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Zhou J, Pan F, Li W, Hu H, Wang W, Huang Q. Feature Fusion for Diagnosis of Atypical Hepatocellular Carcinoma in Contrast- Enhanced Ultrasound. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:114-123. [PMID: 34487493 DOI: 10.1109/tuffc.2021.3110590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is generally employed for focal liver lesions (FLLs) diagnosis. Among the FLLs, atypical hepatocellular carcinoma (HCC) is difficult to distinguish from focal nodular hyperplasia (FNH) in CEUS video. For this reason, we propose and evaluate a feature fusion method to resolve this problem. The proposed algorithm extracts a set of hand-crafted features and the deep features from the CEUS cine clip data. The hand-crafted features include the spatial-temporal feature based on a novel descriptor called Velocity-Similarity and Dissimilarity Matching Local Binary Pattern (V-SDMLBP), and the deep features from a 3-D convolution neural network (3D-CNN). Then the two types of features are fused. Finally, a classifier is employed to diagnose HCC or FNH. Several classifiers have achieved excellent performance, which demonstrates the superiority of the fused features. In addition, compared with general CNNs, the proposed fused features have better interpretability.
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Huang Q, Pan F, Li W, Yuan F, Hu H, Huang J, Yu J, Wang W. Differential Diagnosis of Atypical Hepatocellular Carcinoma in Contrast-Enhanced Ultrasound Using Spatio-Temporal Diagnostic Semantics. IEEE J Biomed Health Inform 2020; 24:2860-2869. [PMID: 32149699 DOI: 10.1109/jbhi.2020.2977937] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atypical Hepatocellular Carcinoma (HCC) is very hard to distinguish from Focal Nodular Hyperplasia (FNH) in routine imaging. However little attention was paid to this problem. This paper proposes a novel liver tumor Computer-Aided Diagnostic (CAD) approach extracting spatio-temporal semantics for atypical HCC. With respect to useful diagnostic semantics, our model automatically calculates three types of semantic feature with equally down-sampled frames based on Contrast-Enhanced Ultrasound (CEUS). Thereafter, a Support Vector Machine (SVM) classifier is trained to make the final diagnosis. Compared with traditional methods for diagnosing HCC, the proposed model has the advantage of less computational complexity and being able to handle the atypical HCC cases. The experimental results show that our method obtained a pretty considerable performance and outperformed two traditional methods. According to the results, the average accuracy reaches 94.40%, recall rate 94.76%, F1-score value 94.62%, specificity 93.62% and sensitivity 94.76%, indicating good merit for automatically diagnosing atypical HCC cases.
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Aubé C, Oberti F, Lonjon J, Pageaux G, Seror O, N'Kontchou G, Rode A, Radenne S, Cassinotto C, Vergniol J, Bricault I, Leroy V, Ronot M, Castera L, Michalak S, Esvan M, Vilgrain V. EASL and AASLD recommendations for the diagnosis of HCC to the test of daily practice. Liver Int 2017; 37:1515-1525. [PMID: 28346737 DOI: 10.1111/liv.13429] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/15/2017] [Indexed: 12/12/2022]
Abstract
AIMS To evaluate the diagnostic performance of CT, MRI and CEUS alone and in combination, for the diagnosis of HCC between 10 and 30 mm, in a large population of cirrhotic patients. PATIENTS AND METHODS In a multicentre prospective trial, 442 patients have been enrolled. Within a month, CEUS, CT and MRI were performed for all patients. A composite algorithm was defined to obtain the more accurate gold standard. RESULTS A total of 544 nodules in 381 patients have been retained for the performance analysis. Eighty-two percent of the patients were male, mean age was 62 years. For the 10-20 mm nodules (n=342), the sensitivity (Se) and specificity (Sp) for the diagnosis of HCC were, respectively, 70.6% and 83.2% for MRI, 67.9% and 76.8% for CT and 39.6% and 92.9% for CEUS. For the 20-30 mm nodules (n=202), the Se and Sp were, respectively, 72.3% and 89.4% for MRI, 71.6% and 93.6% for CT and 52.9% and 91.5% for CEUS. THE BEST COMBINATION FOR THE 10-20 MM NODULES WAS MRI + CT (SE: 55.1%, SP: 100.0%).: After a first inconclusive technique, CEUS as second image technique allowed the highest specificity with only a slight drop of sensitivity for 10-20 mm nodules and the highest sensitivity and specificity for 20-30 mm nodules. CONCLUSION This large multicentre study validates the EASL/AASLD recommendations in daily practice. Specificity using CT or MRI in 10-20 mm HCC was low, but we do not recommend combined imaging at first as sensitivity would be very low. The best sequential approach combined MRI and CEUS.
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Affiliation(s)
- Christophe Aubé
- Département de Radiologie, CHU d'Angers, Université Bretagne Loire, Angers, France.,Laboratoire HIFIH, Université Bretagne Loire, Université d'Angers, Angers, France
| | - Frédéric Oberti
- Laboratoire HIFIH, Université Bretagne Loire, Université d'Angers, Angers, France.,Service de Gastroenterologie et Hépatologie, Université Bretagne Loire, CHU d'Angers, Angers, France
| | - Julie Lonjon
- Département de Radiologie, CHU Saint Eloi, Université de Montpellier, Montpellier, France
| | - Georges Pageaux
- Département d'hépatogastroentérologie, CHU Saint Eloi, Université de Montpellier, Montpellier, France
| | - Olivier Seror
- Service de Radiologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.,Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
| | - Giséle N'Kontchou
- Service d'hépato gastroentérologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France
| | - Agnes Rode
- Département de Radiologie, Hôpital de la Croix Rousse, CHU Lyon, Lyon, France
| | - Sylvie Radenne
- Service d'hépatologie, Hôpital de la croix rousse, Unité INSERM 1052, CHU Lyon, Lyon, France
| | - Christophe Cassinotto
- Département d'imagerie diagnostique et interventionnelle, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
| | - Julien Vergniol
- Service Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Ivan Bricault
- Département d'imagerie, Radiologie et imagerie médicale, CHU, Grenoble, France.,Laboratory of Techniques for Biomedical Engineering And Complexity Management - Informatics, Mathematics and Applications, Université Grenoble Alpes, Grenoble, France
| | - Vincent Leroy
- Service d'hépato gastroentérologie, University Hospital, Grenoble, France
| | - Maxime Ronot
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP), Clichy, France
| | - Laurent Castera
- Service d'hépatologie, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, Paris, France
| | - Sophie Michalak
- Département d'anatomopatologie, CHU d'Angers, LUNAM Université, Angers, France
| | - Maxime Esvan
- Assistance Publique - Hôpitaux de Paris, Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France
| | - Valérie Vilgrain
- Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, Paris, France.,Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP), Clichy, France
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Salvatore V, Gianstefani A, Negrini G, Allegretti G, Galassi M, Piscaglia F. Imaging Diagnosis of Hepatocellular Carcinoma: Recent Advances of Contrast-Enhanced Ultrasonography with SonoVue®. Liver Cancer 2016; 5:55-66. [PMID: 29234627 PMCID: PMC5704684 DOI: 10.1159/000367748] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Due to the ability to detect the typical contrast-imaging pattern for hepatocellular carcinoma (HCC), that is hyperenhancement in the arterial phase and hypoenhancement in the late phase on a cirrhotic background, contrast-enhanced ultrasonography (CEUS) was included in the American diagnostic algorithm for HCC in 2005. However, its role has been questioned because of the possibility of misdiagnosis of cholangiocarcinoma. The present review aims to describe the advantages and disadvantages of CEUS applications using Sonovue® for HCC. In particular there is focus on the accuracy of CEUS in detecting the typical HCC pattern, the CEUS patterns of intrahepatic cholangiocarcinoma (ICC), the risk of misdiagnosis with HCC, the diagnostic use of CEUS in cases of locoregional and systemic treatments, and the evaluation of response to antiangiogenic treatment using dedicated software.
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Affiliation(s)
| | | | | | | | | | - Fabio Piscaglia
- *Fabio Piscaglia, MD, PhD, Division of Internal Medicine, Department of Medical and Surgical Science, University of Bologna, S.Orsola-Malpighi Hospital, Via Albertoni 15, IT-40138, Bologna (Italy), Tel. +39 051 214 2568, E-Mail
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Toyoda H, Kumada T, Tada T, Sone Y, Kaneoka Y, Maeda A. Tumor Markers for Hepatocellular Carcinoma: Simple and Significant Predictors of Outcome in Patients with HCC. Liver Cancer 2015; 4:126-36. [PMID: 26020034 PMCID: PMC4439793 DOI: 10.1159/000367735] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The effectiveness of tumor markers in evaluating outcomes of patients with hepatocellular carcinoma (HCC) remains to be clarified. SUMMARY The usefulness of the HCC tumor markers, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3), and des-gamma-carboxy prothrombin (DCP) was reviewed. Elevations in these tumor markers at the time of HCC diagnosis correlate with disease progression as assessed by both imaging studies and pathologic examinations. The combination of these three tumor markers results in good predictive ability for patient survival after diagnosis. In addition, combination at the time of HCC diagnosis of these three tumor markers (as a measure of tumor progression) and serum albumin and bilirubin levels (as indicators of remnant liver function) can be used for HCC staging and further predicts prognosis in patients with HCC. KEY MESSAGE The prognosis of patients with HCC can be well discriminated based solely on serum markers. Staging of HCC with serum markers is objective; if stored serum samples are available, HCC stages can be standardized across different countries and time periods.
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Affiliation(s)
- Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Takashi Kumada
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Toshifumi Tada
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
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Li W, Wang W, Liu GJ, Chen LD, Wang Z, Huang Y, Liu JY, Xie XY, Lu MD. Differentiation of Atypical Hepatocellular Carcinoma from Focal Nodular Hyperplasia: Diagnostic Performance of Contrast-enhanced US and Microflow Imaging. Radiology 2015; 275:870-9. [PMID: 25584708 DOI: 10.1148/radiol.14140911] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate diagnostic performance of contrast-enhanced (CE) ultrasonography (US) and microflow (MF) imaging in differentiation of atypical hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH). MATERIALS AND METHODS Institutional review board approval was obtained, and informed consent was waived. A total of 103 patients (mean age, 43.9 years; age range, 17-75 years) were included; 38 patients with HCC and 65 with FNH underwent CE US, and vascular architecture pattern (VAP) and arrival time parametric (ATP) images were analyzed. Resident and staff radiologists independently and retrospectively reviewed CE US, VAP, and ATP images. χ(2) test and logistic regression analysis were applied to identify specific features of FNH or HCC on CE US and MF images. To compare diagnostic performance of CE US with or without MF imaging, four sets of criteria were assigned: (a) routine CE US alone, (b) VAP and CE US, (c) ATP imaging and CE US, and (d) all three methods in combination. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) of resident and staff radiologists were analyzed. Cohen κ statistic was used to assess agreement of CE US and MF imaging features between staff and resident radiologists. RESULTS MF imaging offered significant improvements over most detection rates achieved with routine CE US signs in both groups. For staff radiologists, AUCs from criteria sets 3 (AUC = 0.873, P < .05) and 4 (AUC = 0.887, P < .05) were significantly higher than AUC from criteria set 1 (AUC = 0.835). For resident radiologists, specificity (71% and 69% vs 25%, P < .01) and accuracy (78% and 79% vs 50%, P < .01) of criteria sets 3 and 4 were significantly higher than those of criteria set 1. Moreover, AUCs for criteria sets 2 (AUC = 0.728, P < .05), 3 (AUC = 0.823, P < .01), and 4 (AUC = 0.857, P < .01) were significantly higher than those for criteria set 1 (AUC = 0.667). CONCLUSION When compared with routine CE US, MF imaging can more effectively depict specific features and offers improved diagnostic performance in the differentiation of atypical HCC from FNH, especially when used by resident radiologists. Online supplemental material is available for this article.
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Affiliation(s)
- Wei Li
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (W.L., W.W., G.J.L., L.D.C., Z.W., Y.H., J.Y.L., X.Y.X., M.D.L.), and Department of Hepatobiliary Surgery (M.D.L.), The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou 510080, China
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Izamis ML, Efstathiades A, Keravnou C, Georgiadou S, Martins PN, Averkiou MA. Effects of air embolism size and location on porcine hepatic microcirculation in machine perfusion. Liver Transpl 2014; 20:601-11. [PMID: 24478135 DOI: 10.1002/lt.23838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 01/05/2014] [Indexed: 02/07/2023]
Abstract
The handling of donor organs frequently introduces air into the microvasculature, but little is known about the extent of the damage caused as a function of the embolism size and distribution. Here we introduced embolisms of different sizes into the portal vein, the hepatic artery, or both during the flushing stage of porcine liver procurement. The outcomes were evaluated during 3 hours of machine perfusion and were compared to the outcomes of livers with no embolisms. Dynamic contrast-enhanced ultrasound (DCEUS) was used to assess the perfusion quality, and it demonstrated that embolisms tended to flow mostly into the left lobe, occasionally into the right lobe, and rarely into the caudate lobe. Major embolisms could disrupt the flow entirely, whereas minor embolisms resulted in reduced or heterogeneous flow. Embolisms occasionally migrated to different regions of the same lobe and, regardless of their size, caused a general deterioration in the flow over time. Histological damage resulted primarily when both vessels of the liver were compromised, whereas bile production was diminished in livers that had arterial embolisms. Air embolisms produced a dose-dependent increase in vascular resistance and a decline in oxygen consumption. This is the first article to quantify the impact of air embolisms on microcirculation in an experimental model, and it demonstrates that air embolisms have the capacity to degrade the integrity of donor organs. The extent of organ damage is strongly dependent on the size and distribution of air embolisms. The diagnosis of embolism severity can be safely and easily made with DCEUS.
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Affiliation(s)
- Maria-Louisa Izamis
- Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
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