1
|
Yamauchi M, Maekawa M, Sato T, Sato Y, Kumondai M, Tsuruoka M, Inoue J, Masamune A, Mano N. Liquid Chromatography/Tandem Mass Spectrometry-Based Simultaneous Analysis of 32 Bile Acids in Plasma and Conventional Biomarker-Integrated Diagnostic Screening Model Development for Hepatocellular Carcinoma. Metabolites 2024; 14:513. [PMID: 39330520 PMCID: PMC11433973 DOI: 10.3390/metabo14090513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/04/2024] [Accepted: 09/21/2024] [Indexed: 09/28/2024] Open
Abstract
Imaging tests, tumor marker (TM) screening, and biochemical tests provide a definitive diagnosis of hepatocellular carcinoma (HCC). However, some patients with HCC may present TM-negative results, warranting a need for developing more sensitive and accurate screening biomarkers. Various diseases exhibit increased blood levels of bile acids, biosynthesized from cholesterol in the liver, and they have been associated with HCC. Herein, we analyzed plasma bile acids using liquid chromatography/tandem mass spectrometry and integrated them with conventional biomarkers to develop a diagnostic screening model for HCC. Plasma samples were obtained from patients diagnosed with chronic hepatitis, hepatic cirrhosis (HC), and HCC. A QTRAP 6500 mass spectrometer and a Nexera liquid chromatograph with a YMC-Triart C18 analytical column were used. The mobile phase A was a 20 mmol/L ammonium formate solution, and mobile phase B was a methanol/acetonitrile mixture (1:1, v/v) with 20 mmol/L ammonium formate. After determining the concentrations of 32 bile acids, statistical analysis and diagnostic screening model development were performed. Plasma concentrations of bile acids differed between sample groups, with significant differences observed between patients with HC and HCC. By integrating bile acid results with conventional biochemical tests, a potential diagnostic screening model for HCC was successfully developed. Future studies should increase the sample size and analyze the data in detail to verify the diagnostic efficacy of the model.
Collapse
Affiliation(s)
- Minami Yamauchi
- Graduate School of Pharmaceutical Sciences, Tohoku University, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan (N.M.)
| | - Masamitsu Maekawa
- Graduate School of Pharmaceutical Sciences, Tohoku University, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan (N.M.)
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan; (T.S.); (Y.S.); (M.K.)
- Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan
| | - Toshihiro Sato
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan; (T.S.); (Y.S.); (M.K.)
| | - Yu Sato
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan; (T.S.); (Y.S.); (M.K.)
| | - Masaki Kumondai
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan; (T.S.); (Y.S.); (M.K.)
| | - Mio Tsuruoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan (J.I.); (A.M.)
| | - Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan (J.I.); (A.M.)
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan (J.I.); (A.M.)
| | - Nariyasu Mano
- Graduate School of Pharmaceutical Sciences, Tohoku University, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan (N.M.)
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-Ku, Sendai 980-8574, Japan; (T.S.); (Y.S.); (M.K.)
| |
Collapse
|
2
|
Falatah HA, Lacerda Q, Wessner CE, Lo S, Wheatley MA, Liu JB, Eisenbrey JR. Influence of Phase Change Droplet Activation and Microbubble Cavitation on the Microenvironment of Hepatocellular Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1387-1394. [PMID: 38876912 PMCID: PMC11298311 DOI: 10.1016/j.ultrasmedbio.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE Both microbubble ultrasound contrast agents and acoustic phase change droplets (APCD) have been explored in hepatocellular carcinoma (HCC). This work aimed to evaluate changes to the HCC microenvironment following either microbubble or APCD destruction in a syngeneic pre-clinical model. METHODS Mouse RIL-175 HCC tumors were grown in the right flank of 64 immunocompetent mice. Pre-treatment, photoacoustic volumetric tumor oxygenation, and power Doppler measurements were obtained using a Vevo 3100 system (VisualSonics, Toronto, Canada). The experimental groups received a 0.1 mL bolus injection of either Definity ultrasound contrast agent (Lantheus Medical Imaging) or APCD fabricated by condensing Definity. Following injection, ultrasound destruction was performed using flash-replenishment sequences on a Sequoia with a 10L4 probe (Siemens) for the duration of enhancement. Tumor oxygenation and power Doppler measurements were then repeated immediately post-ultrasound treatment. Twenty-four hours post-treatment, animals were euthanized, and tumors were harvested and stained for CD31, Cleaved Caspase 3 and CD45. RESULTS Imaging biomarkers demonstrated a significant reduction in percent vascularity following either microbubble or APCD destruction in the tumor microenvironment ( p < 0.022) but no significant changes in tumor oxygenation (p = 0.12). Similarly, immunohistochemistry data demonstrated a significant decrease in CD31 expression (p < 0.042) and an increase in apoptosis (p < 0.014) in tumors treated with destroyed microbubbles or APCD relative to controls. Finally, a significant increase in CD45 expression was observed in tumors treated with APCD (p = 0.046), indicating an increase in tumor immune response. CONCLUSION Ultrasound-triggered destruction of both microbubbles and APCD reduces vascularity, increases apoptosis, and may also increase immune response in this HCC model.
Collapse
Affiliation(s)
- Hebah A Falatah
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA; College of Applied Medical Sciences King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Quezia Lacerda
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Standley Lo
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Margaret A Wheatley
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
3
|
Wang F, Zhang Q, Yan K, Jing X, Chen Y, Kong W, Zhao Q, Zhu Z, Dong Y, Wang W. 3D-CEUS/MRI-CEUS fusion imaging vs 2D-CEUS after locoregional therapies for hepatocellular carcinoma: a multicenter prospective study of therapeutic response evaluation. Eur Radiol 2024:10.1007/s00330-024-10915-0. [PMID: 38992106 DOI: 10.1007/s00330-024-10915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To compare the diagnostic accuracy of 3D contrast-enhanced ultrasound (CEUS)/MRI-CEUS fusion imaging with 2D-CEUS in assessing the response of hepatocellular carcinoma (HCC) to locoregional therapies in a multicenter prospective study. MATERIALS AND METHODS A consecutive series of patients with HCC scheduled for locoregional treatment were enrolled between April 2021 and March 2023. Patients were randomly divided into 3D-CEUS/MRI-CEUS fusion imaging group (3D/fusion group) or 2D-CEUS group (2D group). CEUS was performed 1 week before and 4-6 weeks after locoregional treatment. Contrast-enhanced MRI (CE-MRI) 4-6 weeks after treatment was set as the reference standard. CEUS images were evaluated for the presence or absence of viable tumors. Diagnostic performance criteria, including sensitivity, specificity, accuracy, and area under the curve (AUC), were determined for each modality. RESULTS A total of 140 patients were included, 70 patients in the 2D group (mean age, 60.2 ± 10.4 years) and 70 patients in the 3D/fusion group (mean age, 59.8 ± 10.6 years). The sensitivity of the 3D/fusion group was 100.0% (95% CI: 75.9, 100.0), higher than that of the 2D group (55.6%, 95% CI: 22.7, 84.7; p = 0.019). The specificity of the 3D/fusion group was 96.3% (95% CI: 86.2, 99.4), which was comparable to that of the 2D group (98.4%, 95% CI: 90.0, 99.9; p = 0.915). The AUC of the 3D/fusion group was 0.98 (95% CI: 0.95, 1.00), higher than that of the 2D group (0.77, 95% CI: 0.56, 0.98; p = 0.020). CONCLUSION 3D-CEUS/MRI-CEUS fusion imaging exhibits superior diagnostic accuracy in evaluating the treatment response to locoregional therapies for HCC. CLINICAL RELEVANCE STATEMENT 3D-CEUS/MRI-CEUS fusion imaging can be applied for post-treatment assessment of residual tumors in HCC undergoing locoregional treatment, offering potential benefits in terms of accurate diagnosis and clinical management. KEY POINTS Evaluating for HCC recurrence following locoregional therapy is important. 3D-CEUS/MRI-CEUS fusion imaging achieved a higher sensitivity than 2D-CEUS in assessing residual tumors after locoregional therapies. 3D-CEUS/MRI-CEUS fusion imaging can help clinicians intervene early in residual HCC lesions after locoregional treatment.
Collapse
Affiliation(s)
- Feihang Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang Jing
- Department of Ultrasonography, Tianjin Third Central Hospital, Tianjin, China
| | - Yaqing Chen
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wentao Kong
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiyu Zhao
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zheng Zhu
- Department of Ultrasound, The First People's Hospital of Taicang, Suzhou, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.
| |
Collapse
|
4
|
Wu H, Cheng Y, Gao W, Chen P, Wei Y, Zhao H, Wang F. Progress in the application of ultrasound in glioma surgery. Front Med (Lausanne) 2024; 11:1388728. [PMID: 38957299 PMCID: PMC11218567 DOI: 10.3389/fmed.2024.1388728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024] Open
Abstract
Brain glioma, which is highly invasive and has a poor prognosis, is the most common primary intracranial tumor. Several studies have verified that the extent of resection is a considerable prognostic factor for achieving the best results in neurosurgical oncology. To obtain gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of existing devices, it is imperative to develop a real-time image-guided resection technique to offer reliable functional and anatomical information during surgery. At present, the application of intraoperative ultrasound (IOUS) has been indicated to enhance resection rates and maximize brain function preservation. IOUS, which is promising due to its lower cost, minimal operational flow interruptions, and lack of radiation exposure, can enable real-time localization and precise tumor size and form descriptions while assisting in discriminating residual tumors and solving brain tissue shifts. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound (CEUS), three-dimensional ultrasound (3DUS), noninvasive ultrasound (NUS), and ultrasound elastography (UE), could assist in achieving GTR in glioma surgery. This article reviews the advantages and disadvantages of IOUS in glioma surgery.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Fenglu Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Xi’an Medical University, Xi’an, China
| |
Collapse
|
5
|
Zgura A, Grasu MC, Dumitru RL, Toma L, Iliescu L, Baciu C. An Investigative Analysis of Therapeutic Strategies in Hepatocellular Carcinoma: A Raetrospective Examination of 23 Biopsy-Confirmed Cases Emphasizing the Significance of Histopathological Insights. Cancers (Basel) 2024; 16:1916. [PMID: 38791994 PMCID: PMC11120296 DOI: 10.3390/cancers16101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/28/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The Liver Imaging Reporting and Data System (LI-RADS) combines standardized terminology with a classification system for imaging findings in patients with HCC, therefore rendering diagnostic biopsy unnecessary in many cases. This retrospective study included 23 patients with a biopsy diagnosis of HCC, performed either before or after local interventional procedures, in order to evaluate the histopathologic changes induced by previous procedures and their potential influence on the response to immune therapy. MATERIAL AND METHODS The study encompassed a cohort of patients diagnosed with Hepatocellular Carcinoma (HCC). Diagnosis was established via contrast-enhanced computer tomography or magnetic resonance imaging that identified LI-RADS-5 nodules in conjunction with historical liver disease and elevated alpha-fetoprotein (AFP) levels or via histological examination confirming positivity for glypican3, heat shock protein 70, and glutamine synthetase. The study detailed the liver disease etiology, LI-RADS scores, characteristics and dimensions of HCC nodules, serum AFP concentrations, Edmondson-Steiner grading, and the expression of programmed cell death ligand 1 (PD-L1) in the tumor cells. RESULTS Among the study's cohort of Hepatocellular Carcinoma (HCC) patients, a portion had not received any prior treatments, while the remainder experienced local HCC recurrence following trans-arterial chemoembolization or radiofrequency ablation. Observations indicated elevated alpha-fetoprotein (AFP) levels in those who had not undergone any previous interventions, showing statistical significance. The Edmondson-Steiner classification predominantly identified grade III differentiation across patients, irrespective of their treatment history. Furthermore, an increase in intra-tumoral programmed cell death ligand 1 (PD-L1) expression was noted in patients who had not been subjected to previous therapies. CONCLUSION Liver biopsy offers valuable insights for patients with Hepatocellular Carcinoma (HCC), assisting in the tailoring of immune therapy strategies, particularly in cases of recurrence following prior local interventions.
Collapse
Affiliation(s)
- Anca Zgura
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.Z.); (R.L.D.); (L.T.); (L.I.); (C.B.)
| | - Mugur Cristian Grasu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.Z.); (R.L.D.); (L.T.); (L.I.); (C.B.)
- Department of Interventional Radiology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Radu Lucian Dumitru
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.Z.); (R.L.D.); (L.T.); (L.I.); (C.B.)
- Department of Interventional Radiology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Letitia Toma
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.Z.); (R.L.D.); (L.T.); (L.I.); (C.B.)
- Department of Internal Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Laura Iliescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.Z.); (R.L.D.); (L.T.); (L.I.); (C.B.)
- Department of Internal Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cosmin Baciu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.Z.); (R.L.D.); (L.T.); (L.I.); (C.B.)
| |
Collapse
|
6
|
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.
Collapse
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.)
| |
Collapse
|
7
|
Kang HJ, Lee JM, Yoon JH, Yoo J, Kim JH, Park J. Contrast-Enhanced Ultrasound With Perfluorobutane for Hepatocellular Carcinoma Diagnosis: Comparison of Imaging Phases and Diagnostic Criteria. AJR Am J Roentgenol 2024; 222:e2330156. [PMID: 37991335 DOI: 10.2214/ajr.23.30156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND. Contrast-enhanced ultrasound (CEUS) with perfluorobutane has used varying protocols and diagnostic criteria for hepatocellular carcinoma (HCC). OBJECTIVE. The purpose of this article was to assess diagnostic performance for HCC of CEUS with perfluorobutane in high-risk patients using various criteria. METHODS. This retrospective post hoc study evaluating individual patient data from three earlier prospective studies from one hospital included 204 patients (136 men, 68 women; mean age, 63 ± 11 [SD] years) at high risk of HCC with 213 liver observations. Patients underwent CEUS using perfluorobutane from March 2019 to June 2022. Three radiologists (the examination's operator and two subsequent reviewers) independently interpreted examinations, assessing arterial, portal venous (arterial phase completion through 2 minutes), transitional (2-5 minutes after injection), and Kupffer (≥ 10 minutes after injection) phase findings. Six criteria for HCC were tested: 1, any arterial phase hyperenhancement (APHE) with Kupffer phase hypoenhancement; 2, nonrim APHE with Kupffer phase hypoenhancement; 3, nonrim APHE with portal venous washout; 4, nonrim APHE with portal venous washout and/or Kupffer phase hypoenhancement; 5, nonrim APHE with portal venous and/or transitional washout; 6, nonrim APHE with any of portal venous washout, transitional washout, or Kupffer phase hypoenhancement. Depending on the criteria, observations were instead deemed to be a non-HCC malignancy if showing rim APHE, early washout (at < 1 minute), or marked washout (at 2 minutes). Reference was pathology for malignant observations and pathology or imaging follow-up for benign observations. Diagnostic performance was assessed, pooling readers' data. RESULTS. Criterion 1 (no recognized features of non-HCC malignancy) had highest sensitivity (86.9%) but lowest specificity (43.2%) for HCC. Compared with nonrim APHE and portal venous washout (criterion 3), the addition of Kupffer phase hypoenhancement (criterion 4), transitional washout (criterion 5), or either feature (criterion 6) significantly increased sensitivity (34.4% vs 62.6-64.2%) and accuracy (61.8% vs 75.1-76.5%), but significantly decreased specificity (98.5% vs 91.9-94.1%). Criteria 2, 4, 5, and 6 (all incorporating transitional washout and/or Kupffer phase hypoenhancement) showed no significant differences in sensitivity (62.6-64.2%), specificity (91.9-94.1%), or accuracy (75.1-76.5%). CONCLUSION. Recognition of features of non-HCC malignancy improved specificity for HCC. Incorporation of the findings of transitional washout and/or Kupffer phase hypoenhancement improved sensitivity and accuracy, albeit lowered specificity, versus arterial and portal venous findings alone, without further performance variation among criteria incorporating those two findings. CLINICAL IMPACT. Kupffer phase acquisition may be optional for observations classified as HCC or non-HCC malignancy by arterial, portal venous, and transitional phases.
Collapse
Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jiwon Park
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
8
|
Cerrito L, Ainora ME, Cuccia G, Galasso L, Mignini I, Esposto G, Garcovich M, Riccardi L, Gasbarrini A, Zocco MA. Dynamic Contrast-Enhanced Ultrasound in the Prediction of Advanced Hepatocellular Carcinoma Response to Systemic and Locoregional Therapies. Cancers (Basel) 2024; 16:551. [PMID: 38339302 PMCID: PMC10854581 DOI: 10.3390/cancers16030551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and the sixth most common malignant tumor in the world, with an incidence of 2-8% per year in patients with hepatic cirrhosis or chronic hepatitis. Despite surveillance schedules, it is sometimes diagnosed at an advanced stage, requiring complex therapeutic efforts with both locoregional and systemic treatments. Traditional radiological tools (computed tomography and magnetic resonance) are used for the post-treatment follow-up of HCC. The first follow-up imaging is performed at 4 weeks after resection or locoregional treatments, or after 3 months from the beginning of systemic therapies, and subsequently every 3 months for the first 2 years. For this reason, these radiological methods do not grant the possibility of an early distinction between good and poor therapeutic response. Contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced ultrasound (DCE-US) have gained the interest of several researchers for their potential role in the early assessment of response to locoregional treatments (chemoembolization) or antiangiogenic therapies in patients with advanced HCC. In fact, DCE-US, through a quantitative analysis performed by specific software, allows the construction of time-intensity curves, providing an evaluation of the parameters related to neoplastic tissue perfusion and its potential changes following therapies. It has the invaluable advantage of being easily repeatable, minimally invasive, and able to grant important evaluations regarding patients' survival, essential for well-timed therapeutic changes in case of unsatisfying response, and eventual further treatment planning.
Collapse
Affiliation(s)
- Lucia Cerrito
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Maria Elena Ainora
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Giuseppe Cuccia
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Linda Galasso
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Irene Mignini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Giorgio Esposto
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Matteo Garcovich
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Laura Riccardi
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| | - Maria Assunta Zocco
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy (M.E.A.); (G.C.); (G.E.); (M.G.); (L.R.); (A.G.)
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, 00168 Rome, Italy; (L.G.); (I.M.)
| |
Collapse
|
9
|
Lee CC, Hwang JI, Chang KH, Lin YC, Chao CC, Cheng TF, Chen YC, Hsueh KC. Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carcinoma. Clin Radiol 2024; 79:e73-e79. [PMID: 37914602 DOI: 10.1016/j.crad.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023]
Abstract
AIM To evaluate inter-reader agreement between novice and expert radiologists in assessing contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) images for detecting viable tumours with different sizes after conventional transarterial chemoembolisation (cTACE). MATERIALS AND METHODS This prospective study included patients who had less than five hepatomas and who underwent cTACE. Hepatomas with one or two feeding arteries were selected as target lesions. CEUS and MRI were performed within 1 week after cTACE to evaluate viable tumours. RESULTS The expert group had higher kappa values in evaluating all tumour sizes via CEUS compared with MRI. The novice group had similar kappa values. In patients with tumours measuring ≤3 cm, the expert group had higher kappa values in reading CEUS compared with MRI images; however, in the novice group, the kappa value was lower in evaluating CEUS compared with MRI images. In patients with tumours measuring >3 cm, the expert and novice groups had good to excellent kappa values. The confidence level of the two groups in reading MRI images was high; however, the novice group had a lower confidence level. CONCLUSION CEUS is a convenient, cost-effective, and easy to apply imaging tool that can help interventionists perform early detection of viable hepatocellular carcinoma post-TACE. It has a higher inter-rater agreement in interpreting CEUS images compared with MRI images among expert radiologists even when they are extremely familiar with post-cTACE MRI images. In novice radiologists, there may be a learning curve to achieve good consistency in CEUS interpretation.
Collapse
Affiliation(s)
- C-C Lee
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - J-I Hwang
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Radiology, National Defense Medical Center, Taipei 11490, Taiwan
| | - K-H Chang
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung Taiwan; Center for General Education, China Medical University, Taichung 404, Taiwan; General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan; Department of Life Sciences and Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Y C Lin
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - C C Chao
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - T-F Cheng
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - Y-C Chen
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung Taiwan
| | - K-C Hsueh
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Division of General Surgery, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40227, Taiwan.
| |
Collapse
|
10
|
Kamal O, Horvat N, Arora S, Chaudhry H, Elmohr M, Khanna L, Nepal PS, Wungjramirun M, Nandwana SB, Shenoy-Bhangle AS, Lee J, Kielar A, Marks R, Elsayes K, Fung A. Understanding the role of radiologists in complex treatment decisions for patients with hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:3677-3687. [PMID: 37715846 PMCID: PMC11234513 DOI: 10.1007/s00261-023-04033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/18/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and represents a significant global health burden. Management of HCC can be challenging due to multiple factors, including variable expectations for treatment outcomes. Several treatment options are available, each with specific eligibility and ineligibility criteria, and are provided by a multidisciplinary team of specialists. Radiologists should be aware of the types of treatment options available, as well as the criteria guiding the development of individualized treatment plans. This awareness enables radiologists to contribute effectively to patient-centered multidisciplinary tumor boards for HCC and play a central role in reassessing care plans when the treatment response is deemed inadequate. This comprehensive review aims to equip radiologists with an overview of HCC staging systems, treatment options, and eligibility criteria. The review also discusses the significance of imaging in HCC diagnosis, treatment planning, and monitoring treatment response. Furthermore, we highlight the crucial branch points in the treatment decision-making process that depend on radiological interpretation.
Collapse
Affiliation(s)
- Omar Kamal
- Department of Diagnostic Radiology, Oregon Health & Science University, Mail Code: L340, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Natally Horvat
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | - Manida Wungjramirun
- Department of Diagnostic Radiology, Oregon Health & Science University, Mail Code: L340, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | | | | | - James Lee
- University of Kentucky, Lexington, KY, USA
| | | | | | | | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health & Science University, Mail Code: L340, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| |
Collapse
|
11
|
Barteselli C, Mazza S, Ravetta V, Viera FT, Veronese L, Frigerio C, Gori G, Bergamaschi G, Sgarlata C, Facciorusso A, Maestri M, Di Sabatino A, Anderloni A. Ultrasound Patterns of Hepatocellular Carcinoma and Their Prognostic Impact: A Retrospective Study. Cancers (Basel) 2023; 15:5396. [PMID: 38001656 PMCID: PMC10670191 DOI: 10.3390/cancers15225396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death. Abdominal ultrasound (US) is by far the most widely used first-level exam for the diagnosis of HCC. We aimed to assess whether different ultrasound patterns were related to tumor prognosis. METHODS We retrospectively reviewed all patients with a new diagnosis of HCC (single nodule) and undergoing radiofrequency thermal ablation (RFTA) at our clinic between January 2009 and December 2021. Patients were classified according to four HCC ultrasound patterns: 1A, single capsulated nodule; 1B, well capsulated intra-node nodule; 1C, cluster consisting of capsulated nodules; and 2, non-capsulated nodule. RESULTS 149 patients were analysed; median follow-up time was 43 months. US patterns 1A (32.9%) and 1B (61.1%) were the most commonly seen. Median overall survival (OS) and recurrence-free survival (RFS) from RFTA were 54 months (95% CI, 42-66) and 22 months (95% CI, 12-32), respectively. Pattern 1A showed the best OS. Compared to pattern 1A, 1B was independently associated with worse OS (51 months (95% CI, 34-68) vs. 46 months (95% CI, 18-62)) and RFS (34 months (95% CI, 27-41) vs. 18 months (95% CI, 12-24)). Patterns 1C and 2 were associated with worse RFS compared to 1A, while no difference was seen for OS. Among baseline clinical variables, pattern 1B exhibited higher histological grade (p = 0.048) and tumor dimension (p = 0.034) compared to pattern 1A. CONCLUSIONS Our findings demonstrate that different US patterns correlate with different survival outcomes and tumor behavior in patients with HCC. Prospective studies are needed to confirm these results.
Collapse
Affiliation(s)
- Chiara Barteselli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Valentina Ravetta
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesca Torello Viera
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Letizia Veronese
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Chiara Frigerio
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Gori
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Gaetano Bergamaschi
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Carmelo Sgarlata
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Marcello Maestri
- General Surgery I, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, 27100 Pavia, Italy
- First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| |
Collapse
|
12
|
Savsani E, Shaw CM, Forsberg F, Wessner CE, Lyshchik A, O'Kane P, Liu JB, Balasubramanya R, Roth CG, Naringrekar H, Keith SW, Tan A, Anton K, Bradigan K, Civan J, Schultz S, Shamimi-Noori S, Hunt S, Soulen MC, Mattrey RF, Kono Y, Eisenbrey JR. Contrast-enhanced US Evaluation of Hepatocellular Carcinoma Response to Chemoembolization: A Prospective Multicenter Trial. Radiology 2023; 309:e230727. [PMID: 37847138 PMCID: PMC10623205 DOI: 10.1148/radiol.230727] [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: 03/30/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Abstract
Background Contrast-enhanced (CE) US has been studied for use in the detection of residual viable hepatocellular carcinoma (HCC) after locoregional therapy, but multicenter data are lacking. Purpose To compare two-dimensional (2D) and three-dimensional (3D) CE US diagnostic performance with that of CE MRI or CT, the current clinical standard, in the detection of residual viable HCC after transarterial chemoembolization (TACE) in a prospective multicenter trial. Materials and Methods Participants aged at least 21 years with US-visible HCC scheduled for TACE were consecutively enrolled at one of three participating academic medical centers from May 2016 to March 2022. Each underwent baseline 2D and 3D CE US before TACE, 2D and 3D CE US 1-2 weeks and/or 4-6 weeks after TACE, and CE MRI or CT 4-6 weeks after TACE. CE US and CE MRI or CT were evaluated by three fellowship-trained radiologists for the presence or absence of viable tumors and were compared with reference standards of pathology (18%), angiography on re-treatment after identification of residual disease at 1-2-month follow-up imaging (31%), 4-8-month CE MRI or CT (42%), or short-term (approximately 1-2 months) CE MRI or CT if clinically decompensated and estimated viability was greater than 50% at imaging (9%). Diagnostic performance criteria, including sensitivity and specificity, were obtained for each modality and time point with generalized estimating equation analysis. Results A total of 132 participants were included (mean age, 64 years ± 7 [SD], 87 male). Sensitivity of 2D CE US 4-6 weeks after TACE was 91% (95% CI: 84, 95), which was higher than that of CE MRI or CT (68%; 95% CI: 58, 76; P < .001). Sensitivity of 3D CE US 4-6 weeks after TACE was 89% (95% CI: 81, 94), which was higher than that of CE MRI or CT (P < .001), with no evidence of a difference from 2D CE US (P = .22). CE MRI or CT had 85% (95% CI: 76, 91) specificity, higher than that of 4-6-week 2D and 3D CE US (70% [95% CI: 56, 80] and 67% [95% CI: 53, 78], respectively; P = .046 and P = .023, respectively). No evidence of differences in any diagnostic criteria were observed between 1-2-week and 4-6-week 2D CE US (P > .21). Conclusion The 2D and 3D CE US examinations 4-6 weeks after TACE revealed higher sensitivity in the detection of residual HCC than CE MRI or CT, albeit with lower specificity. Importantly, CE US performance was independent of follow-up time. Clinical trial registration no. NCT02764801 © RSNA, 2023 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Esika Savsani
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Colette M. Shaw
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Flemming Forsberg
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Corinne E. Wessner
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Andrej Lyshchik
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Patrick O'Kane
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Ji-Bin Liu
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Rashmi Balasubramanya
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Christopher G. Roth
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Haresh Naringrekar
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Scott W. Keith
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Allison Tan
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Kevin Anton
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Kristen Bradigan
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Jesse Civan
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Susan Schultz
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Susan Shamimi-Noori
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Stephen Hunt
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Michael C. Soulen
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Robert F. Mattrey
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - Yuko Kono
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| | - John R. Eisenbrey
- From the Department of Radiology (E.S., C.M.S., F.F., C.E.W., A.L.,
P.O., J.B.L., R.B., C.G.R., H.N., A.T., K.A., K.B., J.R.E.), Sidney Kimmel
Medical College (E.S.), Division of Biostatistics, Department of Pharmacology,
Physiology, and Cancer Biology (S.W.K.), and Department of Medicine (J.C.),
Thomas Jefferson University, 132 S 10th St, 796 E Main Building, Philadelphia,
PA 19107; Department of Radiology, Abramson Cancer Center, University of
Pennsylvania, Philadelphia, Pa (S.S., S.S.N., S.H., M.C.S.); Department of
Radiology, University of Texas Southwestern Medical Center, Dallas, Tex
(R.F.M.); Cancer Prevention and Research Institute of Texas, Austin, Tex
(R.F.M.); and Departments of Medicine and Radiology, University of California,
San Diego, La Jolla, Calif (Y.K.)
| |
Collapse
|
13
|
Lee RM, Russell MC. Is Screening for Hepatocellular Carcinoma Effective? Adv Surg 2023; 57:73-86. [PMID: 37536863 DOI: 10.1016/j.yasu.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Hepatocellular carcinoma occurs primarily in patients with cirrhosis and is an important cause of cancer death. Screening for hepatocellular carcinoma every 6 months with ultrasound with or without alpha fetoprotein measurement is recommended by multiple professional societies. There are no randomized controlled trials in patients with cirrhosis documenting the effectiveness of screening in improving survival, however, making screening controversial. There are multiple retrospective and cohort studies, as well as pooled analyses that do show an association of screening with earlier stage at diagnosis, increased receipt of curative intent treatment, and improved overall survival. Though these studies are limited by lead and length time biases, they make compelling arguments in favor of screening. Additional research into barriers to receiving screening, barriers to receiving treatment, and the optimal screening modalities given the shift of cirrhosis etiology in the United States are needed to further improve patient outcomes.
Collapse
Affiliation(s)
- Rachel M Lee
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Maria C Russell
- Department of Surgery, Division of Surgical Oncology, Emory University, Emory University Hospital Midtown, 9th Floor MOT, 550 Peachtree Street, Atlanta, GA 30308, USA.
| |
Collapse
|
14
|
Schauer MI, Jung EM, Platz Batista da Silva N, Akers M, Loch E, Markowiak T, Piler T, Larisch C, Neu R, Stroszczynski C, Hofmann HS, Ried M. Intraoperative Contrast-Enhanced Ultrasonography (Io-CEUS) in Minimally Invasive Thoracic Surgery for Characterization of Pulmonary Tumours: A Clinical Feasibility Study. Cancers (Basel) 2023; 15:3854. [PMID: 37568670 PMCID: PMC10417103 DOI: 10.3390/cancers15153854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The intraoperative detection of solitary pulmonary nodules (SPNs) continues to be a major challenge, especially in minimally invasive video-assisted thoracic surgery (VATS). The location, size, and intraoperative frozen section result of SPNs are decisive regarding the extent of lung resection. This feasibility study investigates the technical applicability of intraoperative contrast-enhanced ultrasonography (Io-CEUS) in minimally invasive thoracic surgery. METHODS In this prospective, monocentric clinical feasibility study, n = 30 patients who underwent Io-CEUS during elective minimally invasive lung resection for SPNs between October 2021 and February 2023. The primary endpoint was the technical feasibility of Io-CEUS during VATS. Secondary endpoints were defined as the detection and characterization of SPNs. RESULTS In all patients (female, n = 13; mean age, 63 ± 8.6 years) Io-CEUS could be performed without problems during VATS. All SPNs were detected by Io-CEUS (100%). SPNs had a mean size of 2.2 cm (0.5-4.5 cm) and a mean distance to the lung surface of 2.0 cm (0-6.4 cm). B-mode, colour-coded Doppler sonography, and contrast-enhanced ultrasound were used to characterize all tumours intraoperatively. Significant differences were found, especially in vascularization as well as in contrast agent behaviour, depending on the tumour entity. After successful lung resection, a pathologic examination confirmed the presence of lung carcinomas (n = 17), lung metastases (n = 10), and benign lung tumours (n = 3). CONCLUSIONS The technical feasibility of Io-CEUS was confirmed in VATS before resection regarding the detection of suspicious SPNs. In particular, the use of Doppler sonography and contrast agent kinetics revealed intraoperative specific aspects depending on the tumour entity. Further studies on Io-CEUS and the application of an endoscopic probe for VATS will follow.
Collapse
Affiliation(s)
- Martin Ignaz Schauer
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Ernst-Michael Jung
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Natascha Platz Batista da Silva
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Michael Akers
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Tomas Piler
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Christopher Larisch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Christian Stroszczynski
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| |
Collapse
|
15
|
Dobek A, Kobierecki M, Ciesielski W, Grząsiak O, Fabisiak A, Stefańczyk L. Usefulness of Contrast-Enhanced Ultrasound in the Differentiation between Hepatocellular Carcinoma and Benign Liver Lesions. Diagnostics (Basel) 2023; 13:2025. [PMID: 37370920 DOI: 10.3390/diagnostics13122025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
A differentiation between hepatocellular carcinoma (HCC) and benign liver lesions is required. The aim of the study was to perform an analysis of the time of enhancement of focal liver lesions in a contrast-enhanced ultrasound (CEUS) examination. The curves of enhancement and the homogeneity of the tumor enhancement were assessed. The study included 52 patients with diagnoses of hepatocellular adenoma (18), focal nodular hyperplasia (11) and HCC (28). The study included magnetic resonance imaging or computed tomography and a comparison of the obtained information with CEUS. In the benign lesions groups after 20-30 s, the enhancement was similar to the liver parenchyma. In the HCC group, the enhancement was slightly less intense compared to the liver parenchyma and the benign lesions. The difference of the enhancement in the arterial phase (benign lesions vs. HCC) was p = 0.0452, and the difference of enhancement in the late venous phase (benign lesions vs. HCC) was p = 0.000003. The homogeneity of the enhancement (benign lesions vs. HCC), respectively, was p = 0.001 in the arterial phase, p = 0.0003 in the portal venous phase and p = 0.00000007 in the late venous phase. Liver tumors can be classified as benign when they are homogenous in the arterial phase and don't present washout. HCC in the arterial phase is inhomogeneous and washout is observed in the venous phases. When radiological symptoms suggest malignant lesion, CEUS can be used to select the best biopsy access.
Collapse
Affiliation(s)
- Adam Dobek
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Mateusz Kobierecki
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Wojciech Ciesielski
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Oliwia Grząsiak
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Fabisiak
- Department of Digestive Tract Diseases, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| |
Collapse
|
16
|
Lei L, Du LX, He YL, Yuan JP, Wang P, Ye BL, Wang C, Hou Z. Dictionary learning LASSO for feature selection with application to hepatocellular carcinoma grading using contrast enhanced magnetic resonance imaging. Front Oncol 2023; 13:1123493. [PMID: 37091168 PMCID: PMC10118007 DOI: 10.3389/fonc.2023.1123493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/17/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionThe successful use of machine learning (ML) for medical diagnostic purposes has prompted myriad applications in cancer image analysis. Particularly for hepatocellular carcinoma (HCC) grading, there has been a surge of interest in ML-based selection of the discriminative features from high-dimensional magnetic resonance imaging (MRI) radiomics data. As one of the most commonly used ML-based selection methods, the least absolute shrinkage and selection operator (LASSO) has high discriminative power of the essential feature based on linear representation between input features and output labels. However, most LASSO methods directly explore the original training data rather than effectively exploiting the most informative features of radiomics data for HCC grading. To overcome this limitation, this study marks the first attempt to propose a feature selection method based on LASSO with dictionary learning, where a dictionary is learned from the training features, using the Fisher ratio to maximize the discriminative information in the feature.MethodsThis study proposes a LASSO method with dictionary learning to ensure the accuracy and discrimination of feature selection. Specifically, based on the Fisher ratio score, each radiomic feature is classified into two groups: the high-information and the low-information group. Then, a dictionary is learned through an optimal mapping matrix to enhance the high-information part and suppress the low discriminative information for the task of HCC grading. Finally, we select the most discrimination features according to the LASSO coefficients based on the learned dictionary.Results and discussionThe experimental results based on two classifiers (KNN and SVM) showed that the proposed method yielded accuracy gains, compared favorably with another 5 state-of-the-practice feature selection methods.
Collapse
Affiliation(s)
- Lei Lei
- College of Information Science and Engineering, Jiaxing University, Jiaxing, China
- *Correspondence: Lei Lei, ; Ying-Long He,
| | - Li-Xin Du
- Medical Imaging Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Ying-Long He
- School of Mechanical Engineering Sciences, University of Surrey, Guildford, United Kingdom
- *Correspondence: Lei Lei, ; Ying-Long He,
| | - Jian-Peng Yuan
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Pan Wang
- Medical Imaging Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Bao-Lin Ye
- College of Information Science and Engineering, Jiaxing University, Jiaxing, China
| | - Cong Wang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - ZuJun Hou
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| |
Collapse
|
17
|
Bottenus N. Implementation of constrained swept synthetic aperture using a mechanical fixture. APPLIED SCIENCES (BASEL, SWITZERLAND) 2023; 13:4797. [PMID: 38711800 PMCID: PMC11072168 DOI: 10.3390/app13084797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Resolution and target detectability in ultrasound imaging are directly tied to the size of the imaging array. This is especially important for imaging at depth, such as in the detection and diagnosis of hepatocellular carcinoma and other lesions in the liver. Swept synthetic aperture (SSA) imaging has shown promise for building large effective apertures from small physical arrays using motion, but has required bulky fixtures and external motion tracking for precise positioning. In this study we present an approach that constrains the transducer motion with a simple linear sliding fixture and estimates motion from the ultrasound data itself using either speckle tracking or channel correlation. We demonstrate in simulation and phantom experiments the ability of both techniques to accurately estimate lateral transducer motion and form SSA images with improved resolution and target detectability. We observed errors under 83 μm across a 50 mm sweep in simulation and found improvements of up to 61% in resolution and up to 33% in lesion detectability experimentally even imaging through ex vivo tissue layers. This approach will increase the accessibility of SSA imaging and allow us to test its use in clinical settings.
Collapse
Affiliation(s)
- Nick Bottenus
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO 80516, USA
| |
Collapse
|
18
|
Arian A, Abdullah AD, Taher HJ, Suhail Alareer H, Fotouhi M. Diagnostic Values of the Liver Imaging Reporting and Data System in the Detection and Characterization of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e36082. [PMID: 37065286 PMCID: PMC10097431 DOI: 10.7759/cureus.36082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
This review was undertaken to assess the diagnostic value of the Liver Imaging Reporting and Data System (LI-RADS) in patients with a high risk of hepatocellular carcinoma (HCC). Google Scholar, PubMed, Web of Science, Embase, PROQUEST, and Cochrane Library, as the international databases, were searched with appropriate keywords. Using the binomial distribution formula, the variance of all studies was calculated, and using Stata version 16 (StataCorp LLC, College Station, TX, USA), the obtained data were analyzed. Using a random-effect meta-analysis approach, we determined the pooled sensitivity and specificity. Utilizing the funnel plot and Begg's and Egger's tests, we assessed publication bias. The results exhibited pooled sensitivity and pooled specificity of 0.80% and 0.89%, respectively, with a 95% confidence interval (CI) of 0.76-0.84 and 0.87-0.92, respectively. The 2018 version of LI-RADS showed the greatest sensitivity (0.83%; 95% CI 0.79-0.87; I 2 = 80.6%; P < 0.001 for heterogeneity; T 2 = 0.001). The maximum pooled specificity was detected in LI-RADS version 2014 (American College of Radiology, Reston, VA, USA; 93.0%; 95% CI 89.0-96.0; I 2 = 81.7%; P < 0.001 for heterogeneity; T 2 = 0.001). In this review, the results of estimated sensitivity and specificity were satisfactory. Therefore, this strategy can serve as an appropriate tool for identifying HCC.
Collapse
|
19
|
Grazzini G, Chiti G, Zantonelli G, Matteuzzi B, Pradella S, Miele V. Imaging in Hepatocellular Carcinoma: what's new? Semin Ultrasound CT MR 2023; 44:145-161. [DOI: 10.1053/j.sult.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
|
20
|
Boccatonda A, Cocco G, D'Ardes D, Schiavone C. GB-RADS score, a possible role for CEUS? Abdom Radiol (NY) 2023; 48:1199-1201. [PMID: 36680598 DOI: 10.1007/s00261-023-03806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Via Marconi 35 Bentivoglio, 40010, Bologna, Italy.
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Damiano D'Ardes
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| |
Collapse
|
21
|
Candita G, Rossi S, Cwiklinska K, Fanni SC, Cioni D, Lencioni R, Neri E. Imaging Diagnosis of Hepatocellular Carcinoma: A State-of-the-Art Review. Diagnostics (Basel) 2023; 13:diagnostics13040625. [PMID: 36832113 PMCID: PMC9955560 DOI: 10.3390/diagnostics13040625] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Hepatocellular carcinoma (HCC) remains not only a cause of a considerable part of oncologic mortality, but also a diagnostic and therapeutic challenge for healthcare systems worldwide. Early detection of the disease and consequential adequate therapy are imperative to increase patients' quality of life and survival. Imaging plays, therefore, a crucial role in the surveillance of patients at risk, the detection and diagnosis of HCC nodules, as well as in the follow-up post-treatment. The unique imaging characteristics of HCC lesions, deriving mainly from the assessment of their vascularity on contrast-enhanced computed tomography (CT), magnetic resonance (MR) or contrast-enhanced ultrasound (CEUS), allow for a more accurate, noninvasive diagnosis and staging. The role of imaging in the management of HCC has further expanded beyond the plain confirmation of a suspected diagnosis due to the introduction of ultrasound and hepatobiliary MRI contrast agents, which allow for the detection of hepatocarcinogenesis even at an early stage. Moreover, the recent technological advancements in artificial intelligence (AI) in radiology contribute an important tool for the diagnostic prediction, prognosis and evaluation of treatment response in the clinical course of the disease. This review presents current imaging modalities and their central role in the management of patients at risk and with HCC.
Collapse
|
22
|
Systems Pharmacology-Based Strategy to Investigate the Mechanism of Ruangan Lidan Decoction for Treatment of Hepatocellular Carcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2940654. [PMID: 36578460 PMCID: PMC9791079 DOI: 10.1155/2022/2940654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022]
Abstract
epatocellular carcinoma (HCC) is one of the leading contributors to cancer mortality worldwide. Currently, the prevention and treatment of HCC remains a major challenge. As a traditional Chinese medicine (TCM) formula, Ruangan Lidan decoction (RGLD) has been proved to own the effect of relieving HCC symptoms. However, due to its biological effects and complex compositions, its underlying mechanism of actions (MOAs) have not been fully clarified yet. In this study, we proposed a pharmacological framework to systematically explore the MOAs of RGLD against HCC. We firstly integrated the active ingredients and potential targets of RGLD. We next highlighted 25 key targets that played vital roles in both RGLD and HCC disease via a protein-protein interaction (PPI) network and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. Furthermore, an ingredient-target network of RGLD consisting of 216 ingredients with 306 targets was constructed, and multilevel systems pharmacology analyses indicated that RGLD could act on multiple biological processes related to the pathogenesis of HCC, such as cellular response to hypoxia and cell proliferation. Additionally, integrated pathway analysis of RGLD uncovered that RGLD might treat HCC through regulating various pathways, including MAPK signaling pathway, PI3K/Akt signaling pathway, TNF signaling pathway, and ERBB signaling pathway. Survival analysis results showed that HCC patients with low expression of VEGFA, HIF1A, CASP8, and TOP2A were related with a higher survival rate than those with high expression, indicating the potential clinical significance for HCC. Finally, molecular docking results of core ingredients and targets further proved the feasibility of RGLD in the treatment of HCC. Overall, this study indicates that RGLD may treat HCC through multiple mechanisms, which also provides a potential paradigm to investigate the MOAs of TCM prescription.
Collapse
|
23
|
Imaging Features of Hepatocellular Carcinoma in the Non-Cirrhotic Liver with Sonazoid-Enhanced Contrast-Enhanced Ultrasound. Diagnostics (Basel) 2022; 12:diagnostics12102272. [PMID: 36291962 PMCID: PMC9601233 DOI: 10.3390/diagnostics12102272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose: To investigate the Sonazoid-enhanced contrast-enhanced ultrasound (CEUS) features of hepatocellular carcinoma (HCC) in a non-cirrhosis liver background, in comparison to those in liver cirrhosis. Methods: In this retrospective study, 19 patients with surgery and histopathologically proven HCC lesions in non-cirrhosis liver background were included regarding Sonazoid-enhanced CEUS characteristics. Two radiologists evaluated the CEUS features of HCC lesions according to the WFUMB (World Federation of Societies for Ultrasound in Medicine and Biology) guidelines criteria. Thirty-six patients with HCC lesions in liver cirrhosis were included as a control group. Final diagnoses were confirmed by surgery and histopathological results. Results: Liver background of the non-cirrhosis group including normal liver (n = 7), liver fibrosis (n = 11), and alcoholic liver disease (n = 1). The mean size of non-cirrhosis HCC lesions was 60.8 ± 46.8 mm (ranging from 25 to 219 mm). During the arterial phase of Sonazoid-enhanced CEUS, most HCCs in non-cirrhotic liver (94.7%, 18/19) and in cirrhotic liver (83.3%, 30/36) presented non-rim hyperenhancement. During the portal venous phase, HCC lesions in the non-cirrhosis liver group showed relatively early washout (68.4%, 13/19) (p = 0.090). Meanwhile, HCC lesions in liver cirrhosis background showed isoenhancement (55.6%, 20/36). All lesions in the non-cirrhotic liver group showed hypoenhancement in the late phase and the Kupffer phase (100%, 19/19). Five cases of HCC lesions in liver cirrhosis showed isoenhancement during the late phase and hypoenhancement during the Kupffer phase (13.9%, 5/36). The rest of the cirrhotic HCC lesions showed hypoenhancement during the late phase and the Kupffer phase (86.1%, 31/36). Additional hypoenhanced lesions were detected in three patients in the non-cirrhosis liver group and eight patients in the liver cirrhosis group (mean size: 13.0 ± 5.6 mm), which were also suspected to be HCC lesions. Conclusions: Heterogeneous hyperenhancement during the arterial phase as well as relatively early washout are characteristic features of HCC in the non-cirrhotic liver on Sonazoid-enhanced CEUS.
Collapse
|
24
|
Inzerillo A, Meloni MF, Taibbi A, Bartolotta TV. Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography. World J Hepatol 2022; 14:911-922. [PMID: 35721286 PMCID: PMC9157715 DOI: 10.4254/wjh.v14.i5.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the few cancers for which locoregional treatments (LRTs) are included in international guidelines and are considered as a valid alternative to conventional surgery. According to Barcelona Clinic Liver Cancer classification, percutaneous treatments such as percutaneous ethanol injection, radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage, while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC. A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate, whereas residual tumor requires additional treatment. Imaging modalities play a key role in this task. Currently, contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose. Contrast enhanced ultrasound (CEUS), using second generation contrast agents, plays an increasingly important role in detecting residual disease after LRTs. CEUS is a straightforward to perform, repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies. Due to the ability to focus on single regions, CEUS can also provide high temporal resolution. Moreover, several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs, and recently three-dimensional (3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy. Furthermore, CEUS could be used early after procedures in monitoring HCC treatments, but nowadays this indication is still debated, and data from literature are conflicting, especially after transcatheter arterial chemoembolization procedure.
Collapse
Affiliation(s)
- Agostino Inzerillo
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | | | - Adele Taibbi
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
- Department of Radiology, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
| |
Collapse
|
25
|
Ruan SM, Cheng MQ, Huang H, Hu HT, Li W, Xie XY, Lu MD, Kuang M, Lin MX, Wang W. Application of the CT/MRI LI-RADS Treatment Response Algorithm to Contrast-Enhanced Ultrasound: A Feasibility Study. J Hepatocell Carcinoma 2022; 9:437-451. [PMID: 35620274 PMCID: PMC9128751 DOI: 10.2147/jhc.s353914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) is still in development. The aim of this study was to explore whether the CT/MRI LI-RADS TRA features were applicable to CEUS in evaluating the liver locoregional therapy (LRT) response. Patients and Methods This study was a retrospective review of a prospectively maintained database of patients with hepatocellular carcinoma undergoing ablation between July 2017 and December 2018. The standard criteria for a viable lesion were a histopathologically confirmed or typical viable appearance in the follow-up CT/MRI. Performance of the LI-RADS TRA assessing tumor viability was then compared between CEUS and CT/MRI. Inter-reader association was calculated. Results A total of 244 patients with 389 treated observations (118 viable) were evaluated. The sensitivity and specificity of the CEUS TRA and CT/MRI LI-RADS TRA viable categories for predicting viable lesions were 55.0% (65/118) versus 56.8% (67/118) (P = 0.480) and 99.3% (269/271) versus 96.3% (261/271) (P = 0.013), respectively. The PPV of CEUS was higher than that of CT/MRI (97.0% vs 87.0%). Subgroup analysis showed that the sensitivity was low in the 1-month assessment for both CEUS (38.1%, 16/42) and CT/MR (47.6%, 20/42) and higher in the 2–6-month assessment for both CEUS (65.7%, 23/35) and CT/MR (62.9%, 22/35). Interobserver agreements were substantial for both CEUS TRA and CT/MRI LI-RADS TRA (κ, 0.74 for both). Conclusion The CT/MRI LI-RADS TRA features were applicable to CEUS TRA for liver locoregional therapy. The CEUS TRA for liver locoregional therapy has sufficiently high specificity and PPV to diagnose the viability of lesions after ablation.
Collapse
Affiliation(s)
- Si-Min Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Mei-Qing Cheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Hui Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Wei Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Man-Xia Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Man-Xia Lin; Wei Wang, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China, Tel/Fax +86-20-87765183, Email ;
| |
Collapse
|
26
|
MicroRNAs Related to TACE Treatment Response: A Review of the Literature from a Radiological Point of View. Diagnostics (Basel) 2022; 12:diagnostics12020374. [PMID: 35204465 PMCID: PMC8871153 DOI: 10.3390/diagnostics12020374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 01/08/2023] Open
Abstract
Hepatocellular Carcinoma (HCC) is the sixth most common cancer in the world. Patients with intermediate stage (Barcelona Clinic Liver Cancer, B stage) hepatocellular carcinoma (HCC) have been able to benefit from TACE (transarterial chemoembolization) as a treatment option. MicroRNAs (miRNAs), i.e., a subclass of non-coding RNAs (ncRNAs), participate in post-transcriptional gene regulation processes and miRNA dysfunction has been associated with apoptosis resistance, cellular proliferation, tumor genesis, and progression. Only a few studies have investigated the role of miRNAs as biomarkers predicting TACE treatment response in HCC. Here, we review the studies’ characteristics from a radiological point of view, also correlating data with radiological images chosen from the cases of our institution.
Collapse
|
27
|
Zhao D, He N, Shao YQ, Yu XL, Chu J, Yang G. The diagnostic value of contrast-enhanced ultrasound for cervical tuberculous lymphadenitis. Clin Hemorheol Microcirc 2022; 81:69-79. [PMID: 35001882 PMCID: PMC9108573 DOI: 10.3233/ch-211355] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE: To investigate the value of contrast-enhanced ultrasound (CEUS) for the diagnosis of cervical tuberculous lymphadenitis (CTL). METHODS: The cohort study included 203 consecutive patients diagnosed with cervical lymph node. Before pathological or laboratory confirmation, all patients underwent CEUS examination, and the imaging findings were analyzed afterward. The diagnostic efficiency of the CEUS imaging findings of CTL was evaluated. RESULTS: Nighty-seven patients of the 203 (47.8%) were pathologically or laboratory confirmed with a CTL diagnosis while the remainder (52.2%) were diagnosed with non-tuberculous lymphadenitis. Regarding the imaging findings of CEUS, it was more common in CTL patients to find a pattern of heterogeneous enhancement inside the lymph nodes relative to non-tuberculous patients [81.44% (79/97) vs 15.09% (16/106), P < 0.01]. The sensitivity of the feature in diagnosis for CTL was 81.44% and the specificity was 84.91%, resepectively. Furthermore, a pattern of peripheral rim-like enhancement had been notable in CTL patients compared with non-tuberculous patients [86.60% (84/97) vs 12.26% (13/106), P < 0.01], associating with a diagnostic sensitivity of 86.60% and a specificity of 87.74%. When it came to the combination of both imaging findings mentioned above, the features were more prominent in CTL patients than compared with non-tuberculous patients [74.23% (72/97) vs 5.66% (6/106), P < 0.01], with a diagnostic sensitivity of 74.23% and a high specificity of 94.34%. Regarding area under curve (AUC) for the ROC analysis, the feature of internal heterogeneous enhancement, peripheral rim-like enhancement, and both features were 0.832, 0.872, and 0.843. CONCLUSIONS: CEUS patterns of heterogeneous enhancement and peripheral rim-like enhancement of lymph nodes are helpful characteristics for the diagnosis of CTL.
Collapse
Affiliation(s)
- Dan Zhao
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ning He
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ya-Qin Shao
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiu-Lei Yu
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jie Chu
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Gaoyi Yang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou Red Cross Hospital, Tuberculosis Diagnostic and Treatment Center of Zhejiang Province, Hangzhou, Zhejiang, China
| |
Collapse
|
28
|
Hai Y, Savsani E, Chong W, Eisenbrey J, Lyshchik A. Meta-analysis and systematic review of contrast-enhanced ultrasound in evaluating the treatment response after locoregional therapy of hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:5162-5179. [PMID: 34410432 DOI: 10.1007/s00261-021-03248-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) is a useful tool to assess treatment response after percutaneous ablation or transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Here, we performed a systematic review and meta-analysis to evaluate the usefulness of CEUS in identifying residual tumor after locoregional therapy. METHODS PubMed, Scopus, and Cochrane library databases were searched from their inception until March 8, 2021, for diagnostic test accuracy studies comparing CEUS to a reference standard for identifying residual tumors after locoregional therapy of HCC. The pooled sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were obtained using a bivariate random effects model. Subgroup analyses were performed by stratifying the studies based on study design, type of locoregional therapy, CEUS criteria for residual tumor, timing of CEUS follow up, and type of standard reference. RESULTS Two reviewers independently evaluated 1479 publications. After full-text review, 142 studies were found to be relevant, and 43 publications (50 cohorts) were finally included. The overall sensitivity of CEUS in detection of residual disease estimated from the bivariate random effects model was 0.85 (95% CI 0.80-0.89). Similarly, the overall specificity was 0.94 (95% CI 0.91-0.96). The diagnostic accuracy was 93.5%. The DOR was 70.1 (95% CI 62.2-148), and the AUROC was 0.95. Importantly, subgroup analysis showed no apparent differences in the diagnostic performance between locoregional therapy (TACE vs. ablation) and criteria used to define residual enhancement, timing of performing CEUS, study design, or type of reference standard. CONCLUSION CEUS is a highly accurate method to identify HCC residual tumor after TACE or percutaneous ablation.
Collapse
Affiliation(s)
- Yang Hai
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA
| | - Esika Savsani
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA
| | - Weelic Chong
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Suite 100, Philadelphia, PA, USA
- Department of Medical Oncology, Thomas Jefferson University, 1025 Walnut St, Suite 727, Philadelphia, PA, USA
| | - John Eisenbrey
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, 763G Main Building, Philadelphia, PA, 19107, USA.
| |
Collapse
|
29
|
Sheng CZ, Yao GX, Zhang XR, Li D. Correlation between contrast-enhanced ultrasound perfusion parameters and EphB4 expression in hepatocellular carcinoma lesions. Shijie Huaren Xiaohua Zazhi 2021; 29:1084-1088. [DOI: 10.11569/wcjd.v29.i18.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a kind of tumor with rich blood supply. The changes of blood perfusion occur in the whole pathological process of the tumor. By analyzing the changes of blood perfusion, contrast-enhanced ultrasound (CEUS) can objectively assess the state of angiogenesis, and then indirectly analyze its pathobiological characteristics, which has important clinical significance.
AIM To investigate the correlation between the perfusion parameters of CEUS and ephrin type-B receptor 4 (EphB4) expression in HCC lesions.
METHODS Fifty-two patients with HCC who underwent surgical resection at our hospital were selected as the subjects. All patients were examined by CEUS within 1 wk before operation, and the perfusion parameters of HCC and paracancerous tissues were measured, including maximum intensity (IMAX), time to peak (TTP), and washout time (WT). After operation, the specimens of HCC and paracancerous tissues were sent for pathological examination, and EphB4 expression and microvessel density (MVD) were measured.
RESULTS IMAX in HCC was significantly higher than that in paracancerous tissue (P < 0.05). TTP and WT in HCC were significantly shorter than those in paracancerous tissue (P < 0.05). EphB4 expression and MVD in HCC were significantly higher than those in paracancerous tissue (P < 0.05). EphB4 expression in HCC was positively correlated with IMAX (r = 0.862, P < 0.05) and negatively correlated with TTP and WT (r = -0.765, r = -0.781, P < 0.05).
CONCLUSION CEUS can quantitatively evaluate the flow state of HCC microcirculation, and there is a certain correlation between perfusion parameters and EphB4 expression, which can provide reference for clinical non-invasive evaluation of EphB4 expression.
Collapse
Affiliation(s)
- Chen-ZhuoYa Sheng
- Department of Pathology, Deqing People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Gen-Xin Yao
- Department of Ultrasound, Deqing People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Xin-Rong Zhang
- Department of Ultrasound, Deqing People's Hospital, Huzhou 313200, Zhejiang Province, China
| | - Dong Li
- Department of Ultrasound, Zhejiang Hospital, Hangzhou 310013, Zhejiang Province, China
| |
Collapse
|
30
|
Esika S, Mohamed TMD, Corinne EWMBARDMSRVT, Philip LMD, Andrej LMDP, Kevin AMDP, Colette MSMD, Ji-Bin LMD, John REP. Contrast-enhanced Ultrasound Assessment of Treatment Response in a Patient with Multifocal Hepatocellular Carcinoma Treated with Transarterial Chemo and Radioembolization. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|