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Chlorogiannis DD, Moussa AM, Zhao K, Alexander ES, Sofocleous CT, Sotirchos VS. Imaging Considerations before and after Liver-Directed Locoregional Treatments for Metastatic Colorectal Cancer. Diagnostics (Basel) 2024; 14:772. [PMID: 38611685 PMCID: PMC11011364 DOI: 10.3390/diagnostics14070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer is a leading cause of cancer-related death. Liver metastases will develop in over one-third of patients with colorectal cancer and are a major cause of morbidity and mortality. Even though surgical resection has been considered the mainstay of treatment, only approximately 20% of the patients are surgical candidates. Liver-directed locoregional therapies such as thermal ablation, Yttrium-90 transarterial radioembolization, and stereotactic body radiation therapy are pivotal in managing colorectal liver metastatic disease. Comprehensive pre- and post-intervention imaging, encompassing both anatomic and metabolic assessments, is invaluable for precise treatment planning, staging, treatment response assessment, and the prompt identification of local or distant tumor progression. This review outlines the value of imaging for colorectal liver metastatic disease and offers insights into imaging follow-up after locoregional liver-directed therapy.
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Affiliation(s)
| | - Amgad M. Moussa
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ken Zhao
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Erica S. Alexander
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Vlasios S. Sotirchos
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Al-Ibraheem A, Ruzzeh S, Badarneh M, Al-Adhami D, Telfah A. Beyond CT: A Case Analysis of Serial [18F]FDG PET/CT for Assessment of Necrosis and Early Recurrence in Colorectal Liver Metastases. Cureus 2023; 15:e51393. [PMID: 38292976 PMCID: PMC10826454 DOI: 10.7759/cureus.51393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Colorectal cancer is a common malignancy, with the liver being the most frequent site of metastases. [18F] Fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a valuable tool in detecting and evaluating liver metastases and extrahepatic disease. Herein, we present a case of a 76-year-old male with colorectal cancer associated with lung and liver metastases. The patient received 12 chemoimmunotherapy cycles and was then put on maintenance cetuximab; serial [18F]FDG PET/CT scans were utilized to evaluate treatment response. The patient exhibited a positive response to chemoimmunotherapy, with regression of rectal disease and resolution of pulmonary metastatic nodules. Serial [18F]FDG PET/CT scans unveiled three distinct necrotic patterns. The case report advocates that [18F]FDG PET/CT plays an important role in evaluating colorectal liver metastases (CRLM) response to treatment, identifying transient necrosis, early recurrence, and emphasizing the limitations of post-treatment CT scans in identifying early CRLM recurrence. Integrating functional imaging, particularly [18F]FDG PET/CT, promises for management monitoring and surveillance of CRLM patients.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
- School of Medicine, University of Jordan, Amman, JOR
| | - Saad Ruzzeh
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Mohannad Badarneh
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Dhuha Al-Adhami
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC), Amman, JOR
| | - Ahmad Telfah
- Department of Medicine, King Hussein Cancer Center (KHCC), Amman, JOR
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Qu H, Zhai H, Zhang S, Chen W, Zhong H, Cui X. Dynamic radiomics for predicting the efficacy of antiangiogenic therapy in colorectal liver metastases. Front Oncol 2023; 13:992096. [PMID: 36814812 PMCID: PMC9939899 DOI: 10.3389/fonc.2023.992096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
Background and objective For patients with advanced colorectal liver metastases (CRLMs) receiving first-line anti-angiogenic therapy, an accurate, rapid and noninvasive indicator is urgently needed to predict its efficacy. In previous studies, dynamic radiomics predicted more accurately than conventional radiomics. Therefore, it is necessary to establish a dynamic radiomics efficacy prediction model for antiangiogenic therapy to provide more accurate guidance for clinical diagnosis and treatment decisions. Methods In this study, we use dynamic radiomics feature extraction method that extracts static features using tomographic images of different sequences of the same patient and then quantifies them into new dynamic features for the prediction of treatmentefficacy. In this retrospective study, we collected 76 patients who were diagnosed with unresectable CRLM between June 2016 and June 2021 in the First Hospital of China Medical University. All patients received standard treatment regimen of bevacizumab combined with chemotherapy in the first-line treatment, and contrast-enhanced abdominal CT (CECT) scans were performed before treatment. Patients with multiple primary lesions as well as missing clinical or imaging information were excluded. Area Under Curve (AUC) and accuracy were used to evaluate model performance. Regions of interest (ROIs) were independently delineated by two radiologists to extract radiomics features. Three machine learning algorithms were used to construct two scores based on the best response and progression-free survival (PFS). Results For the task that predict the best response patients will achieve after treatment, by using ROC curve analysis, it can be seen that the relative change rate (RCR) feature performed best among all features and best in linear discriminantanalysis (AUC: 0.945 and accuracy: 0.855). In terms of predicting PFS, the Kaplan-Meier plots suggested that the score constructed using the RCR features could significantly distinguish patients with good response from those with poor response (Two-sided P<0.0001 for survival analysis). Conclusions This study demonstrates that the application of dynamic radiomics features can better predict the efficacy of CRLM patients receiving antiangiogenic therapy compared with conventional radiomics features. It allows patients to have a more accurate assessment of the effect of medical treatment before receiving treatment, and this assessment method is noninvasive, rapid, and less expensive. Dynamic radiomics model provides stronger guidance for the selection of treatment options and precision medicine.
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Affiliation(s)
- Hui Qu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, P.R, China
| | - Huan Zhai
- Department of Interventional Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China,Key Laboratory of Diagnostic Imaging and Interventional Radiology of Liaoning Province, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuairan Zhang
- Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenjuan Chen
- Department of Medical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongshan Zhong
- Department of Interventional Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China,Key Laboratory of Diagnostic Imaging and Interventional Radiology of Liaoning Province, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China,*Correspondence: Xiaoyu Cui, ; Hongshan Zhong,
| | - Xiaoyu Cui
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, P.R, China,Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Shenyang, China,*Correspondence: Xiaoyu Cui, ; Hongshan Zhong,
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Anderson BM, Rigaud B, Lin YM, Jones AK, Kang HC, Odisio BC, Brock KK. Automated segmentation of colorectal liver metastasis and liver ablation on contrast-enhanced CT images. Front Oncol 2022; 12:886517. [PMID: 36033508 PMCID: PMC9403767 DOI: 10.3389/fonc.2022.886517] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Colorectal cancer (CRC), the third most common cancer in the USA, is a leading cause of cancer-related death worldwide. Up to 60% of patients develop liver metastasis (CRLM). Treatments like radiation and ablation therapies require disease segmentation for planning and therapy delivery. For ablation, ablation-zone segmentation is required to evaluate disease coverage. We hypothesize that fully convolutional (FC) neural networks, trained using novel methods, will provide rapid and accurate identification and segmentation of CRLM and ablation zones. Methods Four FC model styles were investigated: Standard 3D-UNet, Residual 3D-UNet, Dense 3D-UNet, and Hybrid-WNet. Models were trained on 92 patients from the liver tumor segmentation (LiTS) challenge. For the evaluation, we acquired 15 patients from the 3D-IRCADb database, 18 patients from our institution (CRLM = 24, ablation-zone = 19), and those submitted to the LiTS challenge (n = 70). Qualitative evaluations of our institutional data were performed by two board-certified radiologists (interventional and diagnostic) and a radiology-trained physician fellow, using a Likert scale of 1-5. Results The most accurate model was the Hybrid-WNet. On a patient-by-patient basis in the 3D-IRCADb dataset, the median (min-max) Dice similarity coefficient (DSC) was 0.73 (0.41-0.88), the median surface distance was 1.75 mm (0.57-7.63 mm), and the number of false positives was 1 (0-4). In the LiTS challenge (n = 70), the global DSC was 0.810. The model sensitivity was 98% (47/48) for sites ≥15 mm in diameter. Qualitatively, 100% (24/24; minority vote) of the CRLM and 84% (16/19; majority vote) of the ablation zones had Likert scores ≥4. Conclusion The Hybrid-WNet model provided fast (<30 s) and accurate segmentations of CRLM and ablation zones on contrast-enhanced CT scans, with positive physician reviews.
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Affiliation(s)
- Brian M. Anderson
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- UTHealth Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bastien Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - A. Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - HynSeon Christine Kang
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Rompianesi G, Pegoraro F, Ceresa CDL, Montalti R, Troisi RI. Artificial intelligence in the diagnosis and management of colorectal cancer liver metastases. World J Gastroenterol 2022; 28:108-122. [PMID: 35125822 PMCID: PMC8793013 DOI: 10.3748/wjg.v28.i1.108] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/12/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common malignancy worldwide, with approximately 50% of patients developing colorectal cancer liver metastasis (CRLM) during the follow-up period. Management of CRLM is best achieved via a multidisciplinary approach and the diagnostic and therapeutic decision-making process is complex. In order to optimize patients' survival and quality of life, there are several unsolved challenges which must be overcome. These primarily include a timely diagnosis and the identification of reliable prognostic factors. Furthermore, to allow optimal treatment options, a precision-medicine, personalized approach is required. The widespread digitalization of healthcare generates a vast amount of data and together with accessible high-performance computing, artificial intelligence (AI) technologies can be applied. By increasing diagnostic accuracy, reducing timings and costs, the application of AI could help mitigate the current shortcomings in CRLM management. In this review we explore the available evidence of the possible role of AI in all phases of the CRLM natural history. Radiomics analysis and convolutional neural networks (CNN) which combine computed tomography (CT) images with clinical data have been developed to predict CRLM development in CRC patients. AI models have also proven themselves to perform similarly or better than expert radiologists in detecting CRLM on CT and magnetic resonance scans or identifying them from the noninvasive analysis of patients' exhaled air. The application of AI and machine learning (ML) in diagnosing CRLM has also been extended to histopathological examination in order to rapidly and accurately identify CRLM tissue and its different histopathological growth patterns. ML and CNN have shown good accuracy in predicting response to chemotherapy, early local tumor progression after ablation treatment, and patient survival after surgical treatment or chemotherapy. Despite the initial enthusiasm and the accumulating evidence, AI technologies' role in healthcare and CRLM management is not yet fully established. Its limitations mainly concern safety and the lack of regulation and ethical considerations. AI is unlikely to fully replace any human role but could be actively integrated to facilitate physicians in their everyday practice. Moving towards a personalized and evidence-based patient approach and management, further larger, prospective and rigorous studies evaluating AI technologies in patients at risk or affected by CRLM are needed.
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Affiliation(s)
- Gianluca Rompianesi
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples 80125, Italy
| | - Francesca Pegoraro
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples 80125, Italy
| | - Carlo DL Ceresa
- Department of Hepato-Pancreato-Biliary Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9ES, United Kingdom
| | - Roberto Montalti
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Public Health, Federico II University Hospital, Naples 80125, Italy
| | - Roberto Ivan Troisi
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples 80125, Italy
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Abstract
Colorectal cancer (CRC) is one of the most common cancers in the world. The most important determinant of survival and prognosis is the stage and presence of metastasis. The liver is the most common location for CRC metastasis. The only curative treatment for CRC liver metastasis (CRLM) is resection; however, many patients are ineligible for surgical resection of CRLM. Locoregional treatments such as ablation and intra-arterial therapy are also available for patients with CRLM. Assessment of response after chemotherapy is challenging due to anatomical and functional changes. Antiangiogenic agents such as bevacizumab that are used in the treatment of CRLM may show atypical patterns of response on imaging. It is vital to distinguish patterns of response in addition to toxicities to various treatments. Imaging plays a critical role in evaluating the characteristics of CRLM and the approach to treatment. CT is the modality of choice in the diagnosis and management of CRLM. MRI is best used for indeterminate lesions and to assess response to intra-arterial therapy. PET-CT is often utilized to detect extrahepatic metastasis. State-of-the-art imaging is critical to characterize patterns of response to various treatments. We herein review the imaging characteristics of CRLM with an emphasis on imaging changes following the most common CRLM treatments.
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Ba A, Shams M, Schmidt S, Eckstein MP, Verdun FR, Bochud FO. Search of low-contrast liver lesions in abdominal CT: the importance of scrolling behavior. J Med Imaging (Bellingham) 2020; 7:045501. [PMID: 32743016 PMCID: PMC7380560 DOI: 10.1117/1.jmi.7.4.045501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/15/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose: Visual search using volumetric images is becoming the standard in medical imaging. However, we do not fully understand how eye movement strategies mediate diagnostic performance. A recent study on computed tomography (CT) images showed that the search strategies of radiologists could be classified based on saccade amplitudes and cross-quadrant eye movements [eye movement index (EMI)] into two categories: drillers and scanners. Approach: We investigate how the number of times a radiologist scrolls in a given direction during analysis of the images (number of courses) could add a supplementary variable to use to characterize search strategies. We used a set of 15 normal liver CT images in which we inserted 1 to 5 hypodense metastases of two different signal contrast amplitudes. Twenty radiologists were asked to search for the metastases while their eye-gaze was recorded by an eye-tracker device (EyeLink1000, SR Research Ltd., Mississauga, Ontario, Canada). Results: We found that categorizing radiologists based on the number of courses (rather than EMI) could better predict differences in decision times, percentage of image covered, and search error rates. Radiologists with a larger number of courses covered more volume in more time, found more metastases, and made fewer search errors than those with a lower number of courses. Our results suggest that the traditional definition of drillers and scanners could be expanded to include scrolling behavior. Drillers could be defined as scrolling back and forth through the image stack, each time exploring a different area on each image (low EMI and high number of courses). Scanners could be defined as scrolling progressively through the stack of images and focusing on different areas within each image slice (high EMI and low number of courses). Conclusions: Together, our results further enhance the understanding of how radiologists investigate three-dimensional volumes and may improve how to teach effective reading strategies to radiology residents.
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Affiliation(s)
- Alexandre Ba
- Lausanne University Hospital and University of Lausanne, Institute of Radiation Physics, Lausanne, Switzerland
| | - Marwa Shams
- University of Lausanne, Lausanne, Switzerland
| | - Sabine Schmidt
- Lausanne University Hospital and University of Lausanne, Department of Radiology, Lausanne, Switzerland
| | - Miguel P Eckstein
- University of California Santa Barbara, Department of Psychological and Brain Sciences, Santa Barbara, California, United States.,University of California Santa Barbara, Department of Electrical and Computing Engineering, Santa Barbara, California, United States
| | - Francis R Verdun
- Lausanne University Hospital and University of Lausanne, Institute of Radiation Physics, Lausanne, Switzerland
| | - François O Bochud
- Lausanne University Hospital and University of Lausanne, Institute of Radiation Physics, Lausanne, Switzerland
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Comparison of laparoscopic ultrasound and liver-specific magnetic resonance imaging for staging colorectal liver metastases. Surg Endosc 2020; 35:3547-3553. [PMID: 32710215 DOI: 10.1007/s00464-020-07817-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/10/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Intraoperative liver ultrasound appears superior to liver-specific contrast-enhanced magnetic resonance imaging (MRI) to stage colorectal liver metastases (CRLMs). Most of the data come from studies on open surgery. Laparoscopic ultrasound (LUS) is technically demanding and its reliability is poor investigated. Aim of the study was to assess the accuracy of LUS staging for CRLMs compared to MRI. METHODS All patients with CRLMs scheduled for laparoscopic liver resection (LLR) between 01/2010 and 06/2019 who underwent preoperative MRI were considered for the study. LUS and MRI performance was compared on a patient by patient basis. Reference standards were final pathology and 6 months follow-up results. RESULTS Amongst 189 LLR for CRLMs, 146 met inclusion criteria. Overall, 391 CRLMs were preoperatively detected by MRI. 24 new nodules in 16 (10.9%) patients were found by LUS and resected. Median diameter of new nodules was 5.5 mm (2-10 mm) and 10 (41.6%) were located in the hepatic dome. Pathology confirmed 17 newly detected malignant nodules (median size 4 mm) in 11 (7.5%) patients. Relationships between intrahepatic vessels and tumours differed between LUS and MRI in 9 patients (6.1%). Intraoperative surgical strategy changed according LUS findings in 19 (13%) patients, requiring conversion to open approach in 3 (15.8%) of them. The sensitivity of LUS was superior to MRI (93.1% vs 85.6% whilst specificity was similar (98.6% MRI vs 96.5% LUS). CONCLUSIONS Laparoscopic liver ultrasound improves liver staging for CRLMs compared to liver-specific MRI.
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Yu KY, Jiang CP. Diagnosis and treatment of hepatic pseudolymphoma. Shijie Huaren Xiaohua Zazhi 2019; 27:107-111. [DOI: 10.11569/wcjd.v27.i2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pseudolymphoma, also known as reactive lymphoid hyperplasia or nodular lymphoid lesion, can occur in the gastrointestinal tract, pancreas, eyelids, skin, etc.; however, pseudolymphoma of the liver rarely occurs. Because of the small number of individual case reports of hepatic pseudolymphoma in most institutions, there is a lack of information available regarding its pathogenesis, optimal treatment, and prognosis. Patients with hepatic pseudolymphoma often present non-specific clinical and imaging features, without specific tumor markers. The diagnosis of this disease mainly depends on postoperative pathological and immunohistochemical evaluations and genetic examination; timely and complete surgical resection is currently the most important treatment.
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Affiliation(s)
- Kuan-Yong Yu
- Department of Hepatobiliary Surgery, Drum Tower Clinical Medical College, Nanjing Medical University (Nanjing Drum Tower Hospital), Nanjing 210008, Jiangsu Province, China
| | - Chun-Ping Jiang
- Department of Hepatobiliary Surgery, Drum Tower Clinical Medical College, Nanjing Medical University (Nanjing Drum Tower Hospital), Nanjing 210008, Jiangsu Province, China
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Hepatic pseudolymphoma: imaging features on dynamic contrast-enhanced MRI and diffusion-weighted imaging. Abdom Radiol (NY) 2018; 43:2288-2294. [PMID: 29392361 DOI: 10.1007/s00261-018-1468-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate dynamic contrast-enhanced (DCE) MR findings and diffusion-weighted imaging (DWI) characteristics of hepatic pseudolymphoma. MATERIALS AND METHODS The MR data of 20 lesions in 14 patients with histopathologically proven hepatic pseudolymphoma were retrospectively analyzed. All patients underwent dynamic gadopentetate dimeglumine-enhanced MR imaging and DWI. Morphologic characteristics and signal features on T1- and T2-weighted images (T1WI, T2WI), and DCE pattern were qualitatively evaluated. The quantitative analysis was performed for the size, the degree of enhancement on arterial phase, signal intensity (SI) of DWI, and apparent diffusion coefficient (ADC) values. The Wilcoxon signed ranks test was used for statistical analysis. RESULTS The contour of all lesions was round. The lesion size was 0.7-2.8 cm (mean 1.3 ± 0.5 cm). All lesions manifested as homogeneous hypointensity on T1WI and hyperintensity on T2WI. All lesions were shown as hypervascular with various enhancement patterns on DCE MR imaging. The presence of peripheral enhancement and pseudocapsule was observed in 7 and 4 lesions, respectively. SI of the hepatic pseudolymphoma was significantly lower than that of portal vein on arterial phase (P < 0.001) and the ADC was significantly lower than that of spleen (P = 0.012). CONCLUSION A homogeneous nodule with small size (<2 cm), manifestation of hypervascular with lower SI than that of portal vein on arterial phase and lower ADC values than that of spleen are the common MR features of hepatic pseudolymphoma.
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Current Trends on the Treatment Sequence for Colorectal Cancer with Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0402-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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12
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Qin S, Chen Y, Liu XY, Cheng WJ, Yu JL, Zhang WJ, Jiang QL, Wang YM, Wen YL, Liu GJ. Clinical Application of Contrast-Enhanced Ultrasound Using High-Frequency Linear Probe in the Detection of Small Colorectal Liver Metastases. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2765-2773. [PMID: 29037844 DOI: 10.1016/j.ultrasmedbio.2017.08.932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/28/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
To compare the performance of contrast-enhanced ultrasound (CEUS) using high-frequency linear and convex probes in the detection of small colorectal liver metastases (CRLMs). A total of 85 patients with 143 small CRLMs were evaluated. High-frequency ultrasound (US) and CEUS detected significantly more superficial lesions within 60 mm below the skin than a convex probe (p <0.05). The detection rate decreased in the chemotherapy group, especially when using a convex probe for US (p <0.05). By combining convex and linear probes, detection rates of US and CEUS were significantly higher than that of a convex or a linear probe alone (p <0.05). High-frequency US and CEUS helped to improve detection of small CRLMs and reduce the influence of chemotherapy. For patients with a high risk of CRLMs and those after chemotherapy, we recommend first scanning the liver by using a convex probe and subsequently screening the surface area of the liver and suspicious small lesions by using a linear probe.
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Affiliation(s)
- Si Qin
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yao Chen
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao-Yin Liu
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wen-Jie Cheng
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jun-Li Yu
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wen-Jing Zhang
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qing-Ling Jiang
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yi-Min Wang
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan-Ling Wen
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guang-Jian Liu
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Matos AP, Altun E, Ramalho M, Velloni F, AlObaidy M, Semelka RC. An overview of imaging techniques for liver metastases management. Expert Rev Gastroenterol Hepatol 2016; 9:1561-76. [PMID: 26414180 DOI: 10.1586/17474124.2015.1092873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Evaluation of liver metastases is one of the most common indications for liver imaging. Imaging plays a key role in the of assessment liver metastases. A variety of imaging techniques, including ultrasonography, computed tomography, MRI and PET combined with CT scan are available for diagnosis, planning treatment, and follow-up treatment response. In this paper, the authors present the role of imaging for the assessment of liver metastases and the contribution of each of the different imaging techniques for their evaluation and management. Following recent developments in the field of oncology, the authors also present the importance of imaging for the assessment of liver metastases response to therapy. Finally, future perspectives on imaging of liver metastases are presented.
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Affiliation(s)
- António P Matos
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Ersan Altun
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Miguel Ramalho
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Fernanda Velloni
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Mamdoh AlObaidy
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
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Karaosmanoglu AD, Onur MR, Ozmen MN, Akata D, Karcaaltincaba M. Magnetic Resonance Imaging of Liver Metastasis. Semin Ultrasound CT MR 2016; 37:533-548. [PMID: 27986172 DOI: 10.1053/j.sult.2016.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver magnetic resonance imaging (MRI) is becoming the gold standard in liver metastasis detection and treatment response assessment. The most sensitive magnetic resonance sequences are diffusion-weighted images and hepatobiliary phase images after Gd-EOB-DTPA. Peripheral ring enhancement, diffusion restriction, and hypointensity on hepatobiliary phase images are hallmarks of liver metastases. In patients with normal ultrasonography, computed tomography (CT), and positron emission tomography (PET)-CT findings and high clinical suspicion of metastasis, MRI should be performed for diagnosis of unseen metastasis. In melanoma, colon cancer, and neuroendocrine tumor metastases, MRI allows confident diagnosis of treatment-related changes in liver and enables differential diagnosis from primary liver tumors. Focal nodular hyperplasia-like nodules in patients who received platinum-based chemotherapy, hypersteatosis, and focal fat can mimic metastasis. In cancer patients with fatty liver, MRI should be preferred to CT. Although the first-line imaging for metastases is CT, MRI can be used as a problem-solving method. MRI may be used as the first-line method in patients who would undergo curative surgery or metastatectomy. Current limitation of MRI is low sensitivity for metastasis smaller than 3mm. MRI fingerprinting, glucoCEST MRI, and PET-MRI may allow simpler and more sensitive diagnosis of liver metastasis.
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Affiliation(s)
- Ali Devrim Karaosmanoglu
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Akata
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Musturay Karcaaltincaba
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
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15
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Chiorean L, Cantisani V, Jenssen C, Sidhu P, Baum U, Dietrich C. Focal masses in a non-cirrhotic liver: The additional benefit of CEUS over baseline imaging. Eur J Radiol 2015; 84:1636-43. [PMID: 26049958 DOI: 10.1016/j.ejrad.2015.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/16/2015] [Accepted: 05/02/2015] [Indexed: 02/07/2023]
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16
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Joo I. The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions. Ultrasonography 2015; 34:246-57. [PMID: 25971896 PMCID: PMC4603208 DOI: 10.14366/usg.15014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 12/12/2022] Open
Abstract
Intraoperative ultrasonography (IOUS) has been widely utilized in hepatic surgery both as a diagnostic technique and in the course of treatment. Since IOUS involves direct-contact imaging of the target organ, it can provide high spatial resolution without interference from the surrounding structures. Therefore, IOUS may improve the detection, characterization, localization, and local staging of hepatic tumors. IOUS is also a real-time imaging modality capable of providing interactive information and valuable guidance in a range of procedures. Recently, contrast-enhanced IOUS, IOUS elastography, and IOUS-guided hepatic surgery have attracted increasing interest and are expected to lead to the broader implementation of IOUS. Herein, we review the various applications of IOUS in the diagnosis and management of focal hepatic lesions.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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17
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Tirumani SH, Kim KW, Nishino M, Howard SA, Krajewski KM, Jagannathan JP, Cleary JM, Ramaiya NH, Shinagare AB. Update on the role of imaging in management of metastatic colorectal cancer. Radiographics 2014; 34:1908-28. [PMID: 25384292 PMCID: PMC4386871 DOI: 10.1148/rg.347130090] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 03/06/2014] [Accepted: 03/11/2014] [Indexed: 02/07/2023]
Abstract
Evolution in the treatment of metastatic colorectal cancer (mCRC) has led to significant improvement in the survival of these patients. Surgery is useful in patients with resectable disease. Liver-directed therapies such as hepatic arterial infusion, transarterial radio- and chemoembolization, and percutaneous ablation are sometimes used by oncologists when the liver is the only site of metastatic disease. Unresectable mCRC is typically treated with systemic chemotherapy. First-line systemic chemotherapeutic regimens for mCRC are FOLFOX (combination of 5-fluorouracil/leucovorin [5-FU/LV] and oxaliplatin) and FOLFIRI (combination of 5-FU/LV and irinotecan) combined with molecular targeted drugs. Molecular targeted therapies that are effective in treating mCRC include antiangiogenic agents such as bevacizumab-an antibody against vascular endothelial growth factor-and antibodies directed against epidermal growth factor receptor (EGFR). EGFR-directed antibodies such as cetuximab and panitumumab have been shown to produce activity only in wild-type KRAS tumors. Imaging modalities such as multidetector computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT play a major role in the selection of appropriate treatment strategies. Assessment of treatment response in patients who undergo liver-directed and systemic therapy requires imaging at regular intervals. Recent studies have shown that alternative treatment response criteria may be more predictive of pathologic response in mCRC than conventional criteria such as Response Evaluation Criteria in Solid Tumors. Awareness of unusual response patterns, as well as of complications and toxicities, is helpful in guiding patient management.
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Affiliation(s)
- Sree Harsha Tirumani
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
| | | | - Mizuki Nishino
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
| | - Stephanie A. Howard
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
| | - Katherine M. Krajewski
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
| | - Jyothi P. Jagannathan
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
| | - James M. Cleary
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
| | - Nikhil H. Ramaiya
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
| | - Atul B. Shinagare
- From the Departments of Imaging (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.) and Medical Oncology (J.M.C.), Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215; and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (S.H.T., K.W.K., M.N., S.A.H., K.M.K., J.P.J., N.H.R., A.B.S.)
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18
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Cantisani V, Grazhdani H, Fioravanti C, Rosignuolo M, Calliada F, Messineo D, Bernieri MG, Redler A, Catalano C, D’Ambrosio F. Liver metastases: Contrast-enhanced ultrasound compared with computed tomography and magnetic resonance. World J Gastroenterol 2014; 20:9998-10007. [PMID: 25110428 PMCID: PMC4123379 DOI: 10.3748/wjg.v20.i29.9998] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/23/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound (US) for several applications, especially for the detection of metastases. In particular, contrast enhanced ultrasonography (CEUS) allows the display of the parenchymal microvasculature, enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases, which is similar to contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging. Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US. Furthermore, studies have shown that CEUS yields sensitivities comparable to CT. In this review, we describe the state of the art of CEUS for detecting colorectal liver metastases, the imaging features, the literature reports of metastases in CEUS as well as its technique, its clinical role and its potential applications. Additionally, the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.
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19
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Mungai F, Morone M, Villanacci A, Bondioni MP, Mazzoni LN, Grazioli L, Colagrande S. Diffusion weighted MR and apparent diffusion coefficient measurement in classification and characterization of noncystic focal liver lesions: does a clinical role exist? Medicine (Baltimore) 2014; 93:e40. [PMID: 25058143 PMCID: PMC4602426 DOI: 10.1097/md.0000000000000040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The objective of this study was to assess the clinical role of apparent diffusion coefficient (ADC) analysis in noncystic focal liver lesion (FLL) classification/characterization.Six hundred liver magnetic resonances with multi-b (b = 50, 400, 800 s/mm) diffusion-weighted imaging (DwI) were retrospectively reviewed. Mean ADC was measured in 388 lesions (195 benign and 193 malignant) excluding internal necrotic areas. Cystic benign lesions were excluded from analysis. Sensitivity and specificity in distinguishing benign from malignant lesions were calculated. Analysis of variance was performed to detect differences among subgroups of solid lesions.Mean ADC of malignant lesions was 0.980 × 10 mm/s, significantly (P < 0.05) lower than mean ADC of benign lesions (1.433 × 10 mm/s). Applying an ADC cutoff of 1.066 × 10 mm/s, specificity and sensitivity for malignancy were respectively 86.6% and 73.6%. Of all lesions, >1/3 (39.5%) presented values lower than 1 × 10 mm/s, with 90.0% chance of malignancy. Above 1.5 × 10 mm/s (about 20% of all lesions) chance of malignancy was 9.5%.DwI cannot assist in noncystic FLL characterization, but can help in FLL classification in about half the cases.
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Affiliation(s)
- Francesco Mungai
- Department of Radiology (MM, MPB, LG), Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Department of Radiology (AV), Ospedale S. Cuore di Gesù, Viale Principe di Napoli, 14/A, Benevento, and Department of Experimental and Clinical Biomedical Sciences (FM, SC), Radiodiagnostic Unit no. 2 and Department of Physics (LNM), University of Florence, Azienda Ospedaliero, Universitaria Careggi, Largo Brambilla 3, Florence, Italy
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20
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Sunderland GJ, Dunne DFJ, Jones RP, Malik HZ, Poston GJ, Fenwick SW. Current management of colorectal liver metastases. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.13.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
SUMMARY Colorectal cancer is common worldwide and is predicted to become more so in the coming years. The liver is the most common site of metastasis and management is increasingly complex. A multidisciplinary team approach to management is essential, and is associated with better outcomes. Patients with irresectable liver metastases can still benefit from the involvement of a liver specialist, as high secondary resection rates can be achieved with combination chemotherapy, incorporating novel biological therapies and liver-directed local and locoregional treatments. The application of an enhanced recovery model to perioperative care, alongside improvements in the assessment of patient fitness for surgery, should help to mitigate the challenges presented by an older population with increased comorbidity undergoing increasingly complex treatment.
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Affiliation(s)
| | - Declan FJ Dunne
- Liverpool Hepatobiliary Centre, Aintree University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Robert P Jones
- Liverpool Hepatobiliary Centre, Aintree University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Hassan Z Malik
- Liverpool Hepatobiliary Centre, Aintree University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Graeme J Poston
- Liverpool Hepatobiliary Centre, Aintree University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Stephen W Fenwick
- Liverpool Hepatobiliary Centre, Aintree University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
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21
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Dunne DF, Jones RP, Malik HZ, Fenwick SW, Poston GJ. Surgical management of colorectal liver metastases: a European perspective. Hepat Oncol 2013; 1:121-133. [PMID: 30190946 DOI: 10.2217/hep.13.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The treatment of colorectal cancer metastatic to the liver is increasingly complex as a result of changes in the patient population, advances in preoperative staging, changing definitions of resectability, advances in surgical technique and the expanding chemotherapeutic armamentarium. Management of these patients within a multidisciplinary team is increasingly important and associated with better outcomes. In patients with irresectable hepatic metastases, high secondary resection rates can be achieved with multiagent chemotherapy when managed in conjunction with a liver specialist. Perioperative mortality rates are reducing but morbidity remains high, and enhanced recovery could help reduce morbidity. Despite the advancing age and comorbidity of the patient population, multimodal management is likely to lead to further improvements in perioperative and long-term outcomes.
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Affiliation(s)
- Declan Fj Dunne
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Robert P Jones
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Hassan Z Malik
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Stephen W Fenwick
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Graeme J Poston
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
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22
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McNally SJ, Parks RW. Surgery for colorectal liver metastases. Dig Surg 2013; 30:337-47. [PMID: 24051581 DOI: 10.1159/000351442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 04/10/2013] [Indexed: 12/27/2022]
Abstract
Half of all patients with colorectal cancer develop metastatic disease. The liver is the principal site for metastases, and surgical resection is the only modality that offers the potential for long-term cure. Appropriate patient selection for surgery and improvements in perioperative care have resulted in low morbidity and mortality rates, resulting in this being the therapy of choice for suitable patients. Modern management of colorectal liver metastases is multimodal incorporating open and laparoscopic surgery, ablative therapies such as radiofrequency ablation or microwave ablation and (neo)adjuvant chemotherapy. The majority of patients with hepatic metastases should be considered for resectional surgery, if all disease can be resected, as this offers the only opportunity for prolonged survival.
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Affiliation(s)
- S J McNally
- Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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23
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Liang P, Yu J, Lu MD, Dong BW, Yu XL, Zhou XD, Hu B, Xie MX, Cheng W, He W, Jia JW, Lu GR. Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy. World J Gastroenterol 2013; 19:5430-8. [PMID: 24023485 PMCID: PMC3761095 DOI: 10.3748/wjg.v19.i33.5430] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
Primary liver cancer and liver metastases are among the most frequent malignancies worldwide, with an increasing number of new cases and deaths every year. Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy. This synopsis outlines the first clinical practice guidelines for ultrasound-guided percutaneous microwave ablation therapy for hepatic malignancy, which was created by a joint task force of the Society of Chinese Interventional Ultrasound. The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment, as well as proposing the criteria for the treatment candidates.
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24
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Dunne DFJ, Gaughran J, Jones RP, McWhirter D, Sutton PA, Malik HZ, Poston GJ, Fenwick SW. Routine staging laparoscopy has no place in the management of colorectal liver metastases. Eur J Surg Oncol 2013; 39:721-5. [PMID: 23618549 DOI: 10.1016/j.ejso.2013.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/22/2013] [Accepted: 03/27/2013] [Indexed: 11/19/2022] Open
Abstract
AIMS Staging laparoscopy has been recommended in the management of patients with colorectal liver metastases prior to hepatectomy in order to reduce the incidence and associated morbidity of futile laparotomies. The utility of staging laparoscopy has not been assessed in patients undergoing CT, PET-CT and MRI as standard preoperative staging. METHODS All patients undergoing attempted open hepatectomy for colorectal liver metastases between 1/4/2008 and 31/3/2012 were identified from a prospectively maintained research database. All patients who underwent futile laparotomy were identified, with demographics and operative notes subsequently analysed. RESULTS A total of 274 patients underwent attempted open hepatectomy during the study period. At laparotomy 12 (4.4%) patients were found to have irresectable disease. There were no unifying demographic factors within the patients undergoing futile laparotomy. CONCLUSIONS With modern imaging, the potential yield of staging laparoscopy is low. Staging laparoscopy should not be used routinely, but may have a role in the case of specific clinical concerns.
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Affiliation(s)
- D F J Dunne
- Northwestern Hepatobiliary Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, United Kingdom.
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Gd-EOB-DTPA-Enhanced MRI for Detection of Liver Metastases from Colorectal Cancer: A Surgeon's Perspective! Int J Hepatol 2013; 2013:572307. [PMID: 23653860 PMCID: PMC3638698 DOI: 10.1155/2013/572307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/08/2013] [Accepted: 03/22/2013] [Indexed: 12/20/2022] Open
Abstract
Colorectal cancer affects over one million people worldwide annually, with the liver being the most common site of metastatic spread. Adequate resection of hepatic metastases is the only chance for a cure in a subset of patients, and five-year survival increases to 35% with complete resection. Traditionally, computed tomographic imaging (CT) was utilized for staging and to evaluate metastases in the liver. Recently, the introduction of hepatobiliary contrast-enhanced magnetic resonance imaging (MRI) agents including gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Eovist in the United States, Primovist in Europe, or Gd-EOB-DTPA) has proved to be a sensitive method for detection of hepatic metastases. Accurate detection of liver metastases is critical for staging of colorectal cancer as well as preoperative planning.
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