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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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2
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Kallenbach M, Qvartskhava N, Weigel C, Dörffel Y, Berger J, Kunze G, Luedde T. [Contrast-enhanced ultrasound (CEUS) for characterisation of focal liver lesions]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:952-970. [PMID: 37798924 PMCID: PMC11211032 DOI: 10.1055/a-2145-7461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/21/2023] [Indexed: 10/07/2023]
Abstract
Due to the trend towards increased use of imaging and rising awareness among high-risk patients, gastroenterologists and hepatologists are more frequently confronted with patients with focal liver lesions. In the differentiation of these lesions, CT and MRI have increasingly found their way into primary diagnostic steps in everyday clinical practice. Contrast-enhanced sonography, on the other hand, is a very effective and cost-efficient method for assessing focal liver lesions. The success of the method is not only based on the visualisation of microvascularisation in real time. If sonography is performed by the treating physician, he can use the exact knowledge of history and clinical findings to specifically adapt the examination procedure and to interpret the sonographic findings with greater accuracy ("clinical sonography"). At the same time, the method enables the practitioner to combine diagnostics and management decisions in his or her own hands. To achieve excellent results with contrast-enhanced sonography-as with any other imaging method-it is necessary that the examiner is sufficiently qualified.This article systematically presents the sonographic characteristics of the most common liver lesions and clearly shows their contrast patterns using videos (available via QR code). The article illustrates that CEUS could-and from the authors' point of view, should-have an even greater significance in the future.
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Affiliation(s)
- Michael Kallenbach
- Department of Gastroenterology Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Natalia Qvartskhava
- Department of Gastroenterology Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Christian Weigel
- Department of Gastroenterology Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Yvonne Dörffel
- Medical Outpatient Department, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Berger
- Ernst von Bergmann Klinikum, Department of Gastroenterology, Hepatology, Infectious Diseases and Rheumatology, Potsdam, Germany
| | - Georg Kunze
- Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Germany
| | - Tom Luedde
- Department of Gastroenterology Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
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3
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Naganuma H, Ishida H. Hepatocellular Carcinoma in Non-Fibrotic Liver: A Narrative Review. Diagnostics (Basel) 2023; 13:3426. [PMID: 37998562 PMCID: PMC10670297 DOI: 10.3390/diagnostics13223426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Hepatocellular carcinoma (HCC) in a non-fibrotic liver (F0) is considered to be rare, and there is a marked paucity of studies in the literature on this HCC type. A review of the literature shows some important clinical and tumor characteristics: (a) it occurs mainly in young female and elder male patients; (b) clinically, under normal hepatic function, alpha-fetoprotein level is often normal, and there are no risk factors; (c) associated with metabolic disease; (d) macroscopically, single large lesions are noted; and (e) microscopically, the lesions are well-differentiated and encapsulated. Radiological imaging results are straightforward, showing arterial hyperenhancement and later wash-out. The combined use of B-mode and contrast-enhanced (CE) ultrasound (US) is the most reliable and cost-effective diagnostic method. Few peri-and post-operative complications are noted and 5-year survival is not inferior to patients with HCC on fibrosis liver despite the lesion's large size. Most clinicians believe that HCC is unlikely to occur if patients have no symptoms and normal hepatic function. Although detailed clinical data are very limited, we expect that this review will help to improve the clinical management of HCC in non-fibrotic livers.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Negishi-cho 5-31, Yokote City 013-8602, Japan
| | - Hideaki Ishida
- Department of Gastroenterology, Akita Red Cross Hospital, Kamikitate Saruta aza Naeshirosawa 222-1, Akita City 010-1495, Japan
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4
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Dobek A, Kobierecki M, Ciesielski W, Grząsiak O, Fabisiak A, Stefańczyk L. Usefulness of Contrast-Enhanced Ultrasound in the Differentiation between Hepatocellular Carcinoma and Benign Liver Lesions. Diagnostics (Basel) 2023; 13:2025. [PMID: 37370920 DOI: 10.3390/diagnostics13122025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
A differentiation between hepatocellular carcinoma (HCC) and benign liver lesions is required. The aim of the study was to perform an analysis of the time of enhancement of focal liver lesions in a contrast-enhanced ultrasound (CEUS) examination. The curves of enhancement and the homogeneity of the tumor enhancement were assessed. The study included 52 patients with diagnoses of hepatocellular adenoma (18), focal nodular hyperplasia (11) and HCC (28). The study included magnetic resonance imaging or computed tomography and a comparison of the obtained information with CEUS. In the benign lesions groups after 20-30 s, the enhancement was similar to the liver parenchyma. In the HCC group, the enhancement was slightly less intense compared to the liver parenchyma and the benign lesions. The difference of the enhancement in the arterial phase (benign lesions vs. HCC) was p = 0.0452, and the difference of enhancement in the late venous phase (benign lesions vs. HCC) was p = 0.000003. The homogeneity of the enhancement (benign lesions vs. HCC), respectively, was p = 0.001 in the arterial phase, p = 0.0003 in the portal venous phase and p = 0.00000007 in the late venous phase. Liver tumors can be classified as benign when they are homogenous in the arterial phase and don't present washout. HCC in the arterial phase is inhomogeneous and washout is observed in the venous phases. When radiological symptoms suggest malignant lesion, CEUS can be used to select the best biopsy access.
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Affiliation(s)
- Adam Dobek
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Mateusz Kobierecki
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Wojciech Ciesielski
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Oliwia Grząsiak
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Fabisiak
- Department of Digestive Tract Diseases, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
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Variation in the management of benign liver tumors: A European survey and case vignette study. Clin Res Hepatol Gastroenterol 2023; 47:102094. [PMID: 36781070 DOI: 10.1016/j.clinre.2023.102094] [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: 01/02/2023] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Management of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), is multidisciplinary and subject to practice variation. We aimed to evaluate variation in clinical management of FNH and HCA in Europe. METHODS We distributed an online survey (November 2021-March 2022) among 294 European experts. The survey included questions on local practice and included eight clinical vignettes. The clinical vignettes focused on FNH or HCA management in the setting of sex, lifestyle modification, and pregnancy. RESULTS The response rate was 32% and respondents included surgeons (38%), gastroenterologists/hepatologists (25%), radiologists (32%), and pathologists (1.6%) from ten European countries. We observed practice variation with regard to lifestyle modification and imaging follow-up in patients with FNH, and with regard to the management of HCA >5 cm before and during pregnancy. Finally, the management of HCA >5 cm after lifestyle modification deviated from EASL guideline recommendations. CONCLUSION Our survey illustrates variability in FNH and HCA management in Europe. Several areas were identified for future research and guideline recommendations, including FNH follow-up and the management of HCA >5 cm. We propose the organization of Delphi consensus meetings to prioritize areas of research and update current guidelines to optimize management for all patients with benign liver tumors.
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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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Nault JC, Blanc JF, Moga L, Calderaro J, Dao T, Guiu B, Hocquelet A, Paradis V, Salamé E, de Lédinghen V, Bourlière M, Bureau C, Ganne-Carrié N. Non-invasive diagnosis and follow-up of benign liver tumours. Clin Res Hepatol Gastroenterol 2022; 46:101765. [PMID: 34333196 DOI: 10.1016/j.clinre.2021.101765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
Hepatocellular benign liver tumours are mainly developed on normal liver and include hepatic hemangioma, focal nodular hyperplasia and hepatocellular adenoma from the most frequent to the less frequent. The diagnosis of hepatic hemangioma and of simple hepatic biliary cysts can be performed using non-invasive criteria using liver ultrasonography or contrast enhanced MRI. Most of the time the diagnosis of focal nodular hyperplasia can be achieved using contrast-enhanced ultrasonography or contrast enhanced MRI with an additional value of hepatobiliary contrast-agent in this setting. Rarely, if a doubt persists, a tumour and non-tumour liver biopsy can be required in order to establish the diagnosis. As hepatic hemangioma, simple hepatic biliary cysts and focal nodular hyperplasia are not associated with complications, they don't require any treatments or follow-up. Hepatocellular adenomas are mainly diagnosed at histology on surgical samples or liver biopsy even if some radiological features are highly suggestive of several subtypes of hepatocellular adenomas. Finally, the management of hepatocellular adenomas should be guided according to the tumour size, gender but also to the molecular subtypes.
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Affiliation(s)
- Jean-Charles Nault
- Service d'hépatologie, Hôpital Avicenne, APHP; Université Sorbonne Paris Nord, Bobigny & INSERM UMR 1138, Centre de Recherche des Cordeliers, Université de Paris France.
| | - Jean-Frédéric Blanc
- Service d'hépato-gastroentérologie et d'oncologie digestive, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac & INSERM U1053, Université de Bordeaux, Bordeaux France
| | - Lucile Moga
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Beaujon, APHP, Clichy France
| | - Julien Calderaro
- Service de département de pathologie, Hôpital Henri-Mondor, APHP, Créteil France
| | - Thông Dao
- Service d'hépato-gastro-entérologie et nutrition, CHU Caen Normandie, Caen France
| | - Boris Guiu
- Service de radiologie diagnostique et interventionnelle Saint Eloi, CHU Montpellier, Montpellier France
| | - Arnaud Hocquelet
- Service de radiodiagnostic et radiologie interventionnelle, CHUV Lausanne, Lausanne Switzerland
| | | | - Ephrem Salamé
- Unité de Chirurgie Digestive Endocrinienne et Bariatrique, CHU Tours, Tours France
| | - Victor de Lédinghen
- Service d'hépato-gastroentérologie et d'oncologie digestive, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac & INSERM U1053, Université de Bordeaux, Bordeaux France
| | - Marc Bourlière
- Service d'hépato-gastroentérologie, Hôpital Saint Joseph & INSERM UMR 1252 IRD SESSTIM Aix Marseille Université, Marseille
| | - Christophe Bureau
- Service d'hépatologie, Hôpital Rangueil, CHU Toulouse, Toulouse France
| | - Nathalie Ganne-Carrié
- Service d'hépatologie, Hôpital Avicenne, APHP; Université Sorbonne Paris Nord, Bobigny & INSERM UMR 1138, Centre de Recherche des Cordeliers, Université de Paris France
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8
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Benoit C, Rodrigues A, Calderaro J, Charpy C, Simonin S, Deybach JC, Gouya L, Puy H, Schmitt C, Farcy R, Vilgrain V, Paradis V, Pote N, Lafdil F, Mule S, Itti E, Luciani A. Autofluorescence imaging within the liver: a promising tool for the detection and characterization of primary liver tumors. Eur Radiol 2021; 32:2481-2491. [PMID: 34694452 DOI: 10.1007/s00330-021-08307-9] [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: 04/15/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the performance of 405 nm-induced autofluorescence for the characterization of primary liver nodules on ex vivo resected specimens. MATERIALS AND METHODS Forty resected liver specimens bearing 53 primary liver nodules were included in this IRB-approved prospective study. Intratissular spectroscopic measurements were performed using a 25-G fibered-needle on all ex vivo specimens: 5 autofluorescence measurements were performed in both nodules and adjacent parenchyma. The spectra derivatives of the 635 and 670 nm autofluorescence peaks observed in nodules and in adjacent liver parenchyma were compared (Kruskal-Wallis and Mann-Whitney when appropriate). RESULTS A total of 42 potentially evolutive primary liver nodules-34 hepatocellular carcinomas, 4 intrahepatic cholangiocarcinomas, 4 hepatocellular adenomas-and 11 benign nodules-5 focal nodular hyperplasias, 6 regenerative nodules-were included. Both 635 and 670 nm Δderivatives were significantly higher in benign as compared to potentially evolutive (PEV) nodules (respectively 32.9 ± 4.5 vs 15.3 ± 1.4; p < 0.0001 and 5.7 ± 0.6 vs 2.5 ± 0.1; p < 0.0001) with respective sensitivity and specificity of 78% and 91% for distinguishing PEV from benign nodules. CONCLUSION 405 nm-induced autofluorescence enables the discrimination of benign from PEV primary liver nodules, suggesting that autofluorescence imaging could be used to optimize US targeted liver biopsies. KEY POINTS • 405 nm-induced autofluorescence can distinguish liver tumors from the adjacent liver parenchyma. • The analysis of autofluorescence imaging observed within primary liver tumors can discriminate benign tumors from those requiring follow-up or targeted liver biopsy. • In current practice, autofluorescence imaging could be embedded within biopsy needle, to enable, in addition to ultrasound guidance, optimal targeting of liver nodules which could optimize tissue sampling.
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Affiliation(s)
- Charlotte Benoit
- Nodea Medical, 1 mail du Pr Georges Mathé, 94800, Villejuif, France
| | - Aurélie Rodrigues
- Nodea Medical, 1 mail du Pr Georges Mathé, 94800, Villejuif, France.,INSERM IMRB U955, Equipe 18, Créteil, France
| | - Julien Calderaro
- Faculté de Santé de Créteil, UPEC, Créteil, France.,Département de Pathologie, Hôpitaux Universitaires Henri Mondor, AP-HP, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Cécile Charpy
- Département de Pathologie, Hôpitaux Universitaires Henri Mondor, AP-HP, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Sylvie Simonin
- Centre Français Des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - Jean-Charles Deybach
- Centre Français Des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,UMR1149 INSERM, Centre de Recherche Sur L'Inflammation (CRI), Université Paris Diderot, Site Bichat, Laboratory of Excellence, GR-Ex, Paris, France
| | - Laurent Gouya
- Centre Français Des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,UMR1149 INSERM, Centre de Recherche Sur L'Inflammation (CRI), Université Paris Diderot, Site Bichat, Laboratory of Excellence, GR-Ex, Paris, France
| | - Hervé Puy
- Centre Français Des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,UMR1149 INSERM, Centre de Recherche Sur L'Inflammation (CRI), Université Paris Diderot, Site Bichat, Laboratory of Excellence, GR-Ex, Paris, France
| | - Caroline Schmitt
- Centre Français Des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,UMR1149 INSERM, Centre de Recherche Sur L'Inflammation (CRI), Université Paris Diderot, Site Bichat, Laboratory of Excellence, GR-Ex, Paris, France
| | - René Farcy
- Laboratoire Aimé Cotton, Université Paris-Sud, ENS Cachan, CNRS, Université Paris-Saclay, 91405, Orsay Cedex, France
| | | | | | - Nicolas Pote
- Anatomopathologie, Hôpital Beaujon, APHP, Clichy, France
| | - Fouad Lafdil
- INSERM IMRB U955, Equipe 18, Créteil, France.,Faculté de Santé de Créteil, UPEC, Créteil, France.,Institut Universitaire de France (IUF), Cedex 05 75231, Paris, France
| | - Sébastien Mule
- INSERM IMRB U955, Equipe 18, Créteil, France.,Faculté de Santé de Créteil, UPEC, Créteil, France.,Service d'Imagerie Médicale, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Emmanuel Itti
- Faculté de Santé de Créteil, UPEC, Créteil, France.,Service de Médecine Nucléaire, Hôpitaux Universitaires Henri Mondor, AP-HP, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Alain Luciani
- INSERM IMRB U955, Equipe 18, Créteil, France. .,Faculté de Santé de Créteil, UPEC, Créteil, France. .,Service d'Imagerie Médicale, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France.
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9
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Shyu S, Ali SZ. Significance of hepatocyte atypia in liver fine needle aspiration. Diagn Cytopathol 2021; 50:186-195. [PMID: 34459153 DOI: 10.1002/dc.24851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022]
Abstract
Fine needle aspiration (FNA) of the liver is frequently the diagnostic procedure of choice for sampling hepatic lesions. One of the main diagnostic challenges in the interpretation of liver FNA is distinguishing dysplastic lesions and well-differentiated hepatocellular carcinoma (WD-HCC) from benign processes, as they share significant cytomorphologic overlap. Furthermore, the diagnosis of HCC often requires evaluation of stroma for invasion, which may not be present on cytology and small needle biopsy specimens. A reporting system for liver cytopathology has yet to be instituted. Without standardized and well-defined criteria for hepatocyte atypia, we recommend limiting the use of atypia in evaluation of liver FNA specimens to describe a diagnosis of exclusion, in which all known benign and neoplastic processes have been ruled out. The cytologic findings on the FNA of a liver nodule may be best reported as atypical hepatocytes in the absence of a core needle biopsy or cell block sufficient to render a definitive diagnosis of HCC.
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Affiliation(s)
- Susan Shyu
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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10
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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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11
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Zhu M, Li H, Wang C, Yang B, Wang X, Hou F, Yang S, Wang Y, Guo X, Qi X. Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases. Drug Discov Ther 2021; 15:112-117. [PMID: 33952777 DOI: 10.5582/ddt.2021.01033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Focal nodular hyperplasia (FNH) is a solid benign tumor of the liver, predominantly in young women. A correct diagnosis of FNH is essential for making appropriate clinical decisions and avoiding unnecessary liver resection. Herein, we reported that two male cases with FNH, who initially presented with persistent abdominal discomfort, were misdiagnosed with hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) on contrast-enhanced magnetic resonance imaging and computed tomography scans, respectively. After surgery, a histological diagnosis of FNH was finally established. In this paper, we also reviewed the knowledge regarding diagnosis and differential diagnosis of FNH on imaging examinations, which are helpful for avoiding misdiagnoses and guiding clinical interventions.
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Affiliation(s)
- Menghua Zhu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Chunhui Wang
- Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xuehan Wang
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Feifei Hou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shengye Yang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yuye Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
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Khalili K, Atri M, Kim TK, Jang HJ. Recognizing the Role of the Reticuloendothelial System in the Late Phase of US Contrast Agents. Radiology 2020; 298:287-291. [PMID: 33290174 DOI: 10.1148/radiol.2020203245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Korosh Khalili
- From the Department of Medical Imaging, University of Toronto, 610 University Ave, Room 3-964, Toronto, ON, Canada M5G 2M9; and Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, Toronto, Canada
| | - Mostafa Atri
- From the Department of Medical Imaging, University of Toronto, 610 University Ave, Room 3-964, Toronto, ON, Canada M5G 2M9; and Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, Toronto, Canada
| | - Tae Kyoung Kim
- From the Department of Medical Imaging, University of Toronto, 610 University Ave, Room 3-964, Toronto, ON, Canada M5G 2M9; and Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, Toronto, Canada
| | - Hyun-Jung Jang
- From the Department of Medical Imaging, University of Toronto, 610 University Ave, Room 3-964, Toronto, ON, Canada M5G 2M9; and Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, Toronto, Canada
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Abstract
Focal nodular hyperplasia and hepatocellular adenoma are benign liver lesions that occur most frequently in women and may be found as incidental findings on imaging. hepatocellular adenomas may be infrequently associated with malignant progression or risk of rupture and as such, require surveillance or definitive treatments based on their size threshold. It is important clinically to differentiate these lesions, and utilizing imaging modalities such as contrast enhanced ultrasound or magnetic resonance imaging can be helpful in diagnosis. Further molecular subtyping of hepatocellular adenoma lesions may be beneficial to describe risk factors and potential future clinical complications.
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Affiliation(s)
- Lauren Myers
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, MNP 4112, Portland, OR 97239, USA.
| | - Joseph Ahn
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, MNP 4112, Portland, OR 97239, USA
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Auer TA, Fischer T, Garcia SRM, Penzkofer T, Jung EM, Hamm B, Lerchbaumer MH. Value of contrast-enhanced ultrasound (CEUS) in Focal Liver Lesions (FLL) with inconclusive findings on cross-sectional imaging. Clin Hemorheol Microcirc 2020; 74:327-339. [PMID: 31658052 DOI: 10.3233/ch-190718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to evaluate focal liver lesions. CEUS is easy and fast to perform, overcomes the limitations of B-mode US. OBJECTIVE To evaluate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in focal liver lesions (FLL) with unclear findings on computed tomography (CT) or magnetic resonance imaging (MRI). METHODS In this single-center retrospective study, 146 patients with at least one FLL underwent additional CEUS of the liver to clarify inconclusive cross-sectional imaging findings. Ultrasonography was performed using B-mode imaging and CEUS after injection of sulphur hexafluoride microbubbles (second-generation contrast agent) within two months after ceMRI or ceCT and interpreted by an experienced radiologist (EFSUMB level 3). Histopathological reports, long-term follow-up or clinical course served as reference standard. RESULTS Thirty-eight of the 146 patients had malignant and 108 benign FLL. Overall, CEUS had 92% sensitivity (95% -CI, 79-97) and 98% specificity (95% -CI, 93-99) with an AUC of 0.95 in correctly characterizing the lesion as malignant or benign. Sensitivity increased to 98% (95% -CI, 96-100) for benign lesions and decreased to 92% (95% -CI, 78-98) for malignant lesions. CEUS showed the highest diagnostical accuracy in lesion <1 cm with an AUC of 1.000, while the lowest accuracy was achieved in lesions >2 cm with an AUC of 0.924 due to a decreasing specificity of 86% (95% -CI, 87-100). CONCLUSION CEUS correctly distinguished malignant from benign FLL in cases with inconclusive cross-sectional imaging findings and achieved high levels of diagnostic accuracy. CEUS has added diagnostic value especially in small lesions ≤1 cm while specificity remains limited in larger lesions.
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Affiliation(s)
| | - Thomas Fischer
- Department of Radiology, Charité - University Medicine Berlin, Germany
| | | | - Tobias Penzkofer
- Department of Radiology, Charité - University Medicine Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ernst-Michael Jung
- University Medical Center Regensburg, Department of Radiology, Regensburg, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine Berlin, Germany
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Negrão de Figueiredo G, Mueller-Peltzer K, Schwarze V, Marschner C, Zhang L, Rübenthaler J, Siepmann T, Illigens B, Clevert D. Long-term study analysis of contrast-enhanced ultrasound in the diagnosis of focal nodular hyperplasia. Clin Hemorheol Microcirc 2020; 74:441-452. [DOI: 10.3233/ch-190710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G. Negrão de Figueiredo
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - K. Mueller-Peltzer
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - V. Schwarze
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - C. Marschner
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - L. Zhang
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - J. Rübenthaler
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - T. Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - B.W. Illigens
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - D.A. Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
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Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence? AJR Am J Roentgenol 2020; 214:1295-1304. [DOI: 10.2214/ajr.19.21498] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Gregory J, Paisant A, Paulatto L, Raynaud L, Bertin C, Kerbaol A, Vullierme MP, Paradis V, Vilgrain V, Ronot M. Limited added value of contrast-enhanced ultrasound over B-mode for the subtyping of hepatocellular adenomas. Eur J Radiol 2020; 128:109027. [PMID: 32361381 DOI: 10.1016/j.ejrad.2020.109027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare the features of hepatocellular adenoma subtypes (HCAs) in B-mode and contrast-enhanced ultrasound (CEUS). METHOD Thirty-three patients (31 women [94 %] and two men [6%], median age [Q1-Q3] 43.5 years old [35-51]) with 44 pathologically proven and subtyped HCAs (including 29 inflammatory HCAs [I-HCA] and 15 HNF1-α inactivated HCAs [H-HCA]) who underwent CEUS were included. The features of HCA on B-mode and CEUS were independently reviewed by two radiologists and compared between HCA subtypes. RESULTS I-HCAs were mostly hypoechoic (23/29, 79 %) or isoechoic (4/29, 14 %) with B-mode. Twelve of them (41 %) were heterogeneous. All H-HCAs except one demonstrated homogeneous hyperechogenicity (93 %) (p = 0.001). Moderate or marked liver steatosis was only observed in I-HCAs (12/29, 41 %) (p = 0.001). Arterial hyperenhancement was observed on CEUS in 27/29 (93 %) I-HCAs and in 14/15 (93 %) H-HCAs (p=0.98). Washout was present in 6/29 (21 %) I-HCAs and 1/15 (7%) H-HCAs (p=0.27). A total of 23/29 (79 %) I-HCAs and 15/15 (100 %) HCAs were homogeneous on portal and delayed phase acquisitions (p=0.04). The specificity for identifying an H-HCA was 100 % when the lesion was homogeneous and hyperechoic on B-mode, and the sensibility to rule out an H-HCA was 100 % if neither of these two features was present in a liver with obvious steatosis. CONCLUSIONS Most CEUS features, especially enhancement patterns, do not significantly differ between HCA subtypes. When HCA is suspected on CEUS, B-mode features should be considered, and a combination of lesion hyperechogenicity, homogeneity and the absence of obvious liver steatosis may be useful to distinguish H-HCAs from I-HCAs.
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Affiliation(s)
- Jules Gregory
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université de Paris, Faculté de Médecine, Paris, France
| | - Anita Paisant
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Luisa Paulatto
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Lucas Raynaud
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Caroline Bertin
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Anne Kerbaol
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Marie-Pierre Vullierme
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université de Paris, Faculté de Médecine, Paris, France
| | - Valérie Paradis
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université de Paris, Faculté de Médecine, Paris, France; INSERM U1149, Centre de Recherche de l'Inflammation (CRI), Paris, France
| | - Valérie Vilgrain
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université de Paris, Faculté de Médecine, Paris, France; INSERM U1149, Centre de Recherche de l'Inflammation (CRI), Paris, France
| | - Maxime Ronot
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université de Paris, Faculté de Médecine, Paris, France; INSERM U1149, Centre de Recherche de l'Inflammation (CRI), Paris, France.
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Han H, Ji Z, Ding H, Zhang W, Zhang R, Wang W. Assessment of blood flow in the hepatic tumors using non-contrast micro flow imaging: Initial experience. Clin Hemorheol Microcirc 2019; 73:307-316. [PMID: 31156143 DOI: 10.3233/ch-180532] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hong Han
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhengbiao Ji
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Weibin Zhang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ronghui Zhang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
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Hamada K, Saitoh S, Nishino N, Fukushima D, Techigawara K, Koyanagi R, Horikawa Y, Shiwa Y, Sakuma H, Kondo F. An elderly man with progressive focal nodular hyperplasia. Clin J Gastroenterol 2019; 13:413-420. [PMID: 31768882 PMCID: PMC7239834 DOI: 10.1007/s12328-019-01072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 11/25/2022]
Abstract
Patients with focal nodular hyperplasia (FNH) develop benign hepatocellular nodules. FNH most frequently occurs in young women. There are no reports of the onset of FNH in elderly men. We report a case of FNH in an elderly man, whose nodules increased in number and size. The patient underwent surgery for carcinoma of the left renal pelvis at 69 years of age; no liver masses were noted on yearly follow-up contrast-enhanced computed tomography (CECT). Ten years later, CECT revealed a hepatic mass, and magnetic resonance imaging suggested FNH. The nodules increased in number and size in subsequent follow-up examinations.
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Affiliation(s)
- Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikariga-oka, Fukushima-shi, Fukushima, 960-1295, Japan. .,Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan.
| | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Daizo Fukushima
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Kae Techigawara
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Ryota Koyanagi
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Hideo Sakuma
- Department of Pathology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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20
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Performance of Contrast-Enhanced Sonography Versus MRI With a Liver-Specific Contrast Agent for Diagnosis of Hepatocellular Adenoma and Focal Nodular Hyperplasia. AJR Am J Roentgenol 2019; 214:81-89. [PMID: 31573852 DOI: 10.2214/ajr.19.21251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The purpose of this article is to compare contrast-enhanced sonography (CEUS) with sulfur hexafluoride with MRI with the liver-specific contrast agent gadobenate dimeglumine in the diagnosis of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) in a cohort of consecutive patients. MATERIALS AND METHODS. Patients referred to a tertiary center for hepatobiliary disease who had suspected HCA or FNH on MRI performed with an extracellular gadolinium-based contrast agent underwent a prospective workup including CEUS and MRI with a liver-specific contrast agent. Diagnosis was definite when the findings of CEUS and MRI with a liver-specific contrast agent were concordant; histopathologic examination (HPE) was performed for cases with discordant findings. Descriptive statistics and the association between categoric variables were presented as numbers and percentages and were assessed using the Fisher exact test. The primary analysis was patient based. Sensitivity, specificity, and AUC and predictive values for the diagnosis of HCA and FNH were calculated separately for CEUS and MRI with a liver-specific contrast agent. RESULTS. A total of 181 patients were selected for the first analysis. Findings from CEUS and MRI with a liver-specific contrast agent were concordant for 132 patients (73%) and discordant for 49 (27%). HPE was performed for 26 of the 49 patients with discordant findings (53%), with findings indeterminate for two of these patients, the findings of MRI with a liver-specific contrast agent correct for 21 of the remaining 24 patients (87.5%), and the findings of CEUS correct for three of these 24 patients (12.5%) (p < 0.05). For further analysis, 156 patients with concordant findings or HPE-proven cases were included. For CEUS, the sensitivity and specificity for the diagnosis of HCA and FNH were 85% and 87%, respectively; the ROC AUC value was 0.856; and the positive predictive value and negative predictive value were 79% and 90%, respectively. For MRI with a liver-specific contrast agent, the sensitivity and specificity were 95% each, the ROC AUC value was 0.949, and the positive predictive value and negative predictive value were 92% and 97%, respectively, for the diagnosis of HCA and FNH. CONCLUSION. The findings of CEUS and MRI with a liver-specific contrast agent showed fair agreement for the diagnosis of HCA and FNH. MRI with a liver-specific contrast agent is diagnostically correct significantly more often than CEUS in cases with discordant findings that are HPE proven.
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Müller-Peltzer K, Rübenthaler J, Negrao de Figueiredo G, Clevert DA. [CEUS-diagnosis of benign liver lesions]. Radiologe 2019; 58:521-527. [PMID: 29704011 DOI: 10.1007/s00117-018-0390-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CLINICAL/METHODICAL ISSUE Focal liver lesions are commonly seen during routine ultrasound examinations. STANDARD RADIOLOGICAL METHODS With native ultrasound there are lesions that cannot be sufficiently characterized. In these cases additional imaging might be necessary. METHODICAL INNOVATIONS With contrast-enhanced ultrasound (CEUS), focal liver lesions can be characterized with high diagnostic accuracy. After the ultrasound contrast agent has been injected into a peripheral vein, the examiner saves video loops of the arterial, portal venous and late contrast phases. Combing the findings of native and contrast-enhanced ultrasound allows not only assessment of the etiology as benign or malignant but also detailed characterization of the focal liver lesion in most cases. PERFORMANCE Using CEUS, focal liver lesions can be characterized with a sensitivity of over 95% and a specificity of about 83%. ACHIEVEMENTS The advantages of CEUS include that there is no radiation exposure and that the ultrasound contrast agent has no effects on the function of the liver, kidneys or the thyroid gland. The main limiting factors for CEUS are bowel gas and obesity of the patient. PRACTICAL RECOMMENDATIONS CEUS can visualize micro- and macrovascularization of benign focal liver lesions in real time. It is a useful imaging modality in unclear cases.
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Affiliation(s)
- K Müller-Peltzer
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - J Rübenthaler
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - G Negrao de Figueiredo
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - D A Clevert
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Liver metastases of neuroendocrine tumors: is it possible to diagnose different histologic subtypes depending on multiphasic CT features? Abdom Radiol (NY) 2019; 44:2147-2155. [PMID: 30863999 DOI: 10.1007/s00261-019-01963-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To assess and compare the multiphasic computed tomography (CT) features of neuroendocrine tumor (NET) liver metastases and to investigate the possibility to predict the histologic subtype of the primary tumor. MATERIALS AND METHODS Between January 2013 and December 2017 patients with biopsy proven NET with at least one liver metastasis who underwent multiphasic CT were enrolled in this study. All cases were acquired using a standardized multiphasic liver CT protocol, arterial, portal, and hepatic venous phases were obtained. Images were retrospectively analyzed in consensus by two abdominal radiologists blinded to clinical data and histologic subtype. The size, number, and location of lesions were noted. Enhancement patterns of each lesion on arterial, portal, and hepatic venous phases were assessed. For quantitative analysis, CT attenuation of tumors, liver parenchyma, and aorta were measured using a circular region of interest (ROI) on arterial, portal, and hepatic venous phases for reflecting the blood supply of the tumor. Tumor-to-aorta and tumor-to-liver ratio were calculated in all three phases. Differences between subtypes of NET liver metastases were studied using ROC analysis of clustered data. RESULTS A total of 255 neuroendocrine tumor liver metastases divided into 101 (39.6%) pancreatic, 60 (23.5%) gastroenteric and 94 (36.8%) lung NET liver metastases were analyzed. Contrast enhancement of lesions was homogeneous in 78% of patients (n = 199), which was significantly more frequent in patients with pancreatic group than in those with gastroenteric origin (n = 90, 89.1% vs. n = 28, 46.7%; p < 0.001). Gastroenteric NET metastases frequently showed heterogeneous enhancement, which was significantly higher than in the other two groups (50% vs. 3% and 2%). With respect to the location of the primary tumor, the difference in enhancement patterns of the liver lesions was statistically significant (p < 0.001). Pancreatic NET metastases were mostly hyperdense on arterial images and isodense on portal and hepatic venous phase images (79.2%, n = 80). Gastroenteric NET metastases were mostly hyperdense on arterial phase images and hypodense on portal and hepatic venous phase images (n = 28, 46.7%). The most frequent pattern for lung NET metastases was hypoattenuation on all three phase images (n = 44, 46.8%). ROC analysis of clustered data revealed statistically significant differences between pancreatic NET liver metastases, gastroenteric NET liver metastases, and lung NET liver metastases in terms of tumor-to-aorta (T-A) ratio and tumor-to-liver (T-L) ratio (p < 0.001). CONCLUSION We observed statistically significant differences in multiphasic CT features (enhancement pattern, T-A ratio, and T-L ratio) between histologic subtypes of NET liver metastases. As the difference in histological subtypes of NET liver metastases results in a different prognosis and different management strategy, these CT features might help to identify the primary tumor when it is not known to ensure accurate tumor staging and to provide optimal treatment.
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Dietrich CF, Tannapfel A, Jang HJ, Kim TK, Burns PN, Dong Y. Ultrasound Imaging of Hepatocellular Adenoma Using the New Histology Classification. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1-10. [PMID: 30396597 DOI: 10.1016/j.ultrasmedbio.2018.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
Hepatocellular adenoma is a rare benign liver tumor. Predisposing factors include hepatic storage diseases and some genetic conditions. A new histology-based classification has been proposed but to date, the corresponding ultrasound imaging features have not been reported. Here we review the new classification scheme and discuss the corresponding features on contrast-enhanced ultrasound imaging.
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Affiliation(s)
- Christoph F Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | | | - Hyun-Jung Jang
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tae Kyoung Kim
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability. Pediatr Radiol 2019; 49:82-90. [PMID: 30267165 DOI: 10.1007/s00247-018-4250-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/20/2018] [Accepted: 08/29/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Focal nodular hyperplasia and hepatic adenoma are rare liver tumors in which specific features on contrast-enhanced ultrasound (US) have been reported but are little known in children. OBJECTIVE To assess the interobserver agreement in diagnosing and differentiating focal nodular hyperplasia and hepatic adenoma in children using established adult contrast-enhanced US characteristics. MATERIALS AND METHODS Thirty children with a definite or probable diagnosis of focal nodular hyperplasia or hepatic adenoma on magnetic resonance imaging (MRI)/histology who underwent contrast-enhanced US studies were included. Typical and additional contrast-enhanced US features of focal nodular hyperplasia and hepatic adenoma were included. The lesions were classified as definite/probable focal nodular hyperplasia, definite/probably hepatic adenoma or unclassified. The interobserver kappa of contrast-enhanced US characteristics was calculated. RESULTS Focal nodular hyperplasia and hepatic adenoma in children demonstrate contrast-enhanced US characteristics similar to those in adults. Among the nine lesions with confirmed histological diagnosis, correct diagnosis was made in 7 (77.8%) based on contrast-enhanced US criteria. Two lesions were unclassified by both observers due to a mixed arterial filling pattern. Interobserver kappa for contrast-enhanced US diagnosis was 0.64 (P<0.0001). CONCLUSION There is a good interobserver kappa for separating focal nodular hyperplasia from hepatic adenoma in children using established adult contrast-enhanced US features.
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Taimr P, Klompenhouwer AJ, Thomeer MGJ, Hansen BE, Ijzermans JNM, de Man RA, de Knegt RJ. Can point shear wave elastography differentiate focal nodular hyperplasia from hepatocellular adenoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:380-385. [PMID: 29740826 PMCID: PMC6033170 DOI: 10.1002/jcu.22603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/06/2018] [Accepted: 04/15/2018] [Indexed: 05/10/2023]
Abstract
PURPOSE Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are liver tumors that require different management. We assessed the potential of point shear wave elastography (pSWE) to differentiate FNH from HCA and the interobserver and intraobserver reliability of pSWE in the examination of these lesions and of native liver tissue (NLT). METHODS The study included 88 patients (65 FNH, 23 HCA). pSWE was performed by two experienced liver sonographers (observers 1 [O1] and 2 [O2]) and acquired within the lesion of interest and NLT. Group differences, optimal cutoff for characterization and interobserver reliability was assessed with Mann-Whitney-U, area under the ROC curce (AUROC) and intraclass correlation coefficient (ICC). Intraobserver reliability in NLT was assessed in 20 healthy subjects using ICC. RESULTS Median stiffness was significantly higher in FNH than in HCA (7.01 kPa vs 4.98 kPa for O1 (P = 0.017) and 7.68 kPa vs 6.00 kPa for O2 (P = 0.031)). A cutoff point for differentiation between the two entities could not be determined with an AUROC of 0.67 (O1) and 0.69 (O2). Interobserver reliability was good for lesion- stiffness (ICC = 0.86) and poor for NLT stiffness (ICC = 0.09). In healthy subjects, intraobserver reliability for NLT-stiffness was poor for O1 (ICC = 0.23) and moderate for O2 (ICC = 0.62). CONCLUSION This study shows that pSWE cannot reliably differentiate FNH from HCA. Interobserver and intraobserver reliability for pSWE in NLT were insufficient. Interpretation of results gained with this method should be done with great caution.
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Affiliation(s)
- Pavel Taimr
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
- Department of HepatogastroenterologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | | | | | - Bettina E. Hansen
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
- Toronto Centre for Liver DiseaseUniversity Health Network, Toronto General Hospital, University of TorontoOntarioCanada
| | - Jan N. M. Ijzermans
- Department of SurgeryErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Robert A. de Man
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Robert J. de Knegt
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
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26
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Roux M, Pigneur F, Baranes L, Calderaro J, Chiaradia M, Decaens T, Kastahian S, Charles-Nelson A, Tselikas L, Costentin C, Laurent A, Azoulay D, Mallat A, Rahmouni A, Luciani A. Differentiating focal nodular hyperplasia from hepatocellular adenoma: Is hepatobiliary phase MRI (HBP-MRI) using linear gadolinium chelates always useful? Abdom Radiol (NY) 2018; 43:1670-1681. [PMID: 29110059 DOI: 10.1007/s00261-017-1377-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To assess the value of Hepatobiliary phase MRI (HPB-MRI) to differentiate FNH and HCA, and evaluate its impact on diagnostic accuracy, diagnostic confidence, inter-observer variability, and patient clinical management. METHODS Forty-nine patients referred for Gd-BOPTA-enhanced MRI were retrospectively included in this IRB-approved study, with a total of 119 lesions-90 FNH and 29 HCA. Two observers separately assessed in 2 distinct randomized reading sessions the performance of MRI with (HBP-MRI) or without (conventional MRI) the use of HBP images. Each lesion was ranked with a 5-point scale (from 1 Typical FNH to 5 Certainly not a FNH). Sensitivity, specificity, overall accuracy, and inter-observer agreement for the differentiation of FNH from HCA were calculated and compared between conventional and HBP-MRI. RESULTS Both sensitivity (respective values of 38.9% and 97.8%), overall accuracy (respective values of 53.8% and 98.3%), and inter-observer agreement (respective values of Kappa 0.56 and 0.88) were significantly higher using HBP-MRI than with conventional MRI, with unchanged specificity (100%). The sensitivity of conventional MRI for the diagnosis of FNH was significantly lower in lesions ≤ 3 cm (20% vs. 88%). Overall, HBP could have changed lesion management in 59/119 cases (49.5%), including 53 FNH and 6 HCA with no impact in 60/119 lesions (50.5%) including all 35 lesions classified as scores 1 and 2 for the diagnosis of FNH. CONCLUSIONS The clinical impact of HBP-MRI is mostly important for smaller than 3-cm FNH, and more limited in larger FNH lesions as well as for HCA diagnosis for which conventional MRI is already accurate. The use of extracellular contrast agents upfront could limit the required use of linear HBP contrast agents for benign hepatocellular lesion characterization. On HBP, all FNH appeared hypointense compared to adjacent liver while close to 97% of HCA appeared hypointense.
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Affiliation(s)
- Marion Roux
- Service de Radiodiagnostic et Radiologie interventionnelle, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Frederic Pigneur
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
| | - Laurence Baranes
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Julien Calderaro
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Pathology, AP-HP, 94010, Creteil, France
| | - Mélanie Chiaradia
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Thomas Decaens
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Sandrine Kastahian
- Groupe Henri Mondor Albert Chenevier, Unite de Recherche Clinique (URC), AP-HP, 94010, Creteil, France
| | - Anaïs Charles-Nelson
- Groupe Henri Mondor Albert Chenevier, Unite de Recherche Clinique (URC), AP-HP, 94010, Creteil, France
| | - Lambros Tselikas
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
| | - Charlotte Costentin
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Alexis Laurent
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Liver Surgery, AP-HP, 94010, Creteil, France
| | - Daniel Azoulay
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Liver Surgery, AP-HP, 94010, Creteil, France
| | - Ariane Mallat
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Alain Rahmouni
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Alain Luciani
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unite U 955, Equipe 18, 94010, Creteil, France
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27
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Lee J, Jeong WK, Lim HK, Kim AY. Focal Nodular Hyperplasia of the Liver: Contrast-Enhanced Ultrasonographic Features With Sonazoid. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1473-1480. [PMID: 29159819 DOI: 10.1002/jum.14490] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/18/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate ultrasonographic features of focal nodular hyperplasia of the liver with contrast-enhanced ultrasonography (CEUS) using Sonazoid (perflubutane; GE Healthcare, Oslo, Norway). METHODS Thirty-one patients with 31 focal nodular hyperplasia nodules who underwent CEUS using Sonazoid between July 2012 and February 2015 were included in this study. After the microbubble contrast agent was injected, intermittent CEUS images were obtained during the following 4 phases: arterial (10-40 seconds), portal venous (60-90 seconds), delayed (3 minutes), and Kupffer (>10 minutes). Three abdominal radiologists retrospectively reviewed the images and achieved consensus for vascular (central artery, stellate vascularity, and centrifugal enhancement) and dynamic enhancement patterns during the late arterial, portal venous, delayed, and Kupffer phases. RESULTS The patients included 12 men and 19 women (age range, 21-82 years; mean, 47 years). The mean diameter of the lesions ± SD was 2.2 ± 0.9 cm (range, 1.0-4.0 cm). On CEUS, 24 of 31 lesions (77.4%) showed central artery and stellate vascularity in the early arterial phase, and 25 (80.6%) showed centrifugal enhancement. Twenty-six lesions (83.9%) were hyperechoic during the late arterial phase and showed hyperenhancement or isoenhancement during the serial dynamic phases. Kupffer-phase images indicated that only 2 lesions (6.5%) were hypoechoic compared with surrounding liver parenchyma, whereas 29 (93.5%) remained either hyperechoic (2 [6.5%]) or isoechoic (27 [87.1%]). CONCLUSIONS Contrast-enhanced US using Sonazoid for focal nodular hyperplasia showed typical vascular patterns of central artery vascularity, stellate vascularity, and centrifugal enhancement. Most cases were either hyperenhanced or isoenhanced on serial dynamic- and Kupffer-phase imaging. Based on these results, CEUS can provide useful information for noninvasive focal nodular hyperplasia diagnoses.
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Affiliation(s)
- Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo K Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ah Young Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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28
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Zarzour JG, Porter KK, Tchelepi H, Robbin ML. Contrast-enhanced ultrasound of benign liver lesions. Abdom Radiol (NY) 2018; 43:848-860. [PMID: 29167944 DOI: 10.1007/s00261-017-1402-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver lesions are often incidentally detected on ultrasound examination and may be incompletely characterized, requiring further imaging. Contrast-enhanced ultrasound (CEUS) was recently approved by the Food and Drug Administration in the United States for liver lesion characterization. CEUS has the ability to characterize focal liver lesions and has been shown to be superior to color Doppler and power Doppler ultrasound in the detection of tumor vascularity. Differentiating benign from malignant liver lesions is essential to characterizing liver lesions. The CEUS imaging characteristics of benign liver lesions are reviewed, including hepatic cysts, hemangiomas, focal fat, focal nodular hyperplasia, hepatocellular adenomas, abscesses, and traumatic lesions.
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Affiliation(s)
- Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 338, Birmingham, AL, 35294, USA.
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 338, Birmingham, AL, 35294, USA
| | - Hisham Tchelepi
- Department of Radiology, University of Southern California, Los Angeles, USA
| | - Michelle L Robbin
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 338, Birmingham, AL, 35294, USA
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29
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Taimr P, Bröker MEE, Dwarkasing RS, Hansen BE, de Knegt RJ, De Man RA, IJzermans JNM. A Model-Based Prediction of the Probability of Hepatocellular Adenoma and Focal Nodular Hyperplasia Based on Characteristics on Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2144-2150. [PMID: 28743375 DOI: 10.1016/j.ultrasmedbio.2017.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is an emerging imaging technique that is increasingly used to diagnose liver lesions. It is of the utmost importance to differentiate between the two most common solid focal liver lesions (i.e., hepatocellular adenoma [HCA] and focal nodular hyperplasia [FNH]), because their management and follow-up differ greatly. The main objective of this study was to determine how frequently the specific CEUS features of HCA and FNH are visible on CEUS and to define their predictive value for discrimination between HCA and FNH. We included 324 CEUS examinations performed on patients with FNH (n = 181) or HCA (n = 143). Patients with HCA and FNH significantly differed with respect to age and CEUS features of steatosis, echogenicity, homogeneity, the presence of a central scar, central artery, arterial enhancement pattern, necrosis or thrombus and enhancement in the late venous phase.
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Affiliation(s)
- Pavel Taimr
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mirelle E E Bröker
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roy S Dwarkasing
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bettina E Hansen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Robert A De Man
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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30
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Sun XL, Yao H, Men Q, Hou KZ, Chen Z, Xu CQ, Liang LW. Combination of acoustic radiation force impulse imaging, serological indexes and contrast-enhanced ultrasound for diagnosis of liver lesions. World J Gastroenterol 2017; 23:5602-5609. [PMID: 28852319 PMCID: PMC5558123 DOI: 10.3748/wjg.v23.i30.5602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/24/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the value of combined acoustic radiation force impulse (ARFI) imaging, serological indexes and contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant liver lesions.
METHODS Patients with liver lesions treated at our hospital were included in this study. The lesions were divided into either a malignant tumor group or a benign tumor group according to pathological or radiological findings. ARFI quantitative detection, serological testing and CEUS quantitative detection were performed and compared. A comparative analysis of the measured indexes was performed between these groups. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of ARFI imaging, serological indexes and CEUS, alone or in different combinations, in identifying benign and malignant liver lesions.
RESULTS A total of 112 liver lesions in 43 patients were included, of which 78 were malignant and 34 were benign. Shear wave velocity (SWV) value, serum alpha-fetoprotein (AFP) content and enhancement rate were significantly higher in the malignant tumor group than in the benign tumor group (2.39 ± 1.20 m/s vs 1.50 ± 0.49 m/s, 18.02 ± 5.01 ng/mL vs 15.96 ± 4.33 ng/mL, 2.14 ± 0.21 dB/s vs 2.01 ± 0.31 dB/s; P < 0.05). The ROC curve analysis revealed that the areas under the curves (AUCs) of SWV value alone, AFP content alone, enhancement rate alone, SWV value + AFP content, SWV value + enhancement rate, AFP content + enhancement rate and SWV value + AFP content + enhancement rate were 85.1%, 72.1%, 74.5%, 88.3%, 90.4%, 82.0% and 92.3%, respectively. The AUC of SWV value + AFP content + enhancement rate was higher than those of SWV value + AFP content and SWV value + enhancement rate, and significantly higher than those of any single parameter or the combination of any two of parameters.
CONCLUSION The combination of SWV, AFP and enhancement rate had better diagnostic performance in distinguishing between benign and malignant liver lesions than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.
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31
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32
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Tselikas L, Pigneur F, Roux M, Baranes L, Costentin C, Roche V, Calderaro J, Herin E, Laurent A, Zafrani E, Azoulay D, Mallat A, Rahmouni A, Luciani A. Impact of hepatobiliary phase liver MRI versus Contrast-Enhanced Ultrasound after an inconclusive extracellular gadolinium-based contrast-enhanced MRI for the diagnosis of benign hepatocellular tumors. Abdom Radiol (NY) 2017; 42:825-832. [PMID: 27704147 DOI: 10.1007/s00261-016-0921-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the added values of hepatobiliary phase (HBP) MRI and contrast-enhanced ultrasound (CEUS) in addition to inconclusive extracellular gadolinium-based contrast-enhanced MRI (CE-MRI) to characterize benign hepatocellular tumors (BHT). METHODS Eighty-three BHT-46 focal nodular hyperplasia (FNH) and 37 hepatocellular adenomas (HCA)-with inconclusive CE-MRI in 54 patients (43 women and 11 men, mean age 42 years old ± 14.8) were retrospectively analyzed. All patients underwent both HBP-MRI and CEUS. Two radiologists independently reviewed 2 sets of images, SET-1: CE-MRI and HBP-MRI; SET-2: CE-MRI and CEUS, and classified lesions as "definite FNH," "possible FNH," or "definitely not FNH." Sensitivity (Se) and specificity (Spe) were compared between the two sets; subgroup analyses according to the lesion's size were performed. RESULTS Regardless of lesion size, the respective Se and Spe of both datasets were not statistically different (95.7 and 100% vs. 76.1 and 94.6% for set-1 and -2 respectively; p = 0.18). For lesions larger than 35 mm, although both sets had similar specificity (100%), sensitivity was higher for SET-1 (100% vs. 40%); p = 0.04. Tumor classifications using SET-1 and SET-2 could have changed patient management in 35/54 (64.8%) and 33/54 (61.1%) of all patients, respectively. CONCLUSIONS HBP-MRI or CEUS should be performed after an inconclusive CE-MRI. Both can change patient management by avoiding unnecessary biopsy or surveillance. The use of HBP-MRI should be advocated over CEUS in larger (>35 mm) lesions.
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Affiliation(s)
- Lambros Tselikas
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Frederic Pigneur
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Marion Roux
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurence Baranes
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Charlotte Costentin
- Hepatology Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
| | - Vincent Roche
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Julien Calderaro
- Department of Pathology, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
- Universite Paris Est Creteil, Créteil, 94010, France
| | - Edouard Herin
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Alexis Laurent
- Universite Paris Est Creteil, Créteil, 94010, France
- Liver Surgery Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
- INSERM IMRB Unit U 955, Equipe 18, Créteil, 94010, France
| | - Elie Zafrani
- Department of Pathology, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
| | - Daniel Azoulay
- Universite Paris Est Creteil, Créteil, 94010, France
- Liver Surgery Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
| | - Ariane Mallat
- Hepatology Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
- Universite Paris Est Creteil, Créteil, 94010, France
| | - Alain Rahmouni
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
- Universite Paris Est Creteil, Créteil, 94010, France
| | - Alain Luciani
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.
- Universite Paris Est Creteil, Créteil, 94010, France.
- INSERM IMRB Unit U 955, Equipe 18, Créteil, 94010, France.
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Visualization of draining vein in focal nodular hyperplasia by superb microvascular imaging: report of two cases. J Med Ultrason (2001) 2017; 44:323-328. [DOI: 10.1007/s10396-017-0775-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/05/2017] [Indexed: 12/18/2022]
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Sannier A, Cazejust J, Lequoy M, Cervera P, Scatton O, Rosmorduc O, Wendum D. Liver biopsy for diagnosis of presumed benign hepatocellular lesions lacking magnetic resonance imaging diagnostic features of focal nodular hyperplasia. Liver Int 2016; 36:1668-1676. [PMID: 26969817 DOI: 10.1111/liv.13113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/29/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The contribution of liver biopsy for the diagnosis of presumed benign hepatocellular lesions lacking the diagnostic features of focal nodular hyperplasia (FNH) on magnetic resonance imaging (MRI) is unknown. We evaluated liver biopsy and MRI performances in this setting. METHODS Magnetic resonance imaging and slides of liver biopsies performed for a presumed benign hepatocellular lesion (2006-2013) without the typical features of FNH on MRI were blindly reviewed (n = 45). Eighteen lesions were surgically removed and also analyzed. The final diagnosis was the diagnosis established after surgery or on the biopsy in the absence of surgery. RESULTS The final diagnosis was FNH (n = 19), hepatocellular adenoma (HCA, n = 15), hepatocellular carcinoma (n = 3) and indefinite (n = 4). Four lesions corresponded to non hepatocellular lesions. FNH, HNF1A mutated and inflammatory HCA were diagnosed accurately on the biopsy in 95%, 67% and 100% of the cases respectively. Diagnostic performance of liver biopsy for HNF1A mutated HCA was lower because of the lack of non-tumoral tissue. Diagnosis based on morphological analysis was certain and correct in 27 cases. Immunostaining allowed a definite diagnosis in 12 additionnal cases. Radiological diagnosis was in agreement with the histological diagnosis in 75.6% of the cases, with a very high sensitivity (97%) and specificity (100%) for the diagnosis of HNF1A mutated HCA. CONCLUSIONS Liver biopsy has a good diagnostic performance particularly for FNH and inflammatory HCA, and sampling of non-lesional tissue is highly recommended. A biopsy does not seem necessary if H-HCA is diagnosed on MRI.
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Affiliation(s)
- Aurélie Sannier
- AP-HP, Hôpital St Antoine, Paris, France. .,Service d'Anatomie Pathologique, UPMC Univ Paris 06, Paris, France.
| | - Julien Cazejust
- AP-HP, Hôpital St Antoine, Paris, France.,Service d'Imagerie, UPMC Univ Paris 06, Paris, France
| | - Marie Lequoy
- AP-HP, Hôpital St Antoine, Paris, France.,Service d'Hépatologie, UPMC Univ Paris 06, Paris, France
| | - Pascale Cervera
- AP-HP, Hôpital St Antoine, Paris, France.,Service d'Anatomie Pathologique, UPMC Univ Paris 06, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Olivier Scatton
- AP-HP, Hôpital St Antoine, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,Service de Chirurgie Hépato-biliaire, UPMC Univ Paris 06, Paris, France
| | - Olivier Rosmorduc
- AP-HP, Hôpital St Antoine, Paris, France.,Service d'Hépatologie, UPMC Univ Paris 06, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Dominique Wendum
- AP-HP, Hôpital St Antoine, Paris, France.,Service d'Anatomie Pathologique, UPMC Univ Paris 06, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France
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35
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Bartolotta TV, Vernuccio F, Taibbi A, Lagalla R. Contrast-Enhanced Ultrasound in Focal Liver Lesions: Where Do We Stand? Semin Ultrasound CT MR 2016; 37:573-586. [PMID: 27986175 DOI: 10.1053/j.sult.2016.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography, and it is being increasingly used for the evaluation of focal liver lesions (FLLs). Currently, CEUS is included as a part of the suggested diagnostic workup of FLLs, resulting in a better patient management and delivering cost-effective therapy. After a brief technical note, contrast-enhancement patterns of different types of benign and malignant FLLs, along with hepatic pseudolesions, are described and discussed based on our experience and literature data. At the same time, the most recent concepts and the use of CEUS in different clinical settings are presented.
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Affiliation(s)
| | - Federica Vernuccio
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Adele Taibbi
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Roberto Lagalla
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
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Kumagawa M, Matsumoto N, Watanabe Y, Hirayama M, Miura T, Nakagawara H, Ogawa M, Matsuoka S, Moriyama M, Takayama T, Sugitani M. Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver? World J Hepatol 2016; 8:1110-1115. [PMID: 27660679 PMCID: PMC5026994 DOI: 10.4254/wjh.v8.i26.1110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/10/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular adenoma (HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography (CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A (SAA), focal positive for glutamine synthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.
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Naganuma H, Ishida H, Ogawa M, Watanabe Y, Watanabe D, Ohyama Y, Watanabe T. Focal nodular hyperplasia: our experience of 53 Japanese cases. J Med Ultrason (2001) 2016; 44:79-88. [PMID: 27550510 DOI: 10.1007/s10396-016-0734-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/07/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) is a very sensitive diagnostic tool in characterizing liver tumors. It is especially useful in the diagnosis of focal nodular hyperplasia (FNH) of the liver. According to the previous reports, FNH is common in young women, and it is usually diagnosed by MRI. The majority of the previous reports come from European countries, and a very few studies of large series designed to describe the clinical features in Japanese patients have been reported. The aim of this study was to (a) describe the clinical features in 53 patients (59 lesions) diagnosed with CEUS and (b) compare the data with those from the previous reports. METHODS The medical data from 53 patients diagnosed on the basis of typical CEUS findings at our institution and affiliated hospitals were reviewed, and their clinical data were analyzed. RESULTS (1) The medical data from 53 cases showed a slight male predilection, with 30 male cases (57 %) and 23 female cases (43 %), although the occurrence in both sexes was equal. FNH cases were distributed throughout all generations in both sexes, mostly concentrated in the age of 30-60 years old, and metabolic cases were more common in men than in women (4 vs 0). (2) The lesions were small (mean: 23 mm) and distributed throughout the whole liver. (3) Lesion size was not influenced by age in either sex. (4) A rapid draining to the hepatic vein was recognized in five out of 59 lesions (8 %). CONCLUSIONS Our data indicate that FNH occurs slightly more frequently in men than in women in Japan. It occurs also at any age in both sexes, but the mean lesion size was smaller in our series than in the previous reports. Metabolic disease was seen only in male FNH patients. A direct communication between the FNH lesion and the hepatic vein is diagnostically worth noting.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan.
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
| | - Masahiro Ogawa
- Department of Gastroenterology and Hepatology, Nihon University Hospital, Tokyo, Japan
| | - Yukinobu Watanabe
- Department of Gastroenterology and Hepatology, Nihon University Hospital, Tokyo, Japan
| | - Daisuke Watanabe
- Department of Gastroenterology, Noshiro Ishikai Hospital, Noshiro, Japan
| | - Yoko Ohyama
- Department of Medical Laboratory, Akita Kousei Medical Center, Akita, Japan
| | - Takako Watanabe
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
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38
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Dioguardi Burgio M, Ronot M, Salvaggio G, Vilgrain V, Brancatelli G. Imaging of Hepatic Focal Nodular Hyperplasia: Pictorial Review and Diagnostic Strategy. Semin Ultrasound CT MR 2016; 37:511-524. [PMID: 27986170 DOI: 10.1053/j.sult.2016.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign solid liver lesion after hemangioma, occurring more frequently in young women. The prime differential diagnoses include hepatocellular adenoma, hepatocellular carcinoma, and hypervascular metastasis. As the management of FNH is typically conservative, imaging plays a key role in diagnostic pathway, and misdiagnosis may have a major clinical effect. In this article, we describe the ultrasound, computed tomography, and magnetic resonance imaging features of FNH, underlining the importance of typical radiological features that allow a specific noninvasive diagnosis. We present a large spectrum of a typical imaging findings that FNH may present and discuss the up-to-date diagnostic strategy.
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Affiliation(s)
- Marco Dioguardi Burgio
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France
| | - Maxime Ronot
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France; University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 1149, Paris, France
| | - Giuseppe Salvaggio
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies Di.Bi.Med., University of Palermo, Palermo, Italy
| | - Valérie Vilgrain
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France; University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 1149, Paris, France
| | - Giuseppe Brancatelli
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies Di.Bi.Med., University of Palermo, Palermo, Italy.
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39
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EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol 2016; 65:386-98. [PMID: 27085809 DOI: 10.1016/j.jhep.2016.04.001] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 02/06/2023]
Affiliation(s)
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- European Association for the Study of the Liver (EASL), The EASL Building – Home of European Hepatology, 7 rue Daubin, CH 1203 Geneva, Switzerland.
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40
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Wang W, Liu JY, Yang Z, Wang YF, Shen SL, Yi FL, Huang Y, Xu EJ, Xie XY, Lu MD, Wang Z, Chen LD. Hepatocellular adenoma: comparison between real-time contrast-enhanced ultrasound and dynamic computed tomography. SPRINGERPLUS 2016; 5:951. [PMID: 27386395 PMCID: PMC4929102 DOI: 10.1186/s40064-016-2406-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 05/24/2016] [Indexed: 12/14/2022]
Abstract
Purpose To investigate and compare the contrast-enhanced ultrasound (CEUS) features of histologically proven HCA with those of contrast-enhanced computed tomography (CECT). Methods Eighteen patients with proven hepatic adenoma by pathology were retrospectively selected from the CEUS database. Fourteen of them had undergone liver CECT exams. The basic features on unenhanced imaging and the enhancement level and specific features on contrast-enhanced imaging were retrospectively analyzed, and the differences between CEUS and CECT were compared. Results All the HCAs showed hyper-enhancement in the arterial phase. During the portal and late phases, 12 HCAs (12/18, 66.7 %) on CEUS and 11 (11/14, 78.6 %) on CT showed washout. On CEUS, 10 (10/18, 55.5 %) showed centripetal filling in the arterial phase and persistent peripheral rim enhancement. Five of them (61.1 %, 11/18) showed delayed central washout in the portal or late phase. However, on CECT, 2 (14.3 %, 2/14) and 4 (28.6 %, 4/14) HCAs showed persistent enhancement of the peripheral rim and central non-enhancing hemorrhage areas, respectively. Conclusions Compared with dynamic CT, CEUS was superior at characterizing specific dynamic features. Considering that it is radiation-free, readily availability and easy to use, CEUS is suggested as the first line imaging tool to diagnose HCA.
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Affiliation(s)
- Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin-Ya Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zheng Yang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yue-Feng Wang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shun-Li Shen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Feng-Lian Yi
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Er-Jiao Xu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Hau HM, Atanasov G, Tautenhahn HM, Ascherl R, Wiltberger G, Schoenberg MB, Morgül MH, Uhlmann D, Moche M, Fuchs J, Schmelzle M, Bartels M. The value of liver resection for focal nodular hyperplasia: resection yes or no? Eur J Med Res 2015; 20:86. [PMID: 26494164 PMCID: PMC4619214 DOI: 10.1186/s40001-015-0181-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022] Open
Abstract
Background Focal nodular hyperplasia (FNH) are benign lesions in the liver. Although liver resection is generally not indicated in these patients, rare indications for surgical approaches indeed exist. We here report on our single-center experience with patients undergoing liver resection for FNH, focussing on preoperative diagnostic algorithms and quality of life (QoL) after surgery. Methods Medical records of 100 consecutive patients undergoing liver resection for FNH between 1992 and 2012 were retrospectively analyzed with regard to diagnostic pathways and indications for surgery. Quality of life (QoL) before and after surgery was evaluated using validated assessment tools. Student’s t test, one-way ANOVA, χ2, and binary logistic regression analyses such as Wilcoxon–Mann–Whitney test were used, as indicated. Results A combination of at least two preoperative diagnostic imaging approaches was applied in 99 cases, of which 70 patients were subjected to further imaging or tumor biopsy. In most patients, there was more than one indication for liver resection, including tumor-associated symptoms with abdominal discomfort (n = 46, 40.7 %), balance of risk for malignancy/history of cancer (n = 54, 47.8 %/n = 18; 33.3 %), tumor enlargement/jaundice of vascular and biliary structures (n = 13, 11.5 %), such as incidental findings during elective operation (n = 1, 0.9 %). Postoperative morbidity was 19 %, with serious complications (>grade 2, Clavien–Dindo classification) being evident in 8 %. Perioperative mortality was 0 %. Liver resection was associated with a significant overall improvement in general health (very good–excellent: preoperatively 47.4 % vs. postoperatively 68.1 %; p = 0.015). Conclusions Liver resection remains a valuable therapeutic option in the treatment of either symptomatic FNH or if malignancy cannot finally be ruled out. If clinically indicated, liver resection for FNH represents a safe approach and may lead to significant improvements of QoL especially in symptomatic patients. Electronic supplementary material The online version of this article (doi:10.1186/s40001-015-0181-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hans Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Georgi Atanasov
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. .,Department of General, Visceral, Vascular and Thoracic Surgery, Charité-University Hospital of Berlin, Berlin, Germany.
| | - Hans-Michael Tautenhahn
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. .,Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany.
| | - Rudolf Ascherl
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Georg Wiltberger
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Markus Bo Schoenberg
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Mehmet Haluk Morgül
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Dirk Uhlmann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
| | - Jochen Fuchs
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
| | - Moritz Schmelzle
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. .,Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany. .,Department of General, Visceral, Vascular and Thoracic Surgery, Charité-University Hospital of Berlin, Berlin, Germany.
| | - Michael Bartels
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
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Improvement of the accuracy of liver lesion DCEUS quantification with the use of automatic respiratory gating. Eur Radiol 2015; 26:417-24. [DOI: 10.1007/s00330-015-3797-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/05/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
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43
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Roux M, Pigneur F, Calderaro J, Baranes L, Chiaradia M, Tselikas L, Decaens T, Costentin C, Laurent A, Azoulay D, Mallat A, Zafrani ES, Rahmouni A, Luciani A. Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI. J Magn Reson Imaging 2015; 42:1249-58. [PMID: 25851028 DOI: 10.1002/jmri.24897] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/11/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine the value of quantitative analysis of the hepatobiliary phase (HBP) in gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). MATERIALS AND METHODS Thirty-eight patients bearing 67 lesions (40 FNH; 27 HCA) were retrospectively included in this Institutional Review Board-approved study. The same volumetric interpolated breath-hold examination (VIBE) T1 -weighted sequences were performed before and after contrast injection on a 1.5T MRI, with HBP images acquired with a mean delay of 80 minutes (range 60-120 min). After a visual assessment of lesions enhancement (qualitative HBP analysis), the HBP signal intensity ratio (SIR) and the lesion-to-liver contrast enhancement ratio (LLCER) were calculated for each lesion by two observers (Mann-Whitney test). The sensitivities, specificities (receiver operating characteristic [ROC] curve analysis) and interobserver correlation (intraclass coefficient, ICC) of quantitative HBP analysis were determined. RESULTS All FNH and 44.4% of HCA appeared hyper- or isointense relative to the adjacent liver on qualitative HBP analysis. The mean SIR (P < 0.01) and LLCER (P < 0.0001) of FNH were significantly higher than that of HCA. The area under the ROC curve for the differentiation of FNH from HCA with LLCER was 0.98 for both observers. With a cutoff value of -0.3%-observer 1 with highest experience- LLCER assessment provided respective sensitivity and specificity values of 100% and 96.2% for the differentiation of FNH from HCA. The ICC was 0.7 for SIR measurements and 0.8 for LLCER measurements. CONCLUSION Quantitative LLCER assessment allows an accurate differentiation of FNH from HCA, even in hyper- or isointense HCA on HBP images.
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Affiliation(s)
- Marion Roux
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Frederic Pigneur
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Julien Calderaro
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Laurence Baranes
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Mélanie Chiaradia
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Lambros Tselikas
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Thomas Decaens
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Charlotte Costentin
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Alexis Laurent
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Daniel Azoulay
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Ariane Mallat
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Elie-Serge Zafrani
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Alain Rahmouni
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Alain Luciani
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France.,INSERM Unite U 955, Equipe 17, Molecular Mechanisms of Liver Fibrosis, Creteil, France
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