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Suhail Najm Alareer H, Arian A, Fotouhi M, Taher HJ, Dinar Abdullah A. Evidence Supporting Diagnostic Value of Liver Imaging Reporting and Data System for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. J Biomed Phys Eng 2024; 14:5-20. [PMID: 38357604 PMCID: PMC10862115 DOI: 10.31661/jbpe.v0i0.2211-1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/12/2023] [Indexed: 02/16/2024]
Abstract
Background Based on the Liver Imaging Data and Reporting System (LI-RADS) guidelines, Hepatocellular Carcinoma (HCC) can be diagnosed using imaging criteria in patients at risk of HCC. Objective This study aimed to assess the diagnostic value of LI-RADS in high-risk patients with HCC. Material and Methods This systematic review is conducted on international databases, including Google Scholar, Web of Science, PubMed, Embase, PROQUEST, and Cochrane Library, with appropriate keywords. Using the binomial distribution formula, the variance of each study was calculated, and all the data were analyzed using STATA version 16. The pooled sensitivity and specificity were determined using a random-effects meta-analysis approach. Also, we used the chi-squared test and I2 index to calculate heterogeneity among studies, and Funnel plots and Egger tests were used for evaluating publication bias. Results The pooled sensitivity was estimated at 0.80 (95% CI 0.76-0.84). According to different types of Liver Imaging Reporting and Data Systems (LI-RADS), the highest pooled sensitivity was in version 2018 (0.83 (95% CI 0.79-0.87) (I2: 80.6%, P of chi 2 test for heterogeneity <0.001 and T2: 0.001). The pooled specificity was estimated as 0.89 (95% CI 0.87-0.92). According to different types of LI-RADS, the highest pooled specificity was in version 2014 (93.0 (95% CI 89.0-96.0) (I2: 81.7%, P of chi 2 test for heterogeneity <0.001 and T2: 0.001). Conclusion LI-RADS can assist radiologists in achieving the required sensitivity and specificity in high-risk patients suspected to have HCC. Therefore, this strategy can serve as an appropriate tool for identifying HCC.
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Affiliation(s)
- Hayder Suhail Najm Alareer
- Department of Radiology, College of Health and Medical Technology, Al-Ayen University, Thi-Qar, 64001, Iraq
| | - Arvin Arian
- Cancer Institute ADIR, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Fotouhi
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Centre for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Ayoob Dinar Abdullah
- Department of Radiology Technology, Al-Manara College for Medical Sciences, Missan, Iraq
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Alwassief A, Al-Busafi S, Abbas QL, Al Shamusi K, Paquin SC, Sahai AV. Endohepatology: The endoscopic armamentarium in the hand of the hepatologist. Saudi J Gastroenterol 2024; 30:4-13. [PMID: 37988109 PMCID: PMC10852142 DOI: 10.4103/sjg.sjg_214_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 11/22/2023] Open
Abstract
ABSTRACT Recent advances in the field of hepatology include new and effective treatments for viral hepatitis. Further effort is now being directed to other disease entities, such as non-alcoholic fatty liver disease, with an increased need for assessment of liver function and histology. In fact, with the evolving nomenclature of fat-associated liver disease and the emergence of the term "metabolic-associated fatty liver disease" (MAFLD), new diagnostic challenges have emerged as patients with histologic absence of steatosis can still be classified under the umbrella of MAFLD. Currently, there is a growing number of endoscopic procedures that are pertinent to patients with liver disease. Indeed, interventional radiologists mostly perform interventional procedures such as percutaneous and intravascular procedures, whereas endoscopists focus on screening for and treatment of esophageal and gastric varices. EUS has proven to be of value in many areas within the realm of hepatology, including liver biopsy, assessment of liver fibrosis, measurement of portal pressure, managing variceal bleeding, and EUS-guided paracentesis. In this review article, we will address the endoscopic applications that are used to manage patients with chronic liver disease.
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Affiliation(s)
- Ahmed Alwassief
- Department of Internal Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Said Al-Busafi
- Department of Internal Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Qasim L. Abbas
- Department of Internal Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Khalid Al Shamusi
- Department of Internal Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Sarto C. Paquin
- Division of Gastroenterology, Hopital Saint Luc, Centre Hospitaliér de l’Universite de Montréal, Montreal, Quebec, Canada
| | - Anand V. Sahai
- Division of Gastroenterology, Hopital Saint Luc, Centre Hospitaliér de l’Universite de Montréal, Montreal, Quebec, Canada
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Wei Q, Tan N, Xiong S, Luo W, Xia H, Luo B. Deep Learning Methods in Medical Image-Based Hepatocellular Carcinoma Diagnosis: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:5701. [PMID: 38067404 PMCID: PMC10705136 DOI: 10.3390/cancers15235701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 06/24/2024] Open
Abstract
(1) Background: The aim of our research was to systematically review papers specifically focused on the hepatocellular carcinoma (HCC) diagnostic performance of DL methods based on medical images. (2) Materials: To identify related studies, a comprehensive search was conducted in prominent databases, including Embase, IEEE, PubMed, Web of Science, and the Cochrane Library. The search was limited to studies published before 3 July 2023. The inclusion criteria consisted of studies that either developed or utilized DL methods to diagnose HCC using medical images. To extract data, binary information on diagnostic accuracy was collected to determine the outcomes of interest, namely, the sensitivity, specificity, and area under the curve (AUC). (3) Results: Among the forty-eight initially identified eligible studies, thirty studies were included in the meta-analysis. The pooled sensitivity was 89% (95% CI: 87-91), the specificity was 90% (95% CI: 87-92), and the AUC was 0.95 (95% CI: 0.93-0.97). Analyses of subgroups based on medical image methods (contrast-enhanced and non-contrast-enhanced images), imaging modalities (ultrasound, magnetic resonance imaging, and computed tomography), and comparisons between DL methods and clinicians consistently showed the acceptable diagnostic performance of DL models. The publication bias and high heterogeneity observed between studies and subgroups can potentially result in an overestimation of the diagnostic accuracy of DL methods in medical imaging. (4) Conclusions: To improve future studies, it would be advantageous to establish more rigorous reporting standards that specifically address the challenges associated with DL research in this particular field.
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Affiliation(s)
- Qiuxia Wei
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
| | - Nengren Tan
- School of Electronic and Information Engineering, Guangxi Normal University, 15 Qixing District, Guilin 541004, China;
| | - Shiyu Xiong
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
| | - Wanrong Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
| | - Haiying Xia
- School of Electronic and Information Engineering, Guangxi Normal University, 15 Qixing District, Guilin 541004, China;
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China; (Q.W.); (S.X.); (W.L.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, China
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Yang Q, Zheng R, Zhou J, Tang L, Zhang R, Jiang T, Jing X, Liao J, Cheng W, Zhao C, Liu C, Dietrich CF, Cui X, Cai W, Wu J, Yu F, Cheng Z, Liu F, Han Z, Yu X, Yu J, Liang P. On-Site Diagnostic Ability of CEUS/CT/MRI for Hepatocellular Carcinoma (2019-2022): A Multicenter Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2825-2838. [PMID: 37713625 DOI: 10.1002/jum.16321] [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: 02/10/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES To compare the on-site diagnostic performance of contrast-enhanced ultrasound (CEUS), computed tomography (CECT), and magnetic resonance imaging (CEMRI) for hepatocellular carcinoma (HCC) across diverse practice settings. METHODS Between May 2019 and April 2022, a total of 2085 patients with 2320 pathologically confirmed focal liver lesions (FLLs) were enrolled. Imaging reports were compared with results from pathology analysis. Diagnostic performance was analyzed in defined size, high-risk factors for HCC, and hospital volume categories. RESULTS Three images achieved similar diagnostic performance in classifying HCC from 16 types of FLLs, including HCC ≤2.0 cm. For HCC diagnosis at low-volume hospitals and HCC with high-risk factors, the accuracy and specificity of CEUS were comparable to CECT and CEMRI, while the sensitivity of CEUS (77.4 and 89.5%, respectively) was inferior to CEMRI (87.0 and 92.8%, respectively). The diagnostic accuracy of CEUS + CEMRI and CEUS + CECT increased by 7.8 and 6.2% for HCC ≤2.0 cm, 8.0 and 5.0% for HCC with high-risk factors, and 7.4 and 5.5% for HCC at low-volume hospitals, respectively, compared with CEMRI/CECT alone. CONCLUSIONS Compared with CECT and CEMRI, CEUS provides adequate diagnostic performance in clinical first-line applications at high-volume hospitals. Moreover, a higher diagnostic performance for HCC is achieved by combining CEUS with CECT/CEMRI compared with any single imaging technique.
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Affiliation(s)
- Qi Yang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
- Department of Medical Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lina Tang
- Department of Diagnostic Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Ruifang Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
| | - Jintang Liao
- Department of Diagnostic Ultrasound, Xiangya Hospital Central South University, Changsha, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cun Liu
- Department of Ultrasound, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chirstoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Bern, Switzerland
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjia Cai
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - JiaPeng Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fei Yu
- Department of Medical Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Shin J, Lee S, Yoon JK, Roh YH. Diagnostic Performance of the 2018 EASL vs. LI-RADS for Hepatocellular Carcinoma Using CT and MRI: A Systematic Review and Meta-Analysis of Comparative Studies. J Magn Reson Imaging 2023; 58:1942-1950. [PMID: 37010244 DOI: 10.1002/jmri.28716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) can be diagnosed without pathologic confirmation in high-risk patients. Therefore, it is necessary to compare current imaging criteria for noninvasive-diagnosis of HCC. PURPOSE To systematically compare performance of 2018 European Association for the Study of the Liver (EASL) criteria and Liver Imaging Reporting and Data System (LI-RADS) for noninvasive-diagnosis of HCC. STUDY TYPE Systematic review and meta-analysis. SUBJECTS Eight studies with 2232 observations, including 1617 HCCs. FIELD STRENGTH/SEQUENCE 1.5 T, 3.0 T/T2-weighted, unenhanced T1-weighted in-/opposed-phases, multiphase T1-weighted imaging. ASSESSMENT Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two reviewers independently reviewed and extracted data, including patient characteristics, index test, reference standard and outcomes, from studies intraindividually comparing the sensitivities and specificities of 2018 EASL-criteria and LR-5 of LI-RADS for HCC. Risk of bias and concerns regarding applicability were evaluated using QUADAS-2 tool. Subgroup analysis was performed based on observation size (≥20 mm, 10-19 mm). STATISTICAL TESTS Bivariate random-effects model to calculate pooled per-observation sensitivity and specificity of both imaging criteria, and pooled estimates of intraindividual paired data were compared considering the correlation. Forest and linked-receiver-operating-characteristic plots were drawn, and study heterogeneity was assessed using Q-test and Higgins-index. Publication bias was evaluated by Egger's test. A P-value <0.05 was considered statistically significant, except for heterogeneity (P < 0.10). RESULTS The sensitivity for HCC did not differ significantly between the imaging-based diagnosis using EASL-criteria (61%; 95% CI, 50%-73%) and LR-5 (64%; 95% CI, 53%-76%; P = 0.165). The specificities were also not significantly different between EASL-criteria (92%; 95% CI, 89%-94%) and LR-5 (94%; 95% CI, 91%-96%; P = 0.257). In subgroup analysis, no statistically significant differences were identified in the pooled performances between the two criteria for observations ≥20 mm (sensitivity P = 0.065; specificity P = 0.343) or 10-19 mm (sensitivity P > 0.999; specificity P = 0.851). There was no publication bias for EASL (P = 0.396) and LI-RADS (P = 0.526). DATA CONCLUSION In the present meta-analysis of paired comparisons, the pooled sensitivities and specificities were not significantly different between 2018 EASL-criteria and LR-5 of LI-RADS for noninvasive-diagnosis of HCC. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Jaeseung Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ja Kyung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
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Campello CA, Castanha EB, Vilardo M, Staziaki PV, Francisco MZ, Mohajer B, Watte G, Moraes FY, Hochhegger B, Altmayer S. Machine learning for malignant versus benign focal liver lesions on US and CEUS: a meta-analysis. Abdom Radiol (NY) 2023; 48:3114-3126. [PMID: 37365266 DOI: 10.1007/s00261-023-03984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To perform a meta-analysis of the diagnostic performance of learning (ML) algorithms (conventional and deep learning algorithms) for the classification of malignant versus benign focal liver lesions (FLLs) on US and CEUS. METHODS Available databases were searched for relevant published studies through September 2022. Studies met eligibility criteria if they evaluate the diagnostic performance of ML for the classification of malignant and benign focal liver lesions on US and CEUS. The pooled per-lesion sensitivities and specificities for each modality with 95% confidence intervals were calculated. RESULTS A total of 8 studies on US, 11 on CEUS, and 1 study evaluating both methods met the inclusion criteria with a total of 34,245 FLLs evaluated. The pooled sensitivity and specificity of ML for the malignancy classification of FLLs were 81.7% (95% CI, 77.2-85.4%) and 84.8% (95% CI, 76.0-90.8%) for US, compared to 87.1% (95% CI, 81.8-91.0%) and 87.0% (95% CI, 83.1-90.1%) for CEUS. In the subgroup analysis of studies that evaluated deep learning algorithms, the sensitivity and specificity of CEUS (n = 4) increased to 92.4% (95% CI, 88.5-95.0%) and 88.2% (95% CI, 81.1-92.9%). CONCLUSIONS The diagnostic performance of ML algorithms for the malignant classification of FLLs was high for both US and CEUS with overall similar sensitivity and specificity. The similar performance of US may be related to the higher prevalence of DL models in that group.
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Affiliation(s)
- Carlos Alberto Campello
- School of Medicine, Universidade Federal do Mato Grosso, 2367 Quarenta e Nove St, Cuiabá, Brazil
| | - Everton Bruno Castanha
- School of Medicine, Universidade Federal de Pelotas, 538 Prof. Dr. Araújo St. Pelotas, Pelotas, Brazil
| | - Marina Vilardo
- School of Medicine, Universidade Catolica de Brasilia, QS 07, Brasília, Brazil
| | - Pedro V Staziaki
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, USA
| | - Martina Zaguini Francisco
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Bahram Mohajer
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, USA
| | - Guilherme Watte
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen's University, 76 Stuart St, Kingston, Canada
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, USA
| | - Stephan Altmayer
- Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA.
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Liu X, Tan SBM, Awiwi MO, Jang HJ, Chernyak V, Fowler KJ, Shaaban AM, Sirlin CB, Furlan A, Marks RM, Elsayes KM. Imaging Findings in Cirrhotic Liver: Pearls and Pitfalls for Diagnosis of Focal Benign and Malignant Lesions. Radiographics 2023; 43:e230043. [PMID: 37651277 DOI: 10.1148/rg.230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Cirrhosis is the end stage of chronic liver disease and causes architectural distortion and perfusional anomalies. It is a major risk factor for developing hepatocellular carcinoma (HCC). Common disease entities in noncirrhotic livers, such as hemangiomas, can be rare in cirrhotic livers, and benign entities such as confluent hepatic fibrosis and focal nodular hyperplasia-like lesions may mimic the appearance of malignancies,. HCC usually has typical imaging characteristics, such as the major features established by the Liver Imaging Reporting and Data System. However, HCC can also have a spectrum of atypical or uncommon appearances, such as cystic HCC, hypovascular HCC, or macroscopic fat-containing HCC. HCCs with certain genetic mutations such as CTNNB-1-mutated HCC can harbor unique imaging features not seen in other types of HCC. In addition, malignancies that are less common than HCC, such as cholangiocarcinoma and metastases, which can be difficult to differentiate, can still occur in cirrhotic livers. Atypical imaging features of benign and malignant lesions can be challenging to accurately diagnose. Therefore, familiarity with these features and an understanding of the prevalence of disease entities in cirrhotic livers are key in the daily practice of radiologists for evaluation of cirrhotic livers. The authors illustrate the typical and atypical features of benign and malignant lesions in cirrhosis and discuss the technical pitfalls and unique advantages associated with various imaging modalities in assessing cirrhotic livers, including noncontrast and contrast-enhanced US, CT, and MRI. Work of the U.S. Government published under an exclusive license with the RSNA. Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Xiaoyang Liu
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Stephanie B M Tan
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Muhammad O Awiwi
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Hyun-Jung Jang
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Victoria Chernyak
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Kathryn J Fowler
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Akram M Shaaban
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Claude B Sirlin
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Alessandro Furlan
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Robert M Marks
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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8
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Tu DY, Lin PC, Chou HH, Shen MR, Hsieh SY. Slice-Fusion: Reducing False Positives in Liver Tumor Detection for Mask R-CNN. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2023; 20:3267-3277. [PMID: 37027274 DOI: 10.1109/tcbb.2023.3265394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Automatic liver tumor detection from computed tomography (CT) makes clinical examinations more accurate. However, deep learning-based detection algorithms are characterized by high sensitivity and low precision, which hinders diagnosis given that false-positive tumors must first be identified and excluded. These false positives arise because detection models incorrectly identify partial volume artifacts as lesions, which in turn stems from the inability to learn the perihepatic structure from a global perspective. To overcome this limitation, we propose a novel slice-fusion method in which mining the global structural relationship between the tissues in the target CT slices and fusing the features of adjacent slices according to the importance of the tissues. Furthermore, we design a new network based on our slice-fusion method and Mask R-CNN detection model, called Pinpoint-Net. We evaluated proposed model on the Liver Tumor Segmentation Challenge (LiTS) dataset and our liver metastases dataset. Experiments demonstrated that our slice-fusion method not only enhance tumor detection ability via reducing the number of false-positive tumors smaller than 10mm, but also improve segmentation performance. Without bells and whistles, a single Pinpoint-Net showed outstanding performance in liver tumor detection and segmentation on LiTS test dataset compared with other state-of-the-art models.
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9
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Singh S, Hoque S, Zekry A, Sowmya A. Radiological Diagnosis of Chronic Liver Disease and Hepatocellular Carcinoma: A Review. J Med Syst 2023; 47:73. [PMID: 37432493 PMCID: PMC10335966 DOI: 10.1007/s10916-023-01968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
Medical image analysis plays a pivotal role in the evaluation of diseases, including screening, surveillance, diagnosis, and prognosis. Liver is one of the major organs responsible for key functions of metabolism, protein and hormone synthesis, detoxification, and waste excretion. Patients with advanced liver disease and Hepatocellular Carcinoma (HCC) are often asymptomatic in the early stages; however delays in diagnosis and treatment can lead to increased rates of decompensated liver diseases, late-stage HCC, morbidity and mortality. Ultrasound (US) is commonly used imaging modality for diagnosis of chronic liver diseases that includes fibrosis, cirrhosis and portal hypertension. In this paper, we first provide an overview of various diagnostic methods for stages of liver diseases and discuss the role of Computer-Aided Diagnosis (CAD) systems in diagnosing liver diseases. Second, we review the utility of machine learning and deep learning approaches as diagnostic tools. Finally, we present the limitations of existing studies and outline future directions to further improve diagnostic accuracy, as well as reduce cost and subjectivity, while also improving workflow for the clinicians.
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Affiliation(s)
- Sonit Singh
- School of CSE, UNSW Sydney, High St, Kensington, 2052, NSW, Australia.
| | - Shakira Hoque
- Gastroenterology and Hepatology Department, St George Hospital, Hogben St, Kogarah, 2217, NSW, Australia
| | - Amany Zekry
- St George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW, High St, Kensington, 2052, NSW, Australia
- Gastroenterology and Hepatology Department, St George Hospital, Hogben St, Kogarah, 2217, NSW, Australia
| | - Arcot Sowmya
- School of CSE, UNSW Sydney, High St, Kensington, 2052, NSW, Australia
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10
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Marcos-Vidal A, Heidari P, Xu S, Wood BJ, Mahmood U. Advantages of a Photodiode Detector Endoscopy System in Fluorescence-Guided Percutaneous Liver Biopsies. OPTICS 2023; 4:340-350. [PMID: 38075027 PMCID: PMC10701657 DOI: 10.3390/opt4020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
Image-guided liver biopsies can improve their success rate when combined with the optical detection of Indocyanine Green (ICG) fluorescence accumulated in tumors. Previous works used a camera coupled to a thin borescope to capture and quantify images from fluorescence emission during procedures; however, light-scattering prevented the formation of sharp images, and the time response for weakly fluorescent tumors was very low. Instead, replacing the camera with a photodiode detector shows an improved temporal resolution in a more compact and lighter device. This work presents the new design in a comparative study between both detection technologies, including an assessment of the temporal response and sensitivity to the presence of background fluorescence.
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Affiliation(s)
- Asier Marcos-Vidal
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Pedram Heidari
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Umar Mahmood
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA 02129, USA
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11
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Quek J, Tan DJH, Chan KE, Lim WH, Ng CH, Ren YP, Koh TK, Teh R, Xiao J, Fu C, Syn N, Teng M, Muthiah M, Fowler KJ, Sirlin CB, Loomba R, Huang DQ. Quality Assessment of Ultrasound and Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: A Systematic Review and Meta-Analysis. Dig Dis 2023; 41:757-766. [PMID: 37231918 DOI: 10.1159/000531016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION To achieve early detection and curative treatment options, surveillance imaging for hepatocellular carcinoma (HCC) must remain of quality and without substantial limitations in liver visualization. However, the prevalence of limited liver visualization during HCC surveillance imaging has not been systematically assessed. Utilizing a systematic review and meta-analytic approach, we aimed to determine the prevalence of limited liver visualization during HCC surveillance imaging. METHODS MEDLINE and Embase electronic databases were searched to identify published data on liver visualization limitations of HCC surveillance imaging. An analysis of proportions was pooled using a generalized linear mixed model with Clopper-Pearson intervals. Risk factors were analysed using a generalized mixed model with a logit link and inverse variance weightage. RESULTS Of 683 records, 10 studies (7,131 patients) met inclusion criteria. Seven studies provided data on liver visualization limitations on ultrasound (US) surveillance exams: prevalence of limited liver visualization was 48.9% (95% CI: 23.5-74.9%) in the overall analysis and 59.2% (95% CI: 24.2-86.9%) in a sensitivity analysis for cirrhotic patients. Meta-regression determined that non-alcoholic fatty liver disease was associated with limited liver visualization on US. Four studies provided data for liver visualization limitations in abbreviated magnetic resonance imaging (aMRI), with inadequate visualization ranging from 5.8% to 19.0%. One study provided data for complete MRI and none for computed tomography. CONCLUSION A substantial proportion of US exams performed for HCC surveillance provide limited liver visualization, especially in cirrhosis, which may hinder detection of small observations. Alternative surveillance strategies including aMRI may be appropriate for patients with limited US visualization.
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Affiliation(s)
- Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Ping Ren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Teng Kiat Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Readon Teh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarissa Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Margaret Teng
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Rohit Loomba
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, California, USA
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, California, USA
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12
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Huang M, Qi M, Yang H, Peng Z, Chen S, Liang M, Hu Y, Deng L, Hu M. Noninvasive Strategies for the Treatment of Tiny Liver Cancer: Integrating Photothermal Therapy and Multimodality Imaging EpCAM-Guided Nanoparticles. ACS APPLIED MATERIALS & INTERFACES 2023; 15:21843-21853. [PMID: 37102323 DOI: 10.1021/acsami.3c00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Surgical resection and ablation therapy have been shown to achieve the purpose of a radical cure for liver cancer with a size of less than 3 cm; however, tiny liver cancer lesions of diameters smaller than 2 cm remain challenging to diagnose and cure due to the failure of the generation of new blood vessels within tumors. Emerging evidence has revealed that optical molecular imaging combined with nanoprobes can detect tiny cancer from the perspective of molecular and cellular levels and kill cancer cells by the photothermal effect of nanoparticles in real time, thereby achieving radical goals. In the present study, we designed and synthesized multicomponent and multifunctional ICG-CuS-Gd@BSA-EpCAM nanoparticles (NPs) with a potent antineoplastic effect on tiny liver cancer. Using subcutaneous and orthotopic liver cancer xenograft mouse models, we found that the components of the NPs, including ICG and CuS-Gd@BSA, showed synergistic photothermal effects on the eradication of tiny liver cancer. We also found that the ICG-CuS-Gd@BSA-EpCAM NPs exhibited triple-modal functions of fluorescence imaging, magnetic resonance imaging, and photoacoustic imaging, with targeted detection and photothermal treatment of tiny liver cancer under near-infrared light irradiation. Together, our study demonstrates that the ICG-CuS-Gd@BSA-EpCAM NPs in combination with optical imaging technique might be a potential approach for detecting and noninvasively and radically curing tiny liver cancer by the photothermal effect.
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Affiliation(s)
- Maohua Huang
- Department of Hepatobiliary Surgery, Jinan University First Affiliated Hospital, Jinan University, Guangzhou 510632, China
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Ming Qi
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Hongyan Yang
- Department of Hepatobiliary Surgery, Jinan University First Affiliated Hospital, Jinan University, Guangzhou 510632, China
| | - Zhi Peng
- Department of Hepatobiliary Surgery, Jinan University First Affiliated Hospital, Jinan University, Guangzhou 510632, China
| | - Shouguo Chen
- School of Traditional Chinese Medicine, Jinan University, Guangzhou 510630, China
| | - Mingchao Liang
- Department of Hepatobiliary Surgery, Jinan University Affiliated Shunde Hospital, Jinan University, Foshan 528305, China
| | - Youzhu Hu
- Department of Hepatobiliary Surgery, Jinan University First Affiliated Hospital, Jinan University, Guangzhou 510632, China
- Department of Hepatobiliary Surgery, Jinan University Affiliated Shunde Hospital, Jinan University, Foshan 528305, China
| | - Lijuan Deng
- School of Traditional Chinese Medicine, Jinan University, Guangzhou 510630, China
| | - Min Hu
- Department of Hepatobiliary Surgery, Jinan University First Affiliated Hospital, Jinan University, Guangzhou 510632, China
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13
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Yokoo T, Masaki N, Parikh ND, Lane BF, Feng Z, Mendiratta-Lala M, Lee CH, Khatri G, Marsh TL, Shetty K, Dunn CT, Al-Jarrah T, Aslam A, Davenport MS, Gopal P, Rich NE, Lok AS, Singal AG. Multicenter Validation of Abbreviated MRI for Detecting Early-Stage Hepatocellular Carcinoma. Radiology 2023; 307:e220917. [PMID: 36692401 PMCID: PMC10102624 DOI: 10.1148/radiol.220917] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/12/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023]
Abstract
Background Abbreviated MRI is a proposed paradigm shift for hepatocellular carcinoma (HCC) surveillance, but data on its performance are lacking for histopathologically confirmed early-stage HCC. Purpose To evaluate the sensitivity and specificity of dynamic contrast-enhanced abbreviated MRI for early-stage HCC detection, using surgical pathologic findings as the reference standard. Materials and Methods This retrospective study was conducted at three U.S. liver transplant centers in patients with cirrhosis who underwent liver resection or transplant between January 2009 and December 2019 and standard "full" liver MRI with and without contrast enhancement within 3 months before surgery. Patients who had HCC-directed treatment before surgery were excluded. Dynamic abbreviated MRI examinations were simulated from the presurgical full MRI by selecting the coronal T2-weighted and axial three-dimensional fat-suppressed T1-weighted dynamic contrast-enhanced sequences at precontrast, late arterial, portal venous, and delayed phases. Two abdominal radiologists at each center independently interpreted the simulated abbreviated examinations with use of the Liver Imaging Reporting and Data System version 2018. Patients with any high-risk liver observations (>LR-3) were classified as positive; otherwise, they were classified as negative. With liver pathologic findings as the reference standard for the presence versus absence of early-stage HCC, the sensitivity, specificity, and their 95% CIs were calculated. Logistic regression was used to identify factors associated with correct classification. Results A total of 161 patients with early-stage HCC (median age, 62 years [IQR, 58-67 years]; 123 men) and 138 patients without HCC (median age, 55 years [IQR, 47-63 years]; 85 men) were confirmed with surgical pathologic findings. The sensitivity and specificity of abbreviated MRI were 88.2% (142 of 161 patients) (95% CI: 83.5, 92.5) and 89.1% (123 of 138 patients) (95% CI: 84.4, 93.8), respectively. Sensitivity was lower for Child-Pugh class B or C versus Child-Pugh class A cirrhosis (64.1% vs 94.2%; P < .001). Conclusion With surgical pathologic findings as the reference standard, dynamic abbreviated MRI had high sensitivity and specificity for early-stage hepatocellular carcinoma detection in patients with compensated cirrhosis but lower sensitivity in those with decompensated cirrhosis. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Kim in this issue.
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Affiliation(s)
- Takeshi Yokoo
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Nobuaki Masaki
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Neehar D. Parikh
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Barton F. Lane
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Ziding Feng
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Mishal Mendiratta-Lala
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Chee Hwee Lee
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Gaurav Khatri
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Tracey L. Marsh
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Kirti Shetty
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Colin T. Dunn
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Taim Al-Jarrah
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Anum Aslam
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Matthew S. Davenport
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Purva Gopal
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Nicole E. Rich
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Anna S. Lok
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
| | - Amit G. Singal
- From the Departments of Radiology (T.Y., G.K.), Internal Medicine
(C.T.D., N.E.R., A.G.S.), and Pathology (P.G.), UT Southwestern Medical Center,
5959 Harry Hines Blvd, POB 1, Ste 420, Dallas, TX 75390-8887; Department of
Biostatistics, University of Washington, Seattle, Wash (N.M.); Departments of
Internal Medicine (N.D.P., T.A.J., A.S.L.) and Radiology (M.M.L., A.A., M.S.D.),
University of Michigan Medical School, Ann Arbor, Mich; Departments of
Diagnostic Radiology (B.F.L., C.H.L.) and Internal Medicine (K.S.), University
of Maryland, Baltimore, Md; and Division of Public Health Sciences, Fred Hutch
Cancer Center, Seattle, Wash (Z.F., T.L.M.)
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14
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An H, Bhatia I, Cao F, Huang Z, Xie C. CT texture analysis in predicting treatment response and survival in patients with hepatocellular carcinoma treated with transarterial chemoembolization using random forest models. BMC Cancer 2023; 23:201. [PMID: 36869284 PMCID: PMC9983241 DOI: 10.1186/s12885-023-10620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Using texture features derived from contrast-enhanced computed tomography (CT) combined with general imaging features as well as clinical information to predict treatment response and survival in patients with hepatocellular carcinoma (HCC) who received transarterial chemoembolization (TACE) treatment. METHODS From January 2014 to November 2022, 289 patients with HCC who underwent TACE were retrospectively reviewed. Their clinical information was documented. Their treatment-naïve contrast-enhanced CTs were retrieved and reviewed by two independent radiologists. Four general imaging features were evaluated. Texture features were extracted based on the regions of interest (ROIs) drawn on the slice with the largest axial diameter of all lesions using Pyradiomics v3.0.1. After excluding features with low reproducibility and low predictive value, the remaining features were selected for further analyses. The data were randomly divided in a ratio of 8:2 for model training and testing. Random forest classifiers were built to predict patient response to TACE treatment. Random survival forest models were constructed to predict overall survival (OS) and progress-free survival (PFS). RESULTS We retrospectively evaluated 289 patients (55.4 ± 12.4 years old) with HCC treated with TACE. Twenty features, including 2 clinical features (ALT and AFP levels), 1 general imaging feature (presence or absence of portal vein thrombus) and 17 texture features, were included in model construction. The random forest classifier achieved an area under the curve (AUC) of 0.947 with an accuracy of 89.5% for predicting treatment response. The random survival forest showed good predictive performance with out-of-bag error rate of 0.347 (0.374) and a continuous ranked probability score (CRPS) of 0.170 (0.067) for the prediction of OS (PFS). CONCLUSIONS Random forest algorithm based on texture features combined with general imaging features and clinical information is a robust method for predicting prognosis in patients with HCC treated with TACE, which may help avoid additional examinations and assist in treatment planning.
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Affiliation(s)
- He An
- Diagnostic Imaging Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Inderjeet Bhatia
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Fei Cao
- Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zilin Huang
- Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chuanmiao Xie
- Diagnostic Imaging Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, China.
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15
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. JOURNAL OF LIVER CANCER 2023; 23:1-120. [PMID: 37384024 PMCID: PMC10202234 DOI: 10.17998/jlc.2022.11.07] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/30/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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Affiliation(s)
- Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea
- Corresponding author: KLCA-NCC Korea Practice Guideline Revision Committee (KPGRC) (Committee Chair: Joong-Won Park) Center for Liver and Pancreatobiliary Cancer, Division of Gastroenterology, Department of Internal Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea Tel. +82-31-920-1605, Fax: +82-31-920-1520, E-mail:
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16
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Kesen S, Svensson A, Thor D, Brismar TB. Hepatic enhancement at computed tomography: is there a dependence on body weight past institutional contrast dosing limits? Acta Radiol 2023; 64:435-440. [PMID: 35266404 PMCID: PMC9905147 DOI: 10.1177/02841851221079014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although described in product monographs, the maximum contrast media (CM) dose at computed tomography (CT) varies among institutions. PURPOSE To investigate whether an upper limit of 40 g of iodine in women and 50 g in men is sufficient or if there is a body weight (BW) dependence of mean hepatic enhancement (MHE) beyond those thresholds. MATERIAL AND METHODS At our institution, CM injection duration is fixed to 30 s and dosed 600 mg iodine/kg up to 40 g in women and 50 g in men. Pre- and post-contrast hepatic attenuation values (HU) were retrospectively obtained in 200 women and 200 men with glomerular filtration rate >45 mL/min undergoing 18-flurodeoxyglucose PET-CT (18F-FDG PET-CT) of which half weighed below and half above those dose thresholds using iodixanol 320 mg iodine/mL or iomeprol 400 mg iodine/mL. The correlation between BW and MHE was assessed by simple linear regression. RESULTS Weight range was 41-120 kg in women and 47-137 kg in men. There was no significant relationship between MHE and BW in women receiving <40 g (r = -0.05, P = 0.63) or in men receiving <50 g (r = 0.18, P = 0.07). Above those thresholds there was an inverse relationship (r = -0.64, P<0.001 in women and r = -0.30, P<0.002 in men). There was no apparent upper limit where the dependence of hepatic MHE on BW decreased. Hepatosteatosis limited MHE. CONCLUSION Adjusting CM to BW diminishes the dependence of MHE on BW. There was no apparent upper limit for the relationship between BW and MHE in heavier patients at CM-enhanced CT.
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Affiliation(s)
- Savas Kesen
- Division of Radiology, Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden,Department of Radiology, Södersjukhuset, Stockholm, Sweden,Savas Kesen, Division of Radiology, Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden and Södersjukhuset, Department of Radiology, Stockholm, Sweden.
| | - Anders Svensson
- Division of Radiology, Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden,Department of Radiology, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Thor
- Medical Radiation Physics and Nuclear Medicine, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Torkel B. Brismar
- Division of Radiology, Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden,Department of Radiology, Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
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17
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Artificial intelligence: A review of current applications in hepatocellular carcinoma imaging. Diagn Interv Imaging 2023; 104:24-36. [PMID: 36272931 DOI: 10.1016/j.diii.2022.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 01/10/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and currently the third-leading cause of cancer-related death worldwide. Recently, artificial intelligence (AI) has emerged as an important tool to improve clinical management of HCC, including for diagnosis, prognostication and evaluation of treatment response. Different AI approaches, such as machine learning and deep learning, are both based on the concept of developing prediction algorithms from large amounts of data, or big data. The era of digital medicine has led to a rapidly expanding amount of routinely collected health data which can be leveraged for the development of AI models. Various studies have constructed AI models by using features extracted from ultrasound imaging, computed tomography imaging and magnetic resonance imaging. Most of these models have used convolutional neural networks. These tools have shown promising results for HCC detection, characterization of liver lesions and liver/tumor segmentation. Regarding treatment, studies have outlined a role for AI in evaluation of treatment response and improvement of pre-treatment planning. Several challenges remain to fully integrate AI models in clinical practice. Future research is still needed to robustly evaluate AI algorithms in prospective trials, and improve interpretability, generalizability and transparency. If such challenges can be overcome, AI has the potential to profoundly change the management of patients with HCC. The purpose of this review was to sum up current evidence on AI approaches using imaging for the clinical management of HCC.
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18
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Rafati I, Destrempes F, Yazdani L, Gesnik M, Tang A, Cloutier G. Regularized Ultrasound Phantom-Free Local Attenuation Coefficient Slope (ACS) Imaging in Homogeneous and Heterogeneous Tissues. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:3338-3352. [PMID: 36318570 DOI: 10.1109/tuffc.2022.3218920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Attenuation maps or measurements based on the local attenuation coefficient slope (ACS) in quantitative ultrasound (QUS) have shown potential for the diagnosis of liver steatosis. In liver cancers, tissue abnormalities and tumors detected using ACS are also of interest to provide new image contrast to clinicians. Current phantom-based approaches have the limitation of assuming a comparable speed of sound between the reference phantom and insonified tissues. Moreover, these methods present the inconvenience for operators to acquire data on phantoms and patients. The main goal was to alleviate these drawbacks by proposing a methodology for constructing phantom-free regularized (PF-R) local ACS maps and investigate the performance in both homogeneous and heterogeneous media. The proposed method was tested on two tissue-mimicking media with different ACS constructed as homogeneous phantoms, side-by-side and top-to-bottom phantoms, and inclusion phantoms with different attenuations. Moreover, an in vivo proof-of-concept was performed on healthy, steatotic, and cancerous human liver datasets. Modifications brought to previous works include: 1) a linear interpolation of the power spectrum in the log scale; 2) the relaxation of the underlying hypothesis on the diffraction factor; 3) a generalization to nonhomogeneous local ACS; and 4) an adaptive restriction of frequencies to a more reliable range than the usable frequency range. Regularization was formulated as a generalized least absolute shrinkage and selection operator (LASSO), and a variant of the Bayesian information criterion (BIC) was applied to estimate the Lagrangian multiplier on the LASSO constraint. In addition, we evaluated the proposed algorithm when applying median filtering before and after regularization. Tests conducted showed that the PF-R yielded robust results in all tested conditions, suggesting potential for additional validation as a diagnosis method.
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19
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2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2022; 23:1126-1240. [PMID: 36447411 PMCID: PMC9747269 DOI: 10.3348/kjr.2022.0822] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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20
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Heo HJ, Park Y, Lee JH, Kim Y, Kim EK, Kim GH, Yu Y, Park SY, Seo HB, Pak K, Goh TS, Park S, Oh SO, Kwon W, Kim YH. Clinical big-data-based design of GLUT2-targeted carbon nanodots for accurate diagnosis of hepatocellular carcinoma. NANOSCALE 2022; 14:17053-17064. [PMID: 36367284 DOI: 10.1039/d2nr04238j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite advances in diagnostic and therapeutic methods, the prognosis of patients with hepatocellular carcinoma (HCC) remains poor due to the delay in diagnosis. Herein, we aimed to discover a highly sensitive and specific biomarker for HCC based on genomic big data analysis and create an HCC-targeted imaging probe using carbon nanodots (CNDs) as contrast agents. In genomic analysis, we selected glucose transporter 2 (GLUT2) as a potential imaging target for HCC. We confirmed the target suitability by immunohisto-chemistry tests of 339 patient samples, where 81.1% of the patients exhibited underexpression of GLUT2, i.e., higher GLUT2 intensity in non-tumor tissues than in tumor tissues. To visualize GLUT2, we conjugated CNDs with glucosamine (GLN) as a targeting ligand to yield glucosamine-labeled CNDs (GLN-CNDs). A series of in vitro and in vivo experiments were conducted on GLUT2-modified HepG2 cells to confirm the specificity of the GLN-CNDs. Since the GLUT2 expression is higher in hepatocytes than in HCC cells, the GLUT2-targeted contrast agent is highly attached to normal cells. However, it is possible to produce images in the same form as the images obtained with a cancer cell-targeted contrast agent by inverting color scaling. Our results indicate that GLUT2 is a promising target for HCC and that GLN-CNDs may potentially be used as targeted imaging probes for diagnosing HCC.
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Affiliation(s)
- Hye Jin Heo
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea.
| | - Yoonsang Park
- Institute of Advanced Materials and Systems, Sookmyung Women's University, Seoul 04310, Republic of Korea.
- Nano Convergence Technology Research Center, Korea Electronics Technology Institute (KETI), Seongnam 13509, Republic of Korea
| | - Jung Hee Lee
- Department of Pathology, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Yujin Kim
- Department of Chemical and Biological Engineering, Sookmyung Women's University, Seoul 04310, Republic of Korea
| | - Eun Kyoung Kim
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea.
| | - Ga Hyun Kim
- Interdisciplinary Program of Genomic Data Science, Pusan National University, Yangsan 50612, Republic of Korea
| | - Yeuni Yu
- Biomedical Research Institute, Pusan National University Hospital, Yangsan 50612, Republic of Korea.
| | - So Youn Park
- Gene & Cell Therapy Research Center for Vessel-associated Diseases, Pusan National University, Yangsan 50612, Republic of Korea
| | - Hie Bum Seo
- Department of Radiology, School of Medicine, Pusan National University, Pusan National University Hospital, Yangsan 50612, Republic of Korea
| | - Kyoungjune Pak
- Biomedical Research Institute, Pusan National University Hospital, Yangsan 50612, Republic of Korea.
- Department of Nuclear Medicine, Pusan National University Hospital, Yangsan 50612, Republic of Korea
| | - Tae Sik Goh
- Biomedical Research Institute, Pusan National University Hospital, Yangsan 50612, Republic of Korea.
- Department of Orthopaedic Surgery, Pusan National University Hospital, Yangsan 50612, Republic of Korea
| | - Sehyeon Park
- Department of Chemical and Biological Engineering, Sookmyung Women's University, Seoul 04310, Republic of Korea
| | - Sae-Ock Oh
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea.
| | - Woosung Kwon
- Institute of Advanced Materials and Systems, Sookmyung Women's University, Seoul 04310, Republic of Korea.
- Department of Chemical and Biological Engineering, Sookmyung Women's University, Seoul 04310, Republic of Korea
| | - Yun Hak Kim
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea.
- Biomedical Research Institute, Pusan National University Hospital, Yangsan 50612, Republic of Korea.
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
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21
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Rizzo A, Racca M, Albano D, Dondi F, Bertagna F, Annunziata S, Treglia G. Can PSMA-Targeting Radiopharmaceuticals Be Useful for Detecting Hepatocellular Carcinoma Using Positron Emission Tomography? An Updated Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2022; 15:1368. [PMID: 36355540 PMCID: PMC9699564 DOI: 10.3390/ph15111368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Several studies proposed the use of positron emission tomography (PET) with Prostate-Specific Membrane Antigen (PSMA)-targeting radiopharmaceuticals in hepatocellular carcinoma (HCC). Our aim is to calculate the detection rate (DR) of this examination in HCC with a meta-analysis. METHODS A comprehensive literature search of studies on the DR of PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals in HCC was performed. Original articles evaluating these imaging examinations both in newly diagnosed HCC patients and HCC patients with disease relapse were included. Pooled DR including 95% confidence intervals (95% CI) was calculated. Statistical heterogeneity was also assessed using the I2 test. RESULTS The meta-analysis of six selected studies (126 patients) provided a DR of 85.9% for PET imaging with PSMA-targeting radiopharmaceuticals in the diagnosis of HCC. Moderate statistical heterogeneity among the included studies was found (I2 = 56%). CONCLUSIONS The quantitative data provided demonstrate the high DR of PET/CT or PET/MRI with PSMA-targeting radiopharmaceuticals for HCC lesion detection. However, more studies are needed to confirm the promising role of PSMA-targeted PET in HCC.
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Affiliation(s)
- Alessio Rizzo
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO—IRCCS, 10060 Turin, Italy
| | - Manuela Racca
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO—IRCCS, 10060 Turin, Italy
| | - Domenico Albano
- Division of Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Francesco Dondi
- Division of Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Francesco Bertagna
- Division of Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Salvatore Annunziata
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900 Lugano, Switzerland
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22
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin Mol Hepatol 2022; 28:583-705. [PMID: 36263666 PMCID: PMC9597235 DOI: 10.3350/cmh.2022.0294] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.
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23
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Chang Y, Jeong SW, Jang JY, Eun H, Lee Y, Song DS, Yu SJ, Lee SH, Kim W, Lee HW, Kim SG, Ryu S, Park S. The diagnostic value of circulating tumor DNA in hepatitis B virus induced hepatocellular carcinoma: a systematic review and meta-analysis. JOURNAL OF LIVER CANCER 2022; 22:167-177. [PMID: 37383408 PMCID: PMC10035733 DOI: 10.17998/jlc.2022.09.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 06/30/2023]
Abstract
Background/Aim New biomarkers are urgently needed to aid in the diagnosis of early stage hepatocellular carcinoma (HCC). We performed a meta-analysis on the diagnostic utility of circulating tumor DNA (ctDNA) levels in patients with hepatitis B virus-induced HCC. Methods We retrieved relevant articles from PubMed, Embase, and the Cochrane Library up to February 8, 2022. Two subgroups were defined; one subset of studies analyzed the ctDNA methylation status, and the other subset combined tumor markers and ctDNA assays. Pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC) were analyzed. Results Nine articles including 2,161 participants were included. The overall SEN and SPE were 0.705 (95% confidence interval [CI], 0.629-0.771) and 0.833 (95% CI, 0.769-0.882), respectively. The DOR, PLR, and NLR were 11.759 (95% CI, 7.982-17.322), 4.285 (95% CI, 3.098-5.925), and 0.336 (0.301-0.366), respectively. The ctDNA assay subset exhibited an AUC of 0.835. The AUC of the combined tumor marker and ctDNA assay was 0.848, with an SEN of 0.761 (95% CI, 0.659-0.839) and an SPE of 0.828 (95% CI, 0.692-0.911). Conclusions Circulating tumor DNA has promising diagnostic potential for HCC. It can serve as an auxiliary tool for HCC screening and detection, especially when combined with tumor markers.
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Affiliation(s)
- Young Chang
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soung Won Jeong
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jae Young Jang
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyuksoo Eun
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Young‑Sun Lee
- Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Do Seon Song
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hwan Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Won Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Woong Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seongho Ryu
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
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Kim YY, Lee S, Shin J, Son WJ, Roh YH, Hwang JA, Lee JE. Diagnostic performance of CT versus MRI Liver Imaging Reporting and Data System category 5 for hepatocellular carcinoma: a systematic review and meta-analysis of comparative studies. Eur Radiol 2022; 32:6723-6729. [PMID: 35849177 DOI: 10.1007/s00330-022-08985-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/15/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the performance of Liver Imaging Reporting and Data System category 5 (LR-5) for diagnosing HCC between CT and MRI using comparative studies. METHODS The MEDLINE and EMBASE databases were searched from inception to April 21, 2021, to identify studies that directly compare the diagnostic performance of LR-5 for HCC between CT and MRI. A bivariate random-effects model was fitted to calculate the pooled per-observation sensitivity and specificity of LR-5 of each modality, and compare the pooled estimates of paired data. Subgroup analysis was performed according to the MRI contrast agent. RESULTS Seven studies with 1145 observations (725 HCCs) were included in the final analysis. The pooled per-observation sensitivity of LR-5 for diagnosing HCC was higher using MRI (61%; 95% confidence interval [CI], 43-76%; I2 = 95%) than CT (48%; 95% CI, 31-65%; I2 = 97%) (p < 0.001). The pooled per-observation specificities of LR-5 did not show statistically significant difference between CT (96%; 95% CI, 92-98%; I2 = 0%) and MRI (93%; 95% CI, 88-96%; I2 = 16%) (p = 0.054). In the subgroup analysis, extracellular contrast agent-enhanced MRI showed significantly higher pooled per-observation sensitivity than gadoxetic acid-enhanced MRI for diagnosing HCC (73% [95% CI, 55-85%] vs. 55% [95% CI, 39-70%]; p = 0.007), without a significant difference in specificity (93% [95% CI, 80-98%] vs. 94% [95% CI, 87-97%]; p = 0.884). CONCLUSIONS The LR-5 of MRI showed significantly higher pooled per-observation sensitivity than CT for diagnosing HCC. The pooled per-observation specificities of LR-5 were comparable between the two modalities. KEY POINTS • The pooled sensitivity of LR-5 using MRI was higher than that using CT (61% versus 48%), but the pooled specificities of LR-5 were not significantly different between CT and MRI (96% versus 93%). • Subgroup analysis according to the MRI contrast media showed a significantly higher pooled per-observation sensitivity using ECA-enhanced MRI than with EOB-enhanced MRI (73% versus 55%), and comparable specificities (93% versus 94%). • Although LI-RADS provides a common diagnostic algorithm for CT or MRI, the per-observation performance of LR-5 can be affected by the imaging modality as well as the MRI contrast agent.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Jaeseung Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Won Jeong Son
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
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25
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De Muzio F, Grassi F, Dell’Aversana F, Fusco R, Danti G, Flammia F, Chiti G, Valeri T, Agostini A, Palumbo P, Bruno F, Cutolo C, Grassi R, Simonetti I, Giovagnoni A, Miele V, Barile A, Granata V. A Narrative Review on LI-RADS Algorithm in Liver Tumors: Prospects and Pitfalls. Diagnostics (Basel) 2022; 12:diagnostics12071655. [PMID: 35885561 PMCID: PMC9319674 DOI: 10.3390/diagnostics12071655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Liver cancer is the sixth most detected tumor and the third leading cause of tumor death worldwide. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with specific risk factors and a targeted population. Imaging plays a major role in the management of HCC from screening to post-therapy follow-up. In order to optimize the diagnostic-therapeutic management and using a universal report, which allows more effective communication among the multidisciplinary team, several classification systems have been proposed over time, and LI-RADS is the most utilized. Currently, LI-RADS comprises four algorithms addressing screening and surveillance, diagnosis on computed tomography (CT)/magnetic resonance imaging (MRI), diagnosis on contrast-enhanced ultrasound (CEUS) and treatment response on CT/MRI. The algorithm allows guiding the radiologist through a stepwise process of assigning a category to a liver observation, recognizing both major and ancillary features. This process allows for characterizing liver lesions and assessing treatment. In this review, we highlighted both major and ancillary features that could define HCC. The distinctive dynamic vascular pattern of arterial hyperenhancement followed by washout in the portal-venous phase is the key hallmark of HCC, with a specificity value close to 100%. However, the sensitivity value of these combined criteria is inadequate. Recent evidence has proven that liver-specific contrast could be an important tool not only in increasing sensitivity but also in diagnosis as a major criterion. Although LI-RADS emerges as an essential instrument to support the management of liver tumors, still many improvements are needed to overcome the current limitations. In particular, features that may clearly distinguish HCC from cholangiocarcinoma (CCA) and combined HCC-CCA lesions and the assessment after locoregional radiation-based therapy are still fields of research.
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Affiliation(s)
- Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy;
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
| | - Federica Dell’Aversana
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Ginevra Danti
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Federica Flammia
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Giuditta Chiti
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Tommaso Valeri
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Andrea Agostini
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
- Area of Cardiovascular and Interventional Imaging, Department of Diagnostic Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
- Emergency Radiology, San Salvatore Hospital, Via Lorenzo Natali 1, 67100 L’Aquila, Italy;
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy;
| | - Roberta Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 81100 Naples, Italy; (F.G.); (F.D.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (I.S.); (V.G.)
| | - Andrea Giovagnoni
- Department of Clinical Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (T.V.); (A.A.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, Via Tronto 10/a, 60126 Torrette, Italy
| | - Vittorio Miele
- Division of Radiology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy; (G.D.); (F.F.); (G.C.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (P.P.); (F.B.)
| | - Antonio Barile
- Emergency Radiology, San Salvatore Hospital, Via Lorenzo Natali 1, 67100 L’Aquila, Italy;
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (I.S.); (V.G.)
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Geyer T, Kazmierczak PM, Steffen IG, Malfertheiner P, Peynircioglu B, Loewe C, van Delden O, Vandecaveye V, Gebauer B, Pech M, Sengel C, Bargellini I, Iezzi R, Benito A, Zech CJ, Gasbarrini A, Schütte K, Ricke J, Seidensticker M. Extrahepatic Disease in Hepatocellular Carcinoma: Do We Always Need Whole-Body CT or Is Liver MRI Sufficient? A Subanalysis of the SORAMIC Trial. Biomedicines 2022; 10:biomedicines10051156. [PMID: 35625900 PMCID: PMC9139039 DOI: 10.3390/biomedicines10051156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To investigate whole-body contrast-enhanced CT and hepatobiliary contrast liver MRI for the detection of extrahepatic disease (EHD) in hepatocellular carcinoma (HCC) and to quantify the impact of EHD on therapy decision. Methods: In this post-hoc analysis of the prospective phase II open-label, multicenter, randomized controlled SORAMIC trial, two blinded readers independently analyzed the whole-body contrast-enhanced CT and gadoxetic acid-enhanced liver MRI data sets of 538 HCC patients. EHD (defined as tumor manifestation outside the liver) detection rates of the two imaging modalities were compared using multiparametric statistical tests. In addition, the most appropriate treatment recommendation was determined by a truth panel. Results: EHD was detected significantly more frequently in patients with portal vein infiltration (21% vs. 10%, p < 0.001), macrovascular infiltration (22% vs. 9%, p < 0.001), and bilobar liver involvement (18% vs. 9%, p = 0.006). Further on, the maximum lesion diameter in patients with EHD was significantly higher (8.2 cm vs. 5.8 cm, p = 0.002). CT detected EHD in significantly more patients compared to MRI in both reader groups (p < 0.001). Higher detection rates of EHD in CT led to a change in management only in one patient since EHD was predominantly present in patients with locally advanced HCC, in whom palliative treatment is the standard of care. Conclusions: Whole-body contrast-enhanced CT shows significantly higher EHD detection rates compared to hepatobiliary contrast liver MRI. However, the higher detection rate did not yield a significant impact on patient management in advanced HCC.
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Affiliation(s)
- Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
- Correspondence: ; Tel.: +49-89330073620
| | - Philipp M. Kazmierczak
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
| | - Ingo G. Steffen
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
| | - Peter Malfertheiner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, Ankara 06100, Turkey;
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, The Netherlands;
| | | | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, 39106 Magdeburg, Germany;
| | - Christian Sengel
- Radiologie Interventionnelle Vasculaire et Percutanée, CHU de Grenoble, 38043 Grenoble, France;
| | - Irene Bargellini
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, 00168 Rome, Italy;
| | - Alberto Benito
- Abdominal Radiology Unit, Department of Radiology, Clínica Universidad de Navarra, Universidad de Navarra, 31008 Pamplona, Spain;
| | - Christoph J. Zech
- Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, 4001 Basel, Switzerland;
| | - Antonio Gasbarrini
- Fondazione Policlinico Gemelli IRCCS, Università’ Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von-Guericke University, 39106 Magdeburg, Germany
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, 49074 Osnabrueck, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (P.M.K.); (I.G.S.); (P.M.); (J.R.); (M.S.)
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Nadarevic T, Colli A, Giljaca V, Fraquelli M, Casazza G, Manzotti C, Štimac D, Miletic D. Magnetic resonance imaging for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev 2022; 5:CD014798. [PMID: 35521901 PMCID: PMC9074390 DOI: 10.1002/14651858.cd014798.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma occurs mostly in people with chronic liver disease and ranks sixth in terms of global incidence of cancer, and third in terms of cancer deaths. In clinical practice, magnetic resonance imaging (MRI) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-fetoprotein, or both, either in surveillance programmes or in clinical settings. According to current guidelines, a single contrast-enhanced imaging study (computed tomography (CT) or MRI) showing typical hallmarks of hepatocellular carcinoma in people with cirrhosis is considered valid to diagnose hepatocellular carcinoma. The detection of hepatocellular carcinoma amenable to surgical resection could improve the prognosis. However, a significant number of hepatocellular carcinomas do not show typical hallmarks on imaging modalities, and hepatocellular carcinoma may, therefore, be missed. There is no clear evidence of the benefit of surveillance programmes in terms of overall survival: the conflicting results can be a consequence of inaccurate detection, ineffective treatment, or both. Assessing the diagnostic accuracy of MRI may clarify whether the absence of benefit could be related to underdiagnosis. Furthermore, an assessment of the accuracy of MRI in people with chronic liver disease who are not included in surveillance programmes is needed for either ruling out or diagnosing hepatocellular carcinoma. OBJECTIVES Primary: to assess the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma of any size and at any stage in adults with chronic liver disease. Secondary: to assess the diagnostic accuracy of MRI for the diagnosis of resectable hepatocellular carcinoma in adults with chronic liver disease, and to identify potential sources of heterogeneity in the results. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test of Accuracy Studies Register, the Cochrane Library, MEDLINE, Embase, and three other databases to 9 November 2021. We manually searched articles retrieved, contacted experts, handsearched abstract books from meetings held during the last 10 years, and searched for literature in OpenGrey (9 November 2021). Further information was requested by e-mails, but no additional information was provided. No data was obtained through correspondence with investigators. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, with cross-sectional designs, using one of the acceptable reference standards, such as pathology of the explanted liver and histology of resected or biopsied focal liver lesion with at least a six-month follow-up. DATA COLLECTION AND ANALYSIS At least two review authors independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest plots, and we tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 34 studies, with 4841 participants. We judged all studies to be at high risk of bias in at least one domain because most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time interval between the index test and the reference standard was rarely defined. Regarding applicability, we judged 15% (5/34) of studies to be at low concern and 85% (29/34) of studies to be at high concern mostly owing to characteristics of the participants, most of whom were on waiting lists for orthotopic liver transplantation, and due to pathology of the explanted liver being the only reference standard. MRI for hepatocellular carcinoma of any size and stage: sensitivity 84.4% (95% CI 80.1% to 87.9%) and specificity 93.8% (95% CI 90.1% to 96.1%) (34 studies, 4841 participants; low-certainty evidence). MRI for resectable hepatocellular carcinoma: sensitivity 84.3% (95% CI 77.6% to 89.3%) and specificity 92.9% (95% CI 88.3% to 95.9%) (16 studies, 2150 participants; low-certainty evidence). The observed heterogeneity in the results remains mostly unexplained. The sensitivity analyses, which included only studies with clearly prespecified positivity criteria and only studies in which the reference standard results were interpreted without knowledge of the results of the index test, showed no variation in the results. AUTHORS' CONCLUSIONS We found that using MRI as a second-line imaging modality to diagnose hepatocellular carcinoma of any size and stage, 16% of people with hepatocellular carcinoma would be missed, and 6% of people without hepatocellular carcinoma would be unnecessarily treated. For resectable hepatocellular carcinoma, we found that 16% of people with resectable hepatocellular carcinoma would improperly not be resected, while 7% of people without hepatocellular carcinoma would undergo inappropriate surgery. The uncertainty resulting from the high risk of bias in the included studies and concerns regarding their applicability limit our ability to confidently draw conclusions based on our results.
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Affiliation(s)
- Tin Nadarevic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Vanja Giljaca
- Department of Gastroenterology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Cristina Manzotti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Damir Miletic
- Department of Radiology , Clinical Hospital Centre Rijeka, Rijeka, Croatia
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28
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Martens B, Bosschee JGA, Van Kuijk SMJ, Jeukens CRLPN, Brauer MTH, Wildberger JE, Mihl C. Finding the optimal tube current and iterative reconstruction strength in liver imaging; two needles in one haystack. PLoS One 2022; 17:e0266194. [PMID: 35390018 PMCID: PMC8989341 DOI: 10.1371/journal.pone.0266194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/15/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
The aim of the study was to find the lowest possible tube current and the optimal iterative reconstruction (IR) strength in abdominal imaging.
Material and methods
Reconstruction software was used to insert noise, simulating the use of a lower tube current. A semi-anthropomorphic abdominal phantom (Quality Assurance in Radiology and Medicine, QSA-543, Moehrendorf, Germany) was used to validate the performance of the ReconCT software (S1 Appendix). Thirty abdominal CT scans performed with a standard protocol (120 kVref, 150 mAsref) scanned at 90 kV, with dedicated contrast media (CM) injection software were selected. There were no other in- or exclusion criteria. The software was used to insert noise as if the scans were performed with 90, 80, 70 and 60% of the full dose. Consequently, the different scans were reconstructed with filtered back projection (FBP) and IR strength 2, 3 and 4. Both objective (e.g. Hounsfield units [HU], signal to noise ratio [SNR] and contrast to noise ratio [CNR]) and subjective image quality were evaluated. In addition, lesion detection was graded by two radiologists in consensus in another 30 scans (identical scan protocol) with various liver lesions, reconstructed with IR 3, 4 and 5.
Results
A tube current of 60% still led to diagnostic objective image quality (e.g. SNR and CNR) when IR strength 3 or 4 were used. IR strength 4 was preferred for lesion detection. The subjective image quality was rated highest for the scans performed at 90% with IR 4.
Conclusion
A tube current reduction of 10–40% is possible in case IR 4 is used, leading to the highest image quality (10%) or still diagnostic image quality (40%), shown by a pairwise comparison in the same patients.
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Affiliation(s)
- Bibi Martens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | | | - Sander M. J. Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Cécile R. L. P. N. Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maikel T. H. Brauer
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Cococcia S, Dutta P, Moghim M, Hogan B, Tanwar S, Marshall A, Macdonald D, Yu D, O'Beirne J, Rosenberg WM, Trembling PM. The fate of indeterminate liver lesions: What proportion are precursors of hepatocellular carcinoma? BMC Gastroenterol 2022; 22:118. [PMID: 35272611 PMCID: PMC8908619 DOI: 10.1186/s12876-022-02135-x] [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: 10/07/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The natural history and incidence of hepatocellular carcinoma (HCC) arising from indeterminate liver lesions are not well described. We aimed to define the incidence of HCC in a cohort of patients undergoing surveillance by magnetic resonance imaging (MRI) and estimate any associations with incident HCC. Methods We performed a retrospective follow-up study, identifying MRI scans in which indeterminate lesions had been reported between January 2006 and January 2017. Subsequent MRI scan reports were reviewed for incident HCC arising from indeterminate lesions, data were extracted from electronic patient records and survival analysis performed to estimate associations with baseline factors. Results One hundred and nine patients with indeterminate lesions on MRI were identified. HCC developed in 19 (17%) patients over mean follow up of 4.6 years. Univariate Cox proportional hazards analysis found incident HCC to be significantly associated with baseline low platelet count (hazard ratio (HR) = 7.3 (95% confidence intervals (CI) 2.1–24.9), high serum alpha-fetoprotein level (HR = 2.7 (95% CI 1.0–7.1)) and alcohol consumption above fourteen units weekly (HR = 3.1 (95% CI 1.1–8.7)). Multivariate analysis, however, found that only low platelet count was independently associated with HCC (HR = 5.5 (95% CI 0.6–5.1)). Conclusions HCC arises in approximately one fifth of indeterminate liver lesions over 4.6 years and is associated with a low platelet count at the time of first diagnosis of an indeterminate lesion. Incidence of HCC was more common in people with viral hepatitis and in those consuming > 14 units of alcohol per week. Our data may be used to support a strategy of enhanced surveillance in patients with indeterminate lesions. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02135-x.
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Affiliation(s)
- Sara Cococcia
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.,First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Priti Dutta
- Department of Radiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Melika Moghim
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Brian Hogan
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Sudeep Tanwar
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Aileen Marshall
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Douglas Macdonald
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Dominic Yu
- Department of Radiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - James O'Beirne
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.,Department of Hepatology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - William M Rosenberg
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Paul M Trembling
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK. .,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
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30
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Fazeli S, Covarrubias Y, Bassirian S, Cuevas J, Fowler K, Vodkin I, Kono Y, Marks R, Loomba R, Taouli B, Sirlin C, Carlos R. Eliciting Patient Preferences for Hepatocellular Carcinoma Screening: A Choice-Based Conjoint Analysis. J Am Coll Radiol 2022; 19:502-512. [DOI: 10.1016/j.jacr.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 12/22/2022]
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31
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Blankenburg M, Elhamamy M, Zhang D, Corbin A, Jin G, Harris J, Knobloch G. Evaluation of the health economic impact of initial diagnostic modality selection in patients suspected of having HCC in China and the USA. J Med Econ 2022; 25:1015-1029. [PMID: 35930705 DOI: 10.1080/13696998.2022.2110353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIMS To compare relative costs associated with the diagnostic pathways for hepatocellular carcinoma (HCC) in the US and China according to the initial imaging modality used. Gadoxetate disodium (ethoxylbenzyl-diethylenetriaminepentaacetic acid)-enhanced magnetic resonance imaging (EOB-MRI) was compared to contrast-enhanced multidetector computed tomography (MDCT), extracellular contrast media enhanced-MRI (ECCM-MRI) and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS Decision tree models were developed to simulate the clinical pathway, based on local clinical guidelines, and validated by experts. Input data were derived from the literature (up to 31 December 2020) as well as from interviews with local experts. RESULTS The models showed that compared to alternative initial imaging modalities, EOB-MRI was associated with higher diagnostic accuracy (fewer false-positive and fewer false-negative results). Increasing proportionate use of EOB-MRI resulted in a cost offset per patient (excluding false-negative patients) in both the US (USD 337) and China (CNY 1,443), driven by reductions in scan costs and unnecessary treatment costs. The use of EOB-MRI was also associated with a shorter average waiting time for a final diagnosis and treatment decision for patients compared to MDCT, ECCM-MRI, and CEUS. CONCLUSION The findings of these models demonstrate that EOB-MRI is the most accurate and rapid imaging modality for the diagnosis of HCC in the US and China, resulting in cost offsets that may benefit the healthcare system.
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Affiliation(s)
| | | | - Diana Zhang
- Department of Pharmaceuticals, Bayer Healthcare Company Limited, Beijing, China
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Natu A, Singh A, Gupta S. Hepatocellular carcinoma: Understanding molecular mechanisms for defining potential clinical modalities. World J Hepatol 2021; 13:1568-1583. [PMID: 34904030 PMCID: PMC8637668 DOI: 10.4254/wjh.v13.i11.1568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/12/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Liver cancer is the sixth most commonly occurring cancer and costs millions of lives per year. The diagnosis of hepatocellular carcinoma (HCC) has relied on scanning techniques and serum-based markers such as α-fetoprotein. These measures have limitations due to their detection limits and asymptomatic conditions during the early stages, resulting in late-stage cancer diagnosis where targeted chemotherapy or systemic treatment with sorafenib is offered. However, the aid of conventional therapy for patients in the advanced stage of HCC has limited outcomes. Thus, it is essential to seek a new treatment strategy and improve the diagnostic techniques to manage the disease. Researchers have used the omics profile of HCC patients for sub-classification of tissues into different groups, which has helped us with prognosis. Despite these efforts, a promising target for treatment has not been identified. The hurdle in this situation is genetic and epigenetic variations in the tumor, leading to disparities in response to treatment. Understanding reversible epigenetic changes along with clinical traits help to define new markers for patient categorization and design personalized therapy. Many clinical trials of inhibitors of epigenetic modifiers (also known as epi-drugs) are in progress. Epi-drugs like azacytidine or belinostat are already approved for other cancer treatments. Furthermore, epigenetic changes have also been observed in drug-resistant HCC tumors. In such cases, combinatorial treatment of epi-drugs with systemic therapy or trans-arterial chemoembolization might re-sensitize resistant cells.
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Affiliation(s)
- Abhiram Natu
- Epigenetics and Chromatin Biology Group, Gupta Laboratory, Cancer Research Institute, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400085, Maharashtra, India
| | - Anjali Singh
- Epigenetics and Chromatin Biology Group, Gupta Laboratory, Cancer Research Institute, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400085, Maharashtra, India
| | - Sanjay Gupta
- Epigenetics and Chromatin Biology Group, Gupta Laboratory, Cancer Research Institute, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai 410210, Maharashtra, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400085, Maharashtra, India
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Liu DS, Frampton AE. Plasma extracellular vesicles contain unannotated small RNA clusters suitable as biomarkers for detecting early hepatocellular carcinoma. Gut 2021; 71:gutjnl-2021-325798. [PMID: 34799372 DOI: 10.1136/gutjnl-2021-325798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/31/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Daniel Sk Liu
- HPB Surgical Unit, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam Enver Frampton
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- HPB Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Burti S, Zotti A, Contiero B, Banzato T. Computed tomography features for differentiating malignant and benign focal liver lesions in dogs: A meta-analysis. Vet J 2021; 278:105773. [PMID: 34742915 DOI: 10.1016/j.tvjl.2021.105773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
Computed tomography (CT) is often performed to complement ultrasound following detection of focal liver lesions (FLL). There is no consensus in the literature regarding the CT features that might be helpful in the distinction between benign and malignant FLL. The aim of this meta-analysis was to identify, based on the available literature, the qualitative and quantitative CT features able to distinguish between benign and malignant FLL. Studies on the diagnostic accuracy of CT in characterising FLL were searched in MEDLINE, Web of Science, and Scopus databases. Pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), receiver operator curve (ROC) area, were calculated for qualitative features. DOR were used to determine which qualitative features were most informative to detect malignancy; quantitative features were selected/identified based on standardised mean difference (SMD). Well-defined margins, presence of a capsule, abnormal lymph nodes, and heterogeneity in the arterial, portal and delayed phase were classified as informative qualitative CT features. The pooled sensitivity ranged from 0.630 (abnormal lymph nodes) to 0.786 (well-defined margins), while pooled specificity ranged from 0.643 (well-defined margins) to 0.816 (heterogeneous in delayed phase). Maximum dimensions, ellipsoid volume, attenuation of the liver in the pre-contrast phase, and attenuation of the liver in the arterial, portal, and delayed phase were found to be informative quantitative CT features. Larger maximum dimensions and volume (positive SMD), and lower attenuation values (negative SMD) were more associated with malignancy. This meta-analysis provides the evidence base for the interpreting CT imaging in the characterization of FLL.
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Affiliation(s)
- S Burti
- Department of Animal Medicine, Production and Health, University of Padua, Viale dell'Università 16, 35020 Legnaro, Padua, Italy
| | - A Zotti
- Department of Animal Medicine, Production and Health, University of Padua, Viale dell'Università 16, 35020 Legnaro, Padua, Italy
| | - B Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Viale dell'Università 16, 35020 Legnaro, Padua, Italy
| | - T Banzato
- Department of Animal Medicine, Production and Health, University of Padua, Viale dell'Università 16, 35020 Legnaro, Padua, Italy.
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Castellana M, Donghia R, Lampignano L, Castellana F, Zupo R, Sardone R, Pergola GD, Giannelli G. Prevalence of the Absence of Cirrhosis in Subjects with NAFLD-Associated Hepatocellular Carcinoma. J Clin Med 2021; 10:jcm10204638. [PMID: 34682759 PMCID: PMC8539355 DOI: 10.3390/jcm10204638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/27/2021] [Accepted: 10/02/2021] [Indexed: 12/14/2022] Open
Abstract
Background. Hepatocellular carcinoma (HCC) is most commonly considered as a complication of cirrhosis. However, an increasing number of HCC in subjects with non-alcoholic fatty liver disease (NAFLD) without cirrhosis is being reported. We conducted a meta-analysis to assess the prevalence of the absence of cirrhosis in NAFLD-associated HCC. Methods. Four databases were searched until March 2021 (CRD42021242969). The original articles included were those reporting data on the presence or absence of cirrhosis among at least 50 subjects with NAFLD-associated HCC. The number of subjects with absent cirrhosis in each study was extracted. For statistical pooling of data, a random-effects model was used. Subgroup analyses according to the continent, target condition and reference standard for the diagnosis of cirrhosis were conducted. Results. Thirty studies were included, evaluating 13,371 subjects with NAFLD-associated HCC. The overall prevalence of cases without cirrhosis was 37% (95%CI 28 to 46). A higher prevalence was reported in Asia versus Europe, North America and South America (45, 36, 37 and 22%, respectively) as well as in studies adopting histology only as the reference standard for the diagnosis of cirrhosis versus histology and other modalities (e.g., radiology, endoscopy, biochemistry or overt clinical findings) (53 and 27%, respectively). No difference was found between studies including subjects with non-alcoholic steatohepatitis (NASH) only, versus NAFLD with or without NASH (p = 0.385). One in three subjects with NAFLD-associated HCC presented without cirrhosis. This should be reflected in future guidelines and surveillance programs adapted to allow for the early detection of these cancers too.
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Affiliation(s)
- Marco Castellana
- Unit of Research Methodology, Health Data Sciences and Technology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.D.); (L.L.); (F.C.); (R.Z.); (R.S.); (G.D.P.)
- Correspondence: ; Tel.: +39-0804994111
| | - Rossella Donghia
- Unit of Research Methodology, Health Data Sciences and Technology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.D.); (L.L.); (F.C.); (R.Z.); (R.S.); (G.D.P.)
| | - Luisa Lampignano
- Unit of Research Methodology, Health Data Sciences and Technology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.D.); (L.L.); (F.C.); (R.Z.); (R.S.); (G.D.P.)
| | - Fabio Castellana
- Unit of Research Methodology, Health Data Sciences and Technology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.D.); (L.L.); (F.C.); (R.Z.); (R.S.); (G.D.P.)
| | - Roberta Zupo
- Unit of Research Methodology, Health Data Sciences and Technology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.D.); (L.L.); (F.C.); (R.Z.); (R.S.); (G.D.P.)
| | - Rodolfo Sardone
- Unit of Research Methodology, Health Data Sciences and Technology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.D.); (L.L.); (F.C.); (R.Z.); (R.S.); (G.D.P.)
| | - Giovanni De Pergola
- Unit of Research Methodology, Health Data Sciences and Technology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.D.); (L.L.); (F.C.); (R.Z.); (R.S.); (G.D.P.)
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy;
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Nadarevic T, Giljaca V, Colli A, Fraquelli M, Casazza G, Miletic D, Štimac D. Computed tomography for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev 2021; 10:CD013362. [PMID: 34611889 PMCID: PMC8493329 DOI: 10.1002/14651858.cd013362.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma occurs mostly in people with chronic liver disease and ranks sixth in terms of global incidence of cancer, and fourth in terms of cancer deaths. In clinical practice, computed tomography (CT) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-foetoprotein, or both, either in surveillance programmes or in clinical settings. According to current guidelines, a single contrast-enhanced imaging study CT or magnetic resonance imaging (MRI) showing typical hallmarks of hepatocellular carcinoma in people with cirrhosis is valid to diagnose hepatocellular carcinoma. However, a significant number of hepatocellular carcinomas do not show typical hallmarks on imaging modalities, and hepatocellular carcinoma is, therefore, missed. There is no clear evidence of the benefit of surveillance programmes in terms of overall survival: the conflicting results can be a consequence of inaccurate detection, ineffective treatment, or both. Assessing the diagnostic accuracy of CT may clarify whether the absence of benefit could be related to underdiagnosis. Furthermore, an assessment of the accuracy of CT in people with chronic liver disease, who are not included in surveillance programmes is needed for either ruling out or diagnosing hepatocellular carcinoma. OBJECTIVES Primary: to assess the diagnostic accuracy of multidetector, multiphasic contrast-enhanced CT for the diagnosis of hepatocellular carcinoma of any size and at any stage in adults with chronic liver disease, either in a surveillance programme or in a clinical setting. Secondary: to assess the diagnostic accuracy of CT for the diagnosis of resectable hepatocellular carcinoma in adults with chronic liver disease. SEARCH METHODS We searched the Cochrane Hepato-Biliary Trials Register, Cochrane Hepato-Biliary Diagnostic-Test-Accuracy Studies Register, the Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and Conference Proceedings Citation Index - Science until 4 May 2021. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of CT for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, with cross-sectional designs, using one of the acceptable reference standards, such as pathology of the explanted liver and histology of resected or biopsied focal liver lesion with at least a six-month follow-up. DATA COLLECTION AND ANALYSIS At least two review authors independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest plots, and tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 21 studies, with a total of 3101 participants. We judged all studies to be at high risk of bias in at least one domain because most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time-interval between the index test and the reference standard was rarely defined. Regarding applicability in the patient selection domain, we judged 14% (3/21) of studies to be at low concern and 86% (18/21) of studies to be at high concern owing to characteristics of the participants who were on waiting lists for orthotopic liver transplantation. CT for hepatocellular carcinoma of any size and stage: sensitivity 77.5% (95% CI 70.9% to 82.9%) and specificity 91.3% (95% CI 86.5% to 94.5%) (21 studies, 3101 participants; low-certainty evidence). CT for resectable hepatocellular carcinoma: sensitivity 71.4% (95% CI 60.3% to 80.4%) and specificity 92.0% (95% CI 86.3% to 95.5%) (10 studies, 1854 participants; low-certainty evidence). In the three studies at low concern for applicability (861 participants), we found sensitivity 76.9% (95% CI 50.8% to 91.5%) and specificity 89.2% (95% CI 57.0% to 98.1%). The observed heterogeneity in the results remains mostly unexplained. The sensitivity analyses, which included only studies with clearly prespecified positivity criteria and only studies in which the reference standard results were interpreted without knowledge of the results of the index test, showed no variation in the results. AUTHORS' CONCLUSIONS In the clinical pathway for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, CT has roles as a confirmatory test for hepatocellular carcinoma lesions, and for staging assessment. We found that using CT in detecting hepatocellular carcinoma of any size and stage, 22.5% of people with hepatocellular carcinoma would be missed, and 8.7% of people without hepatocellular carcinoma would be unnecessarily treated. For resectable hepatocellular carcinoma, we found that 28.6% of people with resectable hepatocellular carcinoma would improperly not be resected, while 8% of people without hepatocellular carcinoma would undergo inappropriate surgery. The uncertainty resulting from the high risk of bias in the included studies and concerns regarding their applicability limit our ability to confidently draw conclusions based on our results.
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Affiliation(s)
- Tin Nadarevic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Vanja Giljaca
- Department of Gastroenterology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Damir Miletic
- Department of Radiology , Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Hu H, Wang W, Chen L, Ruan S, Chen S, Li X, Lu M, Xie X, Kuang M. Artificial intelligence assists identifying malignant versus benign liver lesions using contrast-enhanced ultrasound. J Gastroenterol Hepatol 2021; 36:2875-2883. [PMID: 33880797 PMCID: PMC8518504 DOI: 10.1111/jgh.15522] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/14/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM This study aims to construct a strategy that uses assistance from artificial intelligence (AI) to assist radiologists in the identification of malignant versus benign focal liver lesions (FLLs) using contrast-enhanced ultrasound (CEUS). METHODS A training set (patients = 363) and a testing set (patients = 211) were collected from our institute. On four-phase CEUS images in the training set, a composite deep learning architecture was trained and tuned for differentiating malignant and benign FLLs. In the test dataset, AI performance was evaluated by comparison with radiologists with varied levels of experience. Based on the comparison, an AI assistance strategy was constructed, and its usefulness in reducing CEUS interobserver heterogeneity was further tested. RESULTS In the test set, to identify malignant versus benign FLLs, AI achieved an area under the curve of 0.934 (95% CI 0.890-0.978) with an accuracy of 91.0%. Comparing with radiologists reviewing videos along with complementary patient information, AI outperformed residents (82.9-84.4%, P = 0.038) and matched the performance of experts (87.2-88.2%, P = 0.438). Due to the higher positive predictive value (PPV) (AI: 95.6% vs residents: 88.6-89.7%, P = 0.056), an AI strategy was defined to improve the malignant diagnosis. With the assistance of AI, radiologists exhibited a sensitivity improvement of 97.0-99.4% (P < 0.05) and an accuracy of 91.0-92.9% (P = 0.008-0.189), which was comparable with that of the experts (P = 0.904). CONCLUSIONS The CEUS-based AI strategy improved the performance of residents and reduced CEUS's interobserver heterogeneity in the differentiation of benign and malignant FLLs.
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Affiliation(s)
- Hang‐Tong Hu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina,Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Wei Wang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Li‐Da Chen
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Si‐Min Ruan
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Shu‐Ling Chen
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xin Li
- Research Center of GE HealthcareGeneral Electric China Technology CenterShanghaiChina
| | - Ming‐De Lu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina,Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Xiao‐Yan Xie
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Ming Kuang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X‐LabInstitute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina,Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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Choi HH, Rodgers SK, Fetzer DT, Wasnik AP, Millet JD, Morgan TA, Dawkins A, Gabriel H, Kamaya A. Ultrasound Liver Imaging Reporting and Data System (US LI-RADS): An Overview with Technical and Practical Applications. Acad Radiol 2021; 28:1464-1476. [PMID: 32718745 DOI: 10.1016/j.acra.2020.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS), introduced in 2017 by the American College of Radiology, standardizes the technique, interpretation, and reporting of screening and surveillance ultrasounds intended to detect hepatocellular carcinoma in high-risk patients. These include patients with cirrhosis of any cause as well as subsets of patients with chronic hepatitis B viral infection. The US LI-RADS scheme is composed of an ultrasound category and a visualization score: ultrasound categories define the exam as negative, subthreshold, or positive and direct next steps in management; visualization scores denote the expected sensitivity of the exam, based on adequacy of liver visualization with ultrasound. Since its introduction, multiple institutions across the United States have implemented US LI-RADS. This review includes a background of hepatocellular carcinoma and US LI-RADS, definition of screening/surveillance population, recommendations and tips for technique, interpretation, and reporting, and preliminary outcomes analysis.
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Affiliation(s)
- Hailey H Choi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 1001 Potrero Ave. Building 5, 1st floor, San Francisco, CA 94110.
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas Texas
| | - Ashish P Wasnik
- Department of Radiology, Michigan Medicine, University of Michigan, Arbor, Michigan
| | - John D Millet
- Department of Radiology, Michigan Medicine, University of Michigan, Arbor, Michigan
| | - Tara A Morgan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 1001 Potrero Ave. Building 5, 1st floor, San Francisco, CA 94110
| | - Adrian Dawkins
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Helena Gabriel
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Aya Kamaya
- Department of Radiology, Stanford University Medical Center, Stanford, California
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Arab JP, Dirchwolf M, Álvares-da-Silva MR, Barrera F, Benítez C, Castellanos-Fernandez M, Castro-Narro G, Chavez-Tapia N, Chiodi D, Cotrim H, Cusi K, de Oliveira CPMS, Díaz J, Fassio E, Gerona S, Girala M, Hernandez N, Marciano S, Masson W, Méndez-Sánchez N, Leite N, Lozano A, Padilla M, Panduro A, Paraná R, Parise E, Perez M, Poniachik J, Restrepo JC, Ruf A, Silva M, Tagle M, Tapias M, Torres K, Vilar-Gomez E, Costa Gil JE, Gadano A, Arrese M. Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease. Ann Hepatol 2021; 19:674-690. [PMID: 33031970 DOI: 10.1016/j.aohep.2020.09.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) currently represents an epidemic worldwide. NAFLD is the most frequently diagnosed chronic liver disease, affecting 20-30% of the general population. Furthermore, its prevalence is predicted to increase exponentially in the next decades, concomitantly with the global epidemic of obesity, type 2 diabetes mellitus (T2DM), and sedentary lifestyle. NAFLD is a clinical syndrome that encompasses a wide spectrum of associated diseases and hepatic complications such as hepatocellular carcinoma (HCC). Moreover, this disease is believed to become the main indication for liver transplantation in the near future. Since NAFLD management represents a growing challenge for primary care physicians, the Asociación Latinoamericana para el Estudio del Hígado (ALEH) has decided to organize this Practice Guidance for the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease, written by Latin-American specialists in different clinical areas, and destined to general practitioners, internal medicine specialists, endocrinologists, diabetologists, gastroenterologists, and hepatologists. The main purpose of this document is to improve patient care and awareness of NAFLD. The information provided in this guidance may also be useful in assisting stakeholders in the decision-making process related to NAFLD. Since new evidence is constantly emerging on different aspects of the disease, updates to this guideline will be required in future.
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Affiliation(s)
- Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Melisa Dirchwolf
- Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Privado de Rosario, Rosario, Argentina.
| | - Mário Reis Álvares-da-Silva
- Hepatology Division, Hospital de Clinicas de Porto Alegre, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil; Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Francisco Barrera
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Carlos Benítez
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | | | - Graciela Castro-Narro
- Gastroenterology Department, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico.
| | | | - Daniela Chiodi
- Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| | - Helma Cotrim
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA.
| | | | - Javier Díaz
- Departamento del Aparato Digestivo, Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru.
| | - Eduardo Fassio
- Sección Hígado, Vías Biliares y Páncreas, Servicio de Gastroenterología, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.
| | - Solange Gerona
- Liver Unit, Hospital de Fuerzas Armadas, Montevideo, Uruguay.
| | | | - Nelia Hernandez
- Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| | | | - Walter Masson
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - Nathalie Leite
- School of Medicine, Internal Medicine Department and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Adelina Lozano
- Unidad de Hígado, Servicio de Gastroenterología, Hospital Nacional Arzobispo Loayza, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | - Arturo Panduro
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
| | - Raymundo Paraná
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Edison Parise
- Department of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Marlene Perez
- Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic.
| | - Jaime Poniachik
- Sección de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Juan Carlos Restrepo
- Hepatobiliary and Liver Transplant Program, Hospital Pablo Tobon Uribe-Universidad de Antioquia, Medellín, Colombia; Grupo Gastrohepatologia, Facultad de Medicina, Universidad of Antioquía UdeA, Medellin, Colombia.
| | - Andrés Ruf
- Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Privado de Rosario, Rosario, Argentina.
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.
| | - Martín Tagle
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Monica Tapias
- Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | - Kenia Torres
- Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic.
| | - Eduardo Vilar-Gomez
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Adrian Gadano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Adeniji N, Dhanasekaran R. Current and Emerging Tools for Hepatocellular Carcinoma Surveillance. Hepatol Commun 2021; 5:1972-1986. [PMID: 34533885 PMCID: PMC8631096 DOI: 10.1002/hep4.1823] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related mortality worldwide. Early detection of HCC enables patients to avail curative therapies that can improve patient survival. Current international guidelines advocate for the enrollment of patients at high risk for HCC, like those with cirrhosis, in surveillance programs that perform ultrasound every 6 months. In recent years, many studies have further characterized the utility of established screening strategies and have introduced new promising tools for HCC surveillance. In this review, we provide an overview of the most promising new imaging modalities and biomarkers for the detection of HCC. We discuss the role of imaging tools like ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) in the early detection of HCC, and describe recent innovations which can potentially enhance their applicability, including contrast enhanced ultrasound, low‐dose CT scans, and abbreviated MRI. Next, we outline the data supporting the use of three circulating biomarkers (i.e., alpha‐fetoprotein [AFP], AFP lens culinaris agglutinin‐reactive fraction, and des‐gamma‐carboxy prothrombin) in HCC surveillance, and expand on multiple emerging liquid biopsy biomarkers, including methylated cell‐free DNA (cfDNA), cfDNA mutations, extracellular vesicles, and circulating tumor cells. These promising new imaging modalities and biomarkers have the potential to improve early detection, and thus improve survival, in patients with HCC.
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Affiliation(s)
- Nia Adeniji
- Stanford School of Medicine, Stanford, CA, USA
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Magnetic Resonance Imaging for Surveillance of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11091665. [PMID: 34574006 PMCID: PMC8469328 DOI: 10.3390/diagnostics11091665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022] Open
Abstract
Our meta-analysis aimed to evaluate the diagnostic performance of surveillance magnetic resonance imaging (sMRI) for detecting hepatocellular carcinoma (HCC), and to compare the diagnostic performance of sMRI between different protocols. Original articles about the diagnostic accuracy of sMRI for detecting HCC were found in major databases. The meta-analytic pooled sensitivity and specificity of sMRI for detecting HCC were determined using a bivariate random effects model. The pooled sensitivity and specificity of full MRI and abbreviated MRI protocols were compared using bivariate meta-regression. In the total seven included studies (1830 patients), the pooled sensitivity of sMRI for any-stage HCC and very early-stage HCC were 85% (95% confidence interval, 79–90%; I2 = 0%) and 77% (66–85%; I2 = 32%), respectively. The pooled specificity for any-stage HCC and very early-stage HCC were 94% (90–97%; I2 = 94%) and 94% (88–97%; I2 = 96%), respectively. The pooled sensitivity and specificity of abbreviated MRI protocols were 87% (80–94%) and 94% (90–98%), values that were comparable with those of full MRI protocols (84% [76–91%] and 94% [89–99%]; p = 0.83). In conclusion, sMRI had good sensitivity for detecting HCC, particularly very early-stage HCC. Abbreviated MRI protocols for HCC surveillance had comparable diagnostic performance to full MRI protocols.
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Lim M, Goh GB, Chang JP, Low J, Shelat VG, Huey TC, Dan Y, Kow A, Shridhar I, Tan P, Junnarkar SP, Tan C. A study of 3013 cases of hepatocellular carcinoma: Etiology and therapy before and during the current decade. JGH Open 2021; 5:1015-1018. [PMID: 34584969 PMCID: PMC8454472 DOI: 10.1002/jgh3.12624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Hepatocellular carcinoma (HCC) is a significant global problem. With advances in HCC diagnosis and therapy, our hypothesis is that there are significant differences in the clinical characteristics and treatment of HCC over the years. METHODS Patients with HCC between 1980 and 2018 from three major tertiary hospitals in Singapore were enrolled into a Research Electronic Data Capture database. Clinical characteristics and treatment of HCC were compared between those diagnosed before 2008 (cohort A) and during the current decade (ie from 2008 onwards) (cohort B). RESULTS There were 3013 patients. Mean age of HCC diagnosis was significantly older in cohort B (68.6 vs 61.2 years, P < 0.001). The most common etiology remained as chronic hepatitis B infection but the proportion due to hepatitis B was significantly lower in cohort B (46.6% vs 57.2%, P < 0.0001). The prevalence of cryptogenic/non-alcoholic steatohepatitis was significantly higher in cohort B than cohort A (27.1% vs 18.6%, P < 0.0001). More patients received curative therapy in cohort B (43.7% vs 27.1%, P < 0.0001. CONCLUSION In this largest collection of HCC patients in Singapore, patients are diagnosed with HCC at an older age and cryptogenic/non-alcoholic steatohepatitis is becoming more important as an etiology of HCC in the current decade. More patients also received curative therapy in the current decade.
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Affiliation(s)
- Miao‐Shan Lim
- Department of Hepatology and GastroenterologySingapore General HospitalSingapore
| | - George B‐B Goh
- Department of Hepatology and GastroenterologySingapore General HospitalSingapore
| | - Jason P‐E Chang
- Department of Hepatology and GastroenterologySingapore General HospitalSingapore
| | - Jee‐Keem Low
- Department of General Surgery (Hepato‐Pancreato‐Biliary Surgery Service)Tan Tock Seng HospitalSingapore
| | - Vishalkumar G Shelat
- Department of General Surgery (Hepato‐Pancreato‐Biliary Surgery Service)Tan Tock Seng HospitalSingapore
| | - Terence C‐W Huey
- Department of General Surgery (Hepato‐Pancreato‐Biliary Surgery Service)Tan Tock Seng HospitalSingapore
| | - Yock‐Young Dan
- Division of Gastroenterology and Hepatology, University Medicine ClusterNational University Health SystemSingapore
| | - Alfred Kow
- Division of Hepatobiliary and Pancreatic Surgery, University Surgical ClusterNational University Health SystemSingapore
| | - Iyer Shridhar
- Division of Hepatobiliary and Pancreatic Surgery, University Surgical ClusterNational University Health SystemSingapore
| | - Poh‐Seng Tan
- Division of Gastroenterology and Hepatology, University Medicine ClusterNational University Health SystemSingapore
| | - Sameer P Junnarkar
- Department of General Surgery (Hepato‐Pancreato‐Biliary Surgery Service)Tan Tock Seng HospitalSingapore
| | - Chee‐Kiat Tan
- Department of Hepatology and GastroenterologySingapore General HospitalSingapore
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Piñero F, Tanno M, Aballay Soteras G, Tisi Baña M, Dirchwolf M, Fassio E, Ruf A, Mengarelli S, Borzi S, Fernández N, Ridruejo E, Descalzi V, Anders M, Mazzolini G, Reggiardo V, Marciano S, Perazzo F, Spina JC, McCormack L, Maraschio M, Lagues C, Gadano A, Villamil F, Silva M, Cairo F, Ameigeiras B. Argentinian clinical practice guideline for surveillance, diagnosis, staging and treatment of hepatocellular carcinoma. Ann Hepatol 2021; 19:546-569. [PMID: 32593747 DOI: 10.1016/j.aohep.2020.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 02/08/2023]
Abstract
The A.A.E.E.H has developed this guideline for the best care of patients with hepatocellular carcinoma (HCC) from Argentina. It was done from May 2018 to March 2020. Specific clinical research questions were systematically searched. The quality of evidence and level of recommendations were organized according to GRADE. HCC surveillance is strongly recommended with abdominal ultrasound (US) every six months in the population at risk for HCC (cirrhosis, hepatitis B or hepatitis C); it is suggested to add alpha-feto protein (AFP) levels in case of inexeperienced sonographers. Imaging diagnosis in patients at risk for HCC has high specificity and tumor biopsy is not mandatory. The Barcelona Clinic Liver Cancer algorithm is strongly recommended for HCC staging and treatment-decision processes. Liver resection is strongly recommended for patients without portal hypertension and preserved liver function. Composite models are suggested for liver transplant selection criteria. Therapies for HCC with robust clinical evidence include transarterial chemoembolization (TACE) and first to second line systemic treatment options (sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). Immunotherapy with nivolumab and pembrolizumab has failed to show statistical benefit but the novel combination of atezolizumab plus bevacizumab has recently shown survival benefit over sorafenib in frontline.
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Affiliation(s)
- Federico Piñero
- Hepatology and Liver Unit, Hospital Universitario Austral, School of Medicine, Austral University, B1629HJ Buenos Aires, Argentina.
| | - Mario Tanno
- Hospital Centenario de Rosario, Santa Fe, Argentina
| | | | - Matías Tisi Baña
- Internal Medicine and Epidemiology Department, Hospital Universitario Austral, School of Medicine, Austral University, B1629HJ Buenos Aires, Argentina
| | | | | | - Andrés Ruf
- Hospital Privado de Rosario, Santa Fe, Argentina
| | | | - Silvia Borzi
- Instituto Rossi, La Plata, Buenos Aires, Argentina
| | | | - Ezequiel Ridruejo
- Hepatology and Liver Unit, Hospital Universitario Austral, School of Medicine, Austral University, B1629HJ Buenos Aires, Argentina; Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Ciudad de Buenos Aires, Argentina
| | | | | | - Guillermo Mazzolini
- Hepatology and Liver Unit, Hospital Universitario Austral, School of Medicine, Austral University, B1629HJ Buenos Aires, Argentina
| | | | | | | | | | | | | | - Cecilia Lagues
- Hepatology and Liver Unit, Hospital Universitario Austral, School of Medicine, Austral University, B1629HJ Buenos Aires, Argentina
| | | | | | - Marcelo Silva
- Hepatology and Liver Unit, Hospital Universitario Austral, School of Medicine, Austral University, B1629HJ Buenos Aires, Argentina
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Wang W, Wu SS, Zhang JC, Xian MF, Huang H, Li W, Zhou ZM, Zhang CQ, Wu TF, Li X, Xu M, Xie XY, Kuang M, Lu MD, Hu HT. Preoperative Pathological Grading of Hepatocellular Carcinoma Using Ultrasomics of Contrast-Enhanced Ultrasound. Acad Radiol 2021; 28:1094-1101. [PMID: 32622746 DOI: 10.1016/j.acra.2020.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To develop an ultrasomics model for preoperative pathological grading of hepatocellular carcinoma (HCC) using contrast-enhanced ultrasound (CEUS). MATERIAL AND METHODS A total of 235 HCCs were retrospectively enrolled, including 65 high-grade and 170 low-grade HCCs. Representative images of four-phase CEUS were selected from the baseline sonography, arterial, portal venous, and delayed phase images. Tumor ultrasomics features were automatically extracted using Ultrasomics-Platform software. Models were built via the classifier support vector machine, including an ultrasomics model using the ultrasomics features, a clinical model using the clinical factors, and a combined model using them both. Model performances were tested in the independent validation cohort considering efficiency and clinical usefulness. RESULTS A total of 1502 features were extracted from each image. After the reproducibility test and dimensionality reduction, 25 ultrasomics features and 3 clinical factors were selected to build the models. In the validation cohort, the combined model showed the best predictive power, with an area under the curve value of 0.785 (95% confidence interval [CI] 0.662-0.909), compared to the ultrasomics model of 0.720 (95% CI 0.576-0.864) and the clinical model of 0.665 (95% CI 0.537-0.793). Decision curve analysis suggested that the combined model was clinically useful, with a corresponding net benefit of 0.760 compared to the other two models. CONCLUSION We presented an ultrasomics-clinical model based on multiphase CEUS imaging and clinical factors, which showed potential value for the preoperative discrimination of HCC pathological grades.
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Serum epidermal growth factor-like domain 7 serves as a novel diagnostic marker for early hepatocellular carcinoma. BMC Cancer 2021; 21:772. [PMID: 34217251 PMCID: PMC8255001 DOI: 10.1186/s12885-021-08491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
Background Epidermal growth factor-like domain 7 (Egfl7), a recently identified secreted protein, was significantly increased in patients with HCC by our previous studies. However, its efficacy in the diagnosis of early HCC remains unknown. In this study, we therefore evaluate the efficacy of serum Egfl7 for early HCC diagnosis and compare it with alpha-fetoprotein (AFP). Methods Serum Egfl7 levels in testing cohort (1081 participants) and validation cohort (476 participants) were measured by a sandwich enzyme-linked immunoassay (ELISA). The cut-off value of Egfl7 was determined by Youden’s index and the efficacies of Egfl7 and AFP in diagnosing early HCC were estimated by receiver operating characteristic (ROC). Results Serum Egfl7 was significantly elevated in patients with early HCC than all non-HCC controls in whatever Testing Cohort or Validation Cohort. In the Testing Cohort, ROC curves showed the optimum cut-off value of Egfl7 was 2610 ng/mL and Egfl7 showed a significantly higher sensitivity than AFP in discriminating early HCC from healthy individuals (77.4% vs. 65.3%, P = 0.0013) but the area under ROC (AUROC) and accuracy of Egfl7 and AFP were similar (0.860 vs. 0.868, P = 0.704; 80.2% vs. 83.8%, P = 0.184). In distinguishing patients with early HCC from patients with chronic liver disease (CLD), the AUROC, sensitivity, specificity and accuracy of Egfl7 were 0.800, 75.2, 71.7 and 73.5%, which were all significantly higher than AFP (0.675, 61.8, 62.0 and 61.9% in order). Egfl7 also showed a significant higher sensitivity and accuracy than AFP (76.6% vs. 64.0%, P = 0.0031; 79.9% vs. 66.1%, P < 0.0001) in differentiating early HCC patients from non-HCC individuals. Additionally, 70.8% of early HCC patients with negative AFP could be diagnosed by Egfl7 and the combined use of Egfl7 and AFP increased the sensitivity to 91.0%. These results were confirmed by a validation cohort. Conclusion Egfl7 is a valuable serum marker in the diagnosis of early HCC and could complement the efficacy of AFP, especially in distinguishing early HCC from CLD and identifying patients with AFP-negative early HCC.
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Kuang M, Hu HT, Li W, Chen SL, Lu XZ. Articles That Use Artificial Intelligence for Ultrasound: A Reader's Guide. Front Oncol 2021; 11:631813. [PMID: 34178622 PMCID: PMC8222674 DOI: 10.3389/fonc.2021.631813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Artificial intelligence (AI) transforms medical images into high-throughput mineable data. Machine learning algorithms, which can be designed for modeling for lesion detection, target segmentation, disease diagnosis, and prognosis prediction, have markedly promoted precision medicine for clinical decision support. There has been a dramatic increase in the number of articles, including articles on ultrasound with AI, published in only a few years. Given the unique properties of ultrasound that differentiate it from other imaging modalities, including real-time scanning, operator-dependence, and multi-modality, readers should pay additional attention to assessing studies that rely on ultrasound AI. This review offers the readers a targeted guide covering critical points that can be used to identify strong and underpowered ultrasound AI studies.
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Affiliation(s)
- Ming Kuang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Li
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shu-Ling Chen
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Zhou Lu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Caraiani C, Boca B, Bura V, Sparchez Z, Dong Y, Dietrich C. CT/MRI LI-RADS v2018 vs. CEUS LI-RADS v2017-Can Things Be Put Together? BIOLOGY 2021; 10:biology10050412. [PMID: 34066607 PMCID: PMC8148521 DOI: 10.3390/biology10050412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/17/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022]
Abstract
Simple Summary The LI-RADS system is nowadays the mainstream system used in classifying liver nodules in cirrhotic liver according to their risk of malignancy. Two main LI-RADS documents have been released—the CEUS LI-RADS v2017 document, and the CT/MRI LI-RADS v2018 document. In some circumstances, a nodule can be differently classified when using CEUS versus when using CT or MRI. In this paper, we also focus on the existing similitudes between the two documents but, essentially, on the differences between the two main documents and the complementarities between imaging techniques in characterizing liver nodules in cirrhotic livers. Awareness of the complementarity of imaging techniques may lead to an improvement in the characterization and classification of liver nodules and will reduce the number of liver biopsies. This paper proposes practical solutions in order to better classify and manage observations or nodules detected in cirrhotic livers. Abstract Different LI-RADS core documents were released for CEUS and for CT/MRI. Both documents rely on major and ancillary diagnostic criteria. The present paper offers an exhaustive comparison of the two documents focusing on the similarities, but especially on the differences, complementarity, and added value of imaging techniques in classifying liver nodules in cirrhotic livers. The major diagnostic criteria are defined, and the sensitivity and specificity of each major diagnostic criteria are presented according to the literature. The existing differences between techniques in assessing the major diagnostic features can be then exploited in order to ensure a better classification and a better clinical management of liver nodules in cirrhotic livers. Ancillary features depend on the imaging technique used, and their presence can upgrade or downgrade the LI-RADS score of an observation, but only as far as LI-RADS 4. MRI is the imaging technique that provides the greatest number of ancillary features, whereas CEUS has fewer ancillary features than other imaging techniques. In the final part of the manuscript, some recommendations are made by the authors in order to guidephysicians as to when adding another imaging technique can be helpful in managing liver nodules in cirrhotic livers.
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Affiliation(s)
- Cosmin Caraiani
- Department of Medical Imaging, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania;
| | - Bianca Boca
- Department of Medical Imaging, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania;
- Department of Radiology, County Clinical Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania;
- Department of Radiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Correspondence: (B.B.); (Z.S.)
| | - Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania;
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, UK
| | - Zeno Sparchez
- Department of Gastroenterology and Hepatology, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, 400158 Cluj-Napoca, Romania
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
- Correspondence: (B.B.); (Z.S.)
| | - Yi Dong
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China;
| | - Christoph Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland;
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Nadarevic T, Colli A, Giljaca V, Fraquelli M, Casazza G, Manzotti C, Štimac D, Miletic D. Magnetic resonance imaging for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Hippokratia 2021. [DOI: 10.1002/14651858.cd014798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Tin Nadarevic
- Department of Radiology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano Italy
| | - Vanja Giljaca
- Department of Gastroenterology; Heart of England NHS Foundation Trust; Birmingham UK
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit; Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano; Milan Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco"; Università degli Studi di Milano; Milan Italy
| | - Cristina Manzotti
- Obstetrics and Gynecology Department; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano; Milan Italy
| | - Davor Štimac
- Department of Gastroenterology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Damir Miletic
- Department of Radiology ; Clinical Hospital Centre Rijeka; Rijeka Croatia
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Colli A, Nadarevic T, Miletic D, Giljaca V, Fraquelli M, Štimac D, Casazza G. Abdominal ultrasound and alpha-foetoprotein for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev 2021; 4:CD013346. [PMID: 33855699 PMCID: PMC8078581 DOI: 10.1002/14651858.cd013346.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) occurs mostly in people with chronic liver disease and ranks sixth in terms of global instances of cancer, and fourth in terms of cancer deaths for men. Despite that abdominal ultrasound (US) is used as an initial test to exclude the presence of focal liver lesions and serum alpha-foetoprotein (AFP) measurement may raise suspicion of HCC occurrence, further testing to confirm diagnosis as well as staging of HCC is required. Current guidelines recommend surveillance programme using US, with or without AFP, to detect HCC in high-risk populations despite the lack of clear benefits on overall survival. Assessing the diagnostic accuracy of US and AFP may clarify whether the absence of benefit in surveillance programmes could be related to under-diagnosis. Therefore, assessment of the accuracy of these two tests for diagnosing HCC in people with chronic liver disease, not included in surveillance programmes, is needed. OBJECTIVES Primary: the diagnostic accuracy of US and AFP, alone or in combination, for the diagnosis of HCC of any size and at any stage in adults with chronic liver disease, either in a surveillance programme or in a clinical setting. Secondary: to assess the diagnostic accuracy of abdominal US and AFP, alone or in combination, for the diagnosis of resectable HCC; to compare the diagnostic accuracy of the individual tests versus the combination of both tests; to investigate sources of heterogeneity in the results. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic-Test-Accuracy Studies Register, Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, until 5 June 2020. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of US and AFP, independently or in combination, for the diagnosis of HCC in adults with chronic liver disease, with cross-sectional and case-control designs, using one of the acceptable reference standards, such as pathology of the explanted liver, histology of resected or biopsied focal liver lesion, or typical characteristics on computed tomography, or magnetic resonance imaging, all with a six-months follow-up. DATA COLLECTION AND ANALYSIS We independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest-plots, and tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 373 studies. The index-test was AFP (326 studies, 144,570 participants); US (39 studies, 18,792 participants); and a combination of AFP and US (eight studies, 5454 participants). We judged at high-risk of bias all but one study. Most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time-interval between the index test and the reference standard was rarely defined. Most studies with AFP had a case-control design. We also had major concerns for the applicability due to the characteristics of the participants. As the primary studies with AFP used different cut-offs, we performed a meta-analysis using the hierarchical-summary-receiver-operating-characteristic model, then we carried out two meta-analyses including only studies reporting the most used cut-offs: around 20 ng/mL or 200 ng/mL. AFP cut-off 20 ng/mL: for HCC (147 studies) sensitivity 60% (95% CI 58% to 62%), specificity 84% (95% CI 82% to 86%); for resectable HCC (six studies) sensitivity 65% (95% CI 62% to 68%), specificity 80% (95% CI 59% to 91%). AFP cut-off 200 ng/mL: for HCC (56 studies) sensitivity 36% (95% CI 31% to 41%), specificity 99% (95% CI 98% to 99%); for resectable HCC (two studies) one with sensitivity 4% (95% CI 0% to 19%), specificity 100% (95% CI 96% to 100%), and one with sensitivity 8% (95% CI 3% to 18%), specificity 100% (95% CI 97% to 100%). US: for HCC (39 studies) sensitivity 72% (95% CI 63% to 79%), specificity 94% (95% CI 91% to 96%); for resectable HCC (seven studies) sensitivity 53% (95% CI 38% to 67%), specificity 96% (95% CI 94% to 97%). Combination of AFP (cut-off of 20 ng/mL) and US: for HCC (six studies) sensitivity 96% (95% CI 88% to 98%), specificity 85% (95% CI 73% to 93%); for resectable HCC (two studies) one with sensitivity 89% (95% CI 73% to 97%), specificity of 83% (95% CI 76% to 88%), and one with sensitivity 79% (95% CI 54% to 94%), specificity 87% (95% CI 79% to 94%). The observed heterogeneity in the results remains mostly unexplained, and only in part referable to different cut-offs or settings (surveillance programme compared to clinical series). The sensitivity analyses, excluding studies published as abstracts, or with case-control design, showed no variation in the results. We compared the accuracy obtained from studies with AFP (cut-off around 20 ng/mL) and US: a direct comparison in 11 studies (6674 participants) showed a higher sensitivity of US (81%, 95% CI 66% to 90%) versus AFP (64%, 95% CI 56% to 71%) with similar specificity: US 92% (95% CI 83% to 97%) versus AFP 89% (95% CI 79% to 94%). A direct comparison of six studies (5044 participants) showed a higher sensitivity (96%, 95% CI 88% to 98%) of the combination of AFP and US versus US (76%, 95% CI 56% to 89%) with similar specificity: AFP and US 85% (95% CI 73% to 92%) versus US 93% (95% CI 80% to 98%). AUTHORS' CONCLUSIONS In the clinical pathway for the diagnosis of HCC in adults, AFP and US, singularly or in combination, have the role of triage-tests. We found that using AFP, with 20 ng/mL as a cut-off, about 40% of HCC occurrences would be missed, and with US alone, more than a quarter. The combination of the two tests showed the highest sensitivity and less than 5% of HCC occurrences would be missed with about 15% of false-positive results. The uncertainty resulting from the poor study quality and the heterogeneity of included studies limit our ability to confidently draw conclusions based on our results.
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Affiliation(s)
- Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tin Nadarevic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Damir Miletic
- Department of Radiology , Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Vanja Giljaca
- Department of Gastroenterology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
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Shao YY, Wang SY, Lin SM. Management consensus guideline for hepatocellular carcinoma: 2020 update on surveillance, diagnosis, and systemic treatment by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2021; 120:1051-1060. [PMID: 33199101 DOI: 10.1016/j.jfma.2020.10.031] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/28/2020] [Accepted: 10/30/2020] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan had established a management consensus guideline in 2016. The current recommendations focus on updating critical issues regarding the management of HCC, including surveillance, diagnosis, and systemic treatment. For surveillance, the updated guideline suggests the role of dynamic computed tomography or magnetic resonance imaging and contrast-enhanced ultrasound (CEUS) in selected patients. For diagnosis, this update incorporates CEUS and recognizes the role of gadoxetic acid-enhanced magnetic resonance imaging. For systemic therapy, the updated guideline summarizes the multiple choices of targeted therapy, immune checkpoint inhibitors, and the combination of both. Through this update of the management consensus guideline, patients with HCC can benefit from receiving optimal diagnostic and therapeutic modalities.
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Affiliation(s)
- Yu-Yun Shao
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shen-Yung Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shi-Ming Lin
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
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