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Zhu K, Wang W, Luo R, Song D, Wang X, Gao Q, Fan J, Zhou J, Rao S, Wang X. Newly detected liver nodules with a history of colorectal cancer: are they metastatic? Review of 2,632 cases in a single center. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1079. [PMID: 34422991 PMCID: PMC8339815 DOI: 10.21037/atm-20-8153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/05/2021] [Indexed: 12/13/2022]
Abstract
Background The diagnosis of newly detected liver nodules in patients with colorectal cancer (CRC) is crucial for determining prognosis and treatment. Accurate identification of benign nodules can help avoid unnecessary therapy. The aim of our study was to retrospectively review patients with CRC who underwent liver resection for benign liver nodules misdiagnosed as CRC metastasis (CRLM) in our institution. Methods We reviewed all patients with a history of CRC who underwent liver resection from January 2012 to December 2019 in our institution. We specifically focused on nodules pathologically confirmed as benign. The pathology was rechecked by an independent pathologist. The clinicopathological characteristics of these patients were collected. Preoperative imaging examinations, including ultrasound (US), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) were reviewed. Results From 2012 to 2019, a total of 2,632 patients with CRC who were preoperatively diagnosed CRLM received liver resection, among which 2,584 (98.2%) cases were proven to be malignant, and 48 (1.8%) cases were benign. Among these 48 cases, 24 were pathologically confirmed as focal nodular hyperplasia (FNH), 9 were peliosis, 10 were inflammatory lesions, and 5 were hemangioma. At least one preoperative imaging examination indicated CRLM, with a median size of 2.0 cm (range, 0.4–8.0 cm). Before liver resection, ten patients received chemotherapy after the discovery of liver nodules. Conclusions It should be noted that newly detected liver nodules in patients with a history of CRC could be benign. Accurate diagnosis of liver nodules in CRC is necessary to avoid overtreatment and to identify cost-effective medication.
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Affiliation(s)
- Kai Zhu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China
| | - Wentao Wang
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Danjun Song
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
| | - Xi Wang
- Department of Ultrasound, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Qiang Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institute of Biomedical Sciences, Fudan University, Shanghai, China.,State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institute of Biomedical Sciences, Fudan University, Shanghai, China.,State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
| | - Shengxiang Rao
- Key Laboratory of Organ Transplantation, Shanghai, China
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
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Sugi MD, Menias CO, Lubner MG, Bhalla S, Mellnick VM, Kwon MH, Katz DS. CT Findings of Acute Small-Bowel Entities. Radiographics 2018; 38:1352-1369. [DOI: 10.1148/rg.2018170148] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Mark D. Sugi
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Christine O. Menias
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Meghan G. Lubner
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Vincent M. Mellnick
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Matt H. Kwon
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Douglas S. Katz
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
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Birch JC, Khatri G, Watumull LM, Arriaga YE, Leyendecker JR. Unintended Consequences of Systemic and Ablative Oncologic Therapy in the Abdomen and Pelvis. Radiographics 2018; 38:1158-1179. [PMID: 29995613 DOI: 10.1148/rg.2018170137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Human cancers are genetically complex and diverse. Although advances in oncologic therapy aim to define and target unique steps in carcinogenesis, oncologists often rely on less discriminate anticancer therapies that have consequences for normal tissues. Even many of the so-called targeted therapies currently employed can adversely affect normal cells, leading to complications that necessitate dose reductions or cessation of specific therapies. This article explores the unintended consequences of currently employed systemic and ablative anticancer therapies that might manifest at imaging examinations of the abdomen and pelvis, including cytotoxic, molecular targeted, and immunologic agents; ablation; and hematopoietic stem cell transplant. Each of these treatments can have both major and minor unintended effects in the targeted organ(s), in local or adjacent structures, or at distant sites. Timely detection and reporting of adverse consequences of anticancer therapies by the astute imager can result in critical treatment modifications and/or lifesaving interventions; therefore, knowledge of these unintended effects is paramount for radiologists interpreting the results of imaging examinations in cancer patients. ©RSNA, 2018.
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Affiliation(s)
- Julie C Birch
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Gaurav Khatri
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Lori M Watumull
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Yull E Arriaga
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - John R Leyendecker
- From the Department of Radiology (J.C.B., G.K., L.M.W., J.R.L.) and Department of Internal Medicine, Division of Hematology/Oncology (Y.E.A.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
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Abd-Allah SS, El-Morsy A, El-Badrawy A, Settein M, El-Etreby S, Halim A, Elkhodary T, Abdel Monem SM. Multi-detector computed tomography (MDCT) findings of chemotherapy induced hepatic changes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chavhan GB, Babyn PS, Nathan PC, Kaste SC. Imaging of acute and subacute toxicities of cancer therapy in children. Pediatr Radiol 2016; 46:9-20; quiz 6-8. [PMID: 26459011 DOI: 10.1007/s00247-015-3454-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/20/2015] [Accepted: 08/14/2015] [Indexed: 01/03/2023]
Abstract
Effective cancer therapies have resulted in significant improvement in survival. However, treatment-related acute and subacute complications are a cause of significant morbidity and mortality. Effects of cancer therapy in children can be seen early in the survival period or later in life in almost all organ systems of the body. Many of these conditions are evaluated by imaging and some are diagnosed based on characteristic imaging features. This article aims to discuss acute and subacute toxicities of cancer therapy in children involving multiple organ systems, pulmonary, gastrointestinal, hepatobiliary, genitourinary and musculoskeletal systems with emphasis on those in which imaging plays a role in diagnosis or management. We also discuss the role of imaging and choice of imaging modalities in these conditions.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital For Sick Children and University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
| | - Paul S Babyn
- Department of Medical Imaging, Royal University Hospital, Saskatoon, SK, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital For Sick Children and University of Toronto, Toronto, ON, Canada
| | - Sue C Kaste
- Department of Diagnostic Imaging and Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Radiology, University of Tennessee School of Health Sciences Memphis, Memphis, TN, USA
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Viswanathan C, Truong M, Sagebiel T, Garg N, Bhosale P. Imaging of Chemotherapy-related Iatrogenic Abdominal and Pelvic Conditions. Radiol Clin North Am 2014; 52:1029-40. [DOI: 10.1016/j.rcl.2014.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Han NY, Park BJ, Sung DJ, Kim MJ, Cho SB, Lee CH, Jang YJ, Kim SY, Kim DS, Um SH, Won NH, Yang KS. Chemotherapy-induced focal hepatopathy in patients with gastrointestinal malignancy: gadoxetic acid--enhanced and diffusion-weighted MR imaging with clinical-pathologic correlation. Radiology 2014; 271:416-25. [PMID: 24475862 DOI: 10.1148/radiol.13131810] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To retrospectively evaluate findings of chemotherapy-induced focal hepatopathy (CIFH) on gadoxetic acid-enhanced magnetic resonance (MR) and diffusion-weighted (DW) images and to determine imaging features that are most helpful in differentiating CIFH from metastasis. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and informed consent was waived. MR images, including DW images and gadoxetic acid-enhanced images, from 12 patients (four men, eight women; age range, 25-64 years) with 15 CIFHs were reviewed independently and in consensus by two radiologists and were compared with those obtained in 20 control patients (12 men, eight women; age range, 32-84 years) with 30 hepatic metastasis who were matched for tumor size, primary organ, and chemotherapy regimen. Interobserver agreement was assessed with κ statistics, and univariate analysis was performed for comparisons. For quantitative analyses, apparent diffusion coefficients (ADCs) and lesion-to-liver contrast ratios (CRs) were measured. Histopathologic examinations were performed for CIFHs. RESULTS Histopathologic examination revealed that the development of CIFHs was attributable to accentuated manifestations of sinusoidal obstruction syndrome. Interobserver agreement was excellent (κ > 0.85). An ill-defined margin on hepatobiliary phase (HBP) images was the most discriminating independent variable in the differentiation of CIFH from metastasis (odds ratio, 16; P = .009). ADC and CR values in CIFH group were significantly higher than those in metastasis group (P < .001 and P = .041). CONCLUSION CIFH should be considered a mimicker of metastasis in patients with gastrointestinal malignancy during chemotherapy. CIFH can be differentiated from metastasis on the basis of gadoxetic acid-enhanced MR and DW imaging findings; an ill-defined margin on HBP images was especially characteristic.
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Affiliation(s)
- Na Yeon Han
- From the Departments of Radiology (H.N.Y., B.J.P., D.J.S., M.J.K., S.B.C.), Surgery (D.S.K.), Internal Medicine (S.H.U.), and Pathology (N.H.W.), College of Medicine, and Department of Biostatistics (K.S.Y.), Korea University, Anam Hospital, 126-1 5-Ka, Anam-Dong, Sungbuk-ku, Seoul 136-705, Republic of Korea; Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (C.H.L.); Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea (Y.J.J.); and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea (S.Y.K.)
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Virmani V, Khandelwal A, Sethi V, Kielar A, Ryan J, Fasih N. Spectrum of imaging manifestations in non-neoplastic gastric pathologies. Curr Probl Diagn Radiol 2013; 42:127-34. [PMID: 23795991 DOI: 10.1067/j.cpradiol.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article illustrates a wide spectrum of non-neoplastic gastric pathologies on cross-sectional imaging. Salient features of inflammatory, infectious, vascular, traumatic, and miscellaneous conditions of the stomach have been discussed and imaging clues to reach an accurate diagnosis are stressed upon.
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Affiliation(s)
- Vivek Virmani
- Department of Medical Imaging, The Ottawa hospital, Ottawa, Ontario, Canada
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Chikarmane SA, Khurana B, Krajewski KM, Shinagare AB, Howard S, Sodickson A, Jagannathan J, Ramaiya N. What the emergency radiologist needs to know about treatment-related complications from conventional chemotherapy and newer molecular targeted agents. Emerg Radiol 2012; 19:535-46. [PMID: 22673844 DOI: 10.1007/s10140-012-1052-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/10/2012] [Indexed: 12/21/2022]
Abstract
Emergency departments (ED) are increasingly utilized by oncology patients for disease- and treatment-related issues. With the increased use of new molecular targeted therapy (MTT) and conventional chemotherapeutic regimens, oncology patients present with a range of adverse treatment effects, some of which reveal characteristic injury patterns and imaging appearances. Knowledge of these imaging findings is critically important for early detection and prompt management in oncology patients. In this article, we present a brief review of conventional chemotherapeutic and new MTT regimens as well as address adverse reactions that bring oncology patients to the ED.
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Affiliation(s)
- Sona A Chikarmane
- Department of Emergency Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Di Salvo DN, Park J, Laing FC. Lithium nephropathy: unique sonographic findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:637-44. [PMID: 22441921 DOI: 10.7863/jum.2012.31.4.637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This case series describes a unique sonographic appearance consisting of numerous microcysts and punctate echogenic foci seen on renal sonograms of 10 adult patients receiving chronic lithium therapy. Clinically, chronic renal insufficiency was present in 6 and nephrogenic diabetes insipidus in 2. Sonography showed numerous microcysts and punctate echogenic foci. Computed tomography in 5 patients confirmed microcysts and microcalcifications, which were fewer in number than on sonography. Magnetic resonance imaging in 2 patients confirmed microcysts in each case. Renal biopsy in 1 patient showed chronic interstitial nephritis, microcysts, and tubular dilatation. The diagnosis of lithium nephropathy should be considered when sonography shows these findings.
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Affiliation(s)
- Donald N Di Salvo
- Division of Ultrasound Services, Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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