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Kahraman G, Haberal KM, Dilek ON. Imaging features and management of focal liver lesions. World J Radiol 2024; 16:139-167. [DOI: 10.4329/wjr.v16.i6.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Notably, the number of incidentally detected focal liver lesions (FLLs) has increased dramatically in recent years due to the increased use of radiological imaging. The diagnosis of FLLs can be made through a well-documented medical history, physical examination, laboratory tests, and appropriate imaging methods. Although benign FLLs are more common than malignant ones in adults, even in patients with primary malignancy, accurate diagnosis of incidental FLLs is of utmost clinical significance. In clinical practice, FLLs are frequently evaluated non-invasively using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although US is a cost-effective and widely used imaging method, its diagnostic specificity and sensitivity for FLL characterization are limited. FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI. MRI is a problem-solving method with high specificity and sensitivity, commonly used for the evaluation of FLLs that cannot be characterized by US or CT. Recent technical advancements in MRI, along with the use of hepatobiliary-specific MRI contrast agents, have significantly improved the success of FLL characterization and reduced unnecessary biopsies. The American College of Radiology (ACR) appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients. ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommendations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios. The American College of Gastroenterology (ACG) Clinical Guideline offers evidence-based recommendations for both the diagnosis and management of FLL. American Association for the Study of Liver Diseases (AASLD) Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma. In this article, FLLs are reviewed with a comprehensive analysis of ACR Appropriateness Criteria, ACG Clinical Guideline, AASLD Practice Guidance, and current medical literature from peer-reviewed journals. The article includes a discussion of imaging methods used for the assessment of FLL, current recommended imaging techniques, innovations in liver imaging, contrast agents, imaging features of common nonmetastatic benign and malignant FLL, as well as current management recommendations.
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Affiliation(s)
- Gökhan Kahraman
- Department of Radiology, Suluova State Hospital, Amasya 05500, Türkiye
| | - Kemal Murat Haberal
- Department of Radiology, Başkent University Faculty of Medicine, Ankara 06490, Türkiye
| | - Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Türkiye
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2
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Drucker Iarovich M, Hinzpeter R, Moloney BM, Hueniken K, Veit-Haibach P, Ortega C, Metser U. Comparison of 68Ga-DOTATATE Positron Emmited Tomography/Computed Tomography and Gadoxetic Acid-Enhanced Magnetic Resonance Imaging for the Detection of Liver Metastases from Well-Differentiated Neuroendocrine Tumors. Curr Oncol 2024; 31:521-534. [PMID: 38248121 PMCID: PMC10813973 DOI: 10.3390/curroncol31010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
This study aimed to compare the detection of neuroendocrine tumor liver metastases (NLMs) in hepatobiliary-specific contrast-enhanced MRI (pMR) versus 68Ga-DOTATATE PET/CT (DT-PET). This retrospective study cohort included 30 patients with well-differentiated neuroendocrine tumors who underwent both DT-PET and pMR. Two readers independently assessed NLMs count, SUVmax on DT-PET, and signal characteristics on pMR. A consensus review by two additional readers resolved discrepancies between the modalities. Results showed concordance between DT-PET and pMR NLM count in 14/30 patients (47%). pMR identified more NLMs in 12/30 patients (40%), of which 4 patients showed multiple deposits on pMR but only 0-1 lesions on DT-PET. DT-PET detected more in 4/30 patients (13%). Overall, pMR detected more metastases than DT-PET (p = 0.01). Excluding the four outliers, there was excellent agreement between the two methods (ICC: 0.945, 95%CI: 0.930, 0.958). Notably, pMR had a higher NLM detection rate than DT-PET, with correlations found between lesion size on pMR and DT-PET detectability, as well as diffusion restriction on pMR and SUVmax on DT-PET. In conclusion, in consecutive patients with well-differentiated NETs, the detection rate of NLM is higher with pMR than with DT-PET. However, when excluding patients whose tumors do not overexpress somatostatin receptors (13% of the cohort), high concordance in the detection of NLM is observed between DT PET and pMR.
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Affiliation(s)
- Moran Drucker Iarovich
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Ricarda Hinzpeter
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Brian Michael Moloney
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Katrina Hueniken
- Department of Biostatistics, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Claudia Ortega
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
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Starekova J, Pirasteh A, Reeder SB. Update on Gadolinium Based Contrast Agent Safety, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol 2023. [PMID: 37850581 DOI: 10.2214/ajr.23.30036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Since its introduction 35 years ago, gadolinium-enhanced MRI has fundamentally changed medical practice. While extraordinarily safe, gadolinium-based contrast agents (GBCAs) may have side effects. Four distinct safety considerations include: acute allergic-like reactions, nephrogenic systemic fibrosis (NSF), gadolinium deposition, and symptoms associated with gadolinium exposure. Acute reactions after GBCA administration are uncommon-far less than with iodinated contrast agents-and, while rare, serious reactions can occur. NSF is a rare, but serious, scleroderma-like condition occurring in patients with kidney failure after exposure to American College of Radiology (ACR) Group 1 GBCAs. Group 2 and 3 GBCAs are considered lower risk, and, through their use, NSF has largely been eliminated. Unrelated to NSF, retention of trace amounts of gadolinium in the brain and other organs has been recognized for over a decade. Deposition occurs with all agents, although linear agents appear to deposit more than macrocyclic agents. Importantly, to date, no data demonstrate any adverse biologic or clinical effects from gadolinium deposition, even with normal kidney function. This article summarizes the latest safety evidence of commercially available GBCAs with a focus on new agents, discusses updates to the ACR NSF GBCA safety classification, and describes approaches for strengthening the evidence needed for regulatory decisions.
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Affiliation(s)
- Jitka Starekova
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Ali Pirasteh
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
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Marth AA, Auer TA, Walter-Rittel TC, Nevermann N, Krenzien F, Schmelzle M, Müller T, Kolck J, Wieners G, Geisel D, Gebauer B, Hamm B, Schöning W, Fehrenbach U. Gd-EOB-DTPA-MRCP to localize bile leakage after liver trauma and surgery: impact on treatment and outcome. Eur Radiol 2023; 33:5933-5942. [PMID: 37052657 PMCID: PMC10415430 DOI: 10.1007/s00330-023-09608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/20/2023] [Accepted: 03/19/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES Bile leakage (BL) is a challenging complication after hepatobiliary surgery and liver trauma. Gadolinium ethoxybenzyl (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiopancreatography (MRCP) is used to diagnose BL non-invasively. We assessed the value of Gd-EOB-DTPA-MRCP in the detection of postoperative and post-traumatic BL hypothesizing that exact identification of the leakage site is pivotal for treatment planning and outcome. METHODS We retrospectively enrolled 39 trauma and postoperative patients who underwent Gd-EOB-DTPA-MRCP for suspected BL. Three readers rated the presence of BL and leakage site (intraparenchymal, central, peripheral ± aberrant or disconnected ducts). Imaging findings were compared to subsequent interventional procedures and their complexity and outcome. RESULTS BL was detected in Gd-EOB-DTPA-MRCP in 25 of patients and was subsequently confirmed. Sites of BL differed significantly between postoperative (central [58%] and peripheral [42%]) and trauma patients (intraparenchymal [100%]; p < 0.001). Aberrant or disconnected ducts were diagnosed in 8%/26% of cases in the postoperative subgroup. Inter-rater agreement for the detection and localization of BL was almost perfect (Κ = 0.85 and 0.88; p < 0.001). Intraparenchymal BL required significantly less complex interventional procedures (p = 0.002), whereas hospitalization and mortality did not differ between the subgroups (p > 0.05). CONCLUSIONS Gd-EOB-DTPA-MRCP reliably detects and exactly locates BL in postoperative and trauma patients. Exact localization of biliary injuries enables specific treatment planning, as intraparenchymal leakages, which occur more frequently after trauma, require less complex interventions than central or peripheral leaks in the postoperative setting. As a result of specific treatment based on exact BL localization, there was no difference in the duration of hospitalization or mortality. CLINICAL RELEVANCE STATEMENT Gd-EOB-DTPA-MRCP is a reliable diagnostic tool for exactly localizing iatrogenic and post-traumatic biliary leakage. Its precise localization helps tailor local therapies for different injury patterns, resulting in comparable clinical outcomes despite varying treatments. KEY POINTS • Gd-EOB-DTPA-MRCP enables adequate detection and localization of bile leakages in both postoperative and post-traumatic patients. • The site of bile leakage significantly impacts the complexity of required additional interventions. • Intraparenchymal bile leakage is commonly seen in patients with a history of liver trauma and requires less complex interventions than postoperative central or peripheral bile leakages, while hospitalization and mortality are similar.
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Affiliation(s)
- Adrian A Marth
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Timo A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thula C Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nora Nevermann
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Felix Krenzien
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Tobias Müller
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gero Wieners
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Shaikh S. Editorial for "Abbreviated Gadoxetic Acid-Enhanced MRI for the Detection of Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Adenocarcinoma". J Magn Reson Imaging 2022; 56:737-738. [PMID: 34997663 DOI: 10.1002/jmri.28054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sikandar Shaikh
- Department of Radiology, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Recomendaciones de expertos sobre el uso de ácido gadoxético en pacientes con metástasis hepáticas en España. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain. RADIOLOGIA 2022; 64:300-309. [DOI: 10.1016/j.rxeng.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 09/03/2021] [Indexed: 10/15/2022]
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8
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Cisneros-Garza L, González-Huezo M, Moctezuma-Velázquez C, Ladrón de Guevara-Cetina L, Vilatobá M, García-Juárez I, Alvarado-Reyes R, Álvarez-Treviño G, Allende-Pérez S, Bornstein-Quevedo L, Calderillo-Ruiz G, Carrillo-Martínez M, Castillo-Barradas M, Cerda-Reyes E, Félix-Leyva J, Gabutti-Thomas J, Guerrero-Ixtlahuac J, Higuera-de-la-Tijera F, Huitzil-Meléndez D, Kimura-Hayama E, López-Hernández P, Malé-Velázquez R, Méndez-Sánchez N, Morales-Ruiz M, Ruíz-García E, Sánchez-Ávila J, Torrecillas-Torres L. The second Mexican consensus on hepatocellular carcinoma. Part I: Epidemiology and diagnosis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2022; 87:216-234. [DOI: 10.1016/j.rgmxen.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
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Diagnosis and Follow-up of Incidental Liver Lesions in Children. J Pediatr Gastroenterol Nutr 2022; 74:320-327. [PMID: 34984985 DOI: 10.1097/mpg.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Incidental liver lesions are identified in children without underlying liver disease or increased risk of hepatic malignancy in childhood. Clinical and imaging evaluation of incidental liver lesions can be complex and may require a multidisciplinary approach. This review aims to summarize the diagnostic process and follow-up of incidental liver lesions based on review of the literature, use of state-of-the-art imaging, and our institutional experience. Age at presentation, gender, alpha fetoprotein levels, tumor size, and imaging characteristics should all be taken into consideration to optimize diagnosis process. Some lesions, such as simple liver cyst, infantile hemangioma, focal nodular hyperplasia (FNH), and focal fatty lesions, have specific imaging characteristics. Recently, contrast-enhanced ultrasound (CEUS) was Food and Drug Administration (FDA)-approved for the evaluation of pediatric liver lesions. CEUS is most specific in lesions smaller than 3 cm and is most useful in the diagnosis of infantile hemangioma, FNH, and focal fatty lesions. The use of hepatobiliary contrast in MRI increases specificity in the diagnosis of FNH. Recently, lesion characteristics in MRI were found to correlate with subtypes of hepatocellular adenomas and associated risk for hemorrhage and malignant transformation. Biopsy should be considered when there are no specific imaging characteristics of a benign lesion. Surveillance with imaging and alpha fetoprotein (AFP) should be performed to confirm the stability of lesions when the diagnosis cannot be determined, and whenever biopsy is not feasible.
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10
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Chavhan GB, Farras Roca L, Coblentz AC. Liver magnetic resonance imaging: how we do it. Pediatr Radiol 2022; 52:167-176. [PMID: 33797616 DOI: 10.1007/s00247-021-05053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/04/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging is used for evaluating focal liver lesions, hepatic vascular diseases, biliary diseases and diffuse liver diseases in children. MRI examinations take a long time, often requiring sedation or anesthesia in smaller children. This makes it essential to understand the concepts and technique necessary to obtain an optimal examination for answering the clinical question while minimizing the need for sedation/anesthesia. We discuss key concepts including appropriate sequence selection, choice of contrast media, dynamic imaging, phases of contrast enhancement and protocol organization.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Lara Farras Roca
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ailish C Coblentz
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Freitas PS, Janicas C, Veiga J, Matos AP, Herédia V, Ramalho M. Imaging evaluation of the liver in oncology patients: A comparison of techniques. World J Hepatol 2021; 13:1936-1955. [PMID: 35069999 PMCID: PMC8727197 DOI: 10.4254/wjh.v13.i12.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is commonly affected by metastatic disease. Therefore, it is essential to detect and characterize liver metastases, assuming that patient management and prognosis rely on it. The imaging techniques that allow non-invasive assessment of liver metastases include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and PET/MRI. In this paper, we review the imaging findings of liver metastases, focusing on each imaging modality’s advantages and potential limitations. We also assess the importance of different imaging modalities for the management, follow-up, and therapy response of liver metastases. To date, both CT and MRI are the most appropriate imaging methods for initial lesion detection, follow-up, and assessment of treatment response. Multiparametric MRI is frequently used as a problem-solving technique for liver lesions and has evolved substantially over the past decade, including hardware and software developments and specific intravenous contrast agents. Several studies have shown that MRI performs better in small-sized metastases and moderate to severe liver steatosis cases. Although state-of-the-art MRI shows a greater sensitivity for detecting and characterizing liver metastases, CT remains the chosen method. We also present the controversial subject of the "economic implication" to use CT over MRI.
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Affiliation(s)
- Patrícia S Freitas
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon 1150-199, Portugal
| | - Catarina Janicas
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - José Veiga
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon 1150-199, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital CUF Tejo, Lisbon 1350-352, Portugal
| | - Vasco Herédia
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital Espírito Santo de Évora-EPE, Évora 7000-811, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital da Luz, Lisbon 1500-650, Portugal
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12
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Jhaveri KS, Babaei Jandaghi A, Thipphavong S, Espin-Garcia O, Dodd A, Hutchinson S, Reichman TW, Moulton CA, McGilvary ID, Gallinger S. Can preoperative liver MRI with gadoxetic acid help reduce open-close laparotomies for curative intent pancreatic cancer surgery? Cancer Imaging 2021; 21:45. [PMID: 34193282 PMCID: PMC8243548 DOI: 10.1186/s40644-021-00416-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives To evaluate gadoxetic acid-enhanced liver MRI (EOB-MRI) versus contrast-enhanced computed tomography (CECT) for preoperative detection of liver metastasis (LM) and reduction of open-close laparotomies for pancreatic ductal adenocarcinoma (PDAC). Methods Sixty-six patients with PDAC had undergone preoperative EOB-MRI and CECT. LM detection by EOB-MRI and CECT and their impact on surgical planning, open-close laparotomies were compared by clinical and radiology reports and retrospective analysis of imaging by two blinded independent readers. Histopathology or imaging follow-up was the reference standard. Statistical analysis was performed at patient and lesion levels with two-sided McNemar tests. Results EOB-MRI showed higher sensitivity versus CECT (71.7% [62.1-80.0] vs. 34% [25.0-43.8]; p = 0.009), comparable specificity (98.6%, [96.9-99.5] vs. 100%, [99.1-100], and higher AUROC (85.1%, [80.4-89.9] vs. 66.9%, [60.9-73.1]) for LM detection. An incremental 7.6% of patients were excluded from surgery with a potential reduction of up to 13.6% in futile open-close laparotomies due to LM detected on EOB-MRI only. Conclusions Preoperative EOB-MRI has superior diagnostic performance in detecting LM from PDAC. This better informs surgical eligibility with potential reduction of futile open-close laparotomies from attempted curative intent pancreatic cancer surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-021-00416-4.
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Affiliation(s)
- Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada.
| | - Ali Babaei Jandaghi
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto, ON, M5G 1X6, Canada
| | - Seng Thipphavong
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, M5G 2C1, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anna Dodd
- Wallace McCain Centre for Pancreatic Cancer, Princess Margaret Hospital Cancer Centre, Toronto, ON, M5G 2C1, Canada
| | - Shawn Hutchinson
- Wallace McCain Centre for Pancreatic Cancer, Princess Margaret Hospital Cancer Centre, Toronto, ON, M5G 2C1, Canada
| | - Trevor W Reichman
- Department of Surgery, University of Toronto; Hepatobiliary & Pancreatic Surgical Oncology, University Health Network, Toronto, ON, M5G 2C4, Canada
| | - Carol-Anne Moulton
- Department of Surgery, University of Toronto; Hepatobiliary & Pancreatic Surgical Oncology, University Health Network, Toronto, ON, M5G 2C4, Canada
| | - Ian D McGilvary
- Department of Surgery, Hepatobiliary & Pancreatic Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, M5G 2N2, Canada
| | - Steven Gallinger
- Department of Surgery, Hepatobiliary & Pancreatic Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, M5G 2N2, Canada
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Morisaka H, Seno D, Sakurai Y, Sano K, Akamine Y, Ichikawa T, Okada Y. Quantitative analysis of gadoxetic acid-enhanced MRI for the differential diagnosis of focal liver lesions: Comparison between estimated intralesional gadoxetic acid retention by T1 mapping and conventional processing methods. Eur J Radiol 2021; 138:109620. [PMID: 33713905 DOI: 10.1016/j.ejrad.2021.109620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the estimated quantity of intratumor gadoxetic acid retention using T1 mapping of gadoxetic acid-enhanced magnetic resonance imaging (MRI) versus conventional processing methods for the differential diagnosis of focal liver lesions. METHODS Seventy patients with hepatic lesions (colorectal metastasis (CRM) [n = 28], hepatocellular carcinoma (HCC) [n = 20], hemangioma [n = 12], and intrahepatic cholangiocarcinoma (ICC) [n = 10]) underwent gadoxetic acid-enhanced MRI, including pre- and post-contrast T1-weighted imaging and T1 mapping. Quantitative analyses included the lesion-to-liver signal intensity ratio (SIR) on hepatobiliary phase images, the pre- and post-contrast lesion T1 value difference (ΔT1 [ms]), and the lesion retention index (LRI [%]), which was the estimated intralesional gadoxetic acid retention calculated on pre- and post-contrast T1 maps using a two-compartment pharmacokinetic model. Results were compared between the four subcategories of focal liver lesions using the Kruskal-Wallis test, followed by the post-hoc Dunn's test and receiver operating characteristic (ROC) analysis to distinguish between pairs of the four lesion subcategories. RESULTS This study identified significant differences in the LRI of the four lesion subcategories (p < 0.01), without significant differences in ΔT1 or SIR. Post-hoc analysis demonstrated significant differences in CRM vs. hemangioma (p < 0.01), hemangioma vs. ICC (p < 0.01), and HCC vs. ICC (p = 0.047) for the LRI. CONCLUSIONS The quantity of intratumor gadoxetic acid retention estimated using pre- and post- contrast T1 mapping could distinguish focal liver lesions, unlike conventional processing methods, and captured unique lesion characteristics.
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Affiliation(s)
- Hiroyuki Morisaka
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 350-1298, Yamane 1397-1, Hidaka, Saitama, Japan; Department of Radiology, University of Yamanashi, 409-3898, Shimokato, Chuo, Yamanashi, Japan.
| | - Daiki Seno
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 350-1298, Yamane 1397-1, Hidaka, Saitama, Japan
| | - Yasuo Sakurai
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 350-1298, Yamane 1397-1, Hidaka, Saitama, Japan
| | - Katsuhiro Sano
- Department of Radiology, Juntendo University Hospital, 113-8431, Hongo 3-1-3, Bunkyoku, Tokyo, Japan
| | - Yuta Akamine
- Philips Japan, Kounan 2-13-37, Minatoku, Tokyo, Japan
| | - Tomoaki Ichikawa
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 350-1298, Yamane 1397-1, Hidaka, Saitama, Japan; Department of Radiology, Isesaki Municipal Hospital, 372-0817, Tsunatori-honmachi, Isesaki, Gunnma, Japan
| | - Yoshitaka Okada
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 350-1298, Yamane 1397-1, Hidaka, Saitama, Japan
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Does Hepatic Steatosis Influence the Detection Rate of Metastases in the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI? J Clin Med 2020; 10:jcm10010098. [PMID: 33396634 PMCID: PMC7796028 DOI: 10.3390/jcm10010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this exploratory study was to evaluate the influence of hepatic steatosis on the detection rate of metastases in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI). A total of 50 patients who underwent gadoxetic acid-enhanced MRI (unenhanced T1w in- and opposed-phase, T2w fat sat, unenhanced 3D-T1w fat sat and 3-phase dynamic contrast-enhanced (uDP), 3D-T1w fat sat hepatobiliary phase (HP)) were retrospectively included. Two blinded observers (O1/O2) independently assessed the images to determine the detection rate in uDP and HP. The hepatic signal fat fraction (HSFF) was determined as the relative signal intensity reduction in liver parenchyma from in- to opposed-phase images. A total of 451 liver metastases were detected (O1/O2, n = 447/411). O1/O2 detected 10.9%/9.3% of lesions exclusively in uDP and 20.2%/15.5% exclusively in HP. Lesions detected exclusively in uDP were significantly associated with a larger HSFF (area under curve (AUC) of receiver operating characteristic (ROC) analysis, 0.93; p < 0.001; cutoff, 41.5%). The exclusively HP-positive lesions were significantly associated with a smaller diameter (ROC-AUC, 0.82; p < 0.001; cutoff, 5 mm) and a smaller HSFF (ROC-AUC, 0.61; p < 0.001; cutoff, 13.3%). Gadoxetic acid imaging has the advantage of detecting small occult metastatic liver lesions in the HP. However, using non-optimized standard fat-saturated 3D-T1w protocols, severe steatosis (HSFF > 30%) is a potential pitfall for the detection of metastases in HP.
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Moosavi B, Shenoy-Bhangle AS, Tsai LL, Reuf R, Mortele KJ. MRI characterization of focal liver lesions in non-cirrhotic patients: assessment of added value of gadoxetic acid-enhanced hepatobiliary phase imaging. Insights Imaging 2020; 11:101. [PMID: 32960337 PMCID: PMC7509030 DOI: 10.1186/s13244-020-00894-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the added value of the hepatobiliary (HPB) phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) in characterizing newly discovered indeterminate focal liver lesions in non-cirrhotic patients. Results One-hundred and twenty-five non-cirrhotic patients (median age, 46 years; range, 20–85 years; 100 females) underwent gadoxetic acid-enhanced MRI, including the 20-min delayed HPB phase, for characterization of newly discovered focal liver lesions. Images were independently evaluated by two blinded, board-certified abdominal radiologists (R1 and R2) who characterized liver lesions without and with assessment of the HPB phase images in two separate readout sessions. Confidence in diagnosis was scored on a scale from 0 to 3. Inter-observer agreement was assessed using Cohen κ statistics. Change in diagnosis and confidence in diagnosis were evaluated by Wilcoxon signed rank test. There was no significant change in diagnosis before and after evaluation of the HPB phase for both readers (p = 1.0 for R1; p = 0.34 for R2). Confidence in diagnosis decreased from average 2.8 ± 0.45 to 2.6 ± 0.59 for R1 and increased from 2.6 ± 0.83 to 2.8 ± 0.46 for R2. Change in confidence was only statistically significant for R1 (p = 0.003) but not significant for R2 (p = 0.49). Inter-reader agreement in diagnosis was good without (k = 0.66) and with (k = 0.75) inclusion of the HPB phase images. Conclusions The added information obtained from the HPB phase of gadoxetic acid-enhanced MRI does not change the diagnosis or increase confidence in diagnosis when evaluating new indeterminate focal liver lesions in non-cirrhotic patients.
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Affiliation(s)
- Bardia Moosavi
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.
| | - Anuradha S Shenoy-Bhangle
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Leo L Tsai
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Robert Reuf
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.,Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Koenraad J Mortele
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.,Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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Hepatobiliary phase enhancement of liver metastases on gadoxetic acid MRI: assessment of frequency and patterns. Eur Radiol 2020; 31:1359-1366. [PMID: 32886204 DOI: 10.1007/s00330-020-07228-3] [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] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess for and characterize patterns of hepatobiliary phase (HBP) enhancement in hepatic metastases of various malignancies on gadoxetic acid-enhanced MRI. METHODS Eighty gadoxetic acid-enhanced MRI studies performed between July 2012 and November 2019 in patients with hepatic metastases from 13 different primary malignancies were assessed. Most (n = 60) were from colorectal cancer (CRC), pancreatic ductal adenocarcinoma (PDAC), or neuroendocrine tumor (NET) primaries. Two radiologists quantitatively evaluated the dominant lesion on each MRI. A lesion was considered enhancing when HBP enhancement relative to muscle exceeded 20%. Lesions were classified by pattern of enhancement. Quantitative enhancement metrics and patterns of enhancement were compared between CRC, PDAC, and NET using non-parametric statistical tests. RESULTS Most dominant metastatic lesions > 1 cm (77%, 54/70) demonstrated HBP enhancement. HBP enhancement was identified in hepatic metastases from 10 different primary malignancies, including CRC, PDAC, and NET. PDAC metastases demonstrated a lower degree of HBP enhancement (26%) than CRC (44%, padj = 0.04) and NET (51%, padj = 0.01) metastases. Three discrete enhancement patterns were identified: peripheral, central (target), and diffuse heterogeneous. Patterns of HBP enhancement varied between CRC, PDAC, and NET, with secondary analysis demonstrating that PDAC had the highest proportion of peripheral pattern (73%, padj < 0.001), CRC the highest proportion of diffuse heterogeneous pattern (32%, padj < 0.01), and NET the highest proportion of central pattern (89%, padj < 0.001). CONCLUSION Liver metastases from several primary malignancies, including PDAC, demonstrate mild HBP enhancement in variable patterns. Correlation with OATP1B3 expression and prognosis is required. KEY POINTS • Hepatobiliary phase (HBP) enhancement was identified in 77% of hepatic metastases in several different primary malignancies. • Discrete patterns of HBP enhancement exist (peripheral, central, diffuse heterogeneous) and varied between CRC, PDAC, and NET. CRC and PDAC metastases demonstrated mostly non-central patterns (diffuse and peripheral), and NET mostly a central pattern. • Relationship between HBP enhancement, enhancement pattern, OATP1B3 expression, and prognosis requires further dedicated exploration for each malignancy.
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Orimo T, Kamiyama T, Kamachi H, Shimada S, Nagatsu A, Asahi Y, Sakamoto Y, Abo D, Taketomi A. Predictive value of gadoxetic acid enhanced magnetic resonance imaging for posthepatectomy liver failure after a major hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:531-540. [DOI: 10.1002/jhbp.769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Tatsuya Orimo
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Shingo Shimada
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Yuzuru Sakamoto
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology Hokkaido University Hospital Sapporo Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan
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Morin C, Drolet S, Daigle C, Deshaies I, Ouellet JF, Ball CG, Dixon E, Marceau J, Ouellet JFB. Additional value of gadoxetic acid-enhanced MRI to conventional extracellular gadolinium-enhanced MRI for the surgical management of colorectal and neuroendocrine liver metastases. HPB (Oxford) 2020; 22:710-715. [PMID: 31640929 DOI: 10.1016/j.hpb.2019.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/04/2019] [Accepted: 09/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver resection being the only potentially curative treatment for patients with liver metastasis, it is critical to select the appropriate preoperative imaging modality. The aim of this study was to assess the impact of preoperative gadoxetic acid-enhanced MRI compared to a conventional extracellular gadolinium-enhanced MRI on the surgical management of colorectal and neuroendocrine liver metastasis. METHODS We included 110 patients who underwent both a gadoxetic acid-enhanced MRI (hepatospecific contrast) and conventional extracellular gadolinium for the evaluation of colorectal or neuroendocrine liver metastases, from January 2012 to December 2015 at the CHU de Québec - Université Laval. When the number of lesions differed, a hepatobiliary surgeon evaluated if the gadoxetic acid-enhanced MRI modified the surgical management. RESULTS Gadoxetic acid-enhanced MRI found new lesions in 25 patients (22.7%), excluded lesions in 18 patients (16.4%) and identified the same number in 67 patients (60.9%). The addition of the gadoxetic acid-enhanced MRI directly altered the surgical management in 19 patients overall (17.3% (95% CI [10.73-25.65])). CONCLUSION Despite the additional cost associated with gadoxetic acid-enhanced MRI compared to conventional extracellular gadolinium-enhanced MRI, the use of this contrast agent has a significant impact on the surgical management of patients with liver metastases.
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Affiliation(s)
- Claudya Morin
- CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6 QC, Canada.
| | - Sebastien Drolet
- CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6 QC, Canada
| | - Carl Daigle
- CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6 QC, Canada
| | - Isabelle Deshaies
- CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6 QC, Canada
| | | | - Chad G Ball
- Foothills Medical Centre - University of Calgary, 1403 29 St NW, Calgary, T2N 2T9 Alberta, Canada
| | - Elijah Dixon
- Foothills Medical Centre - University of Calgary, 1403 29 St NW, Calgary, T2N 2T9 Alberta, Canada
| | - Julie Marceau
- CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6 QC, Canada
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Abstract
The imaging of focal liver lesions is a common task in daily radiological routine. The objectives of diagnostic imaging are, in addition to lesion detection, the characterization of the lesion as well as the follow-up assessment after surgical or local treatment or under systemic therapy. This article presents the typical morphologies observed in computed tomography and magnetic resonance imaging of hepatocellular carcinomas and intrahepatic cholangiocarcinomas as the most important representatives of primary malignant liver tumors and juxtaposes them with benign primary liver lesions such as adenoma and focal nodular hyperplasia (FNH). In addition, relevant technical aspects of imaging are briefly summarized. Finally, the main and additional criteria of the Liver Imaging Reporting and Data System (LI-RADS®) classification, which are becoming increasingly established clinically for the evaluation of liver lesions in the cirrhotic liver, are presented.
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Affiliation(s)
- H-J Raatschen
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol 2020; 12:1758835920904803. [PMID: 32127925 PMCID: PMC7036491 DOI: 10.1177/1758835920904803] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background The incidence of gastric cancer with liver metastases (GCLM) is 9.9-18.7%, with a median survival time of 11 months and a 5-year survival rate <20%. Multidisciplinary treatment (MDT) is gradually gaining recognition as the most important method. However, specific treatment plans remain unclear. The aim of study was to provide a consensus to improve the diagnosis and treatment of GCLM. Methods We brought together experts from relevant medical fields across China, including the Chinese Research Hospital Association Digestive Tumor Committee, Chinese Association of Upper Gastrointestinal Surgeons, Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association, to discuss and formulate this consensus. Results A consensus was reached on the diagnosis and treatment of GCLM. Moreover, we have developed a new clinical classification system, the Chinese Type for Gastric Cancer Liver Metastases, based on the likelihood of a surgical treatment being successful. Conclusions The MDT mode should be implemented throughout all treatment of GCLM.A Chinese version of this expert consensus has been published in the Chinese Journal of Practical Surgery (Volume 39, Issue 10, p. 405-411). Written permission was obtained from the Chinese Journal of Practical Surgery to disseminate the expert consensus in English.
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Affiliation(s)
- Kecheng Zhang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lin Chen
- Department of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
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21
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Zamboni G, Mazzaro A, Mansueto G. How to Best Image Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-019-00447-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Differentiation of Hepatic Sclerosed Hemangiomas From Cavernous Hemangiomas Based on Gadoxetic Acid-Enhanced Magnetic Resonance Imaging Features. J Comput Assist Tomogr 2019; 43:762-769. [PMID: 31356526 DOI: 10.1097/rct.0000000000000905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the imaging features of a hepatic sclerosed hemangioma by comparing them with those of a cavernous hemangioma using magnetic resonance imaging with gadoxetic acid enhancement. METHODS Nine patients with hepatic sclerosed hemangiomas and 36 patients with cavernous hemangiomas (control group) who underwent gadoxetic acid-enhanced magnetic resonance imaging were included. Qualitative values (imaging findings and enhancement pattern [typical vs atypical enhancement]) and quantitative values (apparent diffusion coefficient) were evaluated. RESULTS Patients with sclerosed hemangiomas showed significantly more irregular tumor margin on hepatobiliary phase images, peritumoral arterial enhancement, and a lower proportion of hyperintensity on heavily T2-weighted images compared with controls (all P values <0.05). In addition, the sclerosed hemangioma group had significantly more frequent atypical enhancement patterns than did the control group (88.9% vs 33.3%; P = 0.006). However, the mean apparent diffusion coefficient value of hemangiomas was not significantly different between the 2 groups (P = 0.639). CONCLUSIONS Gadoxetic acid-enhanced magnetic resonance images can help in differentiating between hepatic sclerosed hemangiomas and cavernous hemangiomas.
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23
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Current Imaging Standards for Nonmetastatic Benign and Malignant Liver Tumors. Surg Oncol Clin N Am 2019; 28:539-572. [PMID: 31472905 DOI: 10.1016/j.soc.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The accurate diagnosis of a liver mass can usually be established with a thorough history, examination, laboratory inquiry, and imaging. The necessity of a liver biopsy to determine the nature of a liver mass is rarely necessary. Contrast-enhanced computed tomography and magnetic resonance are the standard of care for diagnosing liver lesions and high-quality imaging should be performed before performing a biopsy. This article discusses current consensus guidelines for imaging of liver masses, as well as masses found on surveillance imaging. The ability to accurately characterize lesions requires proper use and understanding of the technology and expert interpretation.
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Kim JW, Lee CH, Park YS, Lee J, Kim KA. Abbreviated Gadoxetic Acid-enhanced MRI with Second-Shot Arterial Phase Imaging for Liver Metastasis Evaluation. Radiol Imaging Cancer 2019; 1:e190006. [PMID: 33778670 PMCID: PMC7983790 DOI: 10.1148/rycan.2019190006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate the feasibility of an abbreviated gadoxetic acid-enhanced MRI protocol including second-shot arterial phase (SSAP) imaging for liver metastasis evaluation. MATERIALS AND METHODS For this retrospective study, a total of 197 patients with cancer (117 men and 80 women; mean age, 62.9 years) were included who underwent gadoxetic acid-enhanced MRI performed by using a modified injection protocol for liver metastasis evaluation from July to August 2017. The modified injection protocol included routine dynamic imaging after a first injection of 6 mL and SSAP imaging after a second injection of 4 mL. Image set 1 was obtained with the full original protocol. Image set 2 consisted of T2-weighted, diffusion-weighted, hepatobiliary phase, and SSAP images (the simulated abbreviated protocol). Acquisition time was measured in each image set. The diagnostic performance of each image set was compared by using a jackknife alternative free-response receiver operating characteristic analysis. Image quality evaluation and visual assessment of vascularity were performed on the original arterial phase images, the SSAP images, and their subtraction images. RESULTS The acquisition time was significantly shorter in image set 2 than in image set 1 (18.6 vs 6.2 minutes, P <.0001). The reader-averaged figure-of-merit was not significantly different between image sets 1 and 2 (P = .197). The mean motion artifact score was significantly lower for the SSAP images than for the original arterial phase images (P <.001). All hypervascular metastases (n = 72) showed hyperintensity on the SSAP and/or the second subtraction images. CONCLUSION An abbreviated MRI protocol including SSAP is feasible for liver metastasis evaluation, providing faster image acquisition while preserving diagnostic performance, image quality, and visual vascularity.Keywords: Abdomen/GI, Comparative Studies, Liver, MR-Imaging, Metastases© RSNA, 2019Supplemental material is available for this article.
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Petrillo M, Ierardi AM, Tofanelli L, Maresca D, Angileri A, Patella F, Carrafiello G. Gd-EOB-DTP-enhanced MRC in the preoperative percutaneous management of intra and extrahepatic biliary leakages: does it matter? Gland Surg 2019; 8:174-183. [PMID: 31183327 DOI: 10.21037/gs.2019.03.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Postoperative bile leakage is a common complication of abdominal surgical procedures and a precise localization of is important to choose the best management. Many techniques are available to correctly identify bile leaks, including ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI), being the latter the best to clearly depict "active" bile leakages. This paper presents the state of the art algorithm in the detection of biliary leakages in order to plan a percutaneous biliary drainage focusing on widely available and safe contrast agent, the Gb-EOB-DPA. We consider its pharmacokinetic properties and impact in biliary imaging explain current debates to optimize image quality. We report common sites of leakage after surgery with special considerations in cirrhotic liver to show what interventional radiologists should look to easily detect bile leaks.
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Affiliation(s)
- Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Laura Tofanelli
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Duilia Maresca
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessio Angileri
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
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Shu Z, Fang S, Ding Z, Mao D, Cai R, Chen Y, Pang P, Gong X. MRI-based Radiomics nomogram to detect primary rectal cancer with synchronous liver metastases. Sci Rep 2019; 9:3374. [PMID: 30833648 PMCID: PMC6399278 DOI: 10.1038/s41598-019-39651-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
Synchronous liver metastasis (SLM) remains a major challenge for rectal cancer. Early detection of SLM is a key factor to improve the survival rate of rectal cancer. In this radiomics study, we predicted the SLM based on the radiomics of primary rectal cancer. A total of 328 radiomics features were extracted from the T2WI images of 194 patients. The least absolute shrinkage and selection operator (LASSO) regression was used to reduce the feature dimension and to construct the radiomics signature. after LASSO, principal component analysis (PCA) was used to sort the features of the surplus characteristics, and selected the features of the total contribution of 85%. Then the prediction model was built by linear regression, and the decision curve analysis was used to judge the net benefit of LASSO and PCA. In addition, we used two independent cohorts for training (n = 135) and validation (n = 159). We found that the model based on LASSO dimensionality construction had the maximum net benefit (in the training set (AUC [95% confidence interval], 0.857 [0.787–0.912]) and in the validation set (0.834 [0.714–0.918]). The radiomics nomogram combined with clinical risk factors and LASSO features showed a good predictive performance in the training set (0.921 [0.862–0.961]) and validation set (0.912 [0.809–0.97]). Our study indicated that radiomics based on primary rectal cancer could provide a non-invasive way to predict the risk of SLM in clinical practice.
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Affiliation(s)
- Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Songhua Fang
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Dewang Mao
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Rui Cai
- Department of Anorectal, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | | | | | - Xiangyang Gong
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.
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Abstract
Many elegant inorganic designs have been developed to aid medical imaging. We know better now how to improve imaging due to the enormous efforts made by scientists in probe design and other fundamental sciences, including inorganic chemistry, physiochemistry, analytical chemistry, and biomedical engineering. However, despite several years being invested in the development of diagnostic probes, only a few examples have shown applicability in MRI in vivo. In this short review, we aim to show the reader the latest advances in the application of inorganic agents in preclinical MRI.
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Cha DI, Kang TW, Jang KM, Kim YK, Kim SH, Ha SY, Sohn I. Hepatic neuroendocrine tumors: gadoxetic acid-enhanced magnetic resonance imaging findings with an emphasis on differentiation between primary and secondary tumors. Abdom Radiol (NY) 2018; 43:3331-3339. [PMID: 29858937 DOI: 10.1007/s00261-018-1653-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To describe the findings of magnetic resonance (MR) imaging of hepatic neuroendocrine tumors (hNET) and to identify the features that differentiate secondary from primary tumors. METHODS This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Between August 2008 and December 2014, 50 patients with pathologically proven hNETs who underwent gadoxetic acid-enhanced MR imaging with diffusion-weighted images were included. The patients were divided into two groups according to whether they had primary (n = 17) or secondary (n = 33) hNETs. Qualitative values based on a consensus between two observers [morphologic findings, signal intensity, and enhancement pattern (poor or indeterminate; hepatocellular carcinoma-like or cholangiocarcinoma-like)], and quantitative values (apparent diffusion coefficient) were evaluated as predictors of secondary hNETs using multivariable logistic regression and receiver operating characteristic (ROC) analysis. RESULTS In multivariate analysis, the presence of multiple lesions (p = 0.011), a tumor size less than 6.3 cm (p = 0.001), and a hepatocellular carcinoma-like enhancement pattern (p = 0.031) were significant independent factors for differentiating secondary from primary hNETs, and achieved a sensitivity of 91%, a specificity of 82%, and an accuracy of 88%, with a value of the area under the ROC curve of 0.931. CONCLUSION Using these specific MR imaging criteria, secondary hNETs could be differentiated from primary hNETs with a high degree of accuracy in patients with histopathologically proven hNETs.
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Affiliation(s)
- Dong Ik Cha
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
| | - Kyoung Mi Jang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Young Kon Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Seong Hyun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Sang Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Insuk Sohn
- Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
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Usman S, Smith L, Brown N, Major V. Diagnostic accuracy of Magnetic Resonance Imaging using liver tissue specific contrast agents and contrast enhanced Multi Detector Computed Tomography: A systematic review of diagnostic test in Hepatocellular Carcinoma (HCC). Radiography (Lond) 2018; 24:e109-e114. [PMID: 30292515 DOI: 10.1016/j.radi.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this systematic review is to investigate diagnostic accuracy of Magnetic Resonance Imaging (MRI) scans using liver specific tissue contrast media over contrast enhanced Multi Detector CT (MDCT) in diagnoses of Hepatocellular Carcinoma (HCC) in patients with chronic liver disease. KEY FINDINGS A total of 8 diagnostic studies were identified and generally considered of high quality. The studies reported sufficient evidence on sensitivity and specificity, which was synthesised and summarised providing an overview of the evidence. Findings indicate that MRI scans using liver specific tissue contrast have a better diagnostic performance compared to contrast enhanced MDCT in diagnostic work-up of HCC in patients with chronic liver disease. CONCLUSION The current review identified sufficient high quality studies reporting statistical difference (P < 0.05), to establish the superiority of gadoxetetic acid enhanced MRI for sensitivity and specificity in comparison to MDCT in the diagnosis of HCC in chronic liver disease.
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Affiliation(s)
- S Usman
- London Northwest NHS Trust, Flat 80 Grand Union Heights, Northwick Road, Wembley, HA0 1LF, United Kingdom.
| | - L Smith
- Medical Imaging and Radiation Sciences, Allied Health Professions and Midwifery, School of Health and Social Work University of Hertfordshire, College Lane, Hatfield, AL10 9AB, United Kingdom.
| | - N Brown
- Department of Allied Health and Midwifery School of Health & Social Work University of Hertfordshire, College Lane, Hatfield, Herts, AL10 9AB, United Kingdom.
| | - V Major
- School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, Herts, AL10 9AB, United Kingdom.
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Horvat N, Marcelino ASZ, Horvat JV, Yamanari TR, Batista Araújo-Filho JDA, Panizza P, Seda-Neto J, Antunes da Fonseca E, Carnevale FC, Mendes de Oliveira Cerri L, Chapchap P, Cerri GG. Pediatric Liver Transplant: Techniques and Complications. Radiographics 2018; 37:1612-1631. [PMID: 29019744 DOI: 10.1148/rg.2017170022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Liver transplant is considered to be the last-resort treatment approach for pediatric patients with end-stage liver disease. Despite the remarkable advance in survival rates, liver transplant remains an intricate surgery with significant morbidity and mortality. Early diagnosis of complications is crucial for patient survival but is challenging given the lack of specificity in clinical presentation. Knowledge of the liver and vascular anatomy of the donor and the recipient or recipients before surgery is also important to avoid complications. In this framework, radiologists play a pivotal role on the multidisciplinary team in both pre- and postoperative scenarios by providing a road map to guide the surgery and by assisting in diagnosis of complications. The most common complications after liver transplant are (a) vascular, including the hepatic artery, portal vein, hepatic veins, and inferior vena cava; (b) biliary; (c) parenchymal; (d) perihepatic; and (e) neoplastic. The authors review surgical techniques, the role of each imaging modality, normal posttransplant imaging features, types of complications after liver transplant, and information required in the radiology report that is critical to patient care. They present an algorithm for an imaging approach for pediatric patients after liver transplant and describe key points that should be included in radiologic reports in the pre- and postoperative settings. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Natally Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Antonio Sergio Zafred Marcelino
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Vicente Horvat
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Tássia Regina Yamanari
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Jose de Arimateia Batista Araújo-Filho
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Pedro Panizza
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Joao Seda-Neto
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Eduardo Antunes da Fonseca
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Francisco Cesar Carnevale
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Luciana Mendes de Oliveira Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Paulo Chapchap
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
| | - Giovanni Guido Cerri
- From the Departments of Radiology (N.H., A.S.Z.M., T.R.Y., J.d.A.B.A.F., P.P., L.M.d.O.C., G.G.C.), Surgery (J.S.N., E.A.d.F., P.C.), and Interventional Radiology (F.C.C.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, SP 01308-050, Brazil; and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., J.V.H., J.d.A.B.A.F., F.C.C., G.G.C.)
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Contrast Agent-Induced High Signal Intensity in Dentate Nucleus on Unenhanced T1-Weighted Images: Comparison of Gadodiamide and Gadoxetic Acid. Invest Radiol 2018; 52:389-395. [PMID: 28195932 DOI: 10.1097/rli.0000000000000360] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether an association exists between T1-signal increase in the dentate nucleus (DN) on unenhanced magnetic resonance imaging and previous administration of gadoxetic acid and gadodiamide. MATERIALS AND METHODS This retrospective study was approved by the institutional review board; the requirement for informed patient consent was waived. A total of 132 patients (male-female ratio, 86:46; mean age, 68.8 ± 11.6 years) who underwent imaging between December 2000 and April 2016 were divided into 4 groups: patients with 5 or more administrations of gadoxetic acid ("gadoxetic acid ≥5 administrations" group), only 1 administration of gadoxetic acid ("gadoxetic acid 1 administration" group), no gadolinium-based contrast agent (GBCA) administration or chronic liver disease (CLD; "no GBCA administration and no CLD" group), and 5 or more administrations of gadodiamide ("gadodiamide ≥5 administrations" group). Unenhanced T1-weighted images were quantitatively analyzed by 2 radiologists. Intergroup comparison of DN-to-pons signal intensity ratios was performed by the Dunn test, with the no GBCA administration and no CLD group as control. Interobserver agreement was assessed by intraclass correlation coefficients. RESULTS The DN-to-pons ratio of the "gadodiamide ≥5 administrations" group was significantly higher (P < 0.0001) and those of the "gadoxetic acid ≥5 administrations" and "gadoxetic acid 1 administration" groups did not differ significantly (P = 0.3912 and 1.0000, respectively) compared with the DN-to-pons ratio of the "no GBCA administration and no CLD" group. The interobserver intraclass correlation coefficient for measurement of DN-to-pons ratio was excellent (0.835; 95% confidence interval, 0.767-0.883). CONCLUSIONS Hyperintensity in the DN on unenhanced T1-weighted images is associated with previous administration of gadodiamide but not gadoxetic acid. Although the number of administrations for the 2 GBCA groups was identical, the administered dose of gadoxetic acid was only a quarter the amount of gadolinium as those with gadodiamide. This difference might influence the results of this study.
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Performing Gadoxetic Acid–Enhanced MRI After CT for Guiding Curative Treatment of Early-Stage Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. AJR Am J Roentgenol 2018; 210:W63-W69. [DOI: 10.2214/ajr.17.18300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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How Do Different Indices of Hepatic Enhancement With Gadoxetic Acid Compare in Predicting Liver Failure and Other Major Complications After Hepatectomy? J Comput Assist Tomogr 2018; 42:380-386. [DOI: 10.1097/rct.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Ko Y, Kim J, Park JKH, Kim H, Cho JY, Kang SB, Ahn S, Lee KJ, Lee KH. Limited detection of small (≤ 10 mm) colorectal liver metastasis at preoperative CT in patients undergoing liver resection. PLoS One 2017; 12:e0189797. [PMID: 29244853 PMCID: PMC5731738 DOI: 10.1371/journal.pone.0189797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/02/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To retrospectively determine the sensitivity of preoperative CT in the detection of small (≤ 10 mm) colorectal liver metastasis (CRLM) nodules in patients undergoing liver resection. METHODS The institutional review board approved the study and waived informed consent. We included 461 pathologically confirmed CRLM nodules in 211 patients (including 71 women; mean age, 66.4 years) who underwent 229 liver resections following abdominal CT. Prior to 163 resections, gadoxetic acid-enhanced liver MR imaging was also performed. Nodules were matched between pathology reports and prospective CT reports following a predefined algorithm. Per-nodule sensitivity of CT was calculated by nodule-size category. Generalized estimating equations were used to adjust for within-case correlation. RESULTS Fourteen nodule sizes were missing in the pathology report. Nodules of 1-5 mm and 6-10 mm accounted for 8.1% (n = 36) and 23.5% (n = 105) of the remaining 447 nodules, and the number of nodules gradually decreased as nodule size increased beyond 10 mm. The overall sensitivity of CT was 81.2% (95% confidence interval, 77.1%, 85.2%; 365/461). The sensitivity was 8% (0%, 17%; 3/36), 55% (45%, 65%; 59/105), 91%, 95%, and 100% for nodules of 1-5 mm, 6-10 mm, 11-15 mm, 16-20 mm, and >20 mm, respectively. The nodule-size distribution was similar between resections undergoing gadoxetic acid-enhanced MR imaging and those not undergoing the MR imaging. CONCLUSION CT has limited sensitivity for nodules of ≤ 10 mm and particularly of ≤ 5 mm.
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Affiliation(s)
- Yousun Ko
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | | | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kyong Joon Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Jhaveri KS, Fischer SE, Hosseini-Nik H, Sreeharsha B, Menezes RJ, Gallinger S, Moulton CAE. Prospective comparison of gadoxetic acid-enhanced liver MRI and contrast-enhanced CT with histopathological correlation for preoperative detection of colorectal liver metastases following chemotherapy and potential impact on surgical plan. HPB (Oxford) 2017; 19:992-1000. [PMID: 28760631 DOI: 10.1016/j.hpb.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/20/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced CT (CECT) for preoperative detection of colorectal liver metastases (CRLM) following chemotherapy and to evaluate the potential change in the hepatic resection plan. METHODS 51 patients with CRLM treated with preoperative chemotherapy underwent liver imaging by EOB-MRI and CECT prospectively. Two independent blinded readers characterized hepatic lesions on each imaging modality using a 5-point scoring system. 41 patients underwent hepatic resection and histopathological evaluation. RESULTS 151 CRLM were confirmed by histology. EOB-MRI, compared to CECT, had significantly higher sensitivity in detection of CRLM ≤1.0 cm (86% vs. 45.5%; p < 0.001), significantly lower indeterminate lesions diagnosis (7% vs. 33%; p < 0.001) and significantly higher interobserver concordance rate in characterizing the lesions ≤1.0 cm (72% vs. 51%; p = 0.041). The higher yield of EOB-MRI could have changed the surgical plan in 45% of patients. CONCLUSION Following preoperative chemotherapy, EOB-MRI is superior to CECT in detection of small CRLM (≤1 cm) with significantly higher sensitivity and diagnostic confidence and interobserver concordance in lesion characterization. This improved diagnostic performance can alter the surgical plan in almost half of patients scheduled for liver resection.
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Affiliation(s)
- Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Sandra E Fischer
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hooman Hosseini-Nik
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Boraiah Sreeharsha
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Ravi J Menezes
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Steven Gallinger
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carol-Anne E Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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Does injection flow rate have an impact on arterial phase image degradation in liver MRI? A comparison of gadoxetic acid versus gadobutrol. Clin Radiol 2017; 72:994.e1-994.e8. [DOI: 10.1016/j.crad.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/12/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
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Management consensus guideline for hepatocellular carcinoma: 2016 updated by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2017; 117:381-403. [PMID: 29074347 DOI: 10.1016/j.jfma.2017.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/16/2017] [Accepted: 09/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. METHODS The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. RESULTS The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. CONCLUSION With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality.
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Sheybani A, Gaba RC, Lokken RP, Berggruen SM, Mar WA. Liver Masses: What Physicians Need to Know About Ordering and Interpreting Liver Imaging. Curr Gastroenterol Rep 2017; 19:58. [PMID: 29044439 DOI: 10.1007/s11894-017-0596-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This paper reviews diagnostic imaging techniques used to characterize liver masses and the imaging characteristics of the most common liver masses. RECENT FINDINGS The role of recently adopted ultrasound and magnetic resonance imaging contrast agents will be emphasized. Contrast-enhanced ultrasound is an inexpensive exam which can confirm benignity of certain liver masses without ionizing radiation. Magnetic resonance imaging using hepatocyte-specific gadolinium-based contrast agents can help confirm or narrow the differential diagnosis of liver masses.
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Affiliation(s)
- Arman Sheybani
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA
| | - Ron C Gaba
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA
| | - R Peter Lokken
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA
| | - Senta M Berggruen
- Department of Radiology, Northwestern University, NMH/Arkes Family Pavilion Suite 800, 676 N Saint Clair, Chicago, IL, 60611, USA
| | - Winnie A Mar
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA.
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Cui E, Long W, Luo L, Hu M, Huang L, Chen X. Development and validation of a predictor of insufficient enhancement during the hepatobiliary phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging. Acta Radiol 2017; 58:1174-1181. [PMID: 28090793 DOI: 10.1177/0284185116687170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Insufficient enhancement of liver parenchyma negatively affects diagnostic accuracy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Currently, there is no reliable method for predicting insufficient enhancement during the hepatobiliary phase (HBP) in Gd-EOB-DTPA-enhanced MRI. Purpose To develop a predictor for insufficient enhancement of liver parenchyma during HBP in Gd-EOB-DTPA-enhanced MRI. Material and Methods In order to formulate a HBP enhancement test (HBP-ET), clinical factors associated with relative enhancement ratio (RER) of liver parenchyma were retrospectively determined from the datasets of 156 patients (Development group) who underwent Gd-EOB-DTPA-enhanced MRI between November 2012 and May 2015. The independent clinical factors were identified by Pearson's correlation and multiple stepwise regression analysis; the performance of HBP-ET was compared to Child-Pugh score (CPS), Model for End-stage Liver Disease score (MELD), and total bilirubin (TBIL) using receiver operating characteristic (ROC) curve analysis. The datasets of 52 patients (Validation group), which were examined between June 2015 and Oct 2015, were applied to validate the HBP-ET. Results Six biochemical parameters independently influenced RER and were used to develop HBP-ET. The mean HBP-ET score of patients with insufficient enhancement was significantly higher than that of patients with sufficient enhancement ( P < 0.001) in both the Development and Validation groups. HBP-ET (area under the curve [AUC] = 0.895) had better performance in predicting insufficient enhancement than CPS (AUC = 0.707), MELD (AUC = 0.798), and TBIL (AUC = 0.729). Conclusion The HBP-ET is more accurate than routine indicators in predicting insufficient enhancement during HBP, which is valuable to aid clinical decisions.
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Affiliation(s)
- Enming Cui
- Jinan University, Guangzhou, Guangdong, PR China
- Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China
| | - Wansheng Long
- Jinan University, Guangzhou, Guangdong, PR China
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China
| | - Liangping Luo
- Jinan University, Guangzhou, Guangdong, PR China
- Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China
| | - Maoqing Hu
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China
| | - Liebin Huang
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China
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Horowitz JM, Venkatesh SK, Ehman RL, Jhaveri K, Kamath P, Ohliger MA, Samir AE, Silva AC, Taouli B, Torbenson MS, Wells ML, Yeh B, Miller FH. Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel. Abdom Radiol (NY) 2017. [PMID: 28624924 DOI: 10.1007/s00261-017-1211-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatic fibrosis is potentially reversible; however early diagnosis is necessary for treatment in order to halt progression to cirrhosis and development of complications including portal hypertension and hepatocellular carcinoma. Morphologic signs of cirrhosis on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) alone are unreliable and are seen with more advanced disease. Newer imaging techniques to diagnose liver fibrosis are reliable and accurate, and include magnetic resonance elastography and US elastography (one-dimensional transient elastography and point shear wave elastography or acoustic radiation force impulse imaging). Research is ongoing with multiple other techniques for the noninvasive diagnosis of hepatic fibrosis, including MRI with diffusion-weighted imaging, hepatobiliary contrast enhancement, and perfusion; CT using perfusion, fractional extracellular space techniques, and dual-energy, contrast-enhanced US, texture analysis in multiple modalities, quantitative mapping, and direct molecular imaging probes. Efforts to advance the noninvasive imaging assessment of hepatic fibrosis will facilitate earlier diagnosis and improve patient monitoring with the goal of preventing the progression to cirrhosis and its complications.
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Affiliation(s)
- Jeanne M Horowitz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 St. Clair St, Suite 800, Chicago, IL, 60611, USA.
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kartik Jhaveri
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, Mt. Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Patrick Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Alvin C Silva
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, Box 1234, New York, NY, 10029, USA
| | - Michael S Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Benjamin Yeh
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Frank H Miller
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 St. Clair St, Suite 800, Chicago, IL, 60611, USA
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Li Z, Mao Y, Huang W, Li H, Zhu J, Li W, Li B. Texture-based classification of different single liver lesion based on SPAIR T2W MRI images. BMC Med Imaging 2017; 17:42. [PMID: 28705145 PMCID: PMC5508617 DOI: 10.1186/s12880-017-0212-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 06/19/2017] [Indexed: 12/14/2022] Open
Abstract
Background To assess the feasibility of texture analysis (TA) based on spectral attenuated inversion-recovery T2 weighted magnetic resonance imaging (SPAIR T2W-MRI) for the classification of hepatic hemangioma (HH), hepatic metastases (HM) and hepatocellular carcinoma (HCC). Methods The SPAIR T2W-MRI data of 162 patients with HH (n=55), HM (n=67) and HCC (n=40) were retrospectively analyzed. We used two independent cohorts for training (n = 112 patients) and validation (n = 50 patients). The TA was performed and textual parameters derived from the gray level co-occurrence matrix (GLCM), gray level gradient co-occurrence matrix (GLGCM), gray-level run-length matrix (GLRLM), Gabor wavelet transform (GWTF), intensity-size-zone matrix (ISZM), and histogram features were calculated. The capacity of each parameter to classify three types of single liver lesions was assessed using the Kruskal-Wallis test. Specificity and sensitivity for each of the studied parameters were derived using ROC curves. Four supervised classification algorithms were trained with the most influential textural features in the classification of tumor types. The test datasets validated the reliability of the models. Results The texture analyses showed that the HH versus HM, HM versus HCC, and HH versus HCC could be differentiated by 9, 16 and 10 feature parameters, respectively. The model’s misclassification rates were 11.7, 9.6 and 9.7% respectively. No texture feature was able to adequately distinguish among the three types of single liver lesions at the same time. The BP-ANN model had better predictive ability. Conclusion Texture features of SPAIR T2W-MRI can classify the three types of single liver lesions (HH, HM and HCC) and may serve as an adjunct tool for accurate diagnosis of these diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0212-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhenjiang Li
- Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yu Mao
- Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wei Huang
- Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Hongsheng Li
- Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jian Zhu
- Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wanhu Li
- Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Baosheng Li
- Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Gotra A, Sivakumaran L, Chartrand G, Vu KN, Vandenbroucke-Menu F, Kauffmann C, Kadoury S, Gallix B, de Guise JA, Tang A. Liver segmentation: indications, techniques and future directions. Insights Imaging 2017; 8:377-392. [PMID: 28616760 PMCID: PMC5519497 DOI: 10.1007/s13244-017-0558-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/03/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Liver volumetry has emerged as an important tool in clinical practice. Liver volume is assessed primarily via organ segmentation of computed tomography (CT) and magnetic resonance imaging (MRI) images. The goal of this paper is to provide an accessible overview of liver segmentation targeted at radiologists and other healthcare professionals. METHODS Using images from CT and MRI, this paper reviews the indications for liver segmentation, technical approaches used in segmentation software and the developing roles of liver segmentation in clinical practice. RESULTS Liver segmentation for volumetric assessment is indicated prior to major hepatectomy, portal vein embolisation, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transplant. Segmentation software can be categorised according to amount of user input involved: manual, semi-automated and fully automated. Manual segmentation is considered the "gold standard" in clinical practice and research, but is tedious and time-consuming. Increasingly automated segmentation approaches are more robust, but may suffer from certain segmentation pitfalls. Emerging applications of segmentation include surgical planning and integration with MRI-based biomarkers. CONCLUSIONS Liver segmentation has multiple clinical applications and is expanding in scope. Clinicians can employ semi-automated or fully automated segmentation options to more efficiently integrate volumetry into clinical practice. TEACHING POINTS • Liver volume is assessed via organ segmentation on CT and MRI examinations. • Liver segmentation is used for volume assessment prior to major hepatic procedures. • Segmentation approaches may be categorised according to the amount of user input involved. • Emerging applications include surgical planning and integration with MRI-based biomarkers.
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Affiliation(s)
- Akshat Gotra
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada.,Department of Radiology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Lojan Sivakumaran
- University of Montreal, 2900 boulevard Eduoard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Gabriel Chartrand
- Imaging and Orthopaedics Research Laboratory (LIO), École de technologie supérieure, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Kim-Nhien Vu
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Franck Vandenbroucke-Menu
- Department of Hepato-biliary and Pancreatic Surgery, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Claude Kauffmann
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Samuel Kadoury
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.,École Polytechnique de Montréal, University of Montreal, 2500 chemin de Polytechnique Montréal, Montreal, QC, H3T 1J4, Canada
| | - Benoît Gallix
- Department of Radiology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Jacques A de Guise
- Imaging and Orthopaedics Research Laboratory (LIO), École de technologie supérieure, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada. .,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.
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Scali EP, Walshe T, Tiwari HA, Harris AC, Chang SD. A Pictorial Review of Hepatobiliary Magnetic Resonance Imaging With Hepatocyte-Specific Contrast Agents: Uses, Findings, and Pitfalls of Gadoxetate Disodium and Gadobenate Dimeglumine. Can Assoc Radiol J 2017; 68:293-307. [PMID: 28583364 DOI: 10.1016/j.carj.2016.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/21/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging (MRI) has a well-established role as a highly specific and accurate modality for characterizing benign and malignant focal liver lesions. In particular, contrast-enhanced MRI using hepatocyte-specific contrast agents (HSCAs) improves lesion detection and characterization compared to other imaging modalities and MRI techniques. In this pictorial review, the mechanism of action of gadolinium-based MRI contrast agents, with a focus on HSCAs, is described. The clinical indications, protocols, and emerging uses of the 2 commercially available combined contrast agents available in the United States, gadoxetate disodium and gadobenate dimeglumine, are discussed. The MRI features of these agents are compared with examples of focal hepatic masses, many of which have been obtained within the same patient therefore allowing direct lesion comparison. Finally, the pitfalls in the use of combined contrast agents in liver MRI are highlighted.
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Affiliation(s)
- Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Triona Walshe
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hina Arif Tiwari
- Department of Radiology, University of Arizona, Tuscon, Arizona, USA
| | - Alison C Harris
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Updates in hepatic oncology imaging. Surg Oncol 2017; 26:195-206. [DOI: 10.1016/j.suronc.2017.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 12/17/2022]
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Donato H, França M, Candelária I, Caseiro-Alves F. Liver MRI: From basic protocol to advanced techniques. Eur J Radiol 2017; 93:30-39. [PMID: 28668428 DOI: 10.1016/j.ejrad.2017.05.028] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 02/07/2023]
Abstract
Liver MR is a well-established modality with multiparametric capabilities. However, to take advantage of its full capacity, it is mandatory to master the technique and optimize imaging protocols, apply advanced imaging concepts and understand the use of different contrast media. Physiologic artefacts although inherent to upper abdominal studies can be minimized using triggering techniques and new strategies for motion control. For standardization, the liver MR protocol should include motion-resistant T2-w sequences, in-op phase GRE T1 and T2-w fast spin echo sequences with fat suppression. Diffusion-weighted imaging (DWI) is mandatory, especially for detection of sub-centimetre metastases. Contrast-enhanced MR is the cornerstone of liver MR, especially for lesion characterization. Although extracellular agents are the most extensively used contrast agents, hepatobiliary contrast media can provide an extra-layer of functional diagnostic information adding to the diagnostic value of liver MR. The use of high field strength (3T) increases SNR but is more challenging especially concerning artefact control. Quantitative MR belongs to the new and evolving field of radiomics where the use of emerging biomarkers such as perfusion or DWI can derive new information regarding disease detection, prognostication and evaluation of tumour response. This information can overcome some of the limitations of current tests, especially when using vascular disruptive agents for oncologic treatment assessment. MR is, today, a robust, mature, multiparametric imaging modality where clinical applications have greatly expanded from morphology to advanced imaging. This new concept should be acknowledged by all those involved in producing high quality, high-end liver MR studies.
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Affiliation(s)
- Henrique Donato
- Imaging Department, Faculty of Medicine of Coimbra, University Centre Hospitals of Coimbra (CHUC), Portugal.
| | - Manuela França
- Imaging Department, Centro Hospitalar do Porto, Portugal.
| | - Isabel Candelária
- Imaging Department, Faculty of Medicine of Coimbra, University Centre Hospitals of Coimbra (CHUC), Portugal.
| | - Filipe Caseiro-Alves
- Imaging Department, Faculty of Medicine of Coimbra, University Centre Hospitals of Coimbra (CHUC), Portugal.
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Budjan J, Riffel P, Ong MM, Schoenberg SO, Attenberger UI, Hausmann D. Rapid Cartesian versus radial acquisition: comparison of two sequences for hepatobiliary phase MRI at 3 tesla in patients with impaired breath-hold capabilities. BMC Med Imaging 2017; 17:32. [PMID: 28486977 PMCID: PMC5424346 DOI: 10.1186/s12880-017-0203-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/28/2017] [Indexed: 01/15/2023] Open
Abstract
Background Hepatocyte-specific gadolinium based contrast agents (HSCA) provide substantial information for the classification of liver lesions in magnetic resonance imaging (MRI). However, breathing artifacts which reduce image quality and diagnostic confidence of hepatobiliary phase acquisitions are regularly observed in clinical routine. The aim of this study was to evaluate two approaches to reduce breathing artifacts for hepatobiliary phase imaging. Methods Twenty minutes after administration of a HSCA (gadoxetic acid), a T1-weighted VIBE sequence with radial k-space sampling (radialVIBE, 180 s acquisition time in free breathing) and a highly accelerated Cartesian VIBE with Dixon fat separation (CD-VIBE, CAIPIRINHA acceleration with r = 2 × 2, breath-hold 8–10 s) were acquired in 35 patients (12 female, 57 ± 13 years), who showed breath-holding difficulties in early phases of the examinations. Image quality (image sharpness, noise, artifacts, homogeneity of fat saturation, bile duct delineation and overall image quality) as well as conspicuity and liver-to-lesion signal intensity (SI) ratios of focal liver lesions were assessed for both radial- and CD-VIBE. Results Overall image quality was rated good to excellent for both sequences, while CD-VIBE was preferred in most cases. Though radialVIBE received better results regarding image noise and artifacts, both sequences were rated equally regarding bile duct delineation and sharpness. Focal liver lesion (n = 42) conspicuity was rated significantly better and SI-ratios were significantly higher on CD-VIBE (2.45 ± 1.44 vs. 1.61 ± 0.70 in radialVIBE, p = 0.0001). In three patients, CD-VIBE was rated non-diagnostic due to severe breathing artifacts, while radialVIBE was diagnostic in those patients. Conclusion Both highly accelerated Cartesian as well as radial acquisition techniques provide good to excellent image quality in hepatobiliary phase MRI. In comparison, CD-VIBE offered better overall image quality and liver lesion conspicuity. However, radialVIBE was a valuable alternative in patients unable to sustain even short breath-hold intervals. Further studies including lager patient cohorts are desirable to allow a transfer of these results to a general patient population.
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Affiliation(s)
- Johannes Budjan
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Philipp Riffel
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Melissa M Ong
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ulrike I Attenberger
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Daniel Hausmann
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Szklaruk J, Luersen G, Ma J, Wei W, Underwood M. Gd-EOB-DTPA based magnetic resonance imaging for predicting liver response to portal vein embolization. World J Radiol 2017; 9:199-205. [PMID: 28529683 PMCID: PMC5415889 DOI: 10.4329/wjr.v9.i4.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/11/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the correlation between degree of kinetic growth (kGR) of the liver following portal vein embolization (PVE) liver and the enhancement of the during the hepatobiliary phase of contrast administration and to evaluate if the enhancement can be used to predict response to PVE prior to the procedure.
METHODS Seventeen patients were consented for the prospective study. All patients had an MR of the abdomen with Gd-EOB-DTPA. Fourteen patients underwent PVE. The correlation between the kGR of the liver and the degree of enhancement was evaluated with linear regression (strong assumptions) and Spearman’s correlation test (rank based, no assumptions). The correlation was examined for the whole liver, segments I, VIII, VII, VI, V, IV, right liver and left liver.
RESULTS There was no correlation between the degree of enhancement during the hepatobiliary phase and kGR for any segment, lobe of the liver or whole liver (P = 0.19 to 0.91 by Spearman’s correlation test).
CONCLUSION The relative enhancement of the liver during the hepatobiliary phase with Gd-EOB-DTPA cannot be used to predict the liver response to PVE.
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Cassinotto C, Aubé C, Dohan A. Diagnosis of hepatocellular carcinoma: An update on international guidelines. Diagn Interv Imaging 2017; 98:379-391. [PMID: 28395852 DOI: 10.1016/j.diii.2017.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
Imaging is essential for the successful management of patients with or at risk of developing hepatocellular carcinoma (HCC). If ultrasound remains the key screening modality, computed tomography and magnetic resonance imaging (MRI) can play a major role in the characterization and noninvasive diagnosis of nodules in patients at risk of developing HCC. Each technique has succeeded in adapting to the wide histological spectrum of focal liver lesions. In this review, we discuss recent advancements in imaging techniques and evaluation - notably diffusion-weighted imaging, contrast-enhanced ultrasound, and liver-specific MRI contrast agents - as well as their addition to international guidelines and reporting systems such as the Liver imaging reporting and data system (LI-RADS).
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Affiliation(s)
- C Cassinotto
- Department of diagnostic and interventional imaging, Hôpital Haut-Lévêque, university hospital of Bordeaux, CHU de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France.
| | - C Aubé
- Department of diagnostic and interventional imaging, university hospital of Angers, 49933 Angers, France
| | - A Dohan
- McGill university health center, department of radiology, McGill university health center, Montreal, QC, Canada
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Seo N, Park MS, Han K, Lee KH, Park SH, Choi GH, Choi JY, Chung YE, Kim MJ. Magnetic Resonance Imaging for Colorectal Cancer Metastasis to the Liver: Comparative Effectiveness Research for the Choice of Contrast Agents. Cancer Res Treat 2017; 50:60-70. [PMID: 28292007 PMCID: PMC5784623 DOI: 10.4143/crt.2016.533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/19/2017] [Indexed: 01/01/2023] Open
Abstract
Purpose This study was conducted to compare the diagnostic performance and early recurrence rate between gadoxetic acid–enhanced magnetic resonance imaging (Gd-EOB-MRI) and magnetic resonance imaging (MRI) with extracellular contrast agent (ECA-MRI) for evaluating hepatic lesions in colorectal cancer. Materials and Methods Between 2005 and 2010, 418 colorectal cancer patients with both preoperative computed tomography (CT) and liver MRI were retrospectively reviewed. Image analysis was based on initial radiologic reports, and diagnostic performance was assessed based on the area under the receiver operating characteristic curve (AUROC). The early intrahepatic recurrence rate within 6 months was then evaluated. Results Overall, 291 and 127 patients underwent Gd-EOB-MRI and ECA-MRI, respectively. The AUROCs were not significantly different between Gd-EOB-MRI (0.990; 95% CI, 0.980 to 0.999) and ECA-MRI (0.985; 95% CI, 0.968 to 1.000; p=0.836). When compared with CT alone, ECA-MRI detected additional 21 lesions in 14 patients (14/127, 11.0%), whereas Gd-EOB-MRI detected 56 lesions in 33 patients (33/291, 11.3%) without a significant difference between two MRI groups (p=0.331). The early recurrence rate in the ECA-MRI (28.6%) was significantly higher than that in the Gd-EOB-MRI (11.6%) for patients who underwent hepatic resection (p=0.031). Conclusion Gd-EOB-MRI is potentially better than ECA-MRI for decreasing the early intrahepatic recurrence rate, although the two MRI modalities showed comparable diagnostic performance in colorectal cancer patients.
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Affiliation(s)
- Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Yonsei Biomedical Research Institute, Research Institute of Radiological Science, Seoul, Korea
| | - Kyung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Young Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Costa AF, Tremblay St-Germain A, Abdolell M, Smoot RL, Cleary S, Jhaveri KS. Can contrast-enhanced MRI with gadoxetic acid predict liver failure and other complications after major hepatic resection? Clin Radiol 2017; 72:598-605. [PMID: 28274510 DOI: 10.1016/j.crad.2017.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/09/2017] [Accepted: 02/06/2017] [Indexed: 12/17/2022]
Abstract
AIM To determine whether a combination of clinical factors, the future liver remnant (FLR) ratio, and hepatic uptake of gadoxetic acid can be used to predict post-hepatectomy liver failure (PHLF) and other major complications (OMC). MATERIALS AND METHODS Sixty-five consecutive patients who underwent pre-hepatectomy gadoxetic acid-enhanced magnetic resonance imaging (MRI) between October 2010 and December 2013 were included. The relative liver enhancement (RLE) of gadoxetic acid was calculated from regions of interest on MRI, and FLR ratios were obtained from computed tomography (CT). PHLF and OMC were defined by the International Study Group of Liver Surgery criteria and Clavien-Dindo grade of ≥3, respectively. Multivariate logistic regression modelling was performed to identify predictors of PHLF and OMC, including RLE, FLR ratio, age, sex, chemotherapy history, intra-operative blood loss, and intra-operative transfusion. RESULTS Nine patients experienced PHLF and another nine patients experienced OMC. RLE was comparable to the FLR ratio in predicting PHLF (areas under the receiver operating characteristic [AUROC] curves, 0.665 and 0.705), but performed poorly in predicting OMCs (AUROCs, 0.556 and 0.702). Combining all clinical and imaging parameters as predictors yielded the best performing predictive models (AUROCs, 0.875 and 0.742 for PHLF and OMC, respectively). CONCLUSION A model based on clinical parameters, the FLR ratio, and RLE of gadoxetic acid may improve pre-hepatectomy risk assessment.
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Affiliation(s)
- A F Costa
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Canada.
| | - A Tremblay St-Germain
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - M Abdolell
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - R L Smoot
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - S Cleary
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - K S Jhaveri
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Canada
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