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Yoshino Y, Suzuki G, Shiomi H, Kimoto T, Seri S, Yamazaki H, Yamada K. Albumin-bilirubin score is a useful predictor of worsening liver reserve after stereotactic body radiation therapy in elderly Japanese patients with hepatocellular carcinoma. JOURNAL OF RADIATION RESEARCH 2024; 65:244-250. [PMID: 38415344 PMCID: PMC10959440 DOI: 10.1093/jrr/rrae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/09/2024] [Indexed: 02/29/2024]
Abstract
The prognosis of patients with hepatocellular carcinoma (HCC) is closely related to their liver reserves. The Child-Pugh (CP) score has traditionally been used to evaluate this reserve, with CP Grade B (CP score ≥ 7) associated with a higher risk of radiation-induced liver disease after stereotactic body radiation therapy (SBRT). However, the CP score has limitations, as it does not accurately assess liver reserve capacity. The albumin-bilirubin (ALBI) score has been introduced as a meticulous indicator of liver reserve for the treatment of HCC. We retrospectively evaluated the role of the ALBI score in estimating the worsening liver reserve in 42 patients with HCC treated with SBRT using CyberKnife between 2015 and 2023. The median biologically effective dose (α/β = 10 Gy) was 100 Gy. For a median follow-up duration of 17.4 months, the 1-year overall survival (OS), local control (LC) and progression-free survival (PFS) rates were 100, 98 and 62%, respectively. Worsening liver reserve was defined as an increase in the modified ALBI grade or CP score within 1 year after SBRT. Univariate and multivariate analyses showed that the baseline ALBI score (≥-2.7 vs <-2.7) was the only significantly different predictor of worsening liver reserve. The OS and LC rates after SBRT for HCC were satisfactory. However, the PFS was poor, and recurrent HCC will require additional treatment. It is clinically important to predict the liver reserve capacity after SBRT, and the baseline ALBI score is a useful predictor.
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Affiliation(s)
- Yuki Yoshino
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Gen Suzuki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hiroya Shiomi
- Department of Radiation Oncology, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
- Department of Radiology, Soseikai CyberKnife Center, Fushimi-ku, Kyoto 612-8248, Japan
| | - Takuya Kimoto
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Sho Seri
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Balasubramanian PK, Lai WC, Seng GH, C K, Selvaraj J. APESTNet with Mask R-CNN for Liver Tumor Segmentation and Classification. Cancers (Basel) 2023; 15:cancers15020330. [PMID: 36672281 PMCID: PMC9857237 DOI: 10.3390/cancers15020330] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Diagnosis and treatment of hepatocellular carcinoma or metastases rely heavily on accurate segmentation and classification of liver tumours. However, due to the liver tumor's hazy borders and wide range of possible shapes, sizes, and positions, accurate and automatic tumour segmentation and classification remains a difficult challenge. With the advancement of computing, new models in artificial intelligence have evolved. Following its success in Natural language processing (NLP), the transformer paradigm has been adopted by the computer vision (CV) community of the NLP. While there are already accepted approaches to classifying the liver, especially in clinical settings, there is room for advancement in terms of their precision. This paper makes an effort to apply a novel model for segmenting and classifying liver tumours built on deep learning. In order to accomplish this, the created model follows a three-stage procedure consisting of (a) pre-processing, (b) liver segmentation, and (c) classification. In the first phase, the collected Computed Tomography (CT) images undergo three stages of pre-processing, including contrast improvement via histogram equalization and noise reduction via the median filter. Next, an enhanced mask region-based convolutional neural networks (Mask R-CNN) model is used to separate the liver from the CT abdominal image. To prevent overfitting, the segmented picture is fed onto an Enhanced Swin Transformer Network with Adversarial Propagation (APESTNet). The experimental results prove the superior performance of the proposed perfect on a wide variety of CT images, as well as its efficiency and low sensitivity to noise.
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Affiliation(s)
- Prabhu Kavin Balasubramanian
- Department of Data Science and Business System, Kattankulathur Campus, SRM Institute of Science and Technology, Chennai 603203, Tamil Nadu, India
| | - Wen-Cheng Lai
- Bachelor Program in Industrial Projects, National Yunlin University of Science and Technology, Douliu 640301, Taiwan
- Department of Electronic Engineering, National Yunlin University of Science and Technology, Douliu 640301, Taiwan
| | - Gan Hong Seng
- Department of Data Science, UMK City Campus, University Malaysia Kelantan, Pengkalan Chepa, Kelantan 16100, Malaysia
- Correspondence: (G.H.S.); (K.C.)
| | - Kavitha C
- Department of Computer Science and Engineering, Sathyabama Institute of Science and Technology, Chennai 600119, Tamil Nadu, India
- Correspondence: (G.H.S.); (K.C.)
| | - Jeeva Selvaraj
- Department of Data Science and Business System, Kattankulathur Campus, SRM Institute of Science and Technology, Chennai 603203, Tamil Nadu, India
- Department of Data Science, UMK City Campus, University Malaysia Kelantan, Pengkalan Chepa, Kelantan 16100, Malaysia
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3
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Non-invasive multi-channel deep learning convolutional neural networks for localization and classification of common hepatic lesions. Pol J Radiol 2021; 86:e440-e448. [PMID: 34429791 PMCID: PMC8369821 DOI: 10.5114/pjr.2021.108257] [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: 07/24/2020] [Accepted: 09/06/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose Machine learning techniques, especially convolutional neural networks (CNN), have revolutionized the spectrum of computer vision tasks with a primary focus on supervised and labelled image datasets. We aimed to assess a novel method to segment the liver from the abdomen computed tomography (CT) image using the CNN network, and to train a unique method to locate and classify liver lesion pre-histological findings using multi-channel deep learning CNN (MDL-CNN). Material and methods The post-contrast CT images of the liver with a resolution of 0.625 mm were chosen for the study. In a random method, 50 examples of each hepatocellular carcinomas, metastases tumours, haemangiomas, hepatic cysts were chosen and evaluated. Results The dice score quantitatively analyses the similarity of segmentation results with the training dataset. In the first CNN model for segmenting the liver, the dice score was 96.18%. The MDL-CNN model yielded 98.78% accuracy in classification, and the dice score for locating liver lesions was 95.70%. Additionally, the performance of this model was compared to various other existing models. Conclusions According to our study, the machine learning approach can be successfully implemented to segment the liver and classify lesions, which will help radiologists impart better diagnosis.
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4
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Shaker R, Wilke C, Ober C, Lawrence J. Machine learning model development for quantitative analysis of CT heterogeneity in canine hepatic masses may predict histologic malignancy. Vet Radiol Ultrasound 2021; 62:711-719. [PMID: 34448312 DOI: 10.1111/vru.13012] [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: 02/23/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/24/2023] Open
Abstract
Tumor heterogeneity is a well-established marker of biologically aggressive neoplastic processes and is associated with local recurrence and distant metastasis. Quantitative analysis of CT textural features is an indirect measure of tumor heterogeneity and therefore may help predict malignant disease. The purpose of this retrospective, secondary analysis study was to quantitatively evaluate CT heterogeneity in dogs with histologically confirmed liver masses to build a predictive model for malignancy. Forty dogs with liver tumors and corresponding histopathologic evaluation from a previous prospective study were included. Triphasic image acquisition was standardized across dogs and whole liver and liver mass were contoured on each precontrast and delayed postcontrast dataset. First-order and second-order indices were extracted from contoured regions. Univariate analysis identified potentially significant indices that were subsequently used for top-down model construction. Multiple quadratic discriminatory models were constructed and tested, including individual models using both postcontrast and precontrast whole liver or liver mass volumes. The best performing model utilized the CT features voxel volume and uniformity from postcontrast mass contours; this model had an accuracy of 0.90, sensitivity of 0.67, specificity of 1.0, positive predictive value of 1.0, negative predictive value of 0.88, and precision of 1.0. Heterogeneity indices extracted from delayed postcontrast CT hepatic mass contours were more informative about tumor type compared to indices from whole liver contours, or from precontrast hepatic mass and whole liver contours. Results demonstrate that CT radiomic feature analysis may hold clinical utility as a noninvasive method of predicting hepatic malignancy and may influence diagnostic or therapeutic approaches.
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Affiliation(s)
- Rami Shaker
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA.,Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher Wilke
- Department of Radiation Oncology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher Ober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Jessica Lawrence
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
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Kuhn J, Papanastasiou G, Tai CW, Moran CM, Jansen MA, Tavares AA, Lennen RJ, Corral CA, Wang C, Thomson AJ, Berry CC, Yiu HH. Tri-modal imaging of gold-dotted magnetic nanoparticles for magnetic resonance imaging, computed tomography and intravascular ultrasound: an in vitro study. Nanomedicine (Lond) 2020; 15:2433-2445. [PMID: 32914695 DOI: 10.2217/nnm-2020-0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Aim: To examine the multimodal contrasting ability of gold-dotted magnetic nanoparticles (Au*MNPs) for magnetic resonance (MR), computed tomography (CT) and intravascular ultrasound (IVUS) imaging. Materials & methods: Au*MNPs were prepared by adapting an impregnation method, without using surface capping reagents and characterized (transmission electron microscopy, x-ray diffraction and Fourier-transform infrared spectroscopy) with their in vitro cytotoxicity assessed, followed by imaging assessments. Results: The contrast-enhancing ability of Au*MNPs was shown to be concentration-dependent across MR, CT and IVUS imaging. The Au content of the Au*MNP led to evident increases of the IVUS signal. Conclusion: We demonstrated that Au*MNPs showed concentration-dependent contrast-enhancing ability in MRI and CT imaging, and for the first-time in IVUS imaging due to the Au content. These Au*MNPs are promising toward solidifying tri-modal imaging-based theragnostics.
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Affiliation(s)
- Joel Kuhn
- Chemical Engineering, School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - Giorgos Papanastasiou
- School of Computer Science & Electronic Engineering, University of Essex, Colchester, CO4 3SQ, UK.,Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K
| | - Cheuk-Wai Tai
- Department of Materials & Environmental Chemistry, Arrhenius Laboratory, Stockholm University, Stockholm, SE-106 91, Sweden
| | - Carmel M Moran
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K.,Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Maurits A Jansen
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K.,Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Adriana As Tavares
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K.,Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Ross J Lennen
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K.,Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Carlos Alcaide Corral
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K.,Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Chengjia Wang
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K
| | - Adrian Jw Thomson
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, U.K.,Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Catherine C Berry
- Centre for Cell Engineering, IMCSB, Joseph Black Building, University Avenue, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Humphrey Hp Yiu
- Chemical Engineering, School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, UK
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Gao L, Lv Y, Jin Y, Han F, Yao Z, Yang J, Zhang J. Differential diagnosis of hepatic cancerous nodules and cirrhosis nodules by spectral CT imaging: a feasibility study. Acta Radiol 2019; 60:1602-1608. [PMID: 30943752 DOI: 10.1177/0284185119840230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lu Gao
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Yi Lv
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Yingying Jin
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Fang Han
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Jian Yang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, PR China
| | - Jiawen Zhang
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
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7
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Das A, Das P, Panda SS, Sabut S. Detection of Liver Cancer Using Modified Fuzzy Clustering and Decision Tree Classifier in CT Images. PATTERN RECOGNITION AND IMAGE ANALYSIS 2019. [DOI: 10.1134/s1054661819020056] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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8
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Frid-Adar M, Diamant I, Klang E, Amitai M, Goldberger J, Greenspan H. GAN-based synthetic medical image augmentation for increased CNN performance in liver lesion classification. Neurocomputing 2018. [DOI: 10.1016/j.neucom.2018.09.013] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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9
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Zhou B, Wang R, Chen F, Zhao L, Wang P, Li X, Bányai I, Ouyang Q, Shi X, Shen M. 99mTc-Labeled RGD-Polyethylenimine Conjugates with Entrapped Gold Nanoparticles in the Cavities for Dual-Mode SPECT/CT Imaging of Hepatic Carcinoma. ACS APPLIED MATERIALS & INTERFACES 2018; 10:6146-6154. [PMID: 29380596 DOI: 10.1021/acsami.7b17107] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report the construction and characterization of 99mTc-labeled arginine-glycine-aspartic acid (RGD)-polyethylenimine (PEI) conjugates with entrapped gold nanoparticles in the cavities (RGD-99mTc-Au PENPs) for dual-mode single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging of an orthotopic hepatic carcinoma model. In this study, PEI was successively decorated with diethylenetriaminepentaacetic acid, poly(ethylene glycol) (PEG), and PEGylated RGD segments, and was utilized as an effective nanoplatform to entrap Au NPs and to be labeled with 99mTc. We showed that the designed RGD-99mTc-Au PENPs displayed desirable colloidal stability and radiostability, and cytocompatibility in the investigated concentration range, and could be specifically uptaken by αvβ3 integrin-overexpressing liver cancer cells in vitro. In vivo CT and SPECT imaging results indicated that the particles were able to be accumulated within an orthotopic hepatic carcinoma and displayed both CT and SPECT contrast enhancement in the tumor tissue. With the proven biocompatibility in vivo via histological examinations, the designed RGD-99mTc-Au PENPs may be potentially employed as an effective nanoprobe for a highly efficient dual-mode SPECT/CT imaging of various αvβ3 integrin-overexpressing tumors.
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Affiliation(s)
- Benqing Zhou
- State Key Laboratory for Modifcation of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, P. R. China
| | - Ruizhi Wang
- Department of Interventional Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University , Shanghai 200080, P. R. China
| | - Feng Chen
- State Key Laboratory for Modifcation of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, P. R. China
| | - Lingzhou Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai 200080, P. R. China
| | - Peng Wang
- State Key Laboratory for Modifcation of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, P. R. China
| | - Xin Li
- State Key Laboratory for Modifcation of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, P. R. China
| | - István Bányai
- Department of Physical Chemistry, University of Debrecen , H-4032 Debrecen, Hungary
| | - Qiang Ouyang
- Department of Interventional Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University , Shanghai 200080, P. R. China
| | - Xiangyang Shi
- State Key Laboratory for Modifcation of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, P. R. China
| | - Mingwu Shen
- State Key Laboratory for Modifcation of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, P. R. China
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10
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Chang CC, Chen HH, Chang YC, Yang MY, Lo CM, Ko WC, Lee YF, Liu KL, Chang RF. Computer-aided diagnosis of liver tumors on computed tomography images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 145:45-51. [PMID: 28552125 DOI: 10.1016/j.cmpb.2017.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 02/19/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Liver cancer is the tenth most common cancer in the USA, and its incidence has been increasing for several decades. Early detection, diagnosis, and treatment of the disease are very important. Computed tomography (CT) is one of the most common and robust imaging techniques for the detection of liver cancer. CT scanners can provide multiple-phase sequential scans of the whole liver. In this study, we proposed a computer-aided diagnosis (CAD) system to diagnose liver cancer using the features of tumors obtained from multiphase CT images. METHODS A total of 71 histologically-proven liver tumors including 49 benign and 22 malignant lesions were evaluated with the proposed CAD system to evaluate its performance. Tumors were identified by the user and then segmented using a region growing algorithm. After tumor segmentation, three kinds of features were obtained for each tumor, including texture, shape, and kinetic curve. The texture was quantified using 3 dimensional (3-D) texture data of the tumor based on the grey level co-occurrence matrix (GLCM). Compactness, margin, and an elliptic model were used to describe the 3-D shape of the tumor. The kinetic curve was established from each phase of tumor and represented as variations in density between each phase. Backward elimination was used to select the best combination of features, and binary logistic regression analysis was used to classify the tumors with leave-one-out cross validation. RESULTS The accuracy and sensitivity for the texture were 71.82% and 68.18%, respectively, which were better than for the shape and kinetic curve under closed specificity. Combining all of the features achieved the highest accuracy (58/71, 81.69%), sensitivity (18/22, 81.82%), and specificity (40/49, 81.63%). The Az value of combining all features was 0.8713. CONCLUSIONS Combining texture, shape, and kinetic curve features may be able to differentiate benign from malignant tumors in the liver using our proposed CAD system.
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Affiliation(s)
- Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hong-Hao Chen
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Yang Yang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chung-Ming Lo
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chun Ko
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yee-Fan Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Ruey-Feng Chang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
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11
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Tian H, Wang Q. Quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolisation using contrast-enhanced ultrasound. Eur J Cancer 2016; 68:82-89. [DOI: 10.1016/j.ejca.2016.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/29/2016] [Accepted: 08/21/2016] [Indexed: 02/06/2023]
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12
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Regenboog M, Bohte AE, Somers I, van Delden OM, Maas M, Hollak CE. Imaging characteristics of focal splenic and hepatic lesions in type 1 Gaucher disease. Blood Cells Mol Dis 2016; 60:49-57. [DOI: 10.1016/j.bcmd.2016.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 02/07/2023]
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13
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Dong Y, Wang WP, Mao F, Ji ZB, Huang BJ. Application of imaging fusion combining contrast-enhanced ultrasound and magnetic resonance imaging in detection of hepatic cellular carcinomas undetectable by conventional ultrasound. J Gastroenterol Hepatol 2016; 31:822-8. [PMID: 26480287 DOI: 10.1111/jgh.13202] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/14/2015] [Accepted: 10/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to explore the value of volume navigation image fusion-assisted contrast-enhanced ultrasound (CEUS) in detection for radiofrequency ablation guidance of hepatocellular carcinomas (HCCs), which were undetectable on conventional ultrasound. METHODS From May 2012 to May 2014, 41 patients with 49 HCCs were included in this study. All lesions were detected by dynamic magnetic resonance imaging (MRI) and planned for radiofrequency ablation but were undetectable on conventional ultrasound. After a bolus injection of 2.4 ml SonoVue® (Bracco, Italy), LOGIQ E9 ultrasound system with volume navigation system (version R1.0.5, GE Healthcare, Milwaukee, WI, USA) was used to fuse CEUS and MRI images. The fusion time, fusion success rate, lesion enhancement pattern, and detection rate were analyzed. RESULTS Image fusions were conducted successfully in 49 HCCs, the technical success rate was 100%. The average fusion time was (9.2 ± 2.1) min (6-12 min). The mean diameter of HCCs was 25.2 ± 5.3 mm (mean ± SD), and mean depth was 41.8 ± 17.2 mm. The detection rate of HCCs using CEUS/MRI imaging fusion (95.9%, 47/49) was significantly higher than CEUS (42.9%, 21/49) (P < 0.05). For small HCCs (diameter, 1-2 cm), the detection rate using imaging fusion (96.9%, 32/33) was also significantly higher than CEUS (18.2%, 6/33) (P < 0.01). All HCCs displayed a rapid wash-in pattern in the arterial phase of CEUS. CONCLUSIONS Imaging fusion combining CEUS and MRI is a promising technique to improve the detection, precise localization, and accurate diagnosis of undetectable HCCs on conventional ultrasound, especially small and atypical HCCs.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Mao
- Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Zheng-Biao Ji
- Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Bei-Jian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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14
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Inoue T, Hyodo T, Korenaga K, Murakami T, Imai Y, Higaki A, Suda T, Takano T, Miyoshi K, Koda M, Tanaka H, Iijima H, Ochi H, Hirooka M, Numata K, Kudo M. Kupffer phase image of Sonazoid-enhanced US is useful in predicting a hypervascularization of non-hypervascular hypointense hepatic lesions detected on Gd-EOB-DTPA-enhanced MRI: a multicenter retrospective study. J Gastroenterol 2016; 51:144-52. [PMID: 26373860 DOI: 10.1007/s00535-015-1094-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 06/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND It remains unknown whether Kupffer-phase images in Sonazoid-enhanced ultrasonography (US) can be used to predict hypervascularization of borderline lesions. Therefore, we aimed to clarify whether Kupffer-phase images in Sonazoid-enhanced ultrasonography can predict subsequent hypervascularization in hypovascular borderline lesions detected on hepatobiliary-phase gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging. METHODS From January 2008 to March 2012, 616 low-intensity hypovascular nodules were detected in hepatobiliary-phase images of Gd-EOB-DTPA-enhanced MRI at nine institutions. Among these, 167 nodules, which were confirmed as hypovascular by Gd-EOB-DTPA-enhanced MRI and Sonazoid-enhanced US, were evaluated in this study. Potential hypervascularization factors were selected based on their clinical significance and the results of previous reports. The Kaplan-Meier model and log-rank test were used for univariate analysis and the Cox regression model was used for multivariate analysis. RESULTS The cumulative incidence of hypervascularization of borderline lesions was 18, 37, and 43 % at 1, 2, and 3 years, respectively. Univariate analyses showed that tumor size (p = 0.0012) and hypoperfusion on Kupffer-phase images in Sonazoid-enhanced US (p = 0.004) were associated with hypervascularization of the tumor. Multivariate analysis showed that tumor size [HR: 1.086, 95 % confidence interval = 1.027-1.148, p = 0.004] and hypo perfusion on Kupffer-phase images [HR: 3.684, 95 % confidence interval = 1.798-7.546, p = 0.0004] were significantly different. CONCLUSIONS Kupffer-phase images in Sonazoid-enhanced US and tumor diameter can predict hypervascularization of hypointense borderline lesions detected on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI.
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Affiliation(s)
- Tatsuo Inoue
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan.
| | - Tomoko Hyodo
- Department of Diagnostic Radiology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan
| | - Keiko Korenaga
- Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Takamichi Murakami
- Department of Diagnostic Radiology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan
| | - Atsushi Higaki
- Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan
| | - Takeshi Suda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Toru Takano
- Division of Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kennichi Miyoshi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
| | - Masahiko Koda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
| | - Hironori Tanaka
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Japan
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroko Iijima
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hironori Ochi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan.
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X-ray Scatter Imaging of Hepatocellular Carcinoma in a Mouse Model Using Nanoparticle Contrast Agents. Sci Rep 2015; 5:15673. [PMID: 26511147 PMCID: PMC4625152 DOI: 10.1038/srep15673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/08/2015] [Indexed: 01/22/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and is almost uniformly fatal. Current methods of detection include ultrasound examination and imaging by CT scan or MRI; however, these techniques are problematic in terms of sensitivity and specificity, and the detection of early tumors (<1 cm diameter) has proven elusive. Better, more specific, and more sensitive detection methods are therefore urgently needed. Here we discuss the application of a newly developed x-ray imaging technique called Spatial Frequency Heterodyne Imaging (SFHI) for the early detection of HCC. SFHI uses x-rays scattered by an object to form an image and is more sensitive than conventional absorption-based x-radiography. We show that tissues labeled in vivo with gold nanoparticle contrast agents can be detected using SFHI. We also demonstrate that directed targeting and SFHI of HCC tumors in a mouse model is possible through the use of HCC-specific antibodies. The enhanced sensitivity of SFHI relative to currently available techniques enables the x-ray imaging of tumors that are just a few millimeters in diameter and substantially reduces the amount of nanoparticle contrast agent required for intravenous injection relative to absorption-based x-ray imaging.
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Makino Y, Imai Y, Igura T, Hori M, Fukuda K, Sawai Y, Kogita S, Fujita N, Takehara T, Murakami T. Comparative evaluation of three-dimensional Gd-EOB-DTPA-enhanced MR fusion imaging with CT fusion imaging in the assessment of treatment effect of radiofrequency ablation of hepatocellular carcinoma. ACTA ACUST UNITED AC 2015; 40:102-11. [PMID: 25052767 DOI: 10.1007/s00261-014-0201-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the feasibility of fusion of pre- and post-ablation gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) to evaluate the effects of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC), compared with similarly fused CT images PATIENTS AND METHODS This retrospective study included 67 patients with 92 HCCs treated with RFA. Fusion images of pre- and post-RFA dynamic CT, and pre- and post-RFA Gd-EOB-DTPA-MRI were created, using a rigid registration method. The minimal ablative margin measured on fusion imaging was categorized into three groups: (1) tumor protruding outside the ablation zone boundary, (2) ablative margin 0-<5.0 mm beyond the tumor boundary, and (3) ablative margin ≥5.0 mm beyond the tumor boundary. The categorization of minimal ablative margins was compared between CT and MR fusion images. RESULTS In 57 (62.0%) HCCs, treatment evaluation was possible both on CT and MR fusion images, and the overall agreement between them for the categorization of minimal ablative margin was good (κ coefficient = 0.676, P < 0.01). MR fusion imaging enabled treatment evaluation in a significantly larger number of HCCs than CT fusion imaging (86/92 [93.5%] vs. 62/92 [67.4%], P < 0.05). CONCLUSIONS Fusion of pre- and post-ablation Gd-EOB-DTPA-MRI is feasible for treatment evaluation after RFA. It may enable accurate treatment evaluation in cases where CT fusion imaging is not helpful.
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Affiliation(s)
- Yuki Makino
- Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18, Johnan, Ikeda, Osaka, 563-8510, Japan
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Aramaki O, Takayama T, Higaki T, Nakayama H, Okubo T, Midorikawa Y, Moriguchi M. Preoperative diagnosis with versus without MRI in resection for hepatocellular carcinoma. Surgery 2015. [PMID: 26206318 DOI: 10.1016/j.surg.2015.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Although MRI has been considered one of the most sensitive diagnostic techniques for hepatocellular carcinoma (HCC), a clear-cut beneficial effect of the use of preoperative MRI remains unclear. We assessed whether preoperative MRI has a beneficial effect on outcomes in patients scheduled to undergo resection of HCC. METHODS We evaluated 449 patients with 553 liver tumors. MRI was performed in 349 of these patients, but not in the other 100. Ultrasonography, dynamic CT, and angiography were performed in all patients. Diagnostic abilities and long-term outcomes were compared between patients who did and did not undergo MRI. RESULTS The MRI group (349 patients) had 419 liver tumors and the no MRI group (100 patients) had 134 tumors. Preoperatively, the size of the HCC did not differ between the MRI (median, 30 mm; range, 10-205) and the no MRI group (median, 34 mm; range, 10-175; P = .99). The diagnostic accuracy was 98% in the MRI group and 96% in the no MRI group. Recurrence-free survival rates at 5 years were 31% (95% CI, 20.9-42.5) in the no MRI group, compared with 26% (95% CI, 20.1-32.1) in the MRI (P = .45). Overall survival rates at 5 years were 57% (95% CI, 45.6-68.1) in the no MRI group and 60% (95% CI, 53.4-66.8) in the MRI group (P = .64). After analysis by propensity score matching in 100 pairs of patients, recurrence-free survival rates at 5 years were 31% (95% CI, 20.9-42.5) in the no MRI group, compared with 19% (95% CI, 10.3-30.9) in the MRI group (P = .54). Overall survival rates at 5 years were 57% (95% CI, 45.6-68.1) in the no MRI group and 57% (95% CI, 43.2-68.8) in the MRI group (P = .92). CONCLUSION MRI seemed to offer no beneficial impact on diagnostic abilities or long-term outcomes after resection for HCC and is thus of questionable value as a routine imaging modality when combined with CT and angiography clinical practice.
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Affiliation(s)
- Osamu Aramaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takao Okubo
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
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Hayano K, Lee SH, Sahani DV. Imaging for assessment of treatment response in hepatocellular carcinoma: Current update. Indian J Radiol Imaging 2015; 25:121-8. [PMID: 25969635 PMCID: PMC4419421 DOI: 10.4103/0971-3026.155835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Morphologic methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) are considered as the gold standard for response assessment in the management of cancer. However, with the increasing clinical use of antineoplastic cytostatic agents and locoregional interventional therapies in hepatocellular carcinoma (HCC), conventional morphologic methods are confronting limitations in response assessment. Thus, there is an increasing interest in new imaging methods for response assessment, which can evaluate tumor biology such as vascular physiology, fibrosis, necrosis, and metabolism. In this review, we discuss various novel imaging methods for response assessment and compare them with the conventional ones in HCC.
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Affiliation(s)
- Koichi Hayano
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sang Ho Lee
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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19
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Yamashita H, Onishi H, Murakami N, Matsumoto Y, Matsuo Y, Nomiya T, Nakagawa K. Survival outcomes after stereotactic body radiotherapy for 79 Japanese patients with hepatocellular carcinoma. JOURNAL OF RADIATION RESEARCH 2015; 56:561-7. [PMID: 25691453 PMCID: PMC4426924 DOI: 10.1093/jrr/rru130] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/24/2014] [Accepted: 12/24/2014] [Indexed: 05/17/2023]
Abstract
Stereotactic body radiotherapy (SBRT) is a relatively new treatment for liver tumor. Outcomes of SBRT for liver tumors unsuitable for ablation or surgical resection were evaluated. A total of 79 patients treated with SBRT for primary hepatocellular carcinoma (HCC) between 2004 and 2012 in six Japanese institutions were studied retrospectively. Patients treated with SBRT preceded by trans-arterial chemoembolization were eligible. Their median age was 73 years, 76% were males, and their Child-Pugh scores were Grades A (85%) and B (11%) before SBRT. The median biologically effective dose (α/β = 10 Gy) was 96.3 Gy. The median follow-up time was 21.0 months for surviving patients. The 2-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival were 53%, 40% and 76%, respectively. Sex and serum PIVKA-II values were significant predictive factors for OS. Hypovascular or hypervascular types of HCC, sex and clinical stage were significant predictive factors for PFS. The 2-year PFS was 66% in Stage I vs 18% in Stages II-III. Multivariate analysis indicated that clinical stage was the only significant predictive factor for PFS. No Grade 3 laboratory toxicities in the acute, sub-acute, and chronic phases were observed. PFS after SBRT for liver tumor was satisfactory, especially for Stage I HCC, even though these patients were unsuitable for resection and ablation. SBRT is safe and might be an alternative to resection and ablation.
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Affiliation(s)
- Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | | | - Naoya Murakami
- Department of Radiology, National Cancer Center Hospital
| | - Yasuo Matsumoto
- Department of Radiology, Niigata University School of Medicine
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuma Nomiya
- Department of Radiology, Yamagata University Hospital
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20
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Jiang L, Cheng Q, Zhang BH, Zhang MZ. Circulating microRNAs as biomarkers in hepatocellular carcinoma screening: a validation set from China. Medicine (Baltimore) 2015; 94:e603. [PMID: 25761179 PMCID: PMC4602462 DOI: 10.1097/md.0000000000000603] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a global public health concern. Current diagnostic methods show poor performance in early-stage HCC detection. Accumulating evidences revealed the great potential of microRNAs (miRNAs) as noninvasive biomarkers in HCC detection. In this study, we examined the diagnostic performance of serum miR-10b, miR-106b, and miR-181a for HCC screening in China. Furthermore, a systematic review of previous related studies was conducted to confirm our results. One hundred eight participants including 27 HCC patients, 31 chronic liver disease (CLD) patients, and 50 healthy people were recruited in this study. Blood specimen was drawn from each participant to extract serum miRNAs. Statistical analyses were performed to assess the 3 miRNAs levels in HCC, CLD patients, and normal controls. A meta-analysis was conducted to further assess the diagnostic value of miRNAs in HCC detection based on previous studies. All these miRNAs (miR-10b, miR-181a, miR-106b) could well discriminate HCC patients from normal controls, with area under the receiver-operating characteristic curve (AUC) values of 0.85 (95% confidence interval [CI]: 0.76-0.94), 0.82 (95% CI: 0.72-0.91), and 0.89 (95% CI: 0.81-0.97), respectively. In addition, these miRNAs could distinguish HCC cases from CLD controls with a medium accuracy. However, the ability of these miRNAs in differentiating CLD patients from normal controls was not satisfactory. Panel of these miRNAs displayed a better performance compared with single miRNA assay, with AUC values of 0.94 (95% CI: 0.89-0.99) in discriminating HCC patients from normal controls and 0.91 (95% CI: 0.80-0.97) in discriminating HCC patients from CLD controls. Results of meta-analysis of previous studies combined with the current study suggested that circulating miRNAs could well differentiate HCC from normal controls, with AUC values of 0.86 (95% CI: 0.82-0.89) for single miRNA assay and 0.94 (95% CI: 0.91-0.96) for miRNA panel assay. Serum miR-10b, miR-106b, and miR-181a have great potential to serve as accurate and noninvasive biomarkers for HCC preliminary screening. Meta-analysis of previous studies combined with current study further confirmed that circulating miRNAs could play an important role in HCC detection. Further large-scale studies are needed to confirm the clinical significance of circulating miRNAs in HCC screening.
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Affiliation(s)
- Li Jiang
- From the Department of Biliary and Pancreatic Surgery (LJ); Hepatic Surgery Center, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (QC,B-HZ); and Departments of Medicine and Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee (M-ZZ)
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Abstract
In view of the trend towards personalized treatment strategies for (cancer) patients, there is an increasing need to noninvasively determine individual patient characteristics. Such information enables physicians to administer to patients accurate therapy with appropriate timing. For the noninvasive visualization of disease-related features, imaging biomarkers are expected to play a crucial role. Next to the chemical development of imaging probes, this requires preclinical studies in animal tumour models. These studies provide proof-of-concept of imaging biomarkers and help determine the pharmacokinetics and target specificity of relevant imaging probes, features that provide the fundamentals for translation to the clinic. In this review we describe biological processes derived from the “hallmarks of cancer” that may serve as imaging biomarkers for diagnostic, prognostic and treatment response monitoring that are currently being studied in the preclinical setting. A number of these biomarkers are also being used for the initial preclinical assessment of new intervention strategies. Uniquely, noninvasive imaging approaches allow longitudinal assessment of changes in biological processes, providing information on the safety, pharmacokinetic profiles and target specificity of new drugs, and on the antitumour effectiveness of therapeutic interventions. Preclinical biomarker imaging can help guide translation to optimize clinical biomarker imaging and personalize (combination) therapies.
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22
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Makino Y, Miyazaki M, Shigekawa M, Ezaki H, Sakamori R, Yakushijin T, Ohkawa K, Kato M, Akasaka T, Shinzaki S, Nishida T, Miyake Y, Hama N, Nagano H, Honma K, Morii E, Wakasa K, Hikita H, Tatsumi T, Iijima H, Hiramatsu N, Tsujii M, Takehara T. Solitary fibrous tumor of the liver from development to resection. Intern Med 2015; 54:765-70. [PMID: 25832939 DOI: 10.2169/internalmedicine.54.3053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 55-year-old man was annually followed up for a large hepatic cyst. In 2006, a 20-mm nodule was detected in contact with the cyst that gradually grew thereafter. By 2013, the mass had expanded to 90 mm, and a percutaneous biopsy revealed a solitary fibrous tumor (SFT). Surgical resection was subsequently performed, and the patient has since been doing well for 11 months, without recurrence. SFT of the liver is a rare neoplasm; only 44 cases have been reported to date. This is the first report to describe the long-term progression of hepatic SFT from the time of its development.
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Affiliation(s)
- Yuki Makino
- Departments of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
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23
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Ryu SW, Bok GH, Jang JY, Jeong SW, Ham NS, Kim JH, Park EJ, Kim JN, Lee WC, Shim KY, Lee SH, Kim SG, Cha SW, Kim YS, Cho YD, Kim HS, Kim BS. Clinically useful diagnostic tool of contrast enhanced ultrasonography for focal liver masses: comparison to computed tomography and magnetic resonance imaging. Gut Liver 2014; 8:292-7. [PMID: 24827626 PMCID: PMC4026647 DOI: 10.5009/gnl.2014.8.3.292] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background/Aims To evaluate the diagnostic value of contrast (SonoVue®) enhancement ultrasonography (CEUS) and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating liver masses. Methods CEUS (n=50), CT (n=47), and MRI (n=43) were performed on 50 liver masses in 48 patients for baseline mass characterization. The most likely impression for each modality and the final diagnosis, based on the combined biopsy results (n=14), angiography findings (n=36), and clinical course, were determined. The diagnostic value of CEUS was compared to those of CT and MRI. Results The final diagnosis of the masses was hepatocellular carcinoma (n=43), hemangioma (n=3), benign adenoma (n=2), eosinophilic abscess (n=1), and liver metastasis (n=1). The overall diagnostic agreement with the final diagnosis was substantial for CEUS, CT, and MRI, with κ values of 0.621, 0.763, and 0.784, respectively. The sensitivity, specificity, and accuracy were 83.3%, 87.5%, and 84.0%, respectively, for CEUS; 95.0%, 87.5%, and 93.8%, respectively, for CT; and 94.6%, 83.3%, and 93.0%, respectively for MRI. After excluding the lesions with poor acoustic sonographic windows, the sensitivity, specificity, and accuracy for CEUS were 94.6%, 87.5%, and 93.3%, respectively, with a κ value of 0.765. Conclusions If an appropriate acoustic window is available, CEUS is comparable to CT and MRI for the diagnosis of liver masses.
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Affiliation(s)
- Sung Woo Ryu
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Gene Hyun Bok
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jae Young Jang
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soung Won Jeong
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Nam Seok Ham
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eui Ju Park
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin Nyoung Kim
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Woong Cheul Lee
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kwang Yeun Shim
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sae Hwan Lee
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Gyune Kim
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Woo Cha
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young Deok Cho
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hong Soo Kim
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Boo Sung Kim
- Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Wang Q, Shi G, Qi X, Fan X, Wang L. Quantitative analysis of the dual-energy CT virtual spectral curve for focal liver lesions characterization. Eur J Radiol 2014; 83:1759-64. [PMID: 25088350 DOI: 10.1016/j.ejrad.2014.07.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the usefulness of the spectral curve slope of dual-energy CT (DECT) for differentiating between hepatocellular carcinoma (HCC), hepatic metastasis, hemangioma (HH) and cysts. METHODS In total, 121 patients were imaged in the portal venous phase using dual-energy mode. Of these patients, 23 patients had HH, 28 patients had HCC, 40 patients had metastases and 30 patients had simple cysts. The spectral curves of the hepatic lesions were derived from the 40-190 keV levels of virtual monochromatic spectral imaging. The spectral curve slopes were calculated from 40 to 110 keV. The slopes were compared using the Kruskal-Wallis test. Receiver operating characteristic curves (ROC) were used to determine the optimal cut-off value of the slope of the spectral curve to differentiate between the lesions. RESULTS The spectral curves of the four lesion types had different baseline levels. The HH baseline level was the highest followed by HCC, metastases and cysts. The slopes of the spectral curves of HH, HCC, metastases and cysts were 3.81 ± 1.19, 1.49 ± 0.57, 1.06 ± 0.76 and 0.13 ± 0.17, respectively. These values were significantly different (P<0.008). Based on ROC analysis, the respective diagnostic sensitivity and specificity were 87% and 100% for hemangioma (cut-off value ≥ 2.988), 82.1% and 65.9% for HCC (cut-off value 1.167-2.998), 65.9% and 59% for metastasis (cut-off value 0.133-1.167) and 44.4% and 100% for cysts (cut-off value ≤ 0.133). CONCLUSION Quantitative analysis of the DECT spectral curve in the portal venous phase can be used to determine whether tumors are benign or malignant.
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Affiliation(s)
- Qi Wang
- Department of Radiology, The Fourth Clinical Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China.
| | - Gaofeng Shi
- Department of Radiology, The Fourth Clinical Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China.
| | - Xiaohui Qi
- Department of Radiology, The Fourth Clinical Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China.
| | - Xueli Fan
- Department of Radiology, The Fourth Clinical Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China.
| | - Lijia Wang
- Department of Radiology, The Fourth Clinical Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China.
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Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: comparison with Gd-EOB-DTPA-enhanced MRI. J Gastroenterol 2014; 49:1081-93. [PMID: 23903870 DOI: 10.1007/s00535-013-0859-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 07/04/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is known about the difference in enhancement patterns of hepatocellular carcinoma (HCC) during multistep hepatocarcinogenesis between the post-vascular phase of Sonazoid-enhanced ultrasonography (SEUS) and hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI, as well as uptakes of Sonazoid and Gd-EOB-DTPA by HCC. METHODS Seventy patients with 73 histologically proven HCCs (33 hypovascular well-differentiated HCCs and 40 progressed HCCs) and 9 dysplastic nodules (DNs) were enrolled. Enhancement patterns of the lesions on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were evaluated. Uptakes of Sonazoid and Gd-EOB-DTPA were assessed by Sonazoid enhancement index and EOB enhancement ratio in relation to immunohistochemistry of CD68 and organic anion transporting polypeptide 8 (OATP8), respectively. RESULTS On the post-vascular phase of SEUS, none of the 9 DNs and 3 of 33 hypovascular well-differentiated HCCs (9 %) were hypoechoic, whereas 3 of 9 DNs (33 %) and 31 of 33 hypovascular well-differentiated HCCs (94 %) showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Of 31 progressed HCCs, 95 and 93 % were hypoechoic and hypointense on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, respectively. Sonazoid enhancement indexes decreased in progressed HCCs, correlating with lower Kupffer cell numbers (P < 0.001). EOB enhancement ratios decreased in hypovascular well-differentiated and progressed HCCs, as OATP8 expression declined (P < 0.001). CONCLUSIONS In stepwise hepatocarcinogenesis, uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA. Although signal reductions on the post-vascular phase of SEUS or hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI suggest HCC, hypoechoic appearance on the post-vascular phase of SEUS might be HCC-specific, particularly progressed HCC.
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Schütte K, Schulz C, Malfertheiner P. Hepatocellular Carcinoma: Current Concepts in Diagnosis, Staging and Treatment. Gastrointest Tumors 2014; 1:84-92. [PMID: 26672483 PMCID: PMC4645580 DOI: 10.1159/000362583] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) significantly contributes to the global burden of cancer. Liver cancer is the third most frequent cause of cancer-related death, with HCC representing more than 90% of primary liver cancers. During the last decade, much progress has been made with respect to the definition of patient populations at risk who may benefit from surveillance strategies, as well as in the diagnosis and treatment of the disease. SUMMARY New locoregional and systemic therapies have significantly increased the survival of patients with HCC. A multitude of clinical trials addressing patients with HCC have led to advancements in the allocation of subgroups of patients to their optimal individual treatment strategy. This review provides an overview on recent developments in diagnostic and therapeutic modalities and an outlook on future directions in the management of HCC. KEY MESSAGE New locoregional and systemic therapies in patients with HCC have significantly improved clinical outlook and patient survival. This review provides an overview of recent developments in diagnostics and therapeutics, as well as an outlook on future directions in the management of HCC. PRACTICAL IMPLICATIONS Transabdominal ultrasound is the method of choice for the surveillance of patients at risk of developing HCC, and any suspicious focal lesion in the liver should be characterized. Contrast-enhanced ultrasound with application of second-generation contrast agents enables visualization of tumor vascularity. The Barcelona Clinic Liver Cancer (BCLC) system is the most widely used classification system to guide the clinical management of HCC. Liver resection should be considered for patients with well-preserved liver function and without portal hypertension or elevated bilirubin. Patients not suitable for resection should undergo local tumor ablation. Candidates who are eligible for liver transplantation may benefit from bridging therapy during their waiting period. Patients in the BCLC B category benefit from locoregional transarterial therapy; transarterial chemoembolization is the treatment of choice. Sorafenib is the only systemic therapy that has been shown to prolong overall survival in patients with advanced disease, and is therefore recommended in patients with well-preserved liver function.
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Affiliation(s)
- Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
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Yamashita H, Onishi H, Matsumoto Y, Murakami N, Matsuo Y, Nomiya T, Nakagawa K. Local effect of stereotactic body radiotherapy for primary and metastatic liver tumors in 130 Japanese patients. Radiat Oncol 2014; 9:112. [PMID: 24886477 PMCID: PMC4029909 DOI: 10.1186/1748-717x-9-112] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/21/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Stereotactic body radiotherapy (SBRT) is a relatively new treatment for liver tumor. The outcomes of SBRT for liver tumor unfit for ablation and surgical resection were evaluated. METHODS Liver tumor patients treated with SBRT in seven Japanese institutions were studied retrospectively. Patients given SBRT for liver tumor between 2004 and 2012 were collected. Patients treated with SBRT preceded by trans-arterial chemoembolization (TACE) were eligible. Seventy-nine patients with hepatocellular carcinoma (HCC) and 51 patients with metastatic liver tumor were collected. The median biologically effective dose (BED) (α/β = 10 Gy) was 96.3 Gy for patients with HCC and 105.6 Gy with metastatic liver tumor. RESULTS The median follow-up time was 475.5 days in patients with HCC and 212.5 days with metastatic liver tumor. The 2-year local control rate (LCR) for HCC and metastatic liver tumor was 74.8% ± 6.3% and 64.2 ± 9.5% (p = 0.44). The LCR was not different between BED10 ≥ 100 Gy and < 100 Gy (p = 0.61). The LCR was significantly different between maximum tumor diameter > 30 mm vs. ≤ 30 mm (64% vs. 85%, p = 0.040) in all 130 patients. No grade 3 laboratory toxicities in the acute, sub-acute and chronic phases were observed. CONCLUSIONS There was no difference in local control after SBRT in the range of median BED10 around 100 Gy for between HCC and metastatic liver tumor. SBRT is safe and might be an alternative method to resection and ablation. SUMMARY There was no difference in local control after SBRT in the range of median BED10 around 100 Gy for between HCC and metastatic liver tumor and SBRT is safe and might be an alternative method to resection and ablation.
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Affiliation(s)
- Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Yasuo Matsumoto
- Department of Radiology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Singapore, Singapore
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuma Nomiya
- Department of Radiation Oncology, Yamagata University Hospital, Yamagata, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Hayano K, Fuentes-Orrego JM, Sahani DV. New approaches for precise response evaluation in hepatocellular carcinoma. World J Gastroenterol 2014; 20:3059-3068. [PMID: 24696594 PMCID: PMC3964378 DOI: 10.3748/wjg.v20.i12.3059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/26/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
With the increasing clinical use of cytostatic and novel biologic targeted agents, conventional morphologic tumor burden assessments, including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors, are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue. Therefore, the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired. In this review, we will discuss the conventional and new approaches to assess tumor burden. Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes, these functional tumor burden analyses are very promising. However, some of them have not gone thorough all steps for standardization and validation. Nevertheless, these new techniques and criteria will play an important role in the cancer management, and provide each patient more tailored therapy.
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Takeda A, Sanuki N, Eriguchi T, Kobayashi T, Iwabutchi S, Matsunaga K, Mizuno T, Yashiro K, Nisimura S, Kunieda E. Stereotactic ablative body radiotherapy for previously untreated solitary hepatocellular carcinoma. J Gastroenterol Hepatol 2014; 29:372-9. [PMID: 23927053 DOI: 10.1111/jgh.12350] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Stereotactic ablative body radiotherapy (SABR) is a relatively new treatment for hepatocellular carcinoma (HCC). The outcomes of SABR for previously untreated solitary HCC unfit for ablation and surgical resection were evaluated. METHODS Untreated solitary HCC patients treated with SABR were retrospectively studied. Between 2005 and 2012, 221 HCC patients underwent SABR. Among them, patients with untreated solitary HCC, treated with only SABR or SABR preceded by transarterial chemoembolization, were eligible. Based on baseline liver function and liver volume receiving ≥ 20 Gy, 35-40 Gy in five fractions was prescribed to the planning target volume surface. RESULTS Sixty-three patients were eligible, with a median follow-up duration of 31.1 (range 12.0-88.1) months. No patients were lost to follow-up. Twenty patients were treated with only SABR. In 43 patients treated with SABR preceded by transarterial chemoembolization, accumulation of lipiodol in the tumor remained complete in five, a partial defect in 38 on pre-SABR computed tomography. The 1-, 2-, and 3-year local control rates were 100%, 95%, and 92%, respectively; the intrahepatic recurrence-free rates were 76%, 55%, and 36%, respectively; and the overall survival rates were 100%, 87%, and 73%, respectively. Grade 3 laboratory toxicities in the acute, subacute, and chronic phases were observed in 10, 9, and 13 patients, respectively, and ascites occurred in one patient. CONCLUSIONS Local control and overall survival after SABR for untreated solitary HCC were excellent despite the candidates being unfit for resection and ablation. SABR is safe and might be an alternative to resection and ablation.
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Affiliation(s)
- Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan; Hepatology and Gastroenterology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
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CT and MRI in target delineation in primary hepatocellular carcinoma. Cancer Radiother 2013; 17:750-4. [DOI: 10.1016/j.canrad.2013.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 05/22/2013] [Accepted: 05/25/2013] [Indexed: 12/21/2022]
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Slany A, Haudek-Prinz V, Zwickl H, Stättner S, Grasl-Kraupp B, Gerner C. Myofibroblasts are important contributors to human hepatocellular carcinoma: Evidence for tumor promotion by proteome profiling. Electrophoresis 2013; 34:3315-25. [DOI: 10.1002/elps.201300326] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/19/2013] [Accepted: 08/30/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Astrid Slany
- Faculty of Chemistry, Institute of Analytical Chemistry; University of Vienna; Austria
- Department of Medicine I; Comprehensive Cancer Center; Institute of Cancer Research; Medical University of Vienna; Austria
| | - Verena Haudek-Prinz
- Faculty of Chemistry, Institute of Analytical Chemistry; University of Vienna; Austria
- Department of Medicine I; Comprehensive Cancer Center; Institute of Cancer Research; Medical University of Vienna; Austria
| | - Hannes Zwickl
- Department of Medicine I; Comprehensive Cancer Center; Institute of Cancer Research; Medical University of Vienna; Austria
| | - Stefan Stättner
- Department of Surgery; Paracelsus Medical University; Salzburg Austria
| | - Bettina Grasl-Kraupp
- Department of Medicine I; Comprehensive Cancer Center; Institute of Cancer Research; Medical University of Vienna; Austria
| | - Christopher Gerner
- Faculty of Chemistry, Institute of Analytical Chemistry; University of Vienna; Austria
- Department of Medicine I; Comprehensive Cancer Center; Institute of Cancer Research; Medical University of Vienna; Austria
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Time-resolved computed tomography of the liver: retrospective, multi-phase image reconstruction derived from volumetric perfusion imaging. Eur Radiol 2013; 24:151-61. [PMID: 23995880 DOI: 10.1007/s00330-013-2992-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/11/2013] [Accepted: 07/28/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess feasibility and image quality (IQ) of a new post-processing algorithm for retrospective extraction of an optimised multi-phase CT (time-resolved CT) of the liver from volumetric perfusion imaging. METHODS Sixteen patients underwent clinically indicated perfusion CT using 4D spiral mode of dual-source 128-slice CT. Three image sets were reconstructed: motion-corrected and noise-reduced (MCNR) images derived from 4D raw data; maximum and average intensity projections (time MIP/AVG) of the arterial/portal/portal-venous phases and all phases (total MIP/ AVG) derived from retrospective fusion of dedicated MCNR split series. Two readers assessed the IQ, detection rate and evaluation time; one reader assessed image noise and lesion-to-liver contrast. RESULTS Time-resolved CT was feasible in all patients. Each post-processing step yielded a significant reduction of image noise and evaluation time, maintaining lesion-to-liver contrast. Time MIPs/AVGs showed the highest overall IQ without relevant motion artefacts and best depiction of arterial and portal/portal-venous phases respectively. Time MIPs demonstrated a significantly higher detection rate for arterialised liver lesions than total MIPs/AVGs and the raw data series. CONCLUSION Time-resolved CT allows data from volumetric perfusion imaging to be condensed into an optimised multi-phase liver CT, yielding a superior IQ and higher detection rate for arterialised liver lesions than the raw data series. KEY POINTS • Four-dimensional computed tomography is limited by motion artefacts and poor image quality. • Time-resolved-CT facilitates 4D-CT data visualisation, segmentation and analysis by condensing raw data. • Time-resolved CT demonstrates better image quality than raw data images. • Time-resolved CT improves detection of arterialised liver lesions in cirrhotic patients.
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Salomon LJ, Bernard JP, Millischer AE, Sonigo P, Brunelle F, Boddaert N, Ville Y. MRI and ultrasound fusion imaging for prenatal diagnosis. Am J Obstet Gynecol 2013; 209:148.e1-9. [PMID: 23685001 DOI: 10.1016/j.ajog.2013.05.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/14/2013] [Accepted: 05/14/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE A combination of magnetic resonance imaging (MRI) images with real time high-resolution ultrasound known as fusion imaging may improve prenatal examination. This study was undertaken to evaluate the feasibility of using fusion of MRI and ultrasound (US) in prenatal imaging. STUDY DESIGN This study was conducted in a tertiary referral center. All patients referred for prenatal MRI were offered to undergo fusion of MRI and US examination. All cases underwent 1.5 Tesla MRI protocol including at least 3 T2-weighted planes. The Digital Imaging and Communications in Medicine volume dataset was then loaded into the US system for manual registration of the live US image and fusion imaging examination. RESULTS Over the study period, 24 patients underwent fusion imaging at a median gestational age of 31 (range, 24-35) weeks. Data registration, matching and then volume navigation was feasible in all cases. Fusion imaging allowed superimposing MRI and US images therefore providing with real time imaging capabilities and high tissue contrast. It also allowed adding a real time Doppler signal on MRI images. Significant fetal movement required repeat-registration in 15 (60%) cases. The average duration of the overall additional scan with fusion imaging was 10 ± 5 minutes. CONCLUSION The combination of fetal real time MRI and US image fusion and navigation is feasible. Multimodality fusion imaging may enable easier and more extensive prenatal diagnosis.
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Assessment of hemodynamics in a rat model of liver cirrhosis with precancerous lesions using multislice spiral CT perfusion imaging. BIOMED RESEARCH INTERNATIONAL 2013; 2013:813174. [PMID: 23865067 PMCID: PMC3705863 DOI: 10.1155/2013/813174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/02/2013] [Indexed: 12/21/2022]
Abstract
Rationale and Objectives. To develop an optimal scanning protocol for multislice spiral CT perfusion (CTP) imaging to evaluate hemodynamic changes in liver cirrhosis with diethylnitrosamine- (DEN-) induced precancerous lesions. Materials and Methods. Male Wistar rats were randomly divided into the control group (n = 80) and the precancerous liver cirrhosis group (n = 40). The control group received saline injection and the liver cirrhosis group received 50 mg/kg DEN i.p. twice a week for 12 weeks. All animals underwent plain CT scanning, CTP, and contrast-enhanced CT scanning. Scanning parameters were optimized by adjusting the diatrizoate concentration, the flow rate, and the delivery time. The hemodynamics of both groups was further compared using optimized multislice spiral CTP imaging. Results. High-quality CTP images were obtained with following parameters: 150 kV; 150 mAs; 5 mm thickness, 5 mm interval; pitch, 1; matrix, 512 × 512; and FOV, 9.6 cm. Compared to the control group, the liver cirrhosis group had a significantly increased value of the hepatic arterial fraction and the hepatic artery perfusion (P < 0.05) but significantly decreased hepatic portal perfusion and mean transit time (P < 0.05). Conclusion. Multislice spiral CTP imaging can be used to evaluate the hemodynamic changes in the rat model of liver cirrhosis with precancerous lesions.
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Makino Y, Imai Y, Ohama H, Igura T, Kogita S, Sawai Y, Fukuda K, Takamura M, Ohashi H, Murakami T. Ultrasonography Fusion Imaging System Increases the Chance of Radiofrequency Ablation for Hepatocellular Carcinoma with Poor Conspicuity on Conventional Ultrasonography. Oncology 2013; 84 Suppl 1:44-50. [DOI: 10.1159/000345889] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Makino Y, Imai Y, Igura T, Ohama H, Kogita S, Sawai Y, Fukuda K, Ohashi H, Murakami T. Usefulness of the multimodality fusion imaging for the diagnosis and treatment of hepatocellular carcinoma. Dig Dis 2012; 30:580-7. [PMID: 23258098 DOI: 10.1159/000343070] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A multimodality fusion imaging system has been introduced for the clinical practice of diagnosis and treatment of hepatocellular carcinoma (HCC), especially for loco-regional treatment. An ultrasonography (US) fusion imaging system can provide a side-by-side display of real-time US images and any cross-sectional images of multiplanar reconstruction of CT or MRI that synchronize real-time US. The US fusion imaging system enables us to perform radiofrequency ablation (RFA) for HCCs difficult to detect on conventional US safely. Besides, we can evaluate the treatment effects of RFA easily at the bedside by combining the contrast-enhanced US and the US fusion imaging system. Fusion images of pre- and post-RFA CT have been utilized for the assessment of the treatment effects of RFA. Although the treatment effects of RFA have been conventionally evaluated, comparing pre- and post-RFA CT side-by-side, the evaluation tends to be inaccurate. On CT fusion images, the tumor and the ablation zone are overlaid and we can grasp the positional relation easily, leading to quantitative and more accurate evaluation. The multimodality fusion imaging system has become quite an important tool for loco-regional treatment of HCC because of its usefulness for both the guidance during the RFA procedure and the evaluation of its treatment effects.
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Affiliation(s)
- Yuki Makino
- Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18 Johnan, Ikeda, Osaka, Japan
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Soloperto G, Conversano F, Greco A, Casciaro E, Franchini R, Casciaro S. Advanced spectral analyses for real-time automatic echographic tissue-typing of simulated tumor masses at different compression stages. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2012; 59:2692-2701. [PMID: 23221218 DOI: 10.1109/tuffc.2012.2510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Prototypal software algorithms for advanced spectral analysis of echographic images were developed to perform automatic detection of simulated tumor masses at two different pathological stages. Previously published works documented the possibility of characterizing macroscopic variation of mechanical properties of tissues through elastographic techniques, using different imaging modalities, including ultrasound (US); however, the accuracy of US-based elastography remains affected by the variable manual modality of the applied compression and several attempts are under investigation to overcome this limitation. Quantitative US (QUS), such as Fourier- and wavelet-based analyses of the RF signal associated with the US images, has been developed to perform a microscopic-scale tissue-type imaging offering new solutions for operator-independent examinations. Because materials able to reproduce the harmonic behavior of human liver can be realized, in this study, tissue-mimicking structures were US imaged and the related RF signals were analyzed using wavelet transform through an in-house-developed algorithm for tissue characterization. The classification performance and reliability of the procedure were evaluated on two different tumor stiffnesses (40 and 130 kPa) and with two different applied compression levels (0 and 3.5 N). Our results demonstrated that spectral components associated with different levels of tissue stiffness within the medium exist and can be mapped onto the original US images independently of the applied compressive forces. This wavelet-based analysis was able to identify different tissue stiffness with satisfactory average sensitivity and specificity: respectively, 72.01% ± 1.70% and 81.28% ± 2.02%.
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Affiliation(s)
- Giulia Soloperto
- Bioengineering Division of the National Research Council, Institute of Clinical Physiology, Lecce, Italy
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Huang KW, Chen HH, Yang HC, Horng HE, Liao SH, Yang SY, Chieh JJ, Wang LM. Discriminating hepatocellular carcinoma in rats using a high-Tc SQUID detected nuclear resonance spectrometer in a magnetic shielding box. PLoS One 2012; 7:e47057. [PMID: 23071710 PMCID: PMC3465302 DOI: 10.1371/journal.pone.0047057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022] Open
Abstract
In this study, we report the spin-lattice relaxation rate of hepatocellular carcinoma (HCC) and normal liver tissue in rats using a high-T(c) superconducting quantum interference device (SQUID) based nuclear magnetic resonance (NMR) spectrometer. The resonance spectrometer used for discriminating liver tumors in rats via the difference in longitudinal relaxation time in low magnetic fields was set up in a compact and portable magnetic shielding box. The frequency-domain NMR signals of HCC tissues and normal liver tissues were analyzed to study their respective longitudinal relaxation rate T(1) (-1). The T(1) (-1) of liver tissues for ten normal rats and ten cancerous rats were investigated respectively. The averaged T(1) (-1) value of normal liver tissue was (6.41±0.66) s(-1), and the averaged T(1) (-1) value of cancerous tissue was (3.38±0.15) s(-1). The ratio of T(1) (-1) for normal liver tissues and cancerous liver tissues of the rats investigated is estimated to be 1.9. Since this significant statistical difference, the T(1) (-1) value can be used to distinguish the HCC tissues from normal liver tissues. This method of examining liver and tumor tissues has the advantages of being convenient, easy to operate, and stable.
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Affiliation(s)
- Kai-Wen Huang
- Department of Surgery and Angiogenesis Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Hsien Chen
- Institute of Electro-optical Science and Technology, National Taiwan Normal University, Taipei, Taiwan
| | - Hong-Chang Yang
- Department of Electro-Optical Engineering, Kun Shan University, Tainan, Taiwan
| | - Herng-Er Horng
- Institute of Electro-optical Science and Technology, National Taiwan Normal University, Taipei, Taiwan
| | - Shu-Hsien Liao
- Institute of Electro-optical Science and Technology, National Taiwan Normal University, Taipei, Taiwan
| | - Shieh Yueh Yang
- Institute of Electro-optical Science and Technology, National Taiwan Normal University, Taipei, Taiwan
- MagQu Co Ltd. Sindian Strict, New Taipei City, Taiwan
| | - Jen-Jie Chieh
- Institute of Electro-optical Science and Technology, National Taiwan Normal University, Taipei, Taiwan
| | - Li-Ming Wang
- Graduate Institute of Applied Physics and Department of Physics, National Taiwan University, Taipei, Taiwan
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Abstract
With the recent dramatic advances in diagnostic modalities, the diagnosis of hepatocellular carcinoma (HCC) is primarily based on imaging. Ultrasound (US) plays a crucial role in HCC surveillance. Dynamic multiphasic multidetector-row CT (MDCT) and magnetic resonance imaging (MRI) are the standard diagnostic methods for the noninvasive diagnosis of HCC, which can be made based on hemodynamic features (arterial enhancement and delayed washout). The technical development of MDCT and MRI has made possible the fast scanning with better image quality and resolution, which enables an accurate CT hemodynamic evaluation of hepatocellular tumor, as well as the application of perfusion CT and MRI in clinical practice. Perfusion CT and MRI can measure perfusion parameters of tumor quantitatively and can be used for treatment response assessment to anti-vascular agents. Besides assessing the hemodynamic or perfusion features of HCC, new advances in MRI can provide a cellular information of HCC. Liver-specific hepatobiliary contrast agents, such as gadoxetic acid, give information regarding hepatocellular function or defect of the lesion, which improves lesion detection and characterization. Diffusion-weighted imaging (DWI) of the liver provides cellular information of HCC and also has broadened its role in lesion detection, lesion characterization, and treatment response assessment to chemotherapeutic agents. In this article, we provide an overview of the state-of-the art imaging techniques of the liver and their clinical role in management of HCC.
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Affiliation(s)
- Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea.
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Abstract
Based on recent clinical practice guidelines, imaging is largely replacing pathology as the preferred diagnostic method for determination of hepatocellular carcinoma (HCC). A variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography, are currently used to examine patients with chronic liver disease and suspected HCC. Advancements in imaging techniques such as perfusion imaging, diffusion imaging, and elastography along with the development of new contrast media will further improve the ability to detect and characterize HCC. Early diagnosis of HCC is essential for prompt treatment, which may in turn improve prognosis. Considering the process of hepatocarcinogenesis, it is important to evaluate sequential changes via imaging which would help to differentiate HCC from premalignant or benign lesions. Recent innovations including multiphasic examinations, high-resolution imaging, and the increased functional capabilities available with contrast-enhanced US, multidetector row CT, and MRI have raised the standards for HCC diagnosis. Although hemodynamic features of nodules in the cirrhotic liver remain the main diagnostic criterion, newly developed cellspecific contrast agents have shown great possibilities for improved HCC diagnosis and may overcome the diagnostic dilemma associated with small or borderline hepatocellular lesions. In the 20th century paradigm of medical imaging, radiological diagnosis was based on morphological characteristics, but in the 21st century, a paradigm shift to include biomedical, physiological, functional, and genetic imaging is needed. A multidisciplinary team approach is necessary to foster an integrated approach to HCC imaging. By developing and combining new imaging modalities, all phases of HCC patient care, including screening, diagnosis, treatment, and therapy, can be dramatically improved.
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Affiliation(s)
| | - Byung Ihn Choi
- *Byung Ihn Choi, MD, Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 110-744 (Korea), Tel. +82 2 2072 2515, E-Mail
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Mergental H, Adam R, Ericzon BG, Kalicinski P, Mühlbacher F, Höckerstedt K, Klempnauer JL, Friman S, Broelsch CE, Mantion G, Fernandez-Sellez C, van Hoek B, Fangmann J, Pirenne J, Muiesan P, Königsrainer A, Mirza DF, Lerut J, Detry O, Le Treut YP, Mazzaferro V, Löhe F, Berenguer M, Clavien PA, Rogiers X, Belghiti J, Kóbori L, Burra P, Wolf P, Schareck W, Pisarski P, Foss A, Filipponi F, Krawczyk M, Wolff M, Langrehr JM, Rolles K, Jamieson N, Hop WCJ, Porte RJ. Liver transplantation for unresectable hepatocellular carcinoma in normal livers. J Hepatol 2012; 57:297-305. [PMID: 22521348 DOI: 10.1016/j.jhep.2012.03.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 03/21/2012] [Accepted: 03/22/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The role of liver transplantation in the treatment of hepatocellular carcinoma in livers without fibrosis/cirrhosis (NC-HCC) is unclear. We aimed to determine selection criteria for liver transplantation in patients with NC-HCC. METHODS Using the European Liver Transplant Registry, we identified 105 patients who underwent liver transplantation for unresectable NC-HCC. Detailed information about patient, tumor characteristics, and survival was obtained from the transplant centers. Variables associated with survival were identified using univariate and multivariate statistical analyses. RESULTS Liver transplantation was primary treatment in 62 patients and rescue therapy for intrahepatic recurrences after liver resection in 43. Median number of tumors was 3 (range 1-7) and median tumor size 8 cm (range 0.5-30). One- and 5-year overall and tumor-free survival rates were 84% and 49% and 76% and 43%, respectively. Macrovascular invasion (HR 2.55, 95% CI 1.34 to 4.86), lymph node involvement (HR 2.60, 95% CI 1.28 to 5.28), and time interval between liver resection and transplantation < 12 months (HR 2.12, 95% CI 0.96 to 4.67) were independently associated with survival. Five-year survival in patients without macrovascular invasion or lymph node involvement was 59% (95% CI 47-70%). Tumor size was not associated with survival. CONCLUSIONS This is the largest reported series of patients transplanted for NC-HCC. Selection of patients without macrovascular invasion or lymph node involvement, or patients ≥ 12months after previous liver resection, can result in 5-year survival rates of 59%. In contrast to HCC in cirrhosis, tumor size is not a predictor of post-transplant survival in NC-HCC.
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Lee JM, Yoon JH, Joo I, Woo HS. Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma. Liver Cancer 2012; 1:22-40. [PMID: 24159569 PMCID: PMC3747553 DOI: 10.1159/000339018] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Accurate diagnosis and assessment of disease extent are crucial for proper management of patients with HCC. Imaging plays a crucial role in early detection, accurate staging, and the planning of management strategies. A variety of imaging modalities are currently used in evaluating patients with suspected HCC; these include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography. Among these modalities, dynamic MRI and CT are regarded as the best imaging techniques available for the noninvasive diagnosis of HCC. Recent improvements in CT and MRI technology have made noninvasive and reliable diagnostic assessment of hepatocellular nodules possible in the cirrhotic liver, and biopsy is frequently not required prior to treatment. Until now, the major challenge for radiologists in imaging cirrhosis has been the characterization of small cirrhotic nodules smaller than 2 cm in diameter. Further technological advancement will undoubtedly have a major impact on liver tumor imaging. The increased speed of data acquisition in CT and MRI has allowed improvements in both spatial and temporal resolution, which have made possible a more precise evaluation of the hemodynamics of liver nodules. Furthermore, the development of new, tissue-specific contrast agents such as gadoxetic acid has improved HCC detection on MRI. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC, recent technological advances, and the strengths and limitations of these imaging modalities.
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Affiliation(s)
| | - Jeong-Hee Yoon
- *Jeong Min Lee, MD, Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744 (South Korea), Tel. +82 2 2072 3154, E-Mail
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