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Wang Q, Wang A, Wu X, Hu X, Bai G, Fan Y, Stål P, Brismar TB. Radiomics models for preoperative prediction of the histopathological grade of hepatocellular carcinoma: A systematic review and radiomics quality score assessment. Eur J Radiol 2023; 166:111015. [PMID: 37541183 DOI: 10.1016/j.ejrad.2023.111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE To systematically review the efficacy of radiomics models derived from computed tomography (CT) or magnetic resonance imaging (MRI) in preoperative prediction of the histopathological grade of hepatocellular carcinoma (HCC). METHODS Systematic literature search was performed at databases of PubMed, Web of Science, Embase, and Cochrane Library up to 30 December 2022. Studies that developed a radiomics model using preoperative CT/MRI for predicting the histopathological grade of HCC were regarded as eligible. A pre-defined table was used to extract the data related to study and patient characteristics, characteristics of radiomics modelling workflow, and the model performance metrics. Radiomics quality score and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) were applied for research quality evaluation. RESULTS Eleven eligible studies were included in this review, consisting of 2245 patients (range 53-494, median 165). No studies were prospectively designed and only two studies had an external test cohort. Half of the studies (five) used CT images and the other half MRI. The median number of extracted radiomics features was 328 (range: 40-1688), which was reduced to 11 (range: 1-50) after feature selection. The commonly used classifiers were logistic regression and support vector machine (both 4/11). When evaluated on the two external test cohorts, the area under the curve of the radiomics models was 0.70 and 0.77. The median radiomics quality score was 10 (range 2-13), corresponding to 28% (range 6-36%) of the full scale. Most studies showed an unclear risk of bias as evaluated by QUADAS-2. CONCLUSION Radiomics models based on preoperative CT or MRI have the potential to be used as an imaging biomarker for prediction of HCC histopathological grade. However, improved research and reporting quality is required to ensure sufficient reliability and reproducibility prior to implementation into clinical practice.
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Affiliation(s)
- Qiang Wang
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
| | - Anrong Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Interventional Therapy, People's Hospital of Dianjiang County, Chongqing, China
| | - Xueyun Wu
- Department of General Surgery and Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojun Hu
- Department of General Surgery and Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Guojie Bai
- Department of Radiology, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin, China
| | - Yingfang Fan
- Department of General Surgery and Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Per Stål
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Torkel B Brismar
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Can MRI features predict clinically relevant hepatocellular carcinoma genetic subtypes? Abdom Radiol (NY) 2023; 48:1955-1964. [PMID: 36933025 DOI: 10.1007/s00261-023-03876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE Recent studies in cancer genomics have revealed core drivers for hepatocellular carcinoma (HCC) pathogenesis. We aim to study whether MRI features can serve as non-invasive markers for the prediction of common genetic subtypes of HCC. METHODS Sequencing of 447 cancer-implicated genes was performed on 43 pathology proven HCC from 42 patients, who underwent contrast-enhanced MRI followed by biopsy or resection. MRI features were retrospectively evaluated including tumor size, infiltrative tumor margin, diffusion restriction, arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, peritumoral enhancement, tumor in vein, fat in mass, blood products in mass, cirrhosis and tumor heterogeneity. Fisher's exact test was used to correlate genetic subtypes with imaging features. Prediction performance using correlated MRI features for genetic subtype and inter-reader agreement were assessed. RESULTS The two most prevalent genetic mutations were TP53 (13/43, 30%) and CTNNB1 (17/43, 40%). Tumors with TP53 mutation more often demonstrated an infiltrative tumor margin on MRI (p = 0.01); inter-reader agreement was almost perfect (kappa = 0.95). The CTNNB1 mutation was associated with peritumoral enhancement on MRI (p = 0.04), inter-reader agreement was substantial (kappa = 0.74). The MRI feature of an infiltrative tumor margin correlated with the TP53 mutation with accuracy, sensitivity, and specificity of 74.4%, 61.5% and 80.0%, respectively. Peritumoral enhancement correlated with the CTNNB1 mutation with accuracy, sensitivity, and specificity of 69.8%, 47.0% and 84.6%, respectively. CONCLUSION An infiltrative tumor margin on MRI correlated with TP53 mutation and peritumoral enhancement correlated with CTNNB1 mutation in HCC. Absence of these MRI features are potential negative predictors of the respective HCC genetic subtypes that have implications for prognosis and treatment response.
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Yang X, Yuan C, Zhang Y, Li K, Wang Z. Predicting hepatocellular carcinoma early recurrence after ablation based on magnetic resonance imaging radiomics nomogram. Medicine (Baltimore) 2022; 101:e32584. [PMID: 36596081 PMCID: PMC9803514 DOI: 10.1097/md.0000000000032584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of this study is to investigate a model for predicting the early recurrence of hepatocellular carcinoma (HCC) after ablation. METHODS A total of 181 patients with HCC after ablation (train group was 119 cases; validation group was 62 cases) were enrolled. The cases of early recurrence in the set of train and validation were 63 and 31, respectively. Radiomics features were extracted from the enhanced magnetic resonance imaging scanning, including pre-contrast injection, arterial phase, late arterial phase, portal venous phase, and delayed phase. The least absolute shrinkage and selection operator cox proportional hazards regression after univariate and multivariate analysis was used to screen radiomics features and build integrated models. The nomograms predicting recurrence and survival of patients of HCC after ablation were established based on the clinical, imaging, and radiomics features. The area under the curve (AUC) of the receiver operating characteristic curve and C-index for the train and validation group was used to evaluate model efficacy. RESULTS Four radiomics features were selected out of 34 texture features to formulate the rad-score. Multivariate analyses suggested that the rad-score, number of lesions, integrity of the capsule, pathological type, and alpha-fetoprotein were independent influencing factors. The AUC of predicting early recurrence at 1, 2, and 3 years in the train group was 0.79 (95% CI: 0.72-0.88), 0.72 (95% CI: 0.63-0.82), and 0.71 (95% CI: 0.61-0.83), respectively. The AUC of predicting early recurrence at 1, 2, and 3 years in the validation group was 0.72 (95% CI: 0.58-0.84), 0.61 (95% CI: 0.45-0.78) and 0.64 (95% CI: 0.40-0.87). CONCLUSION The model for early recurrence of HCC after ablation based on the clinical, imaging, and radiomics features presented good predictive performance. This may facilitate the early treatment of patients.
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Affiliation(s)
- Xiaozhen Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Center of Interventional Oncology and Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Chunwang Yuan
- Department of Center of Interventional Oncology and Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yinghua Zhang
- Department of Center of Interventional Oncology and Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Kang Li
- Biomedical Information Center, Beijing You’An Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- * Correspondence: Zhenchang Wang, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong An Road, Xicheng District, Beijing 100050, China (e-mail: )
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The Value of CT Perfusion Parameters and Apparent Diffusion Coefficient Value of Magnetic Resonance Diffusion Weighted Imaging in Diagnosis of Hepatocellular Carcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2771869. [PMID: 36203535 PMCID: PMC9532146 DOI: 10.1155/2022/2771869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022]
Abstract
Background Hepatocellular carcinoma is one of the malignant tumors with the highest incidence in the world. According to the latest statistics of the National Cancer Center, the incidence of liver cancer ranks fifth in malignant tumors and its mortality rate ranks second in China, which seriously threatens people' s life and health. Aim To investigate the value of CT perfusion parameters and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) in the diagnosis of hepatocellular carcinoma. Methods 43 patients with hepatocellular carcinoma and 40 patients with hepatic hemangioma treated in our hospital from August 2018 to August 2021 were selected for CT perfusion imaging and MRI examination. Results The liver blood flow (BF), liver blood volume (BV), and hepatic artery perfusion (HAP) in the hepatocellular carcinoma group were (267.38 ± 35.59) ml/(min·100 g), (30.20 ± 8.82) ml/100 g, and (0.64 ± 0.10) ml/(min·ml), respectively, which were significantly higher than those in the hepatic hemangioma group (p < 0.05). The ADC value of hepatocellular carcinoma DWI sequence was (1.20 ± 0.17) ×10−3 mm2, which was significantly lower than that of hepatic hemangioma (p < 0.05). The area under ROC curve of BF, BV, HAP, and ADC values for hepatocellular carcinoma was 0.860, 0.754, 0.804, and 0.890, respectively. The area under ROC curve of the four groups was compared (p > 0.05). Conclusion CT perfusion parameters BF, BV, HAP, and DWI sequence ADC values have certain application value in the diagnosis of hepatocellular carcinoma, and there is no significant difference between the diagnostic value of each parameter.
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Ma XH, Chen K, Wang S, Liu SY, Li DF, Mi YT, Wu ZY, Qu CF, Zhao XM. Bi-specific T1 positive-contrast-enhanced magnetic resonance imaging molecular probe for hepatocellular carcinoma in an orthotopic mouse model. World J Gastrointest Oncol 2022; 14:858-871. [PMID: 35582105 PMCID: PMC9048532 DOI: 10.4251/wjgo.v14.i4.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/31/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related mortality. HCC-targeted magnetic resonance imaging (MRI) is an effective noninvasive diagnostic method that involves targeting clinically-related HCC biomarkers, such as alpha-fetoprotein (AFP) or glypican-3 (GPC3), with iron oxide nanoparticles. However, in vivo studies of HCC-targeted MRI utilize single-target iron oxide nanoprobes as negative (T2) contrast agents, which might weaken their future clinical applications due to tumor heterogeneity and negative MRI contrast. Ultra-small superparamagnetic iron oxide (USPIO) nanoparticles (approximately 5 nm) are potential optimal positive (T1) contrast agents. We previously verified the efficiency of AFP/GPC3-double-antibody-labeled iron oxide MR molecular probe in vitro.
AIM To validate the effectiveness of a bi-specific probe in vivo for enhancing T1-weighted positive contrast to diagnose the early-stage HCC.
METHODS The single- and double-antibody-conjugated 5-nm USPIO probes, including anti-AFP-USPIO (UA), anti-GPC3-USPIO (UG), and anti-AFP-USPIO-anti-GPC3 (UAG), were synthesized. T1- and T2-weighted MRI were performed on day 10 after establishment of the orthotopic HCC mouse model. Following intravenous injection of U, UA, UG, and UAG probes, T1- and T2-weighted images were obtained at 12, 12, and 32 h post-injection. At the end of scanning, mice were euthanized, and a histologic analysis was performed on tumor samples.
RESULTS T1- and T2-weighted MRI showed that absolute tumor-to-background ratios in UAG-treated HCC mice peaked at 24 h post-injection, with the T1- and T2-weighted signals increasing by 46.7% and decreasing by 11.1%, respectively, relative to pre-injection levels. Additionally, T1-weighted contrast in the UAG-treated group at 24 h post-injection was enhanced 1.52-, 2.64-, and 4.38-fold compared to those observed for single-targeted anti-GPC3-USPIO, anti-AFP-USPIO, and non-targeted USPIO probes, respectively. Comparison of U-, UA-, UG-, and UAG-treated tumor sections revealed that UAG-treated mice exhibited increased stained regions compared to those observed in UG- or UA-treated mice.
CONCLUSION The bi-specific T1-positive contrast-enhanced MRI probe (UAG) for HCC demonstrated increased specificity and sensitivity to diagnose early-stage HCC irrespective of tumor size and/or heterogeneity.
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Affiliation(s)
- Xiao-Hong Ma
- Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kun Chen
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Shuang Wang
- Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Si-Yun Liu
- GE Healthcare (China), Beijing 100176, China
| | - Deng-Feng Li
- Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong-Tao Mi
- Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhi-Yuan Wu
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Chun-Feng Qu
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Xin-Ming Zhao
- Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Subramanian S, Mallia MB, Shinto AS, Mathew AS. Clinical Management of Liver Cancer in India and Other Developing Nations: A Focus on Radiation Based Strategies. Oncol Ther 2021; 9:273-295. [PMID: 34046873 PMCID: PMC8593115 DOI: 10.1007/s40487-021-00154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a global killer with preponderance in Asian and African countries. It poses a challenge for successful management in less affluent or developing nations like India, with large populations and limited infrastructures. This review aims to assess the available options and future directions for management of HCC applicable to such countries. While summarizing current and emerging clinical strategies for detection, staging and therapy of the disease, it highlights radioisotope- and radioactivity-based strategies as part of an overall program. Using the widely accepted Barcelona Clinic Liver Cancer (BCLC) staging system as a base, it evaluates the applicability of different therapeutic approaches and their synergistic combination(s) in the context of a patient-specific dynamic results-based strategy. It distills the conclusions of multiple HCC management-focused consensus recommendations to provide a picture of clinical strategies, especially radiation-related approaches. Additionally, it discusses the logistical and economic feasibility of these approaches in the context of the limitations of the burdened public health infrastructure in India (and like nations) and highlights possible strategies both at the clinical level and in terms of an administrative health policy on HCC to provide the maximum possible benefit to the widest swathe of the affected population.
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Affiliation(s)
- Suresh Subramanian
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India.
| | - Madhava B Mallia
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India
| | - Ajit S Shinto
- Apollo Proton Cancer Centre, Chennai, 600096, Tamil Nadu, India
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Hoshino I, Yokota H. Radiogenomics of gastroenterological cancer: The dawn of personalized medicine with artificial intelligence-based image analysis. Ann Gastroenterol Surg 2021; 5:427-435. [PMID: 34337291 PMCID: PMC8316732 DOI: 10.1002/ags3.12437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/29/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022] Open
Abstract
Radiogenomics is a new field of medical science that integrates two omics, radiomics and genomics, and may bring a major paradigm shift in traditional personalized medicine strategies that require tumor tissue samples. In addition, the acquisition of the data does not require special imaging equipment or special imaging conditions, and it is possible to use image information from computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography in clinical practice, so the versatility and cost-effectiveness of radiogenomics are expected. So far, the field of radiogenomics has developed, especially in the fields of brain tumors and breast cancer, but recently, reports of radiogenomic research on gastroenterological cancer are increasing. This review provides an overview of radiogenomic research methods and summarizes the current radiogenomic research in gastroenterological cancer. In addition, the application of artificial intelligence is considered to be indispensable for the integrated analysis of enormous omics information in the future, and the future direction of this research, including the latest technologies, will be discussed.
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Affiliation(s)
- Isamu Hoshino
- Division of Gastroenterological SurgeryChiba Cancer CenterChibaJapan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation OncologyGraduate School of MedicineChiba UniversityChibaJapan
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Zhou M, Shan D, Zhang C, Nie J, Wang G, Zhang Y, Zhou Y, Zheng T. Value of gadoxetic acid-enhanced MRI for microvascular invasion of small hepatocellular carcinoma: a retrospective study. BMC Med Imaging 2021; 21:40. [PMID: 33673821 PMCID: PMC7934549 DOI: 10.1186/s12880-021-00572-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background The objective of this study was to analyze the accuracy of gadolinium–ethoxybenzyl–diethylenetriamine penta–acetic acid enhanced magnetic resonance imaging (Gd–EOB–DTPA–MRI) for predicting microvascular invasion (MVI) in patients with small hepatocellular carcinoma (sHCC) preoperatively. Methods A total of 60 sHCC patients performed with preoperative Gd–EOB–DTPA–MRI in the Harbin Medical University Cancer Hospital from October 2018 to October 2019 were involved in the study. Univariate and multivariate analyses were performed by chi–square test and logistic regression analysis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Gd–EOB–DTPA–MRI were performed by receiver operating characteristic (ROC) curves. Results Univariate analysis indicated that alanine aminotransferase (≥ 39.00U/L), poorly differentiated pathology, and imaging features including grim enhancement, capsule enhancement, arterial halo sign and hepatobiliary features (tumor highly uptake, halo sign, spicule sign and brush sign) were associated with the occurrence of MVI (p < 0.05). Multivariate analysis revealed that rim enhancement and hepatobiliary spicule sign were independent predictors of MVI (p < 0.05). The area under the ROC curve was 0.917 (95% confidence interval 0.838–0.996), and the sensitivity was 94.74%. Conclusions The morphologies of hepatobiliary phase imaging, especially the spicule sign, showed high accuracy in diagnosing MVI of sHCC. Rim enhancement played a significant role in diagnosing MVI of sHCC.
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Affiliation(s)
- Meng Zhou
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Dan Shan
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Chunhui Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Jianhua Nie
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Guangyu Wang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Yanqiao Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin, 150001, Heilongjiang, People's Republic of China.
| | - Tongsen Zheng
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China. .,Department of Phase 1 Trials Center, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China. .,Heilongjiang Cancer Institute, Harbin, Heilongjiang, People's Republic of China.
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Sun X, Hu D, Zhang Y, Lyu N, Xu L, Chen Q, Lai J, Chen M, Zhao M. Can Immediately Treating Subcentimeter Hepatocellular Carcinoma Improve the Survival of Patients? J Hepatocell Carcinoma 2020; 7:377-384. [PMID: 33365285 PMCID: PMC7751727 DOI: 10.2147/jhc.s287641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background With the development of imaging technology, an increasing number of subcentimeter hepatocellular carcinoma (HCC) has been detected. How to manage these lesions remains controversial and lacks evidence. We aimed to explore whether timely treating subcentimeter HCC is necessary considering the risks of false-positives and treatment failure. Methods In this retrospective study, we reviewed HCC patients treated with hepatectomy or ablation in our institution. Then, we enrolled 439 HCC patients with solitary lesion measuring up to 2 cm from November 1, 2009 to June 30, 2019. The baseline and clinical characteristics of these patients were collected. The patients were classified into primary and recurrent groups. The Kaplan–Meier method with Log-rank test was performed to compare the overall survival (OS) and recurrence-free survival (RFS) between patients with subcentimeter HCC and those with HCC measuring 1–2 cm. Univariate and multivariate analyses were adopted to identify prognostic factors for survival. Results The OS and RFS did not differ significantly between patients with subcentimeter HCC and those with HCC measuring 1–2 cm in the primary group (p = 0.12 and 0.75). Similar results were found in the recurrent group. In multivariate analysis, the albumin-bilirubin (ALBI) grade and serum alpha fetoprotein (AFP) level were significantly associated with OS and RFS in the primary group. The serum AFP level was the only factor that correlated with OS and RFS in the recurrent group. Conclusion Routine screening for subcentimeter HCC is feasible. Considering uncertain diagnosis and treatment difficulties, it is more considerable to follow patients until lesions are larger than 1 cm and then provide curative treatments.
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Affiliation(s)
- Xuqi Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou 510060, People's Republic of China
| | - Dandan Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Yaojun Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Ning Lyu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Li Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Qifeng Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Jinfa Lai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Minshan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Ming Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
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10
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Plaikner M, Kremser C, Viveiros A, Zoller H, Henninger B. [Magnetic resonance elastography of the liver : Worth knowing for clinical routine]. Radiologe 2020; 60:966-978. [PMID: 32399783 DOI: 10.1007/s00117-020-00690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Magnetic resonance elastography (MRE) is a noninvasive, quantitative, MRI-based method to evaluate liver stiffness. Beside biopsy and ultrasound elastography, this imaging method plays in many places a significant role in the detection and additive characterization of chronic liver disease. OBJECTIVES, MATERIALS AND METHODS Based on the literature, a brief review of the underlying method and the commercially available products is given. Furthermore, the practical procedure, the analysis, and the interpretation of clinically relevant questions are illustrated and a comparison with ultrasound elastography is provided. RESULTS This relative "young" MRI method allows extensive evaluation of mechanical properties of the liver and is an important diagnostic tool especially in follow-up examinations. The MRE of the liver is with a maximum technical failure rate of 5.8% a robust technique with high accuracy and an excellent re-test reliability as well as intra- and interobserver reproducibility. There is a high diagnostic certainty within the framework of most important clinical indications, the quantification of fibrosis, and with a very good correlation with the "gold standard" biopsy. CONCLUSION Based on its rising clinical relevance and the broad usage, MRE of the liver is increasingly used in many centers and in routine liver protocols. Therefore, basic knowledge of this method is essential for every radiologist.
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Affiliation(s)
- Michaela Plaikner
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Christian Kremser
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - André Viveiros
- Innere Medizin I, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Heinz Zoller
- Innere Medizin I, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Benjamin Henninger
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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Hu S, Chen Y, Liu L, Yin X, Yang Y, Tang L. PLZF and PLZF-MAPK10 can predict the prognosis of postoperative patients with hepatocellular carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:3158-3166. [PMID: 33425116 PMCID: PMC7791377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The current study aimed to explore the expression level of promyelocytic leukaemia zinc finger (PLZF) in hepatocellular carcinoma tissues and to investigate the value of detecting the expression levels of PLZF and mitogen-activated protein kinase 10 (MAPK10) on predicting prognosis. METHODS This study selected data from 53 patients with HCC who had undergone hepatectomy in our hospital. The expressions of PLZF and MAPK10 in tumor tissues and normal tissues were compared and related clinical factors were analyzed. The clinical data including patient's gender, age, hepatitis B virus infection (HBV), alpha-fetoprotein levels (AFP), tumor size, TNM stage (AJCC), cirrhosis, portal vein tumor thrombus (PVTT), bile duct tumor thrombus (BDTT), and OS (Overall survival) was collected. RESULTS We found that PLZF expression was significantly down-regulated in HCC samples compared with that in adjacent non-tumor tissues (P=0.001). The expression level of PLZF was correlated with patients' gender (P=0.046), tumor stage (P=0.039), and OS (P=0.015). Moreover, the expression level of PLZF-MAPK10 (P-M protein) was correlated with gender (P=0.000) and tumor stage (P=0.045). Multivariate analyses showed that microsatellite nodules, PLZF, and P-M protein were independent risk factors of HCC prognosis. Postoperative patients with a normal expression level of PLZF and MAPK10 have a longer overall survival than those with abnormal levels (P=0.039). CONCLUSION PLZF expression was significantly down-regulated in HCC tissues and itself and PLZF-MAPK10 were both independent prognostic factors for the OS of patients with HCC.
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Affiliation(s)
- Shanshan Hu
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Yue Chen
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Liheng Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Xuedong Yin
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
| | - Yaying Yang
- Department of Pathology, Molecular Medicine and Cancer Research Center, Chongqing Medical UniversityChongqing, China
| | - Liping Tang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical UniversityChongqing, China
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Miranda Magalhaes Santos JM, Clemente Oliveira B, Araujo-Filho JDAB, Assuncao-Jr AN, de M Machado FA, Carlos Tavares Rocha C, Horvat JV, Menezes MR, Horvat N. State-of-the-art in radiomics of hepatocellular carcinoma: a review of basic principles, applications, and limitations. Abdom Radiol (NY) 2020; 45:342-353. [PMID: 31707435 DOI: 10.1007/s00261-019-02299-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Radiomics is a new field in medical imaging with the potential of changing medical practice. Radiomics is characterized by the extraction of several quantitative imaging features which are not visible to the naked eye from conventional imaging modalities, and its correlation with specific relevant clinical endpoints, such as pathology, therapeutic response, and survival. Several studies have evaluated the use of radiomics in patients with hepatocellular carcinoma (HCC) with encouraging results, particularly in the pretreatment prediction of tumor biological characteristics, risk of recurrence, and survival. In spite of this, there are limitations and challenges to be overcome before the implementation of radiomics into clinical routine. In this article, we will review the concepts of radiomics and their current potential applications in patients with HCC. It is important that the multidisciplinary team involved in the treatment of patients with HCC be aware of the basic principles, benefits, and limitations of radiomics in order to achieve a balanced interpretation of the results toward a personalized medicine.
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Affiliation(s)
| | - Brunna Clemente Oliveira
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
- Department of Radiology, Hospital Samaritano, São Paulo, Brazil
| | | | | | | | | | - Joao Vicente Horvat
- Department of Radiology, University of São Paulo, São Paulo, Brazil
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Marcos Roberto Menezes
- Department of Radiology, University of São Paulo, São Paulo, Brazil
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Natally Horvat
- Department of Radiology, University of São Paulo, São Paulo, Brazil.
- Department of Radiology, Hospital Sírio-Libanês, Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil.
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Freitas LBRD, Longo L, Santos D, Grivicich I, Álvares-da-Silva MR. Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population. World J Hepatol 2019; 11:678-688. [PMID: 31602288 PMCID: PMC6783400 DOI: 10.4254/wjh.v11.i9.678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/08/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma (HCC) treatment, the Barcelona clinic liver cancer (BCLC) system has limitations, especially regarding intermediate-grade (BCLC-B) tumors. The recently proposed Hong Kong liver cancer (HKLC) staging system appears useful but requires validation in Western populations.
AIM To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population, estimating the overall patient survival.
METHODS This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016. Demographic, clinical, and laboratory data were collected. HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement. Overall survival was estimated based on the treatment proposed in each system.
RESULTS A total of 519 HCC patients were assessed. Of these, 178 (34.3%) were HKLC-I; 95 (18.3%) HKLC-IIA; 47 (9.1%) HKLC-IIB; 29 (5.6%) HKLC-IIIA; 30 (5.8%) HKLC-IIIB; 75 (14.4%) HKLC-IV; and 65 (12.5%) HKLC-V. According to the BCLC, 25 (4.9%) were BCLC-0; 246 (47.4%) BCLC-A; 107 (20.6%) BCLC-B; 76 (14.6%) BCLC-C; and 65 (12.5%) BCLC-D. The general agreement between the two systems was 80.0% - BCLC-0 and HKLC-I (100%); BCLC-A and HKLC-I/HKLC-II (96.7%); BCLC-B and HKLC-III (46.7%); BCLC-C and HKLC-IV (98.7%); BCLC-D and HKLC-V (41.5%). When sub-classifying BCLC-A, HKLC-IIB, HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion, 13.4, 66.0, 100 and 36.7%, respectively, of the cases were classified as up-to-7 out.
CONCLUSION In a Western population, the general agreement between the two systems was 80.0%, although in BCLC-B cases the agreement was low, suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC. The authors suggest that the BCLC system should be routinely employed, although for BCLC-B cases it should be associated with the HKLC system.
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Affiliation(s)
- Laura Bainy Rodrigues de Freitas
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Experimental Hepatology and Gastroenterology Laboratory, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
| | - Larisse Longo
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Experimental Hepatology and Gastroenterology Laboratory, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
| | - Deivid Santos
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
| | - Ivana Grivicich
- Graduate Program in Health-Applied Cellular and Molecular Biology, ULBRA. Canoas, RS 92425-900, Brazil
| | - Mário Reis Álvares-da-Silva
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Experimental Hepatology and Gastroenterology Laboratory, Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS 90035-003, Brazil
- Department of Gastroenterology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-003, Brazil
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Uhrig M, Mueller J, Longerich T, Straub BK, Buschle LR, Schlemmer HP, Mueller S, Ziener CH. Susceptibility based multiparametric quantification of liver disease: Non-invasive evaluation of steatosis and iron overload. Magn Reson Imaging 2019; 63:114-122. [PMID: 31425813 DOI: 10.1016/j.mri.2019.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/11/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate if single-voxel MR spectroscopy (MRS) of iron and fat correlates with biopsy results of hepatic steatosis and iron overload, and to compare MR-measurements with room-temperature susceptometer (RTS), ultrasound, controlled attenuation parameter (CAP) and serum ferritin. MATERIAL AND METHODS In this prospective study, a set of 42 patients out of 47 screened patients with several chronic liver diseases underwent MRI-examination at 1.5 T including R2-measurements by single-voxel high-speed T2-corrected multiecho spectroscopy, additional liver biopsy, abdominal ultrasound, CAP, and RTS. Routine blood and serum parameters were determined, including ferritin. Atomic absorption spectroscopy (AAS) and histologically confirmed extent of hepatic steatosis from liver biopsy were used as reference standard. For correlation of R2, RTS, CAP, ferritin, and ultrasound with results of AAS and histologically determined fat fraction of liver biopsy specimen, Spearman's and Pearson's correlation as well as receiver operating characteristics curve (ROC) analysis with cut-off values determined by maximizing Youden index was used. RESULTS MRS iron assessment correlated best with AAS, with a Pearson correlation coefficient of 0.715 (p < 0.001), followed by RTS 0.520 (p < 0.001), and serum ferritin 0.213 (p = 0.088, not significant). MRS fat quantification correlated best with the histological confirmed extent of steatosis hepatis with a Spearman correlation coefficient of 0.836 (p < 0.001), followed by CAP 0.604 (p < 0.001) and sonographically diagnosed steatosis 0.358 (p = 0.013). CONCLUSION MRS by T2-corrected multiecho single-voxel spectroscopy correlated best with histological results of hepatic fat and iron content compared to RTS, CAP, abdominal ultrasound, and ferritin. Non-invasive methods to assess hepatic fat and iron are of clinical interest for follow-up examinations of patients with chronic liver diseases, where repeated biopsy is not indicated.
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Affiliation(s)
- Monika Uhrig
- German Cancer Research Center (DKFZ), Department of Radiology, D-69120 Heidelberg, Germany
| | - Johannes Mueller
- Dept. of Medicine, Salem Medical Center and Center for Alcohol Research, University Hospital Heidelberg, D-69120 Heidelberg, Germany
| | - Thomas Longerich
- Dept. of Pathology, University Hospital Heidelberg, D-69120 Heidelberg, Germany
| | - Beate Katharina Straub
- Dept. of Pathology, University Hospital Heidelberg, D-69120 Heidelberg, Germany; Dept. of Pathology, University Hospital Mainz, D-55131 Mainz, Germany
| | - Lukas R Buschle
- German Cancer Research Center (DKFZ), Department of Radiology, D-69120 Heidelberg, Germany; Faculty of Physics and Astronomy, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- German Cancer Research Center (DKFZ), Department of Radiology, D-69120 Heidelberg, Germany
| | - Sebastian Mueller
- Dept. of Medicine, Salem Medical Center and Center for Alcohol Research, University Hospital Heidelberg, D-69120 Heidelberg, Germany
| | - Christian H Ziener
- German Cancer Research Center (DKFZ), Department of Radiology, D-69120 Heidelberg, Germany.
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Comment on "State of the art in magnetic resonance imaging of hepatocellular carcinoma": the role of DWI. Radiol Oncol 2019; 53:369-370. [PMID: 31318697 PMCID: PMC6765167 DOI: 10.2478/raon-2019-0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Indexed: 12/13/2022] Open
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16
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Reply to comments on "State of the art in magnetic resonance imaging of hepatocellular carcinoma": the role of DWI. Radiol Oncol 2019; 53:371-372. [PMID: 31314741 PMCID: PMC6765157 DOI: 10.2478/raon-2019-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Indexed: 12/13/2022] Open
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