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Xu L, Ren Z, Li G, Xu D, Miao J, Ju J, Mo X, Wang X, Deng H, Xu M. Liver-targeting MRI contrast agent based on galactose functionalized o-carboxymethyl chitosan. Front Bioeng Biotechnol 2023; 11:1134665. [PMID: 37284241 PMCID: PMC10239977 DOI: 10.3389/fbioe.2023.1134665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Commercial gadolinium (Gd)-based contrast agents (GBCAs) play important role in clinical diagnostic of hepatocellular carcinoma, but their diagnostic efficacy remained improved. As small molecules, the imaging contrast and window of GBCAs is limited by low liver targeting and retention. Herein, we developed a liver-targeting gadolinium (Ⅲ) chelated macromolecular MRI contrast agent based on galactose functionalized o-carboxymethyl chitosan, namely, CS-Ga-(Gd-DTPA)n, to improve hepatocyte uptake and liver retention. Compared to Gd-DTPA and non-specific macromolecular agent CS-(Gd-DTPA)n, CS-Ga-(Gd-DTPA)n showed higher hepatocyte uptake, excellent cell and blood biocompatibility in vitro. Furthermore, CS-Ga-(Gd-DTPA)n also exhibited higher relaxivity in vitro, prolonged retention and better T1-weighted signal enhancement in liver. At 10 days post-injection of CS-Ga-(Gd-DTPA)n at a dose of 0.03 mM Gd/Kg, Gd had a little accumulation in liver with no liver function damage. The good performance of CS-Ga-(Gd-DTPA)n gives great confidence in developing liver-specifc MRI contrast agents for clinical translation.
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Affiliation(s)
- Li Xu
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhanying Ren
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
- Southern University of Science and Technology, Shenzhen, China
| | - Guolin Li
- Department of Stomatology, Shanghai 8th People’s Hospital, Shanghai, China
| | - Danni Xu
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiaqian Miao
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingxuan Ju
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuan Mo
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xianghui Wang
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Hongping Deng
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Xu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
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Hepatic Adenoma Subtypes on Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2023; 220:28-38. [PMID: 35920706 DOI: 10.2214/ajr.22.27989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. Accumulating evidence indicates that hepatocellular adenoma (HCA) may have a higher frequency of hepatobiliary phase (HBP) iso- or hyperintensity than previously reported. OBJECTIVE. The purpose of this study was to evaluate the proportion of HCA that shows iso- or hyperintensity in the HBP of gadoxetic acid-enhanced MRI, stratified by HCA subtype (HNF1a-inactivated [H-HCA], inflammatory [I-HCA], β-catenin-activated [B-HCA], and unclassified [U-HCA] HCA), and to assess the diagnostic performance of HBP iso- or hyperintensity for differentiating focal nodular hyperplasia (FNH) from HCA. EVIDENCE ACQUISITION. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched through February 14, 2022, for articles reporting HBP signal intensity on gadoxetic acid-enhanced MRI among pathologically proven HCAs, stratified by subtype. The pooled proportion of HBP iso- or hyperintensity was determined for each subtype and compared using metaregression. Diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from all HCA subtypes combined and from B-HCA and U-HCA combined was assessed using bivariate modeling. EVIDENCE SYNTHESIS. Twenty-eight studies (12 original investigations, 16 case reports or case series) were included, yielding 364 patients with 410 HCAs (112 H-HCAs, 203 I-HCAs, 33 B-HCAs, 62 U-HCAs). Pooled proportion of HBP iso- or hyperintensity was 14% (95% CI, 4-26%) among all HCAs, 0% (95% CI, 0-2%) among H-HCAs, 11% (95% CI, 0-29%) among U-HCAs, 14% (95% CI, 2-31%) among I-HCAs, and 59% (95% CI, 26-88%) among B-HCAs; metaregression showed significant difference among subtypes (p < .001). In four studies reporting diagnostic performance information, HBP iso- or hyperintensity had sensitivity of 99% (95% CI, 57-100%) and specificity of 89% (95% CI, 82-94%) for differentiating FNH from all HCA subtypes and sensitivity of 99% (95% CI, 53-100%) and specificity of 65% (95% CI, 44-80%) for differentiating FNH from B-HCA or U-HCA. CONCLUSION. HCA subtypes other than H-HCA show proportions of HBP iso- or hyperintensity ranging from 11% (U-HCA) to 59% (B-HCA). Low prevalence of B-HCA has contributed to prior reports of high diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from HCA. CLINICAL IMPACT. Radiologists should recognize the low specificity of HBP iso- or hyperintensity on gadoxetic acid-enhanced MRI for differentiating FNH from certain HCA subtypes.
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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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Bilreiro C, Soler JC, Ayuso JR, Caseiro-Alves F, Ayuso C. Diagnostic value of morphological enhancement patterns in the hepatobiliary phase of gadoxetic acid-enhanced MRI to distinguish focal nodular hyperplasia from hepatocellular adenoma. Radiol Med 2021; 126:1379-1387. [PMID: 34287759 DOI: 10.1007/s11547-021-01403-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe the different morphological enhancement patterns of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-DTPA MRI) and to determine their added value in their differential diagnosis. METHODS A retrospective analysis of imaging findings in 185 benign hepatocellular lesions (154 FNH; 31 HCA) in 108 patients who underwent Gd-EOB-DTPA MRI was performed by two independent reviewers. Six patterns on HBP were recorded: 1) homogeneous enhancement; 2) peripheral ring-like enhancement with hypointense central core; 3) peripheral ring-like enhancement with hyperintense central core; 4) central core enhancement with hypointense periphery; 5) heterogeneous enhancement; and 6) the absence of enhancement. RESULTS Peripheral ring-like enhancement with hypointense central core and peripheral ring-like enhancement with hyperintense central core showed the highest specificity for the diagnosis of FNH (100% and 96.8%, respectively). The absence of enhancement and central core enhancement with hypointense periphery were only present in 0.6% and 1.9% of FHN, respectively. All other patterns were observed with similar frequencies in FNH (22.1% to 26.6%). Six HCA showed contrast uptake on the HBP: homogeneous (6.5%), peripheral ring-like enhancement with hyperintense central core (3.2%) and heterogeneous (9.7%). CONCLUSION Both FNH and HCA may demonstrate enhancement in the HBP of Gd-EOB-DTPA MRI, limiting its specificity. A significant improvement in specificity can be achieved by the evaluation of morphological enhancement patterns: Peripheral ring-like enhancement with hypointense or hyperintense central core was highly specific for FNH diagnosis. On the other hand, the absence of HBP enhancement makes the diagnosis of FNH unlikely.
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Affiliation(s)
- Carlos Bilreiro
- Radiology Department, Champalimaud Clinical Centre, Lisbon, Portugal
- Pre-Clinical MRI, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Juan Carlos Soler
- Radiology Department, BCLC Group. Hospital Clínic, c/ Villarroel, 170. Escala 3, Planta 1., 08036, Barcelona, Spain
| | - Juan R Ayuso
- Radiology Department, BCLC Group. Hospital Clínic, c/ Villarroel, 170. Escala 3, Planta 1., 08036, Barcelona, Spain
| | - Filipe Caseiro-Alves
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Carmen Ayuso
- Radiology Department, BCLC Group. Hospital Clínic, c/ Villarroel, 170. Escala 3, Planta 1., 08036, Barcelona, Spain.
- IDIBAPS. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas (CIBERehd), Clinic Liver Cancer Group (BCLC), Barcelona, Spain.
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Vernuccio F, Gagliano DS, Cannella R, Ba-Ssalamah A, Tang A, Brancatelli G. Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting. Insights Imaging 2021; 12:8. [PMID: 33432491 PMCID: PMC7801550 DOI: 10.1186/s13244-020-00928-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
Hepatobiliary MRI contrast agents are increasingly being used for liver imaging. In clinical practice, most focal liver lesions do not uptake hepatobiliary contrast agents. Less commonly, hepatic lesions may show variable signal characteristics on hepatobiliary phase. This pictorial essay reviews a broad spectrum of benign and malignant focal hepatic observations that may show hyperintensity on hepatobiliary phase in various clinical settings. In non-cirrhotic patients, focal hepatic observations that show hyperintensity in the hepatobiliary phase are usually benign and typically include focal nodular hyperplasia. In patients with primary or secondary vascular disorders, focal nodular hyperplasia-like lesions arise as a local hyperplastic response to vascular alterations and tend to be iso- or hyperintense in the hepatobiliary phase. In oncologic patients, metastases and cholangiocarcinoma are hypointense lesions in the hepatobiliary phase; however, occasionally they may show a diffuse, central and inhomogeneous hepatobiliary paradoxical uptake with peripheral rim hypointensity. Post-chemotherapy focal nodular hyperplasia-like lesions may be tricky, and their typical hyperintense rim in the hepatobiliary phase is very helpful for the differential diagnosis with metastases. In cirrhotic patients, hepatocellular carcinoma may occasionally appear hyperintense on hepatobiliary phase.
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Affiliation(s)
- Federica Vernuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy. .,University Paris Diderot, Sorbonne Paris Cité, Paris, France. .,I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124, Messina, Italy. .,Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Domenico Salvatore Gagliano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Roberto Cannella
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy.,Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - An Tang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.,Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, Canada
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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HCA vs. FNH – Differenzialdiagnose mittels Sonografie oder MRT. ROFO-FORTSCHR RONTG 2020. [DOI: 10.1055/a-1151-8528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Reizine E, Ronot M, Ghosn M, Calderaro J, Frulio N, Bioulac-Sage P, Trillaud H, Vilgrain V, Paradis V, Luciani A. Hepatospecific MR contrast agent uptake on hepatobiliary phase can be used as a biomarker of marked β-catenin activation in hepatocellular adenoma. Eur Radiol 2020; 31:3417-3426. [PMID: 33146794 DOI: 10.1007/s00330-020-07434-z] [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] [Received: 06/23/2020] [Revised: 09/01/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the value of hepatospecific MR contrast agent uptake on hepatobiliary phase (HBP) images to detect marked activation of the β-catenin pathway in hepatocellular adenomas (HCAs). METHODS This multicentric retrospective IRB-approved study included all patients with a pathologically proven HCA who underwent gadobenate dimeglumine-enhanced liver MRI with HBP. Tumor signal intensity on HBP was first assessed visually, and lesions were classified into three distinct groups-hypointense, isointense, or hyperintense-according to the relative signal intensity to liver. Uptake was then quantified using the lesion-to-liver contrast enhancement ratio (LLCER). Finally, the accuracy of HBP analysis in depicting marked β-catenin activation in HCA was evaluated. RESULTS A total of 124 HCAs were analyzed including 12 with marked β-catenin activation (HCA B+). Visual analysis classified 94/124 (76%), 12/124 (10%), and 18/124 (14%) HCAs as being hypointense, isointense, and hyperintense on HBP, respectively. Of these, 1/94 (1%), 3/12 (25%), and 8/18 (44%) were HCA B+, respectively (p < 0.001). The LLCER of HCA B+ was higher than that of HCA without marked β-catenin activation in the entire cohort (means 4.9 ± 11.8% vs. - 19.8 ± 11.4%, respectively, p < 0.001). A positive LLCER, i.e., LLCER ≥ 0%, had 75% (95% CI 43-95%) sensitivity and 97% (95% CI 92-99%) specificity, with a LR+ of 28 (95% CI 8.8-89.6) for the diagnosis of HCA B+. CONCLUSIONS Hepatospecific contrast uptake on hepatobiliary phase is strongly associated with marked activation of the β-catenin pathway in hepatocellular adenoma, and its use might improve hepatocellular adenoma subtyping on MRI. KEY POINTS • Tumor uptake on hepatobiliary phase in both the visual and quantitative analyses had a specificity higher than 90% for the detection of marked β-catenin activation in hepatocellular adenoma. • However, the sensitivity of visual analysis alone is inferior to that of LLCER quantification on HBP due to the high number of HCAs with signal hyperintensity on HBP, especially those developed on underlying liver steatosis.
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Affiliation(s)
- E Reizine
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.
| | - M Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - M Ghosn
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France
| | - J Calderaro
- Department of Pathology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.,Faculté de Médecine, Universite Paris Est Creteil, 94010, Créteil, France.,INSERM Unit U 955, Equipe 18, 94010, Créteil, France
| | - N Frulio
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, Université de Bordeaux, 33000, Bordeaux, France
| | - P Bioulac-Sage
- Inserm, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, Université de Bordeaux, 33076, Bordeaux, France.,Department of Pathology, Pellegrin Hospital, CHU de Bordeaux, 33076, Bordeaux, France
| | - H Trillaud
- Department of Pathology, Beaujon Hospital, APHP, Clichy, France
| | - V Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - V Paradis
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.,Department of Pathology, Beaujon Hospital, APHP, Clichy, France
| | - A Luciani
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.,Faculté de Médecine, Universite Paris Est Creteil, 94010, Créteil, France.,INSERM Unit U 955, Equipe 18, 94010, Créteil, France
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Kim JH, Joo I, Lee JM. Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging. Korean J Radiol 2020; 20:1019-1041. [PMID: 31270973 PMCID: PMC6609440 DOI: 10.3348/kjr.2018.0636] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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Zember J, Loomis J, Vyas P, Badalyan V, Shet N. Advances in Diagnostic Imaging in Pediatric Gastroenterology. Curr Gastroenterol Rep 2020; 22:22. [PMID: 32193706 DOI: 10.1007/s11894-020-00762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW The purpose is to provide a review of cross-sectional imaging updates in the assessment of gastrointestinal diseases, relevant to clinical practice and research. RECENT FINDINGS New magnetic resonance imaging contrast agents (Eovist) are taken up by hepatocytes and excreted via the biliary tree. As such, a lesion will retain contrast only if hepatocytes are present, which aids in refining the differential diagnosis. Magnetic resonance enterography is a method for non-invasively diagnosing and following various GI conditions, predominantly inflammatory bowel disease. Contrast-enhanced ultrasound uses gas-filled microbubbles providing superb temporal resolution most notably in the arterial phase, which aids in differentiating lesions. Elastography is a new technique which assesses stiffness of liver for evaluating fibrosis. These new techniques provide more accurate diagnoses and information, often limiting ionizing radiation exposure from other modalities. While ultrasound will still remain the initial imaging modality, familiarity with these other options is valuable for appropriate pathology workup.
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Affiliation(s)
- Jonathan Zember
- Department of Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Judyta Loomis
- Department of Radiology, Children's National Hospital, Washington, DC, USA
| | - Pranav Vyas
- Department of Radiology, Children's National Hospital, Washington, DC, USA
| | - Vahe Badalyan
- Department of Gastroenterology, Hepatology and Nutrition, Children's National Hospital, Washington, DC, USA
| | - Narendra Shet
- Department of Radiology, Children's National Hospital, Washington, DC, USA
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Abstract
Contrast enhanced MRI of the liver provides valuable information in the evaluation of both chronic liver disease and focal liver lesions. Currently, two classes of MRI contrast agents are available for clinical use, namely the extracellular contrast agent (ECA) and the hepatobiliary agent (HBA). The use of appropriate contrast agents for liver MRI requires knowledge of the clinical situation and question to be answered. ECAs have been used for decades since their introduction into clinical practice and provide excellent dynamic phase information that is useful in characterizing focal liver lesions. In the last decade, HBAs, particularly Gadoxetate, have been found useful for characterizing lesions with functioning hepatocytes and more importantly in evaluating the biliary tree. Gadoxetate, however, provides less satisfactory dynamic phase images compared to ECAs, particularly during the arterial phase. In this perspective article, we will discuss the various intravenous contrast agents used for liver MRI and their ideal utilization.
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Fujita N, Nishie A, Asayama Y, Ishigami K, Ushijima Y, Kakihara D, Nakayama T, Morita K, Ishimatsu K, Honda H. Hyperintense Liver Masses at Hepatobiliary Phase Gadoxetic Acid–enhanced MRI: Imaging Appearances and Clinical Importance. Radiographics 2020; 40:72-94. [DOI: 10.1148/rg.2020190037] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nobuhiro Fujita
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Akihiro Nishie
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshiki Asayama
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kousei Ishigami
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuhiro Ushijima
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Daisuke Kakihara
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomohiro Nakayama
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Koichiro Morita
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Keisuke Ishimatsu
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Honda
- From the Departments of Clinical Radiology (N.F., A.N., K. Ishigami, Y.U., D.K., K.M., K. Ishimatsu, H.H.), Advanced Imaging and Interventional Radiology (Y.A.), and Molecular Imaging and Diagnosis (T.N.), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Lalwani N. Invited Commentary on “Hyperintense Liver Masses at Hepatobiliary Phase Gadoxetic Acid–enhanced MRI”. Radiographics 2020; 40:94-97. [DOI: 10.1148/rg.2020190200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Neeraj Lalwani
- Department of Radiology, Wake Forest University and Baptist Health Winston-Salem, North Carolina
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Zulfiqar M, Sirlin CB, Yoneda N, Ronot M, Hecht EM, Chernyak V, Matsui O, Bastati N, Ba‐Ssalamah A, Chatterjee D, Bashir M, Fowler KJ. Hepatocellular adenomas: Understanding the pathomolecular lexicon, MRI features, terminology, and pitfalls to inform a standardized approach. J Magn Reson Imaging 2019; 51:1630-1640. [DOI: 10.1002/jmri.26902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Maria Zulfiqar
- Mallinckrodt Institute of RadiologyWashington University School of Medicine St Louis Missouri USA
| | - Claude B. Sirlin
- Department of RadiologyUniversity of California San Diego San Diego California USA
| | | | - Maxime Ronot
- Department of RadiologyHôpitaux Universitaires Paris Nord Val de Seine, Cinchy France
| | | | - Victoria Chernyak
- Department of Radiology, Montefiore Medical CenterAlbert Einstein College of Medicine New York New York USA
| | - Osamu Matsui
- Department of RadiologyKanazawa University Japan
| | - Nina Bastati
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Ahmed Ba‐Ssalamah
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Deyali Chatterjee
- Department of PathologyWashington University School of Medicine St Louis Missouri USA
| | - Mustafa Bashir
- Department of RadiologyDuke University Durham North Carolina USA
| | - Kathryn J. Fowler
- Department of RadiologyUniversity of California San Diego San Diego California USA
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Cannella R, Brancatelli G, Rangaswamy B, Minervini MI, Borhani AA, Furlan A. Enhancement pattern of hepatocellular adenoma (HCA) on MR imaging performed with Gd-EOB-DTPA versus other Gd-based contrast agents (GBCAs): An intraindividual comparison. Eur J Radiol 2019; 119:108633. [PMID: 31437747 DOI: 10.1016/j.ejrad.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE To conduct an intraindividual comparison of the enhancement pattern of hepatocellular adenoma (HCA) on dynamic MRI study obtained following the injection of Gadoxetic acid (Gd-EOB-DTPA) and other gadolinium-based contrast agents (GBCAs). METHOD This is a retrospective, Institutional Review Board-approved study conducted in a single institution. A search of medical records between 2008 and 2017 revealed 17 patients (all females) with at least one pathologically-proven HCA who underwent liver MRI with Gd-EOB-DTPA and another GBCA within 1 year. Enhancement of each lesion on hepatic arterial (HAP), portal venous (PVP), 2 min and 4-5 minutes phases was subjectively evaluated by two abdominal radiologists. Lesions were categorized as hyper-, iso- or hypointense compared to the surrounding liver parenchyma. The presence of a peripheral pseudocapsule was also recorded. The differences in lesion enhancement were assessed using the McNemar Test. A p-value <0.05 was considered statistically significant. RESULTS The final population included 35 HCAs (83% inflammatory subtype). There was no significant difference in lesion size (P = 0.708) and enhancement on HAP (P = 0.625) or PVP (P = 0.125). HCAs showed more frequently hypointensity on 2 min (13/35 vs. 1/35, P < 0.001) and 4-5 minutes (P < 0.001) images obtained after injection of Gd-EOB-DTPA compared to those obtained after other GBCAs. A pseudocapsule was more frequently noted after administration of Gd-EOB-DTPA (13/35 vs 1/35, P = 0.002). CONCLUSIONS Enhancement pattern of HCA differs significantly after the injection of Gd-EOB-DTPA compared to other GBCAs. Lesion hypointensity on 2 min and 4-5 minutes images is more frequent when using Gd-EOB-DTPA.
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Affiliation(s)
- Roberto Cannella
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA; Section of Radiology - BiND., University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiology - BiND., University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Balasubramanya Rangaswamy
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marta I Minervini
- Division of Transplant Pathology, Department of Pathology, UPMC Montefiore, University of Pittsburgh, PA, United States
| | - Amir A Borhani
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Ponnatapura J, Kielar A, Burke LM, Lockhart ME, Abualruz AR, Tappouni R, Lalwani N. Hepatic complications of oral contraceptive pills and estrogen on MRI: Controversies and update - Adenoma and beyond. Magn Reson Imaging 2019; 60:110-121. [DOI: 10.1016/j.mri.2019.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 12/17/2022]
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16
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Diffuse Adenomatosis and Hepatocellular Carcinoma Treated with Liver Transplantation in an Adolescent Female with Kabuki Syndrome with a Novel KMT2D Gene Mutation. Case Rep Pediatr 2019; 2019:7983824. [PMID: 31179148 PMCID: PMC6507262 DOI: 10.1155/2019/7983824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/18/2019] [Accepted: 03/31/2019] [Indexed: 12/14/2022] Open
Abstract
Kabuki syndrome (KS) is a rare disorder primarily associated with mutations in the KMT2D and KDM6A genes. Several tumors have been reported with KS; however, there have been no reports of hepatocellular carcinoma (HCC) or hepatic adenomatosis. We present an adolescent girl with KS and a novel KMT2D mutation who developed diffuse adenomatosis, HCC, and subsequently underwent liver transplantation.
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17
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Shet NS, Flynn JF, Maloney E, Iyer RS. Use of Eovist in Pediatric Patients: Pearls and Pitfalls. Curr Probl Diagn Radiol 2019; 49:266-274. [PMID: 31047739 DOI: 10.1067/j.cpradiol.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging is excellent at characterizing pediatric hepatobiliary pathology. Noncontrast MRI is helpful due to T2 hyperintensity associated with bile, but contrast enhancement offers additional means of lesional characterization. In particular, hepatocyte-specific contrast agents such as gadoxetate disodium (Eovist) exhibit partial hepatobiliary excretion which may be leveraged in these contexts. In this review, we will discuss gadoxetate disodium usage, including a sample-imaging protocol, and demonstrate applications and limitations in the pediatric population.
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Affiliation(s)
- Narendra S Shet
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC.
| | - John F Flynn
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC
| | - Ezekiel Maloney
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
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18
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Reizine E, Ronot M, Pigneur F, Purcell Y, Mulé S, Dioguardi Burgio M, Calderaro J, Amaddeo G, Laurent A, Vilgrain V, Luciani A. Iso- or hyperintensity of hepatocellular adenomas on hepatobiliary phase does not always correspond to hepatospecific contrast-agent uptake: importance for tumor subtyping. Eur Radiol 2019; 29:3791-3801. [DOI: 10.1007/s00330-019-06150-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
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19
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Value of Texture Analysis on Gadoxetic Acid-Enhanced MRI for Differentiating Hepatocellular Adenoma From Focal Nodular Hyperplasia. AJR Am J Roentgenol 2018; 212:538-546. [PMID: 30557050 DOI: 10.2214/ajr.18.20182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of our study was to assess the diagnostic performance of texture analysis (TA) on gadoxetic acid-enhanced MR images for differentiation of hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH). MATERIALS AND METHODS This study included 40 patients (39 women and one man) with 51 HCAs and 28 patients (27 women and one man) with 32 FNH lesions. All lesions were histologically proven with preoperative MRI performed with gadoxetic acid. Two readers reviewed all the imaging sequences to assess the qualitative MRI characteristics. The T2-weighted fast spin-echo, hepatic arterial phase (HAP), and hepatobiliary phase (HBP) sequences were used for TA. Textural features were extracted using commercially available software (TexRAD). The differences in distributions of TA parameters of FNHs and HCAs were assessed using the Mann-Whitney U test. Area under the ROC curve (AUROC) values were calculated for statistically significant features. A logistic regression analysis was conducted to explore the added value of TA. A p value < 0.002 was considered statistically significant after Bonferroni correction for multiple comparisons. RESULTS Multiple TA parameters showed a statistically different distribution in HCA and FNH including skewness on T2-weighted imaging, skewness on HAP imaging, skewness on HBP imaging, and entropy on HBP imaging (p < 0.001). Skewness on HBP imaging showed the largest AUROC (0.869; 95% CI, 0.777-0.933). A skewness value on HBP imaging of greater than -0.06 had a sensitivity of 72.5% and a specificity of 90.6% for the diagnosis of HCA. Six of 51 (11.8%) HCAs lacked hypointensity on HBP imaging. A binary logistic regression analysis including hypointensity on HBP imaging and the statistically significant TA parameters yielded an AUROC of 0.979 for the diagnosis of HCA and correctly predicted 96.4% of the lesions. CONCLUSION TA may be of added value for the diagnosis of atypical HCA presenting without hypointensity on HBP imaging.
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20
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Reizine E, Amaddeo G, Pigneur F, Baranes L, Legou F, Mulé S, Zegai B, Roche V, Laurent A, Rahmouni A, Calderaro J, Luciani A. Quantitative correlation between uptake of Gd-BOPTA on hepatobiliary phase and tumor molecular features in patients with benign hepatocellular lesions. Eur Radiol 2018; 28:4243-4253. [PMID: 29721686 DOI: 10.1007/s00330-018-5438-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of our study was to correlate the quantitative analysis of benign hepatocellular tumor uptake on delayed hepatobiliary phase (HBP) imaging with the quantitative level of OATP expression. METHODS This single-center retrospective study, which took place between September 2009 and March 2015, included 20 consecutive patients with a proven pathologic and immunohistochemical (IHC) diagnosis of FNH or HCA, including quantification of the OATP expression. The patients underwent Gd-BOPTA-enhancement MRI, including an HBP. The analysis of HBP uptake was performed using the liver-to-lesion contrast enhancement ratio (LLCER). Mean LLCER and OATP expressions were compared between FNH and HCA, and the expression of OATP was correlated with the LLCER value. RESULTS Of the 23 benign hepatocellular tumors, 9 (39%) were FNH and 14 (61%) were HCA, including 6 inflammatory, 2 HNF1a inactivated, 3 β-catenin-mutated and 3 unclassified HCAs. On HBP, 100% of the FNH appeared hyper- or isointense, and 79% of the adenomas appeared hypointense. The mean OATP expression of FNH (46.67 ± 26.58%) was significantly higher than that of HCA (22.14 ± 30.74%) (p = 0.0273), and the mean LLCER of FNH (10.66 ± 7.403%) was significantly higher than that of HCA (-13.5 ± 12.25%) (p < 0.0001). The mean LLCER of β-catenin-mutated HCA was significantly higher than that of other HCAs (p = 0.011). Significant correlation was found between the OATP expression and LLCER values (r = 0.661; p = 0.001). CONCLUSION In benign hepatocellular tumors, the quantitative analysis of hepatobiliary contrast agent uptake on HBP is correlated with the level of OATP expression and could be used as an imaging biomarker of the molecular background of HCA and FNH. KEY POINTS • Gd-BOPTA uptake on HBP correlates with the OATP level in benign hepatocellular tumors • FNH and β-catenin-mutated HCA showed an increased lesion-to-liver contrast enhancement ratio (LLCER) • Increased LLCER may be explained by activation of the Wnt β-catenin pathway.
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Affiliation(s)
- Edouard Reizine
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.
| | - Giuliana Amaddeo
- Hepatology Department, AP-HP, Groupe Henri Mondor Albert Chenevier, F-94010, Creteil, France.,Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France
| | - Frederic Pigneur
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurence Baranes
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - François Legou
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Sebastien Mulé
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Benhalima Zegai
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Vincent Roche
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Alexis Laurent
- Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France.,Liver Surgery, AP-HP, Groupe Henri Mondor Albert Chenevier, F-94010, Creteil, France
| | - Alain Rahmouni
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.,Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France
| | - Julien Calderaro
- Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France.,Pathology, AP-HP, Groupe Henri Mondor Albert Chenevier, F-94010, Creteil, France
| | - Alain Luciani
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.,Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France
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