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Nagasbekov M, Baimakhanov Z, Doskhanov M, Nurlanbayev E, Kaniyev S, Akhan O, Baimakhanov B, Fakhradiyev I. Cystic echinococcosis of the liver in Kazakhstan: The effectiveness of the PAIR method in comparison with laparoscopic and «open» surgical methods. Asian J Surg 2024:S1015-9584(24)01061-3. [PMID: 38825418 DOI: 10.1016/j.asjsur.2024.05.170] [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: 03/06/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND One of the urgent problems of surgical parasitology in the Republic of Kazakhstan is liver cystic echinococcosis. The study aimed to analyze the effectiveness and safety of the percutaneous treatment with different techniques in comparison with the results of laparoscopic and "open" surgical methods. METHODS Retrospectively, we analyzed the outcome of 485 patients with active echinococcal cysts in the period from January 2017-July 2023. Indications for surgical treatment and the choice of the intervention method were based on this classification. Patients were conditionally divided into 3 groups: Laparoscopy-33, Laparotomy-319, PAIR-133. RESULTS The duration of the operation in the PAIR was significantly shorter compared to the Laparotomy and Laparoscopy groups (55.4vs.225.2 and 215.3, p = 0.0001). There was no intraoperative blood loss in PAIR, whereas in Laparotomy and Laparoscopy there were 146.0 and 111.0. The postoperative stay of patients in PAIR is significantly shorter than in Laparotomy and Laparoscopy (3.8 compared to 7.5 and 6.4, p = 0.0001). The follow-up time averaged 39.8 months ± 21. There were no statistically significant differences in relapses. Laparotomy and PAIR groups had 11 (3.5 %) and 6 (4.5 %) relapses, respectively. CONCLUSION In cystic echinococcosis of the liver types CE1, CE3a regardless of the localization, the optimal volume is a PAIR is characterized by a shorter postoperative stay of the patient, early recovery and cure. In the CE2, CE3b stages, laparoscopic pericystectomy is the most effective and safe in individual patients. In case of an intimate arrangement of cysts to tubular structures, the safest method is laparotomy.
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Affiliation(s)
- Madiyar Nagasbekov
- «Syzganov National Scientific Center of Surgery», Almaty, Kazakhstan; «S.D.Asfendiyarov Kazakh National Medical University», Almaty, Kazakhstan
| | | | - Maxat Doskhanov
- «Syzganov National Scientific Center of Surgery», Almaty, Kazakhstan
| | - Erik Nurlanbayev
- «Syzganov National Scientific Center of Surgery», Almaty, Kazakhstan
| | - Shokan Kaniyev
- «Syzganov National Scientific Center of Surgery», Almaty, Kazakhstan
| | - Okan Akhan
- «Hacettepe University», Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Bolatbek Baimakhanov
- «Syzganov National Scientific Center of Surgery», Almaty, Kazakhstan; «S.D.Asfendiyarov Kazakh National Medical University», Almaty, Kazakhstan
| | - Ildar Fakhradiyev
- «S.D.Asfendiyarov Kazakh National Medical University», Almaty, Kazakhstan.
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Yel I, Koch V, Gruenewald LD, Mahmoudi S, Alizadeh LS, Goekduman A, Eichler K, Vogl TJ, Dimitrova M, Booz C. Advancing Differentiation of Hepatic Metastases in Malignant Melanoma through Dual-Energy Computed Tomography Rho/Z Maps. Diagnostics (Basel) 2024; 14:742. [PMID: 38611654 PMCID: PMC11012221 DOI: 10.3390/diagnostics14070742] [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: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the diagnostic accuracy of dual-energy computed tomography (DECT)-based Rho/Z maps in differentiating between metastases and benign liver lesions in patients diagnosed with malignant melanoma compared to conventional CT value measurements. METHODS This retrospective study included 73 patients (mean age, 70 ± 13 years; 43 m/30 w) suffering from malignant melanoma who had undergone third-generation DECT as part of tumor staging between December 2017 and December 2021. For this study, we measured Rho (electron density) and Z (effective atomic number) values as well as Hounsfield units (HUs) in hypodense liver lesions. Values were compared, and diagnostic accuracy for differentiation was computed using receiver operating characteristic (ROC) curve analyses. Additional performed MRI or biopsies served as a standard of reference. RESULTS A total of 136 lesions (51 metastases, 71 cysts, and 14 hemangiomas) in contrast-enhanced DECT images were evaluated. The most notable discrepancy (p < 0.001) between measured values and the highest diagnostic accuracy for distinguishing melanoma metastases from benign cysts was observed for the Z (0.992; 95% CI, 0.956-1) parameters, followed by Rho (0.908; 95% CI, 0.842-0.953) and finally HU120kV (0.829; 95% CI, 0.751-0.891). Conversely, when discriminating between liver metastases and hemangiomas, the HU120kV parameters showed the most significant difference (p < 0.001) and yielded the highest values for diagnostic accuracy (0.859; 95% CI, 0.740-0.937), followed by the Z parameters (0.790; 95% CI, 0.681-0.876) and finally the Rho values (0.621; 95% CI, 0.501-0.730). CONCLUSIONS Rho and Z measurements derived from DECT allow for improved differentiation of liver metastases and benign liver cysts in patients with malignant melanoma compared to conventional CT value measurements. In contrast, in differentiation between liver hemangiomas and metastases, Rho/Z maps show inferior diagnostic accuracy. Therefore, differentiation between these two lesions remains a challenge for CT imaging.
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Hossain MSA, Gul S, Chowdhury MEH, Khan MS, Sumon MSI, Bhuiyan EH, Khandakar A, Hossain M, Sadique A, Al-Hashimi I, Ayari MA, Mahmud S, Alqahtani A. Deep Learning Framework for Liver Segmentation from T1-Weighted MRI Images. SENSORS (BASEL, SWITZERLAND) 2023; 23:8890. [PMID: 37960589 PMCID: PMC10650219 DOI: 10.3390/s23218890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/15/2023]
Abstract
The human liver exhibits variable characteristics and anatomical information, which is often ambiguous in radiological images. Machine learning can be of great assistance in automatically segmenting the liver in radiological images, which can be further processed for computer-aided diagnosis. Magnetic resonance imaging (MRI) is preferred by clinicians for liver pathology diagnosis over volumetric abdominal computerized tomography (CT) scans, due to their superior representation of soft tissues. The convenience of Hounsfield unit (HoU) based preprocessing in CT scans is not available in MRI, making automatic segmentation challenging for MR images. This study investigates multiple state-of-the-art segmentation networks for liver segmentation from volumetric MRI images. Here, T1-weighted (in-phase) scans are investigated using expert-labeled liver masks from a public dataset of 20 patients (647 MR slices) from the Combined Healthy Abdominal Organ Segmentation grant challenge (CHAOS). The reason for using T1-weighted images is that it demonstrates brighter fat content, thus providing enhanced images for the segmentation task. Twenty-four different state-of-the-art segmentation networks with varying depths of dense, residual, and inception encoder and decoder backbones were investigated for the task. A novel cascaded network is proposed to segment axial liver slices. The proposed framework outperforms existing approaches reported in the literature for the liver segmentation task (on the same test set) with a dice similarity coefficient (DSC) score and intersect over union (IoU) of 95.15% and 92.10%, respectively.
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Affiliation(s)
- Md. Sakib Abrar Hossain
- NSU Genome Research Institute (NGRI), North South University, Dhaka 1229, Bangladesh
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Sidra Gul
- Department of Computer Systems Engineering, University of Engineering and Technology Peshawar, Peshawar 25000, Pakistan
- Artificial Intelligence in Healthcare, IIPL, National Center of Artificial Intelligence, Peshawar 25000, Pakistan
| | | | | | | | - Enamul Haque Bhuiyan
- Center for Magnetic Resonance Research, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Amith Khandakar
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Maqsud Hossain
- NSU Genome Research Institute (NGRI), North South University, Dhaka 1229, Bangladesh
| | - Abdus Sadique
- NSU Genome Research Institute (NGRI), North South University, Dhaka 1229, Bangladesh
| | | | | | - Sakib Mahmud
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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Kostov S, Selçuk I, Watrowski R, Dineva S, Kornovski Y, Slavchev S, Ivanova Y, Dzhenkov D, Yordanov A. Surgical Anatomy of the Liver-Significance in Ovarian Cancer Surgery. Diagnostics (Basel) 2023; 13:2371. [PMID: 37510115 PMCID: PMC10378601 DOI: 10.3390/diagnostics13142371] [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: 06/15/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Ovarian cancer is the leading cause of death among all gynecological malignancies. Most patients present with an advanced stage of the disease. The routes of spread in ovarian cancer include peritoneal dissemination, direct invasion, and lymphatic or hematogenous spread, with peritoneal and lymphatic spread being the most common among them. The flow direction of the peritoneal fluid makes the right subphrenic space a target site for peritoneal metastases, and the most frequently affected anatomical area in advanced cases is the right upper quadrant. Complete cytoreduction with no macroscopically visible disease is the most important prognostic factor. METHODS We reviewed published clinical anatomy reports associated with surgery of the liver in cases of advanced ovarian cancer. RESULTS The disease could disseminate anatomical areas, where complex surgery is required-Morrison's pouch, the liver surface, or porta hepatis. The aim of the present article is to emphasize and delineate the gross anatomy of the liver and its surgical application for oncogynecologists. Moreover, the association between the gross and microscopic anatomy of the liver is discussed. Additionally, the vascular supply and variations of the liver are clearly described. CONCLUSIONS Oncogynecologists performing liver mobilization, diaphragmatic stripping, and porta hepatis dissection must have a thorough knowledge of liver anatomy, including morphology, variations, functional status, potential diagnostic imaging mistakes, and anatomical limits of dissection.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
- Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria
| | - Ilker Selçuk
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Maternity Hospital, 06800 Ankara, Turkey
| | - Rafał Watrowski
- Department of Obstetrics and Gynecology, Helios Hospital Müllheim, 79379 Müllheim, Germany
- Faculty Associate, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Svetla Dineva
- Diagnostic Imaging Department, Medical University of Sofia, 1431 Sofia, Bulgaria
- National Cardiology Hospital, 1309 Sofia, Bulgaria
| | - Yavor Kornovski
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Stanislav Slavchev
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Yonka Ivanova
- Department of Gynecology, Hospital "Saint Anna", Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Deyan Dzhenkov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University-"Prof. Dr. Paraskev Stoyanov", 9002 Varna, Bulgaria
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
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Nikiforova A, Sedov I. Molecular Design of Magnetic Resonance Imaging Agents Binding to Amyloid Deposits. Int J Mol Sci 2023; 24:11152. [PMID: 37446329 DOI: 10.3390/ijms241311152] [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: 06/12/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The ability to detect and monitor amyloid deposition in the brain using non-invasive imaging techniques provides valuable insights into the early diagnosis and progression of Alzheimer's disease and helps to evaluate the efficacy of potential treatments. Magnetic resonance imaging (MRI) is a widely available technique offering high-spatial-resolution imaging. It can be used to visualize amyloid deposits with the help of amyloid-binding diagnostic agents injected into the body. In recent years, a number of amyloid-targeted MRI probes have been developed, but none of them has entered clinical practice. We review the advances in the field and deduce the requirements for the molecular structure and properties of a diagnostic probe candidate. These requirements make up the base for the rational design of MRI-active small molecules targeting amyloid deposits. Particular attention is paid to the novel cryo-EM structures of the fibril aggregates and their complexes, with known binders offering the possibility to use computational structure-based design methods. With continued research and development, MRI probes may revolutionize the diagnosis and treatment of neurodegenerative diseases, ultimately improving the lives of millions of people worldwide.
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Affiliation(s)
- Alena Nikiforova
- Chemical Institute, Kazan Federal University, Kremlevskaya 18, 420008 Kazan, Russia
| | - Igor Sedov
- Chemical Institute, Kazan Federal University, Kremlevskaya 18, 420008 Kazan, Russia
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Ramli Z, Karim MKA, Effendy N, Abd Rahman MA, Kechik MMA, Ibahim MJ, Haniff NSM. Stability and Reproducibility of Radiomic Features Based on Various Segmentation Techniques on Cervical Cancer DWI-MRI. Diagnostics (Basel) 2022; 12:diagnostics12123125. [PMID: 36553132 PMCID: PMC9777485 DOI: 10.3390/diagnostics12123125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Cervical cancer is the most common cancer and ranked as 4th in morbidity and mortality among Malaysian women. Currently, Magnetic Resonance Imaging (MRI) is considered as the gold standard imaging modality for tumours with a stage higher than IB2, due to its superiority in diagnostic assessment of tumour infiltration with excellent soft-tissue contrast. In this research, the robustness of semi-automatic segmentation has been evaluated using a flood-fill algorithm for quantitative feature extraction, using 30 diffusion weighted MRI images (DWI-MRI) of cervical cancer patients. The relevant features were extracted from DWI-MRI segmented images of cervical cancer. First order statistics, shape features, and textural features were extracted and analysed. The intra-class relation coefficient (ICC) was used to compare 662 radiomic features extracted from manual and semi-automatic segmentations. Notably, the features extracted from the semi-automatic segmentation and flood filling algorithm (average ICC = 0.952 0.009, p > 0.05) were significantly higher than the manual extracted features (average ICC = 0.897 0.011, p > 0.05). Henceforth, we demonstrate that the semi-automatic segmentation is slightly expanded to manual segmentation as it produces more robust and reproducible radiomic features.
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Affiliation(s)
- Zarina Ramli
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Department of Radiology, National Cancer Institute, Putrajaya 65000, Wilayah Persekutuan, Malaysia
| | - Muhammad Khalis Abdul Karim
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Department of Radiology, National Cancer Institute, Putrajaya 65000, Wilayah Persekutuan, Malaysia
- Correspondence:
| | - Nuraidayani Effendy
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Mohd Amiruddin Abd Rahman
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Mohd Mustafa Awang Kechik
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Mohamad Johari Ibahim
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47200, Selangor, Malaysia
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Vidal-Jove J, Serres X, Vlaisavljevich E, Cannata J, Duryea A, Miller R, Merino X, Velat M, Kam Y, Bolduan R, Amaral J, Hall T, Xu Z, Lee FT, Ziemlewicz TJ. First-in-man histotripsy of hepatic tumors: the THERESA trial, a feasibility study. Int J Hyperthermia 2022; 39:1115-1123. [PMID: 36002243 DOI: 10.1080/02656736.2022.2112309] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Rationale Current hepatic locoregional therapies are limited in terms of effectiveness and toxicities. Given promising pre-clinical results, a first in-human trial was designed to assess the technical effectiveness and safety profile of histotripsy, a noninvasive, non-thermal, non-ionizing focused ultrasound therapy that creates precise, predictable tissue destruction, in patients with primary and secondary liver tumors.Methods A multicenter phase I trial (Theresa Study) was performed in a single country with 8 weeks of planned follow-up. Eight of fourteen recruited patients were deemed eligible and enrolled in the study. Hepatic histotripsy, was performed with a prototype system (HistoSonics, Inc., Ann Arbor, MI). Eleven tumors were targeted in the 8 patients who all had unresectable end-stage multifocal liver tumors: colorectal liver metastases (CRLM) in 5 patients (7 tumors), breast cancer metastases in 1 (1 tumor), cholangiocarcinoma metastases in 1 (2 tumors), and hepatocellular carcinoma (HCC) in 1 (1 tumor). The primary endpoint was acute technical success, defined as creating a zone of tissue destruction per planned volume assessed by MRI 1-day post-procedure. Safety (device-related adverse events) through 2 months was a secondary endpoint.Results The 8 patients had a median age of 60.4 years with an average targeted tumor diameter of 1.4 cm. The primary endpoint was achieved in all procedures. The secondary safety profile endpoint identified no device-related adverse events. Two patients experienced a continuous decline in tumor markers during the eight weeks following the procedure.Conclusions This first-in-human trial demonstrates that hepatic histotripsy effectively destroys liver tissue in a predictable manner, correlating very well with the planned histotripsy volume, and has a high safety profile without any device-related adverse events. Based on these results, the need for more definitive clinical trials is warranted. Trial Registration: Study to Evaluate VORTX Rx (Theresa). NCT03741088. https://clinicaltrials.gov/ct2/show/NCT03741088 KEY POINTSHistotripsy, a new noninvasive, non-thermal, non-ionizing focused ultrasound therapy, safely created a zone of tissue destruction in the liver that correlated very well with the pre-defined planned tissue destruction volume.In this first human trial histotripsy was well tolerated with no histotripsy device-related adverse events and its primary endpoint of acute technical success was achieved in all 8 enrolled patients with primary or secondary liver tumors.This new locoregional therapy for patients with liver tumors is safe and effective, warranting further trials.
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Affiliation(s)
- Joan Vidal-Jove
- Institute Khuab for Interventional Oncology, Comprehensive Tumor Center, Barcelona, Spain
| | - Xavier Serres
- Department of Interventional Ultrasound, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering, Virginia Polytechnic University, Blacksburg, Virginia
| | - Jon Cannata
- Research and Development, Histosonics, Inc, Ann Arbor, MI, USA
| | - Alex Duryea
- Research and Development, Histosonics, Inc, Ann Arbor, MI, USA
| | - Ryan Miller
- Research and Development, Histosonics, Inc, Ann Arbor, MI, USA
| | - Xavier Merino
- Department of Interventional Ultrasound, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuela Velat
- Institute Khuab for Interventional Oncology, Comprehensive Tumor Center, Barcelona, Spain
| | - Yossi Kam
- R&D Clinical Excellence, Philips Healthcare, Haifa, Israel
| | - Ryan Bolduan
- Clinical Research and Medical Affairs, Histosonics, Inc, Ann Arbor, MI, USA
| | - Joseph Amaral
- Clinical Research and Medical Affairs, Histosonics, Inc, Ann Arbor, MI, USA
| | - Timothy Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, Madison, WI, USA
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Effectiveness of ADC histogram analysis in the diagnosis of focal liver lesions; is a contrast agent necessary? MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1121815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Stollmayer R, Budai BK, Tóth A, Kalina I, Hartmann E, Szoldán P, Bérczi V, Maurovich-Horvat P, Kaposi PN. Diagnosis of focal liver lesions with deep learning-based multi-channel analysis of hepatocyte-specific contrast-enhanced magnetic resonance imaging. World J Gastroenterol 2021; 27:5978-5988. [PMID: 34629814 PMCID: PMC8475009 DOI: 10.3748/wjg.v27.i35.5978] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/07/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The nature of input data is an essential factor when training neural networks. Research concerning magnetic resonance imaging (MRI)-based diagnosis of liver tumors using deep learning has been rapidly advancing. Still, evidence to support the utilization of multi-dimensional and multi-parametric image data is lacking. Due to higher information content, three-dimensional input should presumably result in higher classification precision. Also, the differentiation between focal liver lesions (FLLs) can only be plausible with simultaneous analysis of multi-sequence MRI images.
AIM To compare diagnostic efficiency of two-dimensional (2D) and three-dimensional (3D)-densely connected convolutional neural networks (DenseNet) for FLLs on multi-sequence MRI.
METHODS We retrospectively collected T2-weighted, gadoxetate disodium-enhanced arterial phase, portal venous phase, and hepatobiliary phase MRI scans from patients with focal nodular hyperplasia (FNH), hepatocellular carcinomas (HCC) or liver metastases (MET). Our search identified 71 FNH, 69 HCC and 76 MET. After volume registration, the same three most representative axial slices from all sequences were combined into four-channel images to train the 2D-DenseNet264 network. Identical bounding boxes were selected on all scans and stacked into 4D volumes to train the 3D-DenseNet264 model. The test set consisted of 10-10-10 tumors. The performance of the models was compared using area under the receiver operating characteristic curve (AUROC), specificity, sensitivity, positive predictive values (PPV), negative predictive values (NPV), and f1 scores.
RESULTS The average AUC value of the 2D model (0.98) was slightly higher than that of the 3D model (0.94). Mean PPV, sensitivity, NPV, specificity and f1 scores (0.94, 0.93, 0.97, 0.97, and 0.93) of the 2D model were also superior to metrics of the 3D model (0.84, 0.83, 0.92, 0.92, and 0.83). The classification metrics of FNH were 0.91, 1.00, 1.00, 0.95, and 0.95 using the 2D and 0.90, 0.90, 0.95, 0.95, and 0.90 using the 3D models. The 2D and 3D networks' performance in the diagnosis of HCC were 1.00, 0.80, 0.91, 1.00, and 0.89 and 0.88, 0.70, 0.86, 0.95, and 0.78, respectively; while the evaluation of MET lesions resulted in 0.91, 1.00, 1.00, 0.95, and 0.95 and 0.75, 0.90, 0.94, 0.85, and 0.82 using the 2D and 3D networks, respectively.
CONCLUSION Both 2D and 3D-DenseNets can differentiate FNH, HCC and MET with good accuracy when trained on hepatocyte-specific contrast-enhanced multi-sequence MRI volumes.
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Affiliation(s)
- Róbert Stollmayer
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
| | - Bettina K Budai
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
| | - Ambrus Tóth
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
| | - Ildikó Kalina
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
| | - Erika Hartmann
- Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest 1082, Hungary
| | - Péter Szoldán
- MedInnoScan Research and Development Ltd., Budapest 1112, Hungary
| | - Viktor Bérczi
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
| | - Pál N Kaposi
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Haniff NSM, Abdul Karim MK, Osman NH, Saripan MI, Che Isa IN, Ibahim MJ. Stability and Reproducibility of Radiomic Features Based Various Segmentation Technique on MR Images of Hepatocellular Carcinoma (HCC). Diagnostics (Basel) 2021; 11:diagnostics11091573. [PMID: 34573915 PMCID: PMC8468357 DOI: 10.3390/diagnostics11091573] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is considered as a complex liver disease and ranked as the eighth-highest mortality rate with a prevalence of 2.4% in Malaysia. Magnetic resonance imaging (MRI) has been acknowledged for its advantages, a gold technique for diagnosing HCC, and yet the false-negative diagnosis from the examinations is inevitable. In this study, 30 MR images from patients diagnosed with HCC is used to evaluate the robustness of semi-automatic segmentation using the flood fill algorithm for quantitative features extraction. The relevant features were extracted from the segmented MR images of HCC. Four types of features extraction were used for this study, which are tumour intensity, shape feature, textural feature and wavelet feature. A total of 662 radiomic features were extracted from manual and semi-automatic segmentation and compared using intra-class relation coefficient (ICC). Radiomic features extracted using semi-automatic segmentation utilized flood filling algorithm from 3D-slicer had significantly higher reproducibility (average ICC = 0.952 ± 0.009, p < 0.05) compared with features extracted from manual segmentation (average ICC = 0.897 ± 0.011, p > 0.05). Moreover, features extracted from semi-automatic segmentation were more robust compared to manual segmentation. This study shows that semi-automatic segmentation from 3D-Slicer is a better alternative to the manual segmentation, as they can produce more robust and reproducible radiomic features.
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Affiliation(s)
- Nurin Syazwina Mohd Haniff
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.S.M.H.); (N.H.O.)
| | - Muhammad Khalis Abdul Karim
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.S.M.H.); (N.H.O.)
- Correspondence:
| | - Nurul Huda Osman
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (N.S.M.H.); (N.H.O.)
| | - M Iqbal Saripan
- Department of Computer Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Iza Nurzawani Che Isa
- Programme of Diagnostic Imaging and Radiotherapy, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Wilayah Persekutuan, Malaysia;
| | - Mohammad Johari Ibahim
- Department Biochemistry & Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47200, Selangor, Malaysia;
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Badia S, Picchia S, Bellini D, Ferrari R, Caruso D, Paolantonio P, Carbone I, Laghi A, Rengo M. The Role of Contrast-Enhanced Imaging for Colorectal Cancer Management. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00443-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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12
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Thibodeau-Antonacci A, Petitclerc L, Gilbert G, Bilodeau L, Olivié D, Cerny M, Castel H, Turcotte S, Huet C, Perreault P, Soulez G, Chagnon M, Kadoury S, Tang A. Dynamic contrast-enhanced MRI to assess hepatocellular carcinoma response to Transarterial chemoembolization using LI-RADS criteria: A pilot study. Magn Reson Imaging 2019; 62:78-86. [PMID: 31247250 DOI: 10.1016/j.mri.2019.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/05/2019] [Accepted: 06/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify quantitative dynamic contrast-enhanced (DCE)-MRI perfusion parameters indicating tumor response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE). MATERIALS AND METHODS This prospective pilot study was approved by our institutional review board; written and informed consent was obtained for each participant. Patients underwent DCE-MRI examinations before and after TACE. A variable flip-angle unenhanced 3D mDixon sequence was performed for T1 mapping. A dynamic 4D mDixon sequence was performed after contrast injection for assessing dynamic signal enhancement. Nonparametric analysis was conducted on the time-intensity curves. Parametric analysis was performed on the time-concentration curves using a dual-input single-compartment model. Treatment response according to Liver Reporting and Data System (LI-RADS) v2018 was used as the reference standard. The comparisons within groups (before vs. after treatment) and between groups (nonviable vs. equivocal or viable tumor) were performed using nonparametric bootstrap taking into account the clustering effect of lesions in patients. RESULTS Twenty-eight patients with 52 HCCs (size: 10-104 mm) were evaluated. For nonviable tumors (n = 27), time to peak increased from 62.5 ± 18.2 s before to 83.3 ± 12.8 s after treatment (P< 0.01). For equivocal or viable tumors (n = 25), time to peak and mean transit time significantly increased (from 54.4 ± 24.1 s to 69.5 ± 18.9 s, P < 0.01 and from 14.2 ± 11.8 s to 33.9 ± 36.8 s, P= 0.01, respectively) and the transfer constant from the extracellular and extravascular space to the central vein significantly decreased from 14.8 ± 14.1 to 8.1 ± 9.1 s-1 after treatment (P= 0.01). CONCLUSION This prospective pilot DCE-MRI study showed that time to peak significantly changed after TACE treatment for both groups (nonviable tumors and equivocal or viable tumors). In our cohort, several perfusion parameters may provide an objective marker for differentiation of treatment response after TACE in HCC patients.
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Affiliation(s)
- Alana Thibodeau-Antonacci
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Léonie Petitclerc
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | | | - Laurent Bilodeau
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Damien Olivié
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Milena Cerny
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Hélène Castel
- Department of Hepatology and Liver transplantation, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Simon Turcotte
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Service, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Catherine Huet
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Pierre Perreault
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Gilles Soulez
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistics, Université de Montréal, QC, Canada
| | - Samuel Kadoury
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; École Polytechnique, Montréal, Québec, Canada
| | - An Tang
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.
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Mürtz P, Sprinkart AM, Reick M, Pieper CC, Schievelkamp AH, König R, Schild HH, Willinek WA, Kukuk GM. Accurate IVIM model-based liver lesion characterisation can be achieved with only three b-value DWI. Eur Radiol 2018; 28:4418-4428. [PMID: 29671057 DOI: 10.1007/s00330-018-5401-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate a simplified intravoxel incoherent motion (IVIM) approach of diffusion-weighted imaging (DWI) with four b-values for liver lesion characterisation at 1.5 T. METHODS DWI data from a respiratory-gated MRI sequence with b = 0, 50, 250, 800 s/mm2 were retrospectively analysed in 173 lesions and 40 healthy livers. The apparent diffusion coefficient ADC = ADC(0,800) and IVIM-based parameters D1' = ADC(50,800), D2' =ADC(250,800), f1', f2', D*', ADClow = ADC(0,50), and ADCdiff=ADClow-D2' were calculated voxel-wise without fitting procedures. Differences between lesion groups were investigated. RESULTS Focal nodular hyperplasias were best discriminated from all other lesions by f1' with an area under the curve (AUC) of 0.989. Haemangiomas were best discriminated by D1' (AUC of 0.994). For discrimination between malignant and benign lesions, ADC(0,800) and D1' were best suited (AUC of 0.915 and 0.858, respectively). Discriminatory power was further increased by using a combination of D1' and f1'. CONCLUSION IVIM parameters D and f approximated from three b-values provided more discriminatory power between liver lesions than ADC determined from two b-values. The use of b = 0, 50, 800 s/mm2 was superior to that of b = 0, 250, 800 s/mm2. The acquisition of four instead of three b-values has no further benefit for lesion characterisation. KEY POINTS • Diffusion and perfusion characteristics are assessable with only three b-values. • Association of b = 0, 50, 800 s/mm2is superior to b = 0, 250, 800 s/mm2. • A fourth acquired b-value has no benefit for differential diagnosis. • For liver lesion characterisation, simplified IVIM analysis is superior to ADC determination. • Simplified IVIM approach guarantees numerically stable, voxel-wise results and short acquisition times.
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Affiliation(s)
- P Mürtz
- Department of Radiology, University of Bonn, Bonn, Germany.
- Radiologische Klinik der Universität Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
| | - A M Sprinkart
- Department of Radiology, University of Bonn, Bonn, Germany
| | - M Reick
- Department of Radiology, University of Bonn, Bonn, Germany
| | - C C Pieper
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - R König
- Department of Radiology, University of Bonn, Bonn, Germany
| | - H H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - W A Willinek
- Department of Radiology, University of Bonn, Bonn, Germany
| | - G M Kukuk
- Department of Radiology, University of Bonn, Bonn, Germany
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Jerjir N, Bruyneel L, Haspeslagh M, Quenet S, Coenegrachts K. Intravoxel incoherent motion and dynamic contrast-enhanced MRI for differentiation between hepatocellular adenoma and focal nodular hyperplasia. Br J Radiol 2017; 90:20170007. [PMID: 28590780 DOI: 10.1259/bjr.20170007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To examine if intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced MRI (DCE-MRI) can be used as new and supplemental MRI techniques to differentiate hepatocellular adenomas (HCAs) from focal nodular hyperplasias (FNHs) and analyse if diffusion parameter apparent diffusion coefficient (ADC) and IVIM parameter true diffusion coefficient (D) differ in doing so. METHODS This prospective study included 21 patients (8 HCAs and 13 FNHs) who underwent a specifically designed MRI scanning protocol, including series for analysis of IVIM (four b-values 0, 10, 150 and 800 s mm-2) and DCE-MRI. On a dedicated workstation, identical regions of interest were placed in parametric maps of Ktrans, Ve, D and ADC in each lesion for quantification. Diagnostic accuracy was assessed using receiver operating characteristics analysis. Time-intensity curves (TICs) were classified in different types. RESULTS HCAs had significantly lower values for Ktrans (mean 1.45 vs 2.68 min-1; p = 0.029) and D (mean 1.02 × 10-3 vs 1.22 × 10-3 mm2 s-1; p = 0.033). Both parameters showed good diagnostic accuracy of 76%. TIC analysis could not differentiate between HCAs and FNHs. CONCLUSION In this exploratory study, Ktrans and D were able to differentiate HCAs from FNHs in most cases, whereas Ve, ADC and TIC analysis were not. Advances in knowledge: Histological differences between HCAs and FNHs can be quantified on MRI using Ktrans and D.
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Affiliation(s)
- Naim Jerjir
- 1 Department of Radiology, AZ St.-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Luk Bruyneel
- 2 Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium
| | - Marc Haspeslagh
- 3 Hospital Administration and Statistics, AZ St.-Jan Brugge-Oostende AV, Bruges, Belgium
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Focal Liver Lesions Classification and Characterization: What Value Do DWI and ADC Have? J Comput Assist Tomogr 2017; 40:701-8. [PMID: 27454786 DOI: 10.1097/rct.0000000000000458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this work was to analyze the value of diffusion-weighted imaging (DWI) in the classification/characterization of focal liver lesions (FLLs). METHODS Retrospective study, approved by ethical board, of 100 proven FLLs (20 hemangiomas, 20 focal nodular hyperplasia, 20 dysplastic nodules, 20 hepatocellular carcinomas, and 20 metastases) was performed by 1.5-T MR. For each lesion, 2 readers, blinded of medical history, have evaluated 6 sets of images: set A (T1/T2-weighted images), set B (set A + DWI), set C (set B + apparent diffusion coefficient [ADC] map), set D (set A + dynamic and hepatobiliary phases), set E (set D + DWI), set F (set E + ADC map). RESULTS In unenhanced images, the evaluation of the ADC improves the accuracy in classification/characterization (+9%/14%, respectively), whereas in enhanced images the accuracy was increased by DWI (+7%/12%, respectively) and ADC (+13%/19%, respectively). Diffusion-weighted imaging does not improve classification/characterization of hemangiomas, may be useful in focal nodular hyperplasia/dysplastic nodules vs metastases/hepatocellular carcinoma differentiation, and increases the classification/characterization of metastases in both unenhanced and enhanced images. CONCLUSIONS Diffusion-weighted imaging may improve classification/characterization of FLLs at unenhanced/enhanced examinations.
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Chiorean L, Caraiani C, Radziņa M, Jedrzejczyk M, Schreiber-Dietrich D, Dietrich CF. Vascular phases in imaging and their role in focal liver lesions assessment. Clin Hemorheol Microcirc 2016; 62:299-326. [PMID: 26444602 DOI: 10.3233/ch-151971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Liliana Chiorean
- Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
- Département d’Imagerie Médicale, Clinique des Cévennes Annonay, France
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, “Octavian Fodor” Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maija Radziņa
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - Maciej Jedrzejczyk
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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Sung S, Son SH, Kay CS, Lee YS. Prognosis Can Be Predicted More Accurately Using Pre- and Postchemoradiotherapy Carcinoembryonic Antigen Levels Compared to Only Prechemoradiotherapy Carcinoembryonic Antigen Level in Locally Advanced Rectal Cancer Patients Who Received Neoadjuvant Chemoradiotherapy. Medicine (Baltimore) 2016; 95:e2965. [PMID: 26962798 PMCID: PMC4998879 DOI: 10.1097/md.0000000000002965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We aimed to evaluate the prognostic value of a change in the carcinoembryonic antigen (CEA) level during neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer. A total of 110 patients with clinical T3/T4 or node-positive disease underwent nCRT and curative total mesorectal resection from February 2006 to December 2013. Serum CEA level was measured before nCRT, after nCRT, and then again after surgery. A cut-off value for CEA level to predict prognosis was determined using the maximally selected log-rank test. According to the test, patients were classified into 3 groups, based on their CEA levels (Group A: pre-CRT CEA ≤3.2; Group B: pre-CRT CEA level >3.2 and post-CRT CEA ≤2.8; and Group C: pre-CRT CEA >3.2 and post-CRT CEA >2.8). The median follow-up time was 31.1 months. The 3-year disease-free survival (DFS) rates of Group A and Group B were similar, while Group C showed a significantly lower 3-year DFS rate (82.5% vs. 89.5% vs. 55.1%, respectively, P = 0.001). Other clinicopathological factors that showed statistical significance on univariate analysis were pre-CRT CEA, post-CRT CEA, tumor distance from the anal verge, surgery type, downstage, pathologic N stage, margin status and perineural invasion. The CEA group (P = 0.001) and tumor distance from the anal verge (P = 0.044) were significant prognostic factors for DFS on multivariate analysis. Post-CRT CEA level may be a useful prognostic factor in patients whose prognosis cannot be predicted exactly by pre-CRT CEA levels alone in the neoadjuvant treatment era. Combined pre-CRT CEA and post-CRT CEA levels enable us to predict prognosis more accurately and determine treatment and follow-up policies. Further large-scale studies are necessary to validate the prognostic value of CEA levels.
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Affiliation(s)
- SooYoon Sung
- From the Department of Radiation Oncology (SYS, SHS, CSK); and Department of Surgery (YSL), Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Diffusion-weighted MRI for uveal melanoma liver metastasis detection. Eur Radiol 2015; 25:2263-73. [DOI: 10.1007/s00330-015-3662-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/11/2014] [Accepted: 02/11/2015] [Indexed: 01/16/2023]
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Maurea S, Mainenti PP, Tambasco A, Imbriaco M, Mollica C, Laccetti E, Camera L, Liuzzi R, Salvatore M. Diagnostic accuracy of MR imaging to identify and characterize focal liver lesions: comparison between gadolinium and superparamagnetic iron oxide contrast media. Quant Imaging Med Surg 2014; 4:181-9. [PMID: 24914419 DOI: 10.3978/j.issn.2223-4292.2014.01.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
To compare the diagnostic value of gadolinium (Gd) and ultrasmall superparamagnetic iron oxide (SPIO) contrast media for characterization of focal liver lesions (FLL), we retrospectively evaluated the results of magnetic resonance (MR) imaging in 68 patients (40 M, 28 F, age from 22 to 81 yrs) of which 36 with diagnosis of colo-rectal cancer, 26 with hepatic cirrhosis and 6 with incidental imaging detection of FLL. MR (Gyroscan Intera 1.5 T, Philips Medical Systems) study was performed using T1 and T2 fast-field-echo (FFE) and T2 turbo-spin-echo (TSE) sequences in axial and coronal views. Dynamic multi-phases gadolinium Gd-enhanced T1-FFE-Bh images were obtained in arterial, portal and equilibrium phases, followed by SPIO-enhanced T2-FFE scans. A qualitative analysis of pre- and post-contrast MR images to classify FLL as benign or malignant was performed using a 3-point scoring system: 0= benign; 1= suspicious for malignancy; 2= malignant. A total of 118 lesions were evaluated. In particular, histology (n=18), cytology (n=14) or clinical-imaging follow-up data (n=86) demonstrated 4 adenomas, 29 cysts, 3 focal steatosis, 25 hemangiomas, 1 focal vascular abnormality, 5 fibrotic lesions as well as 13 regenerative nodules, 6 dysplastic, 14 hepatocellular carcinomas (HCC), 17 metastasis and 1 cholangiocarcinoma. For MR imaging, diagnostic accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of Gd vs. SPIO images were respectively 83% vs. 92%, 79% vs. 74%, 85% vs. 99% (P=0.002), 68% vs. 96% (P=0.005) and 91% vs. 90%, respectively. The results suggest that SPIO-MR provides a diagnostic incremental value, as specificity and PPV, particularly to characterize FLL compared to Gd-MR; thus, we strongly recommend the use of SPIO when liver lesion characterization is requested and Gd images are uncertain.
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Affiliation(s)
- Simone Maurea
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Pier Paolo Mainenti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Annamaria Tambasco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Massimo Imbriaco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Carmine Mollica
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Ettore Laccetti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Luigi Camera
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Raffaele Liuzzi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Marco Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
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Riffel P, Rao RK, Haneder S, Meyer M, Schoenberg SO, Michaely HJ. Impact of field strength and RF excitation on abdominal diffusion-weighted magnetic resonance imaging. World J Radiol 2013; 5:334-344. [PMID: 24198912 PMCID: PMC3817292 DOI: 10.4329/wjr.v5.i9.334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively and prospectively compare diffusion-weighted (DW) images in the abdomen in a 1.5T system and 3.0T systems with and without two-channel functionality for B1 shimming.
METHODS: DW images of the abdomen were obtained on 1.5T and 3.0T (with and without two-channel functionality for B1 shimming) scanners on 150 patients (retrospective study population) and 10 volunteers (prospective study population). Eight regions were selected for clinical significance or artifact susceptibility (at higher field strengths). Objective grading quantified signal-to-noise ratio (SNR), and subjective evaluation qualified image quality, ghosting artifacts, and diagnostic value. Statistical significance was calculated using χ2 tests (categorical variables) and independent two-sided t tests or Mann-Whitney U tests (continuous variables).
RESULTS: The 3.0T using dual-source parallel transmit (dpTX 3.0T) provided the significantly highest SNRs in nearly all regions. In regions susceptible to artifacts at higher field strengths (left lobe of liver, head of pancreas), the SNR was better or similar to the 1.5T system. Subjectively, both dpTX 3.0T and 1.5T systems provided higher image quality, diagnostic value, and less ghosting artifact (P < 0.01, most values) compared to the 3.0T system without dual-source parallel transmit (non-dpTX 3.0T).
CONCLUSION: The dpTX 3.0T scanner provided the highest SNR. Its image quality, lack of ghosting, and diagnostic value were equal to or outperformed most currently used systems.
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Calcagno C, Robson PM, Ramachandran S, Mani V, Kotys-Traughber M, Cham M, Fischer SE, Fayad ZA. SHILO, a novel dual imaging approach for simultaneous HI-/LOw temporal (Low-/Hi-spatial) resolution imaging for vascular dynamic contrast enhanced cardiovascular magnetic resonance: numerical simulations and feasibility in the carotid arteries. J Cardiovasc Magn Reson 2013; 15:42. [PMID: 23706156 PMCID: PMC3668185 DOI: 10.1186/1532-429x-15-42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dynamic contrast enhanced (DCE) cardiovascular magnetic resonance (CMR) is increasingly used to quantify microvessels and permeability in atherosclerosis. Accurate quantification depends on reliable sampling of both vessel wall (VW) uptake and contrast agent dynamic in the blood plasma (the so called arterial input function, AIF). This poses specific challenges in terms of spatial/temporal resolution and matched dynamic MR signal range, which are suboptimal in current vascular DCE-CMR protocols. In this study we describe a novel dual-imaging approach, which allows acquiring simultaneously AIF and VW images using different spatial/temporal resolution and optimizes imaging parameters for the two compartments. We refer to this new acquisition as SHILO, Simultaneous HI-/LOw-temporal (low-/hi-spatial) resolution DCE-imaging. METHODS In SHILO, the acquisition of low spatial resolution single-shot AIF images is interleaved with segments of higher spatial resolution images of the VW. This allows sampling the AIF and VW with different spatial/temporal resolution and acquisition parameters, at independent spatial locations. We show the adequacy of this temporal sampling scheme by using numerical simulations. Following, we validate the MR signal of SHILO against a standard 2D spoiled gradient recalled echo (SPGR) acquisition with in vitro and in vivo experiments. Finally, we show feasibility of using SHILO imaging in subjects with carotid atherosclerosis. RESULTS Our simulations confirmed the superiority of the SHILO temporal sampling scheme over conventional strategies that sample AIF and tissue curves at the same time resolution. Both the median relative errors and standard deviation of absolute parameter values were lower for the SHILO than for conventional sampling schemes. We showed equivalency of the SHILO signal and conventional 2D SPGR imaging, using both in vitro phantom experiments (R2 =0.99) and in vivo acquisitions (R2 =0.95). Finally, we showed feasibility of using the newly developed SHILO sequence to acquire DCE-CMR data in subjects with carotid atherosclerosis to calculate plaque perfusion indices. CONCLUSIONS We successfully demonstrate the feasibility of using the newly developed SHILO dual-imaging technique for simultaneous AIF and VW imaging in DCE-CMR of atherosclerosis. Our initial results are promising and warrant further investigation of this technique in wider studies measuring kinetic parameters of plaque neovascularization with validation against gold standard techniques.
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Affiliation(s)
- Claudia Calcagno
- Translational and Molecular Imaging Institute, Imaging Science Laboratories, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Philip M Robson
- Translational and Molecular Imaging Institute, Imaging Science Laboratories, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Sarayu Ramachandran
- Translational and Molecular Imaging Institute, Imaging Science Laboratories, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Venkatesh Mani
- Translational and Molecular Imaging Institute, Imaging Science Laboratories, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | | | - Matthew Cham
- Translational and Molecular Imaging Institute, Imaging Science Laboratories, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Stefan E Fischer
- MR Clinical Science, Philips Healthcare, 595 Miner Road, Cleveland, OH 44143, USA
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Imaging Science Laboratories, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029, USA
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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Penner AH, Sprinkart AM, Kukuk GM, Gütgemann I, Gieseke J, Schild HH, Willinek WA, Mürtz P. Intravoxel incoherent motion model-based liver lesion characterisation from three b-value diffusion-weighted MRI. Eur Radiol 2013; 23:2773-83. [PMID: 23666233 DOI: 10.1007/s00330-013-2869-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/15/2013] [Accepted: 03/25/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate intravoxel incoherent motion (IVIM) model-based liver lesion characterisation from three b-value diffusion-weighted imaging (DWI). METHODS The 1.5-T DWI data from a respiratory gated spin-echo echo-planar magnetic resonance imaging sequence (b = 0, 50, 800 s/mm(2)) were retrospectively analysed in 38 patients with different liver lesions. Conventional apparent diffusion coefficient ADC = ADC(0,800) as well as IVIM-based parameters D' = ADC(50,800), ADC_low = ADC(0,50), and f' were calculated voxel-wise. Sixty-one regions of interest in hepatocellular carcinomas (HCCs, n = 24), haemangiomas (HEMs, n = 11), focal nodular hyperplasias (FNHs, n = 11), and healthy liver tissue (REFs, n = 15) were analysed. Group differences were investigated using Student's t-test and receiver-operating characteristic (ROC) analysis. RESULTS Mean values ± standard deviations of ADC, D', ADC_low (in 10(-5) mm(2)/s), and f' (in %) for REFs/FNHs/HEMs/HCCs were 130 ± 11/143 ± 27/168 ± 16/113 ± 25, 104 ± 12/123 ± 25/162 ± 18/102 ± 23, 518 ± 66/437 ± 97/268 ± 69/283 ± 120, and 18 ± 3/14 ± 4/6 ± 3/9 ± 5, respectively. Differences between lesions and REFs were more significant for IVIM-based parameters than for conventional ADC. ROC analysis showed the best discriminability between HCCs and FNHs for ADC_low and f' and between HEMs and FNHs or HCCs for D'. CONCLUSION Three instead of two b-value DWI enables a numerically stable and voxel-wise IVIM-based analysis for improved liver lesion characterisation with tolerable acquisition time. KEY POINTS • Quantitative analysis of diffusion-weighted MRI helps liver lesion characterisation. • Analysis of intravoxel incoherent motion is superior to apparent diffusion coefficient determination. • Only three b-values enable separation of diffusion and microcirculation effects. • The method presented is numerically stable, with voxel-wise results and short acquisition times.
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Affiliation(s)
- A-H Penner
- Department of Radiology, University of Bonn, Bonn, Germany
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25
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Wagner M, Maggiori L, Ronot M, Paradis V, Vilgrain V, Panis Y, Van Beers BE. Diffusion-weighted and T2-weighted MR imaging for colorectal liver metastases detection in a rat model at 7 T: a comparative study using histological examination as reference. Eur Radiol 2013; 23:2156-64. [DOI: 10.1007/s00330-013-2789-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/31/2012] [Accepted: 01/20/2013] [Indexed: 01/03/2023]
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26
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Puppa G, Poston G, Jess P, Nash GF, Coenegrachts K, Stang A. Staging colorectal cancer with the TNM 7 th: The presumption of innocence when applying the M category. World J Gastroenterol 2013; 19:1152-7. [PMID: 23483791 PMCID: PMC3587470 DOI: 10.3748/wjg.v19.i8.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/18/2012] [Accepted: 09/19/2012] [Indexed: 02/06/2023] Open
Abstract
One of the main changes of the current TNM-7 is the elimination of the category MX, since it has been a source of ambiguity and misinterpretation, especially by pathologists. Therefore the ultimate staging would be better performed by the patient’s clinician who can classify the disease M0 (no distant metastasis) or M1 (presence of distant metastasis), having access to the completeness of data resulting from clinical examination, imaging workup and pathology report. However this important change doesn’t take into account the diagnostic value and the challenge of small indeterminate visceral lesions encountered, in particular, during radiological staging of patients with colorectal cancer. In this article the diagnosis of these lesions with multiple imaging modalities, their frequency, significance and relevance to staging and disease management are described in a multidisciplinary way. In particular the interplay between clinical, radiological and pathological staging, which are usually conducted independently, is discussed. The integrated approach shows that there are both advantages and disadvantages to abandoning the MX category. To avoid ambiguity arising both by applying and interpreting MX category for stage assigning, its abandoning seems reasonable. The recognition of the importance of small lesion characterization raises the need for applying a separate category; therefore a proposal for their categorization is put forward. By using the proposed categorization the lack of consideration for indeterminate visceral lesions with the current staging system will be overcome, also optimizing tailored follow-up.
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27
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Henninger B, Petersen J, Jaschke W. [Radiological diagnosis of primary hepatic malignancy]. Wien Med Wochenschr 2013; 163:113-22. [PMID: 23392810 DOI: 10.1007/s10354-013-0179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
Abstract
Modern radiology offers countless opportunities both in the detection but also in the characterization of primary liver malignancies. Ultrasound remains usually the first exploratory overview study whereat using ultrasound contrast agent for a further characterization of liver lesions improves this technique considerably. Advanced cross-sectional imaging methods can, in most cases, already provide an exact diagnosis. Thus, the CT is already considered a standard technique for liver imaging and magnetic resonance imaging has gained in recent years due to liver-specific contrast agents and faster sequences a central role in liver imaging. The following article provides an overview of these various radiological procedures and describes the different primary liver malignancies and their imaging characteristics.
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Affiliation(s)
- Benjamin Henninger
- Department Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich.
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28
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Jarraya H, Mirabel X, Taieb S, Dewas S, Tresch E, Bonodeau F, Adenis A, Kramar A, Lartigau E, Ceugnart L. Image-based response assessment of liver metastases following stereotactic body radiotherapy with respiratory tracking. Radiat Oncol 2013; 8:24. [PMID: 23363610 PMCID: PMC3627622 DOI: 10.1186/1748-717x-8-24] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/22/2013] [Indexed: 02/06/2023] Open
Abstract
Objective To describe post-CyberKnife® imaging characteristics of liver metastases as an aid in assessing response to treatment, and a novel set of combined criteria (CC) as an alternative to response according to change in size (RECIST). Subjects and Methods Imaging data and medical records of 28 patients with 40 liver metastases treated with stereotactic body radiotherapy (SBRT) were reviewed. Tumor size, CT attenuation coefficient, and contrast enhancement of lesions were evaluated up to 2 years post SBRT. Rates of local control, progression-free survival, time to progression, and overall survival according to RECIST and CC were estimated. Results Complete response (CR) was 3.6% (95% CI: 0.1–18%) and 18% (95% CI: 6–37%) according to RECIST and combined criteria, respectively. Two progressive diseases and two partial responses according to RECIST were classified as CR by the combined criteria and one stable response according to RECIST was classified as progressive by CC (Stuart-Maxwell test, p = 0.012). The disease control rate was 60.7% (95% CI: 41–78%) by RECIST and 64% (95% CI: 44%–81%) by CC. Conclusion Use of response criteria based on change in size alone in the interpretation of liver response to SBRT may be inadequate. We propose a simple algorithm with a combination of criteria to better assess tumor response. Further studies are needed to confirm their validity.
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Affiliation(s)
- Hajer Jarraya
- Department of Radiology, CLCC Oscar Lambret, 3 rue Frédéric Combemale, BP 307, Lille cedex, 59020, France.
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Lee JM, Yoon JH, Joo I, Woo HS. Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma. Liver Cancer 2012; 1:22-40. [PMID: 24159569 PMCID: PMC3747553 DOI: 10.1159/000339018] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Accurate diagnosis and assessment of disease extent are crucial for proper management of patients with HCC. Imaging plays a crucial role in early detection, accurate staging, and the planning of management strategies. A variety of imaging modalities are currently used in evaluating patients with suspected HCC; these include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography. Among these modalities, dynamic MRI and CT are regarded as the best imaging techniques available for the noninvasive diagnosis of HCC. Recent improvements in CT and MRI technology have made noninvasive and reliable diagnostic assessment of hepatocellular nodules possible in the cirrhotic liver, and biopsy is frequently not required prior to treatment. Until now, the major challenge for radiologists in imaging cirrhosis has been the characterization of small cirrhotic nodules smaller than 2 cm in diameter. Further technological advancement will undoubtedly have a major impact on liver tumor imaging. The increased speed of data acquisition in CT and MRI has allowed improvements in both spatial and temporal resolution, which have made possible a more precise evaluation of the hemodynamics of liver nodules. Furthermore, the development of new, tissue-specific contrast agents such as gadoxetic acid has improved HCC detection on MRI. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC, recent technological advances, and the strengths and limitations of these imaging modalities.
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Affiliation(s)
| | - Jeong-Hee Yoon
- *Jeong Min Lee, MD, Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744 (South Korea), Tel. +82 2 2072 3154, E-Mail
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30
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Abstract
The differential diagnosis of a liver mass is large and requires understanding of the clinical and imaging features of liver lesions. A detailed history, physical examination, hepatic biochemical tests, and imaging studies are all essential in making the diagnosis. Decisions regarding specific imaging modalities for diagnoses, the use of liver biopsy, therapeutic options, and appropriate follow-up are all determined by the presentation of the lesion and associated patient characteristics.
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Affiliation(s)
- Alan Bonder
- Department of Medicine, Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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