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Chang MH, Wang WT, Teng HC, Wang SC, Cheng HW, Huang JS, Wu MT. Multi-average high-acceleration modified volumetric interpolated breath-hold examination (VIBE) for free-breathing multiphase contrast-enhanced liver MRI: a comparative study with breath-hold VIBE. Acta Radiol 2024; 65:735-743. [PMID: 38343006 DOI: 10.1177/02841851231222607] [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: 08/02/2024]
Abstract
BACKGROUND Breath-hold volumetric interpolated breath-hold examination (BH-VIBE) of multiphase contrast-enhanced liver magnetic resonance imaging (MPCE-LMRI) requires good cooperative individuals to comply with multiple breath-holds. PURPOSE To develop a free-breathing modified VIBE (FB-mVIBE) as a substitute of BH-VIBE in MPCE-LMRI. MATERIAL AND METHODS We modified VIBE with a high acceleration factor (2 × 2) and four averages to produce the mVIBE scan. A total of 90 individuals (40 men; mean age = 54.6 ± 10.0 years) who had received MPCE-LMRI as part of a voluntary health check-up for oncology survey were enrolled. Each participant was scanned in four phases (pre-contrast, arterial phase, venous phase, and delay phase), and each phase had two sequential scans. To encounter the timing effect of contrast enhancement, three scan orders were designed: BH-VIBE and FB-mVIBE (group A, n = 30); BH-VIBE and FB-VIBE (group B, n = 30); and FB-mVIBE and BH-VIBE (group C, n = 30). The comparisons included the objective measurements and 25 visual-score by two abdominal radiologists independently. RESULTS Consistency between raters was observed for all three sequences (intraclass correlation coefficient [ICC] = 0.741-0.829). For rater 1, the mean scores of FB-mVIBE (23.67 ± 1.32) were equal to those of BH-VIBE (23.83 ± 1.98) in groups C and B (P = 0.852). The mean scores of FB-mVIBE (22.07 ± 3.02), but significantly higher than those of FB-VIBE (14.7 ± 3.41) in groups A and B (P <0.001). Similar scores were found for rater 2. The objective measurement of FB-mVIBE were equal to or higher than BH-VIBE and markedly superior to FB-VIBE. CONCLUSION FB-mVIBE is a practical alternative to BH-VIBE for individuals who cannot cooperate with multiple breath-holds for MPCE-LMRI.
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Affiliation(s)
- Ming-Hwa Chang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Teng Wang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Hui-Chung Teng
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Shu-Chin Wang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Wen Cheng
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Kurokawa S, Tanaka T, Yamazaki H, Noguchi S, Wada Y, Nishida H, Akiyoshi H. Comparing the CT and MRI findings for canine primary hepatocellular lesions. Vet Rec 2021; 190:e1083. [PMID: 34751436 DOI: 10.1002/vetr.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/24/2021] [Accepted: 10/17/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Triple-phase CT and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MRI have been used to differentiate hepatocellular carcinomas (HCCs) in dogs. METHODS This retrospective case series aimed to compare the CT findings with MRI findings of 20 canine hepatocellular lesions, including eight poorly/moderately-differentiated HCCs, eight well-differentiated HCCs and four hyperplasias. CT data were analysed, and the following parameters were noted: vessel enhancement, enhancement pattern in the equilibrium phase, maximal transverse diameter, the lowest enhancement, and the attenuation values of each hepatocellular lesion in the precontrast and triple-phase series, including the arterial phase, portal phase and equilibrium phase. MRI data were analysed, and the following parameters were noted: signal intensities of each hepatocellular lesion on T2-weighted images and T1-weighted images, and signal intensity ratio of the hepatocellular lesions in the hepatobiliary phase. RESULTS In 62.5% of poorly/moderately-differentiated HCC and 75% of well-differentiated HCC, presumptive necrosis was detected on CT and MRI. In the hepatobiliary phase on MRI, the median signal intensity ratio of poorly/moderately-differentiated HCC (0.54 [range: 0.3-0.71]) was significantly lower than that of well-differentiated HCC (0.75 [range: 0.6-0.96]) and hyperplasia (0.79 [range: 071-0.98]; p = 0.02 and p = 0.02, respectively). CONCLUSION Gd-EOB-DTPA-enhanced MRI may be a superior modality for differentiating hepatocellular origin lesions.
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Affiliation(s)
- Shohei Kurokawa
- Department of Graduate School of Life and Environmental Sciences, Laboratory of Veterinary Surgery, Osaka Prefecture University, Izumisano, Japan
| | - Toshiyuki Tanaka
- Department of Graduate School of Life and Environmental Sciences, Laboratory of Veterinary Surgery, Osaka Prefecture University, Izumisano, Japan.,Kinki Animal Medical Training Institute & Veterinary Clinic, Higashiosaka, Japan
| | - Hiroki Yamazaki
- Department of Graduate School of Life and Environmental Sciences, Laboratory of Veterinary Surgery, Osaka Prefecture University, Izumisano, Japan
| | - Shunsuke Noguchi
- Department of Graduate School of Life and Environmental Sciences, Laboratory of Veterinary Radiology, Osaka Prefecture University, Izumisano, Japan
| | - Yusuke Wada
- Veterinary Medical Centre, College of Life, Environmental and Advanced Sciences, Osaka Prefecture University, Izumisano, Japan
| | - Hidetaka Nishida
- Department of Graduate School of Life and Environmental Sciences, Laboratory of Veterinary Surgery, Osaka Prefecture University, Izumisano, Japan
| | - Hideo Akiyoshi
- Department of Graduate School of Life and Environmental Sciences, Laboratory of Veterinary Surgery, Osaka Prefecture University, Izumisano, Japan
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Tripartite-GAN: Synthesizing liver contrast-enhanced MRI to improve tumor detection. Med Image Anal 2020; 63:101667. [DOI: 10.1016/j.media.2020.101667] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/15/2020] [Accepted: 02/15/2020] [Indexed: 01/08/2023]
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Hu J, Bhayana D, Burak KW, Wilson SR. Resolution of indeterminate MRI with CEUS in patients at high risk for hepatocellular carcinoma. Abdom Radiol (NY) 2020; 45:123-133. [PMID: 31440801 DOI: 10.1007/s00261-019-02181-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To show the contribution of CEUS to characterization of indeterminate MRI observations in high-risk patients for hepatocellular carcinoma (HCC). METHODS From July to December 2015, 42 consecutive patients referred to CEUS with indeterminate MRI scans comprise our study cohort. There are 50 indeterminate nodule-like observations and 10 arterial phase hyperenhancing foci, suggesting pseudolesions/arterio-portal shunts. MRI and CEUS lesions are classified according to their enhancement features in all phases and Liver Imaging and Reporting Data System (LI-RADS) in a blind read format. Clinical pathologic correlation and 24 months follow-up are performed. RESULTS A majority, 37/50 (74%), of indeterminate nodule-like observations have arterial phase enhancement without washout on MRI. CEUS further characterizes enhancement and shows washout in 14/37 (38%). In total, CEUS diagnoses 16 malignant lesions in 14 patients including 14 HCC and 2 ICC. 12/16 (75%) malignant lesions are confirmed by biopsy or follow-up. Ultrasound identification of a nodule differentiates real nodules from pseudolesions. Of the ten suspected arterial-portal shunts on MRI, two show a real nodule on ultrasound, confirmed as an HCC and a regenerative nodule. 15/42 (36%) patients have LI-RADS escalated from LR-3 or 4 on MRI to LR-4 or 5 on CEUS. Overall, the sensitivity of CEUS is (13/16) 81.3% and specificity is (37/37) 100% for malignant diagnosis. CONCLUSION Grayscale ultrasound detects true nodules. Dynamic CEUS detects and characterizes washout, correctly predicting HCC. CEUS is complimentary to MRI and can serve as a problem-solving tool when MRI is indeterminate.
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Ansari-Gilani K, Modaresi Esfeh J. Unusual MRI appearance of a well differentiated hepatocellular carcinoma, mimicking a cavernous hemangioma: A case report. Radiol Case Rep 2019; 14:885-888. [PMID: 31193208 PMCID: PMC6520570 DOI: 10.1016/j.radcr.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/26/2023] Open
Abstract
The typical imaging findings in hepatocellular carcinoma (HCC) are arterial hyperenhancement with washout on portal venous and/or equilibrium phases. Larger HCCs can have atypical imaging findings including fibrous capsule or mosaic appearance. We describe an unusual biopsy proven HCC in a cirrhotic liver with imaging features mimicking cavernous hemangioma which also demonstrated some atypical features such as thick capsule. In addition to knowing the typical imaging findings of HCC, it is important to be familiar with its atypical imaging findings especially in larger lesions.
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Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology & Transplant Hepatology, Cleveland Clinic, Cleveland, OH 44195, USA
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Abdel Kader M, Ghani HSA, Saad ZM, Abdalla NH, Abdel Razek E. To what extent the DW-MRI and ADC value can be used in assessment of hepatic focal lesions in cirrhotic patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Ramalho M, Matos AP, AlObaidy M, Velloni F, Altun E, Semelka RC. Magnetic resonance imaging of the cirrhotic liver: diagnosis of hepatocellular carcinoma and evaluation of response to treatment - Part 1. Radiol Bras 2017; 50:38-47. [PMID: 28298731 PMCID: PMC5347502 DOI: 10.1590/0100-3984.2015.0132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the modern gold standard for the noninvasive evaluation of the cirrhotic liver. The combination of arterial phase hyperenhancement and delayed wash-out allows a definitive diagnosis of hepatocellular carcinoma (HCC) in patients with liver cirrhosis or chronic liver disease, without the requirement for confirmatory biopsy. That pattern is highly specific and has been endorsed in Western and Asian diagnostic guidelines. However, the sensitivity of the combination is relatively low for small HCCs. In this two-part review paper, we will address MRI of the cirrhotic liver. In this first part, we provide a brief background on liver cirrhosis and HCC, followed by descriptions of imaging surveillance of liver cirrhosis and the diagnostic performance of the different imaging modalities used in clinical settings. We then describe some of the requirements for the basic MRI technique, as well as the standard MRI protocol, and provide a detailed description of the appearance of various types of hepatocellular nodules encountered in the setting of the carcinogenic pathway in the cirrhotic liver, ranging from regenerative nodules to HCC.
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Affiliation(s)
- Miguel Ramalho
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal
| | - António P Matos
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal
| | - Mamdoh AlObaidy
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fernanda Velloni
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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8
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Lee EJ, Kim DJ, Cho ES, Kim KA. Effect of increasing the flip angle during the hepatocyte phase of gadobenate dimeglumine-enhanced 1.5T MRI in cirrhotic patients with hepatocellular carcinoma. J Magn Reson Imaging 2015; 43:713-9. [PMID: 26290384 DOI: 10.1002/jmri.25036] [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: 04/13/2015] [Accepted: 08/10/2015] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the effects of increasing the flip angle during the hepatocyte phase of gadobenate dimeglumine-enhanced magnetic resonance imaging (MRI) in cirrhotic patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Sixty-three patients with liver cirrhosis underwent gadobenate dimeglumine-enhanced 1.5T MRI with 90-minute delayed hepatocyte phase with flip angles of 10°, 20°, 30°, consecutively. Relative enhancement and signal-to-noise ratio (SNR) of liver parenchyma at hepatocyte phase according to flip angle were calculated. The liver-to-lesion (low signal intensity HCCs, n = 63; ≥1 cm) and contrast-to-noise ratio (CNR) at the hepatocyte phase according to flip angle were calculated. Two radiologists independently assessed the presence of HCCs using a 5-point scale, and detection sensitivity of HCCs was calculated according to flip angle. RESULTS The relative enhancement of hepatic parenchyma differed significantly according to flip angle (10°, mean relative enhancement = 0.69 ± 0.46; 20°, mean relative enhancement = 0.63 ± 0.47; 30°, mean relative enhancement = 0.49 ± 0.45; P = 0.043). The SNR of hepatic parenchyma was significantly different according to flip angle (10°, mean SNR = 26.2 ± 5.6; 20°, mean SNR = 25.3 ± 5.7; 30°, mean SNR = 22.8 ± 6.1; P = 0.004). The CNR of lesion was not significantly different according to flip angle (10°, mean CNR = 7.5 ± 6.6; 20°, mean CNR = 10.2 ± 6.9; 30°, mean CNR = 10.1 ± 7.1; P = 0.051). The sensitivities with 10° and 20° for HCCs were significantly higher than those with 30° for one reader (P < 0.05). CONCLUSION In patients with cirrhosis, hepatocyte phase gadobenate dimeglumine-enhanced 1.5T MRI with 20° flip angle should be recommended rather than 10° and 30° flip angle.
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Affiliation(s)
- Eun Jung Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Dae Jung Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eun-Suk Cho
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Kyoung Ah Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
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Arif-Tiwari H, Kalb B, Chundru S, Sharma P, Costello J, Guessner RW, Martin DR. MRI of hepatocellular carcinoma: an update of current practices. Diagn Interv Radiol 2015; 20:209-21. [PMID: 24808419 DOI: 10.5152/dir.2014.13370] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and liver transplantation is the optimal treatment for selected patients with HCC and chronic liver disease (CLD). Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. In patients with CLD, the MRI findings of an arterial-enhancing mass with subsequent washout and enhancing capsule on delayed interstitial phase images are diagnostic for HCC. Major organizations with oversight for organ donor distribution, such as The Organ Procurement and Transplantation Network (OPTN), accept an imaging diagnosis of HCC, no longer requiring tissue biopsy. In patients that are awaiting transplantation, or are not candidates for liver transplantation, localized therapies such as transarterial chemoembolization and radiofrequency ablation may be offered. MRI can be used to monitor treatment response. The purpose of this review article is to describe the role of imaging methods in the diagnosis, staging, and follow-up of HCC, with particular emphasis on established and evolving MRI techniques employing nonspecific gadolinium chelates, hepatobiliary contrast agents, and diffusion weighted imaging. We also briefly review the recently developed Liver Imaging Reporting and Data System (LI-RADS) formulating a standardized terminology and reporting structure for evaluation of lesions detected in patients with CLD.
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Affiliation(s)
- Hina Arif-Tiwari
- From the Departments of Medical Imaging University of Arizona College of Medicine, Tucson, Arizona, USA.
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Vinh NQ, Naka S, Cabral H, Murayama H, Kaida S, Kataoka K, Morikawa S, Tani T. MRI-detectable polymeric micelles incorporating platinum anticancer drugs enhance survival in an advanced hepatocellular carcinoma model. Int J Nanomedicine 2015. [PMID: 26203241 PMCID: PMC4487238 DOI: 10.2147/ijn.s81339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most intractable and lethal cancers; most cases are diagnosed at advanced stages with underlying liver dysfunction and are frequently resistant to conventional chemotherapy and radiotherapy. The development of tumor-targeting systems may improve treatment outcomes. Nanomedicine platforms are of particular interest for enhancing chemotherapeutic efficiency, and they include polymeric micelles, which enable targeting of multiple drugs to solid tumors, including imaging and therapeutic agents. This allows concurrent diagnosis, targeting strategy validation, and efficacy assessment. We used polymeric micelles containing the T1-weighted magnetic resonance imaging contrast agent gadolinium-diethylenetriaminpentaacetic acid (Gd-DTPA) and the parent complex of the anticancer drug oxaliplatin [(1,2-diaminocyclohexane)platinum(II) (DACHPt)] for simultaneous imaging and therapy in an orthotopic rat model of HCC. The Gd-DTPA/DACHPt-loaded micelles were injected into the hepatic artery, and magnetic resonance imaging performance and antitumor activity against HCC, as well as adverse drug reactions were assessed. After a single administration, the micelles achieved strong and specific tumor contrast enhancement, induced high levels of tumor apoptosis, and significantly suppressed tumor size and growth. Moreover, the micelles did not induce severe adverse reactions and significantly improved survival outcomes in comparison to oxaliplatin or saline controls. Our results suggest that Gd-DTPA/DACHPt-loaded micelles are a promising approach for effective diagnosis and treatment of advanced HCC.
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Affiliation(s)
- Nguyen Quoc Vinh
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Shigeyuki Naka
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Horacio Cabral
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Murayama
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazunori Kataoka
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Shigehiro Morikawa
- Department of Nursing, Shiga University of Medical Science, Shiga, Japan
| | - Tohru Tani
- Biomedical Innovation Center, Shiga University of Medical Science, Shiga, Japan
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Chu KKW, Cheung TT. Update in management of hepatocellular carcinoma in Eastern population. World J Hepatol 2015; 7:1562-1571. [PMID: 26085915 PMCID: PMC4462694 DOI: 10.4254/wjh.v7.i11.1562] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/10/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the commonest malignant tumours in the East. Although the management of HCC in the West is mainly based on the Barcelona Clinic for Liver Cancer staging, it is considered too conservative by Asian countries where the number of HCC patients is huge. Scientific and clinical advances were made in aspects of diagnosis, staging, and treatment of HCC. HCC is well known to be associated with cirrhosis and the treatment of HCC must take into account the presence and stage of chronic liver disease. The major treatment modalities of HCC include: (1) surgical resection; (2) liver transplantation; (3) local ablation therapy; (4) transarterial locoregional treatment; and (5) systemic treatment. Among these, resection, liver transplantation and ablation therapy for small HCC are considered as curative treatment. Portal vein embolisation and the associating liver partition with portal vein ligation for staged hepatectomy may reduce dropout in patients with marginally resectable disease but the midterm and long-term results are still to be confirmed. Patient selection for the best treatment modality is the key to success of treatment of HCC. The purpose of current review is to provide a description of the current advances in diagnosis, staging, pre-operative liver function assessment and treatment options for patients with HCC in the east.
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Watanabe A, Ramalho M, AlObaidy M, Kim HJ, Velloni FG, Semelka RC. Magnetic resonance imaging of the cirrhotic liver: An update. World J Hepatol 2015; 7:468-487. [PMID: 25848471 PMCID: PMC4381170 DOI: 10.4254/wjh.v7.i3.468] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/10/2014] [Accepted: 12/10/2014] [Indexed: 02/06/2023] Open
Abstract
Noninvasive imaging has become the standard for hepatocellular carcinoma (HCC) diagnosis in cirrhotic livers. In this review paper, we go over the basics of MR imaging in cirrhotic livers and describe the imaging appearance of a spectrum of hepatic nodules marking the progression from regenerative nodules to low- and high-grade dysplastic nodules, and ultimately to HCCs. We detail and illustrate the typical imaging appearances of different types of HCC including focal, multi-focal, massive, diffuse/infiltrative, and intra-hepatic metastases; with emphasis on the diagnostic value of MR in imaging these lesions. We also shed some light on liver imaging reporting and data system, and the role of different magnetic resonance imaging (MRI) contrast agents and future MRI techniques including the use of advanced MR pulse sequences and utilization of hepatocyte-specific MRI contrast agents, and how they might contribute to improving the diagnostic performance of MRI in early stage HCC diagnosis.
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Wang H, Thorling CA, Liang X, Bridle KR, Grice JE, Zhu Y, Crawford DHG, Xu ZP, Liu X, Roberts MS. Diagnostic imaging and therapeutic application of nanoparticles targeting the liver. J Mater Chem B 2015; 3:939-958. [PMID: 32261972 DOI: 10.1039/c4tb01611d] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Liver diseases, particularly viral hepatitis, cirrhosis and hepatocellular carcinoma, are common in clinical practice with high morbidity and mortality worldwide. Many substances for diagnostic imaging and therapy of liver diseases may have either severe adverse effects or insufficient effectiveness in vivo because of their nonspecific uptake. Therefore, by targeting the delivery of drugs into the liver or specific liver cells, drug efficiency may be largely improved. This review summarizes the up-to-date research progress focusing on nanoparticles targeting the liver for both diagnostic and therapeutic purposes. Targeting strategies, mechanisms of enhanced effects, and clinical applications of nanoparticles are discussed specifically. We believe that new targeting nanotechnology such as nanoprobes for multi-modality imaging and multifunctional nanoparticles would facilitate significant advancements in this active research area in the near future.
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Affiliation(s)
- Haolu Wang
- Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
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Aula S, Lakkireddy S, Jamil K, Kapley A, Swamy AVN, Lakkireddy HR. Biophysical, biopharmaceutical and toxicological significance of biomedical nanoparticles. RSC Adv 2015. [DOI: 10.1039/c5ra05889a] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Understanding of interplay between nanoparticles physicochemical and biophysical properties, and their impact on pharmacokinetic biodistribution and toxicological properties help designing of appropriate nanoparticle products for biomedical applications.
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Affiliation(s)
- Sangeetha Aula
- Centre for Biotechnology and Bioinformatics
- Jawaharlal Nehru Institute of Advanced Studies (JNIAS)
- Secunderabad
- India
- Department of Biotechnology
| | - Samyuktha Lakkireddy
- Centre for Biotechnology and Bioinformatics
- Jawaharlal Nehru Institute of Advanced Studies (JNIAS)
- Secunderabad
- India
- Department of Biotechnology
| | - Kaiser Jamil
- Centre for Biotechnology and Bioinformatics
- Jawaharlal Nehru Institute of Advanced Studies (JNIAS)
- Secunderabad
- India
| | - Atya Kapley
- Centre for Biotechnology and Bioinformatics
- Jawaharlal Nehru Institute of Advanced Studies (JNIAS)
- Secunderabad
- India
- Environmental Genomics Division
| | - A. V. N. Swamy
- Department of Chemical Engineering
- Jawaharlal Nehru Technological University Anantapur (JNTUA)
- Anantapuramu
- India
| | - Harivardhan Reddy Lakkireddy
- Drug Delivery Technologies and Innovation
- Pharmaceutical Sciences
- Sanofi Research and Development
- 94403 Vitry-sur-Seine
- France
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Santos LC, Bianchi J, Souza SIG, Szutan LA. Hypervascular Lesion in a Cirrhotic Liver: A Case Report. Gastroenterology Res 2014; 7:146-148. [PMID: 27785286 PMCID: PMC5040539 DOI: 10.14740/gr630w] [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] [Accepted: 11/26/2014] [Indexed: 11/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the leading cause of death among patients with cirrhosis. Therefore, a focal hepatic lesion in a patient with cirrhosis must always be investigated for its high risk of cancer. However, when hepatic lesions in an imaging exam do not present the typical characteristics of a malignant or a benignant tumor, diagnosis may be a challenge. The biopsy can be used in these circumstances, but, as shown by this case, even that can be misleading. A 54-year-old male patient with cirrhosis presented with abdominal pain, jaundice, nausea and vomits. He performed a biopsy at another service, with the result being focal nodular hyperplasia (FNH). He presented adequate hepatic function, and alpha-fetoprotein level was 6.4. Upon first consultation, we required the slides to be brought to our service and reviewed. Our revision also showed no signs of malignancy. Magnetic resonance imaging showed a large hepatic tumor in segments V and VI, predominantly exofitic, with a central scar. The tumor was surgically removed, and its dimensions were 14 × 10 × 9 cm. Microscopic examination revealed an HCC. Even though histological diagnosis was not necessary to indicate surgery, due to its exofitic nature and adequate hepatic function, we discuss the diagnostic characteristics of both HCC and FNH that could help other medical groups in cases where the position of a liver tumor could make the decision to operate more difficult.
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Affiliation(s)
| | - Juliana Bianchi
- Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao Paulo, Brazil
| | | | - Luiz Arnaldo Szutan
- Surgery Department, Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Liver and Portal Hypertension Group of Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
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Burke C, Alexander Grant L, Goh V, Griffin N. The role of hepatocyte-specific contrast agents in hepatobiliary magnetic resonance imaging. Semin Ultrasound CT MR 2013; 34:44-53. [PMID: 23395317 DOI: 10.1053/j.sult.2012.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatocyte-specific contrast agents have been made available in the last 15 years for magnetic resonance imaging of the liver. These agents are differentially taken up by functioning hepatocytes and excreted in the biliary system. They can help distinguish focal liver lesions of hepatocellular origin from lesions of nonhepatocellular origin, and can also be used in the evaluation of the biliary tree. The purpose of this review is to summarize the different types of hepatocyte-specific contrast agents presently available, their use in the characterization of focal liver lesions, their role in the evaluation of biliary pathology, and their potential future applications.
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Affiliation(s)
- Chistopher Burke
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
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17
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Bulut OP, Romero R, Mahle WT, McConnell M, Braithwaite K, Shehata BM, Gupta NA, Vos M, Alazraki A. Magnetic resonance imaging identifies unsuspected liver abnormalities in patients after the Fontan procedure. J Pediatr 2013; 163:201-6. [PMID: 23391043 DOI: 10.1016/j.jpeds.2012.12.071] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 11/12/2012] [Accepted: 12/18/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether abdominal magnetic resonance imaging (MRI) detects hepatic abnormalities before clinical or biochemical perturbations in patients after the Fontan procedure. STUDY DESIGN Thirty-nine children and adolescents who underwent the Fontan procedure and were referred to a pediatric hepatologist by cardiology services between 2011 and 2012 were reviewed retrospectively. Physical examination findings, routine laboratory tests of liver function, evaluation for chronic liver disease, and abdominal MRI findings were recorded. MRI findings were evaluated relative to time elapsed since surgery by 2 radiologists (blinded). RESULTS Assessment for coexisting chronic liver disease was negative in all patients. All patients had a normal serum albumin level and International Normalized Ratio. Twenty-six of the 39 patients (67%) underwent abdominal MRI, 4 had MRI-incompatible hardware, and 9 did not undergo MRI because of insurance denial. All MRI scans demonstrated morphologic liver changes with varying degrees of reticular contrast enhancement compatible with fibrosis and congestion. Reticular contrast enhancement was often nonuniform, and 9 patients (35%) had multifocal arterially enhancing lesions. CONCLUSION MRI can identify hepatic abnormalities in patients after Fontan surgery that go undetected by standard clinical and laboratory assessments. These abnormalities are not uniformly distributed throughout the liver, and thus assessment by liver biopsy analysis is subject to sampling error.
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Affiliation(s)
- Ozlem Pinar Bulut
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
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18
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Baird AJ, Amos GJ, Saad NF, Benson MD. Retrospective audit to determine the diagnostic accuracy of Primovist-enhanced MRI in the detection of hepatocellular carcinoma in cirrhosis with explant histopathology correlation. J Med Imaging Radiat Oncol 2013; 57:314-20. [PMID: 23721140 DOI: 10.1111/1754-9485.12038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 11/21/2012] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study aims to determine the diagnostic accuracy of Primovist-enhanced MRI in the detection of hepatocellular carcinoma (HCC) in cirrhosis, using liver explant histopathology correlation. METHODS Thirty patients underwent a Primovist-enhanced MRI prior to liver transplantation for cirrhosis at the Princess Alexandra Hospital from 2006 to June 2012. Pre-contrast T1, T2 and post-Primovist arterial, portal venous and delayed hepatobiliary phase sequences were routinely obtained. A retrospective audit of MRI reports determined whether HCCs was identified on pre-transplantation imaging. Results were correlated to the explant liver histopathology. Specificity and sensitivity of Primovist in HCC identification in cirrhosis was determined. RESULTS The time interval between preoperative MRI and transplantation ranged from the day of transplantation to 112 weeks pre-transplantation. Thirty-nine HCCs were identified histologically in explants. Fifteen HCCs were identified on pre-transplant MRI in 11 patients, ranging from 11 to 43 mm, all confirmed on histopathology. Fourteen MRI studies identified no lesion, concordant on histology. Twenty-four either well or moderately differentiated HCCs were identified on histopathology, all of which were less than 17 mm, were not depicted on MRI. No poorly differentiated HCCs were present in the explants. Two regenerative nodules were correctly identified on MRI. This correlated to a sensitivity of 42.5%, specificity of 100% and a positive predictive value of 100% and negative predictive value of 39.5%. CONCLUSION Primovist-enhanced MRI is very accurate in the identification of HCC in cirrhosis, especially if the tumour is greater than 17 mm and undifferentiated. However, sensitivity is reduced for well- and moderately differentiated HCC less than 17 mm.
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Affiliation(s)
- Andrew J Baird
- Department of Diagnostic Imaging, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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19
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Hepatocellular carcinoma presenting as an incidental isolated malignant portal vein thrombosis. J Gastrointest Cancer 2013; 43:486-9. [PMID: 21190093 DOI: 10.1007/s12029-010-9235-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Portal vein thrombosis is frequently associated with hepatocellular carcinoma (HCC). Tumor invasion into the portal vein by direct venous extension or metastasis occurs in up to 70% of HCC patients (Cedrone et al., Liver 16:94-8, 1996). However, presentation as an isolated malignant portal vein thrombosis without any evidence of obvious hepatoma-like lesions in the liver by imaging studies is extremely uncommon. We present an unusual case of HCC presenting as a malignant portal vein thrombus, proven on biopsy of the thrombus without any evidence of primary liver lesion. This, to our knowledge, is the first case of HCC presenting as an incidental isolated malignant portal vein thrombosis. The importance of doing delayed enhancement imaging studies to rule out malignant portal vein thrombosis is emphasized. CASE REPORT A 60-year-old man presented with acute substernal chest pain. Physical examination revealed icterus. Examination of the abdomen did not reveal any organomegaly. Liver function test revealed a predominantly conjugated bilirubinemia. Abdominal sonogram revealed thrombosis and occlusion of the posterior right portal vein. Liver parenchyma was homogenous with no intrahepatic mass. Computed tomography (CT) of the abdomen and pelvis after administration of oral and intravenous contrast with delayed views revealed arterial enhancement of the right portal vein thrombus with delayed washout. MRI of the abdomen with gadolinium confirmed the right portal vein thrombus without focal hepatic mass. Aspiration of the right portal vein thrombus under CT guidance revealed hepatocellular carcinoma which was confirmed by immunohistochemistry. Serum alpha-fetoprotein level was very high. Patient was started on sorafenib with subsequent decrease in alpha-fetoprotein level. He was doing well till the date of this report. DISCUSSION This unusual case of hepatocellular carcinoma presenting as an incidental malignant portal vein thrombosis without any primary liver lesion is extremely rare. Other reported cases of malignant portal vein thrombosis have been in patients with underlying hepatoma, cirrhosis, or with intrabiliary hepatocelluar carcinoma. In the clinical setting of portal vein thrombosis, imaging studies showing enhancement of the thrombus in the arterial phase are important in leading to the diagnosis of malignancy.
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Kim DJ, Yu JS, Kim JH, Chung JJ, Kim KW. Small hypervascular hepatocellular carcinomas: value of diffusion-weighted imaging compared with "washout" appearance on dynamic MRI. Br J Radiol 2012; 85:e879-86. [PMID: 22573299 DOI: 10.1259/bjr/23975164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the value of diffusion-weighted MRI (DWI) with the venous "washout" appearance during dynamic MRI for the assessment of small arterial hypervascular lesions in cirrhotic liver. METHODS After exclusion of benign hypervascular lesions, including haemangiomas and subcapsular non-tumorous arterioportal shunts, indicated by typical imaging features, a total of 109 small arterial hypervascular lesions (0.5-3.0 cm in the longest diameter) in 65 patients with cirrhosis who underwent gadopentetate dimeglumine-enhanced dynamic MRI and DWI (b=50, 400, 800 s mm(-2)) at 1.5 T during a 16-month period were retrospectively analysed to determine the presence of venous washout during dynamic imaging or sustained hyperintensity upon increasing the b factor size on DWI. RESULTS Among the 99 hypervascular hepatocellular carcinomas (HCCs), sustained hyperintensity on DWI (92/99, 93%) was more prevalent than the washout appearance (72/99, 72%) on dynamic MRI (p<0.001). Depending on the lesion size, subcentimetre-sized HCCs had a significantly lower prevalence of venous washout (13/30, 43%) than the sustained hyperintensity on DWI (27/30, 90%) (p=0.001). In all 10 hypervascular benign conditions, there was no venous washout on dynamic MRI and no sustained hyperintensity on DWI. Sensitivity and specificity for diagnosis of hypervascular HCCs were 92.9% and 100% in DWI and 72% and 100% in dynamic MRI, respectively. CONCLUSION Compared with the venous washout during dynamic imaging, DWI provides more reliable information in the MRI assessment of small hypervascular HCCs, distinguishing them from atypical hypervascular benign or pseudolesions. DWI could complement the early diagnosis of small hypervascular HCCs that do not display venous washout during dynamic imaging.
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Affiliation(s)
- D J Kim
- Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
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21
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Geninatti Crich S, Cutrin JC, Lanzardo S, Conti L, Kálmán FK, Szabó I, Lago NR, Iolascon A, Aime S. Mn-loaded apoferritin: a highly sensitive MRI imaging probe for the detection and characterization of hepatocarcinoma lesions in a transgenic mouse model. CONTRAST MEDIA & MOLECULAR IMAGING 2012; 7:281-8. [DOI: 10.1002/cmmi.492] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Stefania Lanzardo
- Department of Clinical and Biological Sciences; University of Turin; Turin; Italy
| | - Laura Conti
- Department of Clinical and Biological Sciences; University of Turin; Turin; Italy
| | | | - Ibolya Szabó
- Center for Molecular Imaging, Department of Chemistry IFM; University of Turin; Turin; Italy
| | - Néstor R. Lago
- Center of Experimental Pathology, School of Medicine; University of Buenos Aires; Buenos Aires; Argentina
| | - Achille Iolascon
- CEINGE Biotecnologie Avanzate; University of Naples; Naples; Italy
| | - Silvio Aime
- Center for Molecular Imaging, Department of Chemistry IFM; University of Turin; Turin; Italy
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22
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Predictive value of alpha-fetoprotein in the long-term risk of developing hepatocellular carcinoma in patients with hepatitis B virus infection--results from a clinic-based longitudinal cohort. Eur J Cancer 2012; 48:2319-27. [PMID: 22436980 DOI: 10.1016/j.ejca.2012.02.065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/06/2012] [Accepted: 02/25/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although serum level of alpha-fetoprotein (AFP) has long been used to complement imaging tests in the screening and diagnosis of hepatocellular carcinoma (HCC), whether it can be used as a predictive marker of long-term risk for developing HCC in patients with hepatitis B virus (HBV) has not been extensively evaluated and thus remains controversial. METHODS We retrospectively conducted a clinic-based longitudinal cohort study including 617 Korean American patients with HBV who had been followed for up to 22 years (median follow-up time, 6.2 years) to evaluate the association between baseline serum AFP level and the long-term risk of HCC. RESULTS The median baseline AFP value of these patients was 3.8 ng/ml. Compared to patients with lower-than-median AFP value, those with higher-than-median baseline serum AFP had a significantly increased risk of developing HCC with a hazard ratio (HR) of 2.73 (95% confidence interval [CI] 1.25-5.99), independent of other major HCC risk factors. In addition, we calculated the cumulative incidence of HCC during different years of follow-up time by baseline serum AFP, and found that the cumulative incidence of HCC was significantly higher in HBV patients with high baseline serum AFP compared to those with low baseline serum AFP in each of the five follow-up time periods examined. CONCLUSIONS Our results indicated that AFP was a strong independent prospective predictor of long-term HCC risk in high-risk HBV patients. More targeted prevention and early detection of HCC may be considered for these patients.
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Reddy LH, Couvreur P. Nanotechnology for therapy and imaging of liver diseases. J Hepatol 2011; 55:1461-6. [PMID: 21801699 DOI: 10.1016/j.jhep.2011.05.039] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/10/2011] [Accepted: 05/27/2011] [Indexed: 12/29/2022]
Abstract
Nanotechnology has been considered for the improved delivery of various therapeutic agents, including drugs and genes. Indeed, liposomes and nanoparticles equipped with homing devices for the targeting of receptors over-expressed on the hepatic tissue have improved the treatment of various liver diseases. In this review, various nanotechnology approaches employed for the treatment/imaging of liver disease, either in preclinical or in clinic are discussed.
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Affiliation(s)
- L Harivardhan Reddy
- Drug Delivery Technologies and Innovation, Pharmaceutical Sciences Department, Sanofi-aventis, 13 Quai Jules Guesde, 94403 Vitry-sur-Seine, France
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Abstract
Technologic advancements have allowed imaging modalities to become more useful in the diagnosis of hepatobiliary and pancreatic disorders. Computed tomography scanners now use multidetector row technology with contrast-delayed imaging for quicker and more accurate imaging. Magnetic resonance imaging with cholangiopancreatography can more clearly delineate liver lesions and the biliary and pancreatic ducts, and can diagnose pathologic conditions early in their course. Newer technologies, such as single-operator cholangioscopy and endoscopic ultrasonography, have sometimes shown superiority to traditional modalities. This article addresses the literature regarding available imaging techniques in the diagnosis and treatment of common surgical hepatobiliary and pancreatic diseases.
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Kierans AS, Leonardou P, Hayashi P, Brubaker LM, Elazzazi M, Shaikh F, Semelka RC. MRI findings of rapidly progressive hepatocellular carcinoma. Magn Reson Imaging 2010; 28:790-6. [PMID: 20427139 DOI: 10.1016/j.mri.2010.03.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/05/2010] [Accepted: 03/05/2010] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study is to determine the magnetic resonance imaging (MRI) and patient characteristics in subjects with hepatocellular carcinoma (HCC) that exhibit rapid progression. MATERIALS AND METHODS In this unblinded retrospective study, initial and follow up MR images were reviewed, before and after rapid progression of HCC, respectively. Rapid progression was defined as a lesion <3 cm which exhibited >3 cm increase in one year or 2 cm increase in 6 months. Patient characteristics and MRI findings were determined using clinical information from the institution clinical information system and records from the Radiology and Pathology Departments, Hepatology Division and Liver Transplant Service of the Department of Medicine. RESULTS Seven individuals were identified with HCC that showed rapid progression. Five of the patients had underlying hepatitis C, one had alcoholic hepatitis, and one had immunosuppression due to liver transplantation. On initial MRI, six patients had early intense ring enhancing lesions, which rapidly progressed in size. Five patients died within 6 months, one within 1 year after progression despite treatment. Six of the seven patients also had multiple other liver nodules on initial MRI; those that showed ring enhancement rapidly progressed but those without, did not show rapid progression. CONCLUSION Patients with rapidly progressive HCC had underlying hepatitis C and intense ring enhancement on initial MRI. This group of patients should be evaluated further to determine if they might benefit from early intervention.
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Affiliation(s)
- Andrea S Kierans
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7510, USA
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Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 2010; 29:1725-48. [PMID: 19959518 DOI: 10.1148/rg.296095515] [Citation(s) in RCA: 276] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatobiliary-specific contrast agents are one of several classes of contrast agents available for magnetic resonance (MR) imaging of the liver. These agents are taken up by functioning hepatocytes and excreted in the bile, and their paramagnetic properties cause shortening of the longitudinal relaxation time (T1) of the liver and biliary tree. The three contrast agents that have been developed are mangafodipir trisodium (Mn-DPDP), gadobenate dimeglumine (Gd-BOPTA), and gadoxetic acid (Gd-EOB-DTPA). These three MR contrast agents vary in mode of administration and dose, mechanism of cellular uptake, degree of excretion through the biliary pathway, and imaging characteristics. In the liver, hepatobiliary-specific agents can be used to improve lesion detection, to characterize lesions as hepatocellular or nonhepatocellular, and to specifically characterize some hepatocellular lesions, notably focal nodular hyperplasia. Biliary excretion of these agents can be used to evaluate the anatomic structure and function of the biliary tree. In the future, hepatobiliary-specific contrast agents may have wider applications, such as grading of cirrhosis and quantification of liver function.
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Affiliation(s)
- Melanie K Seale
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, White 270, 55 Fruit St, Boston, MA 02114, USA
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27
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Tamandl D, Herberger B, Gruenberger B, Schoppmann SF, Puhalla H, Schindl M, Schima W, Jakesz R, Gruenberger T. Adequate preoperative staging rarely leads to a change of intraoperative strategy in patients undergoing surgery for colorectal cancer liver metastases. Surgery 2008; 143:648-57. [DOI: 10.1016/j.surg.2007.11.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 11/15/2007] [Accepted: 11/16/2007] [Indexed: 12/27/2022]
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