1
|
Kong BT, Fan QS, Wang XM, Zhang Q, Zhang GL. Clinical implications and mechanism of histopathological growth pattern in colorectal cancer liver metastases. World J Gastroenterol 2022; 28:3101-3115. [PMID: 36051338 PMCID: PMC9331533 DOI: 10.3748/wjg.v28.i26.3101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/21/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Liver is the most common site of metastases of colorectal cancer, and liver metastases present with distinct histopathological growth patterns (HGPs), including desmoplastic, pushing and replacement HGPs and two rare HGPs. HGP is a miniature of tumor-host reaction and reflects tumor biology and pathological features as well as host immune dynamics. Many studies have revealed the association of HGPs with carcinogenesis, angiogenesis, and clinical outcomes and indicates HGP functions as bond between microscopic characteristics and clinical implications. These findings make HGP a candidate marker in risk stratification and guiding treatment decision-making, and a target of imaging observation for patient screening. Of note, it is crucial to determine the underlying mechanism shaping HGP, for instance, immune infiltration and extracellular matrix remodeling in desmoplastic HGP, and aggressive characteristics and special vascularization in replacement HGP (rHGP). We highlight the importance of aggressive features, vascularization, host immune and organ structure in formation of HGP, hence propose a novel "advance under camouflage" hypothesis to explain the formation of rHGP.
Collapse
Affiliation(s)
- Bing-Tan Kong
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Qing-Sheng Fan
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Xiao-Min Wang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Qing Zhang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Gan-Lin Zhang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| |
Collapse
|
2
|
Fahlenkamp UL, Ziegeler K, Adams LC, Böker SM, Engel G, Makowski MR. Native T1 mapping for assessment of the perilesional zone in metastases and benign lesions of the liver. Sci Rep 2020; 10:12889. [PMID: 32733016 PMCID: PMC7393097 DOI: 10.1038/s41598-020-69819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
Adjacent to hepatic metastases, liver parenchyma is often histopathologically altered even if its visual appearance on native magnetic resonance (MR) images is blunt. Yet, relaxation properties in MR imaging may show structural changes prior to visual alteration, and therefore, the aim of this study was to investigate whether T1 relaxation times in the perilesional zone differ between metastases and benign lesions. A total of 113 patients referred for MRI were included prospectively. Images were assessed for metastases, solid benign lesions and cysts, and regions-of-interest were drawn on T1 maps including the focal lesion and a close (inner perilesional zone = IPZ) and a larger perilesional zone (outer perilesional zone = OPZ). Simple ratios between these zones, as well as a gradient ratio between the IPZ and the entire perilesional zone (EPZ) were calculated. Within the collective, 44 patients had lesions of one or two entities. For metastases, the simple ratio between IPZ and OPZ as well as the mean EPZ gradient was significantly higher than for both solid benign lesions and cysts. Lesion size was not a significant covariate. We conclude, that native T1 properties of the perilesional zones differ significantly between malignant and both solid and cystic benign lesions.
Collapse
Affiliation(s)
- Ute Lina Fahlenkamp
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Christine Adams
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Maria Böker
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Günther Engel
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcus Richard Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Radiology, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, Munich, Germany
| |
Collapse
|
3
|
Can medical imaging identify the histopathological growth patterns of liver metastases? Semin Cancer Biol 2020; 71:33-41. [PMID: 32735852 DOI: 10.1016/j.semcancer.2020.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Abstract
The histopathological growth patterns (HGPs) of liver metastases of colorectal cancer and of several other tumor types predict outcome of patients in multiple studies. The HGPs of liver metastases have a prognostic but also a predictive value with one of the growth patterns, the replacement growth pattern, related to resistance to systemic treatment. Given that the HGP can only be assessed in a reliable manner when a surgical resection of the metastasis has been performed, this biomarker cannot be exploited to the full. For example, HGPs can at this moment, not be used to decide whether patients with liver metastatic breast or colorectal cancer will benefit or not from locoregional treatment, such as surgery or radiotherapy, and from peri-operative systemic treatment. In this review we highlight studies that suggest that the HGPs of liver metastases can be identified by medical imaging. Although still to be confirmed by a prospective multicenter approach, some studies indeed achieve a high accuracy in predicting the HGPs by applying radiomic algorithms on CT- or MR-images of liver metastases. This is an important step towards a treatment planning of patients with liver metastatic cancer that takes into account the biology and the progression kinetics of the metastases.
Collapse
|
4
|
Ludwig DR, Fraum TJ, Cannella R, Tsai R, Naeem M, LeBlanc M, Salter A, Tsung A, Fleckenstein J, Shetty AS, Borhani AA, Furlan A, Fowler KJ. Expanding the Liver Imaging Reporting and Data System (LI-RADS) v2018 diagnostic population: performance and reliability of LI-RADS for distinguishing hepatocellular carcinoma (HCC) from non-HCC primary liver carcinoma in patients who do not meet strict LI-RADS high-risk criteria. HPB (Oxford) 2019; 21:1697-1706. [PMID: 31262487 DOI: 10.1016/j.hpb.2019.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/11/2019] [Accepted: 04/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) can be diagnosed using imaging criteria in patients at high-risk for HCC, according to Liver Imaging Reporting and Data System (LI-RADS) guidelines. The aim of this study was to determine the diagnostic performance and inter-rater reliability (IRR) of LI-RADS v2018 for differentiating HCC from non-HCC primary liver carcinoma (PLC), in patients who are at increased risk for HCC but not included in the LI-RADS 'high-risk' population. METHODS This retrospective HIPAA-compliant study included a 10-year experience of pathologically-proven PLC at two liver transplant centers, and included patients with non-cirrhotic hepatitis C infection, non-cirrhotic non-alcoholic fatty liver disease, and fibrosis. Two readers evaluated each lesion and assigned an overall LI-RADS diagnostic category, additionally scoring all major, LR-M, and ancillary features. RESULTS The final study cohort consisted of 27 HCCs and 104 non-HCC PLC in 131 patients. The specificity of a 'definite HCC' designation was 97% for reader 1 and 100% for reader 2. The IRR was fair for overall LI-RADS category and substantial for most major features. CONCLUSION In a population at increased risk for HCC but not currently included in the LI-RADS 'high-risk' population, LI-RADS v2018 demonstrated very high specificity for distinguishing pathologically-proven HCC from non-HCC PLC.
Collapse
Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63104, USA.
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63104, USA
| | - Roberto Cannella
- Department of Radiology, University of Pittsburgh Medical Center, 3708 Fifth Ave, Pittsburgh, PA, 15213, USA; University of Palermo, Palermo, Italy
| | - Richard Tsai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63104, USA
| | - Muhammad Naeem
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63104, USA
| | - Maverick LeBlanc
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63104, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave., CB 8067, St. Louis, MO 63110, USA
| | - Allan Tsung
- Department of Surgery, The Ohio State University Medical Center, N924 Doan Hall, 410 W 10h Ave, Columbus, OH 43210, USA
| | - Jaquelyn Fleckenstein
- Department of Gastroenterology, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, Saint Louis, MO 63104, USA
| | - Amir A Borhani
- Department of Radiology, University of Pittsburgh Medical Center, 3708 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, 3708 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, 200 W Arbor Dr., San Diego, CA, 92103, USA
| |
Collapse
|
5
|
Fujita T, Tanabe M, Iida E, Okimoto T, Matsunaga N. Multi-modality imaging findings of methotrexate-related Epstein-Barr virus-associated hepatic tumor. Clin Imaging 2013; 37:962-4. [PMID: 23849101 DOI: 10.1016/j.clinimag.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/11/2013] [Accepted: 05/09/2013] [Indexed: 11/28/2022]
Abstract
Methotrexate (MTX)-associated lymphoproliferative disorders (MTX-LPDs) that occur in rheumatoid arthritis patients who were administered MTX for long periods are well known. However, studies on their pathology in forming hepatic tumors are rare. An approach using diagnostic imaging modalities, mainly computed tomography (CT), is considered a very useful tool for the differential diagnosis of various hepatic tumors. In the present study, detailed findings of dynamic CT, magnetic resonance (MR) imaging, and contrast-enhanced ultrasonography of a hepatic tumor that was confirmed as infected by Epstein-Barr virus, in a rheumatoid arthritis patient administered MTX are presented.
Collapse
Affiliation(s)
- Takeshi Fujita
- Department of Radiology, UBE INDUSTRIES, LTD. Central Hospital, 750 Nishikiwa, Ube, Yamaguchi 755-0151, Japan.
| | | | | | | | | |
Collapse
|
6
|
Andreano A, Meneghel E, Bovo G, Ippolito D, Salvioni A, Filice C, Sironi S, Meloni M. Contrast-enhanced ultrasound in planning thermal ablation of liver metastases: Should the hypervascular halo be included in the ablation volume?(). J Ultrasound 2010; 13:158-63. [PMID: 23397004 PMCID: PMC3553109 DOI: 10.1016/j.jus.2010.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Liver metastases often exhibit a hypervascular halo during the arterial phase of contrast-enhanced ultrasonography (CEUS). This finding has no correlates on baseline gray-scale imaging, and it has never been characterized. The aim of this study was to identify the features of this halo and determine whether it should be included in the ablation volume during thermal ablation procedures. MATERIALS AND METHODS We prospectively enrolled 25 patients referred to our department for thermal ablation of liver metastases. Before treatment all patients underwent CEUS, and the maximum diameter of the metastatic lesion was measured before administration of the ultrasound contrast agent and during the arterial and portal venous phases of the contrast contrast-enhanced study. Maximum diameters in the different vascular phases were compared with the Turkey-Kramer test. Two biopsies were obtained from each lesion with a 21-gauge needle: 1) one from the center of the metastasis to confirm the diagnosis and 2) one from the hypervascular peripheral halo identified in the arterial phase at CEUS. RESULTS The mean (±standard deviation) maximum lesion diameter was 2.67 ± 1.2 cm before contrast agent injection, 3.50 ± 1.4 cm during the arterial phase, and 2.71 ± 1.2 cm during the venous phase. The difference between maximum diameters measured before contrast enhancement and in the arterial phase was highly significant (mean: 0.84 ± 0.45 cm, p < 0.0001). Histological examination of halo specimens revealed inflammatory infiltrates with no evidence of tumor infiltration in 24/25 (96%) cases and normal hepatic parenchymal tissue in the 25th specimen. DISCUSSION The hypervascular halo surrounding liver metastases during the arterial phase of CEUS represents a chronic inflammatory infiltrate, not tumor infiltration. However, since chronic inflammation appears to promote neovascularization and the production of tumoral growth factors, it seems wise to include the hypervascular halo in the intended-to-treat volume when planning the ablation procedure.
Collapse
Affiliation(s)
- A. Andreano
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
- Corresponding author. Università degli Studi Milano Bicocca, Dipartimento di Radiodiagnostica, Ospedale San Gerardo dei Tintori, Via Pergolesi 33, 20052 Monza, Italy.
| | - E. Meneghel
- Department of Radiology, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - G. Bovo
- Department of Anatomic Pathology, San Gerardo Hospital, Monza, Italy
| | - D. Ippolito
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - A. Salvioni
- Department of Internal Medicine, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - C. Filice
- Department of Infectious and Tropical Diseases, IRCCS Policlinico San Matteo, Pavia, Italy
| | - S. Sironi
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - M.F. Meloni
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| |
Collapse
|
7
|
Hong HS, Byun JH, Won HJ, Kim KW, Lee SS, Lee MG, Yun SC. Characterization of liver metastases: the efficacy of biphasic magnetic resonance imaging with ferucarbotran-enhancement. Clin Radiol 2010; 65:701-7. [PMID: 20696297 DOI: 10.1016/j.crad.2010.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 04/19/2010] [Accepted: 04/25/2010] [Indexed: 11/26/2022]
Abstract
AIM To retrospectively evaluate the efficacy of biphasic magnetic resonance imaging (MRI) of the liver with ferucarbotran-enhancement for the characterization of hepatic metastases. MATERIALS AND METHODS Thirty-six patients underwent MRI of the liver with separate acquisition of double-contrast enhancement consisting of gadolinium and ferucarbotran. A total of 106 focal hepatic lesions (51 metastases, 31 cysts, 23 haemangiomas, and one eosinophilic abscess) were included. Two sets of MRI were analysed: (1) ferucarbotran set: ferucarbotran-enhanced T1-weighted (T1W) dynamic imaging combined with ferucarbotran-enhanced T2*-weighted (T2*W) delayed imaging and (2) double set: gadolinium-enhanced T1W dynamic imaging combined with ferucarbotran-enhanced T2*W delayed imaging. The diagnostic accuracy of the two sets was evaluated using alternative free-response receiver operating characteristic curve analysis. Sensitivity and specificity were compared using the McNemar test. The enhancement pattern of focal hepatic lesions was analysed on gadolinium and ferucarbotran-enhanced T1W dynamic imaging. RESULTS There was no significant difference in the accuracy of characterizing hepatic metastases between the two sets. Sensitivity and specificity were not significantly different between the sets (p>0.05). Peripheral rim enhancement was exhibited in 57% of metastatic lesions on ferucarbotran-enhanced T1W dynamic imaging. The majority (96%) of hepatic haemangiomas demonstrated typical peripheral nodular enhancement with progression on ferucarbotran-enhanced T1W dynamic imaging and were easily differentiated from metastases. CONCLUSION Biphasic MRI of the liver with ferucarbotran-enhancement alone provided comparable diagnostic efficacy to double-contrast MRI for the characterization of hepatic metastases.
Collapse
Affiliation(s)
- H S Hong
- Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
8
|
Sofue K, Tsurusaki M, Miyake M, Sakurada A, Arai Y, Sugimura K. Detection of hepatic metastases by superparamagnetic iron oxide-enhanced MR imaging: prospective comparison between 1.5-T and 3.0-T images in the same patients. Eur Radiol 2010; 20:2265-73. [PMID: 20428875 DOI: 10.1007/s00330-010-1798-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To prospectively compare the diagnostic performance of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging at 3.0 T and 1.5 T for detection of hepatic metastases. METHODS A total of 28 patients (18 men, 10 women; mean age, 61 years) with 80 hepatic metastases were prospectively examined by SPIO-enhanced MR imaging at 3.0 T and 1.5 T. T1-weighted gradient-recalled-echo (GRE) images, T2*-weighted GRE images and T2-weighted fast spin-echo (SE) images were acquired. The tumour-to-liver contrast-to-noise ratio (CNR) of the lesions was calculated. Three observers independently reviewed each image. Image artefacts and overall image quality were analysed, sensitivity and positive predictive value for the detection of hepatic metastases were calculated, and diagnostic accuracy using the receiver-operating characteristics (ROC) method was evaluated. RESULTS The tumour-to-liver CNRs were significantly higher at 3.0 T. Chemical shift and motion artefact were more severe, and overall image quality was worse on T2-weighted fast SE images at 3.0 T. Overall image quality of the two systems was similar on T1-weighted GRE images and T2*-weighted GRE images. Sensitivity and area under the ROC curve for the 3.0-T image sets were significantly higher. CONCLUSION SPIO-enhanced MR imaging at 3.0 T provided better diagnostic performance for detection of hepatic metastases than 1.5 T.
Collapse
Affiliation(s)
- Keitaro Sofue
- Department of Radiology, National Cancer Center, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
9
|
Wu H, Exner AA, Shi H, Bear J, Haaga JR. Dynamic evolutionary changes in blood flow measured by MDCT in a hepatic VX2 tumor implant over an extended 28-day growth period: time-density curve analysis. Acad Radiol 2009; 16:1483-92. [PMID: 19896066 DOI: 10.1016/j.acra.2009.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/08/2009] [Accepted: 09/09/2009] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES The enhancement pattern of malignant tumors has been studied in short-term animal models (7-14 days), but the reported results have been variable and inconsistent. The purpose of this study was to investigate the changing blood flow characteristics of VX2 tumors implanted in rabbit livers with contrast-enhanced multidetector computed tomography (MDCT) to establish a predictable pattern of vascular evolution over an extended 28-day growth period. MATERIALS AND METHODS VX2 carcinoma was implanted in livers of 10 male New Zealand White rabbits. Dynamic CT (2/seconds x 60 seconds) was conducted on days 7, 14, 21, and 28 after tumor implantation. Enhancement parameters of time-density curve (TDC), time to start (T0), time to peak (TP), maximum enhancement (DeltaH), slope of enhancement (SLe), and washout (SLw) in tumor center, tumor rim, and normal liver were analyzed. Tumor samples corresponding to CT images of one tumor on days 14 and 21 and seven tumors on day 28 were stained with hematoxylin and eosin and anti-CD31 monoclonal antibody. The relationship between enhancement parameters and histology parameters (thickness of tumor border, extent of blood stasis, and luminar vessel density) was analyzed. RESULTS Consistent growth, appearance, and vascular changes occurred in 7 of 10 animals over the 4-week observation period. Peripheral rim-like enhancement was noted in CT images. TDC analysis showed that tumor rim enhancement was pronounced and more rapid than normal liver initially but this difference diminished with tumor progression. The SLe, SLw, and DeltaH decreased from 10.03 +/- 3.25 Hu/second, 0.42 +/- 0.25 Hu/sec, and 58.00 +/- 25.27 Hu on day 7 to 5.86 +/- 2.73 Hu/second, 0.10 +/- 0.13 Hu/second, and 37.78 +/- 8.89 Hu/second on day 28, respectively. TP increased from 12.71 +/- 4.85 seconds on day 7 to 25.57 +/- 7.75 seconds on day 28. No significant changes were noted on the TDC parameters in normal liver. The maximum density difference between tumor rim and normal liver (D(rim-liver)) appeared 10.5 +/- 2.1 seconds after contrast injection. The maximum D(rim-liver) decreased from 54.33 +/- 37.86 Hu on day 7 to 11.16 +/- 13.03 Hu on day 28. On histological analysis, viable tumor cells were found in tumor rim with few luminar vessels. The tumor border showed desmoplastic reaction, vascular dilation and proliferation, inflammatory cell infiltration, and blood stasis. These findings were more obvious on day 28 than those on day 14. TP showed significant positive correlations with the extent of blood stasis in tumor border and adjacent liver and the maximum thickness of the tumor border (r = 0.945 and 0.893 respectively, P < .05). CONCLUSION The rabbit VX2 liver tumor is a hypovascular tumor with perilesional enhancement over its lifespan as imaged by MDCT. Consistent changes in the measured vascular parameters correlated with the size/age of the tumor implants. These findings suggest that the accuracy of CT enhancement imaging for VX2 liver tumor detection might be decreased with tumor development.
Collapse
|
10
|
Chou CT, Chen RC, Chen WT, Lii JM. Detection of hepatocellular carcinoma by ferucarbotran-enhanced magnetic resonance imaging: the efficacy of accumulation phase fat-suppressed T1-weighted imaging. Clin Radiol 2008; 64:22-9. [PMID: 19070694 DOI: 10.1016/j.crad.2008.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 06/18/2008] [Accepted: 07/11/2008] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the effectiveness of accumulation phase, fat-suppressed, T1-weighted imaging (FS-T1WI) when detecting hepatocellular carcinoma (HCC) by ferucarbotran-enhanced magnetic resonance imaging (MRI). MATERIALS AND METHODS Thirty patients who underwent ferucarbotran-enhanced MRI, which resulted in 35 confirmed HCCs, were included in this prospective study. Two image sets were prepared and two radiologists independently reviewed these in two reading sessions; set A was without contrast-enhanced accumulation phase FS-T1WI and set B included contrast-enhanced accumulation phase FS-T1WI. All HCCs had been confirmed by operation (n=4), by biopsy (n=28), and by follow-up study for at least 1 year (n=3). RESULTS The contrast-to-noise ratio significantly increased from -1.2+/-7.5 to 12.7+/-7.3 with contrast-enhanced accumulation phase FS-T1WI, but was only slightly increased from 12.2+/-10.3 to 15.5+/-12.2 with contrast-enhanced T2WI (p<0.001). The signal-to-noise ratio (SNR) was decreased with T1WI and T2WI for liver parenchyma. With T2WI, the SNR for HCCs was decreased; however, it was slightly increased with T1WI (p<0.001). Overall, 29 HCCs were detected using set A, and 35 nodules were identified using set B, which included the contrast-enhanced accumulation phase FS-T1WI. Thus, the detection rate significantly increased using post-contrast medium accumulation phase FS-T1WI (p<0.05). CONCLUSION Due to the improved CNR with the post-contrast medium accumulation phase FS-T1WI, which helped to increase HCC detection, accumulation phase FS-T1WI is recommended as one of the routine protocols for inclusion in HCC detection.
Collapse
Affiliation(s)
- C-T Chou
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Department of Radiology, Chang-Hua Christian Hospital, Erlin Branch
| | | | | | | |
Collapse
|
11
|
Miyata R, Tanimoto A, Wakabayashi G, Shimazu M, Nakatsuka S, Mukai M, Kitajima M. Accuracy of preoperative prediction of microinvasion of portal vein in hepatocellular carcinoma using superparamagnetic iron oxide-enhanced magnetic resonance imaging and computed tomography during hepatic angiography. J Gastroenterol 2006; 41:987-95. [PMID: 17096068 DOI: 10.1007/s00535-006-1890-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2006] [Accepted: 08/03/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our aim was to diagnose microinvasion of the portal vein in hepatocellular carcinoma from preoperative radiological findings and to construct a scoring system. METHODS Forty-seven patients (38 men and 9 women; median age, 66.8 years) who underwent hepatic resections for hepatocellular carcinoma were selected retrospectively. Microscopically, 22 had portal vein invasion (PVI) and 25 had no PVI. All patients were examined preoperatively with superparamagnetic iron oxide-enhanced magnetic resonance imaging and computed tomography during hepatic angiography (CTHA). Perilesional enhancement on T1-weighted imaging, tumorous arterioportal (AP) shunt, and corona enhancement (contrast enhancement of the adjacent liver appearing in the late phase of CTHA) were assessed. Relative risk for PVI in terms of clinical and tumor characteristics was also assessed. The relative contribution to PVI was determined by the coefficient of a stepwise logistic regression. Each variable was given a score relative to the coefficient. RESULTS On univariate analysis, distortion of corona, tumorous AP shunt, and tumor size indicated a higher prevalence of PVI. The PVI predictive score was calculated as: total score = (maximum size in cm) + (T1 ring; + = 1, - = 0) + (tumorous AP shunt; + = 3, - = 0) + (distortion of corona; + = 10, - = 0). The PVI (+) group score was four times that of the PVI (-) group (16 vs 4). At a cutoff score of 10, the sensitivity, specificity, and accuracy were 82%, 84%, and 86%. CONCLUSIONS Distortion of corona, tumorous AP shunt, and tumor size are good predictors of the risk of PVI. This scoring system is simple and worth using clinically.
Collapse
Affiliation(s)
- Ryohei Miyata
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
12
|
Tanimoto A, Kuribayashi S. Application of superparamagnetic iron oxide to imaging of hepatocellular carcinoma. Eur J Radiol 2006; 58:200-16. [PMID: 16414230 DOI: 10.1016/j.ejrad.2005.11.040] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 11/25/2005] [Accepted: 11/29/2005] [Indexed: 11/24/2022]
Abstract
Superparamagnetic iron oxide (SPIO) particles are as MR contrast media composed of iron oxide crystals coated with dextran or carboxydextran. These particles are sequestered by phagocytic Kupffer cells in normal reticuloendothelial system (RES), but are not retained in tumor tissue. Consequently, there are significant differences in T2/T2* relaxation between normal RES tissue and tumors, which result in increased lesion conspicuity and detectability. The introduction of SPIO has been expected to substantially increase the detectability of hepatic metastases. For focal hepatocellular lesions, it has been documented that SPIO-enhanced MR imaging exhibits slightly better diagnostic performance than dynamic helical CT in the detection of hypervascular hepatocellular carcinoma (HCC). A combination of dynamic and static MR imaging technique using T1- and T2 imaging criteria appears to provide clinically more useful patterns of enhancement. SPIO-enhanced MR imaging also provides information useful for differential diagnosis, via enhancement of RES-containing tumors. With the exploitation of rapid T2*-sensitive sequences, SPIO-enhanced dynamic MR imaging may become comparable to gadolinium-enhanced dynamic MR imaging and dynamic studies with multidetector-row CT. SPIO-enhanced MR imaging plays an important role in therapeutic decision-making for patients with HCC.
Collapse
Affiliation(s)
- Akihiro Tanimoto
- Department of Diagnostic Radiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | | |
Collapse
|
13
|
Kanematsu M, Kondo H, Goshima S, Kato H, Tsuge U, Hirose Y, Kim MJ, Moriyama N. Imaging liver metastases: review and update. Eur J Radiol 2006; 58:217-28. [PMID: 16406434 DOI: 10.1016/j.ejrad.2005.11.041] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 11/25/2005] [Accepted: 11/29/2005] [Indexed: 12/19/2022]
Abstract
The radiologic diagnosis of liver metastasis involves detection, characterization, and tumor staging. Knowledge of the histopathologic changes that occur with metastases provides the best approach to the accurate interpretation of radiologic imaging findings, and in particular, radiologists need to choose appropriate imaging methods based on such knowledge. Because the majority of metastases are hypovascular, the merits of the routine acquisition of hepatic arterial dominant-phase images by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) are disputable. Hepatic arterial dominant-phase images may be obtained when hypervascular tumors are suspected or three-dimensional CT angiography is necessary. And, imaging during the portal venous phase is essential for detecting metastases, evaluating intrahepatic vessel invasion, and for assessing intratumoral necrosis or fibrosis. Equilibrium- to delayed-phase imaging 3-5 min after contrast administration may improve the detection of intratumoral fibrosis, and occasionally lead to more accurate tissue characterization. MRI offers diagnostic information on vascularity, amount of free water, hemorrhage, fibrosis, necrosis, and water molecule diffusion in metastases. And, liver-specific contrast agents like superparamagnetic iron oxide, liposoluble gadolinium chelate, and manganese may improve the MRI-based diagnosis of liver metastases.
Collapse
Affiliation(s)
- Masayuki Kanematsu
- Department of Radiology Services, Gifu University Hospital, Gifu 501-1194, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Martí-Bonmatí L, Peñaloza F, Villarreal E, Martinez MJ. Nonspecificity of the fat-sparing ring surrounding focal liver lesion at MR imaging. Acad Radiol 2005; 12:1551-6. [PMID: 16321744 DOI: 10.1016/j.acra.2005.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 06/18/2005] [Accepted: 07/24/2005] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The presence of a fat-sparing ring surrounding focal liver lesions in patients with steatosis has been described only in malignant lesions. Our purpose is to evaluate whether this fat-sparing ring peripheral to tumors is a specific marker of malignancy. MATERIALS AND METHODS From 300 magnetic resonance examinations of focal liver lesions, 132 patients with a confirmed nature of the lesions were selected. There were 24 patients (18.2%) with lesions having a perilesional fat-sparing ring in the opposed-phase spoiled T1-weighted gradient echo images. All these livers had steatosis. RESULTS Perilesional fat-sparing rings were observed in 19 (21.6%) malignant and 5 (11.4%) benign lesions. Size of the lesion was not related to the presence of the fat-sparing ring (P=.6), neither was type of lesion (malignant versus benign) statistically related to the presence of the perilesional fat-sparing ring in the opposed-phase gradient echo magnetic resonance images (chi-square, P=.15). Fat-sparing rings were mainly seen in metastases (51.4% of metastases), but seldom in primary malignant tumors (1.9% of hepatocellular carcinomas). Hemangiomas also presented this finding (18.5% of hemangiomas). CONCLUSIONS We believe that the presence of this bright rim surrounding lesions on oppose-phase images in patients with steatosis mainly represent decrease portal flow, either because of compressed and atrophic hepatocyte cords with sinusoidal congestion in expanding metastatic lesions or the presence of arterioportal perfusion abnormalities in vascularized hemangiomas.
Collapse
Affiliation(s)
- Luis Martí-Bonmatí
- Department of Radiology, Magnetic Resonance, Dr Peset University Hospital, E-46017, Valencia, Spain.
| | | | | | | |
Collapse
|
15
|
Lutz AM, Willmann JK, Goepfert K, Marincek B, Weishaupt D. Hepatocellular carcinoma in cirrhosis: enhancement patterns at dynamic gadolinium- and superparamagnetic iron oxide-enhanced T1-weighted MR imaging. Radiology 2005; 237:520-8. [PMID: 16192317 DOI: 10.1148/radiol.2372041183] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To prospectively compare intraindividual differences in enhancement patterns between gadolinium- and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging in patients with histologically proved hepatocellular carcinoma (HCC). MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Twenty-two patients (18 men, four women; mean age, 58.9 years) with 36 pathologically proved HCC lesions underwent contrast material-enhanced dynamic T1-weighted gradient-echo MR imaging twice. Gadopentetate dimeglumine was used at the first session. After a mean interval of 5 days, a second session was performed with a bolus-injectable SPIO agent, ferucarbotran. Qualitative analysis of contrast enhancement patterns with each agent during hepatic arterial, portal venous, and equilibrium phases was performed by two readers who classified lesions as isointense, hypointense, or hyperintense compared with surrounding liver parenchyma and searched for presence of hyperintense peritumoral ring enhancement. Results of signal intensity analysis during different vascular phases at both sessions were compared by using the McNemar test, and kappa statistic was used to evaluate agreement between signal intensity and enhancement pattern of lesions during different vascular phases. RESULTS On gadolinium-enhanced hepatic arterial phase images, HCC lesions (n = 36) were hyperintense in 21 (58%) cases, hypointense in 10 (28%), and isointense in five (14%). On ferucarbotran-enhanced hepatic arterial phase images, HCC lesions were isointense in 18 (50%) cases, hypointense in 11 (31%), and hyperintense in seven (19%). On gadolinium-enhanced portal venous and equilibrium phase images, respectively, HCC lesions were hypointense in 17 (47%) and 21 (58%) cases, hyperintense in 10 (28%) cases and one (3%) case, and isointense in nine (25%) and 14 (39%) cases. On ferucarbotran-enhanced portal venous and equilibrium phase images, respectively, HCC lesions were hypointense in 15 (42%) and 11 (31%) cases, hyperintense in three (8%) and three (8%) cases, and isointense in 18 (50%) and 22 (61%) cases. CONCLUSION For HCC, contrast enhancement pattern on T1-weighted gradient-echo MR images shows marked variability with gadolinium or SPIO contrast agents.
Collapse
Affiliation(s)
- Amelie M Lutz
- Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | | | | | | | | |
Collapse
|
16
|
Tanimoto A, Wakabayashi G, Shinmoto H, Okuda S, Kuribayashi S, Mukai M. The mechanism of ring enhancement in hepatocellular carcinoma on superparamagnetic iron oxide-enhanced T1-weighted images: an investigation into peritumoral Kupffer cells. J Magn Reson Imaging 2005; 21:230-6. [PMID: 15723373 DOI: 10.1002/jmri.20263] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the mechanism of ring enhancement on ferumoxides-enhanced T1-weighted (T1W) gradient echo images in malignant focal hepatic lesions. MATERIALS AND METHODS Eighteen patients with hepatocellular carcinoma (HCC) underwent breath-hold T1-, T2-, and T2*-weighted magnetic resonance (MR) images at 1.5-Tesla after ferumoxides administration. The existence of ring enhancement on T1W, and the maximum size of the area showing decreased phagocytic activity on T2W and T2*W, and that of the area showing ring enhancement on T1W were evaluated. The Kupffer cell (KC) density of HCC itself and peritumoral liver parenchyma was assessed with KC stain sections. RESULTS Ring enhancement was noted in 13 of 18 HCC (72%). Peritumoral KC density was increased in the ring enhancement (+) group as compared with the ring enhancement (-) group. In the ring enhancement (+) group, the tumor size measured on T2W was smaller than that measured on either T1W or T2*W, suggesting a sustained T1 relaxation effect and a decreased T2* relaxation effect in the peritumoral regions. CONCLUSION Ring enhancement on superparamagnetic iron oxide (SPIO)-enhanced T1W may correlate with increased KC density and decreased SPIO clustering in KC in peritumoral regions.
Collapse
Affiliation(s)
- Akihiro Tanimoto
- Department of Diagnostic Radiology, School of Medicine, Keio University, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
17
|
Tsushima K, Nishie A, Yoshimitsu K, Taketomi A, Honda H. Liver metastasis with apparent intratumoral superparamagnetic iron oxide uptake. Eur Radiol 2005; 15:2203-4. [PMID: 15806365 DOI: 10.1007/s00330-005-2722-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 02/17/2005] [Indexed: 11/26/2022]
|