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García-Criado Á, Rimola J, Seijo S, Darnell A, Belmonte E, Sapena V, Moreno-Rojas J, Pérez V, Hernández-Gea V, Ayuso C, Reig M, García-Pagán JC, Bruix J. MRI Using Gadoxetic Acid in the Work-Up of Liver Nodules Not Conclusively Benign in Budd-Chiari Syndrome: A Prospective Long-Term Follow-Up. Liver Cancer 2024; 13:203-214. [PMID: 38751551 PMCID: PMC11095625 DOI: 10.1159/000533598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/11/2023] [Indexed: 05/18/2024] Open
Abstract
Introduction The incidence of hepatocellular carcinoma (HCC) in Budd-Chiari syndrome (BCS) is unknown and there is no validated diagnostic work-up to define the liver nodules with arterial phase hyperenhancement (APHE), suggesting malignancy. This prospective study evaluates HCC incidence in a Western cohort of patients with BCS and assesses the performance of MRI with hepatobiliary contrast (HB-MRI) for nodule characterization. Methods Patients with BCS followed in our hospital were prospectively evaluated by MRI with extracellular contrast (EC-MRI). Nodules with APHE categorized as non-conclusively benign by 2 radiologists were studied by HB-MRI and reviewed by 2 radiologists blinded to the EC-MRI results. A new EC-MRI 1 year later and clinical, analytical, and sonographic follow-up every 6 months for a median of 10 years was performed. Results A total of 55 non-conclusively benign nodules with APHE were detected at EC-MRI in 41 patients. While 32 of them were suggestive of HCC by EC-MRI, all the 55 nodules showed increased uptake of hepatobiliary contrast. An unequivocal central scar was seen in 12/55 nodules at HB-MRI regardless of it was not detected on the EC-MRI. None of the nodules was hypointense in the hepatobiliary phase (HBP). HCC was not detected during a median of 10 years of follow-up. Conclusions Detection of nodules with APHE is frequent in patients with BCS, but HCC is rare in Western patients with BCS. While EC-MRI may detect nodules suggesting malignancy, the identification of contrast uptake in the HBP at HB-MRI may help categorize them as benign.
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Affiliation(s)
- Ángeles García-Criado
- Radiology Department, CDI, BCLC Group, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Rimola
- Radiology Department, CDI, BCLC Group, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Susana Seijo
- Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, ICMDM, IDIBAPS, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Anna Darnell
- Radiology Department, CDI, BCLC Group, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ernest Belmonte
- Radiology Department, CDI, BCLC Group, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Víctor Sapena
- BCLC group, Statistics core, Medical Statistics Core Facility, IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Julián Moreno-Rojas
- Radiology Department, CDI, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Valeria Pérez
- Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, ICMDM, IDIBAPS, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Virginia Hernández-Gea
- Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, ICMDM, IDIBAPS, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
| | - Carmen Ayuso
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Radiology Department, CDI, BCLC Group, IDIBAPS Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Reig
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
- BCLC group, Liver Unit, ICMDM, IDIBAPS, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Juan Carlos García-Pagán
- Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, ICMDM, IDIBAPS, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
| | - Jordi Bruix
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Barcelona, Spain
- BCLC group, Liver Unit, ICMDM, IDIBAPS, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Rizzetto F, Rutanni D, Carbonaro LA, Vanzulli A. Focal Liver Lesions in Budd-Chiari Syndrome: Spectrum of Imaging Findings. Diagnostics (Basel) 2023; 13:2346. [PMID: 37510090 PMCID: PMC10378170 DOI: 10.3390/diagnostics13142346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Budd-Chiari syndrome (BCS) is a rare clinical entity characterized by hepatic venous outflow obstruction, resulting in liver congestion and subsequent chronic parenchymal damage. This condition often leads to the development of focal liver lesions, including benign focal nodular hyperplasia-like regenerative nodules, hepatocellular carcinoma, and perfusion-related pseudo-lesions. Computed tomography, ultrasound, and magnetic resonance are the commonly employed imaging modalities for the follow-up of BCS patients and for the detection and characterization of new-onset lesions. The accurate differentiation between benign and malignant nodules is crucial for optimal patient management and treatment planning. However, it can be challenging due to the variable and overlapping characteristics observed. This review aims to provide a comprehensive overview of the imaging features and differential diagnosis of focal liver lesions in BCS, emphasizing the key findings and discussing the challenges associated with their interpretation, with the purpose of facilitating the subsequent clinical decision-making.
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Affiliation(s)
- Francesco Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Davide Rutanni
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Luca Alessandro Carbonaro
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
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3
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Nolan PE, Catania R, Vendrami CL, Borhani AA, Miller FH. Large Regenerative Nodules and Focal Nodular Hyperplasia-Like Lesions. Radiol Clin North Am 2022; 60:795-808. [DOI: 10.1016/j.rcl.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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MR imaging features and long-term evolution of benign focal liver lesions in Budd-Chiari syndrome and Fontan-associated liver disease. Diagn Interv Imaging 2021; 103:111-120. [PMID: 34654671 DOI: 10.1016/j.diii.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare the magnetic resonance imaging (MRI) features of benign liver lesions developed on Budd-Chiari syndrome (BCS) with those on Fontan-associated liver disease (FALD) and to describe their long-term progression. MATERIALS AND METHODS Patients with BCS or FALD who underwent MRI between 2010 and 2020 were retrospectively included. MRI features of nodules (≥ 5 mm) at baseline and at final follow-up were reviewed. The final diagnosis of benign lesion was based on a combination of clinical and biological data and findings at follow-up MRI examination. RESULTS Two-hundred and thirty benign liver lesions in 39 patients with BCS (10 men, 29 women; mean age, 36 ± 11 [SD] years; age range: 15-66 years) and 84 benign lesions in 14 patients with FALD (2 men, 12 women; mean age, 31 ± 10 [SD] years; age range: 20-48 years) were evaluated. On baseline MRI, BCS nodules were more frequently hyperintense on T1-weighted (183/230, 80%) and hypointense on T2-weighted (142/230; 62%) images, while FALD nodules were usually isointense on both T1- (70/84; 83%) and T2-weighted (64/84; 76%) images (all P< 0.01). Most lesions showed arterial phase hyperenhancement (222/230 [97%] vs. 80/84 [95%] in BCS and FALD, respectively; P = 0.28) but wash-out was more common in BCS (64/230 [28%] vs. 9/84 [11%]; P < 0.01). At follow-up, changes were more frequent in BCS nodules with more frequent disappearance (P < 0.01), changes in size, signal intensity on T2-weighted, portal, and delayed phase, and in the depiction of washout and capsule (all P ≤ 0.03). CONCLUSION MRI features of benign lesions are different at diagnosis and during the course of the disease between BCS and FALD. Changes in size and MRI features are more frequent in benign lesions developed in BCS.
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Shukla A, Shreshtha A, Mukund A, Bihari C, Eapen CE, Han G, Deshmukh H, Cua IHY, Lesmana CRA, Al Meshtab M, Kage M, Chaiteeraki R, Treeprasertsuk S, Giri S, Punamiya S, Paradis V, Qi X, Sugawara Y, Abbas Z, Sarin SK. Budd-Chiari syndrome: consensus guidance of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2021; 15:531-567. [PMID: 34240318 DOI: 10.1007/s12072-021-10189-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/11/2021] [Indexed: 02/07/2023]
Abstract
Budd Chiari syndrome (BCS) is a diverse disease with regard to the site of obstruction, the predisposing thrombophilic disorders and clinical presentation across the Asia-Pacific region. The hepatic vein ostial stenosis and short segment thrombosis are common in some parts of Asia-Pacific region, while membranous obstruction of the vena cava is common in some and complete thrombosis of hepatic veins in others. Prevalence of myeloproliferative neoplasms and other thrombophilic disorders in BCS varies from region to region and with different sites of obstruction. This heterogeneity also raises several issues and dilemmas in evaluation and approach to management of a patient with BCS. The opportunity to recanalize hepatic vein in patients with hepatic vein ostial stenosis or inferior vena cava stenting or pasty among those membranous obstruction of the vena cava is a unique opportunity in the Asia-Pacific region to restore hepatic outflow closely mimicking physiology. In order to address these issues arising out of the diversity as well as the unique features in the region, the Asia Pacific Association for Study of Liver has formulated these guidelines for clinicians.
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Affiliation(s)
- Akash Shukla
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India.
| | | | - Amar Mukund
- Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chhagan Bihari
- Institute of Liver and Biliary Sciences, New Delhi, India
| | - C E Eapen
- Christian Medical College, Vellore, India
| | - Guohong Han
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China
| | - Hemant Deshmukh
- Dean and Head of Radiology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Ian Homer Y Cua
- Institute of Digestive and Liver Diseases, St Lukes Medical Center, Global City, Philippines
| | - Cosmas Rinaldi Adithya Lesmana
- Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia
- Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia
| | - Mamun Al Meshtab
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Center for Innovative Cancer Therapy, Kurume University Research, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Masayoshi Kage
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Roongruedee Chaiteeraki
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suprabhat Giri
- Department of Gastroenterology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Sundeep Punamiya
- Vascular and Interventional Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valerie Paradis
- Dpt dAnatomie Pathologique, Hôpital Beaujon, 100 bd du Gal Leclerc, Clichy, 92110, France
| | - Xingshun Qi
- General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, China
| | - Yasuhiko Sugawara
- Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Dr. Ziauddin University Hospital Clifton, Karachi, Pakistan
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Van Wettere M, Paulatto L, Raynaud L, Bruno O, Payancé A, Plessier A, Rautou PE, Paradis V, Cazals-Hatem D, Valla D, Vilgrain V, Ronot M. Hepatobiliary MR contrast agents are useful to diagnose hepatocellular carcinoma in patients with Budd-Chiari syndrome. JHEP Rep 2020; 2:100097. [PMID: 32435753 PMCID: PMC7232085 DOI: 10.1016/j.jhepr.2020.100097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND & AIMS Hepatobiliary phase (HBP) images can discriminate between benign and malignant liver lesions, but it is unclear if this approach can be used in patients with Budd-Chiari syndrome (BCS). Thus, we aimed to assess the diagnostic utility of HBP images in patients with BCS. METHODS This retrospective study included all patients admitted to our institution with a diagnosis of BCS and focal liver lesions on hepatobiliary contrast agent-enhanced MR imaging (HBCA-MRI) from 2000 to 2019. MR images were reviewed by 2 radiologists blinded to the diagnosis of the lesions. Patient and lesion characteristics were recorded, focusing on HBP imaging features. RESULTS Twenty-six patients (mean 35 ± 11 years old [13-65]; 21 women [81%] 35 ± 12 years old [13-65]; 5 men [19%] 36 ± 10 years old [19-44]) with 99 benign liver lesions and 12 hepatocellular carcinomas (HCCs) were analyzed. Patients with HCC were significantly older than those with benign lesions (mean 50 ± 10 vs. 33 ± 9 years old, p = 0.003), with higher alpha-fetoprotein (AFP) levels (3/4 [75%] vs. 1/22 [5%] with AFP >15 ng/ml, p <0.001). Homogeneous hypointense signals were identified on HBP in 14 lesions, including 12/12 (100%) HCCs, and 2/99 (2%) benign lesions (p <0.001). Most benign liver lesions showed either peripheral (n = 52/99 [53%]) or homogeneous hyperintensity (n = 23/99 [23%]) on HBP. Lesions with signal hypointensity on HBP in patients with AFP serum levels >15 ng/ml were all HCCs. CONCLUSION Most benign lesions showed homogeneous or peripheral hyperintensity on HBP images while all HCCs were homogeneously hypointense. HBP images are helpful to differentiate between benign lesions and HCCs and outperform other sequences. They should be systematically acquired for the characterization of focal lesions in patients with BCS. LAY SUMMARY Hepatobiliary phase imaging is an approach that has recently been shown to discriminate between benign and malignant lesions in the liver. However, it was not known whether this imaging approach could be used effectively in patients with Budd-Chiari syndrome. Herein, we have shown that hepatobiliary phase imaging appears to be useful for differentiating between benign and malignant liver lesions in patients with Budd-Chiari syndrome.
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Key Words
- AFP, alpha-fetoprotein
- APHE, arterial phase hyperenhancement
- BCS, Budd-Chiari syndrome
- FNH, focal nodular hyperplasia-like
- HBP, hepatobiliary phase
- HCC
- HCC, hepatocellular carcinoma
- Imaging
- LR, likelihood ratio
- MRI
- OATP, organic anionic transporting polypeptides
- T1-w, T1-weighted imaging
- TIPS, transjugular intrahepatic portosystemic shunt
- WO, washout
- liver cancer
- non-invasive
- tumor
- vascular liver disease
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Affiliation(s)
- Morgane Van Wettere
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Luisa Paulatto
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Lucas Raynaud
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Onorina Bruno
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Audrey Payancé
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
| | - Aurélie Plessier
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
| | - Pierre-Emmanuel Rautou
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- Inserm, U970, Paris Cardiovascular Research Center - PARCC, University of Paris, Paris, France
- DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Valérie Paradis
- University of Paris, Paris, France
- Department of Pathology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Dominique Cazals-Hatem
- Department of Pathology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Dominique Valla
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
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Hernández-Gea V, De Gottardi A, Leebeek FWG, Rautou PE, Salem R, Garcia-Pagan JC. Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis. J Hepatol 2019; 71:175-199. [PMID: 30822449 DOI: 10.1016/j.jhep.2019.02.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
Budd-Chiari syndrome and non-cirrhotic non-tumoral portal vein thrombosis are 2 rare disorders, with several similarities that are categorized under the term splanchnic vein thrombosis. Both disorders are frequently associated with an underlying prothrombotic disorder. They can cause severe portal hypertension and usually affect young patients, negatively influencing life expectancy when the diagnosis and treatment are not performed at an early stage. Yet, they have specific features that require individual consideration. The current review will focus on the available knowledge on pathophysiology, diagnosis and management of both entities.
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Affiliation(s)
- Virginia Hernández-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, European Reference Network for Rare Vascular Liver Diseases, Universitat de Barcelona, Spain
| | - Andrea De Gottardi
- Hepatology, University Clinic of Visceral Medicine and Surgery, Inselspital, and Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pierre-Emmanuel Rautou
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France; Inserm, UMR-970, Paris Cardiovascular Research Center, PARCC, Paris, France
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA
| | - Juan Carlos Garcia-Pagan
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, European Reference Network for Rare Vascular Liver Diseases, Universitat de Barcelona, Spain.
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8
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Van Wettere M, Purcell Y, Bruno O, Payancé A, Plessier A, Rautou PE, Cazals-Hatem D, Valla D, Vilgrain V, Ronot M. Low specificity of washout to diagnose hepatocellular carcinoma in nodules showing arterial hyperenhancement in patients with Budd-Chiari syndrome. J Hepatol 2019; 70:1123-1132. [PMID: 30654065 DOI: 10.1016/j.jhep.2019.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/11/2018] [Accepted: 01/04/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS It remains unclear whether the classic imaging criteria for the non-invasive diagnosis of hepatocellular carcinoma (HCC) can be applied to chronic vascular liver diseases, such as Budd-Chiari syndrome (BCS). Herein, we aimed to evaluate the diagnostic value of washout for the discrimination between benign and malignant lesions in patients with BCS. METHODS This retrospective study included all patients admitted to our institution with a diagnosis of BCS and focal lesions on MRI from 2000 to 2016. MRI images were reviewed by 2 radiologists blinded to the nature of the lesions. Patient and lesion characteristics were recorded, with a focus on washout on portal venous and/or delayed phases. Lesions were compared using Chi-square, Fisher's, Student's t or Mann-Whitney U tests. RESULTS A total of 49 patients (mean age 35 ± 12 years; 34 women [69%] and 15 men [31%]) with 241 benign lesions and 12 HCC lesions were analyzed. Patients with HCC were significantly older (mean age 44 ± 16 vs. 33 ± 9 years, p = 0.005), with higher alpha-fetoprotein (AFP) levels (median 16 vs. 3 ng/ml, p = 0.007). Washout was depicted in 9/12 (75%) HCC, and 69/241 (29%) benign lesions (p <0.001). A total of 52/143 (36%) lesions ≥1 cm with arterial hyperenhancement showed washout (9 HCC and 43 benign lesions). In this subgroup, the specificity of washout for the diagnosis of HCC was 67%. Adding T1-w hypointensity raised the specificity to 100%. A serum AFP >15 ng/ml was associated with 95% specificity. CONCLUSION Washout was observed in close to one-third of benign lesions, leading to an unacceptably low specificity for the diagnosis of HCC. The non-invasive diagnostic criteria proposed for cirrhotic patients cannot be extrapolated to patients with BCS. LAY SUMMARY Washout on MRI is depicted in a significant proportion of benign nodules in patients with Budd-Chiari syndrome (BCS), limiting its value for the differentiation between benign and malignant lesions. Criteria proposed for the non-invasive diagnosis of hepatocellular carcinoma in patients with cirrhosis cannot be extrapolated to patients with BCS. Additional imaging findings and patient characteristics, including alpha-fetoprotein serum level, can help determine the probability of a nodule being HCC in patients with BCS.
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Affiliation(s)
- Morgane Van Wettere
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Yvonne Purcell
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Onorina Bruno
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Audrey Payancé
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France; University Paris Diderot. Sorbonne Paris Cité, Paris, France
| | - Aurélie Plessier
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France; University Paris Diderot. Sorbonne Paris Cité, Paris, France
| | - Pierre-Emmanuel Rautou
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France; University Paris Diderot. Sorbonne Paris Cité, Paris, France; Inserm, U970, Paris Cardiovascular Research Center - PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Dominique Cazals-Hatem
- Department of Pathology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Dominique Valla
- Department of Hepatology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France; University Paris Diderot. Sorbonne Paris Cité, Paris, France; DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France; University Paris Diderot. Sorbonne Paris Cité, Paris, France; INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France; University Paris Diderot. Sorbonne Paris Cité, Paris, France; INSERM U1149, CRI, Paris, France.
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Budd-Chiari Syndrome and hepatic regenerative nodules: Magnetic resonance findings with emphasis of hepatobiliary phase. Eur J Radiol 2019; 117:15-25. [PMID: 31307641 DOI: 10.1016/j.ejrad.2019.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/06/2019] [Accepted: 05/19/2019] [Indexed: 12/30/2022]
Abstract
Budd-Chiari syndrome (BCS) is a disorder with numerous causes that is a result of hepatic outflow obstruction, in the absence of right heart failure or constrictive pericarditis. Acute Budd-Chiari syndrome is uncommon and clinically characterized by ascites, hepatomegaly, and hepatic insufficiency. In the majority of cases, patients present with chronic BCS, showing a dysmorphic liver disease with variable fibrosis deposition. In chronic Budd-Chiari syndrome, hepatocellular carcinoma (HCC) and benign regenerative nodules (called large regenerative nodules or FNH-like lesions) have been described in the literature. Very few studies have reported magnetic resonance imaging (MRI) findings about these nodules, using hepatobiliary contrast medium. The aim of our review is to describe the magnetic resonance imaging findings of hepatic regenerative nodules in BCS, with emphasis on the hepatobiliary phase, and to compare the imaging features of benign nodules with those of HCC.
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Krishan S, Dhiman RK, Kalra N, Sharma R, Baijal SS, Arora A, Gulati A, Eapan A, Verma A, Keshava S, Mukund A, Deva S, Chaudhary R, Ganesan K, Taneja S, Gorsi U, Gamanagatti S, Madhusudan KS, Puri P, Shalimar, Govil S, Wadhavan M, Saigal S, Kumar A, Thapar S, Duseja A, Saraf N, Khandelwal A, Mukhopadyay S, Gulati A, Shetty N, Verma N. Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System. J Clin Exp Hepatol 2019; 9:625-651. [PMID: 31695253 PMCID: PMC6823668 DOI: 10.1016/j.jceh.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the 6th most common cancer and the second most common cause of cancer-related mortality worldwide. There are currently no universally accepted practice guidelines for the diagnosis of HCC on imaging owing to the regional differences in epidemiology, target population, diagnostic imaging modalities, and staging and transplant eligibility. Currently available regional and national guidelines include those from the American Association for the Study of Liver Disease (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific Association for the Study of the Liver, the Japan Society of Hepatology, the Korean Liver Cancer Study Group, Hong Kong, and the National Comprehensive Cancer Network in the United States. India with its large population and a diverse health infrastructure faces challenges unique to its population in diagnosing HCC. Recently, American Association have introduced a Liver Imaging Reporting and Data System (LIRADS, version 2017, 2018) as an attempt to standardize the acquisition, interpretation, and reporting of liver lesions on imaging and hence improve the coherence between radiologists and clinicians and provide guidance for the management of HCC. The aim of the present consensus was to find a common ground in reporting and interpreting liver lesions pertaining to HCC on imaging keeping LIRADSv2018 in mind.
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Affiliation(s)
- Sonal Krishan
- Department of Radiology, Medanta Hospital, Gurgaon, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Radha Krishan Dhiman, MD, DM, FACG, FRCP, FAASLD, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Navin Kalra
- Department of Radiology, Postgraduate Institute Of Medical Education and Research, Chandigarh, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay S. Baijal
- Department of Diagnostic and Intervention Radiology, Medanta Hospital, Gurgaon, India
| | - Anil Arora
- Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Gangaram Hospital, New Delhi, India
| | - Ajay Gulati
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anu Eapan
- Department of Radiology, Christian Medical College, Vellore, India
| | - Ashish Verma
- Department of Radiology, Banaras Hindu University, Varanasi, India
| | - Shyam Keshava
- Department of Radiology, Christian Medical College, Vellore, India
| | - Amar Mukund
- Department of Intervention Radiology, Institute of liver and biliary Sciences, New Delhi, India
| | - S. Deva
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Chaudhary
- Department of Radiology, Medanta Hospital, Gurgaon, India
| | | | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiology, Postgraduate Institute Of Medical Education and Research, Chandigarh, India
| | | | - Kumble S. Madhusudan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Puri
- Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Gangaram Hospital, New Delhi, India
| | - Shalimar
- Department of GastroEnterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manav Wadhavan
- Institute of Digestive and Liver Diseases, BLK Hospital, Delhi, India
| | - Sanjiv Saigal
- Department of Hepatology, Medanta Hospital, Gurgaon, India
| | - Ashish Kumar
- Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Gangaram Hospital, New Delhi, India
| | - Shallini Thapar
- Department of Radiology, Institute of liver and biliary Sciences, New Delhi, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeraj Saraf
- Department of Hepatology, Medanta Hospital, Gurgaon, India
| | | | | | - Ajay Gulati
- Department of Radiology, Postgraduate Institute Of Medical Education and Research, Chandigarh, India
| | - Nitin Shetty
- Department of Radiology, Tata Memorial Hospital, Kolkata, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
A variety of vascular liver disorders can induce hepatocellular tumors. They may be related to portal venous deprivation, venous outflow obstruction, or arterial diseases. Their common feature is an imbalance between hepatic arterial and portal venous blood flow leading to an increased hepatic arterial inflow. Consequently, hepatocellular tumors may arise, most commonly focal nodular hyperplasia-like lesions but hepatocellular adenomas and hepatocellular carcinoma may be seen as well. This article will review the most common vascular liver diseases associated with hepatocellular nodules (Budd-Chiari syndrome, congenital portosystemic shunt, hereditary hemorrhagic telangiectasia, and portal cavernoma). For each condition, imaging findings will be described as well as the differential diagnosis and the diagnostic clues.
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12
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Taibbi A, Picone D, Midiri M, La Grutta L, Bartolotta TV. Diffuse Liver Diseases: Role of imaging. Semin Ultrasound CT MR 2017; 39:193-205. [PMID: 29571555 DOI: 10.1053/j.sult.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nowadays, the most common imaging techniques allow to study focal liver lesions with high diagnostic accuracy but a relatively recent emerging field of interest is represented by diffuse liver disease. They include a variegated series of storage and metabolic pathologies (ie, iron overload disorders and steatosis) requiring a precise diagnosis not always possible at imaging due to the overlapping of findings at conventional ultrasound, CT, or MR studies. In recent years, several imaging tecniques and specific softwares have been developed, especially for ultrasound and MR imaging, in order to identify different parameters useful in the noninvasive recognition and follow-up of these diffuse processes involving the liver. The aim of this article is to describe the most common and useful imaging findings of the most common and uncommon diffuse liver diseases illustrating the newest imaging technologies and developments at our disposal with corresponding advantages, limitations, and pitfalls.
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Affiliation(s)
- Adele Taibbi
- Department of Radiology, University Hospital, Palermo, Italy.
| | - Dario Picone
- Department of Radiology, University Hospital, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University Hospital, Palermo, Italy
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13
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Martín-Llahí M, Albillos A, Bañares R, Berzigotti A, García-Criado MÁ, Genescà J, Hernández-Gea V, Llop-Herrera E, Masnou-Ridaura H, Mateo J, Navascués CA, Puente Á, Romero-Gutiérrez M, Simón-Talero M, Téllez L, Turon F, Villanueva C, Zarrabeitia R, García-Pagán JC. Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:538-580. [DOI: 10.1016/j.gastrohep.2017.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
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Sakane M, Osuga K, Matsui T, Eguchi H, Hori M, Tomiyama N. Combined hepatocellular-cholangiocarcinoma with stem cell features, cholangiolocellular subtype after inferior vena cava stent placement for a patient with Budd-Chiari syndrome. Acta Radiol Open 2016; 5:2058460116678277. [PMID: 27900203 PMCID: PMC5122174 DOI: 10.1177/2058460116678277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022] Open
Abstract
We report a case of combined hepatocellular-cholangiocarcinoma with stem cell features, cholangiolocellular subtype arising about 15 years after placement of an inferior vena cava stent for primary Budd–Chiari syndrome. Pre-surgical differentiation of the tumor from hepatocellular carcinoma was difficult because of elevated levels of alpha-fetoprotein and hypervascularity in the arterial phase. Histopathological examination revealed atypical cells forming ductal and alveolar structures showing a vague border with the surrounding liver. Immunostaining showed positive results for epithelial membrane antigen, mainly localized to the apical surface of the tubules, representing a characteristic finding for combined hepatocellular-cholangiocarcinoma with stem cell features, cholangiolocellular subtype. Combined hepatocellular-cholangiocarcinoma with stem cell features arising in the liver with hepatic damage from Budd–Chiari syndrome is not common, but diagnosis is important to manage the malignancy, which shows different clinical behaviors from hepatocellular carcinoma.
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Affiliation(s)
- Makoto Sakane
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keigo Osuga
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masatoshi Hori
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
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15
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Channual S, Pahwa A, Lu DS, Raman SS. Enhancements in hepatobiliary imaging: the spectrum of gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid usages in hepatobiliary magnetic resonance imaging. Abdom Radiol (NY) 2016; 41:1825-41. [PMID: 27225503 DOI: 10.1007/s00261-016-0767-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a unique hepatocyte-specific contrast agent approved for clinical use in the United States in 2008. Gd-EOB-DTPA-enhanced MR has shown to improve detection and characterization of hepatic lesions. Gd-EOB-DTPA is now being routinely used in daily clinical practice worldwide. Therefore, it is important for radiologists to be familiar with the potential uses and pitfalls of Gd-EOB-DTPA, which extends beyond the assessment of focal hepatic lesions. The purpose of this article is to review the various usages of Gd-EOB-DTPA in hepatobiliary MR imaging.
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Affiliation(s)
- Stephanie Channual
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza Rm 1921H, Los Angeles, CA, 90095, USA.
| | - Anokh Pahwa
- Department of Radiological Sciences, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA, 14445 Olive View Drive, Sylmar, CA, 91342, USA
| | - David S Lu
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza Rm 1921H, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza Rm 1921H, Los Angeles, CA, 90095, USA
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16
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Numata K, Fukuda H, Nihonmatsu H, Kondo M, Nozaki A, Chuma M, Morimoto M, Oshima T, Okada M, Murakami T, Takebayashi S, Maeda S, Inayama Y, Nakano M, Tanaka K. Use of vessel patterns on contrast-enhanced ultrasonography using a perflubutane-based contrast agent for the differential diagnosis of regenerative nodules from early hepatocellular carcinoma or high-grade dysplastic nodules in patients with chronic liver disease. ACTA ACUST UNITED AC 2016; 40:2372-83. [PMID: 26099473 DOI: 10.1007/s00261-015-0489-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We evaluated the use of tumor vessel patterns observed during arterial-phase contrast-enhanced ultrasonography (US) to differentiate regenerative nodules (RN) from early hepatocellular carcinoma (HCC) or high-grade dysplastic nodules (HGDN) in patients with chronic liver disease. SUBJECTS AND METHODS Pathologically confirmed lesions (83 early HCC, 6 HGDN, and 13 RN with mean maximal diameters of 15.4, 15.3, and 16.2 mm, respectively) were enrolled in this retrospective study. We performed contrast-enhanced US using a perflubutane-based contrast agent. We then classified the tumor vessels observed during the arterial phase of contrast-enhanced US into two patterns: peripheral vessels (centripetal pattern) and central vessels (centrifugal pattern). RESULTS Eighty-one (97.6%) of the 83 early HCC exhibited various enhancement patterns (hypovascular, 44.6%; isovascular, 25.3%; and hypervascular, 27.7%) and a peripheral vessel pattern, while the remaining 2 lesions (2.4%) exhibited hypovascular enhancement and a central vessel pattern. All 6 HGDN lesions were hypovascular with a peripheral vessel pattern. Twelve (92.3%) of the 13 RN were hypovascular with a central vessel pattern, and the remaining one (7.7%) was hypervascular with a central vessel pattern. When lesions exhibiting a central vessel pattern during arterial-phase contrast-enhanced US were diagnosed as RN, the sensitivity, specificity, and accuracy of these diagnoses were 100%, 97.8%, and 98.0%, respectively. CONCLUSION The tumor vessel patterns observed during arterial-phase contrast-enhanced US may be useful for differentiating RN from early HCC or HGDN in patients with chronic liver disease.
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Affiliation(s)
- Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Hiromi Nihonmatsu
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Masaaki Kondo
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Manabu Morimoto
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Takashi Oshima
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Masahiro Okada
- Department of Radiology, University Hospital of the Ryukyus, 207 Azakamihara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan.
| | - Takamichi Murakami
- Department of Radiology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Shigeo Takebayashi
- Department of Radiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Yoshiaki Inayama
- Department of Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Masayuki Nakano
- Pathological Department, Shonan Fujisawa Tokusyukai Hospital, 1-5-1 Kamidai, Tusjido, Fujisawa, Kanagawa, 251-0041, Japan.
| | - Katsuaki Tanaka
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
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17
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Arnold CW, Wallace WD, Chen S, Oh A, Abtin F, Genshaft S, Binder S, Aberle D, Enzmann D. RadPath: A Web-based System for Integrating and Correlating Radiology and Pathology Findings During Cancer Diagnosis. Acad Radiol 2016; 23:90-100. [PMID: 26521686 DOI: 10.1016/j.acra.2015.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES The current paradigm of cancer diagnosis involves uncoordinated communication of findings from radiology and pathology to downstream physicians. Discordance between these findings can require additional time from downstream users to resolve, or given incorrect resolution, may adversely impact treatment decisions. To mitigate this problem, we developed a web-based system, called RadPath, for correlating and integrating radiology and pathology reporting. MATERIALS AND METHODS RadPath includes interfaces to our institution's clinical information systems, which are used to retrieve reports, images, and test results that are structured into an interactive compendium for a diagnostic patient case. The system includes an editing interface for physicians, allowing for the inclusion of additional clinical data, as well as the ability to retrospectively correlate and contextualize imaging findings following pathology diagnosis. RESULTS During pilot deployment and testing over the course of 1 year, physicians at our institution have completed 60 RadPath cases, requiring an average of 128 seconds from a radiologist and an average of 93 seconds from a pathologist per case. Several technical and workflow challenges were encountered during development, including interfacing with diverse clinical information systems, automatically structuring report contents, and determining the appropriate physicians to create RadPath summaries. Reaction to RadPath has been positive, with users valuing the system's ability to consolidate diagnostic information. CONCLUSIONS With the increasing complexity of medicine and the movement toward team-based disease management, there is a need for improved clinical communication and information exchange. RadPath provides a platform for generating coherent and correlated diagnostic summaries in cancer diagnosis with minimal additional effort from physicians.
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Yang C, Xu K, Zheng J, Ma P, Hu C, Li S, Rong Y, Lu X, Zhang Q, Zu M, Hua R, Zhang L. Hepatocellular carcinoma in Budd-Chiari syndrome: enhancement patterns at dynamic gadolinium-enhanced T1-weighted MR imaging. Cell Biochem Biophys 2015; 70:661-6. [PMID: 24760630 DOI: 10.1007/s12013-014-9970-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The objective of this study was to analyze the enhancement patterns at dynamic gadolinium-enhanced T1-weighted MR imaging in patients of Hepatocellular Carcinoma (HCC) with associated Budd-Chiari syndrome (BCS). The MR imaging findings in 10 patients of HCC with associated BCS were compared to those of 32 other patients of HCC without BCS. During the arterial phase, significantly more lesions with BCS were hyperintense than lesions without BCS; during the equilibrium phase, significantly more lesions with BCS were slightly hyperintense or isointense than lesions without BCS (P < 0.05 for both). For HCC, contrast enhancement on MRI shows different enhancement patterns between patients of HCC with associated BCS and those without BCS.
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Affiliation(s)
- Chun Yang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, 99 West Huai-hai Road, Xuzhou, 221002, Jiangsu, People's Republic of China
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20
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Imaging-histologic discordance at percutaneous biopsy of the lung. Acad Radiol 2015; 22:481-7. [PMID: 25601302 DOI: 10.1016/j.acra.2014.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 11/13/2014] [Accepted: 11/25/2014] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to quantify the degree of imaging-histologic discordance in a cohort of patients undergoing computed tomography (CT)-guided lung biopsy for focal lung disease. MATERIALS AND METHODS A retrospective review was performed of 186 patients who underwent percutaneous lung biopsy of a parenchymal lesion at our institution between January and December 2009. Diagnostic radiology reports of CT or positron emission tomography-CTs performed before biopsy were used to classify the lesion as malignant or benign by five readers. Pathology reports of the biopsied lesions were classified by three readers. Inter-reader agreement and imaging-histologic concordance were quantified using kappa statistics. Discordant benign cases were then revisited to determine downstream effects. RESULTS Inter-reader agreement on report content was substantial or almost perfect with kappas >0.783. Kappas for concordance were as follows: malignant (0.448), primary lung cancer (0.517), metastatic disease to lung (0.449), benign (0.510), and overall agreement (0.381). Of the twelve discordant benign cases that were revisited, four were found to be false negatives, resulting in a delay in diagnosis. CONCLUSIONS Our study of imaging-histologic discordance in percutaneous biopsy of lung lesions supports the need for imaging report standardization and improved integration and communication between the fields of radiology and pathology.
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Do BJ, Park IY, Rhee SY, Song JK, Jang MK, Cho SJ, Nam ES, Yun EJ. A Case of Multiple Hypervascular Hyperplastic Liver Nodules in a Patient with No History of Alcohol Abuse or Chronic Liver Diseases. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:321-5. [DOI: 10.4166/kjg.2015.65.5.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Byoung Joo Do
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - In Young Park
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - So Yon Rhee
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Kyung Song
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Myoung Kuk Jang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong Jin Cho
- Department Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Sook Nam
- Department Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Joo Yun
- Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Wang Y, Xue H, Jiang Q, Li K, Tian Y. Multiple hyperplastic nodular lesions of the liver in the Budd-Chari syndrome: a case report and review of published reports. Ann Saudi Med 2015; 35:72-5. [PMID: 26142943 PMCID: PMC6152551 DOI: 10.5144/0256-4947.2015.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The Budd-Chari syndrome (BCS) is a group of disorders of hepatic vein outflow at various levels from the hepatic veins to inferior vena cave. We describe a 49-year-old man with multiple intrahepatic lesions who had been diagnosed with the BCS. The inferior vena cavography showed hepatic vein occlusion and long-range obstruction of inferior vena cava. The biopsy proved to be hyperplastic nodules, also called large regenerative nodules (LRNs). Both benign regenerative nodules and hepatocellular carcinoma (HCC) appear in patients with BCC; however, published reports about the diagnosis and differential diagnosis are limited. The incidence of HCC in patients with BCS varies greatly depending on geography. This case illustrates that benign nodules can arise in BCS patients. We reviewed published reports and speculated that medical procedures leading to portal perfusion decrease may be associated with the development of these hyperplastic nodules.
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Affiliation(s)
- YaoXuan Wang
- YaoXuan Wang, Department of Hepatobiliary Pancreatic Surgery,, People's Hospital of Zhengzhou University,, Zengzhou 450003, China,
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23
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24
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Barr DC, Hussain HK. MR Imaging in Cirrhosis and Hepatocellular Carcinoma. Magn Reson Imaging Clin N Am 2014; 22:315-35. [DOI: 10.1016/j.mric.2014.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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25
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Vilgrain V, Rautou P, Paradis V, Ronot M. Benign and malignant hepatocellular lesions in patients with vascular liver disease. Clin Liver Dis (Hoboken) 2014; 3:122-125. [PMID: 30992904 PMCID: PMC6448717 DOI: 10.1002/cld.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Valérie Vilgrain
- Department of RadiologyAssistance‐Publique Hôpitaux de ParisHôpital BeaujonClichyFrance,Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de recherche Biomédicale Bichat BeaujonCRB3 U773 75018ParisFrance
| | - Pierre‐Emmanuel Rautou
- Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de recherche Biomédicale Bichat BeaujonCRB3 U773 75018ParisFrance,Department of HepatologyAssistance‐Publique Hôpitaux de ParisHôpital BeaujonClichyFrance
| | - Valérie Paradis
- Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de recherche Biomédicale Bichat BeaujonCRB3 U773 75018ParisFrance,Department of PathologyAssistance‐Publique Hôpitaux de ParisHôpital BeaujonClichyFrance
| | - Maxime Ronot
- Department of RadiologyAssistance‐Publique Hôpitaux de ParisHôpital BeaujonClichyFrance,Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de recherche Biomédicale Bichat BeaujonCRB3 U773 75018ParisFrance
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26
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Abstract
Cirrhosis is the main risk factor for the development of hepatocellular carcinoma (HCC). The major causative factors of cirrhosis in the United States and Europe are chronic hepatitis C infection and excessive alcohol consumption with nonalcoholic steatohepatitis emerging as another important risk factor. Magnetic resonance imaging is the most sensitive imaging technique for the diagnosis of HCC, and the sensitivity can be further improved with the use of diffusion-weighted imaging and hepatocyte-specific contrast agents. The combination of arterial phase hyperenhancement, venous or delayed phase hypointensity "washout feature," and capsular enhancement are features highly specific for HCC with reported specificities of 96% and higher. When these features are present in a mass in the cirrhotic liver, confirmatory biopsy to establish the diagnosis of HCC is not necessary. Other tumors, such as cholangiocarcinoma, sometimes occur in the cirrhotic at a much lower rate than HCC and can mimic HCC, as do other benign lesions such as perfusion abnormalities. In this article, we discuss the imaging features of cirrhosis and HCC, the role of magnetic resonance imaging in the diagnosis of HCC and other benign and malignant lesions that occur in the cirrhotic liver, and the issue of nonspecific arterially hyperenhancing nodules often seen in cirrhosis.
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Affiliation(s)
- Daniel C Barr
- From the Department of Radiology/MRI, University of Michigan Health System, Ann Arbor, MI
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27
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Zhou P, Ren J, Han X, Wu G, Zhang W, Ding P, Bi Y. Initial imaging analysis of Budd-Chiari syndrome in Henan province of China: most cases have combined inferior vena cava and hepatic veins involvement. PLoS One 2014; 9:e85135. [PMID: 24416352 PMCID: PMC3885682 DOI: 10.1371/journal.pone.0085135] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/24/2013] [Indexed: 12/12/2022] Open
Abstract
AIM To evaluate the type of venous involvement in Chinese Budd-Chiari syndrome (BCS) patients and the relative diagnostic accuracy of the different imaging modalities. METHODS Using digital subtraction angiography (DSA) as a reference standard, color Doppler ultrasound (CDUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) were performed on 338 patients with BCS. We analyzed the course of the main and any accessory hepatic veins (HVs) and the inferior vena cava (IVC) to assess the etiology of obstructed segments and diagnostic accuracy of CDUS, CTA and MRA. RESULTS Among the 338 cases, there were 8 cases (2.4%) of isolated IVC membranous obstruction, 45 cases (13.3%) of isolated HV occlusion, and 285 cases (84.3%) with both IVC membranous obstruction and HV occlusion. Comparing with DSA, CDUS, CTA had a diagnostic accuracy of 89.3% and 80.2% in detecting BCS, and 83.4% of cases correctly correlated by MRA. CONCLUSION In Henan Province, most patients with BCS have complex lesions combining IVC and HV involvement. The combination of CDUS and CTA or MRI is useful for diagnosis of BCS and guiding therapy.
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Affiliation(s)
- Pengli Zhou
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
- * E-mail:
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wenguang Zhang
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Pengxu Ding
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
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28
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Nishida N, Iwamura S, Ida H, Hagiwara S, Kagioka Y, Minami Y, Maetani Y, Itoh K, Kudo M. Clinical and histological features of different types of Budd-Chiari syndrome: a comparison of 4 cases. Dig Dis 2013; 31:408-14. [PMID: 24281013 DOI: 10.1159/000355237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Budd-Chiari syndrome (BCS) is a rare condition characterized by hepatic venous outflow obstruction. In this report, we present 4 cases of BCS with complete and incomplete obstruction of the inferior vena cava (IVC) and hepatic vein (HV). Each case showed different and unique features of liver damage, which were attributed to the site and degree of obstruction. Interestingly, improved liver functions such as increased serum albumin levels, decreased hyaluronic acid levels and a normal indocyanine green clearance test were evident within 1 month of the balloon angioplasty. Pericellular fibrosis and hypervascular regenerative nodules were also reversible after obstruction removal. Therefore, it is very important to manage this rare disease before it progresses to liver cirrhosis.
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Affiliation(s)
- Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama, Japan
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29
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Bulut OP, Romero R, Mahle WT, McConnell M, Braithwaite K, Shehata BM, Gupta NA, Vos M, Alazraki A. Magnetic resonance imaging identifies unsuspected liver abnormalities in patients after the Fontan procedure. J Pediatr 2013; 163:201-6. [PMID: 23391043 DOI: 10.1016/j.jpeds.2012.12.071] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 11/12/2012] [Accepted: 12/18/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether abdominal magnetic resonance imaging (MRI) detects hepatic abnormalities before clinical or biochemical perturbations in patients after the Fontan procedure. STUDY DESIGN Thirty-nine children and adolescents who underwent the Fontan procedure and were referred to a pediatric hepatologist by cardiology services between 2011 and 2012 were reviewed retrospectively. Physical examination findings, routine laboratory tests of liver function, evaluation for chronic liver disease, and abdominal MRI findings were recorded. MRI findings were evaluated relative to time elapsed since surgery by 2 radiologists (blinded). RESULTS Assessment for coexisting chronic liver disease was negative in all patients. All patients had a normal serum albumin level and International Normalized Ratio. Twenty-six of the 39 patients (67%) underwent abdominal MRI, 4 had MRI-incompatible hardware, and 9 did not undergo MRI because of insurance denial. All MRI scans demonstrated morphologic liver changes with varying degrees of reticular contrast enhancement compatible with fibrosis and congestion. Reticular contrast enhancement was often nonuniform, and 9 patients (35%) had multifocal arterially enhancing lesions. CONCLUSION MRI can identify hepatic abnormalities in patients after Fontan surgery that go undetected by standard clinical and laboratory assessments. These abnormalities are not uniformly distributed throughout the liver, and thus assessment by liver biopsy analysis is subject to sampling error.
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Affiliation(s)
- Ozlem Pinar Bulut
- Division of Pediatric Gastroenterology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
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30
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MacNicholas R, Olliff S, Elias E, Tripathi D. An update on the diagnosis and management of Budd-Chiari syndrome. Expert Rev Gastroenterol Hepatol 2012; 6:731-44. [PMID: 23237258 DOI: 10.1586/egh.12.56] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Budd-Chiari syndrome is a rare disorder caused by hepatic venous outflow obstruction and resulting hepatic dysfunction. Despite a lack of prospective randomized trials, much progress has been made in its management over the last 20 years. The main goals of treatment are to ameliorate hepatic congestion and prevent further thrombosis. The selective use of anticoagulation, vascular stents, transjugular intrahepatic portosystemic stent-shunt and liver transplant has resulted in a significant increase in survival. The diagnosis, initial management and long-term follow-up of patients with Budd-Chiari syndrome is reviewed. The concept of individualization of treatment and a stepwise approach to invasive procedures is also discussed.
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31
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Gore RM, Thakrar KH, Wenzke DR, Newmark GM, Mehta UK, Berlin JW. That liver lesion on MDCT in the oncology patient: is it important? Cancer Imaging 2012; 12:373-84. [PMID: 23023318 PMCID: PMC3485646 DOI: 10.1102/1470-7330.2012.9028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Multidetector-row computed tomography (MDCT) has become the primary imaging test for the staging and follow-up of most malignancies that originate outside of the central nervous system. Technical advances in this imaging technique have led to significant improvement in the detection of metastatic disease to the liver. An unintended by-product of this improving diagnostic acumen is the discovery of incidental hepatic lesions in oncology patients that in the past remained undetected. These ubiquitous, incidentally identified hepatic lesions have created a management dilemma for both clinicians and radiologists: are these lesions benign or do they represent metastases? Naturally, the answer to this question has profound prognostic and therapeutic implications. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidental lesions detected in patients with extrahepatic malignancies are presented.
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Affiliation(s)
- Richard M Gore
- Department of Radiology, NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA.
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32
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Parente DB, Perez RM, Eiras-Araujo A, Oliveira Neto JA, Marchiori E, Constantino CP, Amorim VB, Rodrigues RS. MR imaging of hypervascular lesions in the cirrhotic liver: a diagnostic dilemma. Radiographics 2012; 32:767-87. [PMID: 22582358 DOI: 10.1148/rg.323115131] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cirrhosis is characterized by a spectrum of hepatocellular nodules that mark the progression from regenerative nodules to low- and high-grade dysplastic nodules, followed by small and large hepatocellular carcinomas (HCCs). Characterization of small nodules on the basis of imaging and histopathologic findings is complicated by an overlap in findings associated with each type of nodule, a reflection of their multistep transitions. Vascularity patterns change gradually as the nodules evolve, with an increasing shift from predominantly venous to predominantly arterial perfusion. Regenerative and low-grade dysplastic nodules demonstrate predominantly portal perfusion and contrast enhancement similar to that of surrounding parenchyma. Differentiation of high-grade dysplastic nodules and well-differentiated HCCs on the basis of dynamic imaging and histologic findings is challenging, with a high rate of false-negative results. Some small nodules that lack hypervascularity may be early HCCs. Progressed small and large HCCs usually present no diagnostic difficulty because of their characteristic findings. Although characterization of hypervascular lesions in the cirrhotic liver is difficult, it is a key step in disease management and is the radiologist's responsibility.
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Affiliation(s)
- Daniella B Parente
- Federal University of Rio de Janeiro, Av. Lineu de Paula Machado 896/601, Jardim Botânico, CEP 22470-040, Rio de Janeiro, Brazil.
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33
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Patil P, Deshmukh H, Popat B, Rathod K. Spectrum of imaging in Budd Chiari syndrome. J Med Imaging Radiat Oncol 2012; 56:75-83. [PMID: 22339749 DOI: 10.1111/j.1754-9485.2012.02341.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Budd Chiari syndrome is an uncommon heterogeneous group of disorders which occur due to obstruction at any level from the hepatic venules to the junction of inferior vena cava and right atrium of heart which has significant morbidity and mortality. An early diagnosis of the disease is required for appropriate treatment. Due to the diffuse nature of the disease, normal biopsy findings do not exclude the disease. Proper clinical history and imaging are essential for definitive diagnosis. In this pictorial essay, we discuss the imaging spectrum of Budd Chiari syndrome.
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Affiliation(s)
- Pritam Patil
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India.
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34
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Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings. Case Rep Radiol 2012; 2012:685486. [PMID: 22606569 PMCID: PMC3350005 DOI: 10.1155/2012/685486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/04/2012] [Indexed: 01/09/2023] Open
Abstract
A-26-year old female patient with chronic Budd-Chiari syndrome due to different underlying blood disorders applied for a two-year followup of the liver with Gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic-acid-(Gd-EOB-DTPA-) enhanced MRI. The liver function tests were raised. Besides showing a progressive hepatosplenomegaly and a cirrhotic liver alteration, the MRI revealed multiple new nodular lesions in all liver segments. These lesions showed typical patterns in the precontrast images, while there was an arterial and a persistent portal venous enhancement. In the hepatobiliary liver-specific late phase, a central “washout” and a persistent rim enhancement were observed (target sign). The additionally performed contrast-enhanced ultrasonography showed a strong zentrifugal arterial enhancement of the lesions followed by an isoechoic enhancement in the portal venous and delayed liver phase. Histologically these lesions turned out as focal nodular hyperplasias (FNH) or FNH-like lesions, also known as large regenerative nodules (LRNs). Differentiation between regenerative nodules like LRN and hepatocellular carcinoma (HCC) in cirrhotic livers is crucial, and the target sign in the hepatobiliary phase of Gd-EOB-DTPA as well as the centrifugal arterial enhancement followed by an isoenhancement during a CEUS might be useful for establishing the correct diagnosis of such hypervascular lesions with proliferated and likely aberrant bile ducts.
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35
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Comparison of imaging characteristics between hepatic benign regenerative nodules and hepatocellular carcinomas associated with Budd-Chiari syndrome by contrast enhanced ultrasound. Eur J Radiol 2012; 81:2984-9. [PMID: 22341409 DOI: 10.1016/j.ejrad.2012.01.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare different imaging characteristics between hepatic benign regenerative nodules and hepatocellular carcinomas (HCCs) associated with Budd-Chiari syndrome (BCS) by contrast enhanced ultrasound (CEUS). MATERIALS AND METHODS A total of 32 chronic BCS patients (mean age, 42 years; age range, 18-59 years) with hepatic nodules who underwent CEUS were retrospectively studied. All patients had no the history of viral hepatitis. There were 23 patients with benign regenerative nodules (22±9 mm; range, 8-42 mm) and 9 patients with HCCs (63±21 mm; range, 26-90 mm). Lesion characteristics, including number, size, vascularization on color Doppler flow imaging, echogenicity, peripheral hypoechoic rim, and enhancement patterns in arterial, portal, and late phases on CEUS, were analyzed. RESULTS There were significant differences in number and size of the lesions between two groups. No significant differences were observed in vascularity, echogenicity, and peripheral hypoechoic rim. Overall, there were significant differences in enhancement patterns in arterial, portal, and late phases between them on CEUS. Of 23 patients with benign regenerative nodules, 16 (70%) were center-to-periphery hyperenhanced and 7 patients (30%) were homogeneously hyperenhanced in arterial phase; the majority were homogeneously hyperenhanced in portal and late phases. Of 9 patients with HCCs, 8 (89%) were heterogeneously hyperenhanced in arterial phase and most of them were hypoenhanced in portal and late phases. CONCLUSION CEUS imaging characteristics of benign regenerative nodules radically differ from that of HCCs in BCS patients.
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36
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Mukund A, Gamanagatti S. Imaging and interventions in Budd-Chiari syndrome. World J Radiol 2011; 3:169-77. [PMID: 21860712 PMCID: PMC3158894 DOI: 10.4329/wjr.v3.i7.169] [Citation(s) in RCA: 26] [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: 04/28/2011] [Revised: 07/13/2011] [Accepted: 07/20/2011] [Indexed: 02/06/2023] Open
Abstract
Budd-Chiari syndrome (BCS) consists of a group of disorders with obstruction of hepatic venous outflow leading to increased hepatic sinusoidal pressure and portal hypertension. Clinically, two forms of disease (acute and chronic) are recognized. Mostly the patients present with ascites, hepatomegaly, and portal hypertension. In acute disease the liver is enlarged with thrombosed hepatic veins (HV) and ascites, whereas in the chronic form of the disease there may be membranous occlusion of HV and/or the inferior vena cava (IVC), or there may be short or long segment fibrotic constriction of HV or the suprahepatic IVC. Due to advances in radiological interventional techniques and hardware, there have been changes in the management protocol of BCS with surgery being offered to patients not suitable for radiological interventions or having acute liver failure requiring liver transplantation. The present article gives an insight into various imaging findings and interventional techniques employed in the management of BCS.
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37
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Oliveira EC, Duarte AGE, Boin IFSF, Almeida JRS, Escanhoela CAF. Large benign hepatocellular nodules in cirrhosis due to chronic venous outflow obstruction: diagnostic confusion with hepatocellular carcinoma. Transplant Proc 2011; 42:4116-8. [PMID: 21168640 DOI: 10.1016/j.transproceed.2010.09.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 09/20/2010] [Indexed: 12/31/2022]
Abstract
Budd-Chiari syndrome (BCS) in patients progressing to cirrhosis is an indication for liver transplantation. At this stage of disease, it is common to find large benign hepatocellular nodules (LBHNs) of undetermined cause that may be confused with hepatocellular carcinoma (HCC). Patients with indications for liver transplantation are currently classified according to the MELD (Model for End-Stage Liver Disease) severity score. When they fit Barcelona and Milan eligibility criteria for HCC, they receive 20 points. Thus, misdiagnosis of HCC leads to a privileged position on the waiting list. Herein, we have reported three BCS cases of cirrhotic patients who underwent liver transplantation; the pathologic results of their explanted livers showed LBHN. We analyzed three of 489 OLT who had chronic venous outflow obstruction (CVOO) the first case: was a 19-year-old man, with BCS of undetermined cause. The second 20-year-old female patients displayed BCS due to antiphospholipid syndrome the third, 45-year-old man had CVOO diagnosed preliminarily due to cryptogenic cirrhosis in the explanted liver. In the three cases, the nodules in the explant measured 0.5 to 2.4 cm. In the first case, the diagnosis was not in doubt; in the second case, 23 nodules were confused with HCC histologic evaluation, and in the third case three larger hypervascular nodules were misdiagnosed as HCC in the preoperative period despite low alpha-fetoprotein levels. In conclusion it is fundamental to recognize these benign lesions so as to avoid misdiagnosis, thereby allowing the proper selection of candidates for liver transplantation.
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Affiliation(s)
- E C Oliveira
- Dept of Pathology, Faculty of Medical Science, Unicamp, São Paulo, Brazil.
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38
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Khatri G, Merrick L, Miller FH. MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am 2011; 18:421-50, x. [PMID: 21094448 DOI: 10.1016/j.mric.2010.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common malignancy typically associated with chronic liver disease and is a leading cause of mortality among these patients. Prognosis is improved when detected early. MRI is the best imaging examination for accurate diagnosis. Although arterial enhancement with delayed washout, increased T2-weighted signal intensity, delayed capsular enhancement, restricted diffusion, and tumor thrombus are typical features, not all lesions demonstrate these findings. The radiologist must be familiar with these typical imaging characteristics, and less common appearances and associated findings of HCC, and must be able to differentiate them from those of lesions that mimic HCC. Knowledge of therapeutic options and how those are related to imaging findings is imperative to assist clinicians in managing these patients.
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Affiliation(s)
- Gaurav Khatri
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 800, Chicago, IL 60611, USA
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39
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Kamaya A, Maturen KE, Tye GA, Liu YI, Parti NN, Desser TS. Hypervascular Liver Lesions. Semin Ultrasound CT MR 2009; 30:387-407. [DOI: 10.1053/j.sult.2009.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Radiological and histopathological manifestations of hepatocellular nodular lesions concomitant with various congenital and acquired hepatic hemodynamic abnormalities. Jpn J Radiol 2009; 27:53-68. [PMID: 19373534 DOI: 10.1007/s11604-008-0299-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 10/31/2008] [Indexed: 12/25/2022]
Abstract
Congenital and acquired hepatic hemodynamic abnormalities are classified into four categories: hepatic arterial inflow disorder, portal vein inflow disorder, hepatic vein outflow disorder, and presence of a third inflow to the liver. Although their detailed etiology is not fully understood, these hepatic hemodynamic abnormalities may cause the formation of hepatocellular nodules. Recent advances in imaging modalities now enable visualization of these hepatocellular nodules concomitantly with the identification of various congenital and acquired hemodynamic abnormalities. Most of these nodular lesions are benign hyperplastic nodules, such as focal nodular hyperplasia, nodular regenerative hyperplasia, and other types of regenerative nodules. However, neoplastic nodules such as hepatic adenoma and hepatocellular carcinoma may also occur in conjunction with hepatic hemodynamic abnormalities. Distinguishing neoplastic nodules, especially malignant liver tumors, from hyperplastic nodules is important. Detection of intranodular Kupffer cells with superparamagnetic iron oxide enhanced magnetic resonance imaging is a key indicator that a nodule is regenerative rather than neoplastic.
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Regenerative nodules in patients with chronic Budd-Chiari syndrome: a longitudinal study using multiphase contrast-enhanced multidetector CT. Eur J Radiol 2009; 73:588-93. [PMID: 19200681 DOI: 10.1016/j.ejrad.2009.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 12/18/2008] [Accepted: 01/08/2009] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Our aim was to evaluate the serial evolution of regenerative nodules in patients with Budd-Chiari syndrome (BCS) treated with portal-systemic shunts, using multiphasic multidetector computed tomography (MDCT). MATERIALS AND METHODS Five patients each underwent three MDCT exams over an extended period ranging from 36 to 42 months. Two radiologists in consensus retrospectively reviewed each exam for each patient. Individual nodules were grouped according to size (size I: nodules with diameter < or =15 mm; size II: >15 mm but <30 mm; size III: > or =30 mm), pattern of enhancement (A: homogeneously hypervascular or B: with central scar), and segmental location. Four nodules classified as size II, which increased in size over time, were needle-biopsied. RESULTS We detected 61 nodules at the first exam, 66 nodules at the second exam (7 nodules disappeared and 12 new nodules), and 85 nodules at the third exam (8 disappeared and 27 new) for a total of 212 findings. Nodules were mostly found in the right hepatic lobe. Fourteen of the 15 nodules that disappeared over time were size I and enhancement pattern A. At unenhanced MDCT, 204 (96%) of the 212 findings were isodense. Overall, 100 nodules, including the 61 initially detected, were considered newly diagnosed; of these 84 (84%) were size I and pattern A. Of 57 nodules considered size I and pattern A at the first or second exam, 24 (42%) changed to pattern B at the third exam and either size II (n=18) or III (n=6). The four biopsied nodules were each confirmed as benign regenerative nodule. No patient developed HCC at 5-year follow-up period. CONCLUSION Hepatic nodules in BCS patients not only increase in number over time but may also increase in size and develop a central scar.
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42
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Shen GHHLG, Zhu JYJHMYF, Yang J, Mei JH, Zhu YF. Insight into congenital absence of the portal vein: Is it rare? World J Gastroenterol 2008; 14:5969-79. [PMID: 18932274 PMCID: PMC2760189 DOI: 10.3748/wjg.14.5969] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Congenital absence of portal vein (CAPV) was a rare event in the past. However, the number of detected CAPV cases has increased in recent years because of advances in imaging techniques. Patients with CAPV present with portal hypertension (PH) or porto-systemic encephalopathy (PSE), but these conditions rarely occur until the patients grow up or become old. The patients usually visit doctors for the complications of venous shunts, hepatic or cardiac abnormalities detected by ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). The etiology of this disease is not clear, but most investigators consider that it is associated with abnormal embryologic development of the portal vein. Usually, surgical intervention can relieve the symptoms and prevent occurrence of complications in CAPV patients. Moreover, its management should be stressed on a case-by-case basis, depending on the type or anatomy of the disease, as well as the symptoms and clinical conditions of the patient.
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43
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Kandpal H, Sharma R, Gamangatti S, Srivastava DN, Vashisht S. Imaging the inferior vena cava: a road less traveled. Radiographics 2008; 28:669-89. [PMID: 18480478 DOI: 10.1148/rg.283075101] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A broad spectrum of congenital anomalies and pathologic conditions can affect the inferior vena cava (IVC). Most congenital anomalies are asymptomatic; consequently, an awareness of their existence and imaging appearances is necessary to avoid misinterpretation. Imaging also plays a central role in the diagnosis of Budd-Chiari syndrome secondary to membranous obstruction of the intrahepatic IVC. Primary malignancy of the IVC is far less common than intracaval extension of malignant tumors arising in adjacent organs, and imaging can accurately help determine the presence and extent of tumor thrombus, information that is crucial for surgical planning. However, the radiologist should be aware that artifactual filling defects at computed tomography and magnetic resonance imaging can mimic true thrombus in the IVC and must be able to differentiate true from pseudo filling defects. Other imaging findings such as flat IVC and early enhancement of the IVC are useful in limiting the differential diagnosis. Familiarity with the imaging features of the various congenital and pathologic entities that can affect the IVC is paramount for early diagnosis and management.
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Affiliation(s)
- Harsh Kandpal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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44
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Willatt JM, Hussain HK, Adusumilli S, Marrero JA. MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 2008; 247:311-30. [PMID: 18430871 DOI: 10.1148/radiol.2472061331] [Citation(s) in RCA: 307] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The incidence of hepatocellular carcinoma (HCC) is expected to increase in the next 2 decades, largely due to hepatitis C infection and secondary cirrhosis. HCC is being detected at an earlier stage owing to the implementation of screening programs. Biopsy is no longer required prior to treatment, and diagnosis of HCC is heavily dependent on imaging characteristics. The most recent recommendations by the American Association for the Study of Liver Diseases (AASLD) state that a diagnosis of HCC can be made if a mass larger than 2 cm shows typical features of HCC (hypervascularity in the arterial phase and washout in the venous phase) at contrast material-enhanced computed tomography or magnetic resonance (MR) imaging or if a mass measuring 1-2 cm shows these features at both modalities. There is an ever-increasing demand on radiologists to detect smaller tumors, when curative therapies are most effective. However, the major difficulty in imaging cirrhosis is the characterization of hypervascular nodules smaller than 2 cm, which often have nonspecific imaging characteristics. The authors present a review of the MR imaging and pathologic features of regenerative nodules and dysplastic nodules and focus on HCC in the cirrhotic liver, with particular reference to small tumors and lesions that may mimic HCC. The authors also review the sensitivity of MR imaging for the detection of these tumors and discuss the staging of HCC and the treatment options in the context of the guidelines of the AASLD and the imaging criteria required by the United Network for Organ Sharing for transplantation. MR findings following ablation and chemoembolization are also reviewed.
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Affiliation(s)
- Jonathon M Willatt
- Department of Radiology/MRI, University of Michigan Health System, UH-B2A209K, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0030, USA
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Wang D, Zhang ZR, Li YY, Yan WY, Zhao DL, Wan Y. Advances in imaging diagnosis of Budd-Chiari syndrome. Shijie Huaren Xiaohua Zazhi 2008; 16:746-750. [DOI: 10.11569/wcjd.v16.i7.746] [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] [Indexed: 02/06/2023] Open
Abstract
Budd-Chiari syndrome (BCS) is very easy to be misdiagnosed due to the lack of specificity in clinical manifestation. With the improvement of multiple imaging diagnostic devices and methods, the detection rate of BCS is raised. The noninvasive imaging examination methods, such as ultrasound, multi-slice computed tomography (MSCT), magnetic resonance imaging (MRI), are able to clearly display hepatic vein (HV), inferior vena cave (IVC), and the location and type of stenosis. Therefore, they are useful for the clinical treatment and result observation.
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Marin D, Brancatelli G, Federle MP, Lagalla R, Catalano C, Passariello R, Midiri M, Vilgrain V. Focal nodular hyperplasia: typical and atypical MRI findings with emphasis on the use of contrast media. Clin Radiol 2008; 63:577-85. [PMID: 18374723 DOI: 10.1016/j.crad.2007.06.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 06/15/2007] [Accepted: 06/25/2007] [Indexed: 12/15/2022]
Abstract
Focal nodular hyperplasia is a benign hypervascular hepatic tumour, frequently detected in asymptomatic patients undergoing imaging studies for unrelated reasons. Magnetic resonance imaging (MRI) generally allows a confident differential diagnosis with other hypervascular liver lesions, either benign or malignant. In addition, due to the recent development of hepatospecific MRI contrast agents, MRI concomitantly enables functional and morphological information to be obtained, thus providing important clues for the detection and characterization of focal nodular hyperplasia lesions.
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Affiliation(s)
- D Marin
- Department of Radiological Sciences, University of Rome "La Sapienza", Rome, Italy.
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Brancatelli G, Vilgrain V, Federle MP, Hakime A, Lagalla R, Iannaccone R, Valla D. Budd-Chiari syndrome: spectrum of imaging findings. AJR Am J Roentgenol 2007; 188:W168-76. [PMID: 17242224 DOI: 10.2214/ajr.05.0168] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of our study was to illustrate the imaging findings of Budd-Chiari syndrome, including CT, MRI, sonographic, and angiographic findings. CONCLUSION The key imaging findings in Budd-Chiari syndrome are occlusion of the hepatic veins, inferior vena cava, or both; caudate lobe enlargement; inhomogeneous liver enhancement; and the presence of intrahepatic collateral vessels and hypervascular nodules. Awareness of these findings is important for early diagnosis and appropriate treatment.
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Affiliation(s)
- Giuseppe Brancatelli
- Sezione di Radiologia, Ospedale Specializzato in Gastroenterologia, Saverio de Bellis, IRCCS, Castellana Grotte, Italy.
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Erden A. Budd-Chiari syndrome: a review of imaging findings. Eur J Radiol 2006; 61:44-56. [PMID: 17123764 DOI: 10.1016/j.ejrad.2006.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 11/02/2006] [Indexed: 12/27/2022]
Abstract
Budd-Chiari syndrome is an uncommon, often fatal disorder resulting from an obstructed hepatic venous outflow tract. The obstructive lesion is situated in the main hepatic veins, in the inferior vena cava or in both. The nature, location and extension of the obstruction can be displayed on diagnostic imaging techniques. In addition to this direct evidence, the indirect findings of venous obstruction such as the presence of intra- and extrahepatic collateral veins, when combined with the altered morphology and enhancement pattern of the liver enables one to arrive at a confident diagnosis. In patients with suspected Budd-Chiari syndrome, gray-scale sonography with complementary support of color and pulsed Doppler examinations is the first step in approaching the diagnosis. It is followed by a contrast-enhanced cross-sectional technique, preferrentially by MR angiography. The patients with a high clinical suspicion of Budd-Chiari syndrome may undergo hepatic venography or venacavography directly so that a potential of recanalization (e.g. percutaneous transluminal angioplasty with or without stent placement or TIPS) of the obstructed segment under the guidance of these techniques would not be delayed.
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Affiliation(s)
- Ayşe Erden
- Ankara University, School of Medicine, Department of Radiology, Talatpaşa Bulvari, Sihhiye 06100, Ankara, Turkey.
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Abstract
Budd-Chiari syndrome is a spectrum of disease states, including anatomic abnormalities and hypercoagulable disorders, resulting in hepatic venous outflow occlusion. Clinical manifestations observed in the majority of patients include hepatomegaly, right upper quadrant pain, and abdominal ascites. This article outlines the approach to clinical diagnosis and supportive medical therapy in patients who have BCS and reviews the clinical data supporting surgical shunting and liver transplantation as viable treatment options in this patient population.
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Affiliation(s)
- Michael A Zimmerman
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Pfleger Liver Institute, The Dumont-UCLA Transplant Center, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA 90095, USA
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Qayyum A, Graser A, Westphalen A, Merriman RB, Ferrell LD, Yeh BM, Coakley FV. CT of Benign Hypervascular Liver Nodules in Autoimmune Hepatitis. AJR Am J Roentgenol 2004; 183:1573-6. [PMID: 15547193 DOI: 10.2214/ajr.183.6.01831573] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this report is to describe the frequency and histopathologic basis of benign hypervascular liver nodules seen on CT in patients with autoimmune hepatitis. CONCLUSION Benign hypervascular liver nodules may be seen on CT in patients with cirrhosis due to autoimmune hepatitis and may represent large regenerative nodules. This phenomenon is important to recognize because of the potential for confusion with hepatocellular carcinoma.
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Affiliation(s)
- Aliya Qayyum
- Department of Radiology, University of California-San Francisco, 505 Parnassus Ave., San Francisco, CA 94143-0628, USA
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