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Flory M, Elsayes KM, Kielar A, Harmath C, Dillman JR, Shehata M, Horvat N, Minervini M, Marks R, Kamaya A, Borhani AA. Congestive Hepatopathy: Pathophysiology, Workup, and Imaging Findings with Pathologic Correlation. Radiographics 2024; 44:e230121. [PMID: 38602867 DOI: 10.1148/rg.230121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Liver congestion is increasingly encountered in clinical practice and presents diagnostic pitfalls of which radiologists must be aware. The complex altered hemodynamics associated with liver congestion leads to diffuse parenchymal changes and the development of benign and malignant nodules. Distinguishing commonly encountered benign hypervascular lesions, such as focal nodular hyperplasia (FNH)-like nodules, from hepatocellular carcinoma (HCC) can be challenging due to overlapping imaging features. FNH-like lesions enhance during the hepatic arterial phase and remain isoenhancing relative to the background liver parenchyma but infrequently appear to wash out at delayed phase imaging, similar to what might be seen with HCC. Heterogeneity, presence of an enhancing capsule, washout during the portal venous phase, intermediate signal intensity at T2-weighted imaging, restricted diffusion, and lack of uptake at hepatobiliary phase imaging point toward the diagnosis of HCC, although these features are not sensitive individually. It is important to emphasize that the Liver Imaging Reporting and Data System (LI-RADS) algorithm cannot be applied in congested livers since major LI-RADS features lack specificity in distinguishing HCC from benign hypervascular lesions in this population. Also, the morphologic changes and increased liver stiffness caused by congestion make the imaging diagnosis of cirrhosis difficult. The authors discuss the complex liver macro- and microhemodynamics underlying liver congestion; propose a more inclusive approach to and conceptualization of liver congestion; describe the pathophysiology of liver congestion, hepatocellular injury, and the development of benign and malignant nodules; review the imaging findings and mimics of liver congestion and hypervascular lesions; and present a diagnostic algorithm for approaching hypervascular liver lesions. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Marta Flory
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Khaled M Elsayes
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Ania Kielar
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Carla Harmath
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Jonathan R Dillman
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Mostafa Shehata
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Natally Horvat
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Marta Minervini
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Robert Marks
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Aya Kamaya
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Amir A Borhani
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
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Jajodia A, Soyer P, Barat M, Patlas MN. Imaging of hepato-pancreato-biliary emergencies in patients with cancer. Diagn Interv Imaging 2024; 105:47-56. [PMID: 38040558 DOI: 10.1016/j.diii.2023.11.002] [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: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
Hepato-pancreato-biliary (HPB) emergencies in patients with cancer encompass an extensive array of various conditions, including primary malignancies that require prompt treatment, associated severe complications, and life-threatening consequences arising from treatment. In patients with cancer, the liver can be affected by chemotherapy-induced hepatotoxicity, veno-occlusive disease, Budd-Chiari syndrome, liver hemorrhage, and other complications arising from cancer therapy with all these complications requiring timely diagnosis and prompt treament. Cholecystitis induced by systemic anticancer therapies can result in severe conquences if not promptly identified and treated. The application of immunotherapy in cancer therapy is associated with cholangitis. Hemobilia, often caused by medical interventions, may require arterial embolization in patients with severe bleeding and hemodynamic instability. Malignant biliary obstruction in patients with biliary cancers may necessitate palliative strategies such as biliary stenting. In pancreatic cancer, patients often miss surgical treatment due to advanced disease stages or distant metastases, leading to potential emergencies at different treatment phases. This comprehensive review underscores the complexities of diagnostic and treatment roles of medical imaging in managing HPB emergencies in patients with cancer. It illustrates the crucial role of imaging techniques, including magnetic resonance imaging, computed tomography and ultrasound, in diagnosing and managing these conditions for timely intervention. It provides essential insights into the critical nature of early diagnosis and intervention in cancer-related HPB emergencies, ultimately impacting patient outcomes and survival rates.
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Affiliation(s)
- Ankush Jajodia
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1W7, Canada
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France
| | - Michael N Patlas
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1W7, Canada.
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Khan A, Fosby B, Labori KJ, Lanari J, Dorenberg E, Line PD. Management of Coeliac and Hepatic Artery Aneurysms: An Experience of 84 Cases. Eur J Vasc Endovasc Surg 2023; 66:814-820. [PMID: 37722651 DOI: 10.1016/j.ejvs.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 08/22/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To report outcomes following open or endovascular treatment of true hepatic and coeliac artery aneurysms at a single referral centre. METHODS This was a retrospective cohort study of consecutive patients treated for true hepatic and coeliac artery aneurysms between May 2002 and December 2021. Outcome measures included complications, graft patency, and survival rate. RESULTS Overall, 84 patients were included with a median age of 63 years (interquartile range 55, 79). The majority (76%) of the patients were men. Frequent comorbidities included a history of tobacco (69%), hypertension (65%), hyperlipidaemia (32%), and diabetes (15%). Multiple synchronous aneurysms were detected in 22 patients (26%). There were 33 (39%) symptomatic aneurysms (abdominal pain without rupture [n = 18], rupture [n = 10], and sepsis [n = 5]). Seventeen patients (20%) had mycotic aetiology. Fifty patients (60%) underwent endovascular treatment with either covered stent placement (n = 29) or coil embolisation (n = 21), and 34 patients (40%) were treated with open surgery using allogenic iliac artery (n = 15), autologous saphenous vein (n = 15), GoreTex graft (n = 2), or ligation (n = 2). The complication rate was 32% in the open group and 18% in the endovascular group (p = .048). The overall 90 day post-operative mortality rate was 1.2%, five year primary patency was 90.0%, five year survival rate was 81.2%, and mean follow up was 6.9 ± 4.2 years. CONCLUSION Endovascular treatment is the preferred approach whenever technically possible. Despite higher post-operative morbidity, an open approach with vascular reconstruction using autologous or allogenic vascular grafts yields acceptable long term results.
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Affiliation(s)
- Ammar Khan
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjarte Fosby
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut J Labori
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Jacopo Lanari
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Eric Dorenberg
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Calistri L, Nardi C, Rastrelli V, Maraghelli D, Grazioli L, Messerini L, Colagrande S. MRI of Peliosis Hepatis: A Case Series Presentation With a 2022 Systematic Literature Update. J Magn Reson Imaging 2023; 58:1386-1405. [PMID: 36988385 DOI: 10.1002/jmri.28673] [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: 11/18/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Peliosis hepatis (PH) is a rare benign condition, characterized by hepatic sinusoidal dilatation and blood-filled cystic cavities, often found incidentally, with still challenging diagnosis by imaging due to polymorphic appearance. PURPOSE Based on a retrospective analysis of our series (12 patients) and systematic literature review (1990-2022), to organize data about PH and identify features to improve characterization. STUDY TYPE Retrospective case series and systematic review. POPULATION Twelve patients (mean age 48 years, 55% female) with pathology-proven PH and 49 patients (mean age 52 years, 67% female) identified in 33 studies from the literature (1990-2022). FIELD STRENGTH/SEQUENCE 1,5-T; T1-weighted (T1W), T2-weighted (T2W), diffusion-weighted (DW), contrast-enhanced (CE) T1W imaging. ASSESSMENT We compared our series and literature data in terms of demographic (gender/age/ethnicity), clinical characteristics (symptoms/physical examination/liver test), associated conditions (malignancies/infectious/hematologic/genetic or chronic disorders/drugs or toxic exposure) percentage. On magnetic resonance imaging lesion numbers/shape/mean maximum diameter/location/mass effect/signal intensity were compared. PH pathological type/proposed imaging diagnosis/patient follow-up were also considered. STATISTICAL TESTS Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports/Series quality assessment. Intraclass correlation and Cohen's kappa coefficients for levels of inter/intrareader agreement in our experience. RESULTS Patients were mainly asymptomatic (92% vs. 70% in our study and literature) with associated conditions (83% vs. 80%). Lesions showed homogeneous T1W-hypointensity (58% vs. 65%) and T2W-hyperintensity (58% vs. 66%). Heterogeneous nonspecific (25% vs. 51%), centrifugal (34% vs. 8%), or rim-like centripetal (25% vs. 23%) patterns of enhancement were most frequent, with hypointensity on the hepatobiliary phase (HBP), without restricted diffusivity. Good inter- and intrareader agreement was observed in our experience. Concerning JBI Checklist, 19 out of 31 case reports met at least 7 out of 8 criteria, whereas 2 case series fulfilled 5 and 6 out of 10 items respectively. DATA CONCLUSION A homogeneous, not well-demarcated T1W-hypointense and T2W-hyperintense mass, with heterogeneous nonspecific or rim-like centripetal or centrifugal pattern of enhancement, and hypointensity on HBP, may be helpful for PH diagnosis. Among associated conditions, malignancies and drug exposures were the most frequent. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia "Spedali Civili", Brescia, Italy
| | - Luca Messerini
- Department of Human Pathology and Oncology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Deger S, Bozer A. Liver Pseudotumor Due to Aberrant Left Gastric Vein: A Case Report. J Belg Soc Radiol 2023; 107:82. [PMID: 37900346 PMCID: PMC10607559 DOI: 10.5334/jbsr.3342] [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: 08/25/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Liver pseudotumors (pseudolesions) pose diagnostic challenges in imaging, often linked to anomalous venous drainage. Notably, aberrant left gastric vein (ALGV) plays a role in segment 2 and 3 pseudolesions. A liver parenchymal pseudolesion due to abnormal venous drainage involving ALGV is highlighted. Understanding hepatic vascular dynamics, exemplified by ALGV-related pseudolesions, aids diagnosis and guides decisions. Further investigating intricate mechanisms underlying these anomalies is crucial. Teaching Point The recognition of third inflow pathways such as ALGV holds significance in distinguishing hepatic pseudolesions from true lesions.
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Affiliation(s)
- Serhat Deger
- Department of Radiology, Bozyaka Educatıon and Research Hospıtal, İzmir, Turkey
| | - Ahmet Bozer
- Department of Radiology, Bozyaka Educatıon and Research Hospıtal, İzmir, Turkey
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Lawal IO, Pectasides M, Parihar AS, Shah HU, Halkar RK, Jani AB, Schuster DM. Aberrant Vascular Anatomy Associated With Artifactual Focal Avidity in the Liver on PSMA PET. Clin Nucl Med 2023; 48:e455-e457. [PMID: 37385218 PMCID: PMC10524921 DOI: 10.1097/rlu.0000000000004765] [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] [Indexed: 07/01/2023]
Abstract
ABSTRACT 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT is a valuable tool for staging and restaging of prostate cancer. Prostate-specific membrane antigen expression is not specific to prostate cancer, as it is expressed in normal tissues as well as in neoplastic and nonneoplastic processes. Awareness of the broad possibility of lesions with PSMA avidity is necessary to recognize normal variants and avoid potential pitfalls in image interpretation. We present a series of cases showing physiologic focal PSMA avidity in hepatic segment IVb. We correlate this uptake with aberrant hepatic vasculature. The awareness of this variant is important for accurate image interpretation to prevent additional invasive procedures, undue treatment escalation, and denial of curative treatment to patients.
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Affiliation(s)
- Ismaheel O. Lawal
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Melina Pectasides
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Ashwin Singh Parihar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hardik U. Shah
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Raghuveer K. Halkar
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Ashesh B. Jani
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - David M. Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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Nikpanah M, Sailer A, Khoshpouri P, Panda A. Mass-forming Portal Cavernoma Cholangiopathy. Radiographics 2023; 43:e230074. [PMID: 37590161 DOI: 10.1148/rg.230074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Moozhan Nikpanah
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.N.); Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (A.S.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); and Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 342005 (A.P.)
| | - Anne Sailer
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.N.); Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (A.S.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); and Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 342005 (A.P.)
| | - Pegah Khoshpouri
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.N.); Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (A.S.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); and Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 342005 (A.P.)
| | - Ananya Panda
- From the Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.N.); Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (A.S.); Department of Radiology, University of Washington, Seattle, Wash (P.K.); and Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 342005 (A.P.)
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Aberrant right gastric vein mimicking hepatic spread of prostate cancer on PSMA-PET/CT. Radiol Case Rep 2023; 18:1140-1143. [PMID: 36655004 PMCID: PMC9841349 DOI: 10.1016/j.radcr.2022.12.004] [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: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 01/11/2023] Open
Abstract
Hepatic vasculature can exhibit a wide variety of variants, some of which may resemble pathologic findings. In this case, a 53-year-old man presenting for staging of biochemically recurrent prostatic adenocarcinoma was found to have focally increased prostate-specific membrane antigen (PSMA) tracer uptake on positron emission tomography (PET) imaging in hepatic segment IV. This finding was initially concerning for hepatic metastasis of the patient's primary prostate adenocarcinoma. However, the area of radiotracer uptake was not associated with a discrete lesion on CT, and the geographic morphology of the uptake raised the possibility of a vascular etiology. Magnetic resonance imaging (MRI) of the liver showed no hepatic metastases and confirmed the presence of an aberrant right gastric vein directly perfusing the corresponding portion of hepatic segment IV. This case highlights PSMA uptake in the liver secondary to vascular variants as a potential mimic for metastatic disease on PSMA-PET/CT.
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Interventional Management of Portal Hypertension in Cancer Patients. Curr Oncol Rep 2022; 24:1461-1475. [PMID: 35953600 DOI: 10.1007/s11912-022-01319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the classifications and clinical hallmarks of common cancer-related conditions that contribute to the high incidence of portal hypertension in this population and provide an update on currently available interventional radiology therapeutic approaches. RECENT FINDINGS In the last few decades, there have been significant advancements in understanding the pathophysiology of portal hypertension. This knowledge has led to the development of safer and more effective minimally invasive approaches. The main objective is to provide alternatives to prevent life-threatening complications from clinically significant portal hypertension and to allow the continuation of cancer treatment interventions that would otherwise be stopped. Clinicians involved in cancer care should be aware of risk factors, associated complications, and management of portal hypertension in cancer patients. Interventional radiology offers minimally invasive alternatives that play a central role in improving clinical outcomes and survival of these patients, allowing the continuation of cancer treatments.
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Coussy A, Jambon E, Le Bras Y, Combe C, Chiche L, Grenier N, Marcelin C. The Safety and Efficacy of Hepatic Transarterial Embolization Using Microspheres and Microcoils in Patients with Symptomatic Polycystic Liver Disease. J Pers Med 2022; 12:jpm12101624. [PMID: 36294764 PMCID: PMC9605116 DOI: 10.3390/jpm12101624] [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: 08/08/2022] [Revised: 09/06/2022] [Accepted: 09/11/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose: We investigated the long-term safety and efficacy of hepatic transarterial embolization (TAE) in patients with symptomatic polycystic liver disease (PLD). Materials and Methods: A total of 26 patients were included, mean age of 52.3 years (range: 33−78 years), undergoing 32 TAE procedures between January 2012 and December 2019 were included in this retrospective study. Distal embolization of the segmental hepatic artery was performed with 300−500 µm embolic microspheres associated with proximal embolization using microcoils. The primary endpoint was clinical efficacy, defined by an improvement in health-related quality of life using a modified Short Form-36 Health Survey and improvement in symptoms (digestive or respiratory symptoms and chronic abdominal pain), without invasive therapy during the follow-up period. Secondary endpoints were a decrease in total liver volume and treated liver volume and complications. Results: Hepatic embolization was performed successfully in 30 of 32 procedures with no major adverse events. Clinical efficacy was 73% (19/26). The mean reduction in hepatic volume was −12.6% at 3 months and −27.8% at the last follow-up 51 ± 15.2 months after TAE (range: 30−81 months; both ps < 0.01). The mean visual analog scale pain score was 5.4 ± 2.8 before TAE and decreased to 2.7 ± 1.9 after treatment. Three patients had minor adverse events, and one patient had an adverse event of moderate severity. Conclusion: Hepatic embolization using microspheres and microcoils is a safe and effective treatment for PLD that improves symptoms and reduces the volume of hepatic cysts.
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Affiliation(s)
- Alexis Coussy
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Eva Jambon
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Yann Le Bras
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Christian Combe
- Departement of Nephrology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Laurence Chiche
- Department of Digestive surgery, Haut Leveque, 33076 Bordeaux, France
| | - Nicolas Grenier
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Clément Marcelin
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
- Correspondence: ; Tel.: +33-556-795-599; Fax: +33-557-821-650
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11
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Multiparametric MRI with MR elastography findings in patients with sinusoidal obstruction syndrome after oxaliplatin-based chemotherapy. Insights Imaging 2022; 13:147. [PMID: 36064860 PMCID: PMC9445145 DOI: 10.1186/s13244-022-01281-w] [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: 04/20/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate the magnetic resonance elastography (MRE)-derived liver stiffness measurement (LSM), T1 and T2 relaxation times, and hepatobiliary phase images in patients, who developed sinusoidal obstruction syndrome (SOS) after oxaliplatin-based chemotherapy. Methods Thirty-four patients (M/F:22/12) who underwent liver MRI-MRE and received oxaliplatin for colorectal, gastric, and pancreas cancer were included in the study. SOS was diagnosed by Gd-EOB-DTPA-enhanced MRI in 18 patients. MRE-LSM and T1–T2 maps were evaluated. Patients with SOS were grouped according to the amount of reticular hypointensity on the hepatobiliary phase images. Results The mean MRE-LSM in the patients with SOS was 3.14 ± 0.45 kPa, and the control group was 2.6 ± 0.5 kPa (p = 0.01). The mean-corrected T1 (cT1) relaxation time was 1181 ± 151 ms in the SOS group and 1032 ± 129 ms in the control group (p = 0.005). The mean T2 relaxation time was 50.29 ± 3.6 ms in the SOS group and 44 ± 3.9 ms in the control group (p = 0.01). Parenchymal stiffness values were 2.8 ± 0.22 kPa, 3 ± 0.33 kPa, and 3.65 ± 0.28 kPa in patients with mild, moderate, and advanced SOS findings, respectively (p = 0.002). Although cT1 and T2 relaxation times increased with increasing SOS severity, no statistical significance was found. Conclusions We observed increased MRE-LSM in patients with SOS after chemotherapy compared to control group. T1 and T2 relaxation times were also useful in diagnosing SOS but were found inadequate in determining SOS severity. MRE is effective in diagnosing SOS and determining SOS severity in patients who cannot receive contrast agents, and it may be useful in the follow-up evaluation of these patients.
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12
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Singh JP, Agarwal N, Sahni V, Kumar V, Saruchi, Malhotra R, Pathak D. Detection of blood flow through artery in the presence of steno-occlusive disease post liver transplantation by modeling for theatrical and detrimental environmental changes. J INDIAN CHEM SOC 2022. [DOI: 10.1016/j.jics.2022.100581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Ramdani H, Haddad SE, Allali N, Chat L. Symptomatic congenital hemangiomatosis in a neonate: Imaging of a life-threatening presentation with multifocal liver involvement. Radiol Case Rep 2022; 17:3126-3131. [PMID: 35774051 PMCID: PMC9237947 DOI: 10.1016/j.radcr.2022.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Hemangiomas are the most common benign vascular neoplasms of infancy. Congenital hemangiomas proliferate in utero, and are fully formed at birth. They are usually solitary. Generalized forms are exceptional. The liver is the second most common site of hemangiomas after the skin. When >5 cutaneous hemangiomas are present, screening abdominal ultrasound is recommended. Based on the degree of liver parenchyma involvement, 3 hepatic hemangiomas’ subtypes are defined: focal, multifocal, and diffuse. Hepatic hemangiomas’ clinical presentation varies from asymptomatic to life-threatening. High output cardiac failure, consumptive coagulopathy, abdominal compartment syndrome, and liver dysfunction are possible complications. We report an unusual case of symptomatic congenital hemangiomatosis in a male infant born with innumerable generalized cutaneous hemangiomas whose screening abdominal ultrasound revealed multifocal hepatic hemangiomas with extensive mixed shunts. We aim to highlight this unique entity with severe associated complications and stress the role of imaging at initial presentation, for follow-up, and to guide therapeutic choices.
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14
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Kubo H, Ohgi K, Sugiura T, Ashida R, Yamada M, Otsuka S, Yamazaki K, Todaka A, Sasaki K, Uesaka K. The Association Between Neoadjuvant Therapy and Pathological Outcomes in Pancreatic Cancer Patients After Resection: Prognostic Significance of Microscopic Venous Invasion. Ann Surg Oncol 2022; 29:4992-5002. [PMID: 35368218 DOI: 10.1245/s10434-022-11628-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/04/2022] [Indexed: 12/17/2023]
Abstract
BACKGROUND The impact of neoadjuvant therapy (NAT) on pathological outcomes, including microscopic venous invasion (MVI), remains unclear in pancreatic cancer. METHODS A total of 456 patients who underwent pancreatectomy for resectable and borderline resectable pancreatic cancer between July 2012 and February 2020 were retrospectively reviewed. Patients were divided into two groups: patients with NAT (n = 120, 26%) and those without NAT (n = 336, 74%). Clinicopathological factors, survival outcomes and recurrence patterns were analyzed. RESULTS Regarding pathological findings, the proportion of MVI was significantly lower in patients with NAT than in those without NAT (43% vs 62%, P = 0.001). The 5-year survival rate in patients with NAT was significantly better than that in those without NAT (54% vs 45%, P = 0.030). A multivariate analysis showed that MVI was an independent prognostic factor for the overall survival (OS) (hazard ratio 2.86, P = 0.003) in patients who underwent NAT. MVI was an independent risk factor for liver recurrence (odds ratio [OR] 2.38, P = 0.016) and multiple-site recurrence (OR 1.92, P = 0.027) according to a multivariate analysis. The OS in patients with liver recurrence was significantly worse than that in patients with other recurrence patterns (vs lymph node, P = 0.047; vs local, P < 0.001; vs lung, P < 0.001). The absence of NAT was a significant risk factor for MVI (OR 1.93, P = 0.007). CONCLUSION MVI was a crucial prognostic factor associated with liver and multiple-site recurrence in pancreatic cancer patients with NAT. MVI may be reduced by NAT, which may contribute to the improvement of survival in pancreatic cancer patients.
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Affiliation(s)
- Hidemasa Kubo
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Mihoko Yamada
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shimpei Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keiko Sasaki
- Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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15
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Keshav N, Ohliger MA. Imaging Vascular Disorders of the Liver. Radiol Clin North Am 2022; 60:857-871. [DOI: 10.1016/j.rcl.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Donato P, Facas J, Alves FC. Hepatic Vascular Disorders: From Diagnosis to Interventional Radiology. Semin Ultrasound CT MR 2022; 43:466-475. [DOI: 10.1053/j.sult.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Scalzo N, Canastar M, Lebovics E. Part 1: Disease of the Heart and Liver: A Relationship That Cuts Both Ways. Cardiol Rev 2022; 30:111-122. [PMID: 33337654 DOI: 10.1097/crd.0000000000000379] [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: 12/10/2022]
Abstract
The heart and the liver display multifaceted, complex interactions that can be divided into cardiac effects of liver disease, hepatic effects of heart disease, and disease processes affecting both organs. In part 1 of this 2 part series, we discuss how acute and chronic heart failure can have devastating effects on the liver, such as acute cardiogenic liver injury and congestive hepatopathy. On the other hand, primary liver disease, such as cirrhosis, can lead to a plethora of cardiac insults representative in cirrhotic cardiomyopathy as systolic dysfunction, diastolic dysfunction, and electrophysiological disturbances. Nonalcoholic fatty liver disease has long been associated with cardiovascular events that increase mortality. The management of both disease processes changes when the other organ system becomes involved. This consideration is important with regard to a variety of interventions, most notably transplantation of either organ, as risk of complications dramatically rises in the setting of both heart and liver disease (discussed in part 2). As our understanding of the intricate communication between the heart and liver continues to expand so does our management.
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Affiliation(s)
- Nicholas Scalzo
- From the Department of Medicine, Section of Gastroenterology & Hepatobiliary Diseases, New York Medical College and Westchester Medical Center, Valhalla, NY
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18
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Vardar BU, Dupuis CS, Goldstein AJ, Vardar Z, Kim YH. Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department. Ultrasonography 2022; 41:243-262. [PMID: 35026887 PMCID: PMC8942730 DOI: 10.14366/usg.21152] [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] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/18/2021] [Indexed: 12/24/2022] Open
Abstract
Ultrasonography is often the initial modality used to evaluate patients found to have abnormal liver function tests (LFTs) in the emergency department. While an assessment for biliary ductal dilatation and obstruction remains one of the main questions to answer, radiologists should also be aware of the ultrasonographic appearance of other conditions that can cause abnormal LFTs. This may be crucial for the management and disposition of patients in the emergency department. This article reviews the ultrasonographic features of diseases that may cause abnormal LFTs.
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Affiliation(s)
| | - Carolyn S Dupuis
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alan J Goldstein
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zeynep Vardar
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Young H Kim
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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19
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Pandhi MB, Kord A, Niemeyer MM. Transjugular Liver Biopsy: A Case of a Phrenic Vein Mimic of the Right Hepatic Vein. Semin Intervent Radiol 2022; 39:103-106. [PMID: 35210739 PMCID: PMC8856775 DOI: 10.1055/s-0041-1741079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mithil B. Pandhi
- Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois,Address for correspondence Mithil B. Pandhi, DO Department of Radiology, University of Illinois Hospital and Health Sciences System1740 W. Taylor St., M/C 931, Chicago, IL 60612
| | - Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Matthew M. Niemeyer
- Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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20
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Calistri L, Rastrelli V, Nardi C, Maraghelli D, Vidali S, Pietragalla M, Colagrande S. Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis. World J Gastroenterol 2021; 27:7866-7893. [PMID: 35046618 PMCID: PMC8678821 DOI: 10.3748/wjg.v27.i46.7866] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is the major drug-metabolizing and drug-detoxifying organ. Many drugs can cause liver damage through various mechanisms; however, the liver response to injury includes a relatively narrow spectrum of alterations that, regardless of the cause, are represented by phlogosis, oxidative stress and necrosis. The combination of these alterations mainly results in three radiological findings: vascular alterations, structural changes and metabolic function reduction. Chemotherapy has changed in recent decades in terms of the drugs, protocols and duration, allowing patients a longer life expectancy. As a consequence, we are currently observing an increase in chemotherapy-associated liver injury patterns once considered unusual. Recognizing this form of damage in an early stage is crucial for reconsidering the therapy regimen and thus avoiding severe complications. In this frontier article, we analyze the role of imaging in detecting some of these pathological patterns, such as pseudocirrhosis, “yellow liver” due to chemotherapy-associated steatosis-steatohepatitis, and “blue liver”, including sinusoidal obstruction syndrome, veno-occlusive disease and peliosis.
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Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Sofia Vidali
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
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21
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Hitaka D, Kono T, Arai J, Murakami T, Takahashi-Igari M, Tagawa M, Mori K, Takada H. A novel case of congenital hepatic arterio-veno-portal shunts with umbilical vein aneurysm. Radiol Case Rep 2021; 16:3374-3379. [PMID: 34484548 PMCID: PMC8408554 DOI: 10.1016/j.radcr.2021.08.009] [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: 07/26/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
A term male infant presented with congenital hepatic arterio-veno-portal shunts. A mass-like lesion in the left lobe of the liver received blood supply from not only the umbilical vein, but also the hepatic and inferior intrahepatic arteries, communicating with the hepatic and portal veins in a complicated manner, with an umbilical vein aneurysm. The blood flow of the arterio-veno-portal shunts spontaneously and gradually declined from the neonatal period to six years of age. Although mild high-output cardiac failure had developed, no life-threatening events or health problems originating from portosystemic shunts, such as pulmonary artery hypertension and hepatopulmonary syndrome, were observed. However, this report shows that scrupulous follow-up to identify pulmonary artery hypertension and hepatopulmonary syndrome should be continued because complete resolution of the arterio-veno-portal shunts was not obtained in this case.
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Affiliation(s)
- Daisuke Hitaka
- Department of Pediatrics, University of Tsukuba Hospital
- Department of Neonatology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, 183-8561, Tokyo
| | - Junichi Arai
- Department of Neonatology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Takashi Murakami
- Department of Neonatology, Ibaraki Children's Hospital, Ibaraki, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba
| | | | - Manabu Tagawa
- Department of Child Health, Faculty of Medicine, University of Tsukuba
| | - Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba
| | - Hidetoshi Takada
- Department of Child Health, Faculty of Medicine, University of Tsukuba
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22
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Yang Q, Li J, Wang H, Wang S. A rare variation of duplicated portal vein: left branch derived from splenic vein mimicking cavernous transformation. BMC Gastroenterol 2021; 21:404. [PMID: 34702178 PMCID: PMC8549279 DOI: 10.1186/s12876-021-01970-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background Duplication of the portal vein is a rare type of anatomic variant of the portal vein (PV) system that can be incidentally found and can lead to various challenges and consequences. Herein, we report an unusual case to increase our understanding of such anatomic variants. Case presentation A 67-year-old asymptomatic woman was diagnosed with a liver space-occupying lesion by ultrasonography on a routine physical examination. The laboratory examinations from a local hospital suggested that her liver function tests were normal. The liver appeared normal on pre-contrast enhanced CT images. However, there were multiple complex abnormalities of PV found on contrast-enhanced CT scans, including two independent sources of PV (duplication), preduodenal PV, circum-portal pancreas, mimic cavernous transformation, abnormal branches of PV, and transient abnormal perfusion in the left lobe of the liver. MRI showed fatty infiltration in the left lobe of the liver. Conclusion This case extends our current understanding of the anatomical variations of the PV system. Knowledge of these complex and rare anatomical variations will help clinical doctors make a confident diagnosis or assist with proper planning of a surgical procedure.
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Affiliation(s)
- Qian Yang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.,Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, 400042, China
| | - Jun Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.,Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, 400042, China
| | - Hanwei Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.,Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, 400042, China
| | - Shunan Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China. .,Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, 400042, China.
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23
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Okano H, Okado R, Ito H, Asakawa H, Nose K, Tsuruga S, Tochio T, Kumazawa H, Sakuno T, Isono Y, Tanaka H, Matsusaki S, Sase T, Saito T, Mukai K, Nishimura A. Ischemic hepatitis with infectious endocarditis: A case report. Biomed Rep 2021; 15:97. [PMID: 34631052 PMCID: PMC8493543 DOI: 10.3892/br.2021.1473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022] Open
Abstract
A 58-year-old woman was admitted to Suzuka General Hospital with fever. She was diagnosed with infectious endocarditis based on the presence of anterior mitral leaflet vegetation on the echocardiography analysis and isolation of Pseudomonas guariconensis by blood culture. During treatment, the hepatic enzymes levels, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) were increased without any abdominal symptoms. Prolonged prothrombin time (PT) and prothrombin time international normalized ratio were observed, and acute hepatic failure was diagnosed. However, the hepatic injury resolved spontaneously with restoration of the PT value after the hepatic enzymes (AST, ALT, LDH and ALP) peaked. Diffusion-weighted imaging of hepatic magnetic resonance imaging showed diffuse high intensity of the entire liver except for part of the left lobe. The hepatic injury was diagnosed as ischemic hepatitis caused by embolization from the vegetation associated with infectious endocarditis. The recovery from hepatic ischemia was thought to be due to hepatic blood supply from extrahepatic collateral blood. After antibiotic treatment, the patient underwent resection of the vegetation on the anterior mitral valve leaflet. Hepatic artery occlusion is rare, but it may cause severe hepatic complications. During follow-up of infectious endocarditis, clinicians should be aware of the potential for whole organ ischemic damage caused by vessel occlusion, as well as hepatic ischemic damage.
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Affiliation(s)
- Hiroshi Okano
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Ryo Okado
- Department of Cardiology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Mie University, Tsu, Mie 514-8507, Japan
| | - Hiroki Asakawa
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Kenji Nose
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Satomi Tsuruga
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Tomomasa Tochio
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Hiroaki Kumazawa
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Takashi Sakuno
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Yoshiaki Isono
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Hiroki Tanaka
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Shimpei Matsusaki
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Tomohiro Sase
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Tomonori Saito
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Katsumi Mukai
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
| | - Akira Nishimura
- Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan
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24
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Consul N, Sirlin CB, Chernyak V, Fetzer DT, Masch WR, Arora SS, Do RKG, Marks RM, Fowler KJ, Borhani AA, Elsayes KM. Imaging Features at the Periphery: Hemodynamics, Pathophysiology, and Effect on LI-RADS Categorization. Radiographics 2021; 41:1657-1675. [PMID: 34559586 DOI: 10.1148/rg.2021210019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Liver lesions have different enhancement patterns at dynamic contrast-enhanced imaging. The Liver Imaging Reporting and Data System (LI-RADS) applies the enhancement kinetic of liver observations in its algorithms for imaging-based diagnosis of hepatocellular carcinoma (HCC) in at-risk populations. Therefore, careful analysis of the spatial and temporal features of these enhancement patterns is necessary to increase the accuracy of liver mass characterization. The authors focus on enhancement patterns that are found at or around the margins of liver observations-many of which are recognized and defined by LI-RADS, such as targetoid appearance, rim arterial phase hyperenhancement, peripheral washout, peripheral discontinuous nodular enhancement, enhancing capsule appearance, nonenhancing capsule appearance, corona enhancement, and periobservational arterioportal shunts-as well as peripheral and periobservational enhancement in the setting of posttreatment changes. Many of these are considered major or ancillary features of HCC, ancillary features of malignancy in general, features of non-HCC malignancy, features associated with benign entities, or features related to treatment response. Distinction between these different patterns of enhancement can help with achieving a more specific diagnosis of HCC and better assessment of response to local-regional therapy. ©RSNA, 2021.
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Affiliation(s)
- Nikita Consul
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Claude B Sirlin
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Victoria Chernyak
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - David T Fetzer
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - William R Masch
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Sandeep S Arora
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Richard K G Do
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Robert M Marks
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Kathryn J Fowler
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Amir A Borhani
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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25
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Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes. J Clin Med 2021; 10:jcm10122612. [PMID: 34198478 PMCID: PMC8231897 DOI: 10.3390/jcm10122612] [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: 05/25/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023] Open
Abstract
Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary referral center for pediatric OLT in the interventional radiological (IR) and conservative management of acquired APFs. A retrospective search was performed to retrieve pediatric patients (<18 years old) with a diagnosis of APF at color Doppler ultrasound (CDUS) or computed tomography angiography (CTA) from 2010 to 2020. Criteria for IR treatment were the presence of hemodynamic alterations at CDUS (resistive index <0.5; portal flow reversal) or clinical manifestations (bleeding; portal hypertension). Conservatively managed patients served as a control population. Clinical and imaging follow-up was analyzed. Twenty-three pediatric patients (median age, 4 years; interquartile range = 11 years; 15 males) with 24 APFs were retrieved. Twenty patients were OLT recipients with acquired APFs (16 iatrogenic). Twelve out of twenty-three patients were managed conservatively. The remaining 11 underwent angiography with confirmation of a shunt in 10, who underwent a total of 16 embolization procedures (14 endovascular; 2 transhepatic). Technical success was reached in 12/16 (75%) procedures. Clinical success was achieved in 8/11 (73%) patients; three clinical failures resulted in one death and two OLTs. After a median follow-up time of 42 months (range 1–107), successfully treated patients showed an improvement in hemodynamic parameters at CDUS. Conservatively managed patients showed a stable persistence of the shunts in six cases, spontaneous resolution in four, reduction in one and mild shunt increase in one. In pediatric patients undergoing liver interventions, APFs should be investigated. Although asymptomatic in most cases, IR treatment of APFs should be considered whenever hemodynamic changes are found at CDUS.
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26
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A comprehensive radiologic review of abdominal and pelvic torsions. Abdom Radiol (NY) 2021; 46:2942-2960. [PMID: 33388807 DOI: 10.1007/s00261-020-02868-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
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27
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Liu ZH, Zhou DK, Xiang YC, Zeng C, Wang WL. Huge portal venous aneurysm incidentaloma caused by intrahepatic arterioportal fistula accompany with hepatobiliary stones and cholangitis. Hepatobiliary Surg Nutr 2021; 10:288-290. [PMID: 33898581 DOI: 10.21037/hbsn-20-637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zheng-Hao Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Dong-Kai Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Yu-Cheng Xiang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Cheng Zeng
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Wei-Lin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China.,Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou, China.,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
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28
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Shen Y, Ma W, Hang Y, Liu LL, Jiang W, Wu SD. Clinical application of liver stiffness measurement in patients with cavernous transformation of portal vein. Exp Ther Med 2021; 21:442. [PMID: 33777190 DOI: 10.3892/etm.2021.9881] [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: 09/21/2019] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
The clinical outcomes differ between patients with cavernous transformation of the portal vein (CTPV) with and without cirrhosis. Therefore, invasive liver biopsy may be needed for the differential diagnosis of patients with CTPV with or without cirrhosis. The present study aimed to investigate the diagnostic efficacy of liver stiffness measurements (LSM) for the prediction of cirrhosis in patients with CTPV. A total of 20 patients with CTPV, 34 with chronic hepatitis B (CHB)-related cirrhosis and 20 healthy volunteers, were retrospectively recruited in the study. CTPV was diagnosed with contrast-enhanced computed tomography (CT) and ultrasound for the abdomen. LSM values were detected for each patient, while liver biopsy was performed in each patient in the CTPV and cirrhosis groups. The results demonstrated that LSM values were significantly lower in the CTPV group (12.5 kPa; range, 6.8-21.5 kPa) compared with the CHB-related cirrhosis group (21.0 kPa; range, 15.5-27.2 kPa; P=0.017). However, this was still higher compared with healthy volunteers (4.9 kPa; range 4.0-5.8 kPa; P<0.001). In addition, CTPV patients with cirrhosis (17.7 kPa; range, 13.9-30.8 kPa) exhibited significantly increased LSM values compared with those without cirrhosis (6.4 kPa; range, 5.7-7.8 kPa; P<0.001). Furthermore, LSM values in CTPV patients without cirrhosis were slightly higher compared with those of healthy volunteers (P=0.003), while no statistically significant difference was observed in LSM between CTPV patients with cirrhosis and CHB-related cirrhosis group. These findings indicated that LSM values could be used for the differential diagnosis of CTPV patients with or without cirrhosis. However, further validation studies are needed.
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Affiliation(s)
- Yue Shen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Liver Diseases, Shanghai 200032, P.R. China
| | - Wei Ma
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Liver Diseases, Shanghai 200032, P.R. China
| | - Ying Hang
- Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201204, P.R. China
| | - Li-Li Liu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Liver Diseases, Shanghai 200032, P.R. China
| | - Wei Jiang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Liver Diseases, Shanghai 200032, P.R. China.,Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201204, P.R. China.,Department of Gastroenterology, Xiamen Branch Zhongshan Hospital, Xiamen, Fujian 361006, P.R. China
| | - Sheng-Di Wu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Liver Diseases, Shanghai 200032, P.R. China
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29
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Ladrón-de-Guevara D, Canelo A, Piottante A, Regonesi C. False-Positive 18F-Prostate-Specific Membrane Antigen-1007 PET/CT Caused by Hepatic Multifocal Inflammatory Foci. Clin Nucl Med 2021; 46:e80-e83. [PMID: 33234935 DOI: 10.1097/rlu.0000000000003425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 68-year-old man with history of treated prostate cancer was referred to 68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT imaging. Moderate bone involvement was observed, with a normal liver tracer uptake. Bone biopsy confirmed metastases of prostate cancer. After therapy adjustment, a follow-up 18F-PSMA-1007 PET/CT revealed good response in bone lesions, although it showed 3 new rounded liver intense uptake foci. Concurrent PSA was 0.6 ng/mL. Liver function tests were normal. PET/CT-guided hepatic biopsy demonstrated no malignant cells, focal inflammation, and steatosis, being possibly the inflammation the cause of false-positive multifocal uptake of 18F-PSMA-1007. Following PET/CT, controls showed a normal liver.
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30
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Elsayed AA, Gomaa NA. Reference values and repeatability of pulsed-wave Doppler flowmetry of portal vein in healthy dromedary she-camels. J Adv Vet Anim Res 2020; 7:698-703. [PMID: 33409315 PMCID: PMC7774796 DOI: 10.5455/javar.2020.g470] [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: 02/13/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study was conducted to establish the normal values and repeatability of pulsed-wave (PW) Doppler ultrasonographic parameters of the hepatic portal circulation in healthy dromedary she-camels. MATERIALS AND METHODS According to the American Society of Veterinary Clinical Pathology guidelines, the sample size and statistical analysis were followed. Ten healthy, non-pregnant, non-lactating she-camels were selected after physical, hematological, and ultrasonographic examinations. All hepatic ultrasonographic measurements were obtained from unsedated standing she-camels at the 11th right intercostal space using B-mode and PW Doppler. RESULTS The ultrasonographic measurements were portal vein (PV) diameter 1.76 ± 0.37 cm; portal velocity 12.3 ± 3.2 cm/sec; portal area 2.05 ± 0.57 (cm)2; portal congestion index 0.16 ± 0.04 cms; and portal blood flow volume 0.02 ± 0.05 ml/sec/kg. The intra-assay coefficient of variations (CV)% of the above-mentioned variables were 5.84 ± 4.32, 12.3 ± 7.1, 10.5 ± 5.8, 14.7 ± 7.1, and 15.8 ± 12, respectively. However, the inter-assay CV% were 13.2 ± 5.9, 18.5 ± 8.4, 19.7 ± 7.6, 17.3 ± 8.8, and 31.9 ± 15, respectively. CONCLUSION This study provides data that may be used as reference values for Doppler measurements of the PV in she-camels, which may help diagnose some hepatic disorders in camels.
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Affiliation(s)
- Ahmed A. Elsayed
- Department of Animal Health and Poultry, Animal and Poultry Production Division, Desert Research Center DRC, Matariya, Egypt
| | - Naglaa A. Gomaa
- Department of Animal Medicine, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El Sheikh, Egypt
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31
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McGinty K. Acute Abdomen in the Oncology Patient. Semin Roentgenol 2020; 55:400-416. [PMID: 33220786 DOI: 10.1053/j.ro.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katrina McGinty
- Department of Radiology, UNC School of Medicine, Chapel Hill, NC.
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32
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Kobayashi S, Kozaka K, Gabata T, Matsui O, Koda W, Okuda M, Okumura K, Sugiura T, Ogi T. Pathophysiology and Imaging Findings of Bile Duct Necrosis: A Rare but Serious Complication of Transarterial Therapy for Liver Tumors. Cancers (Basel) 2020; 12:cancers12092596. [PMID: 32932894 PMCID: PMC7565329 DOI: 10.3390/cancers12092596] [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: 08/17/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Bile duct necrosis (BDN) is rare but serious complication of transarterial therapy for liver tumors. During development of BDN, ischemia of the peribiliary vascular plexus (PBP) induces the disruption of the bile duct epithelial protection mechanism, causing necrosis of the surrounding tissue by the detergent action of exuded bile acids, and eventually a biloma forms. Once BDN starts, persistent tissue damage to the surrounding bile duct is induced by imbibed bile acids, and portal vein thrombosis may also be observed. On CT images, BDN shows similar findings to intrahepatic bile duct dilatation, and, therefore, it is sometimes misdiagnosed. Clinicians should be aware that although BDN and biloma can usually be treated conservatively, in the presence of symptoms such as moderate or severe infection or interval growth of the biloma, prompt treatment is essential to avoid lethal abscess formation and sepsis. Abstract Bile duct necrosis (BDN) with biloma formation is a type of ischemic bile duct injury that is one of the serious complications associated with transarterial therapies, such as transcatheter chemoembolization therapy (TACE), and radioembolization for hepatocellular carcinoma (HCC) and hepatic arterial infusion chemotherapy (HAIC) for metastatic liver cancer from colorectal carcinoma. In terms of the occurrence of BDN and subsequent biloma formation, ischemic injury to the peribiliary vascular plexus (PBP), the supporting vessel of bile duct epithelium, is thought to be intimately associated. In this paper, we first describe the anatomy, blood supply, and function of the intrahepatic bile duct, and then illustrate the pathophysiology of BDN, and finally present the imaging findings of BDN. Under the process of BDN formation, ischemia of the PBP induces the disruption of the bile duct epithelial protection mechanism that causes coagulation and fibrinoid necrosis of the surrounding tissue by the detergent action of exuded bile acids, and eventually a biloma forms. Once BDN occurs, persistent tissue damage to the surrounding bile duct is induced by imbibed bile acids, and portal vein thrombosis may also be observed. On pre-contrast and contrast-enhanced computed tomography (CT), BDN shows similar findings to intrahepatic bile duct dilatation, and, therefore, it is sometimes misdiagnosed. Differentiation of imaging findings on CT and ultrasound (US)/magnetic resonance (MR) imaging/MR cholangiopancreatography (MRCP) is important for correct diagnosis of BDN.
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33
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Choi TW, Chung JW, Kim HC, Choi JW, Lee M, Hur S, Jae HJ. Aberrant gastric venous drainage and associated atrophy of hepatic segment II: computed tomography analysis of 2021 patients. Abdom Radiol (NY) 2020; 45:2764-2771. [PMID: 32382821 DOI: 10.1007/s00261-020-02563-x] [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: 01/17/2023]
Abstract
PURPOSE To investigate the prevalence and patterns of aberrant gastric venous drainage and associated atrophy of the hepatic segment on contrast-enhanced computed tomography (CT). METHODS Two radiologists retrospectively reviewed contrast-enhanced CT images from 2021 patients who underwent cone-beam CT-guided chemoembolization between January 2013 and December 2018. They determined the presence or absence of an aberrant gastric vein(s) and its drainage site by consensus, and qualitatively analyzed the presence or absence of atrophy of segments II or III. In cases of disagreement between the two reviewers regarding the presence of atrophy, quantitative analysis was performed using dedicated software. RESULTS A total of 31 aberrant right gastric veins were revealed on CT (1.5%), most of which drained into P2 (n = 8), the S2/3 border zone (n = 8), S2 (n = 6), or S4 (n = 5). An aberrant left gastric vein was observed in 21 (1.0%) patients, and P2 was the most common drainage site (n = 13) in these patients. Atrophy of segment II was more frequently observed among patients with aberrant gastric veins than among those without (26.9% versus 4.1%; p < 0.001). In addition, an aberrant gastric vein draining into P2 was most frequently accompanied by segment II atrophy (47.6%). CONCLUSION Aberrant right and left gastric veins were observed in 1.5% and 1.0% of patients, respectively. Atrophy of segment II was frequently observed in patients with aberrant gastric veins, especially those that drained into P2.
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34
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Costa AF, Clarke SE, Stueck AE, McInnes MDF, Thipphavong S. Benign Neoplasms, Mass-Like Infections, and Pseudotumors That Mimic Hepatic Malignancy at MRI. J Magn Reson Imaging 2020; 53:979-994. [PMID: 32621572 DOI: 10.1002/jmri.27251] [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: 03/23/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
A variety of conditions may mimic hepatic malignancy at MRI. These include benign hepatic tumors and tumor-like entities such as focal nodular hyperplasia-like lesions, hepatocellular adenoma, hepatic infections, inflammatory pseudotumor, vascular entities, and in the cirrhotic liver, confluent fibrosis, and hypertrophic pseudomass. These conditions demonstrate MRI features that overlap with hepatic malignancy, and can be challenging for radiologists to diagnose accurately. In this review we discuss the MRI manifestations of various conditions that mimic hepatic malignancy, and highlight features that may allow distinction from malignancy. Level of Evidence 5 Technical Efficacy Stage 3.
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Affiliation(s)
- Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley E Stueck
- Department of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew D F McInnes
- Department of Radiology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Seng Thipphavong
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
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35
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Naganuma H, Ishida H, Kuroda H, Suzuki Y, Ogawa M. Hereditary hemorrhagic telangiectasia: how to efficiently detect hepatic abnormalities using ultrasonography. J Med Ultrason (2001) 2020; 47:421-433. [PMID: 32390074 DOI: 10.1007/s10396-020-01022-w] [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: 02/03/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT) is a multiorgan genetic angiodysplastic affection characterized by visceral vascular malformations. It affects mainly the brains, lungs, gastrointestinal tract, and nasal mucosa. Unlike those organs, hepatic involvement, although very frequently occurring, is insufficiently recognized, mainly because of the complex vascular structure of this organ. Thus, treating HHT patients requires a solid understanding of these hepatic anomalies. It is especially important for any general clinicians to be able to recognize clinical findings in HHT, which leads to a high suspicion of HHT and have an index of suspicion for liver abnormalities of HHT. For this purpose, keen awareness of clinical as well as hepatic sonographic (US) findings is paramount. AIM The aim of this review is to summarize previously reported findings on the hepatic US through a thorough analysis of related articles, and to (a) determine the role of US in the diagnosis of hepatic involvement in HHT patients and (b) propose the most simple and easy way to detect HHT-related abnormalities during routine US examinations. CONCLUSION Hepatic US serves to diagnose the detailed complex hepatic changes typical of HHT, and contributes to increased diagnostic confidence of hepatic changes in HHT patients, with the most simple way not to overlook HHT-related abnormalities being to find hepatic artery dilatation.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote, Akita, 013-8602, Japan.
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
| | - Hidekatsu Kuroda
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Yasuaki Suzuki
- Department of Gastroenterology, Nayoro City General Hospital, Hokkaido, Japan
| | - Masahiro Ogawa
- Department of Gastroenterology and Hepatology, Nihon University Hospital, Tokyo, Japan
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Andrade RJ, Robles-Díaz M. Diagnostic and prognostic assessment of suspected drug-induced liver injury in clinical practice. Liver Int 2020; 40:6-17. [PMID: 31578817 DOI: 10.1111/liv.14271] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 02/13/2023]
Abstract
Idiosyncratic drug-induced liver injury (DILI) is a challenging liver disorder because it can present with a range of phenotypes, mimicking almost every other hepatic disease, and lacks specific biomarkers for its diagnosis. Hence, a confident DILI diagnosis is seldom possible as it relies on the precise establishment of a temporal sequence between the exposure to a given prescription drug or sometimes hidden herbal product/over the counter medication as well as the exclusion of other aetiologies of liver disease. However, an accurate diagnosis is of most importance, as prompt withdrawal of the causative agent is essential in DILI management. Indeed, DILI can be severe and even fatal or in a fraction of cases evolve to chronic damage, but specific biomarkers for predicting mortality/liver transplantation or a chronic outcome in the very early phases of DILI are not yet available. In this article, we discuss the best diagnostic and prognostic approach of a DILI suspicion by judiciously choosing and interpreting the standard tests currently used in clinical practice.
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Affiliation(s)
- Raúl J Andrade
- Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Facultad de Medicina, Universidad de Málaga, Malaga, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Mercedes Robles-Díaz
- Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Facultad de Medicina, Universidad de Málaga, Malaga, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Hong EK, Joo I, Park J, Lee K. Assessment of hepatic sinusoidal obstruction syndrome with intravoxel incoherent motion diffusion-weighted imaging: An experimental study in a rat model. J Magn Reson Imaging 2019; 51:81-89. [PMID: 31094055 DOI: 10.1002/jmri.26790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters may reflect perfusion and diffusion changes in hepatic sinusoidal obstruction syndrome (SOS). PURPOSE To investigate the feasibility of IVIM-DWI in the noninvasive assessment of hepatic SOS in an experimental rat model. STUDY TYPE Animal study. POPULATION/SUBJECTS Forty-four rats were administered different doses (90 or 160 mg/kg) of monocrotaline by gavage either 48 or 72 hours before MRI to induce different degrees of hepatic SOS, and another 10 rats served as controls. FIELD STRENGTH/SEQUENCE 3T scanner, IVIM-DWI using nine b values (0-800 sec/mm2 ). ASSESSMENT Histologically, rats were classified as having none (n = 10), mild (n = 8), moderate (n = 19), or severe SOS (n = 17). The apparent diffusion coefficient (ADC) and IVIM-derived parameters (D: true diffusion coefficient, D*: pseudo-diffusion coefficient, and f: perfusion fraction) of the liver parenchyma were measured. STATISTICAL TESTS IVIM-DWI parameters were compared according to histologic grades of SOS (none, mild, moderate, and severe), and receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic accuracy. RESULTS ADC, D, and f of the liver parenchyma were significantly different according to SOS severity groups (Ps < 0.01) and significantly decreased as SOS severity increased (rho = -0.323, -0.313, and -0.700; P = 0.017, 0.021, and <0.001, respectively). Means of f in none, mild, moderate, and severe SOS were 17.2%, 13.3%, 12.3%, and 11.1%, respectively. Among ADC and IVIM-derived parameters, f provided the highest area under the ROC curves for detecting ≥mild, ≥moderate, and severe SOS (0.991, 0.890, and 0.803, respectively). DATA CONCLUSION IVIM-DWI may be useful in the diagnosis and severity assessment of hepatic SOS. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:81-89.
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Affiliation(s)
- Eun Kyoung Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Juil Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
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Computed tomography evaluation of patent paraumbilical vein and its aneurysm in relation to other portosystemic collateral channels in patients with liver cirrhosis and portal hypertension. Pol J Radiol 2019; 84:e112-e117. [PMID: 31019603 PMCID: PMC6479138 DOI: 10.5114/pjr.2019.83135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 01/13/2023] Open
Abstract
Purpose The aim of the study was to evaluate the relationship between the diameter and aneurysmal dilatation of the paraumbilical vein (PUV) and the presence of portosystemic collateral shunts and their relationship with age and portal vein diameter. Material and methods The retrospective analysis, performed in the II Department of Radiology, Medical University Hospital in Warsaw, included 126 patients (77 males and 49 females) with patent umbilical vein and signs of portal hypertension due to liver cirrhosis. All patients underwent contrast enhanced abdominal CT. The average age was 54.7 ±12.98. We analysed the number and type of portosystemic collateral channels in respect of age, sex, presence of oesophageal varices, and the diameter of the paraumbilical vein and the portal vein. Results Our results disclosed statistically significant negative correlation between patient age and diameter of paraumbilical vein, number of portosystemic collateral channels and diameter of portal vein and positive correlation between diameter of paraumbilical vein and diameter of portal vein. A statistically significant difference in diameter of portal vein and number of collateral channels was found in groups with and without oesophageal varices. No significant difference in age and portal vein diameter was found in these groups. Conclusions Our study showed that younger patients with liver cirrhosis are characterised by wider paraumbilical veins and higher number of portosystemic collateral channels. The presence of oesophageal varices does not correlate with age, sex, diameter of paraumbilical vein, and number of collateral portosystemic channels.
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Hydrogen Sulfide as a Novel Regulatory Factor in Liver Health and Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:3831713. [PMID: 30805080 PMCID: PMC6360590 DOI: 10.1155/2019/3831713] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/29/2018] [Indexed: 02/08/2023]
Abstract
Hydrogen sulfide (H2S), a colorless gas smelling of rotten egg, has long been recognized as a toxic gas and environment pollutant. However, increasing evidence suggests that H2S acts as a novel gasotransmitter and plays important roles in a variety of physiological and pathological processes in mammals. H2S is involved in many hepatic functions, including the regulation of oxidative stress, glucose and lipid metabolism, vasculature, mitochondrial function, differentiation, and circadian rhythm. In addition, H2S contributes to the pathogenesis and treatment of a number of liver diseases, such as hepatic fibrosis, liver cirrhosis, liver cancer, hepatic ischemia/reperfusion injury, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, hepatotoxicity, and acute liver failure. In this review, the biosynthesis and metabolism of H2S in the liver are summarized and the role and mechanism of H2S in liver health and disease are further discussed.
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Iacobas I, Phung TL, Adams DM, Trenor CC, Blei F, Fishman DS, Hammill A, Masand PM, Fishman SJ. Guidance Document for Hepatic Hemangioma (Infantile and Congenital) Evaluation and Monitoring. J Pediatr 2018; 203:294-300.e2. [PMID: 30244993 DOI: 10.1016/j.jpeds.2018.08.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define the types of hepatic hemangiomas using the updated International Society for the Study of Vascular Anomalies classification and to create a set of guidelines for their diagnostic evaluation and monitoring. STUDY DESIGN We used a rigorous, transparent consensus protocol defined by an approved methodology, with input from multiple pediatric experts in vascular anomalies from hematology-oncology, surgery, pathology, radiology, and gastroenterology. RESULTS In the first section, we define the subtypes of hepatic hemangiomas based on the clinical course, histology, and radiologic characteristics. We recommend against using the term "hemangioma" for any vascular malformations affecting the liver or any hypervascular tumors that are not characterized by the approved definitions. We recommend against using the term "hemangioendothelioma" for infantile or congenital hemangioma. The following 2 sections dedicated to infantile hepatic hemangioma and to congenital hepatic hemangioma individually describe these subtypes in further detail, including complications to be considered during monitoring and respectively recommended screening evaluations. CONCLUSIONS Although institutional variations may exist for specific clinical details, a clear understanding of the diagnosis of hepatic hemangiomas affecting children and the possible complications that require screening during the monitoring period should be standard. As children with hepatic hemangiomas are managed by different medical and surgical specialties, we offer an expert opinion multidisciplinary consensus based on current literature and on data extracted from the liver hemangioma registry.
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Affiliation(s)
- Ionela Iacobas
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
| | - Thuy L Phung
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Denise M Adams
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Adrienne Hammill
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Prakash M Masand
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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Rajesh S, Mukund A, Sureka B, Bansal K, Ronot M, Arora A. Non-cirrhotic portal hypertension: an imaging review. Abdom Radiol (NY) 2018; 43:1991-2010. [PMID: 29564495 DOI: 10.1007/s00261-018-1570-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Non-cirrhotic portal hypertension (NCPH) comprises a group of diseases that are characterized by increased portal pressure in the absence of cirrhosis of the liver. It may arise as a result of either primary hepatic disease or the effects of systemic disorders on liver. The natural course of NCPH is largely indolent and benign with an overall better outcome than cirrhosis, as long as the complications of portal hypertension are properly managed and regular surveillance is carried out. However, due to the numerous and variable etiological factors and lack of standardized diagnostic criteria, this entity is under-recognized clinically as well as pathologically and often gets mislabeled as cryptogenic cirrhosis. Therefore, it is imperative for radiologists to be aware of the imaging features of various entities that constitute NCPH to facilitate early recognition of this disorder. The present review shall comprehensively discuss the role of imaging in the diagnosis of obliterative portal venopathy, which is a common and one of the most poorly understood disorders leading to NCPH. The other radiologically relevant entities will also be briefly appraised.
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Affiliation(s)
- S Rajesh
- The Liver Unit, Cochin Gastroenterology Group, Department of Diagnostic and Interventional Radiology, Ernakulam Medical Centre, Kochi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India
| | - Binit Sureka
- Department of Diagnostic Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India
| | - Kalpana Bansal
- Department of Diagnostic Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India
| | - Maxime Ronot
- Service de Radiologie, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Beaujon, 100 boulevard General Leclerc, 92118, Clichy, France
| | - Ankur Arora
- Department of Radiology, Worthing Hospital, Western Sussex NHS Foundation Trust, Worthing, BN11 2DH, UK.
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Karaosmanoğlu AD, Onur MR, Özmen MN, Akata D, Karçaaltıncaba M. Imaging of pathology involving the space around the hepatic veins: "perivenous pattern". ACTA ACUST UNITED AC 2018; 24:77-82. [PMID: 29757146 DOI: 10.5152/dir.2018.17510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to illustrate diseases involving the potential space around the hepatic veins. Perivenous halo sign can be seen in patients with congestive heart failure or fluid overload. Perivenous involvement can be observed in patients with alcoholic fatty liver disease, which can be focal or diffuse. Metastasis and primary liver tumor spread can also involve this space most likely due to involvement of lymphatics around hepatic veins.
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Affiliation(s)
- Ali Devrim Karaosmanoğlu
- Department of Radiology, Liver Imaging Team, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Liver Imaging Team, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mustafa Nasuh Özmen
- Department of Radiology, Liver Imaging Team, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Liver Imaging Team, Hacettepe University School of Medicine, Ankara, Turkey
| | - Muşturay Karçaaltıncaba
- Department of Radiology, Liver Imaging Team, Hacettepe University School of Medicine, Ankara, Turkey
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Primary Hepatic Neoplasms of Vascular Origin: Key Imaging Features and Differential Diagnoses With Radiology-Pathology Correlation. AJR Am J Roentgenol 2017; 209:W350-W359. [PMID: 29023152 DOI: 10.2214/ajr.17.18100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This article describes, illustrates, and correlates imaging and pathologic features of primary vascular mesenchymal neoplasms of the liver, which arise from the vascular endothelium and perivascular epithelioid cells. CONCLUSION Familiarity with the spectrum of benign, malignant-potential and malignant vascular neoplasms, and nonneoplastic mimickers allows consideration in the differential diagnosis of enhancing hepatic masses. Understanding relevant pathologic features facilitates recognition of key imaging features, specifically dynamic contrast enhancement patterns on CT and MRI, which provide a useful classification system.
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