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Lyshchik A, Fetzer DT, Kono Y, Wilson SR, Dietrich CF, Clevert DA, Meloni MF, Jang HJ, Kim TK, Lee JM, Minami Y, Kudo M, Piscaglia F, Atzen S. Liver Imaging Reporting and Data System Contrast-Enhanced US Nonradiation Treatment Response Assessment Version 2024. Radiology 2024; 311:e232369. [PMID: 38805727 PMCID: PMC11140523 DOI: 10.1148/radiol.232369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 05/30/2024]
Abstract
The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) standardizes the imaging technique, reporting lexicon, disease categorization, and management for patients with or at risk for hepatocellular carcinoma (HCC). LI-RADS encompasses HCC surveillance with US; HCC diagnosis with CT, MRI, or contrast-enhanced US (CEUS); and treatment response assessment (TRA) with CT or MRI. LI-RADS was recently expanded to include CEUS TRA after nonradiation locoregional therapy or surgical resection. This report provides an overview of LI-RADS CEUS Nonradiation TRA v2024, including a lexicon of imaging findings, techniques, and imaging criteria for posttreatment tumor viability assessment. LI-RADS CEUS Nonradiation TRA v2024 takes into consideration differences in the CEUS appearance of viable tumor and posttreatment changes within and in close proximity to a treated lesion. Due to the high sensitivity of CEUS to vascular flow, posttreatment reactive changes commonly manifest as areas of abnormal perilesional enhancement without washout, especially in the first 3 months after treatment. To improve the accuracy of CEUS for nonradiation TRA, different diagnostic criteria are used to evaluate tumor viability within and outside of the treated lesion margin. Broader criteria for intralesional enhancement increase sensitivity for tumor viability detection. Stricter criteria for perilesional enhancement limit miscategorization of posttreatment reactive changes as viable tumor. Finally, the TRA algorithm reconciles intralesional and perilesional tumor viability assessment and assigns a single LI-RADS treatment response (LR-TR) category: LR-TR nonviable, LR-TR equivocal, or LR-TR viable.
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Affiliation(s)
- Andrej Lyshchik
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - David T. Fetzer
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Yuko Kono
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Stephanie R. Wilson
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Christoph F. Dietrich
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Dirk A. Clevert
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Maria Franca Meloni
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Hyun-Jung Jang
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Tae Kyoung Kim
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Jeong Min Lee
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Yasunori Minami
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Masatoshi Kudo
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Fabio Piscaglia
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Sarah Atzen
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
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Benjamin J, O'Leary C, Hur S, Gurevich A, Klein WM, Itkin M. Imaging and Interventions for Lymphatic and Lymphatic-related Disorders. Radiology 2023; 307:e220231. [PMID: 36943078 DOI: 10.1148/radiol.220231] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The lymphatic system is critical in fluid balance homeostasis. Yet, until recently, lymphatic imaging has been outside of mainstream medicine due to a lack of robust imaging and interventional options. However, during the last 20 years, both clinical lymphatic imaging and interventions have shown dramatic advancement. The key to imaging advancement has been the interstitial delivery of contrast agents through lymphatic-rich tissues. These techniques include intranodal lymphangiography and dynamic contrast-enhanced MR lymphangiography. These methods provide the ability to image and recognize lymphatic anatomy and pathologic conditions. Percutaneous thoracic duct catheterization and embolization became the first widely accepted interventional technique for the management of chyle leaks. Advances in interstitial lymphatic embolization, as well as liver and mesenteric lymphatic interventions, have broadened the scope of possible lymphatic interventions. Also, recent techniques of lymphatic decompression allow for the treatment of a variety of lymphatic disorders. Finally, immunologic studies of central lymphatic fluid reveal the potential of lymphatic interventions on immunity. These advances herald an exciting new chapter for lymphatic imaging and interventions in the coming years.
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Affiliation(s)
- Jamaal Benjamin
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Cathal O'Leary
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Saebeom Hur
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Alexey Gurevich
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Willemijn M Klein
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Maxim Itkin
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
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