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Xiao SY, Xu JX, Shao YH, Yu RS. To identify important MRI features to differentiate hepatic mucinous cystic neoplasms from septated hepatic cysts based on random forest. Jpn J Radiol 2024; 42:880-891. [PMID: 38664363 DOI: 10.1007/s11604-024-01562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/17/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To identify important MRI features to differentiate hepatic mucinous cystic neoplasms (MCN) from septated hepatic cysts (HC) using random forest and compared with logistic regression algorithm. METHODS Pathologically diagnosed hepatic cysts and hepatic MCNs with pre-operative contrast-enhanced MRI in our hospital from 2010 to 2023 were collected and only septated lesions on enhanced MRI were enrolled. A total of 21 septated HC and 18 MCNs were included in this study. Eighteen MRI features were analyzed and top important features were identified based on random forest (RF) algorithm. The results were evaluated by the prediction performance of a RF model combining the important features and compared with the performance of the logistic regression (LR) algorithm. Finally, for each identified feature, diagnostic probability, sensitivity, and specificity were calculated and compared. RESULTS Four variables, i.e., the septation arising from wall without indentation, multiseptate, intracapsular cyst sign, and solitary lesion were extracted as top important features with significance for MCNs by the random forest algorithm. The RF model using these variables had an AUC of 0.982 (0.95CI, 0.950-1.000), compared with the LR model based on two identified features with AUC of 0.931 (0.95CI, 0.846-1.000), p = 0.202. Among the four important features, multiseptate had the highest specificity (95.2%) and good sensitivity (72.2%, lower than the septation from wall without indentation, 94.4%) to diagnose MCNs. CONCLUSION Four out of 18 MRI features were extracted as reliably important factors to differ hepatic MCNs from septated HC. The combination of these four features in a RF model could achieve satisfactory diagnostic efficacy.
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Affiliation(s)
- Si-Yu Xiao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi-Huan Shao
- Department of Pathology, Zhejiang University School of Medicine Second Affiliated Hospital Linping Hospital, Hangzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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2
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Sidler F, Turcan V, Storni F, Bernhard S, Jakob DA, Ehrhard S. Spontaneous Atraumatic Rupture of a Liver Hemangioma as a Rare Cause of Syncope. Case Reports Hepatol 2024; 2024:7921410. [PMID: 39104460 PMCID: PMC11300087 DOI: 10.1155/2024/7921410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 08/07/2024] Open
Abstract
Background Syncope is common in emergency medicine, but only a minority of syncopes is caused by hemorrhage. Liver hemangioma is the most frequent benign liver tumor, and they rarely lead to symptoms or complications. Case Presentation. We describe the case of an 81-year-old man with hemorrhagic shock due to an atraumatic rupture of a hepatic hemangioma while on oral anticoagulation. The patient presented to the emergency department after three episodes of syncope before admission, nausea, vomiting, mild epigastric abdominal pain, but with clinical signs of peritonitis. On admission, the patient had a mild tachycardia with a heart rate of 107/min and a blood pressure of 102/83 mmHg. Initial hemoglobin was 122 g/L, and lactate was slightly elevated (2.5 mmol/L). Bedside sonography revealed free intraabdominal fluid. The subsequent computed tomography showed a ruptured hemangioma of the liver with ongoing hemorrhage. After the CT scan, the patient became increasingly tachycardic and the blood pressure dropped to 94/62 mmHg. After administration of blood products and intravenous fluids, the patient responded with improved hemodynamics and was transferred to angiology for emergency embolization. After the intervention, the patient spent two days in the intermediate care unit and was discharged after 10 days of hospitalization. Conclusion Atraumatic rupture of a hemangioma with consecutive hemorrhagic shock is extremely rare. In selected cases of spontaneously ruptured hemangiomas with hemoperitoneum, endovascular embolization can be an alternative to surgery. Furthermore, this case emphasizes the importance of sonographic examination as an additional diagnostic tool in syncope and concomitant abdominal pain.
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Affiliation(s)
- Fabian Sidler
- Department of General Internal MedicineInselspitalBern University HospitalUniversity of Bern, Bern, Switzerland
- Department of Visceral Surgery and MedicineInselspitalBern University HospitalUniversity of Bern, Bern, Switzerland
| | - Vitalie Turcan
- University Clinic for Visceral Surgery and MedicineInselspitalBern University Hospital, Bern, Switzerland
| | - Federico Storni
- University Clinic for Visceral Surgery and MedicineInselspitalBern University Hospital, Bern, Switzerland
| | - Sarah Bernhard
- Division of AngiologySwiss Cardiovascular CenterInselspitalBern University Hospital, Bern, Switzerland
- Vascular CenterBienna Hospital Center, Bienna, Switzerland
| | - Dominik A. Jakob
- Department of Emergency MedicineInselspitalBern University Hospital, Bern, Switzerland
| | - Simone Ehrhard
- Department of Emergency MedicineInselspitalBern University Hospital, Bern, Switzerland
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3
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Okino K, Wakasugi S, Ichihara S. Hyperechogenicity and histopathological features of focal liver lesions. J Med Ultrason (2001) 2024:10.1007/s10396-024-01475-3. [PMID: 38958787 DOI: 10.1007/s10396-024-01475-3] [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: 01/18/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024]
Abstract
The identification and accurate diagnosis of focal liver lesions are important in modern medicine, where diagnostic radiology plays an essential role. This review aimed to examine the hyperechogenicity and histopathological features of focal liver lesions. Hyperechogenic liver lesions can be either benign or malignant. Evidence shows that hyperechogenicity is caused by factors such as fat deposition, sinusoidal dilation, peliotic changes, and pseudoglandular patterns. Fat deposition is a common cause of increased echogenicity in hepatocellular carcinoma (HCC). Meanwhile, sinusoidal dilation and peliotic changes are more frequently observed in larger HCC nodules. Pseudoglandular patterns, characterized by the reflection of ultrasound waves at the walls of numerous acini, are associated with hyperechogenicity in well-to-moderately differentiated HCCs. Moreover, this review comprehensively examined the histological features that may cause hyperechogenic internal echoes in not only HCCs but also localized liver lesions (metastases of adenocarcinoma and neuroendocrine neoplasm, intrahepatic cholangiocarcinoma, cavernous hemangioma, focal nodular hyperplasia, and angiomyolipoma). To make an accurate diagnosis and provide appropriate management, it is important to understand the histopathological basis for hyperechogenicity in focal liver lesions. By maximizing the accuracy of imaging studies and enhancing the radiology-pathology correlation, unnecessary biopsies can be avoided, thereby reducing potential complications and mortality. This review can help facilitate the effective management of patients with focal liver lesions, thereby resulting in timely and appropriate treatment decision-making.
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Affiliation(s)
- Kumiko Okino
- Department of Clinical Laboratory Medicine, School of Medical Technology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Satoshi Wakasugi
- Department of Internal Medicine, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Shin Ichihara
- Department of Surgical Pathology, Sapporo Kosei General Hospital, Sapporo, Japan.
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4
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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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5
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Kahraman G, Haberal KM, Dilek ON. Imaging features and management of focal liver lesions. World J Radiol 2024; 16:139-167. [PMID: 38983841 PMCID: PMC11229941 DOI: 10.4329/wjr.v16.i6.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Notably, the number of incidentally detected focal liver lesions (FLLs) has increased dramatically in recent years due to the increased use of radiological imaging. The diagnosis of FLLs can be made through a well-documented medical history, physical examination, laboratory tests, and appropriate imaging methods. Although benign FLLs are more common than malignant ones in adults, even in patients with primary malignancy, accurate diagnosis of incidental FLLs is of utmost clinical significance. In clinical practice, FLLs are frequently evaluated non-invasively using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although US is a cost-effective and widely used imaging method, its diagnostic specificity and sensitivity for FLL characterization are limited. FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI. MRI is a problem-solving method with high specificity and sensitivity, commonly used for the evaluation of FLLs that cannot be characterized by US or CT. Recent technical advancements in MRI, along with the use of hepatobiliary-specific MRI contrast agents, have significantly improved the success of FLL characterization and reduced unnecessary biopsies. The American College of Radiology (ACR) appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients. ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommendations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios. The American College of Gastroenterology (ACG) Clinical Guideline offers evidence-based recommendations for both the diagnosis and management of FLL. American Association for the Study of Liver Diseases (AASLD) Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma. In this article, FLLs are reviewed with a comprehensive analysis of ACR Appropriateness Criteria, ACG Clinical Guideline, AASLD Practice Guidance, and current medical literature from peer-reviewed journals. The article includes a discussion of imaging methods used for the assessment of FLL, current recommended imaging techniques, innovations in liver imaging, contrast agents, imaging features of common nonmetastatic benign and malignant FLL, as well as current management recommendations.
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Affiliation(s)
- Gökhan Kahraman
- Department of Radiology, Suluova State Hospital, Amasya 05500, Türkiye
| | - Kemal Murat Haberal
- Department of Radiology, Başkent University Faculty of Medicine, Ankara 06490, Türkiye
| | - Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Türkiye
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Calu V, Enciu O, Toma EA, Pârvuleţu R, Pîrîianu DC, Miron A. Complicated Liver Cystic Echinococcosis-A Comprehensive Literature Review and a Tale of Two Extreme Cases. Tomography 2024; 10:922-934. [PMID: 38921947 PMCID: PMC11209078 DOI: 10.3390/tomography10060070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Cystic echinococcosis is a zoonotic parasitic disease that affects the liver in more than 70% of cases, and there is still an underestimated incidence in endemic areas. With a peculiar clinical presentation that ranges from paucisymptomatic illness to severe and possibly fatal complications, quality imaging and serological studies are required for diagnosis. The mainstay of treatment to date is surgery combined with antiparasitic agents. The surgical armamentarium consists of open and laparoscopic procedures for selected cases with growing confidence in parenchyma-sparing interventions. Endoscopic retrograde cholangiopancreatography (ERCP) is extremely useful for the diagnosis and treatment of biliary fistulas. Recent relevant studies in the literature are reviewed, and two complex cases are presented. The first patient underwent open surgery to treat 11 liver cysts, and during the follow-up, a right pulmonary cyst was diagnosed that was treated by minimally invasive surgery. The second case is represented by the peritoneal rupture of a giant liver cyst in a young woman who underwent laparoscopic surgery. Both patients developed biliary fistulas that were managed by ERCP. Both patients exhibited a non-specific clinical presentation and underwent several surgical procedures combined with antiparasitic agents, highlighting the necessity of customized treatment in order to decrease complications and successfully cure the disease.
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Affiliation(s)
- Valentin Calu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Octavian Enciu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Elena-Adelina Toma
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Pârvuleţu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
| | - Dumitru Cătălin Pîrîianu
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Miron
- Elias University Emergency Hospital, 011461 Bucharest, Romania; (V.C.); (E.-A.T.); (R.P.); (A.M.)
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Imai D, Yokoyama M, Sambommatsu Y, Khan AA, Kumaran V, Saeed MI, Lee H, Matherly S, Cotterell AH, Levy MF, Bruno DA, Lee SD, Sharma A. Initial Experience With Robotic Liver Resection in the United States. Am Surg 2024:31348241259043. [PMID: 38840297 DOI: 10.1177/00031348241259043] [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: 06/07/2024]
Abstract
BACKGROUND This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). METHODS A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. RESULTS The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646 mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. CONCLUSIONS The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.
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Affiliation(s)
- Daisuke Imai
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Masaya Yokoyama
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Aamir A Khan
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Vinay Kumaran
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Muhammad I Saeed
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Hannah Lee
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott Matherly
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian H Cotterell
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon F Levy
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David A Bruno
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Seung D Lee
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Amit Sharma
- Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA
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8
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Dai H, Xiao Y, Fu C, Grimm R, von Busch H, Stieltjes B, Choi MH, Xu Z, Chabin G, Yang C, Zeng M. Deep Learning-Based Approach for Identifying and Measuring Focal Liver Lesions on Contrast-Enhanced MRI. J Magn Reson Imaging 2024. [PMID: 38826142 DOI: 10.1002/jmri.29404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The number of focal liver lesions (FLLs) detected by imaging has increased worldwide, highlighting the need to develop a robust, objective system for automatically detecting FLLs. PURPOSE To assess the performance of the deep learning-based artificial intelligence (AI) software in identifying and measuring lesions on contrast-enhanced magnetic resonance imaging (MRI) images in patients with FLLs. STUDY TYPE Retrospective. SUBJECTS 395 patients with 1149 FLLs. FIELD STRENGTH/SEQUENCE The 1.5 T and 3 T scanners, including T1-, T2-, diffusion-weighted imaging, in/out-phase imaging, and dynamic contrast-enhanced imaging. ASSESSMENT The diagnostic performance of AI, radiologist, and their combination was compared. Using 20 mm as the cut-off value, the lesions were divided into two groups, and then divided into four subgroups: <10, 10-20, 20-40, and ≥40 mm, to evaluate the sensitivity of radiologists and AI in the detection of lesions of different sizes. We compared the pathologic sizes of 122 surgically resected lesions with measurements obtained using AI and those made by radiologists. STATISTICAL TESTS McNemar test, Bland-Altman analyses, Friedman test, Pearson's chi-squared test, Fisher's exact test, Dice coefficient, and intraclass correlation coefficients. A P-value <0.05 was considered statistically significant. RESULTS The average Dice coefficient of AI in segmentation of liver lesions was 0.62. The combination of AI and radiologist outperformed the radiologist alone, with a significantly higher detection rate (0.894 vs. 0.825) and sensitivity (0.883 vs. 0.806). The AI showed significantly sensitivity than radiologists in detecting all lesions <20 mm (0.848 vs. 0.788). Both AI and radiologists achieved excellent detection performance for lesions ≥20 mm (0.867 vs. 0.881, P = 0.671). A remarkable agreement existed in the average tumor sizes among the three measurements (P = 0.174). DATA CONCLUSION AI software based on deep learning exhibited practical value in automatically identifying and measuring liver lesions. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Haoran Dai
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyao Xiao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Robert Grimm
- MR Predevelopment, Siemens Healthineers AG, Erlangen, Germany
| | - Heinrich von Busch
- Innovation Owner Artificial Intelligence for Oncology, Siemens Healthineers AG, Erlangen, Germany
| | | | - Moon Hyung Choi
- Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Zhoubing Xu
- Technology Excellence, Digital Technology and Innovation, Siemens Healthineers, Princeton, New Jersey, USA
| | - Guillaume Chabin
- Technology Excellence, Digital Technology and Innovation, Siemens Healthecare SAS, Paris, France
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
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9
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Aziz H, Underwood PW, Gosse MD, Afyouni S, Kamel I, Pawlik TM. Hepatic adenoma: evolution of a more individualized treatment approach. J Gastrointest Surg 2024; 28:975-982. [PMID: 38521190 DOI: 10.1016/j.gassur.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Hepatic adenomas (HAs) are benign, solid liver lesions, which carry a risk of hemorrhage and malignant transformation. This review article highlights the advances in the diagnosis and management of HAs. METHODS A comprehensive review was performed using MEDLINE/PubMed and Web of Science databases with a search period ending on September 30, 2023. Using PubMed, the terms "hepatocellular," "hepatic," and "adenoma" were searched. RESULTS HA has been classified into at least 8 subtypes based on molecular pathology, each exhibiting unique histopathologic features, clinical considerations, and risk of malignant transformation. The most common subtype is inflammatory HA, followed by hepatocyte nuclear factor 1α-inactivated HA, β-catenin exon 3-mutated HA (βex3-HA), β-catenin exon 7- or 8-mutated HA, sonic hedgehog HA, and unclassified HA. Magnetic resonance imaging is the best imaging method for diagnosis and can distinguish among HA subtypes based on fat and telangiectasia pathologic characteristics. The risk of malignant transformation varies among molecular subtypes, ranging from <1% to approximately 50%. Up to 42% of HAs present with spontaneous intratumoral hemorrhage and peritoneal hemorrhage. In general, only 15% to 20% of patients require surgery. HA larger than 5 cm are more likely to be complicated by bleeding and malignant transformation, regardless of subtype, and should generally be resected. In particular, βex3-HA carries a high risk of malignant transformation and can be considered a true precancerous lesion. CONCLUSION The management of HAs is based on a multidisciplinary approach. Clinical decision-making should integrate information on gender, tumor size, and HA subtyping. In the future, patients with HA will benefit from novel medical therapies tailored to the individual molecular subtypes.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Patrick W Underwood
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Matthew D Gosse
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Shadi Afyouni
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ihab Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
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10
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Jia W, Li F, Cui Y, Wang Y, Dai Z, Yan Q, Liu X, Li Y, Chang H, Zeng Q. Deep Learning Radiomics Model of Contrast-Enhanced CT for Differentiating the Primary Source of Liver Metastases. Acad Radiol 2024:S1076-6332(24)00221-6. [PMID: 38702214 DOI: 10.1016/j.acra.2024.04.012] [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: 02/17/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a deep learning radiomics (DLR) model based on contrast-enhanced computed tomography (CT) to identify the primary source of liver metastases. MATERIALS AND METHODS In total, 657 liver metastatic lesions, including breast cancer (BC), lung cancer (LC), colorectal cancer (CRC), gastric cancer (GC), and pancreatic cancer (PC), from 428 patients were collected at three clinical centers from January 2018 to October 2023 series. The lesions were randomly assigned to the training and validation sets in a 7:3 ratio. An additional 112 lesions from 61 patients at another clinical center served as an external test set. A DLR model based on contrast-enhanced CT of the liver was developed to distinguish the five pathological types of liver metastases. Stepwise classification was performed to improve the classification efficiency of the model. Lesions were first classified as digestive tract cancer (DTC) and non-digestive tract cancer (non-DTC). DTCs were divided into CRC, GC, and PC and non-DTCs were divided into LC and BC. To verify the feasibility of the DLR model, we trained classical machine learning (ML) models as comparison models. Model performance was evaluated using accuracy (ACC) and area under the receiver operating characteristic curve (AUC). RESULTS The classification model constructed by the DLR algorithm showed excellent performance in the classification task compared to ML models. Among the five categories task, highest ACC and average AUC were achieved at 0.563 and 0.796 in the validation set, respectively. In the DTC and non-DTC and the LC and BC classification tasks, AUC was achieved at 0.907 and 0.809 and ACC was achieved at 0.843 and 0.772, respectively. In the CRC, GC, and PC classification task, ACC and average AUC were the highest, at 0.714 and 0.811, respectively. CONCLUSION The DLR model is an effective method for identifying the primary source of liver metastases.
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Affiliation(s)
- Wenjing Jia
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China; Shandong First Medical University, Jinan, China.
| | - Fuyan Li
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China.
| | - Yi Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
| | - Yong Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
| | - Zhengjun Dai
- Scientific Research Department, Huiying Medical Technology Co., Ltd, Beijing, China.
| | - Qingqing Yan
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Xinhui Liu
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Yuting Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Huan Chang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Qingshi Zeng
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Lendoire M, Martin A, Montes L, Yance M, Gil O, Schelotto PB, McCormack L, Lendoire J. Patient perspectives and overall satisfaction after liver resection for benign disease. J Gastrointest Surg 2024; 28:679-684. [PMID: 38704206 DOI: 10.1016/j.gassur.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Management of benign liver lesions (BLLs) is still an object of discussion. Frequently, patients receive multiple opinions about their diagnosis and treatment from physicians specialized in different areas, which can be opposite and controversial. This study aimed to understand patients' decision-making process in electing surgery and assess their satisfaction after resection for BLLs. METHODS A 104-question survey was administered to 98 patients who had a resection for BLLs in 4 different hepatopancreatobiliary and transplant centers in Argentina. The first section included 64 questions regarding the initial discovery of the BLL, the decision-making process, and the understanding of the patient's feelings after surgery. The second section, 42 queries, referred to the quality of life. The patient's final diagnosis and outcome were correlated with the survey results using univariate analysis. RESULTS Among 97 patients who had undergone liver resection for BLLs, 69 (70%) completed the survey. The median age was 51.71 years (range, 18-75), and 63% of the patients were females. Moreover, 21% of patients received conflicting information from different healthcare providers. Surgeons were the best to describe the BLL to the patient (63%), and 30% of patients obtained opinions from multiple surgeons. The respondents were quite or fully satisfied with their decision to have surgery (90%) and the decision-making process (91%). Only 59% of patients considered their lifestyle better after surgery, and 89% of patients would have retaken the same decision. CONCLUSION Patients with resected BLLs are delighted with the decision to have surgery, regardless of the final diagnosis and outcome. The role of surgeons is crucial in the decision-making process.
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Affiliation(s)
- Mateo Lendoire
- Department of Liver Surgery and Transplant, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina.
| | - Alfredo Martin
- Department of Liver Surgery and Transplant, Hospital Argerich de Buenos Aires, Buenos Aires, Argentina
| | - Leonardo Montes
- Department of General Surgery, Liver, Intestinal, and Pancreas Transplant Services, Hospital Universitario Fundación Favaloro de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Yance
- Department of Hepatobiliary Surgery and Transplant, Sanatorio Allende of Córdoba, Córdoba, Argentina
| | - Octavio Gil
- Department of Hepatobiliary Surgery and Transplant, Sanatorio Allende of Córdoba, Córdoba, Argentina
| | - Pablo Barros Schelotto
- Department of General Surgery, Liver, Intestinal, and Pancreas Transplant Services, Hospital Universitario Fundación Favaloro de Buenos Aires, Buenos Aires, Argentina
| | - Lucas McCormack
- Department of Liver Surgery and Transplant, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Javier Lendoire
- Department of Liver Surgery and Transplant, Hospital Argerich de Buenos Aires, Buenos Aires, Argentina
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12
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Chen C, Han X, Xiao W, Xu G, Cai X, Hu G, Wan R. A safe and effective endoscopic treatment method for simple hepatic cysts (with video). Endosc Int Open 2024; 12:E513-E519. [PMID: 38628387 PMCID: PMC11018391 DOI: 10.1055/a-2239-9493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/02/2024] [Indexed: 04/19/2024] Open
Abstract
Background and study aims Symptomatic simple hepatic cysts require treatment, with several guidelines recommending laparoscopic deroofing. However, cysts located in the posterosuperior segments are considered poor candidates for this procedure. Gastrointestinal endoscopes are more flexible and able to reach less accessible areas than laparoscopes. This study aimed to evaluate the utility of endoscopic transgastric hepatic cyst deroofing (ETGHCD) for treatment of simple hepatic cysts. Patients and methods Seven patients with simple hepatic cysts were evaluated between June 2021 and October 2023. The success rate, procedure time, post-procedure length of hospital stays, complications, pathologic diagnosis, and efficacy were recorded. Results Eleven cysts in seven patients (5 men; mean age 65.5 (standard deviation [SD] 8.5) years) were successfully treated without any complications. The mean procedure time was 65.6 minutes (SD 17.2). Mean post-procedure hospitalization was 4.4 days (SD 1.0). The pathologic diagnosis of 11 cysts showed simple hepatic cysts. The size of the cysts was significantly decreased from 337.0 cm 3 (SD 528.8) to 5.2 cm 3 (SD 6.3) 1 month after ETGHCD. During the median 12.7-month follow-up in seven patients, the cysts showed a 99.6% reduction with no recurrence. Conclusions ETGHCD provided a feasible, safe, effective, and minimal invasive alternative approach for the treatment of simple hepatic cysts.
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Affiliation(s)
- Congying Chen
- Department of Gastroenterology, Shanghai General Hospital, Shanghai, China
| | - Xiao Han
- Department of Gastroenterology, Shanghai General Hospital, Shanghai, China
| | - Wenqin Xiao
- Department of Gastroenterology, Shanghai General Hospital, Shanghai, China
| | - Gang Xu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai, China
| | - Xiaobo Cai
- Department of Gastroenterology, Shanghai General Hospital, Shanghai, China
| | - Guoyong Hu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai, China
| | - Rong Wan
- Department of Gastroenterology, Shanghai General Hospital, Shanghai, China
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13
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Takano Y, Tamai N, Yamawaki M, Noda J, Matsubara D, Azami T, Niiya F, Nishimoto F, Maruoka N, Yamagami T, Nagahama M. Endoscopic ultrasound-guided infectious liver cyst drainage associated with autosomal dominant polycystic kidney disease in which percutaneous approach is impossible. DEN OPEN 2024; 4:e314. [PMID: 37927950 PMCID: PMC10625053 DOI: 10.1002/deo2.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
A man in his 70s on maintenance dialysis for autosomal dominant polycystic kidney disease was admitted with epigastralgia and a fever lasting for 1 week. Computed tomography showed a thickened liver cyst measuring 121 mm in the caudate lobe, suggesting infection. Percutaneous drainage was impossible because multiple liver cysts and ascites entered the puncture route. Endoscopic ultrasound (EUS) revealed a huge liver cyst with debris-like echoes. Transgastric EUS-guided drainage was performed, and internal and external drainage was performed without adverse events. After the procedure, the symptoms quickly improved, and the external drain was removed after 12 days. The internal drainage stent remained in place, and the patient was discharged from the hospital 53 days after the EUS-guided drainage. EUS-guided drainage is an effective alternative treatment for infected liver cysts where a percutaneous approach is impossible.
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Affiliation(s)
- Yuichi Takano
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Naoki Tamai
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Masataka Yamawaki
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Jun Noda
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Dai Matsubara
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Tetsushi Azami
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Fumitaka Niiya
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Fumiya Nishimoto
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Naotaka Maruoka
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Tatsuya Yamagami
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
| | - Masatsugu Nagahama
- Division of GastroenterologyDepartment of Internal MedicineShowa University Fujigaoka HospitalKanagawaJapan
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14
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Jaber F, Alsakarneh S, Alsharaeh T, Salahat AJ, Elfert K, Beran A, Gangwani MK, Abboud Y, Al-sayyed L, Madi MY, Jaber M, Dahiya DS, Numan L, Duong N. Gastrointestinal Variant of Lemierre's Syndrome: A Systematic Review and Comprehensive Analysis of 36 Case Reports. J Clin Exp Hepatol 2024; 14:101319. [PMID: 38250215 PMCID: PMC10794926 DOI: 10.1016/j.jceh.2023.101319] [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: 10/18/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Background A gastrointestinal (GI) variant of Lemierre's syndrome (LS) involving Fusobacterium species causing pylephlebitis and possibly liver abscesses was recently identified. This systematic review aims to summarize the literature on this variant. Methods PubMed, Embase, Scopus, and Cochrane databases were searched up to November, 2nd, 2023 for case reports or case series detailing the GI variant of LS. Data regarding demographics, clinical features, and management were extracted. Descriptive statistics were used for analysis, including means, standard deviations, and percentages. Results The cohort included 36 patients (mean age 50.8 years; predominantly men 72%). Positive blood cultures were detected in 88.8% of cases, primarily growing Fusobacterium nucleatum (47.2%) and Fusobacterium necrophorum (33.3%). The GI tract was the primary infection source (58.3%), mostly related to diverticular disease (25%). Common manifestations were fever (86.1%), abdominal pain (72.2%), and leukocytosis (86.1%). Thrombosis involved the portal vein in 77.7%, with isolated portal vein thrombosis (PVT) (44.4%) and PVT extending to the superior mesenteric vein (30.5%). Liver abscesses were detected in 50% of cases, with positive aspirate cultures in 92.3%. Treatment included penicillin/penicillin-lactamase inhibitors alone (17%) and ertapenem alone (17%). Abscess drainage (13/18) resulted in complete/near-complete resolution in 83%. Long-term anticoagulation therapy was given in 75% of cases, commonly using vitamin K antagonists (59.2%). No deaths occurred. Conclusion The GI variant of LS should be considered in patients with abdominal pain, fever, leukocytosis, and portal/superior mesenteric vein thrombosis. Identifying Fusobacterium species in blood cultures and liver abscesses further supports the diagnosis. Management involves antibiotic therapy, abscess drainage, and long-term anticoagulation.
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Affiliation(s)
- Fouad Jaber
- Department of Internal Medicine, University of Missouri, Kansas City, MO, United States
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri, Kansas City, MO, United States
| | - Tala Alsharaeh
- Department of Medical Education, The University of Jordan – Faculty of Medicine, Amman, Jordan
| | - Ahmed-Jordan Salahat
- Department of Medical Education, The University of Jordan – Faculty of Medicine, Amman, Jordan
| | - Khaled Elfert
- Department of Internal Medicine, St Barnabas Hospital, Bronx, NY, United States
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Manesh K. Gangwani
- Department of Internal Medicine, University of Toledo, Toledo, OH, United States
| | - Yazan Abboud
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Leen Al-sayyed
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mahmoud Y. Madi
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mohammad Jaber
- Department of Medical Education, Al-Azhar University-Faculty of Medicine, Gaza, Palestine
| | - Dushyant S. Dahiya
- Division of Gastroenterology Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS, United States
| | - Laith Numan
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Nikki Duong
- Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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15
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Seth I, Siu A, Hewitt L, Budak U, Farah B, Jaber M. Clinical Practice Guidelines For the Management of Hepatocellular Carcinoma: A Systematic Review. J Gastrointest Cancer 2024; 55:318-331. [PMID: 37480425 PMCID: PMC11096239 DOI: 10.1007/s12029-023-00961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally, including Australia. The absence of a consensus clinical practice guideline (CPG) specific to HCC management poses challenges in reducing morbidity, mortality, and improving patient recovery. This systematic review aims to evaluate the existing evidence and assess the potential of published guidelines, including those with an international scope, to provide guidance for healthcare professionals in Australia. METHODS Electronic search of MEDLINE, Embase, Cochrane Library, Google Scholar, and PubMed was conducted. Peer-reviewed English language articles from 2005 to June 2022 were included if they described management of HCC as part of an evidence-based overall management plan or CPG. The quality of the included CPGs was assessed by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS Twenty-one articles from 16 regions throughout the world were included in this review. All included guidelines (n = 21, 100%) recommended evaluating cirrhosis, hepatitis B, and hepatitis C as potential risk factors of HCC. Obesity and non-alcoholic fatty liver disease were recommended by 19 CPGs (91%) as risk factor for HCC. Fourteen guidelines (67%) endorsed using the BCLC staging system. Eighteen guidelines (86%) recommended a multidisciplinary approach for the management of HCC. Eighteen guidelines (86%) advised that surveillance using ultrasound should be implemented in all cirrhotic patients every 6 months regardless of the cause of cirrhosis. AGREE II mean overall assessment score was 90% indicating that all guidelines included were highly recommended in majority of domains. CONCLUSIONS The included CPGs provided a comprehensive approach, emphasizing the evaluation of risk factors, utilization of the BCLC staging system, and the importance of a multidisciplinary approach. Regular surveillance using ultrasound for cirrhotic patients was widely recommended. An understanding of contemporary international CPGs can prioritize aspects of the management of HCC to assist healthcare professionals to develop a national guideline to enable standardized, comprehensive, and evidence-based care for patients with HCC.
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Affiliation(s)
- Ishith Seth
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, 2500, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia.
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
- School of Medicine, Graduate Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Faculty of Medicine and Health Sciences, Monash University, Victoria, 3004, Australia.
| | - Adrian Siu
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, 2500, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
- School of Medicine, Graduate Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Lyndel Hewitt
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, 2500, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Ulvi Budak
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, 2500, Australia
| | - Beshoy Farah
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, 2500, Australia
| | - Mouhannad Jaber
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, 2500, Australia
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16
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Furumaya A, Schulz HH, Verheij J, Takkenberg RB, Besselink MG, Kazemier G, Erdmann JI, van Delden OM. Diagnosis and treatment of patients with suspected mucinous cystic neoplasms of the liver: a retrospective cohort study. Langenbecks Arch Surg 2024; 409:66. [PMID: 38368313 PMCID: PMC10874321 DOI: 10.1007/s00423-024-03246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/29/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE Mucinous cystic neoplasms of the liver (MCN-L) are hepatic cysts with a low malignant potential. The recent European Association for the Study of the Liver (EASL) guidelines provide guidance on the imaging features and surgical management of MCN-L, yet are hampered by a lack of studies adhering to the revised World Health Organization (WHO) criteria. This study attempted to validate the new 2022 EASL-guidelines in a retrospective cohort study of patients who underwent surgery for suspected MCN-L. METHODS Patients undergoing surgery for suspected MCN-L in a single center between 2010 and 2020 were included. Imaging features were assessed according to the EASL guidelines and were compared to final pathological diagnoses, according to the WHO criteria. RESULTS In total, 35 patients were included. In three patients, there were no worrisome imaging features, yet final pathological diagnosis showed MCN-L. Contrarily, six patients with worrisome imaging features did not have MCN-L. Five patients were diagnosed with MCN-L on final pathology. The sensitivity of the EASL-guidelines for the diagnosis of MCN-L was 40% (95%CI: 5.3-85%) and the specificity was 80% (95% CI: 61-92%). CONCLUSION Although the new EASL-guidelines provide some guidance, they could not reliably distinguish MCN-L from other cysts in our series. Thus, preoperative diagnosis of MCN-L remains challenging and we should be careful in selecting surgical strategies based on these criteria.
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Affiliation(s)
- Alicia Furumaya
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.
| | - Hannah H Schulz
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.
- Amsterdam UMC, Department of Radiology, Location University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
| | - Joanne Verheij
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
- Amsterdam UMC, Department of Pathology, Location University of Amsterdam, Amsterdam, Netherlands
| | - R Bart Takkenberg
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
- Amsterdam UMC, Department of Gastroenterology and Hepatology, Location University of Amsterdam, Amsterdam, Netherlands
| | - Marc G Besselink
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Geert Kazemier
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Joris I Erdmann
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Otto M van Delden
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
- Amsterdam UMC, Department of Radiology, Location University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
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17
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Mumtaz ZUA, Desai SR, Padley SPG. Frequency of extracardiac findings on "negative" CT coronary angiography studies. Clin Radiol 2024; 79:e334-e343. [PMID: 38092649 DOI: 10.1016/j.crad.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 01/02/2024]
Abstract
AIM To evaluate the prevalence and nature of extracardiac findings identified on computed tomography (CT) coronary angiography (CTCA) in patients with chest pain but without evidence of coronary artery disease (CAD). MATERIALS AND METHODS CTCA studies in patients referred to the hospital between January 2017 to February 2021 with chest pain and a suspected diagnosis of CAD were reviewed retrospectively for the presence of extracardiac findings. Consensus review of CTCA studies was performed by two experienced thoracic radiologists. The presence and severity of extracardiac findings, together with the likelihood that chest pain might be attributed to these, was recorded. Patient records were reviewed to ascertain the recording of extracardiac findings on initial CTCA reports and, where applicable, the nature of the follow-up. RESULTS Extracardiac findings (n=210) were present in 110/180 patients (61%) with a mean of 1.9 findings per patient. Extracardiac findings were more prevalent in patients aged ≥65 years compared to those <65 years (p<0.001). At least one extracardiac finding with the potential to cause chest pain was present in 40 patients (22%): degenerative disc disease (n=23 [13%]) and hiatus hernia (n=6 [3.3%]) were the most common extracardiac findings. Only 37.6% (79) of all retrospectively identified findings had been initially reported and, of these, 12.7% (10) required further follow-up. CONCLUSION Extracardiac findings are common in patients with no evidence of CAD on CTCA. The entire dataset should be evaluated for the presence of extracardiac findings that could explain chest pain symptoms on wide field of view reconstructions.
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Affiliation(s)
- Z-U-A Mumtaz
- Faculty of Medicine, Imperial College School of Medicine, London, UK.
| | - S R Desai
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK; Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, UK
| | - S P G Padley
- Department of Radiology, Royal Brompton and Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
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18
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Hirose K, Toshima T, Tobo T, Kai S, Hirakawa M, Higuchi S, Ofuchi T, Hosoda K, Yonemura Y, Hisamatsu Y, Masuda T, Aishima S, Mimori K. A rare case of liver regenerative and non-neoplastic lesion resembling a well-differentiated hepatocellular carcinoma. Surg Case Rep 2024; 10:30. [PMID: 38300348 PMCID: PMC10834926 DOI: 10.1186/s40792-024-01820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Nodular regenerative hyperplasia (NRH) is a rare disease that presents pathologically as diffuse hepatic nodules without fibrous septa. It is believed to be caused by vasculopathy against a background of various systemic diseases, such as hematologic, autoimmune, and drug-induced diseases, with various symptoms. In spite of the recent imaging advances, various atypical cases of nodular lesions are observed in daily clinical practice. Cases that do not completely meet these criteria are referred to as -like or -similar lesions in clinical situations, making it difficult to understand their pathogenesis. We present a case in which two hepatic nodular lesions were noted and difficult to differentiate from malignancy preoperatively. The lesions were laparoscopically resected and a pathological diagnosis with non-neoplastic liver regenerative nodules resembling NRH was made. CASE PRESENTATION A 49-year-old man with no alcohol or drug intake and no past medical history was identified as having liver tumors on screening examination without any symptoms. Contrast-enhanced computed tomography (CT) showed two hepatic tumors; approximately 2-cm tumors at S7 and S8. Gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) revealed fat inclusions in their contents. Ethoxybenzyl (EOB) uptake was also observed during the hepatobiliary phase. Based on preoperative examinations, we suspected well-differentiated hepatocellular carcinoma (HCC) and performed laparoscopic S7/8 partial resection for these lesions. Macroscopically, the resected specimens showed a non-cirrhotic yellowish-cut surface containing brownish, ill-defined lesions with irregular borders. Microscopically, these lesions showed zonal necrosis, congestion, and aggregation of hemosiderin-laden macrophages around the central vein. In these areas, the fatty deposition of hepatocytes was lower than that in the surrounding background hepatocytes. Histopathologically, neither neoplastic nor hyperplastic lesions were observed, and he was diagnosed as regenerative hepatic change with centrilobular necrosis. CONCLUSIONS Considering the pathological results, these lesions were thought to be a type of NRH-like lesion with possible hepatic vessel disorder. However, the lesion's cause and classification was difficult to determine. The accumulation of these regenerative changes accompanying fatty liver is needed to clarify the mechanism and its clinical significance.
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Affiliation(s)
- Kosuke Hirose
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Takeo Toshima
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Taro Tobo
- Department of Pathology, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Satohiro Kai
- Department of Radiology, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Masakazu Hirakawa
- Department of Radiology, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Satoshi Higuchi
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Takashi Ofuchi
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Kiyotaka Hosoda
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Yusuke Yonemura
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Yuichi Hisamatsu
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Takaaki Masuda
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan
| | - Shinichi Aishima
- Department of Pathology and Microbiology, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, 4546, Shoen, Beppu-Shi, Oita-Ken, 874-0838, Japan.
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19
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Sijberden JP, Zimmitti G, Cipriani F, Furumaya A, Lanari J, Suhool A, Osei-Bordom D, Aghayan D, Jovine E, Ruzzenente A, Ardito F, D'Hondt M, Ferrero A, Benedetti Cacciaguerra A, Lopez-Ben S, Dagher I, Fuks D, Alseidi A, Rotellar F, di Benedetto F, Ratti F, Swijnenburg RJ, Gringeri E, Vivarelli M, Giuliante F, Edwin B, Sutcliffe RP, Primrose JN, Cillo U, Besselink MG, Aldrighetti LA, Abu Hilal M. Trends in the characteristics and perioperative outcomes of patients undergoing laparoscopic and open resections for benign liver lesions: An international multicenter retrospective cohort study of 845 patients. HPB (Oxford) 2024; 26:188-202. [PMID: 37989610 DOI: 10.1016/j.hpb.2023.10.016] [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: 06/13/2023] [Revised: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Solid benign liver lesions (BLL) are increasingly discovered, but clear indications for surgical treatment are often lacking. Concomitantly, laparoscopic liver surgery is increasingly performed. The aim of this study was to assess if the availability of laparoscopic surgery has had an impact on the characteristics and perioperative outcomes of patients with BLL. METHODS This is a retrospective international multicenter cohort study, including patients undergoing a laparoscopic or open liver resection for BLL from 19 centers in eight countries. Patients were divided according to the time period in which they underwent surgery (2008-2013, 2014-2016, and 2017-2019). Unadjusted and risk-adjusted (using logistic regression) time-trend analyses were performed. The primary outcome was textbook outcome (TOLS), defined as the absence of intraoperative incidents ≥ grade 2, bile leak ≥ grade B, severe complications, readmission and 90-day or in-hospital mortality, with the absence of a prolonged length of stay added to define TOLS+. RESULTS In the complete dataset comprised of patients that underwent liver surgery for all indications, the proportion of patients undergoing liver surgery for benign disease remained stable (12.6% in the first time period, 11.9% in the second time period and 12.1% in the last time period, p = 0.454). Overall, 845 patients undergoing a liver resection for BLL in the first (n = 374), second (n = 258) or third time period (n = 213) were included. The rates of ASA-scores≥3 (9.9%-16%,p < 0.001), laparoscopic surgery (57.8%-77%,p < 0.001), and Pringle maneuver use (33.2%-47.2%,p = 0.001) increased, whereas the length of stay decreased (5 to 4 days,p < 0.001). There were no significant changes in the TOLS rate (86.6%-81.3%,p = 0.151), while the TOLS + rate increased from 41.7% to 58.7% (p < 0.001). The latter result was confirmed in the risk-adjusted analyses (aOR 1.849,p = 0.004). CONCLUSION The surgical treatment of BLL has evolved with an increased implementation of the laparoscopic approach and a decreased length of stay. This evolution was paralleled by stable TOLS rates above 80% and an increase in the TOLS + rate.
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Affiliation(s)
- Jasper P Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Giuseppe Zimmitti
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alicia Furumaya
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Jacopo Lanari
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Amal Suhool
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Davit Aghayan
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | - Elio Jovine
- Department of Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Francesco Ardito
- Chirurgia Epatobiliare, Università Cattolica Del Sacro Cuore-IRCCS, Rome, Italy
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Andrea Benedetti Cacciaguerra
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Santi Lopez-Ben
- Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain
| | - Ibrahim Dagher
- Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris 75014, France
| | - Adnan Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA; Department of Surgery, University of California San Francisco, California, USA
| | - Fernando Rotellar
- HPB and Liver Transplantation Unit, Department of Surgery, University Clinic, Universidad de Navarra, Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Enrico Gringeri
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Felice Giuliante
- Chirurgia Epatobiliare, Università Cattolica Del Sacro Cuore-IRCCS, Rome, Italy
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | | | - John N Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Umberto Cillo
- Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy
| | - Marc G Besselink
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Luca A Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
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20
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Cai Q, Qian TG, Zhao QY, Feng SY, Yang Q, Luo YC, Dai YQ, Liang P, Yu XL, Liu FY, Han ZY, Du QW, Li X, Yu J. Percutaneous microwave ablation versus sclerotherapy for large hepatic hemangioma: a multi-center cohort study. Int J Hyperthermia 2024; 41:2285705. [PMID: 38269491 DOI: 10.1080/02656736.2023.2285705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/15/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE The study aimed to compare the effectiveness and safety of ultrasound-guided microwave ablation (MWA) and percutaneous sclerotherapy (PS) for the treatment of large hepatic hemangioma (LHH). METHODS This retrospective study included 96 patients who underwent MWA (n = 54) and PS (n = 42) as first-line treatment for LHH in three tertiary hospitals from January 2016 to December 2021. Primary outcomes were technique efficacy rate (volume reduction rate [VRR] > 50% at 12 months), symptom relief rate at 12 months and local tumor progression (LTP). Secondary outcomes included procedure time, major complications, treatment sessions, cost and one-, two-, three-year VRR. RESULTS During a median follow-up of 36 months, the MWA group showed a higher technique efficacy rate (100% vs. 90.4%, p = .018) and symptom relief rate (100% vs. 80%, p = .123) than the PS group. The MWA group had fewer treatment sessions, higher one-, two- and three-year VRR, lower LTP rate (all p < .05), longer procedure time and higher treatment costs than the PS group (both p < .001). MWA shared a comparable major complications rate (1.8% vs. 2.4%, p = .432) with PS. After multivariate analysis, the lesion's heterogeneity and maximum diameter >8.1 cm were independent risk factors for LTP (all p < .05). In the PS group, lesions with a cumulative dose of bleomycin > 0.115 mg/cm3 had a lower risk of LTP (p = .006). CONCLUSIONS Both MWA and PS treatments for large hepatic hemangioma are safe and effective, with MWA being superior in terms of efficacy.
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Affiliation(s)
- Qian Cai
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Tong-Gang Qian
- Department of Ultrasound, Zunhua People's Hospital, Zunhua, China
| | - Qi-Yu Zhao
- Department of Ultrasound, Zhejiang University School of Medicine & the First Hospital of Zhejiang Province, Hangzhou, China
| | - Shun-You Feng
- Department of Ultrasound, Zunhua People's Hospital, Zunhua, China
| | - Qiao Yang
- Department of Ultrasound, Zunhua People's Hospital, Zunhua, China
| | - Yan-Chun Luo
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Yu-Qing Dai
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Qiao-Wei Du
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Xin Li
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical College, Beijing, China
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21
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Yoshitomi K, Koya Y, Miyagawa K, Maruno Y, Yamaguchi K, Taniguchi R, Onitsuka K, Sakamoto Y, Oe S, Harada M. Symptomatic Liver Cyst Successfully Treated with Transgastric Drainage and Sclerotherapy Using Minocycline Hydrochloride. Case Rep Gastrointest Med 2024; 2024:6942345. [PMID: 38273972 PMCID: PMC10807977 DOI: 10.1155/2024/6942345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
A liver cyst is hepatic fluid-filled cavities often detected in clinical surveillances such as a health examination. Although the liver cyst is usually asymptomatic and observed without any therapeutic intervention, it can be symptomatic and needs treatment due to its enlargement, hemorrhage, and infection. A 74-year-old woman presented with upper abdominal pain and a huge liver cyst in the left lobe. Several examinations including image findings revealed that the symptom could be derived from the liver cyst. Although there is no definite guideline of treatment for symptomatic liver cysts, percutaneous ultrasound-guided drainage with sclerotherapy or surgery is often selected. Because of anatomical accessibility to the liver cyst and the patient's wish, we performed endoscopic transgastric drainage with insertion of both an internal stent and an external nasocystic tube. Sclerotherapy with minocycline hydrochloride was performed through the nasocystic tube, and the liver cyst shrunk completely without any complications. This is the first reported method of administering minocycline hydrochloride through a nasocystic tube, which can be a therapeutic option for patients with symptomatic liver cysts.
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Affiliation(s)
- Kengo Yoshitomi
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yudai Koya
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichiro Miyagawa
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuki Maruno
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koki Yamaguchi
- Department of Gastroenterology, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ryuta Taniguchi
- Department of Surgery, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
| | - Koji Onitsuka
- Department of Surgery, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
| | - Yoshitaka Sakamoto
- Department of Surgery, Kyushu Rosai Hospital, Moji Medical Center, Kitakyushu, Japan
| | - Shinji Oe
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Harada
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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22
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Liang ZN, Wang S, Yang W, Wang H, Zhao K, Bai XM, Zhang ZY, Wu W, Yan K. The added value of color parameter imaging for the evaluation of focal liver lesions with "homogenous hyperenhancement and no wash out" on contrast enhanced ultrasound. Front Oncol 2024; 13:1207902. [PMID: 38273854 PMCID: PMC10808770 DOI: 10.3389/fonc.2023.1207902] [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: 04/18/2023] [Accepted: 10/23/2023] [Indexed: 01/27/2024] Open
Abstract
Objective The purpose of this study was to investigate the added value of color parameter imaging (CPI) in the differential diagnosis of focal liver lesions (FLLs) with "homogeneous hyperenhancement but not wash out" on contrast-enhanced ultrasound (CEUS). Methods A total of 101 patients with 108 FLLs were enrolled in this study. All the FLLs received US and CEUS examinations. The stored CEUS clips of target lesions were postprocessed with CPI analysis by radiologists. The receiver operator characteristic (ROC) curve was used to evaluate the added value of CPI. The McNamara test was used to compare the diagnostic sensitivity, specificity, and accuracy between CEUS and CPI patterns. Univariate and multivariate logistic regression analyses were used to develop a CPI nomogram. The C index and calibration curve were used to evaluate the predictive ability of the nomogram. The intraclass correlation coefficient was used to test the reproducibility and reliability of CPI. Decision curve analysis (DCA) was used to evaluate the added value of applying CPI. Results The following CPI features were more frequently observed in malignant FLLs: eccentric perfusion (malignant: 70.0% vs. benign: 29.2%, p < 0.001), feeding artery (51.7% vs. 4.2%, p < 0.001), mosaic (63.3% vs. 6.3%, p < 0.001), red ingredients >1/3 (90.0% vs. 14.6%, p < 0.001). In addition, centripetal (43.8% vs. 18.3%, p = 0.004), peripheral nodular (54.2% vs. 1.7%, p < 0.001), subcapsular vessel (12.5% vs. 0.0%, p = 0.004), spoke-wheel vessels (25.0% vs. 5.0%, p = 0.003), branched vessels (22.9% vs. 5.0%, p = 0.006), blue and pink ingredients >2/3 (85.4% vs. 10.0%, p < 0.001) were more observed in benign FLLs. A nomogram incorporating peripheral nodular, spoke-wheel vessels, and red ingredients >1/3 was constructed. The model had satisfactory discrimination (AUC = 0.937), and the optimal diagnostic threshold value was 0.740 (0.983, 0.850). By the DCA, the model offered a net benefit over the treat-all-patients scheme or the treat-none scheme at a threshold probability 5%-93%. Conclusion Using CPI can detect and render subtle information of the main features of FLLs on CEUS; it is conducive to the radiologist for imaging interpretation, and a combining read of the CEUS and CPI of the FLLs with features of "homogenous hyperenhancement and no washout" can improve significantly the diagnostic performance of CEUS for FLLs.
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Affiliation(s)
| | | | - Wei Yang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
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23
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Polette D, Mils K, López-Domínguez F, Barrios O, Leiva D, Puig I, Ramos E, Lladó L. Diagnosis and treatment of hepatic cysts. Usefulness of intracystic tumor markers (CEA and CA 19.9.). Cir Esp 2024; 102:19-24. [PMID: 37980963 DOI: 10.1016/j.cireng.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/08/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION To decide treatment of hepatic cysts diagnosis between simple hepatic cyst (SHC) and cystic mucinous neoplasm (CMN). Radiological features are not patognomonic. Some studies have suggested the utility of intracystic tumor markers. METHODS Retrospective analysis of our prospective database including patients treated due to symptomatic SHC from 2003 to 2021. The aim of the study was to evaluate the results of treatment of symptomatic SHC and the usefulness of the determination of intracystic "carcinoembryonic antigen" (CEA) and "carbohydrate antigen" CA 19.9. RESULTS 50 patients diagnosed and treated for symptomatic SHC were included. In 15 patients the first treatment was percutaneous drainage. In 35 patients the first treatment was laparoscopic fenestration. Four patients were diagnosed of premalignant or malignant liver cystic lesions (MCN, IPMN, lymphoma B); three of them required surgery after initial fenestration and pathological diagnosis. Median CEA and CA 19-9 were 196 μg/L and 227.321 U/mL respectively. Patients with malignant or premalignant pathology did not have higher levels of intracystic tumor markers. Positive predictive value was 0% for both markers, and negative predictive value was 89% and 91% respectively. CONCLUSION Values of intracystic tumor markers CEA and CA 19-9 do not allow distinguishing simple cysts from cystic liver neoplasms. The most effective treatment for symptomatic simple liver cysts is surgical fenestration. The pathological analysis of the wall of the cysts enables the correct diagnosis, allowing to indicate a surgical reintervention in cases of hepatic cyst neoplasia.
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Affiliation(s)
- Daniela Polette
- Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain.
| | - Kristel Mils
- Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fina López-Domínguez
- Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Oriana Barrios
- Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - David Leiva
- Unidad de Radiología Hepatobiliopancreática, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Isabel Puig
- Unidad de Radiología Hepatobiliopancreática, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Emilio Ramos
- Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Laura Lladó
- Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain
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24
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Cmarková K, Nosáková L, Pindura M, Vojtko M, Bánovčin P, Miklušica J. Rare Benign Focal Lesions of the Liver: Report of 2 Cases and Literature Review. Case Rep Gastroenterol 2024; 18:90-97. [PMID: 38439817 PMCID: PMC10911787 DOI: 10.1159/000536111] [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: 01/25/2023] [Accepted: 12/12/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction Benign lesions of the liver are very common findings, usually randomly discovered, especially during examinations for other indications. The frequent use of imaging modalities may be responsible for the statistical increase in the incidence of these findings. Case Presentation In this publication, we present the cases of 2 female patients with benign liver lesions, the occurrence of which is considered rare, and only a few dozen cases have been described worldwide. In both cases, clinical symptoms, diagnostic approach, and surgical treatment are presented. Conclusion Due to increasing availability of imaging methods, the occurrence of previously considered rare benign liver lesions increases as well. In many cases, the malignant potential of these findings remains unclear. Decision-making process should include a multidisciplinary board.
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Affiliation(s)
- Kristína Cmarková
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Lenka Nosáková
- Clinic of Internal Medicine – Gastroenterology, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Miroslav Pindura
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Martin Vojtko
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Bánovčin
- Clinic of Internal Medicine – Gastroenterology, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Juraj Miklušica
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
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Rao M, Karki B, Jeffery J, Hakeem A. Laparoscopic deroofing of a large hepatic cyst to relieve atypical cardiac symptoms. BMJ Case Rep 2023; 16:e255631. [PMID: 38129089 DOI: 10.1136/bcr-2023-255631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
A woman in her 60s was referred to the hepato-pancreato-biliary clinic for further assessment of a large hepatic cyst, which was incidentally identified by echocardiography. She was being investigated for possible crescendo angina on the backdrop of a 6-month history of increasing chest pain, shortness of breath, sweating, orthopnoea and paroxysmal nocturnal dyspnoea. Coronary angiography and echocardiography demonstrated normal cardiac physiology. A CT abdomen/pelvis confirmed an 8.5 cm hepatic cyst indenting the posterior and caudate lobes and abutting the inferior vena cava. Nocturnal dyspnoea was attributed to diminished venous return. Due to worsening symptoms and their impact on her job, the patient underwent laparoscopic deroofing of the hepatic cyst. Histopathology confirmed a simple hepatic cyst. In her first postoperative review clinic, 8 months after her initial visit to the cardiology team, the patient was asymptomatic and fully functional with a considerably improved quality of life.
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Affiliation(s)
- Mihir Rao
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Abdul Hakeem
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
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26
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Ohtani T, Ishida T, Ozaki K, Takahashi K, Shimada M, Kidoya E. [Usefulness of Electron Density Calculated from Dual Energy CT in Differential Diagnosis between Hepatocellular Carcinoma and Hepatic Hemangioma]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2023; 79:1337-1343. [PMID: 37704452 DOI: 10.6009/jjrt.2023-1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
PURPOSE The aim of this study were to compare electron density (ED), obtained by dual energy computed tomography (DECT), between hepatocellular carcinoma (HCC) and hemangioma, and to assess the differential diagnostic performance of ED between HCC and hemangioma. METHODS A total of 46 patients (27 men and 19 women; mean age, 65.7±14.0 years) diagnosed with HCC or hemangioma who underwent upper abdominal DECT between October 2021 and December 2022 were included. ED of each lesion was measured. Relative ED (rED), which is normalized by the ED of background liver parenchyma, was calculated. ED and rED of HCC and hemangioma were statistically analyzed. RESULTS The HCC group showed significantly higher ED (48.1±5.2) and rED (80.0±7.3) than the hemangioma group (43.7±4.1, 69.7±7.2, respectively) (p<0.01). The area under the curve of rED was greater than that of ED, but no significant difference was found (p=0.153). CONCLUSION ED may help in the differential diagnosis between HCC and hemangioma.
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Affiliation(s)
| | | | - Kumi Ozaki
- Department of Radiology, University of Fukui Hospital
| | | | | | - Eiji Kidoya
- Radiological Center, University of Fukui Hospital
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27
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Onishi Y, Ohno T, Shimizu H, Shimada K, Isoda H, Ishii T, Takai A, Nakamoto Y. Natural History of Hepatic Hemangiomas Larger Than 10 cm: Imaging Findings and Clinical Course of 22 Cases. Cureus 2023; 15:e50563. [PMID: 38226088 PMCID: PMC10788688 DOI: 10.7759/cureus.50563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION The natural history of a large hepatic hemangioma is important in determining the treatment strategy. Although several studies have assessed the natural history of hepatic hemangiomas, no study has focused on hepatic hemangiomas measuring >10 cm. The aim of this study was to assess the natural history of hepatic hemangiomas measuring >10 cm by evaluating imaging findings and clinical course. METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) reports at Kyoto University Hospital, Kyoto, Japan, between January 2001 and March 2023 were retrospectively searched to find adult patients with hepatic hemangiomas >10 cm. Patients who were followed up without treatment for over six months were included. The maximum diameter of the hepatic hemangioma was compared between the baseline and the final CT or MRI. The clinical course of the patients was evaluated. RESULTS Twenty-two patients (17 women, five men; median age, 51 years) were identified. The median diameter of hepatic hemangiomas in the baseline study was 114 mm. Two patients had abdominal distention at the time of the baseline imaging, whereas the others were asymptomatic. After follow-up without treatment (the median; 95.5 months), enlargement, no change, shrinkage of hepatic hemangioma was observed in six, 11, and five patients, respectively. The median growth rate of hepatic hemangiomas was 2.5 mm/year. Two patients underwent liver resection for hepatic hemangioma, while the others were followed up without treatment. In four patients, symptoms appeared or worsened. Two patients died: one patient died from prostate cancer progression; the cause of death for the other was not confirmed. CONCLUSION Hepatic hemangiomas show a slow growth rate during follow-up, and shrinkage is occasionally observed. Some patients experience new symptoms or aggravation of symptoms; however, deaths associated with hepatic hemangiomas are uncommon.
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Affiliation(s)
- Yasuyuki Onishi
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Tsuyoshi Ohno
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Hironori Shimizu
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Kotaro Shimada
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Hiroyoshi Isoda
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | | | - Atsushi Takai
- Gastroenterology and Hepatology, Kyoto University, Kyoto, JPN
| | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
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Yang Q, Zheng R, Zhou J, Tang L, Zhang R, Jiang T, Jing X, Liao J, Cheng W, Zhao C, Liu C, Dietrich CF, Cui X, Cai W, Wu J, Yu F, Cheng Z, Liu F, Han Z, Yu X, Yu J, Liang P. On-Site Diagnostic Ability of CEUS/CT/MRI for Hepatocellular Carcinoma (2019-2022): A Multicenter Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2825-2838. [PMID: 37713625 DOI: 10.1002/jum.16321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES To compare the on-site diagnostic performance of contrast-enhanced ultrasound (CEUS), computed tomography (CECT), and magnetic resonance imaging (CEMRI) for hepatocellular carcinoma (HCC) across diverse practice settings. METHODS Between May 2019 and April 2022, a total of 2085 patients with 2320 pathologically confirmed focal liver lesions (FLLs) were enrolled. Imaging reports were compared with results from pathology analysis. Diagnostic performance was analyzed in defined size, high-risk factors for HCC, and hospital volume categories. RESULTS Three images achieved similar diagnostic performance in classifying HCC from 16 types of FLLs, including HCC ≤2.0 cm. For HCC diagnosis at low-volume hospitals and HCC with high-risk factors, the accuracy and specificity of CEUS were comparable to CECT and CEMRI, while the sensitivity of CEUS (77.4 and 89.5%, respectively) was inferior to CEMRI (87.0 and 92.8%, respectively). The diagnostic accuracy of CEUS + CEMRI and CEUS + CECT increased by 7.8 and 6.2% for HCC ≤2.0 cm, 8.0 and 5.0% for HCC with high-risk factors, and 7.4 and 5.5% for HCC at low-volume hospitals, respectively, compared with CEMRI/CECT alone. CONCLUSIONS Compared with CECT and CEMRI, CEUS provides adequate diagnostic performance in clinical first-line applications at high-volume hospitals. Moreover, a higher diagnostic performance for HCC is achieved by combining CEUS with CECT/CEMRI compared with any single imaging technique.
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Affiliation(s)
- Qi Yang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
- Department of Medical Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lina Tang
- Department of Diagnostic Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Ruifang Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
| | - Jintang Liao
- Department of Diagnostic Ultrasound, Xiangya Hospital Central South University, Changsha, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cun Liu
- Department of Ultrasound, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chirstoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Bern, Switzerland
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjia Cai
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - JiaPeng Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fei Yu
- Department of Medical Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Zhang Z, Ji J, Qiu G, Hou Z, Mi S, Jin Z, Dai Y, Xie Q, Zeng Y, Huang J. Surgical indications for solid hepatic benign tumors: An updated literature review. Biosci Trends 2023; 17:325-334. [PMID: 37599079 DOI: 10.5582/bst.2023.01152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma are the most common benign solid liver tumors. However, their surgical indications have been the subject of debate. Minimally invasive liver resection reduces the cost of surgery and may lead to overtreatment of benign liver tumors. Recently, there has been a growing understanding of the etiology, pathogenesis, and natural history of these tumors. Great progress has also been made in imaging. The use of MRI and contrast agents has improved the accuracy of non-invasive diagnosis of these tumors, and especially in the identification of specific molecular subtypes of liver adenoma. These factors have resulted in alterations of surgical indications for these tumors. This article examines recent literature and it discusses the surgical indications for hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma while summarizing modifications in clinical management.
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Affiliation(s)
- Zhihong Zhang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Ji
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guoteng Qiu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqi Hou
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shizheng Mi
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoxing Jin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunlong Dai
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyun Xie
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zeng
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiwei Huang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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Hasuike S, Nagata K, Sasaki H, Hirata T, Suzuki S, Komaki Y, Ozono Y, Nakamura K, Miike T, Iwakiri H, Sueta M, Yamamoto S, Maekawa K, Kawakami H. Inflammatory Hepatocellular Adenoma Mimicking Focal Nodular Hyperplasia That Grew during Pregnancy and Changed Its Appearance on Magnetic Resonance Imaging after Delivery. Intern Med 2023; 62:3143-3149. [PMID: 37032077 PMCID: PMC10686732 DOI: 10.2169/internalmedicine.0967-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/29/2023] [Indexed: 04/11/2023] Open
Abstract
We reported a notable case of inflammatory hepatocellular adenoma that grew during pregnancy, consequently changing its appearance on magnetic resonance imaging remarkably. A 5-months-pregnant 35-year-old woman presented with a 37-mm liver nodule that had been diagnosed as focal nodular hyperplasia 3 years earlier. She had never used oral contraceptives. After 2 months, the nodule grew to 57 mm. The patient delivered a full-term infant without complications. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging performed after delivery revealed markedly different findings compared with the first images. A liver biopsy was performed, and the tumor was diagnosed as inflammatory hepatocellular adenoma.
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Affiliation(s)
- Satoru Hasuike
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Kenji Nagata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Haruka Sasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Tomoya Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Yuri Komaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Yoshinori Ozono
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Kenichi Nakamura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Tadashi Miike
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Hisayoshi Iwakiri
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Mitsue Sueta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Shojiro Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
| | - Kazuya Maekawa
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Japan
| | - Hiroshi Kawakami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
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31
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Shin YC, Cho EJ, Na HY, Cho JY, Han HS, Lee YJ, Kim H, Jang S, Choi GH, Jang ES, Kim JW, Jeong SH. Hepatic hemangioma: proportion and predictor of surgical treatment with emphasis on its growth rate. Korean J Intern Med 2023; 38:818-830. [PMID: 37939665 PMCID: PMC10636540 DOI: 10.3904/kjim.2023.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND/AIMS There are limited studies on the management of hepatic hemangiomas (HHs). We investigated the proportion and predictors of surgical resection and analyzed HH growth rates in addition to associated factors. METHODS A retrospective case-control study of patients treated in 2 centers was conducted. Thirty-six patients who underwent surgical resection were assigned to the case group. Patients who did not undergo surgical treatment were randomly sigselected at a 1:10 ratio and assigned to the control group (n = 360). Baseline characteristics, clinical course and surgical outcomes were analyzed. RESULTS The proportion of surgically treated HH patients was 0.3% (36 per 11,049). The longest diameter at diagnosis (mean ± standard deviation) was 7.7 ± 5.2 cm in the case group and 2.4 ± 1.8 cm in the control group (p < 0.001). In the multivariate analysis, the presence of more than 2 HHs (odds ratio [OR] 7.64, 95% confidence interval [CI] 1.40-41.72) and a growth rate of more than 4.8%/year (OR 30.73, 95% CI 4.86-194.51) were independently associated with surgical treatment. Symptom development during follow-up was related to HH size > 10 cm (OR 10.50, 95% CI 1.06-103.77, p = 0.04). The subgroup analysis showed substantial growth in 41.3% with an overall mean annual growth rate of 0.14 cm. CONCLUSION Approximately one in 300 patients with an HH underwent surgical treatment. Multiple HHs and a growth rate of more than 4.8%/year were indications for surgical treatment. Nearly half of the HHs showed growing pattern in our study.
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Affiliation(s)
- Young Cheol Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Sangmi Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Gwang Hyeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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32
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Sauter AP, Proksa R, Knipfer A, Reischl S, Braren RF, Nadjiri J, Kopp F, Noël PB, Makowski MR, Rummeny EJ, Fingerle AA. CT-Guided Liver Biopsy: Evaluation of Spectral Data From Dual-Layer Detector CT for Improved Lesion Detection. Cardiovasc Intervent Radiol 2023; 46:1621-1631. [PMID: 37759090 PMCID: PMC10615904 DOI: 10.1007/s00270-023-03550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Evaluation of dual-layer spectral computed tomography (CT) for contrast enhancement during image-guided biopsy of liver lesions using virtual monoenergetic images (VMI) and virtual non-contrast (VNC) images. METHODS Spectral CT data of 20 patients receiving CT-guided needle biopsy of focal liver lesions were used to generate VMI at energy levels from 40 to 200 keV and VNC images. Images were analyzed objectively regarding contrast-to-noise ratio between lesion center (CNRcent) or periphery (CNRperi) and normal liver parenchyma. Lesion visibility and image quality were evaluated on a 4-point Likert scale by two radiologists. RESULTS Using VMI/VNC images, readers reported an increased visibility of the lesion compared to the conventional CT images in 18/20 cases. In 75% of cases, the highest visibility was derived by VMI-40. Showing all reconstructions simultaneously, VMI-40 offered the highest visibility in 75% of cases, followed by VNC in 12.5% of cases. Either CNRcent (17/20) or/and CNRperi (17/20) was higher (CNR increase > 50%) in 19/20 cases for VMI-40 or VNC images compared to conventional CT images. VMI-40 showed the highest CNRcent in 14 cases and the highest CNRperi in 12 cases. High image quality was present for all reconstructions with a minimum median of 3.5 for VMI-40 and VMI-50. CONCLUSIONS When implemented in the CT scanner software, automated contrast enhancement of liver lesions during image-guided biopsy may facilitate the procedure.
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Affiliation(s)
- Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | | | - Andreas Knipfer
- Department of Radiology, Helios Klinikum München West, Munich, Germany
| | - Stefan Reischl
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Rickmer F Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Jonathan Nadjiri
- Department of Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Felix Kopp
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Peter B Noël
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Markus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine and Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Alexander A Fingerle
- Department of Radiology, Kantonsspital Münsterlingen, Muensterlingen, Switzerland
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Fujita S, Sano K, Cruz G, Velasco C, Kawasaki H, Fukumura Y, Yoneyama M, Suzuki A, Yamamoto K, Morita Y, Arai T, Fukunaga I, Uchida W, Kamagata K, Abe O, Kuwatsuru R, Saiura A, Ikejima K, Botnar R, Prieto C, Aoki S. MR Fingerprinting for Contrast Agent-free and Quantitative Characterization of Focal Liver Lesions. Radiol Imaging Cancer 2023; 5:e230036. [PMID: 37999629 DOI: 10.1148/rycan.230036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Purpose To evaluate the feasibility of liver MR fingerprinting (MRF) for quantitative characterization and diagnosis of focal liver lesions. Materials and Methods This single-site, prospective study included 89 participants (mean age, 62 years ± 15 [SD]; 45 women, 44 men) with various focal liver lesions who underwent MRI between October 2021 and August 2022. The participants underwent routine clinical MRI, non-contrast-enhanced liver MRF, and reference quantitative MRI with a 1.5-T MRI scanner. The bias and repeatability of the MRF measurements were assessed using linear regression, Bland-Altman plots, and coefficients of variation. The diagnostic capability of MRF-derived T1, T2, T2*, proton density fat fraction (PDFF), and a combination of these metrics to distinguish benign from malignant lesions was analyzed according to the area under the receiver operating characteristic curve (AUC). Results Liver MRF measurements showed moderate to high agreement with reference measurements (intraclass correlation = 0.94, 0.77, 0.45, and 0.61 for T1, T2, T2*, and PDFF, respectively), with underestimation of T2 values (mean bias in lesion = -0.5%, -29%, 5.8%, and -8.2% for T1, T2, T2*, and PDFF, respectively). The median coefficients of variation for repeatability of T1, T2, and T2* values were 2.5% (IQR, 3.6%), 3.1% (IQR, 5.6%), and 6.6% (IQR, 13.9%), respectively. After considering multicollinearity, a combination of MRF measurements showed a high diagnostic performance in differentiating benign from malignant lesions (AUC = 0.92 [95% CI: 0.86, 0.98]). Conclusion Liver MRF enabled the quantitative characterization of various focal liver lesions in a single breath-hold acquisition. Keywords: MR Imaging, Abdomen/GI, Liver, Imaging Sequences, Technical Aspects, Tissue Characterization, Technology Assessment, Diagnosis, Liver Lesions, MR Fingerprinting, Quantitative Characterization Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Shohei Fujita
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Katsuhiro Sano
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Gastao Cruz
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Carlos Velasco
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Hideo Kawasaki
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Yuki Fukumura
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Masami Yoneyama
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Akiyoshi Suzuki
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Kotaro Yamamoto
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Yuichi Morita
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Takashi Arai
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Issei Fukunaga
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Wataru Uchida
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Koji Kamagata
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Osamu Abe
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Ryohei Kuwatsuru
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Akio Saiura
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Kenichi Ikejima
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - René Botnar
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Claudia Prieto
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Shigeki Aoki
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
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Golla K, Benesic A, Mannell H, Dreischulte T, Grill E, Strobach D. Hepatic Impairment as a Risk Factor for Drug Safety: Suitability and Comparison of Four Liver Scores as Screening Tools. J Clin Med 2023; 12:6814. [PMID: 37959279 PMCID: PMC10649763 DOI: 10.3390/jcm12216814] [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: 09/11/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Hepatic impairment (HI) influences the pharmacokinetics and pharmacodynamics of drugs and represents an important risk factor for drug safety. A reliable screening tool for HI identification at hospital admission by pharmacists would be desirable but is currently lacking. Therefore, we tested four liver scores as potential screening instruments. We retrospectively recorded liver/bile diagnoses, symptoms and abnormalities (summarized as hepatic findings) of 200 surgical patients followed by an assessment of the relevance of these findings for drug therapy (rating). The agreement between the Model of Endstage Liver Disease (MELD), Non-alcoholic fatty liver disease fibrosis score (NFS), Fibrosis 4 index (FIB-4), and aspartate-aminotransferase to platelet ratio index (APRI) and the rating was quantified by Cohen's Kappa. The performance of the scores in this setting was further evaluated by their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Of 200 patients, 18 (9%) had hepatic findings relevant for drug therapy. Fair agreement was found for FIB-4 and MELD and slight agreement for APRI and NFS compared to the rating. The highest values for sensitivity, specificity, PPV, and NPV were 41.2% (MELD), 99.3% (APRI), 66.7% (APRI), and 93.6% (MELD), respectively. Due to low performance, none of the scores can be recommended for clinical use as a single screening tool for HI at hospital admission.
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Affiliation(s)
- Kathrin Golla
- Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
- Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Andreas Benesic
- Department of Internal Medicine—Gastroenterology, Krankenhaus GmbH Weilheim-Schongau, Marie-Eberth Str. 6, 86956 Schongau, Germany
| | - Hanna Mannell
- Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
- Department of Physiology, Institute for Theoretical Medicine, University of Augsburg, 86159 Augsburg, Germany
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336 Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Dorothea Strobach
- Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
- Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Mao XC, Shi S, Yan LJ, Wang HC, Ding ZN, Liu H, Pan GQ, Zhang X, Han CL, Tian BW, Wang DX, Tan SY, Dong ZR, Yan YC, Li T. A model based on adipose and muscle-related indicators evaluated by CT images for predicting microvascular invasion in HCC patients. Biomark Res 2023; 11:87. [PMID: 37794517 PMCID: PMC10548702 DOI: 10.1186/s40364-023-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND AIM The presence of microvascular invasion (MVI) will impair the surgical outcome of hepatocellular carcinoma (HCC). Adipose and muscle tissues have been confirmed to be associated with the prognosis of HCC. We aimed to develop and validate a nomogram based on adipose and muscle related-variables for preoperative prediction of MVI in HCC. METHODS One hundred fifty-eight HCC patients from institution A (training cohort) and 53 HCC patients from institution B (validation cohort) were included, all of whom underwent preoperative CT scan and curative resection with confirmed pathological diagnoses. Least absolute shrinkage and selection operator (LASSO) logistic regression was applied to data dimensionality reduction and screening. Nomogram was constructed based on the independent variables, and evaluated by external validation, calibration curve, receiver operating characteristic (ROC) curve and decision curve analysis (DCA). RESULTS Histopathologically identified MVI was found in 101 of 211 patients (47.9%). The preoperative imaging and clinical variables associated with MVI were visceral adipose tissue (VAT) density, intramuscular adipose tissue index (IMATI), skeletal muscle (SM) area, age, tumor size and cirrhosis. Incorporating these 6 factors, the nomogram achieved good concordance index of 0.79 (95%CI: 0.72-0.86) and 0.75 (95%CI: 0.62-0.89) in training and validation cohorts, respectively. In addition, calibration curve exhibited good consistency between predicted and actual MVI probabilities. ROC curve and DCA of the nomogram showed superior performance than that of models only depended on clinical or imaging variables. Based on the nomogram score, patients were divided into high (> 273.8) and low (< = 273.8) risk of MVI presence groups. For patients with high MVI risk, wide-margin resection or anatomical resection could significantly improve the 2-year recurrence free survival. CONCLUSION By combining 6 preoperative independently predictive factors of MVI, a nomogram was constructed. This model provides an optimal preoperative estimation of MVI risk in HCC patients, and may help to stratify high-risk individuals and optimize clinical decision making.
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Affiliation(s)
- Xin-Cheng Mao
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Shuo Shi
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Lun-Jie Yan
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Han-Chao Wang
- Institute for Financial Studies, Shandong University, Jinan, 250100, China
| | - Zi-Niu Ding
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Hui Liu
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Guo-Qiang Pan
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Xiao Zhang
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Cheng-Long Han
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Bao-Wen Tian
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Dong-Xu Wang
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Si-Yu Tan
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Zhao-Ru Dong
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Yu-Chuan Yan
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China.
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Campello CA, Castanha EB, Vilardo M, Staziaki PV, Francisco MZ, Mohajer B, Watte G, Moraes FY, Hochhegger B, Altmayer S. Machine learning for malignant versus benign focal liver lesions on US and CEUS: a meta-analysis. Abdom Radiol (NY) 2023; 48:3114-3126. [PMID: 37365266 DOI: 10.1007/s00261-023-03984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To perform a meta-analysis of the diagnostic performance of learning (ML) algorithms (conventional and deep learning algorithms) for the classification of malignant versus benign focal liver lesions (FLLs) on US and CEUS. METHODS Available databases were searched for relevant published studies through September 2022. Studies met eligibility criteria if they evaluate the diagnostic performance of ML for the classification of malignant and benign focal liver lesions on US and CEUS. The pooled per-lesion sensitivities and specificities for each modality with 95% confidence intervals were calculated. RESULTS A total of 8 studies on US, 11 on CEUS, and 1 study evaluating both methods met the inclusion criteria with a total of 34,245 FLLs evaluated. The pooled sensitivity and specificity of ML for the malignancy classification of FLLs were 81.7% (95% CI, 77.2-85.4%) and 84.8% (95% CI, 76.0-90.8%) for US, compared to 87.1% (95% CI, 81.8-91.0%) and 87.0% (95% CI, 83.1-90.1%) for CEUS. In the subgroup analysis of studies that evaluated deep learning algorithms, the sensitivity and specificity of CEUS (n = 4) increased to 92.4% (95% CI, 88.5-95.0%) and 88.2% (95% CI, 81.1-92.9%). CONCLUSIONS The diagnostic performance of ML algorithms for the malignant classification of FLLs was high for both US and CEUS with overall similar sensitivity and specificity. The similar performance of US may be related to the higher prevalence of DL models in that group.
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Affiliation(s)
- Carlos Alberto Campello
- School of Medicine, Universidade Federal do Mato Grosso, 2367 Quarenta e Nove St, Cuiabá, Brazil
| | - Everton Bruno Castanha
- School of Medicine, Universidade Federal de Pelotas, 538 Prof. Dr. Araújo St. Pelotas, Pelotas, Brazil
| | - Marina Vilardo
- School of Medicine, Universidade Catolica de Brasilia, QS 07, Brasília, Brazil
| | - Pedro V Staziaki
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, USA
| | - Martina Zaguini Francisco
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Bahram Mohajer
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, USA
| | - Guilherme Watte
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen's University, 76 Stuart St, Kingston, Canada
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, USA
| | - Stephan Altmayer
- Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA.
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Tsalikidis C, Mitsala A, Pappas-Gogos G, Romanidis K, Tsaroucha AK, Pitiakoudis M. Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out? J Clin Med 2023; 12:6034. [PMID: 37762973 PMCID: PMC10532121 DOI: 10.3390/jcm12186034] [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: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and can rarely present as an exophytic solitary mass attached to the liver by a stalk. Most FNH cases are usually detected as incidental findings during surgery, imaging or physical examination and have a high female predominance. However, the pedunculated forms of FNH are particularly rare and commonly associated with severe complications and diagnostic challenges. Hence, our study aims to provide a comprehensive summary of the available data on the pedunculated FNH cases among adults and children. Furthermore, we will highlight the role of different therapeutic options in treating this clinical entity. The use of imaging techniques is considered a significant addition to the diagnostic toolbox. Regarding the optimal treatment strategy, the main indications for surgery were the presence of symptoms, diagnostic uncertainty and increased risk of complications, based on the current literature. Herein, we also propose a management algorithm for patients with suspected FNH lesions. Therefore, a high index of suspicion and awareness of this pathology and its life-threatening complications, as an uncommon etiology of acute abdomen, is of utmost importance in order to achieve better clinical outcomes.
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Affiliation(s)
- Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Athanasia Mitsala
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - George Pappas-Gogos
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Konstantinos Romanidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Alexandra K. Tsaroucha
- Laboratory of Experimental Surgery & Surgical Research, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
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Maeda H, Fujita Y, Amagai T. Using temporal changes in MR images to determine treatment options for complex liver cysts. Radiol Case Rep 2023; 18:3122-3126. [PMID: 37388529 PMCID: PMC10302169 DOI: 10.1016/j.radcr.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/07/2023] [Accepted: 05/28/2023] [Indexed: 07/01/2023] Open
Abstract
The prevalence of hepatic cyst (HC) ranges from 2.5 to 4.7%. Among them, HCs with with symptoms occur in 15%. Extrahepatic rupture of HCs with hemorrhagic shock and death may occur. Early detection of intracystic hemorrhage is necessary to prevent lifethreatening complications. In this case, a 77-year-old woman underwent regular checkups. Her ultrasound (US) showed multiple hepatic cysts (HCs). The largest HC was 80 mm in diameter and located in segment 8 of the right lobe. Her prognostic nutritional index (PNI) was 41.7, indicating high surgical morbidity and mortality after surgery. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) were added to identify intra- and extra-cystic anatomy. Compared to MDCT, MRI was able to identify intra-cystic heterogeneous low and high intensity. These findings were interpreted to indicate acute to chronic intra-cystic hemorrhage. As a complication of the rupture and death, an anterior segmentectomy with segmentectomy with cholecystectomy was planned and performed. Her postoperative course was uneventful and she was discharged on day 16. The life-threatening complex HCs include intra-cystic hemorrhage, rupture, hemorrhagic shock and death. To prevent these, we would like to emphasize that MRI appears to be superior to US or CT in providing accurate information on the time course of intra-cystic hemorrhage from hemoglobin to hemosiderin changes to guide urgent surgical intervention of hepatectomy to prevent HC rupture and prevent HC rupture and death.
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Affiliation(s)
- Hiroyuki Maeda
- Department of Surgery, Kagoshima Tokushukai General Hospital, Kagoshima, Japan
| | - Yasuhiko Fujita
- Department of Radiology, Kagoshima Tokushukai General Hospital, Kagoshima, Japan
| | - Teruyoshi Amagai
- Faculty of Health Care Sciences, Department of Clinical Engineering, Jikei University of Health Care Sciences, 1-2-8, Miyahara, Yodogawa-Ku, Osaka, 532-0003, Japan
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Umetsu SE, Kakar S. Evaluating Liver Biopsies with Well-Differentiated Hepatocellular Lesions. Surg Pathol Clin 2023; 16:581-598. [PMID: 37536890 DOI: 10.1016/j.path.2023.04.011] [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: 08/05/2023]
Abstract
Needle core biopsies of liver lesions can be challenging, particularly in cases with limited material. The differential diagnosis for well-differentiated hepatocellular lesions includes focal nodular hyperplasia, hepatocellular adenoma, and well-differentiated hepatocellular carcinoma (HCC) in noncirrhotic liver, while dysplastic nodules and well-differentiated HCC are the primary considerations in cirrhotic liver. The first part of this review focuses on histochemical and immunohistochemical stains as well as molecular assays that are useful in the differential diagnosis. The second portion describes the features of hepatocellular adenoma subtypes and focuses on the differential diagnoses in commonly encountered clinicopathologic scenarios.
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Affiliation(s)
- Sarah E Umetsu
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, Box 0102, San Francisco, CA 94143, USA.
| | - Sanjay Kakar
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, Box 0102, San Francisco, CA 94143, USA
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González IA, Torbenson M, Sharifai N, Byrnes K, Chatterjee D, Kakar S, Yeh MM, Wu TT, Zhang X, Jain D. Clinicopathologic characterization of hepatocellular adenomas in men: a multicenter experience. Hum Pathol 2023; 138:24-33. [PMID: 37245629 DOI: 10.1016/j.humpath.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
Hepatocellular adenomas (HCAs) are benign liver neoplasms which most commonly present in women in their reproductive age. In men, they are rare and have a higher risk of malignant transformation to hepatocellular carcinoma (HCC). Here we present our multicenter experience with HCA in men in the United States. A total of 27 HCA cases were included, with a mean age of presentation of 37 years (range, 9-69 years) and a mean size of 6.8 cm (range, 0.9-18.5 cm). Based on the 2019 World Health Organization classification, the most common subtype identified was inflammatory HCA (IHCA; 10 cases, 37.0%) followed by unclassified HCA (UHCA; 7 cases, 25.9%), HNF1A-inactivated HCA (H-HCA; 6 cases, 22.2%), β-catenin-activated IHCA (b-IHCA; 3 cases, 11.1%), and β-catenin-activated HCA (b-HCA; 1 case, 3.7%). Six additional cases diagnosed as hepatocellular neoplasm of uncertain malignant potential (HUMP) were also included in the study. These cases presented in a mean age of 46 years (range, 17-64 years) and a size of 10.8 cm (range, 4.2-16.5 cm). We evaluated the significance of androgen receptor (AR) expression by immunohistochemistry (IHC); of the 16 cases with materials available, 8 were considered positive using the Allred score system (2 IHCA, 2 H-HCA, 1 UHCA, and 3 HUMP). Of the total cases, 12 were diagnosed on biopsies, for which follow-up information is available for 7, and none of them show evidence of malignant transformation. Of the 21 resection cases, a concomitant well-differentiated HCC within the same lesion was identified in 5 cases (23.8%), which were diagnosed as HCA (n = 4) or HUMP (n = 1). Overall, 15% of cases in our entire cohort of HCA and HUMP showed concomitant HCC, while none of the 7 biopsy cases showed any malignant transformation on follow-up (range, 22-160 months; mean, 61.8 months).
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Affiliation(s)
- Iván A González
- Department of Pathology, Yale University, New Haven, CT, 06520, USA
| | - Michael Torbenson
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55901, USA
| | - Nima Sharifai
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Kathleen Byrnes
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Deyali Chatterjee
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Matthew M Yeh
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55901, USA
| | - Xuchen Zhang
- Department of Pathology, Yale University, New Haven, CT, 06520, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University, New Haven, CT, 06520, USA.
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Furtado FS, Badenes-Romero Á, Hesami M, Mostafavi L, Najmi Z, Queiroz M, Mojtahed A, Anderson MA, Catalano OA. External validation of a machine learning based algorithm to differentiate hepatic mucinous cystic neoplasms from benign hepatic cysts. Abdom Radiol (NY) 2023; 48:2311-2320. [PMID: 37055585 DOI: 10.1007/s00261-023-03907-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To externally validate an algorithm for non-invasive differentiation of hepatic mucinous cystic neoplasms (MCN) from benign hepatic cysts (BHC), which differ in management. METHODS Patients with cystic liver lesions pathologically confirmed as MCN or BHC between January 2005 and March 2022 from multiple institutions were retrospectively included. Five readers (2 radiologists, 3 non-radiologist physicians) independently reviewed contrast-enhanced CT or MRI examinations before tissue sampling and applied the 3-feature classification algorithm described by Hardie et al. to differentiate between MCN and BHC, which had a reported accuracy of 93.5%. The classification was then compared to the pathology results. Interreader agreement between readers across different levels of experience was evaluated with Fleiss' Kappa. RESULTS The final cohort included 159 patients, median age of 62 years (IQR [52.0, 70.0]), 66.7% female (106). Of all patients, 89.3% (142) had BHC, and the remaining 10.7% (17) had MCN on pathology. Agreement for class designation between the radiologists was almost perfect (Fleiss' Kappa 0.840, p < 0.001). The algorithm had an accuracy of 98.1% (95% CI [94.6%, 99.6%]), a positive predictive value of 100.0% (95% CI [76.8%, 100.0%]), a negative predictive value of 97.9% (95% CI [94.1%, 99.6%]), and an area under the receiver operator characteristic curve (AUC) of 0.911 (95% CI [0.818, 1.000]). CONCLUSION The evaluated algorithm showed similarly high diagnostic accuracy in our external, multi-institutional validation cohort. This 3-feature algorithm is easily and rapidly applied and its features are reproducible among radiologists, showing promise as a clinical decision support tool.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Álvaro Badenes-Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
- Department of Nuclear Medicine, Hospital Universitario de Tarragona Juan XXIII, Tarragona, Spain
| | - Mina Hesami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Leila Mostafavi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Zahra Najmi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | | | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA.
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Panettieri E, Vega EA, Chirban AM, Salirrosas O, Clancy TE, Malek A, Freeman R, Conrad C. Anatomic Laparoscopic Partial Hepatectomy of a Segment 4a B-Catenin Mutated Adenoma. Ann Surg Oncol 2023; 30:4234-4235. [PMID: 36752966 DOI: 10.1245/s10434-023-13106-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although a β-catenin mutated hepatocellular adenoma (HCA) is a benign liver tumor, it can cause bleeding, obstruction, pain, and hepatocellular carcinoma.1-3 Because surgery needs to balance these risks with its morbidity, a minimally invasive approach may be well suited.4-6 In this report, a strategic approach to minimally invasive resection of HCA encompassing segment 4a (S4a) is reviewed. PATIENT A 22-year-old woman with abdominal pain was found to have two liver lesions involving segment 4a (5 cm) and segment 8 (S8) (4.5 cm). Liver biopsy confirmed a β-catenin mutated HCA in the S4a lesion. After embolization, an anatomic S4a segmentectomy and a partial S8 resection were planned. TECHNIQUE Three-dimensional modeling was used to perform a preoperative virtual hepatectomy; to visualize the spatial relationship between the HCA, the portal bifurcation, and the hepatic veins; and to preplan the port sites.7 With the patient in the French position, after port placement, intraoperative ultrasound was performed to identify the transection plane.8 The main left portal pedicle and Rex's recessus were exposed, and the branches of S4a were dissected out, clipped, and divided. Using ultrasound, the middle hepatic vein was exposed to define the lateral border of the dissection plane. CONCLUSION Although a β-catenin mutated HCA in S4a does not necessitate a formal segmentectomy, understanding the anatomic structures outlining its borders can facilitate the resection, especially for a large HCA. Virtual hepatectomy helps to achieve a detailed comprehension of the complex borders of segment 4a. Preoperative embolization can firm up the tumor and minimize the risk of intraoperative rupture from manipulation.
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Affiliation(s)
- Elena Panettieri
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Ariana M Chirban
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Oscar Salirrosas
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Thomas E Clancy
- Dana-Farber Brigham and Women's Cancer Center, Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anita Malek
- Department of Pathology, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA.
- General Surgery and Surgical Oncology, Hepato-Pancreato-Biliary Surgery, Saint Elizabeth Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Jin Y, Guo YH, Li JC, Li Q, Ye D, Zhang XX, Li JT. Vascular endothelial growth factor protein and gene delivery by novel nanomaterials for promoting liver regeneration after partial hepatectomy. World J Gastroenterol 2023; 29:3748-3757. [PMID: 37426320 PMCID: PMC10324527 DOI: 10.3748/wjg.v29.i24.3748] [Citation(s) in RCA: 1] [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: 04/03/2023] [Revised: 05/13/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Partial hepatectomy (PH) can lead to severe complications, including liver failure, due to the low regenerative capacity of the remaining liver, especially after extensive hepatectomy. Liver sinusoidal endothelial cells (LSECs), whose proliferation occurs more slowly and later than hepatocytes after PH, compose the lining of the hepatic sinusoids, which are the smallest blood vessels in the liver. Vascular endothelial growth factor (VEGF), secreted by hepatocytes, promotes LSEC proliferation. Supplementation of exogenous VEGF after hepatectomy also increases the number of LSECs in the remaining liver, thus promoting the reestablishment of the hepatic sinusoids and accelerating liver regeneration. At present, some shortcomings exist in the methods of supplementing exogenous VEGF, such as a low drug concentration in the liver and the reaching of other organs. More-over, VEGF should be administered multiple times and in large doses because of its short half-life. This review summarized the most recent findings on liver regeneration and new strategies for the localized delivery VEGF in the liver.
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Affiliation(s)
- Yun Jin
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Ying-Hao Guo
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jia-Cheng Li
- Department of General Surgery, Yuhuan Second People’s Hospital, Taizhou 317600, Zhejiang Province, China
| | - Qi Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Dan Ye
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Xiao Zhang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jiang-Tao Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Marell PS, Shi M, Wingo MT. Primary hepatic Epstein-Barr virus-positive diffuse large B-cell lymphoma associated with azathioprine immunosuppression: a case report. J Med Case Rep 2023; 17:175. [PMID: 37127672 PMCID: PMC10152705 DOI: 10.1186/s13256-023-03907-z] [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: 10/28/2022] [Accepted: 03/24/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Hepatic masses are relatively common findings, and the diagnostic approach often begins by identifying patient and mass characteristics that are risk factors for malignancy. Chronic immunosuppression is a known risk factor for various malignancies, and azathioprine in particular has been reported in association with solid and hematologic malignancies, including diffuse large B-cell lymphoma. CASE PRESENTATION A 46-year-old white woman presented to clinic with several weeks of gastrointestinal symptoms and was found to have a hepatic mass on imaging. Her history was notable for neuromyelitis optica spectrum disorder on chronic immunosuppression with azathioprine. It was initially thought to be an inflammatory adenoma. On 6-month follow-up imaging, the mass had grown rapidly in size and was surgically resected. Further workup determined the mass to be an iatrogenic immunodeficiency-associated Epstein-Barr virus-positive diffuse large B-cell lymphoma confined to the liver. Azathioprine was discontinued and the patient underwent treatment with rituximab with no evidence of recurrence 2 years after the initiation of treatment. CONCLUSIONS This case report describes the first time hepatic Epstein-Barr virus-positive diffuse large B-cell lymphoma has been reported with azathioprine, which highlights the unique sequelae of chronic immunosuppression, including atypical hematologic malignancies, and the importance of considering chronic immunosuppression in the diagnostic evaluation of a hepatic mass.
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Affiliation(s)
- Paulina S Marell
- Department of Medicine, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Majken T Wingo
- Department of Medicine, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA.
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Li Z, Lu S, Qian B, Meng Z, Zhou Y, Chen D, Chen B, Yang G, Ma Y. Sex differences in hepatic ischemia‒reperfusion injury: a cross-sectional study. Sci Rep 2023; 13:5724. [PMID: 37029182 PMCID: PMC10081297 DOI: 10.1038/s41598-023-32837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
Several studies have shown that males suffer more severe damage than females in the process of ischemia and reperfusion of the brain, heart and kidney. Accordingly, our study will reveal the correlation between the severity of hepatic ischemia‒reperfusion injury (HIRI) and sex, and preliminarily analyze the underlying mechanism. A total of 75 patients who were considered to have "benign liver tumors" at the initial admission and underwent partial hepatectomy were enrolled. We identified potential differences between different groups and discussed the correlation between the severity of HIRI and sex through a comparative analysis. Results showed that HIRI was more severe in males than in females, especially in younger patients. To explore whether estrogen level differences are the main reason for the sex differences in HIRI, we further revealed that HIRI in premenopausal females was more severe than that in postmenopausal females. By comparing the levels of gonadal hormones, we speculated that multiple gonadal hormones, including follicle-stimulating hormone, luteinizing hormone and testosterone, may jointly participate in the regulation of sex differences in HIRI together with estrogen.
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Affiliation(s)
- Zhongyu Li
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
| | - Shounan Lu
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
| | - Baolin Qian
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
| | - Zhanzhi Meng
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
| | - Yongzhi Zhou
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
| | - Dong Chen
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, Guangdong, China
| | - Bangliang Chen
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
| | - Guangchao Yang
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China
| | - Yong Ma
- Department of Minimal Invasive Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, China.
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, 150001, Heilongjiang, China.
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Adhikari S, Bhattarai M, Gyawali S, Subedi S, Bhattarai A, Awale L, Kansakar PB. Acute abdomen due to rupture of a hydatid cyst of the liver: a rare complication - a case report. Ann Med Surg (Lond) 2023; 85:1172-1176. [PMID: 37113932 PMCID: PMC10129216 DOI: 10.1097/ms9.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/01/2023] [Indexed: 04/29/2023] Open
Abstract
Hydatid cyst is a parasitic disease that is transmitted from animals to humans caused by the larval stage Echinococcus, especially Echinococcus granulosus. A complication of a hydatid cyst of the liver is its rupture, either traumatic or spontaneously. Case presentation A 19-year-old male presented with an acute abdomen for 12 h. After clinical assessment, contrast-enhanced computed tomography showed a rupture of the anterior wall of the hepatic hydatid cyst with intra-abdominal and pelvic dissemination. Exploratory laparotomy was performed with the evacuation of the daughter cyst and peritoneal lavage. The patient recovered well and was discharged with albendazole therapy. Clinical discussion Hydatid cyst rupture is a rare but serious complication. Computed tomography has high sensitivity in demonstrating cyst rupture. The patient underwent laparotomy, where disseminated cysts were evacuated, and the anterior wall of the cyst was deroofed, along with the removal of a ruptured laminated membrane. Emergency surgery plus albendazole therapy are recommended protocols for cases like ours. Conclusions A patient from an endemic region with acute presentation of right upper quadrant pain can have spontaneously ruptured hydatidosis as a differential diagnosis. Intraperitoneal rupture and dissemination of hydatid cysts of the liver can be life-threatening if intervention is delayed. Immediate surgery is life-saving and prevents complications.
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Affiliation(s)
| | - Madhur Bhattarai
- Corresponding author. Address: Institute of Medicine, Tribhuvan University, Maharajgunj 44600, Nepal. Tel.: +977-9861678146. E-mail address: (M. Bhattarai)
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Qureshy Z, Lokken RP, Kakar S, Grab J, Mehta N, Sarkar M. Influence of progestin-only hormonal use on hepatocellular adenomas: A retrospective cohort study. Contraception 2023; 119:109915. [PMID: 36476331 PMCID: PMC10266542 DOI: 10.1016/j.contraception.2022.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Exogenous estrogen is associated with growth of hepatocellular adenomas (HCAs), although the influence of progestin-only agents is unknown. We therefore evaluated the association of progestin-only agents on HCA progression compared to no hormone exposure and compared to estrogen exposure in female patients. STUDY DESIGN In this single-center, retrospective cohort study of reproductive-aged female patients (ages 16-45) with diagnosed HCAs between 2003 and 2021, we evaluated radiographic HCA growth during discrete periods of well-defined exogenous hormone exposures. RESULTS A total of 34 patients were included. Nineteen (55.9%) had follow-up scans during periods without hormone exposure, 7 (20.6%) during estrogen exposure, and 8 (23.5%) during progestin-only exposure. Over a median follow-up of 11 months, percent change in sum of adenoma diameters from baseline to last available scan was -15.0% with progestin-only agents versus 29.4% with estrogen exposure (p = 0.04), and -7.4% with no hormonal exposure (p = 0.52 compared to progestin-only). Greater than 10% growth was observed in two individuals (25.0%) with progestin-only agent use (one patient on high-dose progestin for menorrhagia) versus five individuals (71.4%) with estrogen use (p = 0.13), and 7 (36.8%) with no exogenous hormone use (p = 0.68 vs progestin-only). CONCLUSIONS During discrete periods of progestin-only use, HCA growth overall declined, similar to declining growth during periods without exogenous hormonal exposure. This differed from discrete periods of exogenous estrogen exposure, during which time HCAs demonstrated overall increased growth. Though larger studies are needed, these findings support recent guidance supporting progestin-only agents for female patients with HCAs seeking non-estrogen alternatives for contraception. IMPLICATIONS In this small retrospective study, we observed overall decrease in HCA size during discrete periods of progestin-only contraception use, similar to that observed during periods without exogenous hormone exposure, supporting their use as a safe alternative to estrogen-containing contraceptives in this patient population.
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Affiliation(s)
- Zoya Qureshy
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - R Peter Lokken
- Department of Radiology, Division of Interventional Radiology, University of California San Francisco, San Francisco, CA, United States
| | - Sanjay Kakar
- Department of Pathology, University of California San Francisco, San Francisco, CA, United States
| | - Joshua Grab
- Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States
| | - Neil Mehta
- Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States; Department of Medicine, Division of Gastroenterology/Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Monika Sarkar
- Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States; Department of Medicine, Division of Gastroenterology/Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.
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Differentiation of focal nodular hyperplasia and hepatocellular adenoma using qualitative and quantitative imaging features and classification and regression tree analysis. Abdom Radiol (NY) 2023; 48:874-885. [PMID: 36528729 DOI: 10.1007/s00261-022-03766-0] [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: 09/21/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess qualitative and quantitative analysis of gadoxetate disodium-enhanced hepatobiliary phase MR imaging (MRI) and assess the performance of classification and regression tree analysis for the differentiation of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). MATERIALS AND METHODS This retrospective study was approved by our local ethics committee. One hundred seventy patients suspected of having FNH or HCA underwent gadoxetate disodium-enhanced MRI. The reference standard was either pathology or follow-up imaging. Two readers reviewed images to identify qualitative imaging features and measure signal intensity on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), signal intensity ratio (SIR), and relative signal enhancement ratio (RSER) were calculated. A classification and regression tree (CART) analysis was developed. RESULTS Eighty-five patients met the inclusion criteria, with a total of 97 FNHs and 43 HCAs. For qualitative analysis, the T1 signal intensity on the hepatobiliary phase provided the highest overall classification performance (91.9% sensitivity, 90.1% specificity, and 90.9% accuracy). For quantitative analysis, RSER in the hepatobiliary phase with a threshold of 0.723 provided the highest classification performance (92.6% sensitivity and 89.4% specificity) to differentiate FNHs from HCAs. A CART model based on five qualitative imaging features provided an accuracy of 94.4% (95% confidence interval 90.0-98.9%). CONCLUSION Gadoxetate disodium-enhanced hepatobiliary phase provides high diagnostic performance as demonstrated in quantitative and qualitative analysis in differentiation of FNH and HCA, supported by a CART decision model.
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Kimura Y, Fujiwara K, Matsuura K, Suzuki T, Senoo K, Tsuchida K, Mori Y, Hirano A, Nomura S, Kitagawa M, Tomita Y, Kanaiwa H, Imazu M, Nagura Y, Nojiri S, Kataoka H. Efficacy of minocycline hydrochloride aspiration sclerotherapy with additional monoethanolamine oleate aspiration sclerotherapy for symptomatic hepatic cysts. Hepatol Res 2023; 53:267-275. [PMID: 36479738 DOI: 10.1111/hepr.13865] [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: 08/31/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 02/08/2023]
Abstract
AIM Minocycline hydrochloride (MINO) aspiration sclerotherapy (AS) has been widely used for treating hepatic cysts (HC). However, cyst recurrence remains problematic. Information on monoethanolamine oleate (EO) AS, another effective HC treatment, is currently limited. We investigated the efficacy of EO on ineffective MINO treatments, and the relationship between MINO AS and cyst fluid pH. METHODS A total of 22 cases with symptomatic HC underwent AS with 500 mg of MINO from January 2016 to June 2021. Cyst fluid pH was measured before and after MINO injection. Cyst volume ratio (CVR, %) after 2 weeks was calculated as follows:cyst volume 2 weeks after MINO injection / pre-treatment cyst volume × 100. Treatment was completed if CVR after 2 weeks was ≤35% (MINO-group). For patients with CVR >35%, 2 g of EO was added (MINO/EO-group). Cyst volume ratio was measured every 12 months thereafter. RESULTS There were no recurrence symptoms in any of the patients during follow-up. Of the 22 cases, 21 had CVR ≤20% after 12 months. The MINO/EO-group (n = 8) tended to have smaller CVRs after 12 months than the MINO-group (n = 14). Cyst volume ratio after 2 weeks was correlated to pH change (p = 0.012) and was larger in patients whose pH decreased by <1.5 (p = 0.015). All adverse events were mild, including in elderly patients. CONCLUSION Adding EO is an effective and safe treatment for symptomatic HC when MINO AS alone is insufficient. Patients with pH decreases of <1.5 should be considered for additional EO treatment.
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Affiliation(s)
- Yoshihide Kimura
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kei Fujiwara
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kentaro Matsuura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takanori Suzuki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kyouji Senoo
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kenji Tsuchida
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Yoshinori Mori
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Atsuyuki Hirano
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Satoshi Nomura
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Mika Kitagawa
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Yusaku Tomita
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Hiroki Kanaiwa
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Mitsuki Imazu
- Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Yoshihito Nagura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shunsuke Nojiri
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Sultan LR, Karmacharya MB, Al-Hasani M, Cary TW, Sehgal CM. Hydralazine-augmented contrast ultrasound imaging improves the detection of hepatocellular carcinoma. Med Phys 2023; 50:1728-1735. [PMID: 36680519 PMCID: PMC10128060 DOI: 10.1002/mp.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) detection with B-mode and contrast-enhanced ultrasound (CUS) imaging often varies between subjects, especially in patients with background cirrhosis. Various factors contribute to this variability, including the tumor blood flow, tumor size, internal echoes, and its location in livers with diffuse fibro-cirrhotic changes. OBJECTIVE Towards improving lesion detection, this study evaluates a vasodilator, hydralazine, to enhance the visibility of HCC by reducing its blood flow relative to the surrounding liver tissue. METHODS HCC were analyzed for tumor visibility measured for B-mode, CUS, and hydralazine-augmented-contrast ultrasound (HyCUS) in an autochthonous HCC rat model. 21 tumors from 12 rats were studied. B-mode and CUS images were acquired before hydralazine injection. Rats received an intravenous hydralazine injection of 5 mg/kg, then images were acquired 20 min later. Four rats were used as controls. The difference in echo intensity of the lesion and the surrounding tissue was used to determine the visibility index (VI). RESULTS The visibility index for HCC was found to be significantly improved with the use of HyCUS imaging compared to traditional B-mode and CUS imaging. The visibility index for HCC was 16.5 ± 2.8 for HyCUS, compared to 5.3 ± 4.8 for B-mode and 4.1 ± 3.8 for CUS. The differences between HyCUS and the other imaging modalities were statistically significant, with p-values of 0.001 and 0.02, respectively. Additionally, when compared to control cases, HyCUS showed higher discrimination of HCC (VI = 6.4 ± 1.2) with a p-value of 0.003, while B-mode (VI = 6.7 ± 1.4, p = 0.5) and CUS (VI = 6.4 ± 1.2, p = 0.3) showed lower discrimination. CONCLUSION Vascular blood flow modulation by hydralazine enhances the visibility of HCC. HyCUS offers a potential problem-solving method for detecting HCC when B-mode and CUS are unsuccessful, especially with background fibro-cirrhotic liver disease. Future evaluation of the approach in humans will determine its translatability for clinical applications.
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Affiliation(s)
- Laith R Sultan
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mrigendra B Karmacharya
- Department of Radiology, Children's hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maryam Al-Hasani
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theodore W Cary
- Department of Radiology, Children's hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chandra M Sehgal
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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