACG Case Rep J 2020; 7:e00378. [PMID: 32607378 PMCID: PMC7289280 DOI: 10.14309/crj.0000000000000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) has historically developed in the setting of known risk factors-chronic liver disease from viral hepatitis and cirrhosis. In the absence of a risk factor, the development of HCC was rare. However, the increasing prevalence of nonalcoholic liver disease and nonalcoholic steatohepatitis, the paradigm is shifting. Currently, no HCC screening guidelines exist for these patients. We report a 30-year-old man with a medical history of treated nonseminomatous germ cell testicular cancer who presented with asymptomatic transaminitis. Subsequent workup was notable for a 1.6-cm liver lesion. The patient underwent a left lobe wedge resection with pathology demonstrating a well-differentiated HCC in a background of hepatic steatosis.
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Bashir MR, Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Chronic Liver Disease. J Am Coll Radiol 2020; 17:S70-S80. [PMID: 32370979 DOI: 10.1016/j.jacr.2020.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
The liver fibrosis stage is the most important clinical determinate of morbidity and mortality in patients with chronic liver diseases. With newer therapies, liver fibrosis can be stabilized and possibly reversed, thus accurate diagnosis and staging of liver fibrosis are clinically important. Ultrasound, CT, and conventional MRI can be used to establish the diagnosis of advanced fibrosis/cirrhosis but have limited utility for assessing earlier stages of fibrosis. Elastography-based ultrasound and MRI techniques are more useful for assessment of precirrhotic hepatic fibrosis. In patients with advanced fibrosis at risk for hepatocellular carcinoma (HCC), ultrasound is the surveillance modality recommended by international guidelines in nearly all circumstances. However, in patients in whom ultrasound does not assess the liver well, including those with severe steatosis or obesity, multiphase CT or MRI may have a role in surveillance for HCC. Both multiphase CT and MRI can be used for continued surveillance in patients with a history of HCC, and contrast-enhanced ultrasound may have an emerging role in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Sumeet K Asrani
- Baylor University Medical Center, Dallas, Texas; American Association for the Study of Liver Diseases
| | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Yang Q, Wei J, Hao X, Kong D, Yu X, Jiang T, Xi J, Cai W, Luo Y, Jing X, Yang Y, Cheng Z, Wu J, Zhang H, Liao J, Zhou P, Song Y, Zhang Y, Han Z, Cheng W, Tang L, Liu F, Dou J, Zheng R, Yu J, Tian J, Liang P. Improving B-mode ultrasound diagnostic performance for focal liver lesions using deep learning: A multicentre study. EBioMedicine 2020; 56:102777. [PMID: 32485640 PMCID: PMC7262550 DOI: 10.1016/j.ebiom.2020.102777] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background The diagnosis performance of B-mode ultrasound (US) for focal liver lesions (FLLs) is relatively limited. We aimed to develop a deep convolutional neural network of US (DCNN-US) for aiding radiologists in classification of malignant from benign FLLs. Materials and methods This study was conducted in 13 hospitals and finally 2143 patients with 24,343 US images were enrolled. Patients who had non-cystic FLLs with pathological results were enrolled. The FLLs from 11 hospitals were randomly divided into training and internal validations (IV) cohorts with a 4:1 ratio for developing and evaluating DCNN-US. Diagnostic performance of the model was verified using external validation (EV) cohort from another two hospitals. The diagnosis value of DCNN-US was compared with that of contrast enhanced computed tomography (CT)/magnetic resonance image (MRI) and 236 radiologists, respectively. Findings The AUC of ModelLBC for FLLs was 0.924 (95% CI: 0.889–0.959) in the EV cohort. The diagnostic sensitivity and specificity of ModelLBC were superior to 15-year skilled radiologists (86.5% vs 76.1%, p = 0.0084 and 85.5% vs 76.9%, p = 0.0051, respectively). Accuracy of ModelLBC was comparable to that of contrast enhanced CT (both 84.7%) but inferior to contrast enhanced MRI (87.9%) for lesions detected by US. Interpretation DCNN-US with high sensitivity and specificity in diagnosing FLLs shows its potential to assist less-experienced radiologists in improving their performance and lowering their dependence on sectional imaging in liver cancer diagnosis.
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Affiliation(s)
- Qi Yang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Jingwei Wei
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Xiaohan Hao
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Centers for Biomedical Engineering, University of Science and Technology of China, University of Science and Technology of China, Hefei, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Tianan Jiang
- Department of Ultrasound, the First Affiliated hospital, College of Medicine, Zhejiang University, Hangzhou, Jiangsu, China
| | - Junqing Xi
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Wenjia Cai
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Yanchun Luo
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
| | - Yilin Yang
- Department of Ultrasound Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Jinyu Wu
- Department of Ultrasound, Harbin The First Hospital, Harbin, China
| | - Huiping Zhang
- Department of Medical Ultrasound, Ma'anshan People's Hospital, Ma'anshan, China
| | - Jintang Liao
- Department of Diagnostic Ultrasound, Xiangya Hospital, Changsha, China
| | - Pei Zhou
- Department of Ultrasound, Central Theater Command General Hospital, Chinese People's Liberation Army, Wuhan, China
| | - Yu Song
- Department of Diagnostic Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yao Zhang
- Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lina Tang
- Department of Ultrasound, Fujian Cancer Hospital&Fujian Medical University Cancer Hospita, Fuzhou, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Rongqin Zheng
- Guangdong Key Laboratory of Liver Disease Research, Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China.
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
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Lin Z, Chen J, Yan Y, Chen J, Li Y. Microwave ablation of hepatic malignant tumors using 1.5T MRI guidance and monitoring: feasibility and preliminary clinical experience. Int J Hyperthermia 2020; 36:1216-1222. [PMID: 31814474 DOI: 10.1080/02656736.2019.1690166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: To evaluate the feasibility and therapeutic efficacy of 1.5-T MRI-guided and monitored microwave ablation in patients with hepatic malignant tumors.Materials and Methods: This retrospective study was approved by the ethics committee of the First Affiliated Hospital of Fujian Medical University. Thirty-five patients (32 men, three women) with 48 lesions (maximum diameter < 3 cm) underwent microwave ablation under the guidance and monitoring of a 1.5-T MRI. The MRI-compatible microwave generator was appended with a magnetic shield case, and the cable was combined with a choke coil for shielding the Larmor processing frequency. The average age of the patients was 56.51 ± 11.36 years (31-77 years). Twenty-eight patients (37 lesions) displayed hepatocellular carcinoma and seven patients (11 lesions) had metastatic liver carcinoma. The mean maximum tumor diameter was 12.31 ± 4.72 mm (range 5.0-25.7 mm).Results: MRI scans were performed simultaneously without electromagnetic interference during ablation. The average maximum diameter of the hypointense zone of the last monitored T2WI sequence, hypointense zone of post-procedure T2WI sequence, and hyperintense zone of post-procedure T1WI were 28.82 ± 7.58 mm, 29.79 ± 7.91 mm, and 28.28 ± 8.37 mm, respectively, with no observed statistical difference (F = 0.434, p = .649). The technical success rate was 100%. The average follow-up duration was 11.43 ± 5.29 (4-33) months. The technique efficacy rate was 100%.Conclusion: MRI-guided and monitored microwave ablation of hepatic malignant tumors is feasible and potentially safe and effective.Key pointsMRI-guided microwave ablation of hepatic malignant tumors is feasible.The MRI monitoring scan could accurately reflect the scope of ablation lesion.On T1WI, the ablation lesions of liver showed the 'target sign'.
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Affiliation(s)
- Zhengyu Lin
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin Chen
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan Yan
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Chen
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuliang Li
- The Department of Interventional Radiology, The Second Hospital of Shandong University, Jinan, China
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Iavarone M, Viganò M, Piazza N, Occhipinti V, Sangiovanni A, Maggioni M, D'Ambrosio G, Forzenigo LV, Motta F, Lampertico P, Rumi MG, Colombo M. Contrast imaging techniques to diagnose hepatocellular carcinoma in cirrhotics outside regular surveillance. Ann Hepatol 2020; 18:318-324. [PMID: 31036496 DOI: 10.1016/j.aohep.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM The American Association for the Study of the Liver (AASLD) recommends contrast computerized tomography (CT-scan) and magnetic resonance (MRI) to diagnose hepatocellular carcinoma (HCC) arising in cirrhotic patients under semiannual surveillance with abdominal ultrasound (US). A US guided fine needle biopsy (FNB) serves the same purpose in radiologically undiagnosed tumors and incidentally detected nodules in cirrhotics outside surveillance. In this population, we evaluated the performance of radiological diagnosis of HCC according to 2010 AASLD recommendations. MATERIALS AND METHODS All cirrhotic patients with a liver nodule incidentally detected by US were prospectively investigated with a sequential application of CT-scan/MRI examination and a FNB. RESULTS Between 2011 and 2015, 94 patients (mean age 67 years) had a liver nodule (total 120) detected by US in the context of histologically confirmed cirrhosis. Mean nodules diameter was 40 (10-160) mm, 87 (73%) <5cm. At histology, 84 (70%) nodules were HCC, 8 (7%) intrahepatic cholangiocarcinoma, 6 (5%) metastases, 2 (2%) neuroendocrine tumors and 20 (16%) benign lesions. Hyperenhancement in arterial phase followed by wash-out in venous phases on at least one radiological technique was demonstrated in 62 nodules (61 HCC, 1 high grade dysplastic nodule), with a specificity of 97% (IC95%: 85-100%), sensitivity 73% (IC95%: 62-81%) and diagnostic accuracy 80%, being 64% for ≥5cm HCC. Sensitivity of AFP >200ng/mL was 12% (IC95%: 6-23%). CONCLUSION A single contrast imaging technique showing a typical contrast pattern confidently identifies HCC also in cirrhotic patients with an incidental liver nodule, thereby reducing the need for FNB examinations.
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Affiliation(s)
- Massimo Iavarone
- C.R.C. "A.M. & A. Migliavacca Center for Liver Disease" and Division of Gastroenterology and Hepatology, University of Milan and Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy.
| | - Mauro Viganò
- Hepatology Unit, Ospedale San Giuseppe, Università di Milano, Milan, Italy
| | - Nicole Piazza
- C.R.C. "A.M. & A. Migliavacca Center for Liver Disease" and Division of Gastroenterology and Hepatology, University of Milan and Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | | | - Angelo Sangiovanni
- C.R.C. "A.M. & A. Migliavacca Center for Liver Disease" and Division of Gastroenterology and Hepatology, University of Milan and Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Marco Maggioni
- Department of Pathology, Fondazione IRCCS Ca' Granda, Milan, Italy
| | | | | | - Fabio Motta
- Radiology Unit, Ospedale San Giuseppe, Milan, Italy
| | - Pietro Lampertico
- C.R.C. "A.M. & A. Migliavacca Center for Liver Disease" and Division of Gastroenterology and Hepatology, University of Milan and Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Maria-Grazia Rumi
- Hepatology Unit, Ospedale San Giuseppe, Università di Milano, Milan, Italy
| | - Massimo Colombo
- Center for Translational Hepatology Research, Clinical and Research Center Humanitas Hospital, Rozzano, Italy
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Park HJ, Jang HY, Kim SY, Lee SJ, Won HJ, Byun JH, Choi SH, Lee SS, An J, Lim YS. Non-enhanced magnetic resonance imaging as a surveillance tool for hepatocellular carcinoma: Comparison with ultrasound. J Hepatol 2020; 72:718-724. [PMID: 31836549 DOI: 10.1016/j.jhep.2019.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Recently revised international guidelines for hepatocellular carcinoma (HCC) suggest that patients with inadequate ultrasonography be assessed by alternative imaging modalities. Non-enhanced MRI has potential as a surveillance tool based on the short scan times required and the absence of contrast agent-associated risks. This study compared the performance of non-enhanced MRI and ultrasonography for HCC surveillance in high-risk patients. METHODS We included 382 high-risk patients in a prospective cohort who underwent 1 to 3 rounds of paired gadoxetic acid-enhanced MRI and ultrasonography. Non-enhanced MRI, consisting of diffusion-weighted imaging (DWI) and T2-weighted imaging, was simulated and retrospectively analyzed, with results considered positive when lesion(s) ≥1 cm showed diffusion restriction or mild-moderate T2 hyperintensity. Ultrasonography results were retrieved from patient records. HCC was diagnosed histologically and/or radiologically. Sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) were evaluated using generalized estimating equations. RESULTS Forty-eight HCCs were diagnosed in 43 patients. Per-lesion and per-exam sensitivities of non-enhanced MRI were 77.1% and 79.1%, respectively, which were higher than those achieved with ultrasonography (25.0% and 27.9%, respectively, p <0.001). Specificities of non-enhanced MRI (97.9%) and ultrasonography (94.5%) differed significantly (p <0.001). NPV was higher for non-enhanced MRI (99.1%) than ultrasonography (96.9%). Per-lesion and per-exam PPVs were higher for non-enhanced MRI (56.9% and 61.8%, respectively) than for ultrasonography (16.7% and 17.7%, respectively). The estimated scan time of non-enhanced MRI was <6 min. CONCLUSION Based on its good performance, short scan times, and the lack of contrast agent-associated risks, non-enhanced MRI is a promising option for HCC surveillance in high-risk patients. LAY SUMMARY Recently revised international guidelines for hepatocellular carcinoma (HCC) suggest that selected patients with inadequate surveillance on ultrasonography be assessed by alternative imaging modalities such as computed tomography or magnetic resonance imaging (MRI). Herein, we show that MRI without contrast agents performed significantly better than ultrasonography for HCC surveillance in high-risk patients. Given this good performance, as well as short scan times and the lack of contrast agent-associated risks, non-enhanced MRI is a promising option for HCC surveillance in high-risk patients.
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Affiliation(s)
- Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye Young Jang
- Department of Radiology, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jihyun An
- Department of Gastroenterology and Hepatology, Hanyang University of Medicine, Guri, Republic of Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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78
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Park SH, Kim B. Liver Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance. ACTA ACUST UNITED AC 2020. [DOI: 10.17998/jlc.20.1.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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79
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Çolaklar A, Altınbaş NK. Infiltrative non-mass-like hepatocellular carcinoma initially presenting with isolated malignant portal vein thrombosis: A case report and review of the literature. J Ultrason 2020; 20:e55-e60. [PMID: 32320167 PMCID: PMC7266071 DOI: 10.15557/jou.2020.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/12/2019] [Indexed: 01/09/2023] Open
Abstract
Hepatocellular carcinoma (HCC) shows a rising incidence and mortality rates worldwide. HCC is divided into several distinct subtypes, both morphologically and histopathologically. Among these subtypes, infiltrative HCC may be the most challenging subtype to diagnose, given its characteristic myriad of tumor nodules blended with normal hepatocytes without a distinct mass-like lesion. Herein, we report an unusual case of an infiltrative HCC initially presenting with isolated malignant portal vein thrombosis and provide a brief review of the literature regarding the infiltrative HCC subtype. Additionally, we demonstrate how sonoelastography could aid in detecting the appropriate biopsy area in the infiltrative HCC subtype. To our knowledge, there have not been previously reported cases describing the use of sonoelastography in the evaluation of the appropriate area for the targeted liver biopsy.
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Affiliation(s)
- Anıl Çolaklar
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine , Indianapolis - Indiana , United States of America
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80
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Cheng JT, Tan NE, Volk ML. Utility of positron emission tomography-computed tomography scan in detecting residual hepatocellular carcinoma post treatment: Series of case reports. World J Gastrointest Oncol 2020; 12:358-364. [PMID: 32206185 PMCID: PMC7081113 DOI: 10.4251/wjgo.v12.i3.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multi-phase computed tomography (CT) or magnetic resonance imaging (MRI) has been the standard of care for hepatocellular carcinoma (HCC) diagnosis for years.
CASE SUMMARY We report a case series of four patients in whom positron emission tomography-computed tomography (PET-CT) scan complemented the conventional CT/MRI scans in evaluating treatment response. In these four cases the conventional multi-phase CT and MRI failed to identify residual HCC disease post-treatment, while PET-CT complemented and aided in treatment response evaluation. In each case, the addition of PET-CT identified and located residual HCC disease, allowed retreatment, and altered medical management.
CONCLUSION This case series suggests that PET-CT should perhaps play a role in the HCC management algorithm, in addition to the conventional contrast-enhanced multi-phase scans.
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Affiliation(s)
- Jason T Cheng
- Transplantation Institute, Loma Linda University Medical Center, San Bernardino, CA 92408, United States
| | - Nelly E Tan
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
| | - Michael L Volk
- Transplantation Institute, Loma Linda University Medical Center, San Bernardino, CA 92408, United States
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81
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Mikaiel S, Simonelli J, Li X, Lee Y, Lee YS, Sung K, Lu DS, Tsao T, Wu HH. MRI‐guided targeted needle placement during motion using hydrostatic actuators. Int J Med Robot 2020; 16:e2041. [DOI: 10.1002/rcs.2041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Samantha Mikaiel
- Department of Radiological Sciences University of California Los Angeles Los Angeles California
- Physics and Biology in Medicine Program University of California Los Angeles Los Angeles California
| | - James Simonelli
- Department of Mechanical and Aerospace Engineering University of California Los Angeles Los Angeles California
| | - Xinzhou Li
- Department of Radiological Sciences University of California Los Angeles Los Angeles California
- Department of Bioengineering University of California Los Angeles Los Angeles California
| | - Yu‐Hsiu Lee
- Department of Mechanical and Aerospace Engineering University of California Los Angeles Los Angeles California
| | - Yong Seok Lee
- Department of Radiological Sciences University of California Los Angeles Los Angeles California
- Department of Radiology Dongguk University Ilsan Hospital Republic of Korea
| | - Kyunghyun Sung
- Department of Radiological Sciences University of California Los Angeles Los Angeles California
- Physics and Biology in Medicine Program University of California Los Angeles Los Angeles California
- Department of Bioengineering University of California Los Angeles Los Angeles California
| | - David S. Lu
- Department of Radiological Sciences University of California Los Angeles Los Angeles California
| | - Tsu‐Chin Tsao
- Department of Mechanical and Aerospace Engineering University of California Los Angeles Los Angeles California
| | - Holden H. Wu
- Department of Radiological Sciences University of California Los Angeles Los Angeles California
- Physics and Biology in Medicine Program University of California Los Angeles Los Angeles California
- Department of Bioengineering University of California Los Angeles Los Angeles California
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82
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Kim JS, Lee JK, Baek SY, Yun HI. Diagnostic performance of a minimized protocol of non-contrast MRI for hepatocellular carcinoma surveillance. Abdom Radiol (NY) 2020; 45:211-219. [PMID: 31650374 DOI: 10.1007/s00261-019-02277-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the per-patient diagnostic performance of a minimized non-contrast MRI protocol for hepatocellular carcinoma (HCC) surveillance in cirrhotic liver, as well as factors affecting diagnostic sensitivity. METHODS A total of 226 patients who underwent MRI for HCC surveillance over an 8 year period were included in this retrospective study. Set1 consisted of diffusion-weighted imaging and respiratory-triggered, fast-spin echo T2-weighted imaging with fat suppression. Set2 included T1-weighted in/opposed-phase images added to the images from Set1. Image sets were scored as positive or negative for HCC according to predetermined criteria by two readers independently. The diagnostic performance of the two sets in conjunction with α-fetoprotein (AFP) was assessed and compared using the McNemar test. Logistic regression was used to determine factors that affected sensitivity. RESULTS The sensitivity, specificity, and accuracy of Set1 of readers 1 and 2 were 84.4%/87.3%, 86.8%/86.8%, and 85.0%/87.2%, respectively; and those for Set2 were 87.3%/89.6%, 81.1%/79.2%, and 85.8/87.2%, respectively. The sensitivities of the sets were not significantly different (p = 0.063). Sensitivities of both sets in conjunction with AFP were higher than those of MRI alone without statistical significance (87.3%/89.6%, p = 0.063/> 0.99; 89.6%/89.6%, p = 0.125/> 0.99). In very early-stage HCC, the sensitivities of Sets1 and 2 were 73.1%/76.9% and 76.9%/82.7%, respectively. Perihepatic ascites and size less than 2 cm were associated with sensitivity (p < 0.05). CONCLUSIONS A minimized non-contrast MRI protocol consisting of Fat-sat T2WI and DWI is highly sensitive and may be a viable method for HCC surveillance of the cirrhotic liver. The inclusion of T1-weighted in/opposed-phase and AFP may increase this sensitivity.
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Affiliation(s)
- Jin Sil Kim
- Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Anyangcheon-Ro, 1071, Yangcheon-gu, Seoul, 07985, Korea
| | - Jeong Kyong Lee
- Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Anyangcheon-Ro, 1071, Yangcheon-gu, Seoul, 07985, Korea.
| | - Seung Yon Baek
- Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Anyangcheon-Ro, 1071, Yangcheon-gu, Seoul, 07985, Korea
| | - Hye In Yun
- Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Anyangcheon-Ro, 1071, Yangcheon-gu, Seoul, 07985, Korea
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PENG BINGRU, KITTIPAYAK SAMRIT, PAN LUNGFA, PAN LUNGKWANG. OPTIMIZING THE MINIMUM DETECTABLE DIFFERENCE OF COMPUTED TOMOGRAPHY SCANNED IMAGES VIA THE TAGUCHI ANALYSIS: A FEASIBILITY STUDY WITH AN INDIGENOUS HEPATIC PHANTOM AND A LINE GROUP GAUGE. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419400487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: The minimum detectable difference (MDD) of computed tomography (CT) scanned images was quantified and optimized according to an indigenous hepatic phantom, line group gauge and Taguchi [Formula: see text] optimization analysis in this work. Methods: Optimal combinations of CT scan factors in every group with the level organization were judged using the Taguchi analysis, in which every factor was organized into only 18 groups, creating evaluated outcomes with the same confidence as if every factor was analyzed independently. The five practical factors of the CT scan were (1) kVp, (2) mAs, (3) pitch increment, (4) field of view (FOV) and (5) rotation time for one loop of CT scan. Insofar as each factor had two or three levels, the total number of 162 (i.e., [Formula: see text]) combinations was considered. Results: The optimal setting was 120[Formula: see text]kVp, 300[Formula: see text]mAs, 0.641 pitch, 320[Formula: see text]mm FOV and 1.0[Formula: see text]s of rotation time of CT scan. The minimal MDD was 2.65[Formula: see text]mm under 0.39[Formula: see text]mm of the slit depth from the revised Student’s [Formula: see text]-test with a 95% confidence level. In contrast, the MDD of conventional and the best one (no. 7) among all original 18 groups were 3.27[Formula: see text]mm and 2.93[Formula: see text]mm for 0.43[Formula: see text]mm and 0.41[Formula: see text]mm slit depths, respectively. Conclusion: The Taguchi analysis was found very lucrative for the design of imaging analysis in practical diagnosis. The indigenous line group gauge and hepatic phantom also proved to be suitable in simulating the human body in real hepatic carcinoma examination.
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Affiliation(s)
- BING-RU PENG
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Radiology Taichung, Armed Forces General Hospital, Taichung 411, Taiwan, ROC
| | - SAMRIT KITTIPAYAK
- Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - LUNG-FA PAN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
- Department of Cardiology, Taichung Armed Forces, General Hospital, Taichung 411, Taiwan, ROC
| | - LUNG-KWANG PAN
- Graduate Institute of Radiological Science, Central Taiwan University of Science and Technology, Takun, Taichung 406, Taiwan, ROC
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84
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Personalized 3D-Printed Transparent Liver Model Using the Hepatobiliary Phase MRI: Usefulness in the Lesion-by-Lesion Imaging-Pathologic Matching of Focal Liver Lesions-Preliminary Results. Invest Radiol 2019; 54:138-145. [PMID: 30379728 DOI: 10.1097/rli.0000000000000521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to investigate the usefulness of a personalized, 3-dimensional (3D)-printed, transparent liver model with focal liver lesions (FLLs) for lesion-by-lesion imaging-pathologic matching. MATERIALS AND METHODS This preliminary, prospective study was approved by our institutional review board, and written informed consent was obtained. Twenty patients (male-to-female ratio, 13:7; mean age, 56 years) with multiple FLLs, including at least one presumed malignant, or an indeterminate lesion 10 mm or less on the preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI), were included. After digital segmentation of hepatobiliary phase MRI, a transparent, 3D-printed liver model with colored anatomical structures and FLLs was produced. During the gross examination of the liver specimen, the per-lesion detection rates were compared between those without (routine protocol) and those with the aid of the 3D-printed liver model. RESULTS Among 98 MRI-detected FLLs (11.5 ± 12.5 mm), the per-lesion detection rate on gross examination using the 3D-printed liver model was 99.0% (97/98), which was significantly higher than that obtained on routine examination (82.7% [81/98]; P < 0.001). In the subgroup analysis, according to the tumor size, 23.9% (16/67) of FLLs 10 mm or less were additionally detected using the liver model, whereas none were additionally detected in greater than 10 mm. The additionally detected 16 FLLs in 12 patients included histologic diagnoses of viable metastases, pathologic complete response of metastases, hepatocellular carcinomas, focal nodular hyperplasia-like nodules, and hemangiomas. CONCLUSIONS A personalized, 3D-printed liver model with FLLs may improve the lesion-by-lesion imaging-pathologic matching for small FLLs, thus leading to accurate pathologic tumor staging and obtaining a reliable reference for imaging-detected FLLs.
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85
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Esfeh JM, Hajifathalian K, Ansari-Gilani K. Sensitivity of ultrasound in detecting hepatocellular carcinoma in obese patients compared to explant pathology as the gold standard. Clin Mol Hepatol 2019; 26:54-59. [PMID: 31726817 PMCID: PMC6940490 DOI: 10.3350/cmh.2019.0039] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/16/2019] [Indexed: 12/27/2022] Open
Abstract
Background/Aims The American Association for the Study of Liver Diseases recommends ultrasound (US) screening for hepatocellular carcinoma (HCC) among cirrhotic patients, regardless of body mass index (BMI), every 6 months. We examined US sensitivity for diagnosis of HCC in obese patients.
Methods Liver transplant patients data with HCC in explant was used (January 2012-December 2017). All patients underwent liver US within 3 months of diagnosis of HCC. Number/size of HCC lesions were extracted from radiologic and pathologic reports. Obesity was defined as BMI ≥30 kg/m2.
Results One hundred sixteen patients were included. 80% were male, with mean BMI of 31 kg/m2. The most common underlying liver disease was hepatitis C virus (62%). At the time of diagnosis, median number of HCC lesions was 2 (interquartile range [IQR], 1–3), and median size of the largest lesion was 2.5 cm (IQR, 1.75–3.9). Overall sensitivity of US study for detection of HCC was 33% (95% confidence interval [CI], 29–48%). Sensitivity was 77% (95% CI, 62–93%) in patients with BMI<30 and 21% (95% CI, 11–30%) in patients with BMI≥30 (P<0.001). Size of the largest HCC lesion (P=0.290) and number of lesions (P=0.505) were not different between groups. Computed tomography (CT) scan detected HCC in 98% of the obese patients with negative US. Conclusions Sensitivity of US for detection of HCC is significantly lower among obese patients compared to overweight and normal weight patients. These patients may benefit from alternating between US and a different imaging modality.
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Affiliation(s)
- Jamak Modaresi Esfeh
- Department of Gastroenterology and Transplant Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Kaveh Hajifathalian
- Department of Gastroenterology and Transplant Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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86
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Dietrich CF, Teufel A, Sirlin CB, Dong Y. Surveillance of hepatocellular carcinoma by medical imaging. Quant Imaging Med Surg 2019; 9:1904-1910. [PMID: 31867241 DOI: 10.21037/qims.2019.10.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Christoph F Dietrich
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Andreas Teufel
- Division of Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, CA, USA
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200433, China
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87
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Imaging-Negative Hepatocellular Carcinoma Presents as an Intrabiliary Mass. ACG Case Rep J 2019; 6:e00068. [PMID: 31616745 PMCID: PMC6658063 DOI: 10.14309/crj.0000000000000068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/28/2019] [Indexed: 01/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death and one of the most prevalent cancers worldwide. HCC prognosis remains poor with an average survival rate between 6 and 12 months. Obstructive jaundice, as a main clinical feature, is uncommon in HCC. HCC with bile duct invasion is much rarer than HCC with vascular invasion. We present a case where a patient's HCC was diagnosed by endoscopic retrograde cholangiopancreatography and digital cholangioscopy because his HCC manifested as an obstructing lesion in the intrahepatic duct, but not in the liver.
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88
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Ho CL, Chen S, Cheung SK, Leung TWT. Significant Value of 11C-Acetate and 18F-Fluorodeoxyglucose PET/Computed Tomography on 90Y Microsphere Radioembolization for Hepatocellular Carcinoma. PET Clin 2019; 14:459-467. [DOI: 10.1016/j.cpet.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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89
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Hlady RA, Zhao X, Pan X, Yang JD, Ahmed F, Antwi SO, Giama NH, Patel T, Roberts LR, Liu C, Robertson KD. Genome-wide discovery and validation of diagnostic DNA methylation-based biomarkers for hepatocellular cancer detection in circulating cell free DNA. Am J Cancer Res 2019; 9:7239-7250. [PMID: 31695765 PMCID: PMC6831291 DOI: 10.7150/thno.35573] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/09/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC), the most prevalent form of liver cancer, is growing in incidence but treatment options remain limited, particularly for late stage disease. As liver cirrhosis is the principal risk state for HCC development, markers to detect early HCC within this patient population are urgently needed. Perturbation of epigenetic marks, such as DNA methylation (5mC), is a hallmark of human cancers, including HCC. Identification of regions with consistently altered 5mC levels in circulating cell free DNA (cfDNA) during progression from cirrhosis to HCC could therefore serve as markers for development of minimally-invasive screens of early HCC diagnosis and surveillance. Methods: To discover DNA methylation derived biomarkers of HCC in the background of liver cirrhosis, we profiled genome-wide 5mC landscapes in patient cfDNA using the Infinium HumanMethylation450k BeadChip Array. We further linked these findings to primary tissue data available from TCGA and other public sources. Using biological and statistical frameworks, we selected CpGs that robustly differentiated cirrhosis from HCC in primary tissue and cfDNA followed by validation in an additional independent cohort. Results: We identified CpGs that segregate patients with cirrhosis, from patients with HCC within a cirrhotic liver background, through genome-wide analysis of cfDNA 5mC landscapes. Lasso regression analysis pinpointed a panel of probes in our discovery cohort that were validated in two independent datasets. A panel of five CpGs (cg04645914, cg06215569, cg23663760, cg13781744, and cg07610777) yielded area under the receiver operating characteristic (AUROC) curves of 0.9525, 0.9714, and 0.9528 in cfDNA discovery and tissue validation cohorts 1 and 2, respectively. Validation of a 5-marker panel created from combining hypermethylated and hypomethylated CpGs in an independent cfDNA set by bisulfite pyrosequencing yielded an AUROC of 0.956, compared to the discovery AUROC of 0.996. Conclusion: Our finding that 5mC markers derived from primary tissue did not perform well in cfDNA, compared to those identified directly from cfDNA, reveals potential advantages of starting with cfDNA to discover high performing markers for liquid biopsy development.
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90
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Kim HL, An J, Park JA, Park SH, Lim YS, Lee EK. Magnetic Resonance Imaging Is Cost-Effective for Hepatocellular Carcinoma Surveillance in High-Risk Patients With Cirrhosis. Hepatology 2019; 69:1599-1613. [PMID: 30365164 DOI: 10.1002/hep.30330] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/21/2018] [Indexed: 12/21/2022]
Abstract
Ultrasonography (US) is generally recommended for the surveillance of hepatocellular carcinoma (HCC) in patients at risk. However, in patients with cirrhosis who have sufficiently high HCC incidence, surveillance using magnetic resonance imaging (MRI) with liver-specific contrast showed markedly higher sensitivity in detecting early-stage HCC than US. This study aimed to compare the cost-effectiveness of semiannual surveillance using MRI versus US in patients with compensated cirrhosis and to identify the population that would gain optimal cost-effectiveness through MRI surveillance. We designed a Markov model to compare the expected costs and quality-adjusted life-years (QALYs), between MRI and US, with a 20-year time horizon, from the health care system perspective. The starting age of the cohort was 50 years, and 71% had hepatitis B virus-associated cirrhosis. The cycle length was 6 months. Transition probabilities and costs were obtained mainly from a prospective cohort study (the PRIUS study, NCT01446666). Cost and effectiveness were discounted at 5%. An incremental cost-effectiveness ratio (ICER) was calculated and tested using sensitivity analyses. The cost-effectiveness analysis indicated that the use of MRI incurred $5,562 incremental costs, 0.384 incremental life-years (LYs), and 0.221 incremental QALYs compared to US. The annual HCC incidence was the most influential factor on the ICER. The ICERs were $14,474/LY and $25,202/QALY at an annual HCC incidence of 3%. When the HCC incidence rate was >1.81%, the ICER was below $50,000/QALY. With increased HCC incidence, MRI surveillance was acceptable as a cost-effective option, even with an increased MRI/US cost ratio. Conclusion: Semiannual surveillance using MRI with liver-specific contrast may be more cost-effective than US in patients with virus-associated compensated cirrhosis at sufficiently high HCC risk despite the higher test cost of MRI.
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Affiliation(s)
- Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, Korea
| | - Jihyun An
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-A Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Korea
| | - Seung-Hoo Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Korea
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Canellas R, Rosenkrantz AB, Taouli B, Sala E, Saini S, Pedrosa I, Wang ZJ, Sahani DV. Abbreviated MRI Protocols for the Abdomen. Radiographics 2019; 39:744-758. [PMID: 30901285 DOI: 10.1148/rg.2019180123] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Technical advances in MRI have improved image quality and have led to expanding clinical indications for its use. However, long examination and interpretation times, as well as higher costs, still represent barriers to use of MRI. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols. These abbreviated MRI protocols seek to reduce longer MRI protocols by eliminating unnecessary or redundant sequences that negatively affect cost, MRI table time, patient comfort, image quality, and image interpretation time. However, the diagnostic information is generally not compromised. Abbreviated MRI protocols have already been used successfully for hepatocellular carcinoma screening, for prostate cancer detection, and for screening for nonalcoholic fatty liver disease as well as monitoring patients with this disease. It has been reported that image acquisition time and costs can be considerably reduced with abbreviated MRI protocols, compared with standard MRI protocols, while maintaining a similar sensitivity and accuracy. Nevertheless, multiple applications still need to be explored in the abdomen and pelvis (eg, surveillance of metastases to the liver; follow-up of cystic pancreatic lesions, adrenal incidentalomas, and small renal masses; evaluation of ovarian cysts in postmenopausal women; staging of cervical and uterine corpus neoplasms; evaluation of müllerian duct anomalies). This article describes some successful applications of abbreviated MRI protocols, demonstrates how they can help in improving the MRI workflow, and explores potential future directions. ©RSNA, 2019.
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Affiliation(s)
- Rodrigo Canellas
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Andrew B Rosenkrantz
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Bachir Taouli
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Evis Sala
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Sanjay Saini
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Ivan Pedrosa
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Zhen J Wang
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Dushyant V Sahani
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (R.C., S.S., D.V.S.); Department of Radiology, NYU Langone Health, New York, NY (A.B.R.); Department of Radiology, Mount Sinai Hospital, New York, NY (B.T.); Department of Radiology, University of Cambridge, Cambridge, England (E.S.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
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92
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Ultrasound Screening and Surveillance in Hepatocellular Carcinoma. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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93
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Fetzer DT, Rodgers SK, Seow JH, Dawkins AA, Joshi G, Gabriel H, Kamaya A. Ultrasound Evaluation in Patients at Risk for Hepatocellular Carcinoma. Radiol Clin North Am 2019; 57:563-583. [PMID: 30928078 DOI: 10.1016/j.rcl.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the context of chronic liver disease (CLD), sonographic features of hepatic steatosis, cirrhosis, and portal hypertension are discussed and examples are provided. The impact of CLD and hepatocellular carcinoma (HCC) is introduced, providing the rationale for a robust HCC screening and surveillance program for at-risk patients. The American College of Radiology Liver Imaging Reporting and Data System algorithms for screening and surveillance by ultrasound and for the definitive diagnosis of HCC by contrast-enhanced ultrasound are explained, with imaging examples provided. Contrast-enhanced ultrasound technique, limitations, and pitfalls also are introduced.
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Affiliation(s)
- David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9316, USA.
| | - Shuchi K Rodgers
- Abdominal Radiology, Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - James H Seow
- Department of Radiology, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
| | - Adrian A Dawkins
- Department of Radiology, University of Kentucky, 800 Rose Street, Room HX-318A, Lexington, KY 40536-0293, USA
| | - Gayatri Joshi
- Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA
| | - Helena Gabriel
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Avenue, Suite 800, Chicago, IL 60611, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive H1307, Stanford, CA 94305, USA
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94
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Hussein RS, Tantawy W, Abbas YA. MRI assessment of hepatocellular carcinoma after locoregional therapy. Insights Imaging 2019; 10:8. [PMID: 30694398 PMCID: PMC6352610 DOI: 10.1186/s13244-019-0690-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022] Open
Abstract
Liver cirrhosis and hepatocellular carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. This will be addressed by conventional MR methods using LI-RADS v2018 and by functional MR using diffusion-weighted imaging, perfusion, and highlighting the value of the novel intravoxel incoherent motion (IVIM).
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Affiliation(s)
- Rasha S Hussein
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt.
| | - Wahid Tantawy
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
| | - Yasser A Abbas
- Radiology Department, Faculty of Medicine, Ain Shams University and MR Unit of Misr Radiology Center, Cairo, Egypt
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95
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Purcell Y, Copin P, Paradis V, Vilgrain V, Ronot M. Lessons learnt from pathologic imaging correlation in the liver: an historical perspective. Br J Radiol 2019; 92:20180701. [PMID: 30604641 DOI: 10.1259/bjr.20180701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Imaging and pathology can be considered as two sides of the same diagnostic coin. Yet, pathology remains the gold-standard technique for the diagnosis of most diseases. Nevertheless, significant and constant progress in imaging has been made thanks to fruitful rad-path correlations. The aim of this article is to show how much imaging has benefited from pathology and to illustrate the different ways in which imaging has evolved according to different types of pathological references. Imaging of hepatocellular carcinoma shows how image-based knowledge and expertise can be exploited to yield a non-invasive diagnosis approaching that of a fixed, robust pathological reference. Hepatocellular adenomas provide an example of the constant radiological evolutions triggered by changing pathological definitions. Finally, hepatic steatosis illustrates the possibility for imaging to surpass its historical reference, and become a new gold-standard. For these three examples, we have taken a historical approach to demonstrate how rad-path interminglement creates knowledge.
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Affiliation(s)
- Yvonne Purcell
- 1 Department of Radiology, Hôpitaux Universitaires Paris Nord Val de Seine , Clichy , France
| | - Pauline Copin
- 1 Department of Radiology, Hôpitaux Universitaires Paris Nord Val de Seine , Clichy , France
| | - Valérie Paradis
- 2 Department of Pathology, Hôpitaux Universitaires Paris Nord Val de Seine , Clichy , France.,3 University Paris Diderot, Sorbonne Paris Cité , Paris , France
| | - Valérie Vilgrain
- 1 Department of Radiology, Hôpitaux Universitaires Paris Nord Val de Seine , Clichy , France.,3 University Paris Diderot, Sorbonne Paris Cité , Paris , France.,4 Centre de recherche biomédicale Bichat-Beaujon , Paris , France
| | - Maxime Ronot
- 1 Department of Radiology, Hôpitaux Universitaires Paris Nord Val de Seine , Clichy , France.,3 University Paris Diderot, Sorbonne Paris Cité , Paris , France.,4 Centre de recherche biomédicale Bichat-Beaujon , Paris , France
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96
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Krishan S, Dhiman RK, Kalra N, Sharma R, Baijal SS, Arora A, Gulati A, Eapan A, Verma A, Keshava S, Mukund A, Deva S, Chaudhary R, Ganesan K, Taneja S, Gorsi U, Gamanagatti S, Madhusudan KS, Puri P, Shalimar, Govil S, Wadhavan M, Saigal S, Kumar A, Thapar S, Duseja A, Saraf N, Khandelwal A, Mukhopadyay S, Gulati A, Shetty N, Verma N. Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System. J Clin Exp Hepatol 2019; 9:625-651. [PMID: 31695253 PMCID: PMC6823668 DOI: 10.1016/j.jceh.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the 6th most common cancer and the second most common cause of cancer-related mortality worldwide. There are currently no universally accepted practice guidelines for the diagnosis of HCC on imaging owing to the regional differences in epidemiology, target population, diagnostic imaging modalities, and staging and transplant eligibility. Currently available regional and national guidelines include those from the American Association for the Study of Liver Disease (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific Association for the Study of the Liver, the Japan Society of Hepatology, the Korean Liver Cancer Study Group, Hong Kong, and the National Comprehensive Cancer Network in the United States. India with its large population and a diverse health infrastructure faces challenges unique to its population in diagnosing HCC. Recently, American Association have introduced a Liver Imaging Reporting and Data System (LIRADS, version 2017, 2018) as an attempt to standardize the acquisition, interpretation, and reporting of liver lesions on imaging and hence improve the coherence between radiologists and clinicians and provide guidance for the management of HCC. The aim of the present consensus was to find a common ground in reporting and interpreting liver lesions pertaining to HCC on imaging keeping LIRADSv2018 in mind.
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Affiliation(s)
- Sonal Krishan
- Department of Radiology, Medanta Hospital, Gurgaon, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Radha Krishan Dhiman, MD, DM, FACG, FRCP, FAASLD, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Navin Kalra
- Department of Radiology, Postgraduate Institute Of Medical Education and Research, Chandigarh, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay S. Baijal
- Department of Diagnostic and Intervention Radiology, Medanta Hospital, Gurgaon, India
| | - Anil Arora
- Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Gangaram Hospital, New Delhi, India
| | - Ajay Gulati
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anu Eapan
- Department of Radiology, Christian Medical College, Vellore, India
| | - Ashish Verma
- Department of Radiology, Banaras Hindu University, Varanasi, India
| | - Shyam Keshava
- Department of Radiology, Christian Medical College, Vellore, India
| | - Amar Mukund
- Department of Intervention Radiology, Institute of liver and biliary Sciences, New Delhi, India
| | - S. Deva
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Chaudhary
- Department of Radiology, Medanta Hospital, Gurgaon, India
| | | | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiology, Postgraduate Institute Of Medical Education and Research, Chandigarh, India
| | | | - Kumble S. Madhusudan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Puri
- Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Gangaram Hospital, New Delhi, India
| | - Shalimar
- Department of GastroEnterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manav Wadhavan
- Institute of Digestive and Liver Diseases, BLK Hospital, Delhi, India
| | - Sanjiv Saigal
- Department of Hepatology, Medanta Hospital, Gurgaon, India
| | - Ashish Kumar
- Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Gangaram Hospital, New Delhi, India
| | - Shallini Thapar
- Department of Radiology, Institute of liver and biliary Sciences, New Delhi, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeraj Saraf
- Department of Hepatology, Medanta Hospital, Gurgaon, India
| | | | | | - Ajay Gulati
- Department of Radiology, Postgraduate Institute Of Medical Education and Research, Chandigarh, India
| | - Nitin Shetty
- Department of Radiology, Tata Memorial Hospital, Kolkata, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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97
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McNamara MM, Thomas JV, Alexander LF, Little MD, Bolus DN, Li YE, Morgan DE. Diffusion-weighted MRI as a screening tool for hepatocellular carcinoma in cirrhotic livers: correlation with explant data-a pilot study. Abdom Radiol (NY) 2018; 43:2686-2692. [PMID: 29500648 DOI: 10.1007/s00261-018-1535-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the sensitivity and specificity of diffusion-weighted liver MRI alone with complete, multiphasic gadoteridol-enhanced MRI for the detection of hepatocellular carcinoma in cirrhotic patients before liver transplant. MATERIALS AND METHODS This single institution retrospective study was performed after IRB approval and was HIPAA compliant. MRI scans of 37 patients who underwent liver transplant were evaluated and findings correlated with liver explant (36) or biopsy (1). All MRI scans were obtained within six months of explant. MRI from 17 patients with liver lesions by report at imaging subsequently proven to be HCC at pathology and 20 controls without liver lesions by imaging and pathology were reviewed in random order on the radiology PACS by three independent readers blinded to the MRI reports and pathology reports in two separate sittings. First, only the diffusion-weighted images (DWI) were interpreted. Second, the complete multiphasic MRI exam with DWI was reviewed. A consensus read was obtained by two separate radiologists who had access to the patients' explant data in order to map lesions. Reader-specific and pooled classification was assessed using sensitivity, specificity, positive predictive value, and negative predictive values and corresponding 95% confidence intervals (CI) for both DWI and complete MRI examination readings compared to pathology. McNemar's test and Kappa coefficient were used to assess differences (agreement) in DWI and complete examination readings. RESULTS A total of 37 patients have been studied (25M 12F age range 21-70). Averaged results of the three independent readers demonstrated a sensitivity of 78% (95% CI 65-89%) and specificity of 88% (95% CI 77-95%) for DWI alone for detection of liver lesions, with a positive predictive value of 85% (95% CI 72-94%) and a negative predictive value of 83% (95% CI 71-91%). Review of the complete MRI exam showed a sensitivity of 90% (95% CI 76-97%) and a specificity of 82% (95% CI 66-92%) with a positive predictive value of 83% (95% CI 69-93%) and a negative predictive value of 89% (95% CI 74-97%). McNemar's agreement test revealed no significant difference between the DWI and complete multiphasic interpretations (p = 0.3458), with simple Kappa coefficient of 0.6716 (95% CI 0.5332-0.8110). Lesions identified on DWI ranged in size from 1.5 to 5 cm. Detection of lesions was decreased in the presence of artifact from motion, large ascites, and technical issues. CONCLUSION Diffusion-weighted MRI has NPV and PPV comparable to complete multiphasic MRI examination for liver lesion detection in cirrhotic patients and may have a role in screening.
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Affiliation(s)
- M M McNamara
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - J V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L F Alexander
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - M D Little
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D N Bolus
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yufeng E Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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98
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Ao L, Zhang Z, Guan Q, Guo Y, Guo Y, Zhang J, Lv X, Huang H, Zhang H, Wang X, Guo Z. A qualitative signature for early diagnosis of hepatocellular carcinoma based on relative expression orderings. Liver Int 2018; 38:1812-1819. [PMID: 29682909 PMCID: PMC6175149 DOI: 10.1111/liv.13864] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/12/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Currently, using biopsy specimens to confirm suspicious liver lesions of early hepatocellular carcinoma are not entirely reliable because of insufficient sampling amount and inaccurate sampling location. It is necessary to develop a signature to aid early hepatocellular carcinoma diagnosis using biopsy specimens even when the sampling location is inaccurate. METHODS Based on the within-sample relative expression orderings of gene pairs, we identified a simple qualitative signature to distinguish both hepatocellular carcinoma and adjacent non-tumour tissues from cirrhosis tissues of non-hepatocellular carcinoma patients. RESULTS A signature consisting of 19 gene pairs was identified in the training data sets and validated in 2 large collections of samples from biopsy and surgical resection specimens. For biopsy specimens, 95.7% of 141 hepatocellular carcinoma tissues and all (100%) of 108 cirrhosis tissues of non-hepatocellular carcinoma patients were correctly classified. Especially, all (100%) of 60 hepatocellular carcinoma adjacent normal tissues and 77.5% of 80 hepatocellular carcinoma adjacent cirrhosis tissues were classified to hepatocellular carcinoma. For surgical resection specimens, 99.7% of 733 hepatocellular carcinoma specimens were correctly classified to hepatocellular carcinoma, while 96.1% of 254 hepatocellular carcinoma adjacent cirrhosis tissues and 95.9% of 538 hepatocellular carcinoma adjacent normal tissues were classified to hepatocellular carcinoma. In contrast, 17.0% of 47 cirrhosis from non-hepatocellular carcinoma patients waiting for liver transplantation were classified to hepatocellular carcinoma, indicating that some patients with long-lasting cirrhosis could have already gained hepatocellular carcinoma characteristics. CONCLUSIONS The signature can distinguish both hepatocellular carcinoma tissues and tumour-adjacent tissues from cirrhosis tissues of non-hepatocellular carcinoma patients even using inaccurately sampled biopsy specimens, which can aid early diagnosis of hepatocellular carcinoma.
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Affiliation(s)
- Lu Ao
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Zimei Zhang
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Qingzhou Guan
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Yating Guo
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - You Guo
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Jiahui Zhang
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Xingwei Lv
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Haiyan Huang
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Huarong Zhang
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina
| | - Xianlong Wang
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina,Key Laboratory of Medical Bioinformatics, Fujian ProvinceFuzhouChina
| | - Zheng Guo
- Department of BioinformaticsKey Laboratory of Ministry of Education for Gastrointestinal CancerSchool of Basic Medical SciencesFujian Medical UniversityFuzhouChina,Key Laboratory of Medical Bioinformatics, Fujian ProvinceFuzhouChina,Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
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99
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An C, Kim DY, Choi JY, Han KH, Roh YH, Kim MJ. Noncontrast magnetic resonance imaging versus ultrasonography for hepatocellular carcinoma surveillance (MIRACLE-HCC): study protocol for a prospective randomized trial. BMC Cancer 2018; 18:915. [PMID: 30249190 PMCID: PMC6154402 DOI: 10.1186/s12885-018-4827-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 09/17/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Biannual ultrasound (US)-with or without alpha-fetoprotein (AFP)-is recommended by current guidelines for the surveillance of hepatocellular carcinoma (HCC). However, the inadequate sensitivity of US has been a concern. Magnetic resonance imaging (MRI) is known to have high sensitivity in detecting hepatic malignancies, even without contrast enhancement. The purpose of our study is to compare US with noncontrast (unenhanced) MRI for HCC surveillance of high-risk patients. METHODS/DESIGN MIRACLE-HCC (usefulness of noncontrast MagnetIc Resonance imAging versus nonContrast ultrasonography for surveiLlancE of HepatoCellular Carcinoma) is a prospective, single-center, nonblinded, balanced-randomized, parallel-group study. This study was approved by our institutional review board, and informed consent will be obtained from all participating patients. All patients with compensated liver cirrhosis will undergo noncontrast US or MRI, with serum AFP testing every 6 months. If a suspicious lesion is newly detected, or if the serum AFP level is elevated in an increasing trend for two consecutive tests, dynamic contrast-enhanced imaging will be performed to confirm the diagnosis. The primary endpoints are detection rates of very early or early stage HCC, stage distribution at the initial diagnosis, and false positive referral rates, which will be compared using Fisher's exact or chi-square tests. The study will include 416 patients in a tertiary academic medical center in South Korea. DISCUSSION MIRACLE-HCC is the first prospective randomized trial to compare the effectiveness of noncontrast MRI and noncontrast US in the surveillance of HCC in at-risk patients. The results of this trial will show whether noncontrast MRI surveillance is superior to noncontrast US surveillance in the early detection of HCC. The trial will also determine whether there are fewer false referrals with noncontrast MRI than with noncontrast US and, eventually, whether there is improvement in the overall survival of HCC patients. TRIAL REGISTRATION The date of trial registration (ClincalTrials.gov: NCT02514434 ) for this study is July 23, 2015. Enrollment of participants was finished in November 2017. No authors have relationships, conditions, or circumstances that present potential conflicts of interest.
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Affiliation(s)
- Chansik An
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin-Young Choi
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Kwang Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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100
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Diagnostic accuracy of contrast-enhanced dynamic CT for small hypervascular hepatocellular carcinoma and assessment of dynamic enhancement patterns: Results of two-year follow-up using cone-beam CT hepatic arteriography. PLoS One 2018; 13:e0203940. [PMID: 30231076 PMCID: PMC6145528 DOI: 10.1371/journal.pone.0203940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the accuracy of CT for small, hypervascular hepatocellular carcinomas (HCCs) and assess the enhancement patterns on CT. Materials and methods Ninety-nine patients who underwent cone-beam CT hepatic arteriography (CBCT-HA) during initial chemoembolization for HCC suspected on CT were enrolled in this study. A total of 297 hypervascular HCCs (142 ≥ 1 cm, 155 < 1 cm) were confirmed as HCCs based on two-year follow-up CT and CBCT-HA images. During the two-year follow-up, pre-existing hypervascular foci on CBCT-HA were regarded as HCCs at the initial presentation. Two radiologists categorized HCCs according to the following enhancement patterns on CT: type I, arterial enhancement and washout; type II, arterial enhancement without washout; and type III, no arterial enhancement. Two blinded reviewers rated the possibility of HCC. Results For the 297 HCCs, the enhancement patterns according to size were as follows: type I ≥1 cm in 114 HCCs; type I <1 cm in 40 HCCs; type II ≥1 cm in 16 HCCs; type II <1 cm in 37 HCCs; type III ≥1 cm in 12 HCCs; and type III <1 cm in 10 HCCs. The remaining 68 HCCs (22.9%) were not detected on CT. The detection rates of HCCs ≥ 1 cm were 83.1%, 76.8%, and 83.1% in the formal report for reviewer 1 and reviewer 2. In comparison, the detection rates of HCCs < 1 cm were 20.6%, 17.4%, and 17.4% in the formal report for reviewer 1 and reviewer 2. Conclusion Many subcentimeter sized hypervascular HCCs were frequently missed or not evident on CT at the initial diagnostic workup. CT has limitations for diagnosing HCCs that are <1 cm in size or have atypical enhancement patterns.
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