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Chartampilas E, Rafailidis V, Georgopoulou V, Kalarakis G, Hatzidakis A, Prassopoulos P. Current Imaging Diagnosis of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14163997. [PMID: 36010991 PMCID: PMC9406360 DOI: 10.3390/cancers14163997] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The role of imaging in the management of hepatocellular carcinoma (HCC) has significantly evolved and expanded beyond the plain radiological confirmation of the tumor based on the typical appearance in a multiphase contrast-enhanced CT or MRI examination. The introduction of hepatobiliary contrast agents has enabled the diagnosis of hepatocarcinogenesis at earlier stages, while the application of ultrasound contrast agents has drastically upgraded the role of ultrasound in the diagnostic algorithms. Newer quantitative techniques assessing blood perfusion on CT and MRI not only allow earlier diagnosis and confident differentiation from other lesions, but they also provide biomarkers for the evaluation of treatment response. As distinct HCC subtypes are identified, their correlation with specific imaging features holds great promise for estimating tumor aggressiveness and prognosis. This review presents the current role of imaging and underlines its critical role in the successful management of patients with HCC. Abstract Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related death worldwide. Radiology has traditionally played a central role in HCC management, ranging from screening of high-risk patients to non-invasive diagnosis, as well as the evaluation of treatment response and post-treatment follow-up. From liver ultrasonography with or without contrast to dynamic multiple phased CT and dynamic MRI with diffusion protocols, great progress has been achieved in the last decade. Throughout the last few years, pathological, biological, genetic, and immune-chemical analyses have revealed several tumoral subtypes with diverse biological behavior, highlighting the need for the re-evaluation of established radiological methods. Considering these changes, novel methods that provide functional and quantitative parameters in addition to morphological information are increasingly incorporated into modern diagnostic protocols for HCC. In this way, differential diagnosis became even more challenging throughout the last few years. Use of liver specific contrast agents, as well as CT/MRI perfusion techniques, seem to not only allow earlier detection and more accurate characterization of HCC lesions, but also make it possible to predict response to treatment and survival. Nevertheless, several limitations and technical considerations still exist. This review will describe and discuss all these imaging modalities and their advances in the imaging of HCC lesions in cirrhotic and non-cirrhotic livers. Sensitivity and specificity rates, method limitations, and technical considerations will be discussed.
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Affiliation(s)
- Evangelos Chartampilas
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence:
| | - Vasileios Rafailidis
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Vivian Georgopoulou
- Radiology Department, Ippokratio General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
| | - Georgios Kalarakis
- Department of Diagnostic Radiology, Karolinska University Hospital, 14152 Stockholm, Sweden
- Department of Clinical Science, Division of Radiology, Intervention and Technology (CLINTEC), Karolinska Institutet, 14152 Stockholm, Sweden
- Department of Radiology, Medical School, University of Crete, 71500 Heraklion, Greece
| | - Adam Hatzidakis
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Panos Prassopoulos
- Radiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Value of precontrast and portal venous phases for evaluating atypical hepatocellular carcinoma mimicking arterioportal shunt. Eur J Radiol 2021; 143:109933. [PMID: 34492626 DOI: 10.1016/j.ejrad.2021.109933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the value of precontrast phase (PP) and portal venous phase (PVP) for differentiation of small hypervascular hepatocellular carcinomas (HCCs) without delayed washout from arterioportal (AP) shunts in high-risk patients of HCC. METHODS A total of 122 lesions (73 AP shunts and 49 HCCs) detected on quadriphasic CT in 101 patients with chronic liver disease were analyzed. All lesions (≤2 cm) showed arterial enhancement and isodensity on delayed phase (DP) with exclusion of typical features of AP shunts. Lesion morphologic features (size, location, shape, margin) on biphasic CT (arterial phase and DP), Alpha-fetoprotein (AFP) values and coexistent HCC were evaluated. The qualitative and quantitative analyses of lesion attenuation on quadriphasic CT were performed. Diagnostic performances for prediction of AP shunts over HCC were compared among the biphasic CT, triphasic CT (adding PP or PVP) and quadriphasic CT. RESULTS In multivariate analysis, the presence of concomitant HCC (p = 0.0005, odds ratio [OR] = 0.11), visual hypodensity on PP (p = 0.0004, OR = 17.72) and visual hyperdensity on PVP (p = 0.0003, OR = 0.051) were independent predictors for HCCs rather than AP shunts. Additional review of PP and PVP revealed significantly improved diagnostic performance yielding the highest diagnostic performance. CONCLUSIONS Hypodensity on PP and hyperdensity on PVP are significant predictive features in differentiating atypical small hypervascular HCC from AP shunts in patients with high-risk of HCC. Careful evaluation of the PP and PVP may reduce underdiagnosis and lead to earlier diagnosis of atypical small HCCs.
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Soloff EV, Desai N, Busey JM, Koprowicz KM, Shuman WP. Feasibility of wide detector three-pass arterial phase liver CT in patients with cirrhosis: timing of hyperenhancing lesion peak conspicuity. Abdom Radiol (NY) 2020; 45:2370-2377. [PMID: 32333072 DOI: 10.1007/s00261-020-02539-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate feasibility of a wide detector liver CT protocol with three acquisitions in the hepatic arterial phase. METHODS Forty-one patients with cirrhosis prospectively underwent a wide detector axial liver CT protocol. Three 16 cm axial liver acquisitions were obtained during a single breath hold at peak aortic enhancement plus 10, 20, and 25 s. Two readers working separately scored overall exam quality, identified hyperenhancing lesions, and subjectively scored and ranked relative lesion conspicuity. Objective lesion enhancement was measured and CNR calculated. Data were analyzed using a generalized linear models and Tukey's post hoc testing. RESULTS Seventy-one hyperenhancing lesions were identified with average size of 1.8 cm (range 0.4-9.6 cm). The two readers separately identified 60 and 54 lesions on the 10 s arterial acquisition, 70 and 67 on the 20 s, and 52 and 51 on the 25 s. The readers determined all exams had diagnostic image quality. Subjective ranking of lesion conspicuity was greatest at 20 s in 62% of lesions but was greatest at 10 or 25 s in 38%. CNR was highest at 20 s in 58% of lesions but was highest at 10 or 25 s in 42%. Overall, there was no significant difference in mean CNR between the three arterial acquisitions. CONCLUSION A wide detector axial liver CT protocol with three acquisitions in the hepatic arterial phase is technologically feasible and results in diagnostic image quality. With this protocol, peak subjective and objective hyperenhancing lesion conspicuity may be earlier or later than 20 s in up to 40% of lesions.
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Affiliation(s)
- Erik V Soloff
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA.
| | - Nitin Desai
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Janet M Busey
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Kent M Koprowicz
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - William P Shuman
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
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Laroia ST, Yadav K, Rastogi A, Kumar G, Kumar S, Sarin SK. Diagnostic efficacy of dynamic liver imaging using qualitative diagnostic algorithm versus LI-RADS v2018 lexicon for atypical versus classical HCC lesions: A decade of experience from a tertiary liver institute. Eur J Radiol Open 2020; 7:100219. [PMID: 32083152 PMCID: PMC7016378 DOI: 10.1016/j.ejro.2020.100219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To analyze and evaluate the diagnostic performance of conventional diagnostic (qualitative) imaging features versus LI-RADSv2018 lexicon for indeterminate and atypical Hepatocellular carcinoma (HCC) on dynamic liver imaging with reference to histopathology. PATIENTS AND METHODS This retrospective study (June 2009-June 2019) evaluated the performance characteristics of conventional imaging findings, versus the Liver Imaging Reporting and Data System (LIRADS) v2018, for interpretation of indeterminate and atypical HCC, in patients who underwent subsequent histopathological analysis (gold standard). A total of 100,457 dynamic hepatobiliary CT and MR examinations were performed over ten years at our institute. Using current international imaging guidelines, 3218 patients were found to have suspected liver cancer lesions on imaging. Classical enhancement pattern of typical HCC was seen in 2916 of these patients. These patients did not require further biopsy. We enrolled, the remaining (n = 302) patients, who underwent biopsy, into our study group. Two radiologists, blinded to pathology findings, reviewed and classified these lesions, in consensus, according to LI-RADS® lexicon and as per 'conventional' (Indeterminate, Atypical HCC, Classical HCC, other malignancies) imaging. The histopathology diagnosis was considered as the final diagnosis. Alpha feto protein (AFP) levels amongst various subgroups were compared. Statistical analysis was performed to calculate the efficacy of LIRADS versus qualitative imaging parameters in comparison with histopathology. RESULTS A total of n = 302 patients, [89 % men (n = 269), mean age 57.08 ± 12.43 years] underwent biopsy for suspected liver lesions. Qualitative imaging had 92.3 % (CI 88.53-94.91) sensitivity, 41.4 % (CI 25.51-59.26) specificity, positive predictive value (PPV) of 93.7 % (CI 90.11-96.02), negative predictive value (NPV) of 36.4 % (CI 22.19-53.38), positive likelihood ratio (PLHR) of 1.575 (CI 1.40-1.77) and negative likelihood ratio of (NLHR) 0.19 (CI 0.13-0.26). It correctly classified 87.4 % of lesions diagnosed on pathology. In comparison, LI-RADS was found to have 92 % sensitivity, 55.5 % specificity, 97 % PPV, 30.3 %, NPV, PLHR 2.068 (CI 1.62-2.64), NLHR 0.15 (CI 0.11-0.18) and 89.7 % diagnostic accuracy. A total of 38 patients (17 false negative, 21 false positive lesions) had discordant diagnoses on imaging versus histopathology. The kappa agreement between LIRADs and qualitative Imaging was found to be 0.77 ± .07 (p < 0.001). LIRADS and qualitative imaging collectively had 97 % sensitivity, 30 % specificity, 91.9 % PPV, 55.6 % NPV, PLHR of 1.39 (CI 1.27-1.51) and NLHR of 0.09 (0.048-0.19) which was better than, either reporting system, independently. CONCLUSION It was observed that the LI-RADS v2018 lexicon with qualitative imaging as a combination technique added extra value in interpretation of atypical HCC or indeterminate lesions on dynamic CT and MRI compared to either as 'stand- alone' reporting systems.
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Affiliation(s)
- Shalini Thapar Laroia
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Komal Yadav
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Archana Rastogi
- Department of Pathology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Guresh Kumar
- Department of Research, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Senthil Kumar
- Department of HPB Surgery and Liver Transplantation, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Shiv Kumar Sarin
- Chair of Department of Hepatology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
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Wang J, Shen JL. Spectral CT in evaluating the therapeutic effect of transarterial chemoembolization for hepatocellular carcinoma: A retrospective study. Medicine (Baltimore) 2017; 96:e9236. [PMID: 29384909 PMCID: PMC6393018 DOI: 10.1097/md.0000000000009236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study aimed to investigate the value of computed tomographic (CT) spectral imaging in evaluating the effect of transarterial chemoembolization (TACE).The records of 67 patients with hepatocellular carcinoma (HCC) who had undergone dynamic spectral CT before treatment were selected for the study. Iodine concentrations pretreatment in liver parenchyma, the HCC lesion(s), portal vein, and aorta were measured from the decomposition images. The normalized iodine concentrations (NIC) were calculated. All of them underwent plain scan or contrast-enhanced CT post-treatment (approximately 4-6 weeks after TACE).The values of arterial phase normalized iodine concentrations (AP NIC) before TACE correlated with the grades of lipiodol deposition in tumors (r = 0.76, P < .001). However, there was no relationship between normalized iodine concentrations in the portal venous phase (PVP NIC) before TACE and the grade of lipiodol deposition (r = 0.17, P = .17). Values of AP NIC in residual tumors pre-TACE were significantly lower than those in partial lesions with deposition of iodized oil. The threshold AP NIC of 0.18 yielded an AUC of 0.895, 83.33% sensitivity, 81.03% specificity, 83.33% positive predictive value (PPV), and 82.76% negative predictive value, respectively. The survival probability in patients with AP NIC values pre-TACE ≥ 0.18 was higher than those whose AP NIC values pre-TACE were < 0.18 (P = .028).Spectral CT with quantitative analysis of AP NIC may help to evaluate the utility and predict the therapeutic effect of TACE. Values of AP NIC had high sensitivity and specificity for differentiating partial tumors with lipiodol deposition from those without lipiodol deposition.
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Curative Resection of Single Primary Hepatic Malignancy: Liver Imaging Reporting and Data System Category LR-M Portends a Worse Prognosis. AJR Am J Roentgenol 2017; 209:576-583. [DOI: 10.2214/ajr.16.17478] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lack of anti-tumor activity by anti-VEGF treatments in hepatic hemangiomas. Angiogenesis 2016; 19:147-53. [PMID: 26816001 DOI: 10.1007/s10456-016-9494-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/13/2016] [Indexed: 12/12/2022]
Abstract
Recently, anti-vascular endothelial growth factor (anti-VEGF) agents have been described in the literature as a valid treatment option for symptomatic liver hemangiomas, but only limited evidence supports this notion. The purpose of this study was to elucidate whether or not the administration of anti-VEGF agents can reliably achieve a size reduction in liver hemangiomas. We examined patients with incidental hemangiomas who received anti-angiogenic agents for the treatment of other malignancies. Our study population consisted of 17 colorectal cancer patients and one lung cancer patient carrying 21 hemangiomas who received bevacizumab, and seven renal cell carcinoma patients carrying nine hepatic hemangiomas who received sunitinib. We have measured the liver hemangioma volume on both the pre-treatment and post-treatment computed tomography images and then calculated the volume alteration rates. No statistically significant difference (P = 0.365) in the volume of the liver hemangiomas was observed before (1.1-168.8 cm(3); mean ± SD 19.8 ± 39.7 cm(3)) or after (1.2-163.6 cm(3); 19.3 ± 38.0 cm(3)) bevacizumab treatment. The volume reduction rate ranged from -35.0 to 11.2 % (mean ± SD -1.3 ± 10.8 %). The sunitinib treatment group also showed no statistically significant difference (P = 0.889) in hemangioma volume before (1.2-6.5 cm(3); 3.0 ± 1.8 cm(3)) or after (1.2-6.0 cm(3); 3.0-1.7 cm(3)) treatment. The volume reduction rate ranged from -13.3 to 7.7 % (median: mean ± SD -2.5 ± 6.6 %). We did not observe liver hemangioma shrinkage after bevacizumab or sunitinib treatment. Our data do not support the application of anti-VEGF agents for the treatment of hepatic hemangiomas.
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Lin YY, Chen CM, Huang YH, Lin CY, Chu SY, Hsu MY, Pan KT, Tseng JH. Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings. World J Gastroenterol 2015; 21:13524-13531. [PMID: 26730164 PMCID: PMC4690182 DOI: 10.3748/wjg.v21.i48.13524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/07/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the dynamic computed tomography (CT) findings of liver metastasis from hepatoid adenocarcinoma of the stomach (HAS) and compared them with hepatocellular carcinoma (HCC).
METHODS: Between January 2000 and January 2015, 8 patients with pathologically proven HAS and liver metastases were enrolled. Basic tumor status was evaluated for the primary tumor location and metastatic sites. The CT findings of the liver metastases were analyzed for tumor number and size, presence of tumor necrosis, hemorrhage, venous tumor thrombosis, and dynamic enhancing pattern.
RESULTS: The body and antrum were the most common site for primary HAS (n = 7), and observed metastatic sites included the liver (n = 8), lymph nodes (n = 7), peritoneum (n = 4), and lung (n = 2). Most of the liver metastases exhibited tumor necrosis regardless of tumor size. By contrast, tumor hemorrhage was observed only in liver lesions larger than 5 cm (n = 4). Three patterns of venous tumor thrombosis were identified: direct venous invasion by the primary HAS (n = 1), direct venous invasion by the liver metastases (n = 7), and isolated portal vein tumor thrombosis (n = 2). Dynamic CT revealed arterial hyperattenuation and late phase washout in all the liver metastases.
CONCLUSION: On dynamic CT, liver metastasis from HAS shared many imaging similarities with HCC. For liver nodules, the presence of isolated portal vein tumor thrombosis and a tendency for tumor necrosis are imaging clues that suggest the diagnosis of HAS.
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Sheng RF, Zeng MS, Ji Y, Yang L, Chen CZ, Rao SX. MR features of small hepatocellular carcinoma in normal, fibrotic, and cirrhotic livers: a comparative study. ACTA ACUST UNITED AC 2015; 40:3062-9. [DOI: 10.1007/s00261-015-0536-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Kitzing YX, Ng BHK, Kitzing B, Waugh R, Kench JG, Strasser SI, McCormack S. Washout of hepatocellular carcinoma on portal venous phase of multidetector computed tomography in a pre-transplant population. J Med Imaging Radiat Oncol 2015; 59:673-80. [DOI: 10.1111/1754-9485.12347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/21/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Yu Xuan Kitzing
- Department of Radiology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Bernard HK Ng
- Department of Radiology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Bjoern Kitzing
- Department of Radiology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Richard Waugh
- Department of Radiology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - James G Kench
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Samuel McCormack
- Department of Radiology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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Fischer MA, Kartalis N, Grigoriadis A, Loizou L, Stål P, Leidner B, Aspelin P, Brismar TB. Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis. Eur Radiol 2015; 25:3123-32. [PMID: 25903707 DOI: 10.1007/s00330-015-3732-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of dynamic perfusion CT (P-CT) for detection of hepatocellular carcinoma (HCC) in the cirrhotic liver. MATERIALS AND METHODS Twenty-six cirrhotic patients (19 men, aged 69 ± 10 years) with suspicion of HCC prospectively underwent P-CT of the liver using the 4D spiral-mode (100/80 kV; 150/175mAs/rot) of a dual-source system. Two readers assessed: (1) arterial liver-perfusion (ALP), portal-venous liver-perfusion (PLP) and hepatic perfusion-index (HPI) maps alone; and (2) side-by-side with maximum-intensity-projections of arterial time-points (art-MIP) for detection of HCC using histopathology and imaging follow-up as standard of reference. Another reader quantitatively assessed perfusion maps of detected lesions. RESULTS A total of 48 HCCs in 21/26 (81%) patients with a mean size of 20 ± 10 mm were detected by histopathology (9/48, 19%) or imaging follow-up (39/48, 81%). Detection rates (Reader1/Reader2) of HPI maps and side-by-side analysis of HPI combined with arterial MIP were 92/88% and 98/96%, respectively. Positive-predictive values were 63/63% and 68/71%, respectively. A cut-off value of ≥85% HPI and ≥99% HPI yielded a sensitivity and specificity of 100%, respectively, for detection of HCC. CONCLUSION P-CT shows a high sensitivity for detection of HCC in the cirrhotic liver. Quantitative assessment has the potential to reduce false-positive findings improving the specificity of HCC diagnosis. KEY POINTS • Visual analysis of perfusion maps shows good sensitivity for detection of HCC. • Additional assessment of anatomical arterial MIPs further improves detection rates of HCC. • Quantitative perfusion analysis has the potential to reduce false-positive findings. • In cirrhotic livers, a hepatic-perfusion-index ≥ 9 9% might be specific for HCC.
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Affiliation(s)
- Michael A Fischer
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden. .,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
| | - Nikolaos Kartalis
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Aristeidis Grigoriadis
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Louiza Loizou
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Per Stål
- Department of Hepatology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Bertil Leidner
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
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Chen J, Wu M, Liu R, Li S, Gao R, Song B. Preoperative evaluation of the histological grade of hepatocellular carcinoma with diffusion-weighted imaging: a meta-analysis. PLoS One 2015; 10:e0117661. [PMID: 25658359 PMCID: PMC4320049 DOI: 10.1371/journal.pone.0117661] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in the preoperative prediction of the histological grade of hepatocellular carcinoma (HCC). MATERIALS AND METHODS A comprehensive literature search was performed in several authoritative databases to identify relevant articles. QUADAS-2 was used to assess the quality of included studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Summary receiver operating characteristic (SROC) curves were derived and areas under the SROC curve (AUC) were computed to indicate the diagnostic accuracy. Heterogeneity test, meta-regression analysis and sensitivity analysis were performed to identify factors and studies contributed to the heterogeneity. RESULTS A total of 11 studies with 912 HCCs were included in this meta-analysis. The pooled sensitivity, specificity, PLR and NLR with corresponding 95% confidence intervals (CI) were 0.54(0.47-0.61), 0.90(0.87-0.93), 4.88(2.99-7.97) and 0.46(0.27-0.77) for the prediction of well-differentiated HCC (w-HCC), 0.84(0.78-0.89), 0.48(0.43-0.52), 2.29(1.43-3.69) and 0.30(0.22-0.41) for the prediction of poorly-differentiated HCC (p-HCC). The AUC were 0.9311 and 0.8513 in predicting w-HCC and p-HCC, respectively. Results were further evaluated according to the method of image interpretation. Significant heterogeneity was observed. CONCLUSION DWI had excellent and moderately high diagnostic accuracy for the detection of w-HCC and p-HCC, respectively. Nonetheless, further studies in larger populations and an optimized image acquisition and interpretation are required before DWI-derived parameters can be used as a useful image biomarker for the prediction of the histological grade of HCC.
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Affiliation(s)
- Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Mingpeng Wu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Rongbo Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Siyi Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Ronghui Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P. R. China
- * E-mail:
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Yoon JH, Lee JM, Yang HK, Lee KB, Jang JJ, Han JK, Choi BI. Non-hypervascular hypointense nodules ≥1 cm on the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging in cirrhotic livers. Dig Dis 2014; 32:678-89. [PMID: 25376284 DOI: 10.1159/000368000] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the pathologic nature of non-hypervascular hypointense nodules (≥1 cm) on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) imaging and to describe the chronological changes of their imaging features on follow-up MR imaging. PATIENTS AND METHODS This retrospective study was approved by our Institutional Review Board and the requirement for informed consent was waived. 69 patients with 115 non-hypervascular HBP hypointense nodules (≥1 cm in diameter) in cirrhotic livers were enrolled. 67 nodules were histologically diagnosed (group 1) and 52 nodules were followed up with MR for at least 12 months (group 2); 4 nodules belonged to both groups. Two radiologists reviewed the initial and follow-up MR images to determine the size and signal intensities on unenhanced T1- and T2-weighted images, dynamic phases and HBP images in consensus. In addition, two pathologists reviewed the histologic findings including H&E staining and four kinds of immunohistochemical staining in group 1. RESULTS In group 1, 73.1% (49/67) of nodules were hepatocellular carcinomas. In group 2, 32.7% (17/52) of nodules developed arterial hypervascularity on follow-up, and 78.8% (41/52) showed at least one of the three imaging features considered to indicate malignant changes during follow-up (mean 19 ± 10 months): increase in diameter by ≥5 mm (23/52, 44.2%), arterialization (17/52, 32.7%) and hyperintensity on T2-weighted images (18/52, 34.6%). CONCLUSION Our study results demonstrate that a significant proportion of non-hypervascular HBP hypointense nodules (≥1 cm in diameter) in patients with cirrhosis showed either malignant features on pathology (73.1%) or developed hypervascularity (32.7%) during follow-up.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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14
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Chan SL, Mo F, Johnson PJ, Siu DYW, Chan MHM, Lau WY, Lai PBS, Lam CWK, Yeo W, Yu SCH. Performance of serum α-fetoprotein levels in the diagnosis of hepatocellular carcinoma in patients with a hepatic mass. HPB (Oxford) 2014; 16:366-72. [PMID: 23980880 PMCID: PMC3967889 DOI: 10.1111/hpb.12146] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/20/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The role of serum α-fetoprotein (AFP) measurements in the diagnosis of hepatocellular carcinoma (HCC) remains controversial. Some guidelines have advised against the use of AFP in the diagnosis of HCC. This study was conducted to evaluate the performance of AFP in the diagnosis of HCC, and to identify the optimal cut-off value of serum AFP in the diagnosis of HCC in patients with a hepatic mass. METHODS Patients who presented during the period from May 1997 to March 2003 with hepatic lesions, for whom paired data on serum AFP values at baseline and lesion histology were available, were reviewed. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis. RESULTS Data for a total of 805 patients were evaluated. The mean AFP value was 26,900 ng/ml (range: 0-1,965,461 ng/ml). The histological diagnosis was HCC in 557 patients. The optimal AFP cut-off value was 10 ng/ml (for sensitivity of 82.6% and specificity of 70.4%). At a cut-off level of 200 ng/ml, sensitivity, specificity, and positive and negative predictive values were 47.7%, 97.1%, 97.5% and 44.4%, respectively. The diagnostic performance of AFP remains similar in patients with chronic hepatitis B virus infection, despite a lower negative predictive value. Common aetiologies of liver lesions associated with elevated AFP include cholangiocarcinoma and neuroendocrine tumours. CONCLUSIONS In Asian patients with suspicious liver lesions, the cut-off AFP level of 200 ng/ml is useful to achieve a diagnosis of HCC with high specificity and reasonable sensitivity. The measurement of serum AFP should not be excluded from guidelines for the diagnosis of HCC.
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Affiliation(s)
- Stephen L Chan
- State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer InstituteHong Kong, China
| | - Frankie Mo
- State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer InstituteHong Kong, China
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of LiverpoolLiverpool, UK
| | - Deyond Y W Siu
- Department of Vascular and Interventional Radiology Foundation Clinical Science Center, Chinese University of Hong KongHong Kong, China
| | - Michael H M Chan
- Department of Chemical Pathology, Chinese University of Hong KongHong Kong, China
| | - Wan Y Lau
- Department of Faculty of Medicine, Chinese University of Hong KongHong Kong, China
| | - Paul B S Lai
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong KongHong Kong, China
| | - Christopher W K Lam
- Department of Chemical Pathology, Chinese University of Hong KongHong Kong, China
| | - Winnie Yeo
- State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer InstituteHong Kong, China
| | - Simon C H Yu
- Department of Vascular and Interventional Radiology Foundation Clinical Science Center, Chinese University of Hong KongHong Kong, China,Correspondence Simon C. H. Yu, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. Tel: + 852 2632 8055. Fax: + 852 2648 4122. E-mail:
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15
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Sheng RF, Zeng MS, Rao SX, Ji Y, Chen LL. MRI of small intrahepatic mass-forming cholangiocarcinoma and atypical small hepatocellular carcinoma (≤3 cm) with cirrhosis and chronic viral hepatitis: a comparative study. Clin Imaging 2014; 38:265-72. [PMID: 24559750 DOI: 10.1016/j.clinimag.2013.12.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/24/2013] [Accepted: 12/31/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objective was to identify the decision-making magnetic resonance (MR) features in differentiating small intrahepatic mass-forming cholangiocarcinoma (sIMCC) from atypical small hepatocellular carcinoma (sHCC) (≤3 cm) in patients with cirrhosis and chronic viral hepatitis. METHODS Signal features and relative contrast of sHCCs and sIMCCs in T2-weighted and dynamic enhanced imaging were analyzed. A subgroup comparison between the cirrhosis and noncirrhosis chronic viral hepatitis group was also made. RESULTS Univariate analysis revealed that tumor contours (P<.001), signals in T2-weighted (P<.001) and each phase of contrast-enhanced scanning (P<.001), enhancement patterns (P<.001), as well as accompanying findings of tumor capsule (P<.001), hepatic capsule retraction (P<.001), bile duct dilation (P=.031), and transient hepatic intensity difference (P=.002) were different between sIMCC and atypical sHCC. Multivariate analysis indicated that dynamic enhancement patterns (P<.001) and signals in T2-weighted images (P=.024) were independent predictors for differentiation. Confusing MR features were more often observed in the cirrhosis group compared with those in the noncirrhosis chronic viral hepatitis group. CONCLUSION Dynamic enhancement patterns and signals in T2-weighted images were the most important MR features to differentiate sIMCC from atypical sHCC with cirrhosis and chronic viral hepatitis.
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Affiliation(s)
- Ruo-Fan Sheng
- Department of Radiology, Zhongshan Hospital, Shanghai Medical School, Fudan, University, Shanghai Medical Imaging Institute, No. 180 Fenglin Road, Xuhui, District, Shanghai 200032, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Shanghai Medical School, Fudan, University, Shanghai Medical Imaging Institute, No. 180 Fenglin Road, Xuhui, District, Shanghai 200032, China.
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Shanghai Medical School, Fudan, University, Shanghai Medical Imaging Institute, No. 180 Fenglin Road, Xuhui, District, Shanghai 200032, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Shanghai Medical School, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Ling-Li Chen
- Department of Pathology, Zhongshan Hospital, Shanghai Medical School, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
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16
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Cuce F, Sonmez G, Karaşahin E. RE: Evaluation of Small Hepatocellular Carcinomas with Diffusion Weighted Imaging. Korean J Radiol 2013; 14:544. [PMID: 23690727 PMCID: PMC3655314 DOI: 10.3348/kjr.2013.14.3.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/31/2012] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ferhat Cuce
- Department of Radiology, Van Military Hospital, Van 65020, Turkey
| | - Guner Sonmez
- Department of Radiology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul 34040, Turkey
| | - Emre Karaşahin
- Department of Obstetrics anda Gynecology, Van Military Hospital, Van 65020, Turkey
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