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Romeih M, Mahrous MR, El Kassas M. Incidental radiological findings suggestive of COVID-19 in asymptomatic patients. World J Radiol 2022; 14:1-12. [PMID: 35126873 PMCID: PMC8788167 DOI: 10.4329/wjr.v14.i1.1] [Citation(s) in RCA: 1] [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: 02/01/2021] [Revised: 09/09/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Despite routine screening of patients for coronavirus disease 2019 (COVID-19) symptoms and signs at hospital entrances, patients may slip between the cracks and be incidentally discovered to have lung findings that could indicate COVID-19 infection on imaging obtained for other reasons. Multiple case reports and case series have been published to identify the pattern of this highly infectious disease. This article addresses the radiographic findings in different imaging modalities that may be incidentally seen in asymptomatic patients who carry COVID-19. In general, findings of COVID-19 infection may appear in computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, ultrasound, or plain X-rays that show lung or only apical or basal cuts. The identification of these characteristics by radiologists and clinicians is crucial because this would help in the early recognition of cases so that a rapid treatment protocol can be established, the immediate isolation to reduce community transmission, and the organization of close monitoring. Thus, it is important to both the patient and the physician that these findings are highlighted and reported.
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Affiliation(s)
- Marwa Romeih
- Department of Radiodiagnosis, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Mary R Mahrous
- Department of Radiodiagnosis, National Heart institute, Cairo 11795, Egypt
| | - Mohamed El Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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2
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Abstract
There are >1.5 billion people with chronic liver disease worldwide, causing liver diseases to be a significant global health issue. Diffuse parenchymal liver diseases, including hepatic steatosis, fibrosis, metabolic diseases, and hepatitis cause chronic liver injury and may progress to fibrosis and eventually hepatocellular carcinoma. As early diagnosis and treatment of these diseases impact the progression and outcome, the need for assessment of the liver parenchyma has increased. While the current gold standard for evaluation of the hepatic parenchymal tissue, biopsy has disadvantages and limitations. Consequently, noninvasive methods have been developed based on serum biomarkers and imaging techniques. Conventional imaging modalities such as ultrasound, computed tomography scan, and magnetic resonance imaging provide noninvasive options for assessment of liver tissue. However, several recent advances in liver imaging techniques have been introduced. This review article focuses on the current status of imaging methods for diffuse parenchymal liver diseases assessment including their diagnostic accuracy, advantages and disadvantages, and comparison between different techniques.
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Hu P, Sun J, Lv F, Pi B, Xu F, Han G, Hu X, Wang Y, Huang N, Wu X, Yang X. Diffusion-weighted imaging and variable flip angle T1 mapping: a supplement for image-guided biopsy in follow-up analysis of liver fibrosis. J Interv Med 2019; 1:150-156. [PMID: 34805843 PMCID: PMC8586563 DOI: 10.19779/j.cnki.2096-3602.2018.03.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose To evaluate the performance of diffusion-weighted imaging (DWI) and variable flip angle (VFA) T1 mapping as a supplement to image-guided biopsy in follow-up analysis of liver fibrosis. Materials and Methods This prospective study was approved by the institution's committee on human research, and written informed consent was provided from the enrolled patients. We investigated five MRI parameters of DWI and VFA T1 mapping, collected from 11 patients who underwent serial ultrasound image-guided biopsy with follow-up MRI within 1.5 years after treatment for liver fibrosis/cirrhosis. For each patient, four consecutive MRI examinations were conducted, including baseline MRI before treatment and three follow-up MRI examinations after treatment at each 0.5-year interval. ADC values at four b values and T1 relaxation times were correlated to pathology-confirmed liver fibrosis stages, which were subsequently divided into two groups, stages F2-3 and F4. The receiver operating characteristic (ROC) analysis and repeated measurement analysis of variance were used for statistical analysis. Results Among these ADC parameters, ADC value (b = 500 s/mm2) was the most consistent in differentiating between stage F2-3 and F4 liver fibrosis. Repeated measurement analysis showed that the intra-group and inter-group differences were 0.447 and 0.024, respectively. T1 relaxation time could not consistently differentiate between the F2-3 and F4 groups; however, it was repeatable, and the intra-group and inter-group differences were 0.410 and 0.042, respectively. Conclusion MRI-ADC value at a b value of 500 s/mm2 can be a promising biomarker for differentiating stages F2-3 and F4 liver fibrosis. A combination of this biomarker with repeatable T1 relaxation time may function as a non-invasive tool for follow-up liver fibrosis in patients who reject repeated image-guided biopsy.
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Affiliation(s)
- Peng Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China,Correspondence: Xiaoming Yang, MD, PhD, Image-Guided Bio-Molecular Interventions Research, Department of Radiology, University of Washington School of Medicine, 815 Mercer Street, Room S470, Seattle, WA 98109, USA, Tel: +1-206-685-6967; E-mail: . Jihong Sun MD, PhD, Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China, Tel: +86-571-86006764; E-mail:
| | - Fangfang Lv
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Borui Pi
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Fangping Xu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Guocan Han
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Xi Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Yue Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | | | - Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City 310016, Zhejiang Province, China,Image-Guided Bio-Molecular Interventions Research, Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA 98109,Correspondence: Xiaoming Yang, MD, PhD, Image-Guided Bio-Molecular Interventions Research, Department of Radiology, University of Washington School of Medicine, 815 Mercer Street, Room S470, Seattle, WA 98109, USA, Tel: +1-206-685-6967; E-mail: . Jihong Sun MD, PhD, Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China, Tel: +86-571-86006764; E-mail:
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Wang G, Zhu S, Li X. Comparison of values of CT and MRI imaging in the diagnosis of hepatocellular carcinoma and analysis of prognostic factors. Oncol Lett 2018; 17:1184-1188. [PMID: 30655882 PMCID: PMC6312947 DOI: 10.3892/ol.2018.9690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023] Open
Abstract
Value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of small hepatocellular carcinoma (HCC), and in analysis of the prognostic factors of primary hepatocellular carcinoma (PHC) were compared. A total of 300 patients with PHC were selected from January 2013 to January 2016. Among them, 170 patients were diagnosed with small HCC. Patients were diagnosed by MRI and CT scans, respectively, and diagnostic efficacy of the methods was compared. A single factor and multivariate analysis of prognostic factors were performed on 300 patients. The sensitivity of MRI screening was 78.82%, specificity was 78.46%, accuracy was 78.67%, positive predictive value was 82.72%, and negative predictive value was 73.91%. CT screening showed a sensitivity of 62.35%, a specificity of 73.85%, an accuracy of 67.33%, a positive predictive value of 75.71%, and a negative predictive value of 60.00%. Differences in sensitivity, accuracy, and negative predictive value between MRI and CT screening were statistically significant (P<0.05). There was no statistically significant difference between two groups in specificity and positive predictive value (P>0.05). Diagnostic efficiency of MRI is better than that of CT diagnosis. Univariate analysis showed that age, hepatitis B cirrhosis background, tumor stage, and portal vein embolization were prognostic factors for PHC. Cox multivariate regression analysis showed that the background of liver cirrhosis, tumor stage, and portal thrombosis were independent risk factors for poor prognosis for PHC patient and the differences were statistically significant (P<0.05). MRI is superior to CT in the sensitivity, specificity and accuracy of the diagnosis of small HCC. Individualized comprehensive treatment plans based on the patient's condition may be effective in prolonging the patient's survival time. Imaging diagnosis can provide survival basis for patients, improve diagnostic accuracy, and help to improve the survival rate.
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Affiliation(s)
- Guibin Wang
- Department of Imaging, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Shicai Zhu
- Department of Imaging, Linyi Thoracic Hospital, Linyi, Shandong 276002, P.R. China
| | - Xiukui Li
- Department of Imaging, Linyi Cancer Hospital, Linyi, Shandong 276001, P.R. China
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Barat M, Soyer P, Dautry R, Pocard M, Lo-Dico R, Najah H, Eveno C, Cassinotto C, Dohan A. Preoperative detection of malignant liver tumors: Comparison of 3D-T2-weighted sequences with T2-weighted turbo spin-echo and single shot T2 at 1.5 T. Eur J Radiol 2018; 100:7-13. [PMID: 29496082 DOI: 10.1016/j.ejrad.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/28/2017] [Accepted: 01/05/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the performances of three-dimensional (3D)-T2-weighted sequences compared to standard T2-weighted turbo spin echo (T2-TSE), T2-half-Fourier acquisition single-shot turbo spin-echo (T2-HASTE), diffusion weighted imaging (DWI) and 3D-T1-weighted VIBE sequences in the preoperative detection of malignant liver tumors. METHODS From 2012 to 2015, all patients of our institution undergoing magnetic resonance imaging (MRI) examination for suspected malignant liver tumors were prospectively included. Patients had contrast-enhanced 3D-T1-weighted, DWI, 3D-T2-SPACE, T2-HASTE and T2-TSE sequences. Imaging findings were compared with those obtained at follow-up, surgery and histopathological analysis. Sensitivities for the detection of malignant liver tumors were compared for each sequence using McNemar test. A subgroup analysis was conducted for HCCs. Image artifacts were analyzed and compared using Wilcoxon paired signed rank-test. RESULTS Thirty-three patients were included: 13 patients had 40 hepatocellular carcinomas (HCC) and 20 had 54 liver metastases. 3D-T2-weighted sequences had a higher sensitivity than T2-weighted TSE sequences for the detection of malignant liver tumors (79.8% versus 68.1%; P < 0.001). The difference did not reach significance for HCC. T1-weighted VIBE and DWI had a higher sensitivity than T2-weighted sequences. 3D-T2-weighted-SPACE sequences showed significantly less artifacts than T2-weitghted TSE. CONCLUSION 3D-T2-weighted sequences show very promising performances for the detection of liver malignant tumors compared to T2-weighted TSE sequences.
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Affiliation(s)
- Maxime Barat
- Department of Body and Interventional Imaging, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; UMR INSERM 965, Hôpital Lariboisière, 2 rue Amboise Paré, 75010 Paris, France.
| | - Philippe Soyer
- UMR INSERM 965, Hôpital Lariboisière, 2 rue Amboise Paré, 75010 Paris, France; Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du faubourg St Jacques, 75014 Paris, France; Université Sorbonne-Paris Cité, Paris-Diderot, 10 rue de Verdun, 75010 Paris, France.
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
| | - Marc Pocard
- UMR INSERM 965, Hôpital Lariboisière, 2 rue Amboise Paré, 75010 Paris, France; Université Sorbonne-Paris Cité, Paris-Diderot, 10 rue de Verdun, 75010 Paris, France; Department of Digestive and Oncologic Surgery, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
| | - Rea Lo-Dico
- Université Sorbonne-Paris Cité, Paris-Diderot, 10 rue de Verdun, 75010 Paris, France; Department of Digestive and Oncologic Surgery, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
| | - Haythem Najah
- Université Sorbonne-Paris Cité, Paris-Diderot, 10 rue de Verdun, 75010 Paris, France; Department of Digestive and Oncologic Surgery, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
| | - Clarisse Eveno
- UMR INSERM 965, Hôpital Lariboisière, 2 rue Amboise Paré, 75010 Paris, France; Université Sorbonne-Paris Cité, Paris-Diderot, 10 rue de Verdun, 75010 Paris, France; Department of Digestive and Oncologic Surgery, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
| | - Christophe Cassinotto
- Department of Diagnostic and Interventional Imaging, Hôpîtal Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1 Avenue de Magellan, 33604 Pessac, France; INSERM U1053, Université Bordeaux, Bordeaux, France.
| | - Anthony Dohan
- UMR INSERM 965, Hôpital Lariboisière, 2 rue Amboise Paré, 75010 Paris, France; Department of Body and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du faubourg St Jacques, 75014 Paris, France; Université Sorbonne-Paris Cité, Paris-Diderot, 10 rue de Verdun, 75010 Paris, France; McGill University Health Center, Department of Radiology, McGill University Health Center, 1650 Cedar Avenue, Rm C5 118, Montreal, QC, Canada.
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Abstract
Liver fibrosis is an important pathological precondition for hepatocellular carcinoma. The degree of hepatic fibrosis is positively correlated with liver cancer. Liver fibrosis is a series of pathological and physiological process related to liver cell necrosis and degeneration after chronic liver injury, which finally leads to extracellular matrix and collagen deposition. The early detection and precise staging of fibrosis and cirrhosis are very important for early diagnosis and timely initiation of appropriate therapeutic regimens. The risk of severe liver fibrosis finally progressing to liver carcinoma is >50%. It is known that biopsy is the gold standard for the diagnosis and staging of liver fibrosis. However, this method has some limitations, such as the potential for pain, sampling variability, and low patient acceptance. Furthermore, the necessity of obtaining a tissue diagnosis of liver fibrosis still remains controversial. An increasing number of reliable non-invasive approaches are now available that are widely applied in clinical practice, mostly in cases of viral hepatitis, resulting in a significantly decreased need for liver biopsy. In fact, the non-invasive detection and evaluation of liver cirrhosis now has good accuracy due to current serum markers, ultrasound imaging, and magnetic resonance imaging quantification techniques. A prominent advantage of the non-invasive detection and assessment of liver fibrosis is that liver fibrosis can be monitored repeatedly and easily in the same patient. Serum biomarkers have the advantages of high applicability (>95%) and good reproducibility. However, their results can be influenced by different patient conditions because none of these markers are liver-specific. The most promising techniques appear to be transient elastography and magnetic resonance elastography because they provide reliable results for the detection of fibrosis in the advanced stages, and future developments promise to increase the reliability and accuracy of the staging of hepatic fibrosis. This article aims to describe the recent progress in the development of non-invasive assessment methods for the staging of liver fibrosis, with a special emphasize on computer-aided quantitative and deep learning methods.
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Affiliation(s)
- Chengxi Li
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Rentao Li
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Wei Zhang
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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7
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Talaat Ali M, Fouad Osman M, Homos MD, Mohamed Nabil D. Role of 3-T diffusion-weighted magnetic resonance imaging in differentiation between benign and malignant hepatic lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Lavelle L, O'Neill A, McMahon C, Cantwell C, Heffernan E, Malone D, Daly L, Skehan S. Is diffusion-weighted MRI sufficient for follow-up of neuroendocrine tumour liver metastases? Clin Radiol 2016; 71:863-8. [DOI: 10.1016/j.crad.2016.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023]
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9
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Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aubé C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol 2016; 26:4595-4615. [PMID: 26883327 DOI: 10.1007/s00330-016-4250-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. METHODS A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. RESULTS Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. CONCLUSIONS In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. KEY POINTS • DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard.
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Affiliation(s)
- Valérie Vilgrain
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,University Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Maxime Esvan
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Maxime Ronot
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Aurore Caumont-Prim
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Christophe Aubé
- Department of Radiology, CHU d'Angers, Angers, France.,Laboratoire HIFIH, LUNAM, Université d'Angers, Angers, France
| | - Gilles Chatellier
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 75006, Paris, France
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10
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Colagrande S, Castellani A, Nardi C, Lorini C, Calistri L, Filippone A. The role of diffusion-weighted imaging in the detection of hepatic metastases from colorectal cancer: A comparison with unenhanced and Gd-EOB-DTPA enhanced MRI. Eur J Radiol 2016; 85:1027-34. [PMID: 27130067 DOI: 10.1016/j.ejrad.2016.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/14/2015] [Accepted: 02/08/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare the role of DWI vs. gadoxetic-acid-disodium enhanced MRI in the detection of colorectal hepatic metastases. METHODS Fifty-four patients with 115 hepatic metastases were included in this retrospective study, approved by the Ethical Board. All patients underwent intraoperative-ultrasound and surgical resection within two weeks after MRI. Images were grouped in 4 sets, which were analyzed by two radiologists in different sessions: unenhanced T1-T2w (set A), set A plus DWI (set B), set A plus gadoxetic-acid-disodium (set C), set A plus DWI plus gadoxetic-acid-disodium (set D). For each set, metastases presence/size/site was reported. Interobserver agreement and statistical significance were assessed by Cohen's kappa and Mc-Nemar's test, respectively. RESULTS Readers' agreement was always very good (k>0.80). Mean sensitivity values were 84.3/92.1/95.6/97.3% for set A/B/C/D, respectively. Mean specificity, positive predicted, negative predicted, and accuracy values strongly and progressively increased in the various set too: from 62.5% (set A) to 85.0% as for specificity, from 92.8% to 97.3% as for positive predicted value, from 41.0% to 85.1% as for negative predicted value, and from 81.1% to 95.5% as for accuracy. For each reader from set A to D, the number of false negatives progressively decreases. CONCLUSIONS For both readers, DWI improved all statistical parameters in the unenhanced examinations, as for nodules either smaller or greater than 1cm, while in the EOB-enhanced examinations DWI prevalently increased specificity/negative predictive value.
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Affiliation(s)
- Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy.
| | - Alessandro Castellani
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy.
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy.
| | - Chiara Lorini
- Department of Health Science, University of Florence, viale GB Morgagni 48, Florence 50134, Italy.
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence 50134, Italy.
| | - Antonella Filippone
- Departement of Neurosciences and Imaging, Section of Radiological Imaging, "G. d'Annunzio" University-Ospedale SS. Annunziata, Via dei Vestini, Chieti 66013, Italy.
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11
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Ni P, Lin Y, Zhong Q, Chen Z, Sandrasegaran K, Lin C. Technical advancements and protocol optimization of diffusion-weighted imaging (DWI) in liver. Abdom Radiol (NY) 2016; 41:189-202. [PMID: 26830624 DOI: 10.1007/s00261-015-0602-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An area of rapid advancement in abdominal MRI is diffusion-weighted imaging (DWI). By measuring diffusion properties of water molecules, DWI is capable of non-invasively probing tissue properties and physiology at cellular and macromolecular level. The integration of DWI as part of abdominal MRI exam allows better lesion characterization and therefore more accurate initial diagnosis and treatment monitoring. One of the most technical challenging, but also most useful abdominal DWI applications is in liver and therefore requires special attention and careful optimization. In this article, the latest technical developments of DWI and its liver applications are reviewed with the explanations of the technical principles, recommendations of the imaging parameters, and examples of clinical applications. More advanced DWI techniques, including Intra-Voxel Incoherent Motion (IVIM) diffusion imaging, anomalous diffusion imaging, and Diffusion Kurtosis Imaging (DKI) are discussed.
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Affiliation(s)
- Ping Ni
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Yuning Lin
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Qun Zhong
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Ziqian Chen
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Kumar Sandrasegaran
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 950 West Walnut St. R2 E124, Indianapolis, IN, 46202, USA
| | - Chen Lin
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 950 West Walnut St. R2 E124, Indianapolis, IN, 46202, USA.
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12
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Improved differentiation between hepatic hemangioma and metastases on diffusion-weighted MRI by measurement of standard deviation of apparent diffusion coefficient. Clin Imaging 2015; 39:654-8. [DOI: 10.1016/j.clinimag.2015.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 12/15/2022]
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13
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Diffusion-weighted MRI for the assessment of liver fibrosis: principles and applications. BIOMED RESEARCH INTERNATIONAL 2015; 2015:874201. [PMID: 25866819 PMCID: PMC4383436 DOI: 10.1155/2015/874201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 12/14/2014] [Accepted: 01/01/2015] [Indexed: 12/19/2022]
Abstract
The importance of an early identification of hepatic fibrosis has been emphasized, in order to start therapy and obtain fibrosis regression. Biopsy is the gold-standard method for the assessment of liver fibrosis in chronic liver diseases, but it is limited by complications, interobserver variability, and sampling errors. Several noninvasive methods have been recently introduced into clinical routine, in order to detect liver fibrosis early. One of the most diffuse approaches is represented by diffusion-weighted liver MRI. In this review, the main technical principles are briefly reported in order to explain the rationale for clinical applications. In addition, roles of apparent diffusion coefficient, intravoxel incoherent motion, and relative apparent diffusion coefficient are also reported, showing their advantages and limits.
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Palmucci S. Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI. World J Hepatol 2014; 6:477-485. [PMID: 25067999 PMCID: PMC4110539 DOI: 10.4254/wjh.v6.i7.477] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/14/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Since its clinical introduction, several studies in literature have investigated gadolinium ethoxybenzhyl diethylenetriaminepentaacetic acid or gadoxetic acid (Gd-EOB-DTPA) properties. Following contrast injection, it provides dynamic vascular phases (arterial, portal and equilibrium phases) and hepatobiliary phase, the latter due to its uptake by functional hepatocytes. The main advantages of Gd-EOB-DTPA of focal liver lesion detection and characterization are discussed in this paper. Namely, we focus on the possibility of distinguishing focal nodular hyperplasia (FNH) from hepatic adenoma (HA), the identification of early hepatocellular carcinoma (HCC) and the pre-operative assessment of metastasis in liver parenchyma. Regarding the differentiation between FNH and HA, adenoma typically appears hypointense in hepatobiliary phase, whereas FNH is isointense or hyperintense to the surrounding hepatic parenchyma. As for the identification of early HCCs, many papers recently published in literature have emphasized the contribution of hepatobiliary phase in the characterization of nodules without a typical hallmark of HCC. Atypical nodules (no hypervascularizaton observed on arterial phase and/or no hypovascular appearance on portal phase) with low signal intensity in the hepatobiliary phase, have a high probability of malignancy. Finally, regarding the evaluation of focal hepatic metastases, magnetic resonance pre-operative assessment using gadoxetic acid allows for more accurate diagnosis.
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Yoo RE, Lee JM, Yoon JH, Kim JH, Han JK, Choi BI. Differential diagnosis of benign and malignant distal biliary strictures: Value of adding diffusion-weighted imaging to conventional magnetic resonance cholangiopancreatography. J Magn Reson Imaging 2013; 39:1509-17. [DOI: 10.1002/jmri.24304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 06/18/2013] [Indexed: 02/01/2023] Open
Affiliation(s)
- Roh-Eul Yoo
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
| | - Jeong Min Lee
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
| | - Jeong Hee Yoon
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
| | - Jung Hoon Kim
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
| | - Joon Koo Han
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
| | - Byung Ihn Choi
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
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Krause P, Flikweert H, Monin M, Seif Amir Hosseini A, Helms G, Cantanhede G, Ghadimi BM, Koenig S. Increased growth of colorectal liver metastasis following partial hepatectomy. Clin Exp Metastasis 2013; 30:681-93. [PMID: 23385555 PMCID: PMC3663204 DOI: 10.1007/s10585-013-9572-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/22/2013] [Indexed: 12/11/2022]
Abstract
Nearly 50 % of colorectal cancer (CRC) patients develop liver metastases with liver resection being the only option to cure patients. Residual micrometastases or circulating tumor cells are considered a cause of tumor relapse. This work investigates the influence of partial hepatectomy (PH) on the growth and molecular composition of CRC liver metastasis in a syngeneic rat model. One million CC531 colorectal tumor cells were implanted via the portal vein in WAG/Rij rats followed by a 30 % PH a day later. Control groups either received tumor cells followed by a sham-operation or were injected with a buffer solution followed by PH. Animals were examined with magnetic resonance imaging (MRI) and liver tissues were processed for immunolabeling and PCR analysis. One-third PH was associated with an almost threefold increase in relative tumor mass (MRI volumetry: 2.8-fold and transcript levels of CD44: 2.3-fold). Expression of molecular markers for invasiveness and aggressiveness (CD49f, CXCR4, Axin2 and c-met) was increased following PH, however with no significant differences when referring to the relative expression levels (relating to tumor mass). Liver metastases demonstrated a significantly higher proliferation rate (Ki67) 2 weeks following PH and cell divisions also increased in the surrounding liver tissue. Following PH, the stimulated growth of metastases clearly exceeded the compensation in liver volume with long-lasting proliferative effects. However, the distinct tumor composition was not influenced by liver regeneration. Future investigations should focus on the inhibition of cell cycle (i.e. systemic therapy strategies, irradiation) to hinder liver regeneration and therefore restrain tumor growth.
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Affiliation(s)
- P Krause
- Department of General and Visceral Surgery, University Medical Centre, Georg-August-University Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany
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