1
|
Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, Ganesan K, Yaghmai V, Guimaraes AR, Sahani DV, Miller FH. LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY) 2018; 43:56-74. [PMID: 28940042 DOI: 10.1007/s00261-017-1325-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate detection and characterization of liver observations to enable HCC diagnosis and staging using LI-RADS requires a technically adequate imaging exam. To help achieve this objective, LI-RADS has proposed technical requirements for CT, MR, and contrast-enhanced ultrasound of liver. This article reviews the technical requirements for liver imaging, including the description of minimum acceptable technical standards, such as the scanner hardware requirements, recommended dynamic imaging phases, and common technical challenges of liver imaging.
Collapse
Affiliation(s)
- Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
Ramalho M, Matos AP, AlObaidy M, Velloni F, Altun E, Semelka RC. Magnetic resonance imaging of the cirrhotic liver: diagnosis of hepatocellular carcinoma and evaluation of response to treatment - Part 1. Radiol Bras 2017; 50:38-47. [PMID: 28298731 PMCID: PMC5347502 DOI: 10.1590/0100-3984.2015.0132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the modern gold standard for the noninvasive evaluation of the cirrhotic liver. The combination of arterial phase hyperenhancement and delayed wash-out allows a definitive diagnosis of hepatocellular carcinoma (HCC) in patients with liver cirrhosis or chronic liver disease, without the requirement for confirmatory biopsy. That pattern is highly specific and has been endorsed in Western and Asian diagnostic guidelines. However, the sensitivity of the combination is relatively low for small HCCs. In this two-part review paper, we will address MRI of the cirrhotic liver. In this first part, we provide a brief background on liver cirrhosis and HCC, followed by descriptions of imaging surveillance of liver cirrhosis and the diagnostic performance of the different imaging modalities used in clinical settings. We then describe some of the requirements for the basic MRI technique, as well as the standard MRI protocol, and provide a detailed description of the appearance of various types of hepatocellular nodules encountered in the setting of the carcinogenic pathway in the cirrhotic liver, ranging from regenerative nodules to HCC.
Collapse
Affiliation(s)
- Miguel Ramalho
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal
| | - António P Matos
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal
| | - Mamdoh AlObaidy
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fernanda Velloni
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
3
|
Tanabe M, Kanki A, Wolfson T, Costa EAC, Mamidipalli A, Ferreira MPFD, Santillan C, Middleton MS, Gamst AC, Kono Y, Kuo A, Sirlin CB. Imaging Outcomes of Liver Imaging Reporting and Data System Version 2014 Category 2, 3, and 4 Observations Detected at CT and MR Imaging. Radiology 2016; 281:129-39. [PMID: 27115054 DOI: 10.1148/radiol.2016152173] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the proportion of untreated Liver Imaging Reporting and Data System (LI-RADS) version 2014 category 2, 3, and 4 observations that progress, remain stable, or decrease in category and to compare the cumulative incidence of progression in category. Materials and Methods In this retrospective, longitudinal, single-center, HIPAA-compliant, institutional review board-approved study, 157 patients (86 men and 71 women; mean age ± standard deviation, 59.0 years ± 9.7) underwent two or more multiphasic computed tomographic (CT) or magnetic resonance (MR) imaging examinations for hepatocellular carcinoma surveillance, with the first examination in 2011 or 2012. One radiologist reviewed baseline and follow-up CT and MR images (mean follow-up, 614 days). LI-RADS categories issued in the clinical reports by using version 1.0 or version 2013 were converted to version 2014 retrospectively; category modifications were verified with another radiologist. For index category LR-2, LR-3, and LR-4 observations, the proportions that progressed, remained stable, or decreased in category were calculated. Cumulative incidence curves for progression were compared according to baseline LI-RADS category (by using log-rank tests). Results All 63 index LR-2 observations remained stable or decreased in category. Among 166 index LR-3 observations, seven (4%) progressed to LR-5, and eight (5%) progressed to LR-4. Among 52 index LR-4 observations, 20 (38%) progressed to a malignant category. The cumulative incidence of progression to a malignant category was higher for index LR-4 observations than for index LR-3 or LR-2 observations (each P < .001) but was not different between LR-3 and LR-2 observations (P = .155). The cumulative incidence of progression to at least category LR-4 was trend-level higher for index LR-3 observations than for LR-2 observations (P = .0502). Conclusion Observations classified according to LI-RADS version 2014 categories are associated with different imaging outcomes. (©) RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Masahiro Tanabe
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Akihiko Kanki
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Tanya Wolfson
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Eduardo A C Costa
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Adrija Mamidipalli
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Marilia P F D Ferreira
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Cynthia Santillan
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Michael S Middleton
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Anthony C Gamst
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Yuko Kono
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Alexander Kuo
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| |
Collapse
|
4
|
Hennedige T, Venkatesh SK. Advances in computed tomography and magnetic resonance imaging of hepatocellular carcinoma. World J Gastroenterol 2016; 22:205-220. [PMID: 26755871 PMCID: PMC4698486 DOI: 10.3748/wjg.v22.i1.205] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Imaging is important for establishing a diagnosis of HCC and early diagnosis is imperative as several potentially curative treatments are available when HCC is small. Hepatocarcinogenesis occurs in a stepwise manner on a background of chronic liver disease or cirrhosis wherein multiple genes are altered resulting in a range of cirrhosis-associated nodules. This progression is related to increased cellularity, neovascularity and size of the nodule. An understanding of the stepwise progression may aid in early diagnosis. Dynamic and multiphase contrast-enhanced computed tomography and magnetic resonance imaging still form the cornerstone in the diagnosis of HCC. An overview of the current diagnostic standards of HCC in accordance to the more common practicing guidelines and their differences will be reviewed. Ancillary features contribute to diagnostic confidence and has been incorporated into the more recent Liver Imaging Reporting and Data System. The use of hepatocyte-specific contrast agents is increasing and gradually changing the standard of diagnosis of HCC; the most significant benefit being the lack of uptake in the hepatocyte phase in the earlier stages of HCC progression. An outline of supplementary techniques in the imaging of HCC will also be reviewed.
Collapse
|
5
|
Sofue K, Sirlin CB, Allen BC, Nelson RC, Berg CL, Bashir MR. How reader perception of capsule affects interpretation of washout in hypervascular liver nodules in patients at risk for hepatocellular carcinoma. J Magn Reson Imaging 2015; 43:1337-45. [PMID: 26559157 DOI: 10.1002/jmri.25094] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/29/2015] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine whether reader perception of a capsule affects reader interpretation of washout in hypervascular liver nodules at dynamic magnetic resonance imaging (MRI) in patients at risk for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study was Institutional Review Board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant, with waiver of informed consent. MRI reports for 111 hypervascular liver nodules (median 2.0 cm, range 1.0-17.8 cm) in 62 patients were reviewed, and the presence/absence of capsule and washout were recorded for one reading. A second independent study reading was also performed. The signal intensity ratio (SIR) for each nodule and liver parenchyma was measured. An objective SIR threshold was identified for nodules without capsules that correctly classified the presence/absence of washout, then applied to nodules with capsules to classify them as having / not having objective washout. Nodules were categorized as definite / not definite HCC using subjective and objective washout, based on LI-RADS, OPTN, AASLD, and EASL criteria, and proportions compared using McNemar's test. RESULTS Agreement on nodule features was high for Readings 1 and 2 (κ = 0.70-0.82). For Reading 1, 71 nodules lacked capsules (43 with and 28 without subjective washout); an SIR threshold of 0.88 classified the presence/absence of washout correctly in 94% (67/71, P < 0.001). Forty nodules had capsules; although all had subjective washout (100%, 40/40), 75% (30/40) had objective washout (P < 0.05). Using objective washout caused 4.5% (3/66; LI-RADS, OPTN) and 12% (10/83; AASLD, EASL) of nodules to be recategorized from definite HCC to not definite HCC. CONCLUSION Reader perception of capsule affects interpretation of washout. This effect can influence nodule categorization using imaging-based diagnostic systems. J. Magn. Reson. Imaging 2016;43:1337-1345.
Collapse
Affiliation(s)
- Keitaro Sofue
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, California, USA
| | - Brian C Allen
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Rendon C Nelson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Carl L Berg
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.,Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
6
|
|
7
|
Ronot M, Vilgrain V. Hepatocellular carcinoma: diagnostic criteria by imaging techniques. Best Pract Res Clin Gastroenterol 2014; 28:795-812. [PMID: 25260309 DOI: 10.1016/j.bpg.2014.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/12/2014] [Accepted: 08/15/2014] [Indexed: 01/31/2023]
Abstract
Imaging plays a very important role in the diagnosis of HCC. Indeed, in high-risk patients a noninvasive diagnosis can only be obtained by imaging in presence of typical features. These features include arterial enhancement followed by washout during the portal venous and/or delayed phases on CT scan or MRI. This pattern is quite specific and has been endorsed by both Western and Asian diagnostic guidelines. However, its sensitivity is not very high, especially for small lesions. Therefore ancillary signs may be needed to increase the reliability of the diagnosis. Recent hepatobiliary MRI contrast agents seem to be interesting to improve characterization of small nodules in the cirrhotic liver.
Collapse
Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| |
Collapse
|
8
|
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]
|
9
|
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.
Collapse
Affiliation(s)
- Daniel C Barr
- From the Department of Radiology/MRI, University of Michigan Health System, Ann Arbor, MI
| | | |
Collapse
|
10
|
Bashir MR, Gupta RT, Davenport MS, Allen BC, Jaffe TA, Ho LM, Boll DT, Merkle EM. Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis? J Magn Reson Imaging 2012; 37:398-406. [PMID: 23011874 DOI: 10.1002/jmri.23818] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 08/14/2012] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd-EOB-DTPA, in a North American population. MATERIALS AND METHODS One hundred MRI examinations performed with the intravenous injection of Gd-EOB-DTPA in patients with cirrhosis were reviewed retrospectively. Nodules were classified as HCC (n = 70), indeterminate (n = 33), or benign (n = 22). Five readers independently reviewed each examination with and without hepatobiliary phase images (HBP). Lesion conspicuity scores were compared between the two readings. Lesion detection, confidence scores, and receiver operating characteristic (ROC) analysis were compared. RESULTS Lesion detection was slightly improved for all lesion types with the inclusion of the HBP, and was substantially higher for small HCCs (96.0% versus 85.3%). Mean confidence scores for the diagnosis of HCC increased for HCCs overall and each size category (P < 0.001). Diagnostic performance improved with the addition of the HBP (aggregate AROC 87.7% versus 80.0%, P < 0.01), and sensitivity for characterization improved (90.9% versus 78.3%, P < 0.01) while specificity was unchanged. CONCLUSION Hepatobiliary phase imaging may improve small lesion detection (<1 cm) and characterization of lesions in general, in MRI of the cirrhotic liver with Gd-EOB-DTPA.
Collapse
Affiliation(s)
- Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Fowler KJ, Brown JJ, Narra VR. Magnetic resonance imaging of focal liver lesions: approach to imaging diagnosis. Hepatology 2011; 54:2227-37. [PMID: 21932400 DOI: 10.1002/hep.24679] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article is a review of magnetic resonance imaging (MRI) of incidental focal liver lesions. This review provides an overview of liver MRI protocol, diffusion-weighted imaging, and contrast agents. Additionally, the most commonly encountered benign and malignant lesions are discussed with emphasis on imaging appearance and the diagnostic performance of MRI based on a review of the literature.
Collapse
Affiliation(s)
- Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA.
| | | | | |
Collapse
|
12
|
Rode A. [Radiological diagnosis of hepatocellular carcinoma in 2010]. Cancer Radiother 2011; 15:7-12. [PMID: 21256790 DOI: 10.1016/j.canrad.2010.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 05/10/2010] [Accepted: 11/05/2010] [Indexed: 11/25/2022]
Abstract
The aim of diagnosis imaging is to detect hepatocellular carcinoma at an early stage, when a curative treatment is available. Biopsy is no longer required prior to treatment, and diagnosis of hepatocellular carcinoma is heavily dependent of imaging characteristics. Therefore, the purpose of this article is to describe the typical features of small (<20mm) and larger hepatocellular carcinomas with noninvasive diagnostic criteria, including ultrasound, computed tomography and MRI. Advances in these imaging modalities have greatly improved the detection of small hepatic nodules on liver cirrhosis, including the different steps of carcinogenesis, from regenerative to dysplastic nodules, and we emphasize the difficulties of radiological differentiation of precancerous lesions and small hepatocellular carcinomas.
Collapse
Affiliation(s)
- A Rode
- Service d'imagerie médicale, hôpital de la Croix-Rousse, 93 Grande-Rue de la Croix-Rousse, Lyon, France.
| |
Collapse
|
13
|
Khan AS, Hussain HK, Johnson TD, Weadock WJ, Pelletier SJ, Marrero JA. Value of delayed hypointensity and delayed enhancing rim in magnetic resonance imaging diagnosis of small hepatocellular carcinoma in the cirrhotic liver. J Magn Reson Imaging 2010; 32:360-6. [PMID: 20677263 DOI: 10.1002/jmri.22271] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine the diagnostic utility of delayed hypointensity and delayed enhancing rim on magnetic resonance imaging (MRI) as indicators of hepatocellular carcinoma (HCC) in arterially enhancing nodules < or =5 cm in the cirrhotic liver and determine the features that best predict HCC. MATERIALS AND METHODS Gadolinium-enhanced MRI studies performed from January 2001 to December 2004 in patients with cirrhosis were evaluated for arterially enhancing nodules measuring < or =5 cm. Verification was via explant correlation, biopsy, or imaging follow-up. Sensitivity and specificity of diagnostic features of HCC were calculated. Features predictive of HCC were determined using the Generalized Estimating Equation approach. RESULTS In all, 116 arterially enhancing nodules were identified in 80 patients (<2 cm: n = 79, 2-5 cm n = 37). Sensitivity and specificity of delayed hypointensity for HCC measuring < or =5 cm, 2-5 cm, and <2 cm were 0.54 (40 of 74) and 0.86 (36 of 42); 0.72 (23 of 32) and 0.80 (4 of 5); and 0.41 (17 of 42) and 0.87 (32 of 37). For the delayed enhancing rim sensitivity and specificity were 0.64 (47 of 74) and 0.86 (36 of 42); 0.75 (24 of 32) and 1.0 (5 of 5); and 0.55 (23 of 42) and 0.83 (31 of 37), respectively. Lesion size (> or =2 cm) and delayed enhancing rim, as main features and their interaction, were the most significant predictors of HCC. CONCLUSION Delayed hypointensity and enhancing rim improve the specificity of diagnosis of HCC of all sizes but are seen less frequently in small (<2 cm) HCC. Nodule size (> or =2 cm) and delayed enhancing rim are the strongest predictors of HCC.
Collapse
Affiliation(s)
- Asra S Khan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Furlan A, Marin D, Vanzulli A, Patera GP, Ronzoni A, Midiri M, Bazzocchi M, Lagalla R, Brancatelli G. Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout. Br J Radiol 2010; 84:403-12. [PMID: 21081569 DOI: 10.1259/bjr/18329080] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Our aim was to compare retrospectively hepatic venous and delayed phase images for the detection of tumour washout during multiphasic multidetector row CT (MDCT) of the liver in patients with hepatocellular carcinoma (HCC). METHODS 30 cirrhotic patients underwent multiphasic MDCT in the 90 days before liver transplantation. MDCT was performed before contrast medium administration and during hepatic arterial hepatic venous and delayed phases, images were obtained at 12, 55 and 120 s after trigger threshold. Two radiologists qualitatively evaluated images for lesion attenuation. Tumour washout was evaluated subjectively and objectively. Tumour-to-liver contrast (TLC) was measured for all pathologically proven HCCs. RESULTS 48 HCCs were detected at MDCT. 46 of the 48 tumours (96%) appeared as either hyper- or isoattenuating during the hepatic arterial phase subjective washout was present in 15 HCCs (33%) during the hepatic venous phase and in 35 (76%) during the delayed phase (p<0.001, McNemar's test). Objective washout was present in 30 of the 46 HCCs (65%) during the hepatic venous phase and in 42 of the HCCs (91%) during the delayed phase (p=0.001). The delayed phase yielded significantly higher mean TLC absolute values compared with the hepatic venous phase (-16.1±10.8 HU vs -10.5±10.2 HU; p<0.001). CONCLUSIONS The delayed phase is superior to the hepatic venous phase for detection of tumour washout of pathologically proven HCC in cirrhotic patients.
Collapse
Affiliation(s)
- A Furlan
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia Udine, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Gadoxetate disodium-enhanced MRI of the liver: part 2, protocol optimization and lesion appearance in the cirrhotic liver. AJR Am J Roentgenol 2010; 195:29-41. [PMID: 20566795 DOI: 10.2214/ajr.10.4538] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to review the use of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium [Gd-EOB-DTPA]) in the cirrhotic liver and illustrate the imaging appearance of lesions commonly encountered in the cirrhotic liver. CONCLUSION Gd-EOB-DTPA shows promise as a problem-solving tool in the cirrhotic liver because it provides additional information that may be helpful in lesion detection and characterization. Further research is needed to optimize Gd-EOB-DTPA imaging protocols in cirrhosis and develop diagnostic criteria for liver lesions in the cirrhotic liver.
Collapse
|
16
|
Qualitative and Quantitative Evaluation of Hepatocellular Carcinoma and Cirrhotic Liver Enhancement Using Gd-EOB-DTPA. AJR Am J Roentgenol 2009; 193:1053-60. [DOI: 10.2214/ajr.08.1946] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
17
|
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.
Collapse
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
| | | | | | | |
Collapse
|
18
|
Elsayes KM, Leyendecker JR, Menias CO, Oliveira EP, Narra VR, Chapman WC, Hassanien MH, Elsharkawy MS, Brown JJ. MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility. HPB (Oxford) 2007; 9:208-15. [PMID: 18333224 PMCID: PMC2063603 DOI: 10.1080/13651820701216950] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT. PATIENTS AND METHODS In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination. CT and MR images were reviewed independently by two separate groups of two radiologists. The value of MRI in characterizing these lesions was assessed. Diagnoses were confirmed based on histology, characteristic imaging features, and clinical follow-up. RESULTS MRI definitely characterized 73 lesions (58%) that were indeterminate on CT. MRI was accurate in 72/73 of these lesions. MRI could not definitely characterize 51 lesions (42%). Ten lesions were not visualized on MRI, and follow-up imaging confirmed that no lesion was present in eight of these cases (pseudolesions). CONCLUSION MRI is valuable for the characterization of indeterminate focal hepatic lesions detected on CT.
Collapse
Affiliation(s)
- Khaled M. Elsayes
- Department of Radiology, University of Michigan Health CenterAnn Arbor USA,Department of Radiology, Theodore Bilharz InstituteGizaEgypt
| | | | | | - Erica P. Oliveira
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
| | - Vamsidhar R. Narra
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
| | | | | | | | - Jeffrey J. Brown
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
| |
Collapse
|
19
|
Li CS, Chen RC, Lii JM, Chen WT, Shih LS, Zhang TA, Tu HY. Magnetic Resonance Imaging Appearance of Well-differentiated Hepatocellular Carcinoma. J Comput Assist Tomogr 2006; 30:597-603. [PMID: 16845290 DOI: 10.1097/00004728-200607000-00008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the magnetic resonance imaging (MRI) features of well-differentiated hepatocellular carcinoma (HCC). METHODS We reviewed the MRI of 32 patients with 33 pathologically confirmed well-differentiated HCC. The MRI protocol included T2-weighted imaging with and without fat saturation, dual-phase T1-weighted imaging, and gadolinium-enhanced dynamic study. The signal intensity of each lesion was categorized as hyperintense, isointense, and hypointense with reference to the surrounding liver parenchyma. RESULTS Thirty-one (93.9%) of 33 well-differentiated HCC were demonstrated on the MRI. The remaining 2 were isointense in all magnetic resonance sequences and, therefore, could not be identified. Most of them were hyperintense (n = 15 [45.4%]) or isointense (n = 16 [48.5%]) on T1-weighted imaging, and hyperintense (n = 12 [36.4%]) or isointense (n = 17 [51.5%]) on T2-weighted imaging. On the dynamic study, 17 lesions (51.5%) were enhanced. CONCLUSIONS MRI may identify most well-differentiated HCC; however, the imaging appearance is diverse. Biopsy should be performed if magnetic resonance study is inconclusive.
Collapse
Affiliation(s)
- Chao-Shiang Li
- Department of Radiology, Renai Branch, Taipei City Hospital, Taiwan
| | | | | | | | | | | | | |
Collapse
|
20
|
Bixby S, Tello R, Kuligowska E. Presence of a yolk sac on transvaginal sonography is the most reliable predictor of single-dose methotrexate treatment failure in ectopic pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:591-598. [PMID: 15840789 DOI: 10.7863/jum.2005.24.5.591] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this study was to determine which imaging characteristics can be used as prognostic indicators in conjunction with beta-human chorionic gonadotropin (beta-hCG) levels in the treatment of ectopic pregnancy (EP) with single-dose methotrexate (MTX). METHODS A retrospective study was performed on 62 patients (age range, 16-47 years; mean, 29 years) treated with MTX for EP from November 2000 to August 2003. The transvaginal sonographic findings in each case were analyzed for the presence and size of an extraovarian mass or a pseudogestational sac, amount of free fluid, presence of a yolk sac, and fetal heart motion. Patient age and beta-hCG level were also noted. Success of treatment was defined as a single dose of MTX that resulted in appropriate lowering of beta-hCG levels. RESULTS Of 62 patients, 17 (27%) had single-dose MTX treatment failure. A yolk sac was identified in 15 (88%) of the 17 treatment failures and in none of the cases in which treatment was successful (positive predictive value, 100%). The average beta-hCG level in the cohort of patients who had single-dose treatment failure was 3282 mIU/mL compared with 1544 mIU/mL in the treatment success cohort. The presence of fetal heart motion was seen in only 1 patient, and this patient had treatment failure. The age of the patient, size of the extraovarian mass, presence of a pseudogestational sac, and amount of free fluid did not correlate with outcome. CONCLUSIONS The presence of a yolk sac was always associated with treatment failure in single-dose MTX treatment of EP and was the most reliable predictor of failure among all features analyzed. The beta-hCG level was a useful adjunct. A prediction rule was created correlating the probability of treatment success with the beta-hCG level.
Collapse
Affiliation(s)
- Sarah Bixby
- Department of Radiology, Boston University Medical Center, 1 Boston Medical Center Pl, Boston, MA 02115, USA.
| | | | | |
Collapse
|
21
|
Marrero JA, Hussain HK, Nghiem HV, Umar R, Fontana RJ, Lok AS. Improving the prediction of hepatocellular carcinoma in cirrhotic patients with an arterially-enhancing liver mass. Liver Transpl 2005; 11:281-9. [PMID: 15719410 DOI: 10.1002/lt.20357] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the United States, cirrhotic patients with known or suspected hepatocellular carcinoma (HCC) are prioritized for liver transplantation. Noninvasive criteria for the diagnosis of HCC rely on arterial enhancement of a mass. The aim of this study was to determine whether clinical, laboratory, and / or radiologic data can improve the prediction of HCC in cirrhotic patients with an arterially-enhancing mass. Between May 2002 and June 2003, dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of consecutive patients with liver cirrhosis and a solid mass were reviewed by 2 radiologists blinded to the clinical diagnosis. Clinical, laboratory, and radiologic data were recorded for all patients. A total of 94 patients with cirrhosis and an arterially-enhancing liver mass were studied, 66 (70%) of whom had HCC. Alpha-fetoprotein (AFP) >20 ng/mL (P = .029), tumor size >2 cm (P = .0018), and delayed hypointensity (P = .0001) were independent predictors of HCC. Delayed hypointensity of an arterially-enhancing mass had a sensitivity of 89% and a specificity of 96% for HCC. The presence of delayed hypointensity was the only independent predictor of HCC among patients with arterially-enhancing lesions <2 cm (odds ratio, 6.3; 95% confidence interval [CI], 1.8-13), with a sensitivity of 80% and a specificity of 95%. In conclusion, delayed hypointensity of an arterially-enhancing mass was the strongest independent predictor of HCC, regardless of the size of the lesion. If additional studies confirm our results, the noninvasive criteria utilized to make a diagnosis of HCC should be revised.
Collapse
Affiliation(s)
- Jorge A Marrero
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0362, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. In the United States, the incidence of HCC has increased by nearly 75% since the 1980s. The rise in HCC diagnoses in the United States has been attributed to an increased number of patients infected with viral hepatitis and better diagnostic techniques. The management of HCC begins with diagnostic confirmation, followed by accurate staging. Historically, the prognosis for patients with HCC has been poor; however, improved surveillance and radiologic imaging techniques have led to earlier detection of HCC and an increased opportunity to treat patients. Treatment options for HCC include surgical and nonsurgical modalities. Surgical therapy, by way of partial hepatectomy or orthotopic liver transplantation, is the only potentially curative treatment for HCC, but most patients are not eligible for these procedures by the time of diagnosis. Palliative options include ablative techniques, radiation, and systemic therapies. As the incidence of this malignancy continues to rise, oncology nurses, who are an integral part of the multidisciplinary team caring for these patients, must be aware of current management for HCC. This article will provide an overview of the complex management of patients with HCC in the United States.
Collapse
Affiliation(s)
- Bridget A Cahill
- Department of Medicine, Northwestern Medical Faculty Foundation, Chicago, IL, USA.
| | | |
Collapse
|
23
|
Clifford CA, Pretorius ES, Weisse C, Sorenmo KU, Drobatz KJ, Siegelman ES, Solomon JA. Magnetic Resonance Imaging of Focal Splenic and Hepatic Lesions in the Dog. J Vet Intern Med 2004. [DOI: 10.1111/j.1939-1676.2004.tb02554.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
24
|
Hussain HK, Syed I, Nghiem HV, Johnson TD, Carlos RC, Weadock WJ, Francis IR. T2-weighted MR imaging in the assessment of cirrhotic liver. Radiology 2004; 230:637-44. [PMID: 14739306 DOI: 10.1148/radiol.2303020921] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess if T2-weighted magnetic resonance (MR) imaging provides added diagnostic value in combination with dynamic gadolinium-enhanced MR imaging in the detection and characterization of nodular lesions in cirrhotic liver. MATERIALS AND METHODS Two readers retrospectively and independently analyzed 54 MR imaging studies in 52 patients with cirrhosis. In session 1, readers reviewed T1-weighted and dynamic gadolinium-enhanced images. In session 2, readers reviewed T1-weighted, dynamic gadolinium-enhanced, and respiratory-triggered T2-weighted fast spin-echo images. Readers identified and characterized all focal lesions by using a scale of 1-4 (1, definitely benign; 4, definitely malignant). Multireader correlated receiver operating characteristic (ROC) analysis was employed to assess radiologist performance in session 2 compared with session 1. The difference in the areas under the ROC curves for the two sessions was tested. In a third session, readers assessed conspicuity of biopsy-proved lesions on T2-weighted MR images by using a scale of 1-3 (1, not seen; 3, well seen) and identified causes of reduced conspicuity. RESULTS Two additional benign lesions were detected by each reader in session 2. Fifty-five lesions had pathologic verification, including 32 malignant, three high-grade dysplastic, and 20 benign nodules. There was no significant difference in the area under the ROC curves between the two sessions (P =.48). Thirty-two lesions were inconspicuous on T2-weighted MR images because of parenchymal heterogeneity, breathing artifacts (particularly in patients with ascites), and lesion isointensity with liver parenchyma. T2-weighted MR imaging was useful in the evaluation of cysts and lymph nodes. CONCLUSION T2-weighted MR imaging does not provide added diagnostic value in the detection and characterization of focal lesions in cirrhotic liver.
Collapse
Affiliation(s)
- Hero K Hussain
- Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr, MRI B2B311, Ann Arbor, MI 48109-0030, USA.
| | | | | | | | | | | | | |
Collapse
|