1
|
Boraschi P, Mazzantini V, Donati F, Coco B, Vianello B, Pinna A, Morganti R, Colombatto P, Brunetto MR, Neri E. Primary sclerosing cholangitis: Is qualitative and quantitative 3 T MR imaging useful for the evaluation of disease severity? Eur J Radiol Open 2024; 13:100595. [PMID: 39206437 PMCID: PMC11357777 DOI: 10.1016/j.ejro.2024.100595] [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: 06/28/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose To analyze the role of qualitative and quantitative 3 T MR imaging assessment as a non-invasive method for the evaluation of disease severity in patients with primary sclerosing cholangitis (PSC). Methods A series of 26 patients, with histological diagnosis of PSC undergoing 3 T MRI and hepatological evaluation, was retrospectively enrolled. All MR examinations included diffusion-weighted imaging (DWI), T2-weighted (T2w) and T1-weighted (T1w) sequences, before and after administration of Gd-EOB-DTPA with the acquisition of both dynamic and hepato-biliary phase (HBP). Qualitative analysis was performed by assessment of liver parenchyma and biliary tract changes, also including biliary excretion of gadoxetic acid on HBP. Quantitative evaluation was conducted on liver parenchyma by measurement of apparent diffusion coefficient (ADC) and relative enhancement (RE) on 3-minute delayed phase and on HBP. Results of blood tests (ALT, ALP, GGT, total and direct bilirubin, albumin, and platelets) and transient elastography-derived liver stiffness measurements (TE-LSM) were collected and correlated with qualitative and quantitative MRI findings. Results Among qualitative and quantitative findings, fibrosis visual assessment and RE had the best performance in estimating disease severity, showing a statistically significant correlation with both biomarkers of cholestasis and TE-LSM. Statistical analysis also revealed a significant correlation of gadoxetic acid biliary excretion with ALT and direct bilirubin, as well as of ADC with total bilirubin. Conclusion Qualitative and quantitative 3 T MR evaluation is a promising non-invasive method for the assessment of disease severity in patients with PSC.
Collapse
Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Radiological Nuclear and Laboratory Medicine - Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Valentina Mazzantini
- Academic Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Francescamaria Donati
- 2nd Unit of Radiology, Department of Radiological Nuclear and Laboratory Medicine - Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Barbara Coco
- Hepatology Unit, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Barbara Vianello
- Hepatology Unit, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Andrea Pinna
- Hepatology Unit, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Riccardo Morganti
- Departmental Section of Statistical Support for Clinical Trials, Pisa University Hospital, Via Roma 67, Pisa 56126, Italy
| | - Piero Colombatto
- Hepatology Unit, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | | | - Emanuele Neri
- Academic Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy
| |
Collapse
|
2
|
Catucci D, Hrycyk J, Lange NF, Obmann VC, Berzigotti A, Brönnimann MP, Zbinden L, Fischer K, Guensch DP, Ebner L, Roos J, Christe A, Huber AT. Liver segmental volumes and their relationship with 5-year prognostication. Abdom Radiol (NY) 2024:10.1007/s00261-024-04552-w. [PMID: 39254712 DOI: 10.1007/s00261-024-04552-w] [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: 06/08/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/11/2024]
Abstract
PURPOSE This study aimed to analyze the predictive value of caudate to right lobe ratio (CRL-R) and liver segmental volume ratio (LSVR) for chronic liver disease (CLD) on routine abdominal CT scans and their association with 5-year decompensation- and transplant-free survival. METHOD This retrospective study included 108 patients without CLD and 98 patients with biopsy-proven CLD. All patients underwent abdominal CT scans between 03/2015 and 08/2017. Patients with CLD were divided into three groups: early CLD (F0-F2; eCLD; n = 40), advanced CLD (F3-F4; aCLD; n = 20), and aCLD with clinically significant portal hypertension (aCLDPH; n = 38). CRL-R and LSVR were compared between groups using Kruskal-Wallis test and ROC analysis to determine cutoff-values. 5-year decompensation- and transplant-free survival were assessed by Kaplan-Meier curve analysis. RESULTS CRL-R and LSVR were significantly different between all groups (p < 0.001). A CRL-R cutoff-value of > 0.99 predicted aCLD with a sensitivity of 69% and a specificity of 80% (AUC = 0.75, p < 0.001), while LSVR > 0.37 had a sensitivity of 67% and a specificity of 84% (AUC = 0.80, p < 0.001). CLD-patients with both CRL-R > 0.99 and LSVR > 0.37 had a significantly lower probability of 5-year decompensation-free survival (31%) as well as lower probability of 5-year transplant-free survival (41%) than those with a CRL-R < 0.99 and/or LSVR < 0.37 (70%, 62%, p = 0.006, p = 0.038). CONCLUSION CRL-R and LSVR showed a high predictive value for CLD on routine abdominal CT scans. In patients with CLD, both CRL-R and LSVR may be combined and are associated with 5-year decompensation-free and transplant-free survival.
Collapse
Affiliation(s)
- Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Joris Hrycyk
- Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Naomi Franziska Lange
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Patrick Brönnimann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Lukas Zbinden
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- ARTORG Center for Biomedical Engineering, Bern, Switzerland
| | - Kady Fischer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Anesthesiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Paul Guensch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Anesthesiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Justus Roos
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
3
|
Bernardo CCDO, Godoy G, Eik Filho W, Curi R, Bazotte RB. Heterogeneous Pathological Changes in Liver Lobes During Liver Disease: A Perspective Review. Metab Syndr Relat Disord 2024. [PMID: 39037911 DOI: 10.1089/met.2023.0311] [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: 07/24/2024] Open
Abstract
Liver diseases have a global prevalence of 25%, accounting for 4% of all deaths worldwide, and are associated with a 36% increased risk of fatal and nonfatal cardiovascular events. Metabolic dysfunction-associated steatotic liver disease constitutes the liver expression of metabolic syndrome and represents the primary type of liver disease. Microscopical analysis of biopsies, which allows the evaluation of a small portion of tissue with inferences made to the entire organ, is considered the gold standard for determining the presence of liver diseases. However, potential sampling errors in liver biopsies are conceivable because the obtained tissue represents only a tiny fraction of the entire liver mass and may not accurately reflect the true pathological state. Studies have demonstrated the existence of sampling errors in liver biopsies, particularly concerning the severity of inflammation, degree of fibrosis, and the presence of cirrhosis. Also, clinical studies have shown that histopathological abnormalities are better detected in humans when liver samples are collected from both the right and the left lobes. However, a gap exists in clinical investigation to clarify the role of differences between these lobes in improving the diagnostic and prognostic for liver diseases. Building upon the heterogeneous nature of pathological alterations observed in liver lobes, this perspective review provided recommendations to enhance the precision of diagnosis and prognostic accuracy of liver diseases.
Collapse
Affiliation(s)
| | - Guilherme Godoy
- Post-Graduate Program in Pharmaceutical Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | - Wilson Eik Filho
- Department of Medicine, State University of Maringá, Maringá, Brazil
| | - Rui Curi
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, São Paulo, Brazil
| | - Roberto Barbosa Bazotte
- Post-Graduate Program in Pharmaceutical Sciences, State University of Maringá, Maringá, Paraná, Brazil
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, São Paulo, Brazil
| |
Collapse
|
4
|
Zheng T, Qu Y, Chen J, Yang J, Yan H, Jiang H, Song B. Noninvasive diagnosis of liver cirrhosis: qualitative and quantitative imaging biomarkers. Abdom Radiol (NY) 2024; 49:2098-2115. [PMID: 38372765 DOI: 10.1007/s00261-024-04225-8] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
A diagnosis of cirrhosis initiates a shift in the management of chronic liver disease and affects the diagnostic workflow and treatment decision of primary liver cancer. Liver biopsy remains the gold standard for cirrhosis diagnosis, but it is invasive and susceptible to sampling bias and observer variability. Various qualitative and quantitative imaging biomarkers based on ultrasound, CT and MRI have been proposed for noninvasive diagnosis of cirrhosis. Qualitative imaging features are easy to apply but have moderate diagnostic sensitivity. Elastography techniques allow quantitative assessment of liver stiffness and are highly accurate for cirrhosis diagnosis. Ultrasound elastography are widely used in clinical practice, while MR elastography has narrower availability. Although not applicable in clinical practice yet, other quantitative imaging features, including liver surface nodularity, linear and volumetric measurement, extracellular volume fraction, liver enhancement on hepatobiliary phase, and parameters derived from diffusion-weighted imaging, can provide additional information of liver morphology, perfusion, and function, thus may increase diagnosis performance. The introduction of radiomics and deep learning has further improved diagnostic accuracy while reducing subjectivity. Several imaging features may also help to assess liver function and outcomes in patients with cirrhosis. In this review, we summarize the qualitative and quantitative imaging biomarkers for noninvasive cirrhosis diagnosis, and the assessment of liver function and outcomes, and discuss the challenges and future directions in this field.
Collapse
Affiliation(s)
- Tianying Zheng
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Yali Qu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Jie Yang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hualin Yan
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China.
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China.
| |
Collapse
|
5
|
Grave EC, Loehfelm T, Corwin MT, Zepeda J, Bath HK, Dhaliwal S, Yazdanfar M, Bowlus CL. Interobserver agreement and prognostic value of image-based scoring systems in patients with primary sclerosing cholangitis. Abdom Radiol (NY) 2024; 49:60-68. [PMID: 37831167 DOI: 10.1007/s00261-023-04051-4] [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: 07/06/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a cholestatic liver disease that progresses to cirrhosis and liver failure. The Anali and Amsterdam scores are based upon imaging features on MRI and ERCP, respectively. AIMS We aimed to compare the interobserver variability and performances of these scores. METHODS Patients with PSC with at least 1 MRCP were included. Images were independently scored by 2 experts. Agreement and prognostic performance with a primary end point of hepatic decompensation was assessed. RESULTS Fifty-nine patients were included (67.8% male, 86.4% IBD). Interobserver agreement for the Anali and Amsterdam scores were moderate (k = 0.49; 95% CI 0.35-0.64 and k = 0.43; 95% CI 0.30-0.56, respectively). Among the Anali components, dysmorphy (caudate/right lobe ratio > 0.9) had fair agreement (k = 0.37; 95% CI 0.14-0.60) and portal hypertension (k = 0.64, 95% CI 0.32-0.89) and intrahepatic dilation (k = 0.70; 95% CI 0.53-0.87) had substantial agreement. The Amsterdam extrahepatic and intrahepatic scores had fair agreement (k = 0.38; 95% CI 0.23-0.52) and moderate agreement (k = 0.50; 95% CI 0.34-0.67), respectively. Anali score (HR 5.90, 95% CI 1.64-21.21), total bilirubin (HR = 3.23; 95% Cl 1.06-9.91), and age (HR = 1.05; 95% CI 1.00-1.11) were independent predictors of hepatic decompensation. Mayo risk score and Anali score had good discriminative ability with c-statistics of 0.78 (CI 0.59-0.96) and 0.76 (CI 0.56-0.91). Anali score remained an independent predictor after adjusting for Mayo risk score. CONCLUSION Anali score adds additional predictive value for hepatic decompensation in patients with PSC.
Collapse
Affiliation(s)
- Erick Cruz Grave
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, USA
| | - Thomas Loehfelm
- Department of Radiology, University of California Davis School of Medicine, Sacramento, USA
| | - Michael T Corwin
- Department of Radiology, University of California Davis School of Medicine, Sacramento, USA
| | - Joseph Zepeda
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, USA
| | - Harjot K Bath
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, USA
| | - Sandeep Dhaliwal
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, USA
| | - Maryam Yazdanfar
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, USA
| | - Christopher L Bowlus
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, USA.
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, 4150 V Street, Suite 3500, Sacramento, CA, 95817, USA.
| |
Collapse
|
6
|
Tsochatzis A, Charalampopoulos G, Tzelves L, Velonakis G, Kelekis A, Kelekis N, Filippiadis DK. Percutaneous microwave ablation of hepatic tumors: is there an impact of cirrhotic liver parenchyma upon the volume and short-term assessment of the ablation zone? Br J Radiol 2023; 96:20230383. [PMID: 37750857 PMCID: PMC10646625 DOI: 10.1259/bjr.20230383] [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: 04/24/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To retrospectively compare and evaluate ablation zone volume and its reduction from baseline to 1 month follow-up post-percutaneous microwave ablation (MWA) between healthy and cirrhotic liver parenchyma. METHODS Institutional database research identified 84 patients (118 hepatic tumors) who underwent percutaneous MWA with the same system. Caudal-right lobe ratio was applied to distinguish cirrhotic (n = 51) and healthy (n = 67) group; ITK-SNAP software was used to quantify ablation zone volume. Long (LAD) and short 1 (SAD-1) and 2 (SAD-2) axis, tumor size diameter (mm) and volume (cm³) of the ablation zones were evaluated for each treated lesion in both groups at baseline (immediately post-ablation) and at 1 month follow-up. RESULTS There was no significant difference comparing ablation zone volumes at baseline (healthy group: mean ablation volume 14.84 cm³ vs cirrhotic group: mean ablation volume 17.85 cm³, p = 0.31) and 1 month post-ablation (healthy group: mean ablation volume 9.15 cm³ vs cirrhotic group: mean ablation volume 11.58 cm³, p = 0.24). When both "healthy" and "cirrhotic" liver group were evaluated independently, there was a significant difference of ablation volumes reduction (p-value < 0.001) from baseline to 1 month follow-up. When both groups were compared based on reduction (35.12-38.34%) there was no significant difference in ablation zone volumes (p-value = 0.77). CONCLUSION Percutaneous MWA results in ablation zones of a comparable volume in both healthy and cirrhotic liver parenchyma. Both cirrhotic and healthy liver parenchyma experience a similar significant reduction of ablation zone volume at 1 month post-therapy. ADVANCES IN KNOWLEDGE STATEMENT This study evaluates and compares the volume of the ablation zone after MWA between healthy and cirrhotic liver parenchyma from baseline to 1 month follow-up and attempts to identify potential differences. It is the first study to demonstrate significant shrinkage of ablation volumes in healthy livers as compared to cirrhotic livers after 4 weeks of follow-up. The results of this study can help us understand the effect of MWA when applied in different backgrounds of liver parenchyma, which could lead to different treatment planning.
Collapse
Affiliation(s)
- Athanasios Tsochatzis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Charalampopoulos
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- Department of Urology, Uro-Oncology, University College of London Hospitals, NHS Trust, London, United Kingdom
| | - George Velonakis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios K Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
7
|
Hu N, Yan G, Tang M, Wu Y, Song F, Xia X, Chan LWC, Lei P. CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease. Eur Radiol Exp 2023; 7:72. [PMID: 37985560 PMCID: PMC10661153 DOI: 10.1186/s41747-023-00387-0] [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] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023] Open
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD), previously called metabolic nonalcoholic fatty liver disease, is the most prevalent chronic liver disease worldwide. The multi-factorial nature of MAFLD severity is delineated through an intricate composite analysis of the grade of activity in concert with the stage of fibrosis. Despite the preeminence of liver biopsy as the diagnostic and staging reference standard, its invasive nature, pronounced interobserver variability, and potential for deleterious effects (encompassing pain, infection, and even fatality) underscore the need for viable alternatives. We reviewed computed tomography (CT)-based methods for hepatic steatosis quantification (liver-to-spleen ratio; single-energy "quantitative" CT; dual-energy CT; deep learning-based methods; photon-counting CT) and hepatic fibrosis staging (morphology-based CT methods; contrast-enhanced CT biomarkers; dedicated postprocessing methods including liver surface nodularity, liver segmental volume ratio, texture analysis, deep learning methods, and radiomics). For dual-energy and photon-counting CT, the role of virtual non-contrast images and material decomposition is illustrated. For contrast-enhanced CT, normalized iodine concentration and extracellular volume fraction are explained. The applicability and salience of these approaches for clinical diagnosis and quantification of MAFLD are discussed.Relevance statementCT offers a variety of methods for the assessment of metabolic dysfunction-associated fatty liver disease by quantifying steatosis and staging fibrosis.Key points• MAFLD is the most prevalent chronic liver disease worldwide and is rapidly increasing.• Both hardware and software CT advances with high potential for MAFLD assessment have been observed in the last two decades.• Effective estimate of liver steatosis and staging of liver fibrosis can be possible through CT.
Collapse
Affiliation(s)
- Na Hu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Gang Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Maowen Tang
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuhui Wu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Fasong Song
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xing Xia
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lawrence Wing-Chi Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
| | - Pinggui Lei
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
| |
Collapse
|
8
|
Grove RL, Vespa F, Aineseder M, Villamil A, Spina JC. Prognostic role of magnetic resonance imaging of the abdomen with intravenous contrast and magnetic resonance cholangiopancreatography in primary sclerosing cholangitis. Radiol Bras 2023; 56:301-307. [PMID: 38504819 PMCID: PMC10948161 DOI: 10.1590/0100-3984.2023.0041] [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: 04/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To evaluate the usefulness of Anali scores, determined by magnetic resonance imaging, for predicting the prognosis of primary sclerosing cholangitis (PSC) and to analyze interobserver variability, as well as to assess the impact of periportal edema and heterogeneous signal intensity on diffusion-weighted imaging of the liver. Materials and Methods This was a retrospective cohort study of 29 patients with PSC and baseline magnetic resonance imaging. Anali scores, without gadolinium (0-5 points) and with gadolinium (0-2 points), were calculated by two radiologists. Clinical end-points included liver transplantation, cirrhotic decompensation, and death. We calculated intraclass correlation coefficients (ICCs) for interobserver agreement on the Anali scores, performed Kaplan-Meier survival analysis comparing event-free survival among the score strata, and calculated the areas under receiver operating characteristic curves to determine sensitivity and specificity. Results Among the patients with a clinical event, the median Anali score was 4 (interquartile range [IQR], 2-5) without gadolinium and 2 (IQR, 1-2) with gadolinium, compared with 1 (IQR, 1.0-2.5) and 1 (IQR, 0.25-1.0), respectively, among those without a clinical event. The ICC was 0.79 (95% confidence interval: 0.57-0.91) for the Anali score with gadolinium and 0.99 (95% confidence interval: 0.98-0.99) for the Anali score without gadolinium. Periportal edema and heterogeneous signal intensity in the liver on diffusion-weighted imaging showed no statistical impact on clinical events (p = 0.65 and p = 0.5, respectively). Conclusion Anali scores correlate with clinical events in PSC, with a high level of interobserver agreement.
Collapse
Affiliation(s)
- Roy López Grove
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Florência Vespa
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Martina Aineseder
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Alejandra Villamil
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Juan Carlos Spina
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| |
Collapse
|
9
|
Gomes NBN, Torres US, Silva GSE, Mamone POS, Ferraz MLCG, D’ippolito G. Magnetic resonance imaging findings in autoimmune hepatitis: how frequent and reproducible are they? Radiol Bras 2023; 56:308-316. [PMID: 38504809 PMCID: PMC10948163 DOI: 10.1590/0100-3984.2023.0044] [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: 05/06/2023] [Revised: 06/19/2023] [Accepted: 09/11/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To determine the frequency and interobserver reproducibility of the magnetic resonance imaging (MRI) features considered diagnostic for autoimmune hepatitis. Materials and Methods Two abdominal radiologists, blinded to pathology data, reviewed the MRI examinations of 20 patients with autoimmune hepatitis, looking for liver enhancement, lymphadenopathy, portal hypertension, and chronic liver disease. The pattern of liver fibrosis was categorized as reticular, confluent, or mixed. Interobserver agreement was assessed by calculating intraclass correlation coefficients and kappa statistics. Results The most common abnormal finding on MRI was surface nodularity (in 85%), followed by liver fibrosis with a reticular pattern (in 80%)-categorized as mild (in 25.0%), moderate (in 43.8%), or severe (in 31.2%)-; heterogeneous liver enhancement (in 65%); splenomegaly (in 60%); caudate lobe enlargement (in 50%); and lymphadenopathy (in 40%). The interobserver agreement was almost perfect for surface nodularity (0.83), ascites (0.89), and liver volume (0.95), whereas it was just slight and fair for the degree of fibrosis and for heterogeneous liver enhancement (0.12 and 0.25, respectively). It was also slight and fair for expanded gallbladder fossa and enlarged preportal space (0.14 and 0.36, respectively), both of which are indicative of chronic liver disease. Conclusion The interobserver agreement was satisfactory for surface nodularity (the most prevalent abnormal MRI finding), ascites, liver volume, and splenomegaly. Conversely, it was only slight or fair for common but less objective criteria.
Collapse
Affiliation(s)
- Natália Borges Nunes Gomes
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
- Grupo Fleury, São Paulo, SP, Brazil
| | - Ulysses S. Torres
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
- Grupo Fleury, São Paulo, SP, Brazil
| | - Gabriella Souza e Silva
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
- Grupo Fleury, São Paulo, SP, Brazil
| | | | | | - Giuseppe D’ippolito
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
- Grupo Fleury, São Paulo, SP, Brazil
| |
Collapse
|
10
|
Zheng S, He K, Zhang L, Li M, Zhang H, Gao P. Conventional and artificial intelligence-based computed tomography and magnetic resonance imaging quantitative techniques for non-invasive liver fibrosis staging. Eur J Radiol 2023; 165:110912. [PMID: 37290363 DOI: 10.1016/j.ejrad.2023.110912] [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: 03/13/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Chronic liver disease (CLD) ultimately develops into liver fibrosis and cirrhosis and is a major public health problem globally. The assessment of liver fibrosis is important for patients with CLD for prognostication, treatment decisions, and surveillance. Liver biopsies are traditionally performed to determine the stage of liver fibrosis. However, the risks of complications and technical limitations restrict their application to screening and sequential monitoring in clinical practice. CT and MRI are essential for evaluating cirrhosis-associated complications in patients with CLD, and several non-invasive methods based on them have been proposed. Artificial intelligence (AI) techniques have also been applied to stage liver fibrosis. This review aimed to explore the values of conventional and AI-based CT and MRI quantitative techniques for non-invasive liver fibrosis staging and summarized their diagnostic performance, advantages, and limitations.
Collapse
Affiliation(s)
- Shuang Zheng
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Kan He
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Lei Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Mingyang Li
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Huimao Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Pujun Gao
- Department of Hepatology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| |
Collapse
|
11
|
Rao C, Chen J, Wang W, Xue C, Wu L, Huang X, Chen S, Rao S, Li F. Computed tomography imaging features to evaluate the severity of portal hypertension and predict the rebleeding risk after endoscopic treatment in cirrhotic patients with variceal hemorrhage. Eur J Radiol 2023; 163:110841. [PMID: 37104896 DOI: 10.1016/j.ejrad.2023.110841] [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: 02/01/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To investigate the association of computed tomography (CT) imaging features and severity of portal hypertension (PH) and develop a nomogram to predict high-risk PH in cirrhotic patients with gastroesophageal variceal hemorrhage (GVH). METHODS The study retrospectively enrolled 158 cirrhotic patients with a history of endoscopic treatment for GVH. Hepatic vein pressure gradient (HVPG) was measured and the patients were classified into high-risk (HVPG > 16 mmHg) or low-risk (HVPG ≤ 16 mmHg) PH group. Pre-treatment CT features, including cavernous transformation of portal vein (CTPV), hilar periportal space (a distance between right portal vein and posterior edge of segment IV of the liver), and depth of right posterior hepatic notch sign (a sharp indentation in the right medial posterior liver surface), were evaluated. Risk factors associated with high-risk PH were analyzed, and a nomogram based on the imaging features was developed. RESULTS High-risk PH group showed a higher rebleeding rate after treatment than that of the low-risk (P = 0.029). Multivariate analysis indicated that larger hilar periportal space (P < 0.001), less frequencies of CTPV (P = 0.044) and deeper right posterior hepatic notch (P < 0.001) were independent risk factors associated with high-risk PH. A nomogram based on the three CT imaging features was established to predict high-risk PH with an excellent discrimination (c-statistic 0.854). CONCLUSION The nomogram based on CT features of hilar periportal space, depth of right posterior hepatic notch and CTPV can help to distinguish cirrhotic patients with high-risk PH, who are more vulnerable of variceal rebleeding after endoscopic treatment.
Collapse
Affiliation(s)
- Chenyi Rao
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jiejun Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wentao Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chunyan Xue
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ling Wu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaoquan Huang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shiyao Chen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shenxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Feng Li
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| |
Collapse
|
12
|
Liver cirrhosis: relationship between fibrosis-associated hepatic morphological changes and portal hemodynamics using four-dimensional flow magnetic resonance imaging. Jpn J Radiol 2023; 41:625-636. [PMID: 36656540 DOI: 10.1007/s11604-023-01388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The mechanisms underlying the morphological changes in liver cirrhosis remain unknown. This study aimed to clarify the relationship between fibrotic hepatic morphology and portal hemodynamic changes using four-dimensional flow magnetic resonance imaging (MRI). MATERIALS AND METHODS Overall, 100 patients with suspected liver disease who underwent 3-T MRI were evaluated in this retrospective study. Liver fibrosis was assessed using a combination of visual assessment of the hepatic morphology and quantitative measures, including the fibrosis-4 index and aspartate transaminase-to-platelet ratio. It was classified into three groups according to the severity of fibrosis as follows: A (normal), B (mild-to-moderate), and C (severe). Quantitative indices, including area (mm2), net flow (mL/s), and average velocity (cm/s), were measured in the right portal vein (RPV) and left portal vein (LPV), and were compared across the groups using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS Among the 100 patients (69.1 ± 12.1 years; 59 men), 45, 35, and 20 were categorized into groups A, B, and C, respectively. The RPV area significantly differed among the groups (from p < 0.001 to p = 0.001), showing a gradual decrease with fibrosis progression. Moreover, the net flow significantly differed between groups A and B and between groups A and C (p < 0.001 and p < 0.001, respectively), showing a decrease during the early stage of fibrosis. In the LPV, the net flow significantly differed among the groups (from p = 0.001 to p = 0.030), revealing a gradual increase with fibrosis progression. CONCLUSION The atrophy-hypertrophy complex, which is a characteristic imaging finding in advanced cirrhosis, was closely associated with decreased RPV flow in the early stage of fibrosis and a gradual increase in LPV flow across all stages of fibrosis progression.
Collapse
|
13
|
Lampichler K, Semmler G, Wöran K, Simbrunner B, Jachs M, Hartl L, Bauer DJM, Balcar L, Burghart L, Trauner M, Tamandl D, Ba-Ssalamah A, Mandorfer M, Reiberger T, Scheiner B, Scharitzer M. Imaging features facilitate diagnosis of porto-sinusoidal vascular disorder. Eur Radiol 2023; 33:1422-1432. [PMID: 36166087 PMCID: PMC9889423 DOI: 10.1007/s00330-022-09132-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Porto-sinusoidal vascular disorder (PSVD) is a recently defined vascular liver disease. Since diagnosis remains challenging, we aimed to evaluate radiological features that are distinct between PSVD and cirrhosis. METHODS Clinical, laboratory, and radiological parameters (CT/MRI) of patients with histologically-confirmed PSVD vs. cirrhosis vs. non-cirrhotic parenchymal liver disease were retrospectively evaluated. RESULTS Sixty-three PSVD, 155 cirrhosis, and 41 non-cirrhotic patients were included. As compared to cirrhosis, PSVD patients were younger and had lower HVPG, liver stiffness, and MELD. Routine clinical and imaging findings indicative of portal hypertension were similarly common. Intrahepatic portal tract abnormalities (49% vs. 15%; p < 0.001), FNH-like lesions (30% vs. 1%; p < 0.001), and abnormal liver morphology defined as peripheral parenchymal atrophy and compensatory hypertrophy of central segments (32% vs. 7%; p < 0.001) were significantly more common in PSVD patients. Hypertrophy of segment I (70% vs. 84%; p = 0.019), atrophy of segment IV (24% vs. 47%; p = 0.001), and nodular liver surface (22% vs. 89%; p < 0.001) were more common in patients with cirrhosis. In patients with gadoxetic acid-enhanced MRI, we identified the distinct imaging feature of "periportal hyperintensity" in the hepatobiliary phase (HBP) in 42% of patients with PSVD (14/33) vs. 1% in cirrhosis (1/95) vs. 0% in non-cirrhotic controls (0/41); p < 0.001). CONCLUSIONS Diagnosis of PSVD must be considered in younger patients presenting with clinical features of portal hypertension, portal tract abnormalities, and FNH-like lesions on CT/MRI. 'Periportal hyperintensity' in the HBP of gadoxetic acid-enhanced MRI was identified as a specific radiological feature of PSVD. KEY POINTS • Cross-sectional imaging can provide essential information to identify patients with porto-sinusoidal vascular disorder (PSVD). • Intrahepatic portal tract abnormalities, FNH-like lesions, and abnormal liver morphology are common in PSVD patients. • Periportal hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI seems to be specific for patients with PSVD.
Collapse
Affiliation(s)
- Katharina Lampichler
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Katharina Wöran
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Simbrunner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Mathias Jachs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Lukas Hartl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - David Josef Maria Bauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Lukas Burghart
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria.
- Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Rare Liver Disease (RALID) Center of the European Reference Network (ERN) RARE-LIVER, Medical University of Vienna, Vienna, Austria
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
14
|
Biyoukar M, Corpechot C, El Mouhadi S, Chambenois E, Vanderbecq Q, Barbu V, Dong C, Lemoinne S, Tordjman M, Jomaah R, Chazouilleres O, Arrivé L. ABCB4 variant is associated with hepatobiliary MR abnormalities in people with low phospholipid associated cholelithiasis syndrome. JHEP Rep 2022; 4:100590. [PMID: 36277956 PMCID: PMC9582794 DOI: 10.1016/j.jhepr.2022.100590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Moustafa Biyoukar
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP) and Sorbonne University, Paris, France
| | - Christophe Corpechot
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Department of Hepatology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP), and INSERM, UMRS 938 Sorbonne University, Paris, France
| | - Sanaâ El Mouhadi
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP) and Sorbonne University, Paris, France
| | - Edouard Chambenois
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP) and Sorbonne University, Paris, France
| | - Quentin Vanderbecq
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP) and Sorbonne University, Paris, France
| | - Véronique Barbu
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Department of Hepatology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP), and INSERM, UMRS 938 Sorbonne University, Paris, France
| | - Catherine Dong
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Department of Hepatology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP), and INSERM, UMRS 938 Sorbonne University, Paris, France
| | - Sara Lemoinne
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Department of Hepatology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP), and INSERM, UMRS 938 Sorbonne University, Paris, France
| | - Mickael Tordjman
- Department of Radiology, Raymond Poincaré Hospital, Assistance Publique – Hôpitaux de Paris (APHP), Garches, France
| | - Raphel Jomaah
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Olivier Chazouilleres
- Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare-Liver, Department of Hepatology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP), and INSERM, UMRS 938 Sorbonne University, Paris, France
| | - Lionel Arrivé
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique – Hôpitaux de Paris (APHP) and Sorbonne University, Paris, France
- Corresponding author. Address: Department of Radiology, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France. Tel.: +33-149282257.
| |
Collapse
|
15
|
Yang C, Chen Y, Wang C, Liu J, Huang S, Zhou C, Wang Y, Ju S, Li T, Bai Y, Yao W, Xiong B. Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation. BMC Gastroenterol 2022; 22:363. [PMID: 35906529 PMCID: PMC9336111 DOI: 10.1186/s12876-022-02447-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Targeted puncture of an appropriate portal venous branch during transjugular intrahepatic portosystemic shunt (TIPS) procedure may reduce the risk of postprocedural overt hepatic encephalopathy (HE). This study aimed to describe blood distribution under portography and combined it with puncture site to determine portal flow diversion, and to evaluate its prognostic value in predicting post-TIPS overt HE. Methods In this retrospective analysis of patients with cirrhosis undergoing TIPS, we included 252 patients to describe blood distribution under portography and 243 patients to assess the association between portal flow diversion and post-TIPS overt HE. Results At the first stage, 51 (20.2%) patients were identified as type A (unilateral type with the right portal branch receives blood from splenic vein [SV]), 16 (6.4%) as type B (unilateral type with the right branch receives blood from superior mesenteric vein [SMV]) and 185 (73.4%) as type C (fully mixed type). At the second stage, 40 patients were divided into the SV group, 25 into the SMV group and 178 into the mixed group. Compared with the mixed group, the risk of post-TIPS overt HE was significantly higher in the SMV group (adjusted HR 3.70 [95% CI 2.01–6.80]; p < 0.001), whereas the SV group showed a non-significantly decreased risk (adjusted HR 0.57 [95% CI 0.22–1.48]; p = 0.25). Additionally, the SMV group showed a substantial increase in ammonia level at 3 days and 1 month after procedure. Conclusions Our results support the clinical use of portal flow diversion for risk stratification and decision-making in the management of post-TIPS overt HE. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02447-y.
Collapse
Affiliation(s)
- Chongtu Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yang Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chaoyang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Songjiang Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chen Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuguang Ju
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Tongqiang Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yaowei Bai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Wei Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| |
Collapse
|
16
|
Reizine E, Meurgey A, Amaddeo G, Laurent A, Calderaro J, Mule S, Luciani A. Fat in mass in primary liver lesions: are usual MRI diagnostic criteria of both malignant and benign liver lesions still applicable? Abdom Radiol (NY) 2022; 47:2347-2355. [PMID: 35672475 DOI: 10.1007/s00261-022-03561-x] [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: 04/18/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the accuracy of the usual MRI diagnostic patterns of primary liver lesions applied to the diagnosis of pathologically proven fat-containing liver lesions. MATERIALS AND METHODS This monocentric IRB approved retrospective study included all patients with pathologically proven focal liver lesions and documented intra-tumoral fat on pathology and who underwent preoperative liver MRI for characterization. Both liver morphology and usual lesion MRI features were analyzed and their distribution correlated to the final pathological result (Khi-2 or Fisher exact tests, Student t-test or Mann-Whitney U test, as appropriate). The Sensitivity (Se) and Specificity (Sp) of MRI patterns known to be associated to both Hepatocellular Carcinoma (HCC), Focal Nodular Hyperplasia (FNH), and Hepatocellular Adenoma (HCA) subtypes were evaluated. RESULTS Between March 2014 and November 2021, 66 lesions were included, corresponding to: 26 HCC, 32 HCA, 6 FNH and 2 hepatic angiomyolipoma (HAML). All lesions developed on a dysmorphic liver were HCC. A non-rim arterial phase hyperenhancement with a washout and an enhancing capsule had a 98% specificity for HCC diagnosis; A homogeneous dropout of signal on the opposed phase had a sensitivity of 92% and a specificity of 89% for the diagnosis of HNF1alpha inactivated subtype of HCA (HHCA). The FNH pattern was specific at 100% for the diagnosis of FNH with a 40% Se. Finally, the accuracy of inflammatory hepatocellular adenoma (IHCA) pattern had a low 60% Se but a high 89% Sp for IHCA diagnosis. CONCLUSION Known MRI patterns remain reliable for the accurate diagnosis of primary liver tumors on MRI even in fat-containing lesions.
Collapse
Affiliation(s)
- Edouard Reizine
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France.
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France.
| | - Azure Meurgey
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Giuliana Amaddeo
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Department of Hepatology, APHP, HU Henri Mondor, Créteil, France
| | - Alexis Laurent
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Departement of Liver Surgery, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Julien Calderaro
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
- Department of Pathology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
| | - Sebastien Mule
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
| | - Alain Luciani
- Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France
- Faculté de Médecine, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unit U 955, Equipe 18, 94010, Creteil, France
| |
Collapse
|
17
|
Rubino JG, Nasirzadeh AR, van der Pol CB, Dhindsa K, Chung AD. Quantitative and qualitative liver CT: imaging feature association with histopathologically confirmed hepatic cirrhosis. Abdom Radiol (NY) 2022; 47:2314-2324. [PMID: 35583820 DOI: 10.1007/s00261-022-03550-0] [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: 02/09/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the diagnostic performance of quantitative and qualitative imaging features of hepatic cirrhosis on CT. METHODS A single-center retrospective cohort study was performed on all patients who had undergone non-targeted liver biopsy < 3 months following abdominal CT imaging between 2007 and 2020. Histopathology was required as a reference standard for hepatic cirrhosis diagnosis. Two readers independently assessed all CT quantitative and qualitative features, blinded to the clinical history and the reference standard. The diagnostic performance of each imaging feature was assessed using multivariate regression and logistic regression in a recursive feature elimination framework. RESULTS 98 consecutive patients met inclusion criteria including 26 with histopathologically confirmed hepatic cirrhosis, and 72 without cirrhosis. Liver surface nodularity (p < 0.0001), lobar redistribution (p < 0.0001), and expanded gallbladder fossa (p < 0.0016) were qualitative CT features associated with liver cirrhosis consistent between both reviewers. Liver surface nodularity demonstrated highest sensitivity (73-77%) and specificity (79-82%). Falciform space width was the only quantitative feature associated with cirrhosis, for a single reviewer (p < 0.04). Using a recursive feature elimination framework, liver surface nodularity and falciform space width were the strongest performing features for identifying cirrhosis. No feature combinations strengthened diagnostic performance. CONCLUSION Many quantitative and qualitative CT imaging signs of hepatic cirrhosis have either poor accuracy or poor inter-observer agreement. Qualitative imaging features of hepatic cirrhosis on CT performed better than quantitative metrics, with liver surface nodularity the most optimal feature for diagnosing hepatic cirrhosis.
Collapse
Affiliation(s)
| | - Amir Reza Nasirzadeh
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Christian B van der Pol
- Department of Radiology, Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Kiret Dhindsa
- Berlin Institute of Health and Department of Neurology and Experimental Neurology, Brain Simulation Section, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew D Chung
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada.
| |
Collapse
|
18
|
Sadraei N, Jafari H, Sadraee A, Zeinali-Rafsanjani B, Rastgooyan H, Zahergivar A. Assessment of Three-Phasic CT Scan Findings of Cirrhosis Due to Primary Sclerosing Cholangitis Versus Cryptogenic Cirrhosis. Cureus 2022; 14:e23956. [PMID: 35547407 PMCID: PMC9085709 DOI: 10.7759/cureus.23956] [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] [Accepted: 03/30/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The CT findings of cirrhosis caused by primary sclerosing cholangitis (PSC) differ from cryptogenic cirrhosis. PSC could become complicated with biliary cirrhosis and cholangiocarcinoma. This study aimed at augmenting the information on the role of the three-phasic-abdominopelvic CT scan in PSC. MATERIAL AND METHODS A total of 185 CT scans were retrospectively reviewed, including 100 patients with cryptogenic cirrhosis and 85 patients with PSC-cirrhosis. Different morphologic criteria were compared, including segmental atrophy/hypertrophy, hepatic contour, portal-hypertension, perihilar lymphadenopathy, biliary tree dilatation, gallbladder appearance. Inflammatory-bowel-disease (IBD) and cholangiocarcinoma frequency, presence of perihilar lymph nodes (LNs), and their size during end-stage PSC cirrhosis are investigated. RESULTS Six findings occur more frequently with PSC than those diagnosed with cryptogenic cirrhosis. Modified caudate/right lobe (m-CRL) ratio >0.73, moderate and severe lobulated liver contour, lateral left lobe atrophy, over distended gallbladder (GB), biliary tree dilatation and wall thickening, and LN sizes were higher in PSC patients as compared to cryptogenic cirrhosis (P < 0.005). Ascites and portosystemic collateral formations were significant in cryptogenic cirrhosis compared to PSC patients (P < 0.005). Cholangiocarcinoma frequency in PSC patients was 14.7%, and the frequency of inflammatory bowel disease (IBD) was 57.6%. Further, 22.4% of the patients were diagnosed with IBD and PSC simultaneously. The LN number and size in PSC patients were not different between those with or without cholangiocarcinoma. CONCLUSION Using three-phasic CT scans and PSC characteristics could be considered as an additional suggestion besides pathology measures. Diagnosis of PSC based on histological findings could be a last resort due to its invasive essence and specific characteristics of PSC in imaging.
Collapse
Affiliation(s)
- Nazanin Sadraei
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IRN
| | - Hamed Jafari
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IRN
| | - Amin Sadraee
- Department of Urology, Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, IRN
| | | | | | - Aryan Zahergivar
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IRN
| |
Collapse
|
19
|
Wan S, Wei Y, Zhang X, Yang C, Song B. CT-derived quantitative liver volumetric parameters for prediction of severe esophageal varices and the risk of first variceal hemorrhage. Eur J Radiol 2021; 144:109984. [PMID: 34638080 DOI: 10.1016/j.ejrad.2021.109984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess whether CT (computed tomography)-derived quantitative parameters of liver lobe volume can predict severe esophageal varices (EV) and the risk of first varicealhemorrhage (FVH) in patients with liver cirrhosis. METHODS A total of 217 endoscopically confirmed EV patients were included in this retrospective study and were divided into a low-risk EV group (mild-to-moderate EV, n = 83) and a high-risk EV group (severe EV, n = 134), a FVH group (n = 17) and a non-FVH group (n = 27), patients' clinical findings were recorded. The left, right, caudate lobe, total liver volume and the corresponding functional volume were measured respectively, and the ratio of caudate volume/total volume (CV/TV), caudate functional volume/total functional volume (CFV/TFV) were calculated. Univariate and multivariate logistic analysis were used to determine the independent factors and the receiver operating characteristic (ROC) curves were performed to evaluate the diagnostic performance. RESULTS CV, CFV, CV/TV, CFV/TFV were significantly different in the EV severity study and FVH study (p < 0.05). Multivariate analysis indicated that CV/TV and ascites were independent predictive factors for severe EV, a predictive model combing those two factors revealed a satisfactory diagnostic performance (area under the curve (AUC), 0.853, 95 %CI 0.797-0.905). Furthermore, CV/TV and the presence of red color sign under endoscopy were found to be independent predictive factors for FVH, and the former showed a better discriminative performance than the latter (AUC, 0.851 vs 0.779). CONCLUSIONS CT-derived quantitative parameters of CV, CFV, CV/TV, CFV/TFV may be used as an alternative to endoscopy in predicting severe varices and the risk of bleeding.
Collapse
Affiliation(s)
- Shang Wan
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Xin Zhang
- Pharmaceutical Diagnostic Team, GE Healthcare, Life Sciences, Beijing 100176, PR China
| | - Caiwei Yang
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China.
| |
Collapse
|
20
|
Nair AV, Macdonald DB, Kelly EM, Satheesh S, Venugopalan P, Soman DK. Utility of MRCP in surveillance of primary sclerosing cholangitis associated hepatobiliary malignancy: 15 year experience at a single institution in Ontario, Canada. Clin Imaging 2021; 81:47-53. [PMID: 34598005 DOI: 10.1016/j.clinimag.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Magnetic resonance cholangiopancreatography (MRCP) is used for the surveillance of primary sclerosing cholangitis (PSC) and its associated complications. The time interval gap for subsequent follow-up MRCP is variable depending on clinical practice patterns, therefore this study was done to assess the MRCP follow-up strategy used in our institution for screening PSC-associated hepatobiliary malignancies. MATERIALS AND METHODS This retrospective observational cohort included MRCP studies in adult patients, with clinical and radiological diagnosis of PSC over the past 15-year period between January 1, 2003 to December 31, 2018. The study population was grouped based on the presence and absence of PSC-associated malignancy. The frequency of MRCP follow-up was compared between the groups to look for MRI ordering trends in surveillance for PSC-associated complications. RESULTS The overall median interval follow-up with MRCP was 14 months. The median follow-up interval in cases with PSC-associated malignancy was 6.0 months, compared to 13.1 months in the PSC group without malignancy (p 0.013). During the study period, the PSC-associated malignancy group had a median number of 7.5 scans, while the no malignancy group had a median number of 4 scans. Three patients (3/10, 30%) developed hepatobiliary malignancies within the first year of clinical diagnosis of PSC. The most common malignancy associated with PSC was cholangiocarcinoma (4.6%,7/10). Other PSC-associated malignancies included carcinoma gallbladder (1.3%,2/10), and hepatocellular carcinoma (0.6%,1/10). The median age of PSC associated malignancies was 56 (IQR 15) and higher compared to median age of PSC group without malignancies 46 (IQR 25.5), p 0.035. CONCLUSION The median interval for subsequent follow-up MRCP in our study cohort was 14 months. One-third of PSC-associated hepato-biliary malignancies developed within the first year of clinical diagnosis of PSC, and the risk of PSC-associated hepato-biliary malignancy is constant after the first year.
Collapse
Affiliation(s)
| | - D Blair Macdonald
- Dept of Medical Imaging, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Erin M Kelly
- Dept of Gastro-enterology, The Ottawa Hospital, University of Ottawa, Canada
| | - Soumya Satheesh
- Dept of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Prasanna Venugopalan
- Dept of Obstetrics and Gynaecology, Travancore Medical College, Kollam, Kerala, India
| | | |
Collapse
|
21
|
The impact of MRI findings in the liver in the diagnosis of pediatric Wilson’s disease. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.951931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis. Eur J Radiol 2021; 142:109884. [PMID: 34380098 DOI: 10.1016/j.ejrad.2021.109884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE ANALI-scores are two prognostic magnetic resonance imaging (MRI)-based scores developed for patients with primary sclerosing cholangitis (PSC). Our study aims to assess the interreader agreement between expert radiologists of the two ANALI-scores and of the radiological parameters they utilize, and to test the prognostic performance of the scores in our population. METHOD Three radiologists evaluated MRIs of 98 PSC-patients from a prospectively collected cohort with median follow-up of 6.7 years. Each parameter of ANALI-scores was assessed, and the scores were calculated. Interreader agreement was assessed with intraclass correlation coefficient (ICC). After consensus reading was reached, the prognostic value of ANALI-scores was assessed with Cox regression, and outcome-free survival rates were evaluated with Kaplan-Meier estimates. RESULTS The ANALI-score without gadolinium had poor to moderate (ICC = 0.56, 95 %CI: 0.42-0.68) and with gadolinium poor (ICC = 0.30, 95 %CI: 0.16-0.44) agreement. Liver deformity (ICC = 0.28, 95 %CI: 0.13-0.44) and parenchymal enhancement heterogeneity (ICC = 0.24, 95 %CI: 0.12-0.38) had poor agreement. Portal hypertension had poor to moderate (ICC = 0.48, 95 %CI: 0.36-0.59) and dilatation of the intrahepatic ducts had moderate (ICC = 0.64, 95 %CI: 0.54-0.73) agreement. Hazard ratios for liver-related death, transplantation or cirrhosis decompensation of the ANALI-scores with and without gadolinium were 3.53 (95 %CI: 1.40-8.93) and 2.25 (95 %CI: 1.56-3.24), respectively. Outcome-free survival was better for patients with low ANALI-scores. CONCLUSIONS The ANALI-scores show poor to moderate agreement, which challenges their usefulness in clinical practice. They are associated with clinical outcomes, confirming the value of imaging in prognosis of PSC, but need further multicenter evaluation.
Collapse
|
23
|
Liver segmental volume and attenuation ratio (LSVAR) on portal venous CT scans improves the detection of clinically significant liver fibrosis compared to liver segmental volume ratio (LSVR). Abdom Radiol (NY) 2021; 46:1912-1921. [PMID: 33156949 PMCID: PMC8131336 DOI: 10.1007/s00261-020-02834-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/21/2020] [Accepted: 10/17/2020] [Indexed: 12/14/2022]
Abstract
Background The aim of this proof-of-concept study was to show that the liver segmental volume and attenuation ratio (LSVAR) improves the detection of significant liver fibrosis on portal venous CT scans by adding the liver vein to cava attenuation (LVCA) to the liver segmental volume ratio (LSVR). Material and methods Patients who underwent portal venous phase abdominal CT scans and MR elastography (reference standard) within 3 months between 02/2016 and 05/2017 were included. The LSVAR was calculated on portal venous CT scans as LSVR*LVCA, while the LSVR represented the volume ratio between Couinaud segments I-III and IV-VIII, and the LVCA represented the density of the liver veins compared to the density in the vena cava. The LSVAR and LSVR were compared between patients with and without significantly elevated liver stiffness (based on a cutoff value of 3.5 kPa) using the Mann–Whitney U test and ROC curve analysis. Results The LSVR and LSVAR allowed significant differentiation between patients with (n = 19) and without (n = 122) significantly elevated liver stiffness (p < 0.001). However, the LSVAR showed a higher area under the curve (AUC = 0.96) than the LSVR (AUC = 0.74). The optimal cutoff value was 0.34 for the LSVR, which detected clinically increased liver stiffness with a sensitivity of 53% and a specificity of 88%. With a cutoff value of 0.67 for the LSVAR, the sensitivity increased to 95% while maintaining a specificity of 89%. Conclusion The LSVAR improves the detection of significant liver fibrosis on portal venous CT scans compared to the LSVR.
Collapse
|
24
|
Porto-sinusoidal vascular disease with portal hypertension versus liver cirrhosis: differences in imaging features on CT and hepatobiliary contrast-enhanced MRI. Abdom Radiol (NY) 2021; 46:1891-1903. [PMID: 33095310 DOI: 10.1007/s00261-020-02831-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To differentiate the computed tomography (CT) and magnetic resonance imaging (MRI) features of porto-sinusoidal vascular disease (PSVD) and liver cirrhosis (LC). METHODS In this retrospective case-control study of patients with PSVD matched in a 1:3 ratio with LC patients according to liver function, initial diagnosis and time to final diagnosis were analyzed. Imaging features on CT and the parenchymal enhancement on hepatobiliary phase of hepatobiliary agent-enhanced MRI (HBA-MRI) were compared using a generalized linear mixed model. Focal hepatic lesions in the PSVD group were analyzed. RESULTS In total, 43 PSVD patients and 129 LC patients were included. Among PSVD patients, 72.1% were initially misdiagnosed with LC. PSVD patients had a longer diagnostic delay than LC patients (32 months vs. 4 months; p < 0.001). Liver surface nodularity was less common in the PSVD group than in the LC group (16.3% vs. 89.2%, p < 0.001). Increased caudate-to-right lobe ratio, heterogeneous parenchymal enhancement, and portal vein abnormalities were more frequently noted in the PSVD group than in the LC group (all p < 0.001). The grade of portal hypertension was significantly higher in the PSVD group than in the LC group (p < 0.001), and they also had brighter parenchymal enhancement during the hepatobiliary phase of HBA-MRI (p < 0.001). In the PSVD group, 14% patients had at least one focal hepatic lesion, primarily a focal nodular hyperplasia (FNH)-like nodule. CONCLUSIONS Some imaging features on CT and HBA-MRI can distinguish PSVD from LC. Benign focal lesions, most commonly FNH-like nodules, can develop in PSVD.
Collapse
|
25
|
Abstract
Early diagnosis of hepatic fibrosis (HF) is pivotal for management to cease progression to cirrhosis and hepatocellular carcinoma. HF is the telltale sign of chronic liver disease, and confirmed by liver biopsy, which is an invasive technique and inclined to sampling errors. The morphologic parameters of cirrhosis are assessed on conventional imaging such as on ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Newer imaging modalities such as magnetic resonance elastography and US elastography are reliable and accurate. More research studies on novel imaging modalities such as MRI with diffusion weighted imaging, enhancement by hepatobiliary contrast agents, and CT using perfusion are essential for earlier diagnosis, surveillance and accurate management. The purpose of this article is to discuss non-invasive CT, MRI, and US imaging modalities for diagnosis and stratify HF.
Collapse
Affiliation(s)
- Mayur Virarkar
- Department of Neuroradiology, The University of Texas Health Science Center, Houston, TX.
| | - Ajaykumar C Morani
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa W Taggart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
26
|
Imaging Biomarkers of Hepatic Fibrosis: Reliability and Accuracy of Hepatic Periportal Space Widening and Other Morphologic Features on MRI. AJR Am J Roentgenol 2021; 216:1229-1239. [PMID: 33729883 DOI: 10.2214/ajr.20.23099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. The purpose of this article was to assess the reliability and accuracy of hepatic periportal space widening and other qualitative imaging features for the prediction of hepatic fibrosis. MATERIALS AND METHODS. This single-center retrospective study identified consecutive patients who had undergone liver MR elastography. Two abdominal radiologists independently reviewed anatomic images, assessing multiple qualitative features of chronic liver disease (CLD) including periportal space widening. Each reader also measured the periportal space at the main portal vein (MPV) and right portal vein (RPV). Interrater reliability analysis was then performed. Sensitivity and specificity were determined for the detection of any hepatic fibrosis (stage I or higher) and of advanced fibrosis (stage III or higher) using stiffness on MR elastography as the reference standard. RESULTS. Of 229 subjects, 157 (69%) had fibrosis and 78 (34%) had advanced fibrosis. Agreement for periportal space widening was moderate (κ = 0.47), and agreement for remaining features was moderate to substantial (κ = 0.42-0.80). Agreement for the periportal space at the MPV was moderate (ICC, 0.55), and agreement for the periportal space at the RPV was near perfect (ICC, 0.83). Periportal space widening had the highest sensitivity (83.0%) for any fibrosis, with limited specificity (61.3%). Surface nodularity had the highest specificity (94.4%) for any fibrosis, with limited sensitivity (51.6%). Periportal space widening plus one or more additional imaging feature of CLD or the presence of surface nodularity alone had sensitivity of 72.6% and specificity of 76.1%. A periportal space at the MPV greater than 9.5 mm had substantial agreement with qualitative periportal space widening (κ = 0.74). CONCLUSION. Periportal space widening has a high sensitivity for hepatic fibrosis, with moderate specificity when combined with additional anatomic features of CLD.
Collapse
|
27
|
Cannella R, Dasyam N, Seo SH, Furlan A, Borhani AA. Performance of morphologic criteria for the diagnosis of cirrhosis in patients with non-alcoholic steatohepatitis compared to other etiologies of chronic liver disease: effect of level of training and experience. Abdom Radiol (NY) 2021; 46:960-968. [PMID: 32902660 DOI: 10.1007/s00261-020-02719-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the diagnostic performance of morphologic criteria for detection of cirrhosis in patients with alcoholic liver disease (ALD), hepatitis C (HCV), and non-alcoholic steatohepatitis (NASH). METHODS One hundred patients (53 male) with different etiologies of chronic liver disease (NASH, n = 41; HCV, n = 39; and ALD, n = 20) and with different degrees of fibrosis on histopathologic examination (74 with cirrhosis) were retrospectively evaluated. Four readers (R1: fellowship-trained abdominal radiologist, R2: community attending radiologist, R3: senior radiology resident/research fellow, R4: junior radiology resident) analyzed the contrast-enhanced CTs for presence of commonly accepted morphologic changes of cirrhosis and portal hypertension. Each reader assigned an overall score (using a 5-point scale) for possibility of cirrhosis based on liver morphology and features of portal hypertension. Diagnostic performance, sensitivity, and specificity for the diagnosis of cirrhosis were calculated and compared between different etiologies of chronic liver disease. RESULTS Performance of readers was affected by their level of training. Less experienced readers had overall lower sensitivity for diagnosis of cirrhosis in NASH group (R3: 81.5%, R4: 63.0% compared to 96.3% for both R1 and R2). Sensitivities for detection of NASH cirrhosis significantly decreased for less experienced readers in the absence of ascites (R3: 75.0%, R4: 62.0%) or other features of portal hypertension (R3: 50.0%; R4: 0%). The specificity was consistently high among different etiologies and for all readers (85.7-100%). Inter-reader agreement for morphologic features ranged widely from fair to almost perfect (k: 0.23-0.85). CONCLUSION Cirrhotic changes in NASH are subtler and can be underestimated by less experienced readers.
Collapse
Affiliation(s)
- Roberto Cannella
- Department of Radiology - Division of Abdominal Imaging, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy.
| | - Navya Dasyam
- Department of Radiology - Division of Abdominal Imaging, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Su-Hun Seo
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- Department of Radiology - Division of Abdominal Imaging, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Amir A Borhani
- Department of Radiology - Division of Abdominal Imaging, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Department of Radiology, Division of Abdominal Imaging, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St., Chicago, IL, 60611, USA
| |
Collapse
|
28
|
Using qualitative descriptors of chronic liver disease on MRI: A practice prone to error. Clin Imaging 2021; 74:89-92. [PMID: 33461018 DOI: 10.1016/j.clinimag.2020.12.023] [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: 09/02/2020] [Revised: 11/18/2020] [Accepted: 12/26/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Assess accuracy of qualitative descriptors for chronic liver disease (CLD) in radiology reports compared to histopathological staging. METHODS Database search for patients with hepatitis B/C (HBV/HCV) CLD, abdominal MRI during 2009-2016, and liver biopsy within 6 months of MRI or prior biopsy showing cirrhosis. Reports reviewed for mention of CLD and associated descriptors. Findings stratified into categories: normal/no mention of CLD; changes of CLD without qualitative descriptor; mild/early; moderate; severe/advanced and cirrhosis. Descriptive ranges categorized to the lesser degree. Percent concordance/discordance of descriptors and Scheuer stage (F0-F4), false positive (FP), false negative (FN) and sensitivity/specificity calculated. RESULTS 309 patients, median age 54 (24-74). 91% had HCV (282/309), 7% HBV and 2% both HBV/HCV. Biopsy showed 19% without CLD/F0; 8% F1, 15% F2, 15% F3 and 43% F4. 188 MRI reports (61%) stated CLD was present; however, 16 had no fibrosis on histopathology (9% FP). 39% (121/309) did not mention or stated no CLD; however, 78 had CLD on histopathology (64% FN). 59% of FN were early fibrosis (F1 or F2), 27% F3 and 11% F4. Overall sensitivity and specificity was 69% and 73%, respectively. 77% (145/188) of MRI reports used a descriptive qualifier when describing CLD. 10% were concordant with exact histopathology staging. Of discordant reports, 90% identified CLD but under-called severity. CONCLUSION Abdominal radiologists can detect CLD on MRI but degree of CLD is often under-called compared to histopathology suggesting radiologists should refrain from qualitative descriptors in assessing CLD on MRI and reaffirms the need for quantitative imaging.
Collapse
|
29
|
Yamamoto A, Ito K, Yasokawa K, Kanki A, Tanimoto D, Hayashida M, Tamada T. Morphologic changes in hepatitis virus-related liver cirrhosis: Relationship to hemodynamics of portal vein on dynamic contrast-enhanced CT. Radiography (Lond) 2020; 27:598-604. [PMID: 33358531 DOI: 10.1016/j.radi.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The morphologic changes in the compensated stage of liver cirrhosis (cLC) are not diffuse atrophic changes. With cLC lobar or segmental changes combined with atrophy of the right lobe and medial segment together with hypertrophy of the caudate lobe and lateral segment are commonly seen. The purpose of this study was to evaluate the morphologic changes in hepatitis virus-related liver cirrhosis in relationship to haemodynamics of the portal vein on dynamic contrast-enhanced computed tomography (DCE-CT) METHODS: This study included 72 patients, 46 with hepatitis virus-related cirrhosis and 26 with a normally functioning liver, who underwent DCE-CT. In cirrhosis patients, the morphologic change index (MCI) of the liver was calculated and categorised into two groups, high-MCI (MCI ≥ 0.4) (n = 21) and low-MCI (MCI < 0.4) (n = 25). Cross-sectional areas of the main, right and left portal veins and the intra-portal distribution from splenic venous flow were evaluated for their relationships with the MCI and compared among three groups (normal-control, low MCI and high MCI). RESULTS There was a significant difference in the cross-sectional area of the left portal vein between the high-MCI group and the low-MCI group (p = 0.013) and the control group (p = 0.008). A significant correlation was identified between the cross-sectional area of the left portal vein and the MCI (r = 0.508, p < 0.001). CONCLUSION Cross-sectional area of the left portal vein may be a factor related to morphologic changes in hepatitis virus-related liver cirrhosis and could be a possible index of the left portal venous flow volume. IMPLICATIONS FOR PRACTICE This study may be useful for predicting the degree of hepatic morphologic changes and the condition of cirrhosis in association with regional hepatic morphologic changes.
Collapse
Affiliation(s)
- A Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan.
| | - K Ito
- Department of Radiology, Yamaguchi University, Japan
| | - K Yasokawa
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - A Kanki
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - D Tanimoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - M Hayashida
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - T Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| |
Collapse
|
30
|
Non-invasive diagnosis of severe alcoholic hepatitis: Usefulness of cross-sectional imaging. Diagn Interv Imaging 2020; 102:247-254. [PMID: 33069642 DOI: 10.1016/j.diii.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the computed tomography (CT) and magnetic resonance imaging (MRI) features of severe acute alcoholic hepatitis (SAAH) and estimate the capabilities of CT and MRI in differentiating SAAH from alcoholic cirrhosis and non-alcoholic steato-hepatitis (NASH) cirrhosis. MATERIALS AND METHODS Fifty patients with pathologically proven SAAH (SAAH group) who underwent CT or MRI examinations up to 30 days before or 15 days after liver biopsy between January 2008 and June 2018 were retrospectively included. There were 31 men and 29 women with a mean age of 52±9 (SD) years (range: 33-67 years). Imaging features of the SAAH group were compared to those obtained in two control groups including 62 patients with alcoholic cirrhosis without acute alcoholic hepatitis (control group 1) and 19 patients with NASH cirrhosis (control group 2) by two independent radiologists blinded to the final diagnosis. Univariate analyses were performed to compare imaging characteristics between the three groups, followed by diagnostic performance analysis for the diagnosis of SAAH of the main CT features. RESULTS Heterogeneous steatosis was significantly more frequent in SAAH group than in the control groups (41/50; 82% vs. 7/62; 10% and 1/19; 5% in control groups 1 and 2, respectively for reader 1 and 34/50; 68% vs. 8/62; 13% and 1/19; 5% in control groups 1 and 2, respectively for reader 2; both P=0.01). Transient perfusion disorders were more frequent in SAAH group than in the control groups (35/50; 70% vs. 12/62; 21% and 5/19; 26% in control groups 1 and 2, respectively for reader 1 and 39/50; 78% vs. 14/62; 23% and 13/19; 6% in control groups 1 and 2, respectively for reader 2; both P=0.01). The combination of these two findings yielded 100% specificity (45/45; 95% CI: 92-100) for readers 1 and 2 for the diagnosis of SAAH vs. alcoholic cirrhosis and NASH cirrhosis. CONCLUSION The imaging features of SAAH are specific and mainly associate transient heterogeneous steatosis and liver perfusion disorders. CT/MRI may be useful to differentiate SAAH from alcoholic cirrhosis and NASH cirrhosis.
Collapse
|
31
|
Abstract
There are many different imaging features of cirrhosis, some of which are less commonly recognized. It is important that the radiologist is familiar with these features as cirrhosis can be first discovered on imaging performed for other indications, thus alerting the clinician for the need to screen for complications of cirrhosis and referral for potential treatment. This article reviews the various imaging findings of cirrhosis seen on cross-sectional imaging of the abdomen and pelvis.
Collapse
|
32
|
Kozaka K, Sheedy SP, Eaton JE, Venkatesh SK, Heiken JP. Magnetic resonance imaging features of small-duct primary sclerosing cholangitis. Abdom Radiol (NY) 2020; 45:2388-2399. [PMID: 32417935 DOI: 10.1007/s00261-020-02572-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the biliary tree and hepatic parenchymal findings on magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) in small-duct primary sclerosing cholangitis (SD-PSC). METHODS Thirty-nine patients with biopsy-proven primary sclerosing cholangitis (PSC) without any bile duct abnormality on MRCP (n = 15) or ERCP (n = 24) at the time of diagnosis were identified. Follow-up MRCP was available in 36/39 patients (12/15 Baseline MRCP group and 24 Baseline ERCP group). Two radiologists in consensus assessed the MRI/MRCP findings. The baseline MRI/MRCP of 15 SD-PSC patients was compared with MRI/MRCP of 15 normal healthy potential liver donors (Control group). Comparisons were made between SD-PSC patients and the Control group, and between baseline and follow-up MRI/MRCP findings in the SD-PSC patients. RESULTS In the 15 Baseline MRCP SD-PSC subjects, the biliary tree was normal with a trend of larger bile ducts compared to the Control group. Periductal enhancement (arterial phase: 70%, 7/10; delayed phase: 90%, 9/10), heterogeneous parenchymal signal on T2-weighted (53%, 8/15) and post contrast-enhanced images (70%, 7/10), and enlarged periportal lymph nodes (73%, 11/15) were frequently present in patients with SD-PSC. Eight (33%) of 24 SD-PSC patients who had normal MRCP at baseline MRCP or initial follow-up MRCP after normal baseline ERCP showed large-duct PSC (LD-PSC) features on follow-up and the 10-year cumulative incidence for progression to LD-PSC rate was 8.5%. CONCLUSION SD-PSC patients have a normal biliary tree but frequently have peribiliary enhancement, abnormal parenchymal signal intensity, and periportal lymphadenopathy. One-third shows progression to LD-PSC on follow-up.
Collapse
Affiliation(s)
- Kazuto Kozaka
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Shannon P Sheedy
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA
| | - John E Eaton
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA
| | - Jay P Heiken
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
33
|
Hwang HE, Chiu NC, Liu CA, Chou YH, Lee RC. Specific liver volume parameters in cirrhotic patients with peribiliary cysts. J Chin Med Assoc 2020; 83:571-576. [PMID: 32132381 DOI: 10.1097/jcma.0000000000000284] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The presence of peribiliary cysts and morphological changes in the volumes of lobes in the livers of patients with cirrhosis are both related to the alteration of portal flow. Our study explored the relationship between these two features in patients with cirrhosis. METHODS We retrospectively selected 150 computed tomography (CT) images of cirrhotic livers and 105 CT images of healthy livers. The cirrhotic livers were further classified according to the presence of peribiliary cysts (peribiliary cysts group) or the absence of peribiliary cysts (control cirrhotic group). The characteristic features of liver cirrhosis, including modified caudate-right lobe ratio (mCR ratio), splenomegaly, ascites, and collateral shunts, were reviewed. Liver volume calculations included the sum of the left hepatic volume (LHV) and right hepatic volume (RHV; LHV + RHV) and the ratio of LHV to RHV (LHV/RHV). RESULTS The two groups did not differ in the presence of splenomegaly, ascites, or collateral shunts. The control cirrhotic group exhibited a significantly higher mCR ratio and LHV/RHV ratio than the peribiliary cysts group did (p < 0.001). The healthy liver group exhibited a significantly higher LHV + RHV value than either the peribiliary cysts group or the control cirrhotic group did (p < 0.001). The peribiliary cysts group and the control cirrhotic group did not differ significantly for LHV + RHV (p > 0.05). CONCLUSION The control cirrhotic group exhibited a significantly higher mCR ratio and LHV/RHV ratio than the peribiliary cysts group did, but the two groups were similar for most measurements. Peribiliary cysts might result in reduction of portal flow, causing cirrhotic liver with peribiliary cysts with left-sided dominance not to demonstrate the typical morphological appearance of the common cirrhotic liver.
Collapse
Affiliation(s)
- Hsuen-En Hwang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Nai-Chi Chiu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| |
Collapse
|
34
|
Ozaki K, Kozaka K, Kosaka Y, Kimura H, Gabata T. Morphometric changes and imaging findings of diffuse liver disease in relation to intrahepatic hemodynamics. Jpn J Radiol 2020; 38:833-852. [PMID: 32347423 DOI: 10.1007/s11604-020-00978-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/13/2020] [Indexed: 01/20/2023]
Abstract
Diffuse hepatic diseases have a variety of etiologies, with each showing characteristic morphometric changes. These changes are closely related to micro- and macro-level intrahepatic hemodynamics, in addition to the specific underlying pathophysiology. Short-term disorders in intrahepatic hemodynamics caused by each pathophysiological condition are compensated for by the balance of blood perfusion systems using potential trans-sinusoidal, transversal, and transplexal routes of communication (micro-hemodynamics), while long-term alterations to the intrahepatic hemodynamics result in an increase in total hepatic vascular resistance. Blood flow disorders induced by this increased vascular resistance elicit hepatic cellular necrosis and fibrosis. These changes should be uniformly widespread throughout the whole liver. However, morphometric changes do not occur uniformly, with shrinkage or enlargement not occurring homogeneously. Against this background, several macro-intrahepatic hemodynamic effects arise, such as asymmetrical and complicating morphometric structures of the liver, intricate anatomy of portal venous flow and hepatic venous drainage, and zonal differentiation between central and peripheral zones. These hemodynamic factors and pathophysiological changes are related to characteristic morphometric changes in a complicated manner, based on the combination of selective atrophy and compensatory hypertrophy (atrophy-hypertrophy complex). These changes can be clearly depicted on CT and MR imaging.
Collapse
Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yasuo Kosaka
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| |
Collapse
|
35
|
Mihai F, Trifan A, Stanciu C, Singeap AM, Cucuteanu B, Lupascu Ursulescu C, Pop C, Girleanu I, Cuciureanu T, Negru D, Cojocariu C. Liver Remodeling on CT Examination in Patients with HCV Compensated Cirrhosis Who Achieved Sustained Virological Response after Direct-Acting Antivirals Treatment. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:medicina56040171. [PMID: 32290305 PMCID: PMC7231305 DOI: 10.3390/medicina56040171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 02/05/2023]
Abstract
Aims: The purpose of this study was to assess the changes in hepatic morphology evaluated by computed tomography (CT) examination in patients with hepatitis C virus (HCV)-related compensated cirrhosis who achieved sustained virologic response (SVR) after direct-acting antivirals (DAAs) treatment. Methods: CT examination was performed in 56 patients with HCV-related compensated cirrhosis before and within 6-18 months after the treatment with Ombitasvir/Paritaprevir/ritonavir + Dasabuvir. The liver CT changes were assessed by measuring liver volume, caudate-right lobe ratio (C/RL), hepatic vessels diameters, periportal widening space, and right posterior notch. Portal trunk, splenic and superior mesenteric vein diameters, as well as spleen volume were assessed as part of portal hypertension. Results: Right hepatic vein diameter was significantly wider after treatment (median: 8.12 mm; IQR: 4.20) than before treatment (median: 6.36 mm; IQR: 3.94) z = -3.894; p < 0.001. The liver volume was significantly higher prior to the treatment (median: 1786.77 mm3; IQR: 879.23) than after treatment (median: 1716.44 mm3; IQR: 840.50), z = -1.970; p = 0.049. Splenic volume was considerably higher before treatment (median: 564.79 mm3; IQR: 342.54) than after (median: 474.45 mm3; IQR: 330.00), z = -2.500; p = 0.012. The other parameters, such as C/RL, periportal space widening, and right hepatic notch showed no significant changes. Conclusions: SVR in patients with HCV-related compensated cirrhosis treated with DAAs is associated with some improvements of hepatic morphology detectable by CT, the most constant being the increase of right hepatic vein diameter.
Collapse
Affiliation(s)
- Florin Mihai
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Department of Radiology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Anca Trifan
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
- Correspondence: (A.T.); (A.M.S.)
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Ana Maria Singeap
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
- Correspondence: (A.T.); (A.M.S.)
| | - Bogdan Cucuteanu
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Department of Radiology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Corina Lupascu Ursulescu
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Department of Radiology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Corina Pop
- Gastroenterology Department, Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Irina Girleanu
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| | - Tudor Cuciureanu
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
| | - Dragos Negru
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Department of Radiology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania
| | - Camelia Cojocariu
- “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.M.); (B.C.); (C.L.U.); (I.G.); (T.C.); (D.N.); (C.C.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, 700111 Iasi, Romania;
| |
Collapse
|
36
|
Cannella R, Minervini MI, Rachakonda V, Bollino G, Furlan A. Liver stiffness measurement in patients with nodular regenerative hyperplasia undergoing magnetic resonance elastography. Abdom Radiol (NY) 2020; 45:373-383. [PMID: 31834457 DOI: 10.1007/s00261-019-02367-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Nodular regenerative hyperplasia (NRH) may mimic cirrhosis at imaging. We aim to investigate the effect of NRH on liver stiffness measurement (LSM) obtained with magnetic resonance elastography (MRE). METHODS This retrospective, Institutional Review Board-approved study included 37 subjects with NRH (Group 1) and no or minimal fibrosis (F0-F1), a control group (Group 2) made of 30 subjects with non-advanced fibrosis (F0-F2), and a control group (Group 3) made of 30 subjects with advanced fibrosis (F3-F4), all with available MRE. LSM was measured in each subject along with assessment of hepatic morphological features of cirrhosis and signs of portal hypertension. The significance of the difference in mean LSM between Group 1 and 2 and between Group 1 and 3 was evaluated using the Mann-Whitney U test. The difference in distribution of imaging features among groups was assessed using the Pearson χ2 or Fisher exact test. RESULTS The mean ± SD LSM in Group 1 (3.56 ± 1.10 kPa) was significantly higher compared to Group 2 (2.91 ± 0.52 kPa, P = 0.019) and significantly lower compared to Group 3 (7.18 ± 2.08 kPa, P < 0.001). Twelve (32%) patients with NRH had LSM ≥ 4.11 kPa, and 6 (16%) patients had LSM ≥ 4.71 kPa. Surface nodularity (P = 0.032) and caudate lobe hypertrophy (P = 0.004) were more commonly visualized in Group 1 than in Group 2. At least one feature of portal hypertension was observed in 16 (43%) NRH subjects. CONCLUSION NRH may increase the LSM obtained with MRE and may represent a confounding factor when using liver stiffness for the non-invasive diagnosis of fibrosis.
Collapse
Affiliation(s)
- Roberto Cannella
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Marta I Minervini
- Division of Transplantation Pathology UPMC Montefiore, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vikrant Rachakonda
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gideon Bollino
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- Abdominal Imaging Division, Department of Radiology, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
37
|
Chen F, Chen YL, Chen TW, Li R, Pu Y, Zhang XM, Li HJ, Tang S, Cao JM, Yang JQ. Liver lobe based intravoxel incoherent motion diffusion weighted imaging in hepatitis B related cirrhosis: Association with child-pugh class and esophageal and gastric fundic varices. Medicine (Baltimore) 2020; 99:e18671. [PMID: 31914057 PMCID: PMC6959964 DOI: 10.1097/md.0000000000018671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Liver cirrhosis is a common chronic progressive liver disease in clinical practice, and intravoxel incoherent motion (IVIM) is a promising magnetic resonance method to assess liver cirrhosis, so our purpose was to investigate association of liver-lobe-based IVIM-derived parameters with hepatitis-B-related cirrhosis and its severity, and esophageal and gastric fundic varices. Seventy-four patients with hepatitis-B-related cirrhotic and 25 healthy volunteers were enrolled and underwent upper abdominal IVIM diffusion-weighted imaging with b-values of 0, 20, 50, 80, 100, 200, 400, 600, and 800 s/mm. IVIM-derived parameters (D, pure molecular diffusion; D, pseudo diffusion; and f, perfusion fraction) of left lateral lobe (LLL), left medial lobe (LML), right lobe (RL), and caudate lobe (CL) were assessed statistically to show their associations with cirrhosis and its severity, and esophageal and gastric fundic varices. In this research, we found that D, D, and f values of LLL, LML, RL, and CL were lower in cirrhotic liver than in normal liver (all P-values <.05). D, D, and f values of LLL, LML, RL, and CL were inversely correlated with Child-Pugh class of cirrhosis (r = -0.236 to -0.606, all P-values <.05). D of each liver lobe, D of LLL and CL, and f of LLL, LML, and CL in patients with esophageal and gastric fundic varices were lower than without the varices (all P-values <.05). D values of RL and CL could best identify cirrhosis, and identify esophageal and gastric fundic varices with areas under receiver-operating characteristic curve of 0.857 and 0.746, respectively. We concluded that liver-lobe-based IVIM-derived parameters can be associated with cirrhosis, and esophageal and gastric fundic varices.
Collapse
Affiliation(s)
- Fan Chen
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Yan-li Chen
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing
| | - Tian-wu Chen
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Rui Li
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Yu Pu
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Xiao-ming Zhang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Hong-jun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Sun Tang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Jin-ming Cao
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| | - Jian-qiong Yang
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
| |
Collapse
|
38
|
Ghonge NP, Sahu A. 'Hepato-diaphragmatic fat interposition' and 'increased right hemi-diaphragmatic thickness': new imaging signs for early diagnosis of hepatic cirrhosis on routine CT abdomen. Abdom Radiol (NY) 2020; 45:153-160. [PMID: 31542819 DOI: 10.1007/s00261-019-02230-w] [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: 11/25/2022]
Abstract
BACKGROUND Cirrhosis of liver is often a silent disease and need early diagnosis for effective treatment strategy. OBJECTIVES The present article aims to describe new imaging signs for early diagnosis of cirrhosis on routine CT. These are 'hepato-diaphragmatic fat interposition' (HDFI) and 'increased right hemi-diaphragmatic thickness' (increased r-DT sign). MATERIALS AND METHODS This was a retrospective study based on the presence or absence of cirrhosis of liver (n = 100). 'HDFI sign' was labeled as positive if F is more than 50% of D; where F is the medio-lateral extent of the intra-abdominal fat along the postero-medial margin of liver and D is the distance from the lateral vertebral margin to the medial margin of the outer-most rib in the same axial image. Increased 'r-DT sign' is labeled when the dimension on right side exceeds left side by at least 0.2 cm. Pearson χ2 was performed to calculate the p value. A p value of < 0.05 was considered to indicate a significant difference. RESULTS There was a significant difference between cirrhotic and normal group, The sensitivity, specificity, positive predictive value and the negative predictive value of HDFI sign was found to be 94%, 62%, 71.21% and 91.17%, while that of increased r-DT sign was found to be 96%,52%, 66.66% and 92.85%. The area under the ROC curve for the HDFI sign was found to be 0.78 as compared to 0.74 for the increased r-DT sign. CONCLUSION Both these new signs should be used as additional imaging signs for early diagnosis of cirrhosis.
Collapse
Affiliation(s)
| | - Amit Sahu
- Max Superspeciality Hospital, Saket, New Delhi, India
| |
Collapse
|
39
|
Assessment of the Hallmarks of Wilson Disease in CT Scan Imaging. J Med Imaging Radiat Sci 2019; 51:145-153. [PMID: 31884064 DOI: 10.1016/j.jmir.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Owing to nonspecific clinical symptoms, Wilson disease (WD) diagnosis is often missed or delayed; hence, many patients reach end-stage liver disease. When cirrhosis takes place, it is difficult to distinguish between WD and other causes of cirrhosis by imaging alone. This study outlines abdominal computed tomography (CT) imaging findings that occur more frequently in patients with WD cirrhosis. MATERIAL AND METHODS Fifty-seven patients with WD who had referred for liver transplantation took part in this study and underwent dynamic liver CT examination before transplantation. Qualitative and quantitative parameters including liver density, contour irregularity, dysmorphia, hypertrophy of caudate lobe, presence of focal parenchymal lesion, thickness of perihepatic fat layer, periportal thickness, lymphadenopathy, and other associated findings were recorded and evaluated. RESULTS Among these patients, 85.9% had contour irregularity, 28% had hepatic dysmorphia, and periportal thickening and cholelithiasis were found in 25.5% and 12.3% of patients, respectively. Splenomegaly, lymphadenopathy, and portosystemic shunting were observed in all patients. Also, hyperdense nodules (>20 mm) and honeycomb pattern were detected in 65.2% and 15.2% of patients, respectively, in the arterial phase. In the portal phase, these findings were detected only in 13% and 4.3% of patients. Hypertrophy of caudate lobe was seen only in 12.2% of patients. CONCLUSION WD-associated cirrhosis has many CT imaging findings, although most of them are nonspecific. Some findings, such as hyperdense nodules and honeycomb pattern in non-contrast-enhanced CT scan and arterial phase of triphasic CT scan with lack of hypertrophy of caudate lobes, are hallmarks of WD.
Collapse
|
40
|
The Complementary Value of Magnetic Resonance Imaging and Vibration-Controlled Transient Elastography for Risk Stratification in Primary Sclerosing Cholangitis. Am J Gastroenterol 2019; 114:1878-1885. [PMID: 31738286 DOI: 10.14309/ajg.0000000000000461] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Magnetic resonance (MR) risk scores and liver stiffness (LS) have individually been shown to predict clinical outcomes in primary sclerosing cholangitis (PSC). The aim of this study was to assess their complementary prognostic value. METHODS Patients with PSC from 3 European centers with a 3-dimensional MR cholangiography available for central reviewing and a valid LS measurement assessed by vibration-controlled transient elastography by FibroScan performed within a 6-month interval were included in a longitudinal retrospective study. The MR score (Anali) without gadolinium (Gd) was calculated according to the formula: (1 × dilatation of intrahepatic bile ducts) + (2 × dysmorphy) + (1 × portal hypertension). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic values of LS and Anali score without Gd were assessed using Cox proportional hazard models. RESULTS One hundred sixty-two patients were included. Over a total follow-up of 753 patient-years, 40 patients experienced an adverse outcome (4 liver transplantations, 6 liver-related deaths, and 30 cirrhosis decompensations). LS and Anali score without Gd were significantly correlated (ρ = 0.51, P < 0.001) and were independently associated with the occurrence of an adverse outcome. Optimal prognostic thresholds were 10.5 kPa for LS and 2 for the Anali score without Gd. Hazard ratios (95% confidence interval) were 2.07 (1.06-4.06) and 3.78 (1.67-8.59), respectively. The use in combination of these 2 thresholds allowed us to separate patients into low-, medium-, and high-risk groups for developing adverse outcomes. The 5-year cumulative rates of adverse outcome in these 3 groups were 8%, 16%, and 38% (P < 0.001), respectively. DISCUSSION The combined use of MRI and vibration-controlled transient elastography permits easy risk stratification of patients with PSC.
Collapse
|
41
|
Al-Sharhan F, Dohan A, Barat M, Feddal A, Terris B, Pol S, Mallet V, Soyer P. MRI presentation of hepatocellular carcinoma in non-alcoholic steatohepatitis (NASH). Eur J Radiol 2019; 119:108648. [DOI: 10.1016/j.ejrad.2019.108648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022]
|
42
|
Can we differentiate HIV-associated obliterative portopathy from liver cirrhosis using MRI? Eur Radiol 2019; 30:213-223. [PMID: 31410601 DOI: 10.1007/s00330-019-06391-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023]
Abstract
AIM To describe the magnetic resonance imaging (MRI) features of HIV-associated obliterative portopathy (HIV-OP) and determine the most indicative appearance of this condition on MRI by using a retrospective case-control study. METHODS MRI examinations of 24 patients with HIV-OP (16 men, 8 women; mean age = 48 ± 6.6 [SD] years; age range, 35-71 years) were analyzed by two blinded observers and compared with those obtained in 18 HIV-infected patients with hepatic cirrhosis (14 men, 4 women; mean age = 51 ± 3.4 [SD] years; age range, 35-60 years). Images were qualitatively and quantitatively analyzed with respect to imaging presentation. Comparisons were performed using uni- and multivariate analyses. RESULTS Regular liver contours had the highest accuracy for the diagnosis of HIV-OP (83%, 35 of 42; 95% confidence interval [CI], 69-93%) and was the most discriminating independent variable for the diagnosis of HIV-OP (odds ratio, 51; 95%CI, 4.96-1272%) (p < 0.0001). At multivariate analysis, the width of segment 4 in millimeters (OR = 1.23 [95%CI, 1.05-1.44%]; p = 0.011) and the presence of regular liver contours (OR = 7.69 [95%CI, 1.48-39.92%]; p = 0.015) were the variables independently associated with the diagnosis of HIV-OP. CONCLUSIONS Regular liver contours are the most discriminating independent variable for the diagnosis of HIV-OP but have limited accuracy. Familiarity with this finding may help differentiate HIV-OP from cirrhosis in HIV-infected patients. KEY POINTS • Regular liver contour is the most discriminating independent variable for the diagnosis of HIV-OP (odds ratio = 51) with 83% accuracy. • At multivariate analysis, the width of segment 4 in millimeters and the presence of regular liver contours are the variables independently associated with the diagnosis of HIV-OP. • MRI helps diagnose HIV-OP in the presence of several categorical findings, which are more frequently observed in HIV-OP patients than in HIV patients with cirrhosis.
Collapse
|
43
|
Gupta P, Kalra N, Gulati A, Chandel K, Priyaranjan P, Dahal P, Sinha SK, Duseja A, Dhiman RK, Sandhu MS. Changes in liver morphology in patients with extrahepatic portal venous obstruction: a retrospective magnetic resonance imaging study. Br J Radiol 2019; 92:20180890. [PMID: 30924678 DOI: 10.1259/bjr.20180890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the liver parenchymal changes on MRI in patients with extrahepatic portal venous obstruction (EHPVO). METHODS This was a retrospective evaluation of the MRI studies in patients with EHPVO between January 2016 and April 2018. The diagnosis of EHPVO in each case had been established on the basis of clinical and Doppler parameters. Following findings were recorded on MRI: liver size; outline; overall volume redistribution; volume redistribution of caudate, right and left lobes; signal heterogeneity, intrahepatic biliary radicle dilatation, focal liver lesions, gallstones and ascites. RESULTS A total of 164 MRI studies were evaluated. Median age was 27 years (range, 6-70). There were 90 (54.9%) males and 74 (45.1%) females. The median liver size was 14 cm (range 5-17). The median spleen size was 15.9 cm (range, 6-28). A spleen size ≥12 cm was seen in 136 (82.9%) patients. The liver outline was nodular in 32 (19.5%) patients. Volume redistribution was seen in 63 (38.4%) patients. Caudate lobe hypertrophy was seen in 49 (29.9%) patients. Right lobe atrophy and hypertrophy was seen in 4 (2.4%) and 1 (0.6%) patients respectively. Left lobe atrophy and hypertrophy was seen in 15 (9.1%) and 10 (6.1%) patients respectively. 30 MRI (18.3%) showed heterogeneous signal intensity. Focal lesions were seen in 22 (13.4%) patients. Intrahepatic biliary radicle dilatation, gallstones and ascites were seen in 120 (73.2%), 54 (32.9%) and 26 (15.9%) patients respectively. CONCLUSION Liver morphological changes are common in EHPVO. ADVANCES IN KNOWLEDGE The morphological changes in liver in patients with EHPVO have not been described previously. This information will prevent misdiagnosis of this condition as cirrhosis.
Collapse
Affiliation(s)
- Pankaj Gupta
- 1 Department of Gastroenterology, PGIMER , Chandigarh , India
| | - Naveen Kalra
- 2 Radiodiagnosis and Imaging, PGIMER , Chandigarh , India
| | - Ajay Gulati
- 2 Radiodiagnosis and Imaging, PGIMER , Chandigarh , India
| | | | | | - Prajwal Dahal
- 2 Radiodiagnosis and Imaging, PGIMER , Chandigarh , India
| | - Saroj K Sinha
- 1 Department of Gastroenterology, PGIMER , Chandigarh , India
| | | | | | | |
Collapse
|
44
|
Onishi H, Theisen D, Zachoval R, Reiser MF, Zech CJ. Intrahepatic diffuse periportal enhancement patterns on hepatobiliary phase gadoxetate disodium-enhanced liver MR images: Do they correspond to periportal hyperintense patterns on T2-weighted images? Medicine (Baltimore) 2019; 98:e14784. [PMID: 30882651 PMCID: PMC6426476 DOI: 10.1097/md.0000000000014784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The purpose of this study was to investigate the findings of diffuse periportal enhancement in the liver on hepatobiliary phase gadoxetate disodium-enhanced magnetic resonance images by comparing with the finding of periportal hyperintensity on T2-weighted images and to reveal their clinical significance.Nineteen consecutive patients with diffuse periportal enhancement on hepatobiliary phase images constituted the study population. The intrahepatic diffuse periportal enhancement finding was assessed on whether it corresponded to periportal hyperintense patterns on T2-weighted images or not in the location, and the cases were classified into 2 groups according to this characteristic. Signal intensities at the periportal areas were also assessed on T1-, T2-, diffusion-weighted and dynamic images. Furthermore, possible associations between these image findings and the final diagnoses were explored.In 7 of the 19 patients, periportal enhancement area corresponded with the periportal hyperintensity area on T2-weighted images. In the remaining 12 patients, the finding of periportal T2-hyperintensity was absent or the periportal enhancement differed from the periportal T2-hyperintensity in the location. Diseases of the former group comprised autoimmune hepatitis, acute exacerbation of chronic hepatitis and acute alcoholic steatohepatitis, and those of the latter group primary sclerosing cholangitis, autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, and liver cirrhosis with miscellaneous etiology.Diffuse periportal enhancement during the hepatobiliary phase did not always correspond to periportal hyperintensity on T2-weighted images. In the classification based on whether enhancement area corresponded or not, each enhancement pattern appeared in different groups of liver diseases. Specifically, the former (corresponding) was associated with active inflammation such as hepatitis and the latter (not corresponding) was predominantly associated with a chronic change such as cirrhosis. Appropriate recognition of these periportal enhancement patterns may contribute to the improved diagnosis of diffuse liver diseases.
Collapse
Affiliation(s)
- Hiromitsu Onishi
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daniel Theisen
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
| | - Reinhart Zachoval
- Department of Internal Medicine II, Ludwig Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F. Reiser
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
| | - Christoph J. Zech
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
45
|
Fetzer DT, Rodgers SK, Seow JH, Dawkins AA, Joshi G, Gabriel H, Kamaya A. Ultrasound Evaluation in Patients at Risk for Hepatocellular Carcinoma. Radiol Clin North Am 2019; 57:563-583. [PMID: 30928078 DOI: 10.1016/j.rcl.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the context of chronic liver disease (CLD), sonographic features of hepatic steatosis, cirrhosis, and portal hypertension are discussed and examples are provided. The impact of CLD and hepatocellular carcinoma (HCC) is introduced, providing the rationale for a robust HCC screening and surveillance program for at-risk patients. The American College of Radiology Liver Imaging Reporting and Data System algorithms for screening and surveillance by ultrasound and for the definitive diagnosis of HCC by contrast-enhanced ultrasound are explained, with imaging examples provided. Contrast-enhanced ultrasound technique, limitations, and pitfalls also are introduced.
Collapse
Affiliation(s)
- David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9316, USA.
| | - Shuchi K Rodgers
- Abdominal Radiology, Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - James H Seow
- Department of Radiology, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia
| | - Adrian A Dawkins
- Department of Radiology, University of Kentucky, 800 Rose Street, Room HX-318A, Lexington, KY 40536-0293, USA
| | - Gayatri Joshi
- Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Emory University School of Medicine, 550 Peachtree Street Northeast, Atlanta, GA 30308, USA
| | - Helena Gabriel
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Avenue, Suite 800, Chicago, IL 60611, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive H1307, Stanford, CA 94305, USA
| |
Collapse
|
46
|
Planz VB, Lubner MG, Pickhardt PJ. Volumetric analysis at abdominal CT: oncologic and non-oncologic applications. Br J Radiol 2018; 92:20180631. [PMID: 30457881 DOI: 10.1259/bjr.20180631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Volumetric analysis is an objective three-dimensional assessment of a lesion or organ that may more accurately depict the burden of complex objects compared to traditional linear size measurement. Small changes in linear size are amplified by corresponding changes in volume, which could have significant clinical implications. Though early methods of calculating volumes were time-consuming and laborious, multiple software platforms are now available with varying degrees of user-software interaction ranging from manual to fully automated. For the assessment of primary malignancy and metastatic disease, volumetric measurements have shown utility in the evaluation of disease burden prior to and following therapy in a variety of cancers. Additionally, volume can be useful in treatment planning prior to resection or locoregional therapies, particularly for hepatic tumours. The utility of CT volumetry in a wide spectrum of non-oncologic pathology has also been described. While clear advantages exist in certain applications, some data have shown that volume is not always the superior method of size assessment and the associated labor intensity may not be worthwhile. Further, lack of uniformity among software platforms is a challenge to widespread implementation. This review will discuss CT volumetry and its potential oncologic and non-oncologic applications in abdominal imaging, as well as advantages and limitations to this quantitative technique.
Collapse
Affiliation(s)
| | | | - Perry J Pickhardt
- 1 Department of Radiology, The University of Wisconsin School of Medicine & Public Health , Madison, WI , USA
| |
Collapse
|
47
|
Mixed Imaging on Port-Venous Phase of Contrast-Enhanced Dual-Source Dual-Energy Computed Tomography: A Measurement Method Based on Couinaud Segments. J Comput Assist Tomogr 2018; 42:944-953. [PMID: 30407245 DOI: 10.1097/rct.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the changes of the iodine value quantified on the Couinaud segments measured in port-venous phase using the iodine-mixed technique of contrast-enhanced dual-source dual-energy computed tomography (CT) scanning in different Child-Pugh stages of hepatitis B-induced liver cirrhosis. METHODS Patients clinically diagnosed with hepatitis B-induced cirrhosis were prospectively engaged in our study. Each patient underwent multiphase iodine agent contrast-enhanced dual-source dual-energy CT scanning, and then the iodine-mixed imaging of port-venous phase was postprocessed. Iodine concentration was obtained for each segment based on the Couinaud segments. The volume of each segment and the total of the liver were measured and calculated using the postprocessing software of volume. All the cirrhosis patients were grouped into 3 subgroups based on the Child-Pugh stage method. Patients without cirrhosis were engaged for the control group. The iodine concentration, volume, and iodine storage among groups were analyzed by SPSS version 19.0. Single energy was used for the nonenhanced phase scanning, which was used for the radiation dosage comparison with dual-energy CT scanning. RESULTS Two hundred three patients were ultimately enrolled in our study, including 148 patients with cirrhosis (Child A, 69; Child B, 51; Child C, 28) and 55 patients without cirrhosis as control subjects. The total volume and iodine storage of cirrhosis group were smaller than those of the control group (P < 0.001). Compared with the control group, the iodine concentration in each segment decreased with progression of cirrhosis. The volume, iodine concentration, and iodine storage of the right hepatic lobe and left medial segment decreased with cirrhosis severity (P < 0.001). There was no significant difference in the volume of right hepatic lobe between Child C group and Child B group, whereas the iodine storage of Child C group was lower than that of Child B group (P < 0.05). The volume and iodine storage of left lateral segment increased with the progression of liver cirrhosis in the Child A and Child B groups (P < 0.05), whereas there was no statistical difference between the Child B and Child C groups, and the iodine storage in the Child C group was lower than that of the Child B group (P < 0.05). The radiation dose of dual-energy scanning was lower than that of single-energy scanning (P < 0.001). The iodine concentration 1.512 mg/mL on the left medial segment reached the most optimal evaluation on cirrhosis, with a sensitivity of 100%, specificity of 0.722, and area under the curve of 0.914. CONCLUSIONS Iodine concentration in portal phase measurement can evaluate and reflect the severity of cirrhosis. Iodine content segmental quantification can analyze the changes of the liver storage with a progression of cirrhosis. Dual-energy scanning reduced the radiation damage in patients and is valuable for a further study and clinical application.
Collapse
|
48
|
Tawfik AK, Helmy A, Yousef M, Abou-Saif S, Kobtan A, Asaad E, Abd-Elsalam S. Copeptin as a novel marker predicting prognosis of liver cirrhosis and its major complications. Hepat Med 2018; 10:87-93. [PMID: 30214326 PMCID: PMC6128273 DOI: 10.2147/hmer.s174267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aim of the work was to assess the level of copeptin as a surrogate marker predicting the severity of liver diseases and its major complications. PATIENTS AND METHODS This was a cross-sectional study that included 40 patients and 10 controls and was performed in Tanta University Hospital between June 2016 and November 2016. The studied cases were divided into five groups: group I (10 patients): compensated cirrhosis; group II (10 patients): cirrhosis with gastrointestinal hemorrhage due to portal hypertension; group III (10 patients): cirrhosis with hepatorenal syndrome; group IV (10 patients): cirrhosis with liver cell failure; and group V (10 controls): normal healthy individuals. RESULTS Regarding serum copeptin in the studied groups, copeptin showed a significant decrease in group I vs group II' group I vs group III, and group I vs group IV; and there was a significant increase in group II vs group III' group II vs group IV' group II vs control' group III vs control, and group IV vs control. No significance was detected between group I vs control and group III vs group IV. CONCLUSIONS Copeptin is a novel marker for the determination of prognosis of liver cirrhosis. There is significant association between serum level of copeptin and complications of liver cirrhosis.
Collapse
Affiliation(s)
- Ahmed Khaled Tawfik
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt,
| | - Amal Helmy
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Yousef
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt,
| | - Sabry Abou-Saif
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt,
| | - Abdelrahman Kobtan
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt,
| | - Eman Asaad
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt,
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt,
| |
Collapse
|
49
|
Lubner MG, Pickhardt PJ. Multidetector Computed Tomography for Retrospective, Noninvasive Staging of Liver Fibrosis. Gastroenterol Clin North Am 2018; 47:569-584. [PMID: 30115438 DOI: 10.1016/j.gtc.2018.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Although not traditionally used to assess hepatic fibrosis, computed tomography (CT) is fast, accessible, robust, and commonly used for abdominal indications. CT metrics are often easily retrospectively obtained without special equipment. Metrics such as liver segmental volume ratio, which quantifies regional hepatic volume changes; splenic volume; and liver surface nodularity scoring show diagnostic performance comparable to elastography techniques for detecting significant and advanced fibrosis. Other emerging CT tools, such as CT texture analysis and fractional extracellular volume, have also shown promise in identifying fibrosis and warrant further study.
Collapse
Affiliation(s)
- Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA
| |
Collapse
|
50
|
Obmann VC, Mertineit N, Berzigotti A, Marx C, Ebner L, Kreis R, Vermathen P, Heverhagen JT, Christe A, Huber AT. CT predicts liver fibrosis: Prospective evaluation of morphology- and attenuation-based quantitative scores in routine portal venous abdominal scans. PLoS One 2018; 13:e0199611. [PMID: 29990333 PMCID: PMC6038998 DOI: 10.1371/journal.pone.0199611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Our aim was to prospectively determine whether quantitative computed tomography (CT) scores, consisting of simplified indices for liver remodeling and attenuation, may predict liver fibrosis in abdominal CT scans. Materials and methods This cross-sectional, prospective study was approved by the local IRB (Kantonale Ethikkommission Bern). Written informed consent was given from all patients undergoing study-MR exams. Between 02/16 and 05/17, four different liver fibrosis scores (CRL-R = caudate-right-lobe ratio, LIMV-, LIMA- and LIMVA-fibrosis score, with “LIM” for liver imaging morphology, “V” for liver vein diameter and “A” for attenuation) were calculated in 1534 consecutive abdominal CT scans, excluding patients with prior liver surgery and liver metastasis. Patients were invited to undergo magnetic resonance (MR) elastography as the non-invasive gold standard to evaluate liver fibrosis. MR elastography shear modulus ≥2.8 kPa was defined as beginning liver fibrosis, while ≥3.5 kPa was defined as significant liver fibrosis (which would correspond to fibrosis stage F2 or higher in histology). Cutoff values, sensitivities and specificities obtained from the receiver operating characteristics (ROC) analysis were then calculated in 141 patients who followed the invitation for MR elastography. To mitigate selection bias, prevalence was estimated in the screened total population (n = 1534) by applying the cutoff values with sensitivities and specificities calculated in the MR elastography sub-group. Positive predictive values (PPV) and negative predictive values (NPV) were then calculated. Results Fibrosis scores including liver vein attenuation LIMA-FS and LIMVA-FS showed higher areas under the ROC curves (0.96–0.97) than CRL-R (0.82) to detect significant liver fibrosis, while LIMV-FS showed good performance as well (0.92). The prevalence-corrected PPV were 29% for CRL-R, 70% for LIMV-FS, 76% for LIMA-FS and 82% for LIMVA-FS. Conclusion CT fibrosis scores, notably LIMA-FS and LIMVA-FS, may predict significant liver fibrosis on routine abdominal CT scans.
Collapse
Affiliation(s)
- Verena C. Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nando Mertineit
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Hepatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina Marx
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Kreis
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, Unit for Magnetic Resonance Spectroscopy and Methodology, University of Bern, Bern, Switzerland
| | - Peter Vermathen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research, Unit for Magnetic Resonance Spectroscopy and Methodology, University of Bern, Bern, Switzerland
| | - Johannes T. Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
| |
Collapse
|