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Bonatti M, Valletta R, Corato V, Gorgatti T, Posteraro A, Vingiani V, Lombardo F, Avesani G, Mega A, Zamboni GA. I thought it was a hemangioma! A pictorial essay about common and uncommon liver hemangiomas' mimickers. Insights Imaging 2024; 15:228. [PMID: 39298015 DOI: 10.1186/s13244-024-01745-1] [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: 03/11/2024] [Accepted: 06/16/2024] [Indexed: 09/21/2024] Open
Abstract
Focal liver lesions are frequently encountered during imaging studies, and hemangiomas represent the most common solid liver lesion. Liver hemangiomas usually show characteristic imaging features that enable characterization without the need for biopsy or follow-up. On the other hand, there are many benign and malignant liver lesions that may show one or more imaging features resembling hemangiomas that radiologists must be aware of. In this article we will review the typical imaging features of liver hemangiomas and will show a series of potential liver hemangiomas' mimickers, giving radiologists some hints for improving differential diagnoses. CRITICAL RELEVANCE STATEMENT: The knowledge of imaging features of potential liver hemangiomas mimickers is fundamental to avoid misinterpretation. KEY POINTS: Liver hemangiomas typically show imaging features that enable avoiding a biopsy. Many benign and malignant liver lesions show imaging features resembling hemangiomas. Radiologists must know the potentially misleading imaging features of hemangiomas' mimickers.
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Affiliation(s)
- Matteo Bonatti
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy.
| | - Riccardo Valletta
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Valentina Corato
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Tommaso Gorgatti
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Andrea Posteraro
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Vincenzo Vingiani
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Fabio Lombardo
- Department of Radiology, IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar (VR), Italy
| | - Giacomo Avesani
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Andrea Mega
- Department of Gastroenterology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Giulia A Zamboni
- Department of Diagnostics and Public Health, Institute of Radiology, University of Verona, Policlinico GB Rossi, P.Le LA Scuro 10, 37134, Verona, Italy
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Matteini F, Cannella R, Dioguardi Burgio M, Torrisi C, Sartoris R, Brancatelli G, Vilgrain V, Ronot M, Vernuccio F. Discontinuous peripheral enhancement of focal liver lesions on CT and MRI: outside the box of typical cavernous hemangioma. Abdom Radiol (NY) 2024:10.1007/s00261-024-04522-2. [PMID: 39192088 DOI: 10.1007/s00261-024-04522-2] [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: 04/29/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
The discontinuous peripheral enhancement is a pattern of enhancement usually attributed to typical cavernous hemangioma, that is the most common benign solid lesion of the liver. The discontinuous peripheral enhancement, however, may be encountered in many other benign and malignant focal liver lesions as an atypical presentation or evolution, and hemangiomas with discontinuous peripheral hyperenhancement on hepatic arterial phase may not always have the typical post-contrast pattern on portal venous and delayed phases. Therefore, abdominal radiologists may be challenged in their practice by lesions with discontinuous peripheral enhancement. This pictorial essay aims to review the spectrum of benign and malignant focal liver lesions that may show discontinuous peripheral enhancement. A particular point of interest is the diagnostic tree pathway that may guide the radiologists in the differential diagnosis.
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Affiliation(s)
- Francesco Matteini
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy.
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Chiara Torrisi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Riccardo Sartoris
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- INSERM U1149 Centre de Recherche sur l'Inflammation (CRI), Université Paris Cité, Paris, France
| | - Federica Vernuccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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Frenette C, Mendiratta-Lala M, Salgia R, Wong RJ, Sauer BG, Pillai A. ACG Clinical Guideline: Focal Liver Lesions. Am J Gastroenterol 2024; 119:1235-1271. [PMID: 38958301 DOI: 10.14309/ajg.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.
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Affiliation(s)
| | | | - Reena Salgia
- Department of Gastroenterology/Hepatology, Henry Ford Health, Detroit, Michigan, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California, USA
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, USA
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Zhao D, Xie L, Makamure J, Liu Z, Zhang L, Li Q, Zhang X, Zhao Y, Zheng C, Shi L, Liang B. Transcatheter Arterial Embolization with Bleomycin-Lipiodol of Hepatic Hemangiomas: Safety, Efficacy and Predictors of Response. Cardiovasc Intervent Radiol 2024; 47:931-942. [PMID: 38509337 DOI: 10.1007/s00270-024-03690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate the safety, efficacy and predictors of response of transcatheter arterial embolization (TAE) to treat hepatic hemangiomas (HHs). MATERIALS AND METHODS A retrospective analysis was conducted of consecutive HH patients who received TAE with bleomycin-Lipiodol emulsion and gelatin sponge particles at three institutions from January 2014 to January 2021. TAE effectiveness was defined as more than 50% reduction of tumor volume. The effectiveness, safety, and CT changes of hemangiomas after TAE were assessed. Factors affecting TAE efficacy on tumor size were analyzed with logistic regression analysis. RESULTS A total of 102 patients with 109 HHs were included. After treatment, both the tumor diameter and volume were significantly reduced from 8.5 ± 3.9 to 5.9 ± 3.8 cm (P < 0.001) and 412.6 ± 742.3 cm3 to 102.0 ± 232.7 cm3 (P < 0.001), respectively. TAE effectiveness was achieved in 80.7% (88/109) of hemangiomas, which was characterized by progressive reduction in tumor volume over time with Lipiodol retention. Atypical enhancement pattern (tiny enhancing dots in the hepatic arterial and portal venous phase) (p = 0.001) and central arterioportal shunt (APS) (p = 0.002) associated with the tumor were independent predictors of TAE ineffectiveness. Postembolization syndrome and transient increase in liver enzymes were common without severe complications and death. CONCLUSION TAE was safe and effective in reducing HH size. Lesion enhancement pattern and APS type were associated with TAE efficacy on tumor shrinkage. LEVEL OF EVIDENCE Level 3, non-controlled retrospective cohort study.
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Affiliation(s)
- Dan Zhao
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Lingli Xie
- Department of Gastroenterology, General Hospital of the Yangtze River Shipping, No. 1 Huiji Road, Wuhan, 430010, China
| | - Joyman Makamure
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Ziyi Liu
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Lijie Zhang
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Qing Li
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Xin Zhang
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yazhuo Zhao
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China
| | - Chuansheng Zheng
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Liangrong Shi
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China.
| | - Bin Liang
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China.
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Onishi Y, Ohno T, Shimizu H, Shimada K, Isoda H, Ishii T, Takai A, Nakamoto Y. Natural History of Hepatic Hemangiomas Larger Than 10 cm: Imaging Findings and Clinical Course of 22 Cases. Cureus 2023; 15:e50563. [PMID: 38226088 PMCID: PMC10788688 DOI: 10.7759/cureus.50563] [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] [Accepted: 12/10/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION The natural history of a large hepatic hemangioma is important in determining the treatment strategy. Although several studies have assessed the natural history of hepatic hemangiomas, no study has focused on hepatic hemangiomas measuring >10 cm. The aim of this study was to assess the natural history of hepatic hemangiomas measuring >10 cm by evaluating imaging findings and clinical course. METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) reports at Kyoto University Hospital, Kyoto, Japan, between January 2001 and March 2023 were retrospectively searched to find adult patients with hepatic hemangiomas >10 cm. Patients who were followed up without treatment for over six months were included. The maximum diameter of the hepatic hemangioma was compared between the baseline and the final CT or MRI. The clinical course of the patients was evaluated. RESULTS Twenty-two patients (17 women, five men; median age, 51 years) were identified. The median diameter of hepatic hemangiomas in the baseline study was 114 mm. Two patients had abdominal distention at the time of the baseline imaging, whereas the others were asymptomatic. After follow-up without treatment (the median; 95.5 months), enlargement, no change, shrinkage of hepatic hemangioma was observed in six, 11, and five patients, respectively. The median growth rate of hepatic hemangiomas was 2.5 mm/year. Two patients underwent liver resection for hepatic hemangioma, while the others were followed up without treatment. In four patients, symptoms appeared or worsened. Two patients died: one patient died from prostate cancer progression; the cause of death for the other was not confirmed. CONCLUSION Hepatic hemangiomas show a slow growth rate during follow-up, and shrinkage is occasionally observed. Some patients experience new symptoms or aggravation of symptoms; however, deaths associated with hepatic hemangiomas are uncommon.
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Affiliation(s)
- Yasuyuki Onishi
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Tsuyoshi Ohno
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Hironori Shimizu
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Kotaro Shimada
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Hiroyoshi Isoda
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | | | - Atsushi Takai
- Gastroenterology and Hepatology, Kyoto University, Kyoto, JPN
| | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
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Hossain MSA, Gul S, Chowdhury MEH, Khan MS, Sumon MSI, Bhuiyan EH, Khandakar A, Hossain M, Sadique A, Al-Hashimi I, Ayari MA, Mahmud S, Alqahtani A. Deep Learning Framework for Liver Segmentation from T1-Weighted MRI Images. SENSORS (BASEL, SWITZERLAND) 2023; 23:8890. [PMID: 37960589 PMCID: PMC10650219 DOI: 10.3390/s23218890] [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: 06/23/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/15/2023]
Abstract
The human liver exhibits variable characteristics and anatomical information, which is often ambiguous in radiological images. Machine learning can be of great assistance in automatically segmenting the liver in radiological images, which can be further processed for computer-aided diagnosis. Magnetic resonance imaging (MRI) is preferred by clinicians for liver pathology diagnosis over volumetric abdominal computerized tomography (CT) scans, due to their superior representation of soft tissues. The convenience of Hounsfield unit (HoU) based preprocessing in CT scans is not available in MRI, making automatic segmentation challenging for MR images. This study investigates multiple state-of-the-art segmentation networks for liver segmentation from volumetric MRI images. Here, T1-weighted (in-phase) scans are investigated using expert-labeled liver masks from a public dataset of 20 patients (647 MR slices) from the Combined Healthy Abdominal Organ Segmentation grant challenge (CHAOS). The reason for using T1-weighted images is that it demonstrates brighter fat content, thus providing enhanced images for the segmentation task. Twenty-four different state-of-the-art segmentation networks with varying depths of dense, residual, and inception encoder and decoder backbones were investigated for the task. A novel cascaded network is proposed to segment axial liver slices. The proposed framework outperforms existing approaches reported in the literature for the liver segmentation task (on the same test set) with a dice similarity coefficient (DSC) score and intersect over union (IoU) of 95.15% and 92.10%, respectively.
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Affiliation(s)
- Md. Sakib Abrar Hossain
- NSU Genome Research Institute (NGRI), North South University, Dhaka 1229, Bangladesh
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Sidra Gul
- Department of Computer Systems Engineering, University of Engineering and Technology Peshawar, Peshawar 25000, Pakistan
- Artificial Intelligence in Healthcare, IIPL, National Center of Artificial Intelligence, Peshawar 25000, Pakistan
| | | | | | | | - Enamul Haque Bhuiyan
- Center for Magnetic Resonance Research, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Maqsud Hossain
- NSU Genome Research Institute (NGRI), North South University, Dhaka 1229, Bangladesh
| | - Abdus Sadique
- NSU Genome Research Institute (NGRI), North South University, Dhaka 1229, Bangladesh
| | | | | | - Sakib Mahmud
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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Ghosh NK, R R, Singh A, Malage S, Sharma S, Kumar A, Singh RK, Behari A, Kumar A, Saxena R. Surgery for symptomatic hepatic hemangioma: Resection vs. enucleation, an experience over two decades. Ann Hepatobiliary Pancreat Surg 2023; 27:258-263. [PMID: 37127398 PMCID: PMC10472124 DOI: 10.14701/ahbps.22-130] [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] [Received: 12/13/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 05/03/2023] Open
Abstract
Backgrounds/Aims Hemangiomas are the most common benign liver lesions; however, they are usually asymptomatic and seldom require surgery. Enucleation and resection are the most commonly performed surgical procedures for symptomatic lesions. This study aims to compare the outcomes of these two surgical techniques. Methods A retrospective analysis of symptomatic hepatic hemangiomas (HH) operated upon between 2000 and 2021. Patients were categorized into the enucleation and resection groups. Demographic profile, intraoperative bleeding, and morbidity (Clavien-Dindo Grade) were compared. Independent t-test and chi-square tests were used for continuous and categorical variables respectively. p-value of < 0.05 was considered significant. Results Sixteen symptomatic HH patients aged 30 to 66 years underwent surgery (enucleation = 8, resection = 8) and majority were females (n = 10 [62.5%]). Fifteen patients presented with abdominal pain, and one patient had an interval increase in the size of the lesion from 9 to 12 cm. The size of hemangiomas varied from 6 to 23 cm. The median blood loss (enucleation: 350 vs. resection: 600 mL), operative time (enucleation: 5.8 vs. resection: 7.5 hours), and postoperative hospital stay (enucleation: 6.5 vs. resection: 11 days) were greater in the resection group (statistically insignificant). In the resection group, morbidity was significantly higher (62.6% vs. 12.5%, p = 0.05), including one mortality. All patients remained asymptomatic during the follow-up. Conclusions Enucleation was simpler with less morbidity as compared to resection in our series. However, considering the small number of patients, further studies are needed with comparable groups to confirm the superiority of enucleation over resection.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rahul R
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashish Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Somanath Malage
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Supriya Sharma
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rajan Saxena
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Liu T, Pan W, Lai S, Luo J. Can angiogenesis inhibitor therapy cause changes in imaging features of hepatic hemangioma- Initial study. Front Oncol 2023; 13:1134179. [PMID: 36969035 PMCID: PMC10036792 DOI: 10.3389/fonc.2023.1134179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundTo observe whether anti-angiogenesis therapy can induce changes in size and enhancement characteristics of hepatic hemangioma.Method133 patients with hepatic hemangioma lesions were analyzed and classified into a Bevacizumab group (n=65) and the control group (n=68). The parameters (Volume, CT enhancement ratio, enhancement patterns) of pre-and post-treatment in the bevacizumab and control groups independently calculated and compared by two radiologists. Correlation among the systolic blood pressure, diastolic blood pressure, heart rate with the hemangioma volume was evaluated using Pearson’s correlation analysis.ResultsThe hepatic hemangioma volume was significantly decreased after treatment in the Bevacizumab group (8.6 ± 18.7mL vs.7.3 ± 16.3mL, P<0.05), and there was no significant change in the control group (15.1 ± 19.8mL vs.15.4 ± 20.7mL, P = 0.504). A significant difference in enhancement patterns of hepatic hemangiomas was observed after treatment with Bevacizumab (P<0.01). There was no significant difference in arterial phase (AP)enhancement rate and arterial phase-portal venous phase (AP-PVP) enhancement ratios after treatment in the Bevacizumab and control groups (Ps>0.05).The Pearson correlation results showed that blood pressure, heart rate, and hemangioma volume were unrelated or weakly related before and after bevacizumab treatment under the control of factors including weight, contrast injection scheme and CT scanning scheme.ConclusionsAnti-angiogenesis therapy can cause changes in enhancement pattern and volume of hepatic hemangioma. Radiologists should pay more attention to the reexamination of tumor patients treated with anti-angiogenesis therapy.
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Jhan SR, Wu YY, Chang PY, Chai JW, Su TC. Comparison of ability of lesion detection of two MRI sequences of T2WI HASTE and T2WI BLADE for hepatocellular carcinoma. Medicine (Baltimore) 2023; 102:e32890. [PMID: 36820556 PMCID: PMC9907974 DOI: 10.1097/md.0000000000032890] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
We investigated the diagnostic accuracy of 2 magnetic resonance imaging (MRI) sequences of T2 weighted image (T2WI) half-Fourier acquired single turbo spin-echo (HASTE) and BLADE, for hepatocellular carcinoma (HCC) detection. From November 2010 to August 2018, patients diagnosed with HCC and regularly followed up, and who underwent MRI with 2 kinds of T2WI, were included in this study. The diagnosis of HCC was established based on histopathological findings or LI-RADS 4 and 5 by image. The sensitivities and positive predictive value for the detection of HCC by T2WI HASTE and BLADE were compared for each sequence. Quantitative assessment with lesion contrast-to-noise ratio and visual rating scoring of image quality, based on factors such as artifact, margin of organs, and vessel sharpness of the 2 sequences, were compared. No significant differences in lesion detection were observed based on paired comparison of all lesions and lesions larger than 1 cm across both sequences. The sensitivity was higher in larger than 1cm group in all sequences. The HASTE sequence had less motion artifact, but the BLADE images had advantage in edge sharpness of organs and vessels. The HASTE without fat-saturation seems to have better overall image quality. The lesions contrast-to-noise ratio of the 2 image modalities were not significantly different. Compared with T2 BLADE, T2 HASTE may be a more effective protocol for detecting HCC larger than 1 cm without loss of sensitivity. The accuracy of data from 2 T2WI protocols could be applied to streamline MRI protocols of HCC screening and surveillance.
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Affiliation(s)
- Song-Ru Jhan
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ying Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Electrical Engineering, National Chung Hsing University, Taichung, Taiwan
| | - Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
- Section of Radiology, College of Medicine, China Medical University, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Tainchung, Taiwan
| | - Te-Cheng Su
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine of Chung Shan Medical University, Taichung, Taiwan
- * Correspondence: Te-Cheng Su, Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan (e-mail: )
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Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part I - Cystic lesions. Dig Liver Dis 2022; 54:1469-1478. [PMID: 36089525 DOI: 10.1016/j.dld.2022.08.030] [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] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/29/2022]
Abstract
Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.
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Affiliation(s)
- Maurizio Pompili
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy.
| | - Francesco Ardito
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Cliniche, Chirurgiche, Diagnostiche e Pediatriche, IRCCS Fondazione Ospedale San Matteo, Università di Pavia, Unità di Malattie Infettive e Immunologia, Pavia, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Fabrizio Calliada
- Dipartimento di Radiologia, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Italy
| | - Umberto Cillo
- Chirurgia Epatobiliare e Trapianto di Fegato, Ospedale Universitario di Padova, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Facoltà di Medicina e Chirurgia, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Rita Golfieri
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Mauro Grova
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Salvatore Gruttadauria
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMCI, Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, Università di Catania, Palermo, Italy
| | - Maria Guido
- Dipartimento di Anatomia Patologica, Azienda ULSS2 Marca Trevigiana, Treviso, Italy; Dipartimento di Medicina - DIMED, Università di Padova, Italy
| | - Massimo Iavarone
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Duilio Pagano
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMC, Palermo, Italy
| | - Irene Pettinari
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Santopaolo
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Maurizio Soresi
- Medicina Interna, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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11
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Wilson A, Lim A. Microvascular imaging: new Doppler technology for assessing focal liver lesions. Is it useful? Clin Radiol 2022; 77:e807-e820. [DOI: 10.1016/j.crad.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022]
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12
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Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Pavlek G, Romic I, Silovski H, Müller-Rahmel L. [57-year-old patient with upper abdominal pain and anemia]. Dtsch Med Wochenschr 2022; 147:897-898. [PMID: 35868314 DOI: 10.1055/a-1820-4555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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14
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Schreyer AG, Grenacher L, Wessling J, Juchems M, Bazan Serrano GF, Ringe KI, Dendl LM. [Incidental and "leave me alone" findings of abdominal organs-part 1 : Liver, gall ducts and pancreas]. Radiologe 2022; 62:351-364. [PMID: 35352138 DOI: 10.1007/s00117-022-00987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/19/2022]
Abstract
Incidentalomas of the parenchymal organs of the abdomen, i.e. radiological findings in these organs that are not the primary focus of the clinical question, are frequent in this region of the body. In particular, findings presumed to be unimportant, such as cystic masses in the liver, the bile duct system or the pancreas, initially appear to be irrelevant in the diagnosis. For the liver we define the mostly clearly diagnosable simple cysts and hemangiomas as leave me alone lesions. Otherwise, we recommend a classification of incidentalomas into the three major categories (<0.5 cm, 0.5-1.5 cm and >1.5 cm) as well as an assessment with respect to clearly benign and suspect imaging characteristics in the context of a classification of patients into three different risk groups.
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Affiliation(s)
- A G Schreyer
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Brandenburg an der Havel, Medizinische Hochschule Brandenburg Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Deutschland.
| | | | - J Wessling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenshospital, Raphaelsklinik, EVK Münster, Münster, Deutschland
| | - M Juchems
- Diagnostische und Interventionelle Radiologie, Klinikum Konstanz, Konstanz, Deutschland
| | - G F Bazan Serrano
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Brandenburg an der Havel, Medizinische Hochschule Brandenburg Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Deutschland
| | - K I Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - L M Dendl
- Radiologie, Johanniter-Krankenhaus Treuenbrietzen, Treuenbrietzen, Deutschland
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A sonographic software program, Fluctuational Imaging, for diagnosis of hepatic hemangioma. Sci Rep 2022; 12:4701. [PMID: 35304519 PMCID: PMC8933546 DOI: 10.1038/s41598-022-08482-9] [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: 07/09/2021] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
Hepatic hemangioma is the most common benign solid lesion of the liver. Contrast-enhanced computed tomography or magnetic resonance imaging is recommended for definitive diagnosis of hepatic hemangioma. However, these modalities have drawbacks in terms of radiation exposure, invasiveness, and high cost for examination. “Fluttering sign” is one of the candidate findings considered specific for hepatic hemangioma that can be useful for diagnosis of hepatic hemangioma using grayscale US alone. However, the assessment is subjective and the findings are weak and likely to be overlooked in some cases. We developed a software program, Fluctuational Imaging, for objective detection and depiction of “fluttering sign”. Here, we evaluated the ability of Fluctuational Imaging software to depict “fluttering sign” in hepatic hemangioma. Presence or absence of “fluttering sign” was evaluated in the grayscale US videos and Fluctuational Imaging software analysis results of patients with hepatic hemangioma. The Cohen’s kappa test showed very good agreement (0.95). Fluctuational Imaging software can detect and depict the phenomenon of “fluttering sign” well and may be a useful tool for diagnosis of hepatic hemangioma.
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Farhat W, Ammar H, Said MA, Mizouni A, Ghabry L, Hammami E, Gupta R, Habiba Ben Hamada, Mabrouk MB, Ali AB. Surgical management of giant hepatic hemangioma: A 10-year single center experience. Ann Med Surg (Lond) 2021; 69:102542. [PMID: 34457247 PMCID: PMC8379432 DOI: 10.1016/j.amsu.2021.102542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic hemangiomas are the most typical benign mesenchymal lesions of the liver. Most of these lesions are asymptomatic. Giant hepatic hemangiomas (GHH) (>10 cm) are often symptomatic and require surgical intervention. This study aimed to describe the clinical findings, risk factors, diagnostic approach and management of GHH. Methods We performed a retrospective analysis of patients with GHH treated at our hospital from January 2008 to December 2018. The medical records of each patient were reviewed to obtain the clinical and surgical data. Results Twelve patients with GHH were treated during the study period. 9 were female and 3 were male. The mean age of diagnosis was 48,2 years. The most common presenting symptom was abdominal pain. Eight patients presented an abdominal mass. Indications for surgical resections were rupture (n = 2), Kasabach-Merritt syndrome (n = 1) and abdominal pain (n = 9). Right hepatectomy was done in four patients, left lobectomy in four patients, and enucleation in four patients. Embolization was performed in 4 patients, but due to the persistence of symptoms or bleeding, surgery was indicated. The mean operative time was 3.5 h, and median blood loss was 870 ml. The median hospital stay was 5.3 days. For four patients, we registered postoperative complications causing death in one case. All alive patients were asymptomatic at a median follow-up of 55 months. Conclusion Despite limitations and alternative modalities, surgery remains the only effective curative treatment for GHH. Hepatic hemangiomas are the most common benign tumors of the liver with the incidence of 0.4–20%. Giant hepatic hemangiomas (GHH) are usually responsible for overt clinical symptoms and complications. Management of liver hemangiomas ranges from close observation to surgery depending upon the site, size and symptoms. Surgical resection is indicated in patients with abdominal complaints or complications, or when diagnosis remains inconclusive.
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Affiliation(s)
- Waad Farhat
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | | | | | - Linda Ghabry
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Eya Hammami
- Department of Gastroenterology, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Sciences, Synergy Institute of Medical Sciences, Dehradun, India
| | | | | | - Ali Ben Ali
- Department of Digestive Surgery, Sahloul Hospital, Sousse, Tunisia
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17
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Haring MPD, Cuperus FJC, Duiker EW, de Haas RJ, de Meijer VE. Scoping review of clinical practice guidelines on the management of benign liver tumours. BMJ Open Gastroenterol 2021; 8:bmjgast-2020-000592. [PMID: 34362758 PMCID: PMC8351490 DOI: 10.1136/bmjgast-2020-000592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/18/2021] [Indexed: 12/18/2022] Open
Abstract
Objective Benign liver tumours (BLT) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of BLT. High-quality clinical practice guidelines are needed, because of the many nuances in tumour types, diagnostic modalities, and conservative and invasive management strategies. Yet, available observational evidence is subject to interpretation which may lead to practice variation. Therefore, we aimed to systematically search for available clinical practice guidelines on BLT, to critically appraise them, and to compare management recommendations. Design A scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to. Results The literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging. Conclusion Recognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.
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Affiliation(s)
- Martijn P D Haring
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Frans J C Cuperus
- Department of Hepatology and Gastroenterology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Evelien W Duiker
- Department of Medical Biology and Pathology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Vincent E de Meijer
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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18
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Saito K, Araki Y, Kokubo R, Kurata C, Wakabayashi Y, Suzuki K. Abdominal Organ Enhancement in Dynamic MRI using 1 M Gadobutrol vs 0.5 M Meglumine Gadoterate in Liver of Hemangioma Patients. Curr Med Imaging 2021; 17:662-668. [PMID: 33172380 DOI: 10.2174/1573405616999201109215827] [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: 03/03/2020] [Revised: 08/15/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The utility of gadobutrol (GAD) which is higher r1 value contrast media for evaluating abdominal solid organ have not been fully evaluated. OBJECTIVE To compare the contrast enhancement of abdominal organs on dynamic MRI using 0.1 mmol/kg 1.0 M GAD or 0.5 M meglumine gadoterate (MG) in patients with a liver hemangioma. METHODS A phantom study was performed at different concentrations (0.05, 0.1, 0.3, 0.5, 0.7, 0.9, 1.0, 5.0 and 10 mmol/L) of GAD and MG. Sixty-two patients with a liver hemangioma were enrolled. Contrast media was injected at a rate of 2 mL/s followed by 40 mL of saline. Two arterial phases, a portal phase and an equilibrium phase were obtained. One certified radiologist set regions of interest on the abdominal aorta, liver, pancreas, spleen and the liver hemangioma. The relative enhancement ratio (RER) was calculated. RESULTS In the phantom study the signal intensity of both contrast media was similar at lower concentrations. However, the signal intensity of MG was higher at concentrations of more than 5.0 mmol/L. In the clinical study the RER of the abdominal viscera during the portal and equilibrium phases was higher with GAD. The hemangioma had a higher equilibrium phase enhancement with GAD. The aortic RER was equivalent during all phases and the liver RER during the 2nd arterial phase was higher with GAD. The arterial phase during GAD imaging might have been measured later than was optimal. CONCLUSION When the same injection protocol was used for an abdominal dynamic MRI, arterial phase imaging was late when GAD was used. The higher T1 relaxation value was significantly higher in the abdominal viscera during the portal and equilibrium phases, while the liver hemangioma also had significantly higher contrast enhancement during the equilibrium phase. CLINICAL TRIAL REGISTRATION NUMBER 3186.
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Affiliation(s)
- Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Yoichi Araki
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Reiji Kokubo
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Chishio Kurata
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | | | - Kunihito Suzuki
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
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Hepatic sclerosed hemangioma and sclerosing cavernous hemangioma: a radiological study. Jpn J Radiol 2021; 39:1059-1068. [PMID: 34041675 PMCID: PMC8568860 DOI: 10.1007/s11604-021-01139-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022]
Abstract
Purpose To investigate and compare the CT and MRI features of hepatic sclerosed hemangioma (HSH) and sclerosing cavernous hemangioma (SCH). Materials and methods Twelve HSH cases and 36 SCH cases were included, the imaging findings on CT (9 HSH and 34 SCH) and MRI (8 HSH and 10 SCH) were analyzed. Qualitative image analysis included the location, size, shape, capsular retraction, density, calcification, signal intensity on T1-weighted image (T1WI) and T2-weighted image (T2WI), presence of diffusion restriction, apparent diffusion coefficient (ADC) map, transient hepatic attenuation difference around the lesion, and the dynamic enhancement patterns. Results The presence of liver cirrhosis in patients with HSH (3/12) was higher than SCH (1/36) (P = 0.043). The morphology appearance before enhancement showed no significant difference between HSH and SCH. Moreover, SCH had a stronger trend of centripetal enhancement patterns of cavernous hemangiomas (83.3%) compared to HSH (25%) (P < 0.001). Due to more frequent atypical enhancement features, containing rim-like enhancement, no enhancement, and peripheral heterogeneous enhancement, the misdiagnosis rate of HSH (75%) was significantly higher than that of SCH (16.7%) (P < 0.001). Furthermore, the ADC values of HSH and SCH were both higher than that of the surrounding liver parenchyma (P = 0.009, P = 0.002); however, there was no significant difference in ADC values between themselves (P = 0.613). Conclusion SCH showed the same trend of centripetal enhancement characteristics as typical hemangioma, while HSH exhibited atypical enhancement features due to complete sclerosis. Higher ADC values might contribute to the identification of atypical HSH and SCH from malignancies.
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20
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Bae H, Lee H, Kim S, Han K, Rhee H, Kim DK, Kwon H, Hong H, Lim JS. Radiomics analysis of contrast-enhanced CT for classification of hepatic focal lesions in colorectal cancer patients: its limitations compared to radiologists. Eur Radiol 2021; 31:8786-8796. [PMID: 33970307 DOI: 10.1007/s00330-021-07877-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate diagnostic performance of a radiomics model for classifying hepatic cyst, hemangioma, and metastasis in patients with colorectal cancer (CRC) from portal-phase abdominopelvic CT images. METHODS This retrospective study included 502 CRC patients who underwent contrast-enhanced CT and contrast-enhanced liver MRI between January 2005 and December 2010. Portal-phase CT images of training (n = 386) and validation (n = 116) cohorts were used to develop a radiomics model for differentiating three classes of liver lesions. Among multiple handcrafted features, the feature selection was performed using ReliefF method, and random forest classifiers were used to train the selected features. Diagnostic performance of the developed model was compared with that of four radiologists. A subgroup analysis was conducted based on lesion size. RESULTS The radiomics model demonstrated significantly lower overall and hemangioma- and metastasis-specific polytomous discrimination index (PDI) (overall, 0.8037; hemangioma-specific, 0.6653; metastasis-specific, 0.8027) than the radiologists (overall, 0.9622-0.9680; hemangioma-specific, 0.9452-0.9630; metastasis-specific, 0.9511-0.9869). For subgroup analysis, the PDI of the radiomics model was different according to the lesion size (< 10 mm, 0.6486; ≥ 10 mm, 0.8264) while that of the radiologists was relatively maintained. For classifying metastasis from benign lesions, the radiomics model showed excellent diagnostic performance, with an accuracy of 84.36% and an AUC of 0.9426. CONCLUSION Albeit inferior to the radiologists, the radiomics model achieved substantial diagnostic performance when differentiating hepatic lesions from portal-phase CT images of CRC patients. This model was limited particularly to classifying hemangiomas and subcentimeter lesions. KEY POINTS • Albeit inferior to the radiologists, the radiomics model could differentiate cyst, hemangioma, and metastasis with substantial diagnostic performance using portal-phase CT images of colorectal cancer patients. • The radiomics model demonstrated limitations especially in classifying hemangiomas and subcentimeter liver lesions.
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Affiliation(s)
- Heejin Bae
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hansang Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sungwon Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyungjin Rhee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dong-Kyu Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyuk Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Helen Hong
- Department of Software Convergence, College of Interdisciplinary Studies for Emerging Industries, Seoul Women's University, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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21
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Lin J, Westerhoff M. Vascular Neoplasms of the Liver. Clin Liver Dis (Hoboken) 2021; 17:261-266. [PMID: 33968386 PMCID: PMC8087917 DOI: 10.1002/cld.1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/17/2020] [Accepted: 08/23/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jingmei Lin
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisIN
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22
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Takayama Y, Nishie A, Okamoto D, Fujita N, Asayama Y, Ushijima Y, Yoshizumi T, Yoneyama M, Ishigami K. Differentiating Liver Hemangioma from Metastatic Tumor Using T2-enhanced Spin-echo Imaging with a Time-reversed Gradient-echo Sequence in the Hepatobiliary Phase of Gadoxetic Acid-enhanced MR Imaging. Magn Reson Med Sci 2021; 21:445-457. [PMID: 33883364 PMCID: PMC9316131 DOI: 10.2463/mrms.mp.2020-0151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: To evaluate the utility of T2-enhanced spin-echo imaging using the time-reversed gradient echo sequence (T2FFE imaging) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for differentiating hemangiomas from metastatic tumors. Methods: A total of 61 patients with 133 liver lesions, including 37 hemangiomas and 96 metastatic tumors, were scanned by Gd-EOB-MRI. Four data sets were independently analyzed by two readers: (1) 3D fat-suppressed T2-weighted imaging (FS-T2WI) alone; (2) the combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI; (3) the combination of 3D FS-T2WI, diffusion-weighted imaging (DWI) with the b-value of 1000 s/mm2 and the apparent diffusion coefficient (ADC); and (4) a dynamic study of Gd-EOB-MRI. After classifying the lesion sizes as ≤ 10 mm or > 10 mm, we conducted a receiver-operating characteristic analysis to compare diagnostic accuracies among the four data sets for differentiating hemangiomas from metastatic tumors. Results: The areas under the curves (AUCs) of the four data sets of two readers were: (1) ≤ 10 mm (0.85 and 0.91) and > 10 mm (0.88 and 0.97), (2) ≤ 10 mm (0.94 and 0.94) and > 10 mm (0.96 and 0.95), (3) ≤ 10 mm (0.90 and 0.87) and > 10 mm (0.89 and 0.95), and (4) ≤ 10 mm (0.62 and 0.67) and > 10 mm (0.76 and 0.71), respectively. Data sets (2) and (3) showed no significant differences in AUCs, but both showed significantly higher AUCs compared to that of (4) regardless of the lesion size (P < 0.05). Conclusion: The combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI achieved an accuracy equivalent to that of the combination of 3D FS-T2WI, DWI, and ADC and might be helpful in differentiating hemangiomas from metastatic tumors.
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Affiliation(s)
- Yukihisa Takayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Yoshiki Asayama
- Department of Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
| | | | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
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Lee NK, Kim S, Hong SB, Lee SJ, Seo HI. Multilocular cystic hemangioma of the liver mimicking mucinous cystic neoplasm. Yeungnam Univ J Med 2021; 39:53-57. [PMID: 33823568 PMCID: PMC8895960 DOI: 10.12701/yujm.2021.00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
Hepatic hemangiomas infrequently exhibit atypical imaging features, which may cause diagnostic confusion with hepatic malignancies and lead to unnecessary surgery. We report a rare case of multilocular cystic hemangioma of the liver mimicking a mucinous cystic neoplasm of the liver in a 48-year-old female, focusing on computed tomography and magnetic resonance imaging features and their differential diagnosis.
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Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute and Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute and Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute and Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - So Jeong Lee
- Department of Pathology, Biomedical Research Institute and Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyung Il Seo
- Department of Surgery, Biomedical Research Institute and Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Local Ablation Versus Surgical Resection for Liver Hemangioma: a Systematic Review and Meta-analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Mahmood KA, Rashid RJ, Fateh SM, Mohammed NA. Evaluation of the Effect of Patient Preparation Using Castor Oil on ADC Value of Focal Liver Lesion. Int J Gen Med 2021; 14:469-474. [PMID: 33623419 PMCID: PMC7896795 DOI: 10.2147/ijgm.s289661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the role of patient preparation using castor oil on the ADC value of focal liver lesion. Patients and Methods Retrospective case-control study over more than two years. Magnetic resonance imaging (MRI) scan, including diffusion-weighted imaging (DWI) of the upper abdomen performed for 87 cases and 71 controls in patients with focal hepatic hemangiomas. Cases were prepared using castor oil prior to the scan without identifiable unwanted effect, while controls did not receive any special preparation. Since liver hemangioma is a common lesion, it was selected and used as a sample. Apparent Diffusion Coefficient (ADC) values of focal liver lesion were calculated in cases and controls. Results The mean ADC value of liver hemangioma was lower in cases compared to controls; the mean ADC value was (2.21±0.39x10ˉ3mm2/s) in cases and (2.51±0.49x10ˉ3mm2/s) in controls. Left lobes were more affected by lesions; the mean ADC value of the left lobe lesions was (2.26±0.37 x10ˉ3mm2/s) and (2.86±0.43 x10ˉ3mm2/s) in cases and controls, respectively. The ADC value of lesions in the right lobe was (2.19±0.39x10ˉ3mm2/s) in cases and (2.39± 0.45x10ˉ3mm2/s) in controls. There was a significant segmental ADC variation; lesions at segments II, III, IVb, and V demonstrated illusive ADC elevation in controls. Conclusion There is erroneous elevation of lobar and segmental ADC value of liver hemangiomas in non prepared patients. This Potential source of error (peristalsis, partial volume, and paramagnetic gas effect of gastrointestinal tract) on hepatic lesions’ ADC value can be avoided by proper preparation using castor oil prior to MRI scanning.
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Affiliation(s)
- Kawa Abdulla Mahmood
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Rezheen Jamal Rashid
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Salah Mohammed Fateh
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Naser Abdullah Mohammed
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
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Dane B, Shanbhogue K, Menias CO, Taffel MT. The humbling hemangioma: uncommon CT and MRI imaging features and mimickers of hepatic hemangiomas. Clin Imaging 2021; 74:55-63. [PMID: 33434867 DOI: 10.1016/j.clinimag.2020.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, Department of Radiology, United States of America.
| | | | - Christine O Menias
- Mayo Clinic, Department of Radiology, Scottsdale, AZ, United States of America
| | - Myles T Taffel
- NYU Langone Health, Department of Radiology, United States of America
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Hepatic Sclerosing Hemangioma Mimicking Malignancy: A Case and Literature Review. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2021; 9:144-146. [PMID: 33447656 PMCID: PMC7806202 DOI: 10.12691/ajmcr-9-3-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Sclerosing hemangiomas of the liver are rare, benign tumors with degenerative changes. These degenerative changes, however, often obscure the true, benign nature of the tumor and give them features indistinguishable from other malignant processes, thus making the diagnosis difficult. CASE PRESENTATION A 70-year-old male without any previously diagnosed liver disease or malignant process presented with incidental right hepatic mass in ultrasonography and weight loss. Physical exam was unremarkable. The labs were significant for mild pancytopenia, elevated total bilirubin and slightly decreased transferrin. Follow-up triple phase-contrast CT scan of the abdomen revealed a lobulated, poorly demarcated lesion measuring 4.8 x 4.5 cm, located in segment V of the liver with encasement of the left portal branch. The overall picture was indeterminate but highly suspicious for malignancy. A decision was made to perform a CT-guided biopsy which revealed sclerosing hemangioma of the liver. CONCLUSION It is challenging to differentiate sclerosing hepatic hemangioma from atypical hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastatic tumors utilizing only imaging modalities. The diagnostic workup should include biopsy of the atypical liver lesion which unveils the final diagnosis and avoid subjecting the patient to an extensive, and invasive surgical resection.
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Boey CY, Mohamed Aslum Khan F, Amir Hassan SZ. Giant Liver Hemangioma Mimicking a Hydronephrotic Kidney on 99mTc-DTPA Scintigraphy. Clin Nucl Med 2021; 46:88-89. [PMID: 33181737 DOI: 10.1097/rlu.0000000000003368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report a case of a 56-year-old woman who underwent Tc-DTPA renal scintigraphy for the evaluation of a right pelviureteric junction calculi, which incidentally showed radiotracer uptake in a giant liver hemangioma. The initial scintigraphic images showed a large lobulated lesion with peripheral uptake of radiotracer at the right abdominal region, resembling a large hydronephrotic kidney. However, the pattern of progression of the radiotracer, coupled with the clinical history and available corresponding radiologic images, confirmed the uptake to be that of a giant liver hemangioma.
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Mogahed MM, Zytoon AA, Essa B, Abdellatif W, Ghanem N, ElWakeel B. Natural history of hepatic hemangiomas as a guide for surgical indication. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Generally, hemangiomas are asymptomatic and most lesions are incidentally diagnosed on abdominal ultrasonography. The indications for surgery are still debated mainly due to limited data about the natural history of hepatic hemangiomas. The aim of this study is to investigate the natural history of hepatic hemangiomas, the effects of age and sex on their growth, and their tendency to increase in size or causing symptoms or complications as a guide for surgical indication. In this current study, combined retrospective and prospective analysis was conducted on 186 Egyptian adult patients having 244 hepatic hemangiomas who attended to the outpatient clinics. Follow-up was performed to observe the accurate site, size, number, rate of growth of the lesions, and their tendency to cause symptoms or complications.
Results
Ninety-one percent of patients were asymptomatic and 9% were symptomatic. During follow-up, 48% of patients showed an increase in tumor diameter, 22% decreased, and 30% were stable. The growth rate at 18–45-year group showed an increasing trend that was higher in females; it was 3.3 ± 2 mm/year for males and 3.9 ± 1.8 mm/year for females. At ˃ 45 year group, the female patients showed a decreasing trend (− 2.1 ± 1.1 mm/year) while in males showed an increasing trend that was slower than in 18–45-year group (2.6 ± 1.7 mm/year).
Conclusion
Growth pattern of liver hemangiomas is affected by age and sex. The majority of hemangiomas are asymptomatic and complications are rare. Hemangioma size alone is not an indication for surgery in asymptomatic patients. Surgical indications are limited to patients with severe symptoms, complications, or suspicious lesions. Most hemangiomas can be managed conservatively even giant hemangiomas.
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Surgical Treatment of Giant Liver Hemangioma, Case Report and Literature Review. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 53:318-321. [PMID: 32377104 PMCID: PMC7192281 DOI: 10.14744/semb.2017.09815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/08/2017] [Indexed: 11/21/2022]
Abstract
Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases, they are small, asymptomatic and often require follow up. Giant hemangiomas are known as being larger than 5 cm and mostly consists of a cavernous haemangioma, is usually asymptomatic, diagnosed incidentally. In this study, we aimed to show that giant hemangiomas would be treated safely with surgical resection without transarterial embolization before the surgery. We present a 56-year-old male patient with liver hemangioma, who was diagnosed incidentally on thorax computarised tomography and consulted to thorax disease clinic with coughing complaint for a month. A case, which is rarely mentioned in literature, of a 30 cm sized asymptomatic giant cavernous hemangioma treated by surgical resection without any complication. We suggest that some patients should go through surgical treatment even if they do not have any complaint. Not only symptoms but also size and risk of rupture by trauma should be considered in these cases. However, all possible circumstances must be taken under consideration. Transarterial embolization is not the necessary.
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Mamone G, Di Piazza A, Carollo V, Cannataci C, Cortis K, Bartolotta TV, Miraglia R. Imaging of hepatic hemangioma: from A to Z. Abdom Radiol (NY) 2020; 45:672-691. [PMID: 31686179 DOI: 10.1007/s00261-019-02294-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.
| | - Ambra Di Piazza
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Vincenzo Carollo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | | | - Kelvin Cortis
- Department of Radiology, Mater Dei Hospital, Msida, Malta
| | - Tommaso Vincenzo Bartolotta
- Dipartimento di Biomedicina, neuroscienze e diagnostica avanzata (Bi.ND) - Università degli studi di Palermo, Palermo, Italy
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
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Patacsil SJ, Noor M, Leyva A. A Review of Benign Hepatic Tumors and Their Imaging Characteristics. Cureus 2020; 12:e6813. [PMID: 32140369 PMCID: PMC7047931 DOI: 10.7759/cureus.6813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This paper concisely reviews the benign hepatic tumors most commonly encountered by clinicians. It includes the epidemiology, pathology, and imaging characteristics of hepatic hemangiomas, focal nodular hyperplasia (FNH), and hepatic adenomas (HAs).
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Sweed DM, Fayed ZA, Sweed EM, El-Sherif A, Mohamady M. Hepatic sclerosing hemangioma mimics hepatic malignancies: a case report and multidisciplinary approach. EGYPTIAN LIVER JOURNAL 2019. [DOI: 10.1186/s43066-019-0007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hepatic sclerosing hemangiomas (HSH) are rare benign vascular tumors that mimic radiologically hepatic malignancies. HSH is characterized by extensive fibrosis and hyalinosis as a result of degeneration and thrombosis. Pre-operative diagnosis is very difficult and most of the cases undergo surgical resections.
Case presentation
A 65 years old, hepatitis C virus-infected female presented by an accidentally discovered hepatic focal lesion. Magnetic resonance imaging (MRI) showed a T2 hyperintense mass displaying peripheral enhancement in porto-venous phase. The patient had a simultaneous typical hepatic hemangioma and multiple vertebral bodies’ hemangiomata. Tissue-guided biopsy revealed a densely sclerotic stroma containing vascular spaces with occasional obliteration of the lumen. Immunohistochemical staining was performed for Pan CK, CD34, SMA, VEGF, and c-Kit which confirmed the vascular nature of neoplasm and the involuting phase of hemangioma development. The patient was reassured and recommended for a regular radiological follow-up to reassess the lesion size.
Conclusion
The definitive preoperative diagnosis of HSH is still problematic. However, the awareness of surgeons by this entity, peripheral enhancement in porto-venous phase on dynamic MRI, the presence of simultaneous typical hepatic hemangioma in the absence of cancer history could raise suspicion for HSH. Liver biopsy is still the gold standard in approaching the accurate diagnosis.
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Differentiation of Hepatic Sclerosed Hemangiomas From Cavernous Hemangiomas Based on Gadoxetic Acid-Enhanced Magnetic Resonance Imaging Features. J Comput Assist Tomogr 2019; 43:762-769. [PMID: 31356526 DOI: 10.1097/rct.0000000000000905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the imaging features of a hepatic sclerosed hemangioma by comparing them with those of a cavernous hemangioma using magnetic resonance imaging with gadoxetic acid enhancement. METHODS Nine patients with hepatic sclerosed hemangiomas and 36 patients with cavernous hemangiomas (control group) who underwent gadoxetic acid-enhanced magnetic resonance imaging were included. Qualitative values (imaging findings and enhancement pattern [typical vs atypical enhancement]) and quantitative values (apparent diffusion coefficient) were evaluated. RESULTS Patients with sclerosed hemangiomas showed significantly more irregular tumor margin on hepatobiliary phase images, peritumoral arterial enhancement, and a lower proportion of hyperintensity on heavily T2-weighted images compared with controls (all P values <0.05). In addition, the sclerosed hemangioma group had significantly more frequent atypical enhancement patterns than did the control group (88.9% vs 33.3%; P = 0.006). However, the mean apparent diffusion coefficient value of hemangiomas was not significantly different between the 2 groups (P = 0.639). CONCLUSIONS Gadoxetic acid-enhanced magnetic resonance images can help in differentiating between hepatic sclerosed hemangiomas and cavernous hemangiomas.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy
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36
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Wu S, Zuo D, Hong Y. The Prevalence of Hyperechoic Rim in Solid Focal Liver Lesions and Its Implication. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318798365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The objective of this study was to investigate the prevalence and clinical implications of the hyperechoic rim of liver focal solid lesions. A retrospective review was conducted of sonograms of focal liver lesions with a hyperechoic rim, as well as relative examinations such as computed tomography, magnetic resonance imaging, biopsy, resection, and histopathology reports. A cohort of 10 232 patients was found to have solid focal liver lesions (2030 malignant, 8202 benign). A hyperechoic rim was determined in 182 hemangiomas, 2 granulomas, 2 hepatocellular carcinomas (HCCs), and 4 other malignancies. There were significant differences between malignant and benign lesions ( P < .001), between HCCs and hemangiomas ( P < .001), between malignancies and hemangiomas ( P < .001), between HCCs and granulomas ( P = .044), and between other malignancies and granulomas ( P = .005). There was no significant difference between liver granulomas and hemangiomas ( P = .656). In this study, a hyperechoic rim in solid focal liver lesions appeared mainly in hemangiomas, granulomas, and rarely in malignant lesions.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Dongsheng Zuo
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yamin Hong
- Department of Radiology, the First Affiliated Hospital of Hainan Medical University, Haikou, China
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Pang G, Duan Z, Shao C, Zhao F, Zhong H, Shao G. Heterogeneity analysis of triphasic CT scan perfusion parameters in differential diagnosis of hepatocellular carcinoma and hemangioma. Medicine (Baltimore) 2018; 97:e12512. [PMID: 30235766 PMCID: PMC6160147 DOI: 10.1097/md.0000000000012512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study is to investigate quantitative measures and heterogeneity of perfusion parameters in the differential diagnosis of hepatocellular carcinoma (HCC) and hemangioma.In total, 32 HCC and 44 hemangioma (types 1, 2, and 3) cases were included in this retrospective study. Hepatic artery coefficient (HAC), portal vein coefficient (PVC), and arterial enhancement fraction (AEF) were calculated. Tumor heterogeneity was analyzed. Perfusion parameters and corresponding percentiles were compared between the HCC and hemangioma (especially atypical hemangioma) cases, as well as between the substantial lesion part and surrounding normal tissue.The mean value, and the 10th, 50th, 75th, and 90th percentiles of PVC were significantly lower in the HCC cases than the types 1 and 2 hemangioma cases (P < .01). Moreover, the 90th percentile PVC in the HCC cases was also significantly lower than the type 3 hemangioma case (P < .01), while the mean value, and all the percentiles of AEF in the HCC cases were higher than the types 2 and 3 hemangioma cases (P < .01). The 10th percentile HAC in the HCC cases was higher than the type 2 hemangioma cases (P < .05). The mean value, and the 10th and 50th percentile HAC in the HCC cases were higher than the type 3 hemangioma case (P < .05). However, there was no statistically significant difference in HAC between the HCC and type 1 hemangioma cases (P > .05).Quantitative measurement of perfusion parameters and heterogeneity analysis show significance differences in the early detection and differential diagnosis of HCC and hemangioma cases, which might contribute to increasing the diagnostic accuracy.
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Affiliation(s)
- Guodong Pang
- Department of Radiology, The Second Hospital of Shandong University, Jinan
| | - Zuyun Duan
- Department of Radiology, The Second People's Hospital of Dongying, Dongying
| | - Chunchun Shao
- Department of Evidence-Based Medicine, The Second Hospital of Shandong University
| | - Fang Zhao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hai Zhong
- Department of Radiology, The Second Hospital of Shandong University, Jinan
| | - Guangrui Shao
- Department of Radiology, The Second Hospital of Shandong University, Jinan
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Utility of contrast-enhanced ultrasonography with perflubutane in evaluating indications for diagnostic percutaneous tumor biopsy in a case of hepatic sclerosed hemangioma. Clin J Gastroenterol 2018; 11:514-520. [DOI: 10.1007/s12328-018-0880-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022]
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Yugawa K, Yoshizumi T, Harada N, Motomura T, Harimoto N, Itoh S, Ikegami T, Soejima Y, Maehara Y. Multiple hepatic sclerosing hemangiomas: a case report and review of the literature. Surg Case Rep 2018; 4:60. [PMID: 29916092 PMCID: PMC6006004 DOI: 10.1186/s40792-018-0468-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic sclerosing hemangioma, a very rare benign tumor, is characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma. Such atypical hemangiomas can be diagnosed incorrectly as primary or metastatic malignancies based on imaging characteristics. We present herein a rare case of giant and multiple hepatic sclerosing hemangiomas that are difficult to differentiate from hepatic malignancies and review the relevant literature. Case presentation The patient was a 48-year-old male who was found to have multiple hepatic tumors and a giant tumor (67 × 53 mm) superior to the inferior vena cave by an abdominal ultrasonography during a routine medical examination. The patient was referred to our hospital for further evaluations and diagnosis of the multiple hepatic tumors. Dynamic CT showed low-density tumors in the delayed phase suggestive of membrane-covered lesions. EOB-MRI demonstrated a mass with low-signal intensity mass on T1-weighted images and areas of high-signal intensity on T2-weighted images and a hypointense mass in the hepatobiliary phase, which showed high intensity on DWI-based ADC map. FDG-PET showed no accumulation of [18F]-FDG. A provisional diagnosis of multiple scirrhous hepatocellular carcinomas was made on the basis of these imaging studies, and caudate lobectomy of the liver and partial hepatectomy of S2 and S6 were performed. Histopathological examination showed that the tumors were composed of various sized irregularly dilated vessels with some blood thrombi, inflammatory cell infiltration, fibrous and hyalinized sclerotic or myxomatous stroma, resulting in a diagnosis of multiple hepatic sclerosing hemangiomas. Conclusions Differentiation of multiple sclerosing hemangiomas from other hepatic malignant tumors, such as intrahepatic cholangiocarcinoma, metastatic liver cancer, and scirrhous hepatocellular carcinoma characterized by abundant fibrous stroma, is difficult because the radiological findings are very similar. Inclusion of hepatic sclerosing hemangioma in the differential diagnosis of multiple liver tumors could enable optimal management; this possibility is important to consider before planning invasive therapies.
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Affiliation(s)
- Kyohei Yugawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takashi Motomura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Norifumi Harimoto
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Showa-machi 3-39-22, Maebashi-shi, Gunma, 371-85111, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuji Soejima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan
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Ozaki K, Yoshikawa J, Yamamoto T, Maeda K, Kaizaki Y. Preoperative diagnosis of the sclerosed hemangioma of the liver using multimodality imaging findings: A case report. Radiol Case Rep 2018; 13:1025-1029. [PMID: 30228837 PMCID: PMC6137339 DOI: 10.1016/j.radcr.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/01/2018] [Indexed: 11/13/2022] Open
Abstract
A sclerosed hemangioma of the liver is a rare benign lesion characterized by fibrosis and hyalinization of a hepatic cavernous hemangioma as a result of degeneration. This condition has been difficult to correctly diagnose with imaging. Our patient was a 57-year-old man whose computed tomography (CT) scan showed a mass of 45 mm in diameter in the lateral segment. On dynamic contrast-enhanced CT, the lesion was found to comprise peripheral, gradual, and heterogeneous enhanced areas with a central nonenhanced area; malignancy was suspected. On magnetic resonance imaging, the peripheral area showed slight hperintensity on T2-weighted image, and showed a similar intensity on T1- and diffusion-weighted images as compared to the background liver and gradual enhancement, and the presence of abundant fibrous tissue was suspected. Conversely, the central area showed remarkable hyperintensity on T2-weighted images and no enhancement, and degeneration or hyalinization was suspected. The mass showed no uptake of fluorine-18 fludeoxyglucose (FDG). Some imaging findings suspected a benign tumor, and sclerosed hemangioma with abundant fibrosis and hyalinization was pathologically confirmed. Herein, we report a case of sclerosed hemangioma focusing on possible preoperative diagnosis using a combination of multimodality imaging findings—diffusion-weighted imaging and FDG-positron emission tomography imaging.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Jun Yoshikawa
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Toru Yamamoto
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Kazuya Maeda
- Department of Surgery, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Yasuharu Kaizaki
- Department of Pathology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
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Dietrich CF, Tana C, Caraiani C, Dong Y. Contrast enhanced ultrasound (CEUS) imaging of solid benign focal liver lesions. Expert Rev Gastroenterol Hepatol 2018; 12:479-489. [PMID: 29658347 DOI: 10.1080/17474124.2018.1464389] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasound is well accepted worldwide for imaging of the liver. Absences of radiation exposure, low cost and large diffusion are some of the advantages that make this technique the first to be used in the assessment of focal liver lesions (FLL). Areas covered: Contrast enhanced ultrasound (CEUS) has been introduced more than twenty years ago, and its detection rate is comparable to that of contrast enhanced magnetic resonance imaging (CEMRI) and contrast enhanced computed tomography (CECT). In this narrative review, we discuss the main CEUS features of benign liver lesions and controversies in published results including the gold standard chosen and the quality and knowledge of the preferred techniques. Expert commentary: CEUS is safe and allows an immediate evaluation of the nature of FLL. CEUS permits differentiation between malignant and benign FLL in healthy liver parenchyma by analysing the arterial, portal venous and late phases. CEMRI and CECT are reliable to characterize FLL but higher costs, radiation exposure, nephrotoxicity (in particular for CECT) and absence of real time imaging limit the appropriate evaluation of FLL. Therefore CEUS can be preferred in most clinical situations, and when results are unclear or suggestive for malignant FLL, biopsy and histological examination can be directly initiated avoiding unnecessary additional imaging.
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Affiliation(s)
- Christoph F Dietrich
- a Department of Internal Medicine 2 , Caritas Krankenhaus , Bad Mergentheim , Germany.,b Ultrasound Department , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Claudio Tana
- c Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department , University-Hospital of Parma , Parma , Italy
| | - Cosmin Caraiani
- d Department of Radiology , University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Yi Dong
- e Department of Ultrasound , Zhongshan Hospital, Fudan University , Shanghai , China
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Yin X, Huang X, Li Q, Li L, Niu P, Cao M, Guo F, Li X, Tan W, Huo Y. Hepatic Hemangiomas Alter Morphometry and Impair Hemodynamics of the Abdominal Aorta and Primary Branches From Computer Simulations. Front Physiol 2018; 9:334. [PMID: 29674973 PMCID: PMC5895747 DOI: 10.3389/fphys.2018.00334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/16/2018] [Indexed: 01/25/2023] Open
Abstract
Background: The formation of hepatic hemangiomas (HH) is associated with VEGF and IL-7 that alter conduit arteries and small arterioles. To our knowledge, there are no studies to investigate the effects of HH on the hemodynamics in conduit arteries. The aim of the study is to perform morphometric and hemodynamic analysis in abdominal conduit arteries and bifurcations of HH patients and controls. Methods: Based on morphometry reconstructed from CT images, geometrical models were meshed with prismatic elements for the near wall region and tetrahedral and hexahedral elements for the core region. Simulations were performed for computation of the non-Newtonian blood flow using the Carreau-Yasuda model, based on which multiple hemodynamic parameters were determined. Results: There was an increase of the lumen size, diameter ratio, and curvature in the abdominal arterial tree of HH patients as compared with controls. This significantly increased the surface area ratio of low time-averaged wall shear stress (i.e., SAR-TAWSS =Surface areaTAWSS≤4 dynes·cm−2Total surface area× 100%) (24.1 ± 7.9 vs. 5 ± 6%, 11.6 ± 12.8 vs. < 0.1%, and 44.5 ± 9.2 vs. 21 ± 24% at hepatic bifurcations, common hepatic arteries, and abdominal aortas, respectively, between HH and control patients). Conclusions: Morphometric changes caused by HH significantly deteriorated the hemodynamic environment in abdominal conduit arteries and bifurcations, which could be an important risk factor for the incidence and progression of vascular diseases.
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Affiliation(s)
- Xiaoping Yin
- Department of Radiology, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
| | - Xu Huang
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Qiao Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Li Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Pei Niu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Minglu Cao
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Fei Guo
- College of Medicine, Hebei University, Baoding, China
| | - Xuechao Li
- College of Medicine, Hebei University, Baoding, China
| | - Wenchang Tan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.,Shenzhen Graduate School, Peking University, Shenzhen, China
| | - Yunlong Huo
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,College of Medicine, Hebei University, Baoding, China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China
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Xiao L. Effect of microwave ablation and laparoscopic hepatectomy on visual analogue scale score and liver function in patients with hepatic hemangiomas. Shijie Huaren Xiaohua Zazhi 2018; 26:500-505. [DOI: 10.11569/wcjd.v26.i8.500] [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
AIM To investigate the effect of microwave ablation and laparoscopic hepatectomy on visual analogue scale (VAS) score and liver function in patients with hepatic hemangiomas.
METHODS A total of 79 patients diagnosed with hepatic hemangioma and would undergo surgery at our hospital from June 2014 to December 2016 were chosen and randomly divided into either a study group (n = 41) or a control group (n = 38). The study group underwent microwave ablation, while the control group underwent laparoscopic partial hepatectomy. Surgical time, intraoperative blood loss, adverse reactions, total hospital stay time, and VAS scores at 12 h, 24 h, and 48 h after surgery were recorded and compared between the two groups. The indexes of hepatic function [alanine transaminase (ALT) and aspartate transaminase (AST)] at 1 d and 3 d after surgery were also compared.
RESULTS Both surgical time and intraoperative blood loss were significantly lower in the study group than in the control group (38.63 min ± 11.74 min vs 187.21 min ± 78.85 min, 20.52 mL ± 7.45 mL vs 329.72 mL ± 104.63 mL, P < 0.01). There was no significant difference in hospitalization time between the two groups. The adverse reaction rate (3%) in the study group was significantly lower than that in the control group (36.8%) (P < 0.01). The VAS scores of the study group at 12 h, 24 h, and 48 h after surgery were significantly lower than those of the control group (P < 0.01). The ALT and AST in the study group at 1 d after surgery were significantly higher than those in the control group (P < 0.05), although there was no significant difference in ALT and AST between the two groups at 3 days after surgery.
CONCLUSION Microwave ablation can shorten surgical time, reduce intraoperative blood loss and postoperative VAS score, improve ALT and AST levels, and effectively prevent liver injury in patients with hepatic hemangiomas with good safety.
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Peritumoral Hyperplasia in Hepatic Sclerosed Hemangioma. ACG Case Rep J 2017; 4:e61. [PMID: 28462238 PMCID: PMC5407361 DOI: 10.14309/crj.2017.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/15/2017] [Indexed: 11/17/2022] Open
Abstract
Peritumoral hyperplasia (PTH) is a hyperplastic lesion located around hypervascular tumors. Hepatic sclerosed hemangioma is a very rare form of hemangioma with sclerotic changes and is distinct from sclerosing hemangioma. We present a patient with non-alcoholic steatohepatitis-induced cirrhosis who presented with a hypervascular tumor. The tumor showed atypical findings of hemangioma and was treated with surgical resection because hepatic malignancy could not be ruled out. Histopathologic examination revealed the tumor was a sclerosed hemangioma with PTH. Lesions with carcinogenic potential were found in the PTH lesion. Sclerosed hemangioma should be observed and managed carefully.
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45
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Yu MH, Kim YJ, Park HS, Jung SI, Jeon HJ. Imaging Patterns of Intratumoral Calcification in the Abdominopelvic Cavity. Korean J Radiol 2017; 18:323-335. [PMID: 28246512 PMCID: PMC5313520 DOI: 10.3348/kjr.2017.18.2.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/20/2016] [Indexed: 12/12/2022] Open
Abstract
Intratumoral calcification is one of the most noticeable of radiologic findings. It facilitates detection and provides information important for correctly diagnosing tumors. In the abdominopelvic cavity, a wide variety of tumors have calcifications with various imaging features, though the majority of such calcifications are dystrophic in nature. In this article, we classify the imaging patterns of intratumoral calcification according to number, location, and morphology. Then, we describe commonly-encountered abdominopelvic tumors containing typical calcification patterns, focusing on their differentiable characteristics using the imaging patterns of intratumoral calcification.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
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Saito K, Yoshimura N, Shirota N, Saguchi T, Sugimoto K, Tokuuye K. Distinguishing liver haemangiomas from metastatic tumours using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced diffusion-weighted imaging at 1.5T MRI. J Med Imaging Radiat Oncol 2016; 60:599-606. [DOI: 10.1111/1754-9485.12487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/23/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Kazuhiro Saito
- Department of Radiology; Tokyo Medical University; Tokyo Japan
| | | | | | - Toru Saguchi
- Department of Radiology; Tokyo Medical University; Tokyo Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Tokyo Japan
| | - Koichi Tokuuye
- Department of Radiology; Tokyo Medical University; Tokyo Japan
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Strauss E, Ferreira ADSP, França AVC, Lyra AC, Barros FMDR, Silva I, Garcia JHP, Parise ER. Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations. ARQUIVOS DE GASTROENTEROLOGIA 2016; 52 Suppl 1:47-54. [PMID: 26959805 DOI: 10.1590/s0004-28032015000500003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Space-occupying lesions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenomas and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenomas are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenomas may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenomas growth, particularly of the hepatocyte nuclear factor-1alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of the liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the absence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agents are indicated.
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Affiliation(s)
- Edna Strauss
- Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Jing L, Liang H, Caifeng L, Jianjun Y, Feng X, Mengchao W, Yiqun Y. New recognition of the natural history and growth pattern of hepatic hemangioma in adults. Hepatol Res 2016; 46:727-33. [PMID: 26492419 DOI: 10.1111/hepr.12610] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 12/12/2022]
Abstract
AIM Surgical indications for hepatic hemangiomas are still not clearly defined due to limited data on their natural history. This study aimed to investigate the natural history and growth pattern of hepatic hemangiomas in adults. METHODS From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled. A routine follow up was performed to observe the natural history of the lesions and their tendency to cause complications. RESULTS A total of 236 patients were enrolled in the study. The median size of hemangiomas was 4.5 cm (range, 0.6-19.2). During a median follow-up period of 48 months (range, 3-266), 61.0% patients had hemangiomas that increased in size, 23.7% patients had stable lesions and 8.5% patients had hemangiomas that decreased in size. The peak growth period of hemangiomas was in patients of less than 30 years of age (0.46 ± 0.41 cm/year) and the growth rate decreased significantly after 50 years of age (0.21 ± 0.40 cm/year). Hemangiomas of less than 2 cm had the lowest growth rate (0.16 ± 0.42 cm/year). The peak growth rate of hemangioma size was 8-10 cm (0.80 ± 0.62 cm/year), then decreased rapidly to 0.47 ± 0.91 cm/year while the hemangiomas were of more than 10 cm. Only nine patients had severe symptoms caused by hemangioma. No patients presented with hemangioma-related complications. CONCLUSION The majority of hepatic hemangiomas have the tendency to increase in size but rarely cause complications. All the hemangiomas can be safely managed by observation, and surgery is only considered for patients with severe complications.
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Affiliation(s)
- Li Jing
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Huang Liang
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Liu Caifeng
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yan Jianjun
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xu Feng
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wu Mengchao
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yan Yiqun
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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Tanaka M, Kishi Y, Esaki M, Nara S, Miyake M, Hiraoka N, Nagino M, Shimada K. Feasibility of Routine Application of Gadoxetic Acid-Enhanced MRI in Combination with Diffusion-Weighted MRI for the Preoperative Evaluation of Colorectal Liver Metastases. Ann Surg Oncol 2016; 23:3991-3998. [PMID: 27357179 DOI: 10.1245/s10434-016-5362-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gadoxetic acid-enhanced magnetic resonance imaging (MRI) in combination with diffusion-weighted MRI (Gd-EOB-MRI/DWI) has become popular for evaluating colorectal liver metastases (CRLM). This retrospective observational study aimed to determine whether this procedure should be indicated prior to hepatectomy in all patients with CRLM. METHODS A retrospective survey of relevant data of patients who had undergone hepatectomy for CRLM from 2008 to 2014 was performed. The rates of detection by contrast-enhanced computed tomography (CE-CT) and Gd-EOB-MRI/DWI were evaluated. In addition, relapse-free and overall survivals after primary hepatectomy were compared between patients who had undergone only CE-CT versus those who had undergone both CE-CT and Gd-EOB-MRI/DWI. RESULTS In all, 419 pathologically confirmed CRLM were resected in 202 hepatectomies in 177 patients. The sensitivity of detection of CRLM was 77 % for CE-CT and 93 % for Gd-EOB-MRI/DWI (P < 0.01). The sensitivity of detection of 1-5, 6-10, and 11-15 mm CRLM by CE-CT was 9.6 % (5/52), 47 % (26/55), and 76 % (57/75), respectively, whereas that by Gd-EOB-MRI/DWI was 54 % (28/52), 91 % (50/55), and 99 % (74/75), respectively; these differences are significant (P < 0.01 for all three groups). Relapse-free (P = 0.99) and overall survival (P = 0.79) did not differ significantly between 37 patients evaluated preoperatively by only CE-CT and 168 patients evaluated by both CE-CT and Gd-EOB-MRI/DWI. CONCLUSION Gd-EOB-MRI/DWI detects small CRLM (≤15 mm) with higher sensitivity than CE-CT. However, whether Gd-EOB-MRI/DWI should be a routine component of preoperative evaluation remains unclear in terms of survival benefit.
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Affiliation(s)
- Masahiro Tanaka
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.,Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Kishi
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Minoru Esaki
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Nara
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Mototaka Miyake
- Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuyoshi Hiraoka
- Division of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuaki Shimada
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Combined gadoxetic acid and gadofosveset enhanced liver MRI for detection and characterization of liver metastases. Eur Radiol 2016; 27:32-40. [PMID: 27137648 DOI: 10.1007/s00330-016-4375-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE To compare gadoxetic acid alone and combined gadoxetic acid/gadofosveset trisodium-enhanced liver MRI for detection of metastases and differentiation of metastases from haemangiomas. METHODS Ninety-one patients underwent gadoxetic acid-enhanced liver MRI before and after additional injection of gadofosveset. First, two readers retrospectively identified metastases on gadoxetic acid alone enhanced delayed hepatobiliary phase T1-weighted images together with all other MR images (dynamic images, T2-weighted images, diffusion-weighted images). Second, readers assessed additional T1-weighted images obtained after administration of gadofosveset trisodium. For both interpretations, readers rated lesion conspicuity and confidence in differentiating metastases from haemangiomas. Results were compared using alternative free-response receiver-operating characteristic (AFROC) and conventional ROC methods. Histology and follow-up served as reference standard. RESULTS There were 145 metastases and 16 haemangiomas. Both readers detected more metastases using combined gadoxetic acid/gadofosveset (reader 1 = 130; reader 2 = 124) compared to gadoxetic acid alone (reader 1 = 104; reader 2 = 103). Sensitivity of combined gadoxetic acid/gadofosveset (reader 1 = 90 %; reader 2 = 86 %) was higher than that of gadoxetic acid alone (reader 1 = 72 %; reader 2 = 71 %, both P < 0.01). AFROC-AUC was higher for the combined technique (0.92 vs. 0.86, P < 0.001). Sensitivity for correct differentiation of metastases from haemangiomas was higher for the combined technique (reader 1 = 98 %; reader 2 = 99 % vs. reader 1 = 86 %; reader 2 = 91 %, both P < 0.01). ROC-AUC was significantly higher for the combined technique (reader 1 = 1.00; reader 2 = 1.00 vs. reader 1 = 0.87; reader 2 = 0.92, both P < 0.01). CONCLUSION Combined gadoxetic acid/gadofosveset-enhanced MRI improves detection and characterization of liver metastases compared to gadoxetic acid alone. KEY POINTS • Combined gadoxetic acid and gadofosveset-enhanced liver MRI significantly improves detection of metastases. • The combined enhancement technique improves the accuracy to differentiate metastases from haemangiomas. • Prospective studies need to determine the clinical impact of the combined technique.
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