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Shimizu R, Ida Y, Kitano M. Predicting Outcome after Percutaneous Ablation for Early-Stage Hepatocellular Carcinoma Using Various Imaging Modalities. Diagnostics (Basel) 2023; 13:3058. [PMID: 37835800 PMCID: PMC10572637 DOI: 10.3390/diagnostics13193058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Percutaneous ablation is a low-invasive, repeatable, and curative local treatment that is now recommended for early-stage hepatocellular carcinoma (HCC) that is not suitable for surgical resection. Poorly differentiated HCC has high-grade malignancy potential. Microvascular invasion is frequently seen, even in tumors smaller than 3 cm in diameter, and prognosis is poor after percutaneous ablation. Biopsy has a high risk of complications such as bleeding and dissemination; therefore, it has limitations in determining HCC tumor malignancy prior to treatment. Advances in diagnostic imaging have enabled non-invasive diagnosis of tumor malignancy. We describe the usefulness of ultrasonography, computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography for predicting outcome after percutaneous ablation for HCC.
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Affiliation(s)
- Ryo Shimizu
- Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
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Yang YQ, Wen ZY, Liu XY, Ma ZH, Liu YE, Cao XY, Hou L, Xie H. Current status and prospect of treatments for recurrent hepatocellular carcinoma. World J Hepatol 2023; 15:129-150. [PMID: 36926237 PMCID: PMC10011906 DOI: 10.4254/wjh.v15.i2.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/13/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
Owing to its heterogeneous and highly aggressive nature, hepatocellular carcinoma (HCC) has a high recurrence rate, which is a non-negligible problem despite the increasing number of available treatment options. Recent clinical trials have attempted to reduce the recurrence and develop innovative treatment options for patients with recurrent HCC. In the event of liver remnant recurrence, the currently available treatment options include repeat hepatectomy, salvage liver transplantation, tumor ablation, transcatheter arterial chemoembolization, stereotactic body radiotherapy, systemic therapies, and combination therapy. In this review, we summarize the strategies to reduce the recurrence of high-risk tumors and aggressive therapies for recurrent HCC. Additionally, we discuss methods to prevent HCC recurrence and prognostic models constructed based on predictors of recurrence to develop an appropriate surveillance program.
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Affiliation(s)
- Yu-Qing Yang
- Department of Epidemiology and Biostatistics, Jilin University, Changchun 130021, Jilin Province, China
| | - Zhen-Yu Wen
- Department of Occupational and Environmental Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Yan Liu
- Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Zhen-Hu Ma
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Yan-E Liu
- Department of Epidemiology and Biostatistics, Jilin University, Changchun 130021, Jilin Province, China
| | - Xue-Ying Cao
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Li Hou
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Hui Xie
- Senior Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
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Gadoxetate disodium-enhanced MRI for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: late portal venous phase may improve identification of enhancing capsule. Abdom Radiol (NY) 2023; 48:621-629. [PMID: 36494608 DOI: 10.1007/s00261-022-03756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate added value of late portal venous phase (LPVP) for identification of enhancing capsule (EC) on gadoxetate disodium-enhanced MRI (GD-MRI) for diagnosing hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD). METHODS This retrospective study comprised 116 high-risk patients with 128 pathologically proven HCCs who underwent GD-MRI including arterial phase, conventional portal venous phase (CPVP, 60 s), LPVP (mean, 104.4 ± 6.7 s; range, 90-119 s), and transitional phase (TP, 3 min). Two independent radiologists assessed the presence of major HCC features, including EC on CPVP and/or TP (CPVP/TP) and EC on LPVP. The frequency of EC was compared on GD-MRI between with and without inclusion of LPVP. The radiologists assigned Liver Imaging Reporting and Data System (LI-RADS) v2018 categories before and after identifying EC on LPVP. RESULTS Of the total 128 HCCs, 74 and 73 revealed EC on CPVP/TP for reviewer 1 and 2, respectively. After inclusion of LPVP, each reviewer identified seven more EC [Reviewer 1, 57.8% (74/128) vs. 63.3% (81/128); Reviewer 2, 57.0% (73/128) vs. 62.5% (80/128); P = 0.016, respectively]. Sensitivities of LR-5 assignment for diagnosing HCCs were not significantly different in GD-MRI with or without LPVP for EC identification [Reviewer 1, 71.9% (92/128) vs. 72.7% (93/128); Reviewer 2, 75.0% (96/128) vs. 75.8% (97/128); P = 1.000, respectively]. CONCLUSION Including the LPVP in GD-MRI may improve identification of EC of HCC in patients with CLD. However, LI-RADS v2018 using GD-MRI showed comparable sensitivity for diagnosing HCC regardless of applying LPVP for EC.
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Chao JS, Zhu Q, Chen DS, Chen GM, Xie XQ, Liu AQ, Zhao SL, Sun HC. Combined analysis of imaging tumor capsule with imaging tumor size guides the width of resection margin for solitary hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2022; 21:551-558. [PMID: 35000845 DOI: 10.1016/j.hbpd.2021.12.009] [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] [Received: 05/18/2021] [Accepted: 12/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The optimal width of resection margin (RM) for hepatocellular carcinoma (HCC) remains controversial. This study aimed to investigate the value of imaging tumor capsule (ITC) and imaging tumor size (ITS) in guiding RM width for patients with HCC. METHODS Patients who underwent hepatectomy for HCC in our center were retrospectively reviewed. ITC (complete/incomplete) and ITS (≤ 3 cm/> 3 cm) were assessed by preoperative magnetic resonance imaging (MRI). Using subgroup analyses based on ITC and ITS, the impact of RM width [narrow RM (< 5 mm)/wide RM (≥ 5 mm)] on recurrence-free survival (RFS), overall survival (OS), and RM recurrence was analyzed. RESULTS A total of 247 patients with solitary HCC were included. ITC and ITS were independent predictors for RFS and OS in the entire cohort. In patients with ITS ≤ 3 cm, neither ITC nor RM width showed a significant impact on prognosis, and the incidence of RM recurrence was comparable between the narrow RM and wide RM groups (15.6% vs. 4.3%, P = 0.337). In patients with ITS > 3 cm and complete ITC, the narrow RM group exhibited comparable RFS, OS, and incidence of RM recurrence with the wide RM group (P = 0.606, 0.916, and 0.649, respectively). However, in patients with ITS > 3 cm and incomplete ITC, the wide RM group showed better RFS and OS and a lower incidence of RM recurrence compared with the narrow RM group (P = 0.037, 0.018, and 0.046, respectively). CONCLUSIONS As MRI-based preoperative markers, conjoint analysis of ITC with ITS aids in determining RM width for solitary HCC patients. Narrow RM is applicable in patients with ITS ≤ 3 cm regardless of ITC status and in those with ITS > 3 cm and complete ITC. Wide RM is preferred in those with ITS > 3 cm and incomplete ITC.
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Affiliation(s)
- Jia-Shuo Chao
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Qi Zhu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - De-Sheng Chen
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Gui-Ming Chen
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xue-Qian Xie
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ai-Qun Liu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Sen-Lin Zhao
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Hong-Cheng Sun
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
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5
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Duch P, Díaz-Valdivia N, Ikemori R, Gabasa M, Radisky ES, Arshakyan M, Gea-Sorlí S, Mateu-Bosch A, Bragado P, Carrasco JL, Mori H, Ramírez J, Teixidó C, Reguart N, Fillat C, Radisky DC, Alcaraz J. Aberrant TIMP-1 overexpression in tumor-associated fibroblasts drives tumor progression through CD63 in lung adenocarcinoma. Matrix Biol 2022; 111:207-225. [PMID: 35787446 PMCID: PMC9667815 DOI: 10.1016/j.matbio.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/10/2022] [Accepted: 06/29/2022] [Indexed: 12/29/2022]
Abstract
Tissue inhibitor of metalloproteinase-1 (TIMP-1) is an important regulator of extracellular matrix turnover that has been traditionally regarded as a potential tumor suppressor owing to its inhibitory effects of matrix metalloproteinases. Intriguingly, this interpretation has been challenged by the consistent observation that increased expression of TIMP-1 is associated with poor prognosis in virtually all cancer types including lung cancer, supporting a tumor-promoting function. However, how TIMP-1 is dysregulated within the tumor microenvironment and how it drives tumor progression in lung cancer is poorly understood. We analyzed the expression of TIMP-1 and its cell surface receptor CD63 in two major lung cancer subtypes: lung adenocarcinoma (ADC) and squamous cell carcinoma (SCC), and defined the tumor-promoting effects of their interaction. We found that TIMP-1 is aberrantly overexpressed in tumor-associated fibroblasts (TAFs) in ADC compared to SCC. Mechanistically, TIMP-1 overexpression was mediated by the selective hyperactivity of the pro-fibrotic TGF-β1/SMAD3 pathway in ADC-TAFs. Likewise, CD63 was upregulated in ADC compared to SCC cells. Genetic analyses revealed that TIMP-1 secreted by TGF-β1-activated ADC-TAFs is both necessary and sufficient to enhance growth and invasion of ADC cancer cells in culture, and that tumor cell expression of CD63 was required for these effects. Consistently, in vivo analyses revealed that ADC cells co-injected with fibroblasts with reduced SMAD3 or TIMP-1 expression into immunocompromised mice attenuated tumor aggressiveness compared to tumors bearing parental fibroblasts. We also found that high TIMP1 and CD63 mRNA levels combined define a stronger prognostic biomarker than TIMP1 alone. Our results identify an excessive stromal TIMP-1 within the tumor microenvironment selectively in lung ADC, and implicate it in a novel tumor-promoting TAF-carcinoma crosstalk, thereby pointing to TIMP-1/CD63 interaction as a novel therapeutic target in lung cancer.
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Affiliation(s)
- Paula Duch
- Unit of Biophysics and Bioengineering, Department of Biomedicine, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona 08036, Spain
| | - Natalia Díaz-Valdivia
- Unit of Biophysics and Bioengineering, Department of Biomedicine, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona 08036, Spain
| | - Rafael Ikemori
- Unit of Biophysics and Bioengineering, Department of Biomedicine, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona 08036, Spain
| | - Marta Gabasa
- Unit of Biophysics and Bioengineering, Department of Biomedicine, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona 08036, Spain; Thoracic Oncology Unit, Hospital Clinic Barcelona, Barcelona 08036, Spain
| | - Evette S Radisky
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Marselina Arshakyan
- Unit of Biophysics and Bioengineering, Department of Biomedicine, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona 08036, Spain
| | - Sabrina Gea-Sorlí
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 08029, Spain
| | - Anna Mateu-Bosch
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 08029, Spain
| | - Paloma Bragado
- Instituto de Investigaciones Sanitarias San Carlos (IdISSC), Madrid, 28040, Spain; Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad Complutense, 28040 Madrid, Spain
| | - Josep Lluís Carrasco
- Unit of Biostatistics, Department of Basic Clinical Practice, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Hidetoshi Mori
- Center for Immunology and Infectious Diseases, University of California Davis, Davis, CA 95616, United States
| | - Josep Ramírez
- Thoracic Oncology Unit, Hospital Clinic Barcelona, Barcelona 08036, Spain; Pathology Service, Hospital Clínic de Barcelona, Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Cristina Teixidó
- Thoracic Oncology Unit, Hospital Clinic Barcelona, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Pathology Service, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Noemí Reguart
- Thoracic Oncology Unit, Hospital Clinic Barcelona, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
| | - Cristina Fillat
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 08029, Spain; Department of Medicine, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Derek C Radisky
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Jordi Alcaraz
- Unit of Biophysics and Bioengineering, Department of Biomedicine, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona 08036, Spain; Thoracic Oncology Unit, Hospital Clinic Barcelona, Barcelona 08036, Spain; Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute for Science and Technology (BIST), Barcelona 08028, Spain.
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Petukhova-Greenstein A, Zeevi T, Yang J, Chai N, DiDomenico P, Deng Y, Ciarleglio M, Haider SP, Onyiuke I, Malpani R, Lin M, Kucukkaya AS, Gottwald LA, Gebauer B, Revzin M, Onofrey J, Staib L, Gunabushanam G, Taddei T, Chapiro J. MR Imaging Biomarkers for the Prediction of Outcome after Radiofrequency Ablation of Hepatocellular Carcinoma: Qualitative and Quantitative Assessments of the Liver Imaging Reporting and Data System and Radiomic Features. J Vasc Interv Radiol 2022; 33:814-824.e3. [PMID: 35460887 PMCID: PMC9335926 DOI: 10.1016/j.jvir.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/28/2022] [Accepted: 04/08/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the Liver Imaging Reporting and Data System (LI-RADS) and radiomic features in pretreatment magnetic resonance (MR) imaging for predicting progression-free survival (PFS) in patients with nodular hepatocellular carcinoma (HCC) treated with radiofrequency (RF) ablation. MATERIAL AND METHODS Sixty-five therapy-naïve patients with 85 nodular HCC tumors <5 cm in size were included in this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved, retrospective study. All patients underwent RF ablation as first-line treatment and demonstrated complete response on the first follow-up imaging. Gadolinium-enhanced MR imaging biomarkers were analyzed for LI-RADS features by 2 board-certified radiologists or by analysis of nodular and perinodular radiomic features from 3-dimensional segmentations. A radiomic signature was calculated with the most informative features of a least absolute shrinkage and selection operator Cox regression model using leave-one-out cross-validation. The association between both LI-RADS features and radiomic signatures with PFS was assessed via the Kaplan-Meier analysis and a weighted log-rank test. RESULTS The median PFS was 19 months (95% confidence interval, 16.1-19.4) for a follow-up period of 24 months. Multifocality (P = .033); the appearance of capsular continuity, compared with an absent or discontinuous capsule (P = .012); and a higher radiomic signature based on nodular and perinodular features (P = .030) were associated with poorer PFS in early-stage HCC. The observation size, presence of arterial hyperenhancement, nonperipheral washout, and appearance of an enhancing "capsule" were not associated with PFS (P > .05). CONCLUSIONS Although multifocal HCC clearly indicates a more aggressive phenotype even in early-stage disease, the continuity of an enhancing capsule and a higher radiomic signature may add value as MR imaging biomarkers for poor PFS in HCC treated with RF ablation.
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Affiliation(s)
- Alexandra Petukhova-Greenstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Institute of Radiology, Berlin, Germany
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Junlin Yang
- Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, Connecticut
| | - Nathan Chai
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Paul DiDomenico
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Yanhong Deng
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Maria Ciarleglio
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | | | - Rohil Malpani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Visage Imaging, Inc., San Diego, California
| | - Ahmet S Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Institute of Radiology, Berlin, Germany
| | - Luzie A Gottwald
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Institute of Radiology, Berlin, Germany
| | - Bernhard Gebauer
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Institute of Radiology, Berlin, Germany
| | - Margarita Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - John Onofrey
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence Staib
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Biomedical Engineering, Yale School of Engineering and Applied Science, New Haven, Connecticut
| | - Gowthaman Gunabushanam
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Tamar Taddei
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
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Mak SH, Wong SMN, Chiu WHK, Chiang CL, Yip WLW, Ho HMC, Yeung SYC, Chan KHM, Lee WYV, Lee ASF. Presence of tumour capsule on contrast-enhanced CT is associated with improved outcomes of stereotactic body radiation therapy in hepatocellular carcinoma patients. Strahlenther Onkol 2022; 198:639-647. [PMID: 34988623 DOI: 10.1007/s00066-021-01879-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is a novel local therapy for the treatment of hepatocellular carcinoma (HCC). While effective, there is currently no reliable radiological marker to guide patient selection. In this study, we investigated the prognostic value of capsule appearance on contrast-enhanced computed tomography (CT) for patients undergoing SBRT. MATERIALS AND METHODS Between 2006 and 2017, 156 consecutive patients with Child-Pugh score class A/B and HCC ≥ 5 cm who underwent SBRT were retrospectively analysed. Baseline triple-phase CTs of the abdomen were reviewed for the presence of capsule appearances and correlated with objective response rate (ORR), overall survival (OS) and pattern of treatment failure. RESULTS Capsule appearance on CT was present in 83 (53.2%) patients. It was associated with improved ORR by Response Evaluation Criteria in Solid Tumours (RECIST) (60.2 vs. 24.7%, p < 0.001) and Modified Response Evaluation Criteria in Solid Tumours (mRECIST) (78.3 vs. 34.2%, p < 0.001). The presence of a capsule was also associated with superior 2‑year local control (89.1 vs. 51.4%, p < 0.001) and 2‑year OS (34.1 vs. 14.8%, p < 0.01). Hepatic out-field failure was the dominant mode of progression, which was less common in patients with intact capsule (54.2 vs. 60.3%, p = 0.01). CONCLUSION Capsule appearance on CT could potentially be a non-invasive prognostic marker for selecting HCC patients to undergo SBRT. A larger cohort is warranted to validate our findings.
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Affiliation(s)
- Siu Hin Mak
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Wan Hang Keith Chiu
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Chi Leung Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Hoi Man Connie Ho
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Ka Heng Mark Chan
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Proton Therapy Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Wan Yan Venus Lee
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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8
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Xi W, Tan Q, Hou Y, Hu X, Wang H, Liu L, Xia Y, Bai Q, Wang J, Zhou J, Guo J. No Detection of Pseudocapsule of Tumor-Parenchyma Interface on Multidetector Computed Tomography (MDCT) Images: Clinical Significance and Histological Reflections in Renal Cell Carcinoma. Cancer Manag Res 2021; 13:5403-5411. [PMID: 34262348 PMCID: PMC8275039 DOI: 10.2147/cmar.s315379] [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: 04/22/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Pseudocapsule (PS) of tumor-parenchyma interface (TPI) can be detected by MDCT (ctPS) in renal cell carcinoma (RCC) with exceptions. We aim to study the prognostic implications and histological reflections of no detection of ctPS in RCC. Patients and Methods A total of 210 RCC patients who had MDCT examination and received nephrectomy in our institution were included in the analysis. Absence or presence of ctPS was recognized, and its associations with overall survival (OS) and progression-free survival (PFS), pathological PS (pPS) and vasculature were studied. Results A total of 172 (81.9%) patients were recognized to have a ctPS and 38 (18.1%) had no detection of it. They had comparable histology, stage, grade, and necrosis. Patients without a ctPS had significantly shortened overall survival (OS, p = 0.001) and progression-free survival (PFS, p <0.001), the significance of which persisted in multivariable analysis (OS, HR 3.104, p = 0.003; PFS, HR 3.313, p = 0.001). Nearly all tumors (34/38, 89.4%) without a ctPS actually had a pPS being detected and incompleteness of pPS was also irrelevant (p = 0.739). Compared with ctPS presence, those without a ctPS had significantly thinned pPS (0.36 vs 0.43 mm, p = 0.005). In clear-cell histology, those without a ctPS also contained increased vascular density and cross-sectional area of vessels with long diameter ≥200 um in the pPS layer (p = 0.005 and 0.011) and increased vascular density in the 500 um layer outside pPS (p = 0.017). Conclusion Absence of ctPS on MDCT significantly increases the risk of adverse clinical outcome in RCC. It is the reflection of a thinner pPS and enriched vasculature of TPI rather than absence of pPS itself.
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Affiliation(s)
- Wei Xi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Qinxuan Tan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Li Liu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yu Xia
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Qi Bai
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jiajun Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
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9
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Corona enhancement can substitute enhancing capsule in the imaging diagnosis of small (≤ 3 cm) HCCs on gadoxetic acid-enhanced MRI. Eur Radiol 2021; 31:8628-8637. [PMID: 33891153 DOI: 10.1007/s00330-021-07911-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study aimed to elucidate the relationship between gadoxetic acid-enhanced magnetic resonance imaging (MRI) features-enhancing capsule, corona enhancement or hypointense rim-observed in hepatocellular carcinomas (HCCs). METHODS Of the HCCs surgically confirmed during a 5-year period (2013-2017), ≤ 3-cm lesions (n = 83) in 78 patients were evaluated. Presence of corona enhancement and enhancing capsule on multiphasic dynamic imaging and presence of hypointense rim on hepatobiliary phase imaging were determined retrospectively by two independent observers. The relationship among the three imaging features was statistically analysed and correlated with the presence of histologic fibrous capsules, tumour differentiation and gross morphologic type. RESULTS There was substantial overall interobserver agreement in determining the presence of the three imaging features. Sixty (72.3%) lesions had histologic fibrous capsule positively correlated with all three imaging features (p < 0.05). Corona enhancement was the most common (66.3%) feature followed by enhancing capsule (61.4%) and hypointense rim (33.7%), and the correspondence rate of enhancing capsule to corona enhancement was 68.6% (p = 0.004). Corona enhancement was more frequently observed in moderately differentiated HCCs than other lesions (p = 0.012) and not dependent (p = 0.465) on the tumour size, while enhancing capsule was significantly dependent on tumour size, as indicated by univariate (p < 0.001) and multivariate analyses (odds ratio, 4.241; p = 0.002). CONCLUSIONS Among the capsular features, corona enhancement might closely relate to enhancing capsule in HCCs. Corona enhancement was not dependent on tumour size and had the highest incidence of appearance on gadoxetic acid-enhanced multiphasic dynamic MRI. KEY POINTS • Enhancing capsule has a limited role in the LI-RADS categorisation during gadoxetic acid-enhanced MRI. • Appearance of corona enhancement is closely related to enhancing capsule and is not dependent on size of HCCs. • Corona enhancement can substitute enhancing capsule in the diagnosis of HCCs during multiple arterial and portal venous phase gadoxetic acid-enhanced MRI.
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Tsukahara Y, Okajima Y, Yamada A, Momose M, Uehara T, Shimizu A, Soejima Y, Fujinaga Y. The peritumoral hypointense rim around hepatocellular carcinoma on T2*-weighted magnetic resonance imaging: radiologic-pathologic correlation. World J Surg Oncol 2021; 19:41. [PMID: 33549104 PMCID: PMC7868021 DOI: 10.1186/s12957-021-02152-2] [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: 11/05/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background A peritumoral hypointense rim (PTHR) is sometimes observed around hepatocellular carcinoma (HCC) on T2*-weighted images (T2*WIs). We aimed to investigate the association between the PTHR and histopathologic findings on T2*WIs. Methods We assessed the presence of a PTHR on T2*WIs in 39 pathologically proven HCCs from April 2012 to December 2013. Prussian blue staining was performed, and iron deposition was evaluated by semiquantitative and quantitative methods. Optical density was used in the quantitative methods. The associations between a PTHR on T2*WI and histopathologic peritumoral or background liver iron deposition were analyzed. Results A PTHR on T2*WI was observed in 23 of 39 (59%) HCCs. There was no significant difference in the histopathologic fibrous capsule findings (P = 0.394). In the semiquantitative methods, both peritumoral and background liver iron deposition grade were significantly higher in HCCs with a PTHR compared with HCCs without a PTHR (P < 0.001). The mean optical density in HCCs with a PTHR was significantly higher compared with HCCs without a PTHR, in the quantitative peritumoral (42,244.1 ± 20,854.9 vs. 18,739.1 ± 12,258.7, respectively; P < 0.001) and background liver iron deposition analyses (35,554.7 ± 19,854.8 vs. 17,292.4 ± 11,605.8, respectively; P < 0.001). Tumor size (P = 0.005), etiology (P = 0.001), and degree of fibrosis (P = 0.042) were significantly associated with the presence of a PTHR. Conclusions A PTHR in HCCs on T2*WIs was strongly associated with peritumoral iron deposition in the iron-deposited background liver but not with the fibrous capsule.
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Affiliation(s)
- Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Yukinori Okajima
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masanobu Momose
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Shimizu
- Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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11
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Wang X, Zhang Z, Zhou X, Zhang Y, Zhou J, Tang S, Liu Y, Zhou Y. Computational quantitative measures of Gd-EOB-DTPA enhanced MRI hepatobiliary phase images can predict microvascular invasion of small HCC. Eur J Radiol 2020; 133:109361. [PMID: 33120240 DOI: 10.1016/j.ejrad.2020.109361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This study was designed to preoperatively predict microvascular invasion (MVI) of solitary small hepatocellular carcinoma (sHCC) by quantitative analysis of Gd-EOB-DTPA enhanced hepatobiliary phase (HBP) magnetic resonance imaging (MRI). METHOD Sixty-one patients, 19 with and 42 without histologically confirmed MVI following hepatic resection for solitary sHCC (≤ 3 cm), were preoperatively examined with Gd-EOB-DTPA-enhanced MRI. The regions of interest (ROIs) of the hepatic lesions were manually delineated on the maximum cross-sectional area in the HBP images and used to calculate the lesion boundary index (LBI) and marginal gray changes (MGC). Histogram analysis was performed to measure standard deviations (STD) and coefficients of variation (CV). Correlations between quantitative parameters and MVI were evaluated and differences between MVI positive and negative groups were assessed. RESULTS The average LBI (0.85 ± 0.07) and MGC (0.48 ± 0.27) values of the negative group were significantly higher (p < 0.05) than the corresponding LBI (0.72 ± 0.07) and MGC (0.28 ± 0.18) values of the positive group. STDs and CVs in the negative group were significantly smaller (p < 0.05) than those of the positive group. Receiver operating characteristic (ROC) analysis revealed that LBI had the best predictive value with an AUC, sensitivity, and specificity of 0.91, 87 %, and 80 %, respectively. CONCLUSIONS Quantitative analysis of HBP images is useful for predicting MVI and beneficial to clinicians in making decisions before treatment.
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Affiliation(s)
- Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Ziqian Zhang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Xueyan Zhou
- School of Technology, Harbin University, 109 Zhongxing Street, Harbin 150010, Heilongjiang, China
| | - Yuning Zhang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Jiamin Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Shuli Tang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Yang Liu
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China.
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China.
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12
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Kim JH, Joo I, Lee JM. Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging. Korean J Radiol 2020; 20:1019-1041. [PMID: 31270973 PMCID: PMC6609440 DOI: 10.3348/kjr.2018.0636] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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13
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Ansari-Gilani K, Modaresi Esfeh J. Unusual MRI appearance of a well differentiated hepatocellular carcinoma, mimicking a cavernous hemangioma: A case report. Radiol Case Rep 2019; 14:885-888. [PMID: 31193208 PMCID: PMC6520570 DOI: 10.1016/j.radcr.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/26/2023] Open
Abstract
The typical imaging findings in hepatocellular carcinoma (HCC) are arterial hyperenhancement with washout on portal venous and/or equilibrium phases. Larger HCCs can have atypical imaging findings including fibrous capsule or mosaic appearance. We describe an unusual biopsy proven HCC in a cirrhotic liver with imaging features mimicking cavernous hemangioma which also demonstrated some atypical features such as thick capsule. In addition to knowing the typical imaging findings of HCC, it is important to be familiar with its atypical imaging findings especially in larger lesions.
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Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology & Transplant Hepatology, Cleveland Clinic, Cleveland, OH 44195, USA
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14
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Huang K, Dong Z, Cai H, Huang M, Peng Z, Xu L, Jia Y, Song C, Li ZP, Feng ST. Imaging biomarkers for well and moderate hepatocellular carcinoma: preoperative magnetic resonance image and histopathological correlation. BMC Cancer 2019; 19:364. [PMID: 30999947 PMCID: PMC6472074 DOI: 10.1186/s12885-019-5574-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background Our aim of the study is to investigate the feasibility of preoperative prediction for hepatocellular carcinoma (HCC) histological grading using gadoxetic acid-enhanced magnetic resonance imaging (MRI). Methods This study included one hundred and fifty-six patients with solitary HCC. Preoperative gadoxetic acid-enhanced MRI findings were retrospectively analyzed. MRI qualitative features such as tumor size, margin, capsule status, signal homogeneity, intratumoral vessels, peritumoral enhancement during mid-arterial phase, peritumoral hypointensity during the hepatobiliary phase (HBP) were investigated. Apparent diffusion coefficients (ADCs), T1 reduction ratio of pre- and post-contrast enhanced images of the tumors were calculated. HCC histological grading in surgical specimens were confirmed by Edmonson’s criteria. Correlations between these MRI features and HCC histological grading were analyzed using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy of the model. Results Univariate analysis showed that maximum tumor diameter (p = 0.004), tumor margin (p = 0.006), intratumoral vessels (p = 0.001) and peritumoral hypointensity during HBP (p = 0.000), were significantly correlated with HCC histological grading. There was no relationship between capsule, tumor signal, venous thrombosis, peritumoral enhancement during mid-arterial phase, ADC value, T1 reduction ratio, and HCC histological grading. Multivariate logistic regression analysis demonstrated that the maximum tumor diameter (p = 0.012, odds ratio = 1.002, 95% confidence interval: 1.007–1.046)) was an independent risk factor for high grade HCC. Conclusions Greater tumor size, a more irregular margin, presence of intratumoral vessels, and peritumoral hypointensity during HBP were indicators for high grade HCC. The maximum tumor diameter was an independent risk factor for high grade HCC. Electronic supplementary material The online version of this article (10.1186/s12885-019-5574-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China.,Department of Radiology, Guizhou Provincial People's Hospital, No. 83 East, Zhongshan Road, Guiyang, 550002, Guizhou, China
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Mengqi Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Ling Xu
- Faculty of Medicine and Dentistry, University of Western Australia, Perth, Australia
| | - Yingmei Jia
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Chenyu Song
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
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15
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Abstract
As opposed to most solid cancers, hepatocellular carcinoma (HCC) does not necessarily require histological confirmation. Noninvasive diagnosis is possible and relies on imaging. In cirrhotic patients, the diagnosis can be obtained in tumors displaying typical features that include non-rim arterial phase hyperenhancement followed by washout during the portal venous and/or delayed phases on CT or MR imaging. This pattern is very specific and, as such, has been endorsed by both Western and Asian diagnostic guidelines and systems. However, its sensitivity is not very high, especially for small lesions. Numerous ancillary features favoring the diagnosis of HCC may be depicted, including appearance after injection of hepatobiliary MR imaging contrast agents. These features increase confidence in diagnosis, but cannot be used as substitutes to liver biopsy. Aside from its diagnostic purpose, imaging also helps to assess tumor biology and patient outcome, by identifying features of local invasiveness. The purpose of this review article is to offer an overview of the role of imaging for the diagnosis and prognostication of HCC.
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16
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Yoneda N, Matsui O, Kobayashi S, Kitao A, Kozaka K, Inoue D, Yoshida K, Minami T, Koda W, Gabata T. Current status of imaging biomarkers predicting the biological nature of hepatocellular carcinoma. Jpn J Radiol 2019; 37:191-208. [PMID: 30712167 DOI: 10.1007/s11604-019-00817-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is heterogeneous in terms of its biological nature. Various factors related to its biological nature, including size, multifocality, macroscopic morphology, grade of differentiation, macro/microvascular invasion, bile duct invasion, intra-tumoral fat and molecular factors, and their value as prognostic imaging biomarkers have been reported. And recently, genome-based molecular HCC classification correlated with clinical outcome has been elucidated. The imaging biomarkers suggesting a less aggressive nature of HCC are smaller size, solitary tumor, smooth margin suggesting small nodular type with indistinct margin and simple nodular type with distinct margin, capsule, imaging biomarkers predicting early or well-differentiated grade, intra-tumoral fat detection, and low fluorodeoxyglucose (FDG) accumulation. The imaging biomarkers suggesting an aggressive HCC nature are larger size, multifocality, non-smooth margin suggesting simple nodular type with extranodular growth, confluent multinodular, and infiltrative type, imaging biomarkers predicting poor differentiation, macrovascular tumor thrombus, predicting microvascular invasion imaging biomarkers, bile duct dilatation or tumor thrombus, and high FDG accumulation. In the genome-based molecular classification, CTNNB-1 mutated HCC shows a less aggressive nature, while CK19/EpCAM positive HCC and macrotrabecular massive HCC show an aggressive one. Better understanding of these imaging biomarkers can contribute to devising more appropriate treatment plans for HCC.
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Affiliation(s)
- Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan.
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Satoshi Kobayashi
- Department of Quantum Medical Imaging, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Azusa Kitao
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Kotaro Yoshida
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Tetsuya Minami
- Department of Radiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
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Ren AH, Zhao PF, Yang DW, Du JB, Wang ZC, Yang ZH. Diagnostic performance of MR for hepatocellular carcinoma based on LI-RADS v2018, compared with v2017. J Magn Reson Imaging 2019; 50:746-755. [PMID: 30648327 DOI: 10.1002/jmri.26640] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- A-Hong Ren
- Department of Radiology; Beijing Friendship Hospital, Capital Medical University; Beijing P.R. China
- Department of Radiology; People's Hospital of Beijing DaXing District, Capital Medical University; Beijing P.R. China
| | - Peng-Fei Zhao
- Department of Radiology; Beijing Friendship Hospital, Capital Medical University; Beijing P.R. China
| | - Da-Wei Yang
- Department of Radiology; Beijing Friendship Hospital, Capital Medical University; Beijing P.R. China
| | - Jing-Bo Du
- Department of Radiology; People's Hospital of Beijing DaXing District, Capital Medical University; Beijing P.R. China
| | - Zhen-Chang Wang
- Department of Radiology; Beijing Friendship Hospital, Capital Medical University; Beijing P.R. China
| | - Zheng-Han Yang
- Department of Radiology; Beijing Friendship Hospital, Capital Medical University; Beijing P.R. China
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18
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LI-RADS v2017 categorisation of HCC using CT: Does moderate to severe fatty liver affect accuracy? Eur Radiol 2018; 29:186-194. [DOI: 10.1007/s00330-018-5657-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 12/22/2022]
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19
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Patella F, Pesapane F, Fumarola EM, Emili I, Spairani R, Angileri SA, Tresoldi S, Franceschelli G, Carrafiello G. CT-MRI LI-RADS v2017: A Comprehensive Guide for Beginners. J Clin Transl Hepatol 2018; 6:222-236. [PMID: 29951368 PMCID: PMC6018316 DOI: 10.14218/jcth.2017.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer-related deceases worldwide. Early diagnosis is essential for correct management and improvement of prognosis. Proposed for the first time in 2011 and updated for the last time in 2017, the Liver Imaging-Reporting and Data System (LI-RADS) is a comprehensive system for standardized interpretation and reporting of computed tomography (CT) and magnetic resonance imaging (MRI) liver examinations, endorsed by the American College of Radiology to achieve congruence with HCC diagnostic criteria in at-risk populations. Understanding its algorithm is fundamental to correctly apply LI-RADS in clinical practice. In this pictorial review, we provide a guide for beginners, explaining LI-RADS indications, describing major and ancillary features and eventually elucidating the diagnostic algorithm with the use of some clinical examples.
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Affiliation(s)
- Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
- *Correspondence to: Filippo Pesapane, Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, Milan 20122, Italy. Tel: +39-13012751123; Fax: +39-2-50323393; E-mail:
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Riccardo Spairani
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Silvia Tresoldi
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Giuseppe Franceschelli
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
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20
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Kim B, Lee JH, Kim JK, Kim HJ, Kim YB, Lee D. The capsule appearance of hepatocellular carcinoma in gadoxetic acid-enhanced MR imaging: Correlation with pathology and dynamic CT. Medicine (Baltimore) 2018; 97:e11142. [PMID: 29924016 PMCID: PMC6023655 DOI: 10.1097/md.0000000000011142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study aimed to evaluate the capability of gadoxetic acid-enhanced MR (GAeMR) to detect presence of capsule appearance in hepatocellular carcinoma (HCC), and to correlate it with dynamic computed tomography (CT) and pathological features.Sixty-three patients (54: 9 = M: F, mean age 55.8) surgically confirmed HCCs with preoperative CT and GAeMR were included in this retrospective study. Two readers evaluated presence of capsule appearances on CT and GAeMR images in each phase including precontrast (Pre), portal phase (PP), delayed phase (DP), transitional phase (TP), and hepatobiliary phase (HBP). Histologic capsule was compared with CT and GAeMR. Diagnostic performance of CT and GAeMR of each phase for histologic capsule was evaluated and compared by receiver operating characteristic curve. Interobserver agreement was assessed with kappa statistics.Histologically the capsule was complete in 12.7% (8/63) and incomplete in 60.3% (38/63). Four cases (6.3%) were pseudocapsule. Interobserver agreement for capsule appearance on GAeMR was good in Pre (κ = 0.684), moderate in PP (κ = 0.434), poor in TP (κ = 0.187), fair in HBP (κ = 0.395), and moderate on CT in PP (κ = 0.476) and DP (κ = 0.485). Diagnostic performance and sensitivity for the histologic capsule in DP on CT was highest among PP on CT and other phases on GAeMR. DP on CT images showed a higher Az value than PP on CT images with statistical significance (P < .001). PP on MR images revealed higher Az value than PP on CT images.The capsule appearance was most frequently observed in the DP on CT with highest diagnostic performance, and so DP images should be obtained on CT study for liver mass categorization. GAeMR yielded comparable capsule appearance to CT with moderate interobserver agreement. Considering hypointense rim on the HBP as fibrous capsule on pathology should be refrained, and so further study is warranted to correlate HBP hypointense rim with pathologic findings.
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Affiliation(s)
| | | | | | | | - Young Bae Kim
- Department of Pathology, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Dakeun Lee
- Department of Pathology, Ajou University School of Medicine, Suwon-si, Republic of Korea
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Liu W, Qin J, Guo R, Xie S, Jiang H, Wang X, Kang Z, Wang J, Shan H. Accuracy of the diagnostic evaluation of hepatocellular carcinoma with LI-RADS. Acta Radiol 2018. [PMID: 28648125 DOI: 10.1177/0284185117716700] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There are few studies about the Liver Imaging Reporting and Data System (LI-RADS), which was developed with the purpose of standardizing the interpretation and reporting of liver imaging examinations in patients at risk for hepatocellular carcinoma (HCC). Purpose To evaluate the diagnostic accuracy of HCC diagnosis using LI-RADS. Material and Methods The computed tomography (CT), magnetic resonance imaging (MRI), and clinical data of 297 lesions in 249 patients between June 2012 and August 2013 were retrospectively analyzed. Using LI-RADS 2014, two radiologists evaluated the lesions and a LI-RADS category was retrospectively assigned to each nodule. Results The final diagnoses of 297 nodules in 249 patients consisted of 191 malignant and 106 benign lesions. Out of 44 LI-RADS category 1 lesions, none were HCCs. However, 2/25 category 2 lesions, 3/35 category 3 lesions, 16/25 category 4 lesions, 151/156 category 5 lesions, and 3/12 category LRM/OM (probable malignancy, not specific for HCC/other malignancy) lesions were HCCs. The Kappa value was 0.44 (95% confidence interval [CI] = 0.39-0.49) between two observers during LI-RADS grading. Conclusion The negative predictive value of LI-RADS category 1 was 100%. In addition, a relevant proportion of lesions categorized as category 2 or 3, or even as other malignancies, were HCCs. LI-RADS category 5 had a high specificity for HCC. LI-RADS was not able to give a differential diagnosis for the false-positive lesions of LI-RADS category 5.
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Affiliation(s)
- Weimin Liu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Jie Qin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Ruomi Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Sidong Xie
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Hang Jiang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Xiaohong Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Hong Shan
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, PR China
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, PR China
- Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, PR China
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22
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Lewis S, Besa C, Wagner M, Jhaveri K, Kihira S, Zhu H, Sadoughi N, Fischer S, Srivastava A, Yee E, Mortele K, Babb J, Thung S, Taouli B. Prediction of the histopathologic findings of intrahepatic cholangiocarcinoma: qualitative and quantitative assessment of diffusion-weighted imaging. Eur Radiol 2017; 28:2047-2057. [PMID: 29234913 DOI: 10.1007/s00330-017-5156-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To correlate qualitative and quantitative diffusion weighted imaging (DWI) characteristics of intrahepatic cholangiocarcinoma (ICC) with histopathologic tumour grade and fibrosis content. METHODS Fifty-one patients (21M/30F; mean age 61y) with ICC and MRI including DWI were included in this IRB-approved multicentre retrospective study. Qualitative tumour features were assessed. Tumour apparent diffusion coefficient (ADC) mean, minimum, and normalized (nADCliver) values were computed. Tumour grade [well(G1), moderately(G2), or poorly differentiated(G3)] and tumour fibrosis content [minimal(1), moderate(2), or abundant(3)] were categorized pathologically. Imaging findings and ADC values were compared with pathologic measures. Utility of ADC values for predicting tumour grade was assessed using ROC analysis. RESULTS 51 ICCs (mean size 6.5±1.1 cm) were assessed. 33/51(64%) of ICCs demonstrated diffuse hyperintensity and 15/51(29%) demonstrated target appearance on DWI. Infiltrative morphology (p=0.02) and tumour size (p=0.04) were associated with G3. ADCmean and nADCmean of G3 (1.32±0.47x10-3 mm2/sec and 0.97±0.95) were lower than G1+G2 (1.57±0.39x10-3 mm2/sec and 1.24±0.49; p=0.03 and p=0.04). ADCmean and nADCmean were inversely correlated with tumour grade (p<0.025). No correlation was found between ADC and tumour fibrosis content. AUROC, sensitivity and specificity of nADCmean for G3 versus G1+G2 were 0.71, 89.5% and 55.5%. CONCLUSION ADC quantification has reasonable accuracy for predicting ICC grade. KEY POINTS • ADC quantification was useful for predicting ICC tumour grade. • Infiltrative tumour morphology and size were associated with poorly differentiated ICCs. • ADC values depended more on ICC tumour grade than fibrosis content. • Ability to predict ICC tumour grade non-invasively could impact patient management.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Cecilia Besa
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kartik Jhaveri
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Shingo Kihira
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hongfa Zhu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nima Sadoughi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiology, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Sandra Fischer
- Department of Pathology, University of Toronto, Ontario, Canada
| | - Amogh Srivastava
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eric Yee
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Koenraad Mortele
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Swan Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ünal E, İdilman İS, Akata D, Özmen MN, Karçaaltıncaba M. Microvascular invasion in hepatocellular carcinoma. Diagn Interv Radiol 2017; 22:125-32. [PMID: 26782155 DOI: 10.5152/dir.2015.15125] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microvascular invasion is a crucial histopathologic prognostic factor for hepatocellular carcinoma. We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule, irregular tumor margin, peritumoral enhancement, multifocal tumor, increased tumor size, and increased glucose metabolism on positron emission tomography-computed tomography. In the presence of typical findings, microvascular invasion may be predicted.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Hacettepe University School of Medicine Ankara, Turkey; Department of Radiology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
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Zhang B, Yang W, Yu J, Guo W, Wang J, Liu S, Xiao Y, Shi D. Green Synthesis of Sub-10 nm Gadolinium-Based Nanoparticles for Sparkling Kidneys, Tumor, and Angiogenesis of Tumor-Bearing Mice in Magnetic Resonance Imaging. Adv Healthc Mater 2017; 6. [PMID: 28004887 DOI: 10.1002/adhm.201600865] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/18/2016] [Indexed: 12/13/2022]
Abstract
Gadolinium (Gd)-based nanoparticles are known for their high potential in magnetic resonance imaging (MRI). However, further MRI applications of these nanoparticles are hampered by their relatively large sizes resulting in poor organ/tumor targeting. In this study, ultrafine sub-10 nm and biocompatible Gd-based nanoparticles are synthesized in a bioinspired, environmentally benign, and straightforward fashion. This novel green synthetic strategy is developed for growing dextran-coated Gd-based nanoparticles (GdNPs@Dex). The as-prepared GdNPs@Dex is not only biocompatible but also stable with a sub-10 nm size. It exhibits higher longitudinal and transverse relaxivities in water (r1 and r2 values of 5.43 and 7.502 s-1 × 10-3 m-1 of Gd3+ , respectively) than those measured for Gd-DTPA solution (r1 and r2 values of 3.42 and 3.86 s-1 × 10-3 m-1 of Gd3+ , respectively). In vivo dynamic T1 -weighted MRI in tumor-bearing mice shows GdNPs@Dex can selectively target kidneys and tumor, in addition to liver and spleen. GdNPs@Dex is found particularly capable for determining the tumor boundary with clearly enhanced tumor angiogenesis. GdNPs@Dex is also found cleared from body gradually mainly via hepatobiliary and renal processing with no obvious systemic toxicity. With this green synthesis strategy, the sub-10 nm GdNPs@Dex presents promising potentials for translational biomedical imaging applications.
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Affiliation(s)
- Bingbo Zhang
- Institute of Photomedicine; Shanghai Skin Disease Hospital; The Institute for Biomedical Engineering and Nano Science; Tongji University School of Medicine; Shanghai 200443 China
| | - Weitao Yang
- School of Materials Science and Engineering; School of Life Science; Tianjin Engineering Center of Micro-Nano Biomaterials and Detection-Treatment Technology; Tianjin University; Tianjin 300072 China
| | - Jiani Yu
- Institute of Photomedicine; Shanghai Skin Disease Hospital; The Institute for Biomedical Engineering and Nano Science; Tongji University School of Medicine; Shanghai 200443 China
| | - Weisheng Guo
- CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety; National Center for Nanoscience and Technology; No. 11 Beiyitiao, Zhongguancun Beijing 100190 China
| | - Jun Wang
- Institute of Photomedicine; Shanghai Skin Disease Hospital; The Institute for Biomedical Engineering and Nano Science; Tongji University School of Medicine; Shanghai 200443 China
| | - Shiyuan Liu
- Department of Radiology; Changzheng Hospital; The Second Military Medical University; Shanghai 200003 China
| | - Yi Xiao
- Department of Radiology; Changzheng Hospital; The Second Military Medical University; Shanghai 200003 China
| | - Donglu Shi
- The Institute for Translational Nanomedicine; Shanghai East Hospital; The Institute for Biomedical Engineering and Nano Science; Tongji University School of Medicine; Shanghai 200092 P. R. China
- Department of Mechanical and Materials Engineering; College of Engineering and Applied Science; University of Cincinnati; Cincinnati OH 45221-0072 USA
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25
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Cruite I, Tang A, Mamidipalli A, Shah A, Santillan C, Sirlin CB. Liver Imaging Reporting and Data System: Review of Major Imaging Features. Semin Roentgenol 2016; 51:292-300. [DOI: 10.1053/j.ro.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Dioguardi Burgio M, Picone D, Cabibbo G, Midiri M, Lagalla R, Brancatelli G. MR-imaging features of hepatocellular carcinoma capsule appearance in cirrhotic liver: comparison of gadoxetic acid and gadobenate dimeglumine. Abdom Radiol (NY) 2016; 41:1546-54. [PMID: 27052455 DOI: 10.1007/s00261-016-0726-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of the study is to compare the MR-imaging features of hepatocellular carcinoma (HCC) capsule appearance on gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging, using imaging-based presumptive diagnosis of HCC as the reference standard. METHODS Gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging of 51 patients with 71 HCCs were retrospectively reviewed. Three readers graded in consensus, using a five-point scale, the presence (score 4-5) of capsule appearance on images obtained during T1-weighted GRE portal venous phase (PVP), 3-min phase, and hepatobiliary phase (HBP). The Fisher's exact test and the t student unpaired test were performed. RESULTS A hyperintense capsule appearance was present either on PVP or 3-min phase in 11/46 and in 24/25 HCCs imaged with gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging, respectively (24% vs. 96% p < 0.001). A hypointense capsule appearance was present on HBP in 8/46 and 0/22 HCCs evaluated with gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging, respectively (17% vs. 0% p = 0.046). A capsule appearance was detected either on PVP, 3-min phase, or HBP in 17/46 (37%) HCCs after gadoxetic acid injection and in 24/25 (96%) HCCs after gadobenate dimeglumine injection (p < 0.001). CONCLUSIONS A capsule appearance was more frequently seen on gadobenate dimeglumine-enhanced MR imaging when compared to gadoxetic acid-enhanced MR imaging.
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Affiliation(s)
- Marco Dioguardi Burgio
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies DiBiMed, University of Palermo, Palermo, Italy.
| | - Dario Picone
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies DiBiMed, University of Palermo, Palermo, Italy
| | - Giuseppe Cabibbo
- Section of Gastroenterology, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies DiBiMed, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies DiBiMed, University of Palermo, Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies DiBiMed, University of Palermo, Palermo, Italy
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27
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Yang W, Yan K, Wang S, Dai Y, Wu W, Yin SS, Chen MH. Differential Diagnosis of Arterial Phase Enhanced Hepatic Inflammatory Lesions and Hepatocellular Carcinomas with Contrast-enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:82-91. [PMID: 26456578 DOI: 10.1016/j.ultrasmedbio.2015.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
We aimed to investigate the enhancement patterns of contrast-enhanced ultrasound (CEUS) with SonoVue and determine the utility of this method for differential diagnosis between hepatic inflammatory lesions with arterial phase enhancement and hepatocellular carcinomas (HCC). Twenty-three patients with arterial-enhanced inflammatory liver lesions and 46 HCC patients were included. These lesions had been subjected to CEUS examination and confirmed by pathologic results or imaging follow-up for at least 1 y. In the arterial phase of CEUS, 65.2% of the inflammatory lesions showed patchy (slight enhancement with poorly defined margins) or centripetal enhancement, whereas 89.1% of the HCC lesions showed homogeneous or heterogeneous enhancement (p < 0.001). Moreover, 82.6% of the inflammatory lesions had poorly defined margins, and 78.3% were irregular in shape at the peak, whereas 87.0% of the HCC lesions had well-defined margins and 76.1% were regular (both p < 0.001). Feeding vessels were more frequently visualized in HCCs (71.7%) than in inflammatory lesions (26.1%, p < 0.001). Additionally, 88.2% of the internal non-perfused areas in inflammatory lesions were regular in shape, while 68.0% of these areas in HCCs had an irregular shape (p < 0.001). CEUS pattern analysis provides important information for differentiating inflammatory liver lesions and HCCs and is helpful for improving diagnostic accuracy.
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Affiliation(s)
- Wei Yang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Dai
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Shan-Shan Yin
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Min-Hua Chen
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
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28
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Xu L, Peng ZW, Chen MS, Shi M, Zhang YJ, Guo RP, Lin XJ, Lau WY. Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization. J Hepatol 2015; 63:122-30. [PMID: 25725438 DOI: 10.1016/j.jhep.2015.02.034] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 02/16/2015] [Accepted: 02/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS To establish an effective prognostic nomogram for patients with unresectable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). METHODS The nomogram was constructed based on data obtained from a retrospective study on 2938 patients who received TACE as an initial therapy from 2000 to 2008. The predictive accuracy and discriminative ability of the nomogram were compared with seven current commonly used staging systems on HCC by using data obtained from a prospective study on a cohort of 647 patients treated from January 2011 to December 2011 at the same institution. Additional external validation was performed using a data set (n=221) from another institution. RESULTS Portal vein invasion, tumor number, tumor capsule, alpha fetoprotein, aspartate aminotransferase, and indocyanine green retention at 15 min formed the basis of the nomogram. The concordance index (C-index) of the nomogram was 0.755, which was significantly better than the American Joint Committee on Cancer seventh edition (0.612), the Barcelona Clinic Liver Cancer system (0.692), the Okuda system (0.579), the Japan Integrated Staging system (0.637), Cancer of the Liver Italian Program system (0.683), the Chinese University Prognostic Index (0.637) and the Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire (0.577) (p<0.001 for all). The calibration curve for predicting probability of survival showed a good agreement between the nomogram and actual observation. The findings were supported by the external validation cohort. The nomogram gave better discrimination than the seven staging systems. CONCLUSIONS The proposed nomogram gave accurate prognostic prediction in patients with unresectable HCC after treatment with TACE.
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Affiliation(s)
- Li Xu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhen-Wei Peng
- Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, China
| | - Min-Shan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Ming Shi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yao-Jun Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Rong-Ping Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiao-Jun Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Wan-Yee Lau
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
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Cho ES, Choi JY. MRI features of hepatocellular carcinoma related to biologic behavior. Korean J Radiol 2015; 16:449-64. [PMID: 25995679 PMCID: PMC4435980 DOI: 10.3348/kjr.2015.16.3.449] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/23/2015] [Indexed: 12/12/2022] Open
Abstract
Imaging studies including magnetic resonance imaging (MRI) play a crucial role in the diagnosis and staging of hepatocellular carcinoma (HCC). Several recent studies reveal a large number of MRI features related to the prognosis of HCC. In this review, we discuss various MRI features of HCC and their implications for the diagnosis and prognosis as imaging biomarkers. As a whole, the favorable MRI findings of HCC are small size, encapsulation, intralesional fat, high apparent diffusion coefficient (ADC) value, and smooth margins or hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI. Unfavorable findings include large size, multifocality, low ADC value, non-smooth margins or hypointensity on hepatobiliary phase images. MRI findings are potential imaging biomarkers in patients with HCC.
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Affiliation(s)
- Eun-Suk Cho
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
| | - Jin-Young Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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30
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Kircher A, Bongartz G, Merkle EM, Zech CJ. [Rational imaging of hepatocellular carcinoma. The challenge of multimodal diagnostic criteria]. Radiologe 2015; 54:664-72. [PMID: 25047522 DOI: 10.1007/s00117-014-2652-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CLINICAL/METHODICAL ISSUE Both computed tomography (CT) and magnetic resonance imaging (MRI) constitute the gold standard in radiological imaging of hepatocellular carcinoma (HCC). In cases of typical contrast behavior each modality as a single dynamic technique allows the diagnosis of HCC. There is still a challenge in detection of small HCCs < 2 cm, in differentiating HCC and high-grade dysplasia from other benign liver lesions as well as the evaluation of hypovascular liver lesions in the cirrhotic liver. PERFORMANCE Nowadays, both modalities achieve high detection rates of 90-100 % for lesions > 2 cm. Regarding lesions between 1 and 2 cm there is a higher sensitivity for MRI ranging between 80 and 90 % compared to 60-75 % with CT. Besides the multimodal diagnostic criteria, MRI provides significant benefits with the use of hepatobiliary contrast. Especially in combination with diffusion- weighted imaging (DWI) increased sensitivity and diagnostic accuracy compared to CT has been described for lesions sized < 2 cm. Regarding the differentiation from other hepatic nodules in the cirrhotic liver there is strong evidence that the coexistence of arterial enhancement and hypointensity on hepatobiliary imaging is specific for HCC. Moreover, hypointensity on hepatobiliary imaging is associated with a high positive predictive value (PPV) of up to 100 % for the presence of high-grade dysplasia and HCC. ACHIEVEMENTS The use of MRI including hepatobiliary imaging and DWI has to be regarded as the best non-invasive imaging modality for the detection of HCC and for the characterization of nodules in patients with liver cirrhosis. In comparison to CT there are benefits regarding detection of small lesions < 2 cm and evaluation of hypovascular liver lesions in the context of the hepatocarcinogenesis including prognostic values of premalignant lesions. PRACTICAL RECOMMENDATIONS Both MRI and CT provide a high diagnostic performance in evaluation of HCC in liver cirrhosis. With MRI there are considerable advantages regarding the detection rate and specificity. For daily clinical routine, CT offers a fast, reliable and easy available modality with benefits for patients in reduced general state of health and restricted compliance.
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Affiliation(s)
- A Kircher
- Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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Asayama Y, Nishie A, Ishigami K, Ushijima Y, Takayama Y, Fujita N, Kubo Y, Aishima S, Shirabe K, Yoshiura T, Honda H. Distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma using precontrast and gadoxetic acid-enhanced MRI. Diagn Interv Radiol 2015; 21:96-104. [PMID: 25698097 PMCID: PMC4463313 DOI: 10.5152/dir.2014.13013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/03/2014] [Accepted: 09/24/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to gain further insight in magnetic resonance imaging characteristics of mass-forming intrahepatic cholangiocarcinoma (mICC), its enhancement pattern with gadoxetic acid contrast agent, and distinction from poorly differentiated hepatocellular carcinoma (pHCC). METHODS Fourteen mICC and 22 pHCC nodules were included in this study. Two observers recorded the tumor shape, intratumoral hemorrhage, fat on chemical shift imaging, signal intensity at the center of the tumor on T2-weighted image, fibrous capsule, enhancement pattern on arterial phase of dynamic study, late enhancement three minutes after contrast injection (dynamic late phase), contrast uptake on hepatobiliary phase, apparent diffusion coefficient, vascular invasion, and intrahepatic metastasis. RESULTS Late enhancement was more common in mICC (n=10, 71%) than in pHCC (n=3, 14%) (P < 0.001). A fat component was observed in 11 pHCC cases (50%) versus none of mICC cases (P = 0.002). Fibrous capsule was observed in 13 pHCC cases (59%) versus none of mICC cases (P < 0.001). On T2-weighted images a hypointense area was seen at the center of the tumor in 43% of mICC (6/14) and 9% of pHCC (2/22) cases (P = 0.018). Other parameters were not significantly different between the two types of nodules. CONCLUSION The absence of fat and fibrous capsule, and presence of enhancement at three minutes appear to be most characteristic for mICC and may help its differentiation from pHCC.
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Affiliation(s)
- Yoshiki Asayama
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Akihiro Nishie
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kousei Ishigami
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasuhiro Ushijima
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yukihisa Takayama
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Nobuhiro Fujita
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yuichiro Kubo
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Shinichi Aishima
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ken Shirabe
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takashi Yoshiura
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroshi Honda
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Darnell A, Forner A, Rimola J, Reig M, García-Criado Á, Ayuso C, Bruix J. Liver Imaging Reporting and Data System with MR Imaging: Evaluation in Nodules 20 mm or Smaller Detected in Cirrhosis at Screening US. Radiology 2015; 275:698-707. [PMID: 25658038 DOI: 10.1148/radiol.15141132] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) with magnetic resonance (MR) imaging for hepatic nodules 20 mm or smaller detected during ultrasonographic (US) surveillance in patients with cirrhosis. MATERIALS AND METHODS Between November 2003 and January 2010, patients with cirrhosis with a newly US-detected solitary hepatic nodule 20 mm or smaller were included in this institutional ethics committee-approved study. All patients provided written informed consent before the study; the need to obtain consent for reanalysis of the data was waived. Patients underwent MR imaging and fine-needle biopsy (the reference standard). Nodules without pathologic confirmation were followed up with MR imaging every 6 months. A LI-RADS category was retrospectively assigned to nodules seen at MR imaging. The diagnostic accuracy for each LI-RADS category was described by sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals. RESULTS Final diagnoses of 133 nodules in 159 patients were as follows: 102 hepatocellular carcinomas (HCCs), three intrahepatic cholangiocarcinomas (ICCs), one neuroendocrine metastasis, and 27 benign lesions (median MR imaging follow-up, 95 months). None (0%) of five LI-RADS category 1 lesions, three (25%) of 12 category 2 lesions, 29 (69%) of 42 category 3 lesions, 24 (96%) of 25 category 4 lesions, and 44 (98%) of 45 category 5 lesions were HCCs. One category 3 lesion was ICC, one category 5 lesion was a neuroendocrine metastasis, and two (50%) of four lesions categorized as other malignancies were HCCs. In patients with nodules detected at surveillance US, LI-RADS category 4 criteria were as effective as category 5 criteria for HCC diagnosis. Combining both categories would improve sensitivity without impairing specificity or positive or negative predictive value for HCC diagnosis (42.3%, 98.2%, 97.8%, and 47.4% vs 65.4%, 96.4%, 97.1%, and 59.6%, respectively). CONCLUSION In patients with cirrhosis with US-detected nodules 20 mm or smaller, both LI-RADS category 4 and category 5 have high specificity for HCC. In addition, a relevant proportion of lesions categorized as LI-RADS category 2 or 3 or as other malignancies were HCCs. Thus, active diagnostic work-up, including biopsy to allow prompt treatment, is recommended in such patients. Online supplemental material is available for this article.
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Affiliation(s)
- Anna Darnell
- From the Department of Radiology, Barcelona Clinic Liver Cancer group, Hospital Clinic Barcelona, University of Barcelona, Spain (A.D., J.R., A.G.C., C.A.); Liver Unit, Barcelona Clinic Liver Cancer Group, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, c/Villarroel 170, Escala 7, Planta 3, 08036 Barcelona, Spain (A.F., M.R., J.B.); and Networked Biomedical Research Center in Hepatic and Liver Diseases, Barcelona, Spain (A.F., J.R., M.R., C.A., J.B.)
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Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 2015; 273:30-50. [PMID: 25247563 DOI: 10.1148/radiol.14132362] [Citation(s) in RCA: 349] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging play critical roles in the diagnosis and staging of hepatocellular carcinoma (HCC). The second article of this two-part review discusses basic concepts of diagnosis and staging, reviews the diagnostic performance of CT and MR imaging with extracellular contrast agents and of MR imaging with hepatobiliary contrast agents, and examines in depth the major and ancillary imaging features used in the diagnosis and characterization of HCC.
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Affiliation(s)
- Jin-Young Choi
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California-San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
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Lee JM, Park JW, Choi BI. 2014 KLCSG-NCC Korea Practice Guidelines for the management of hepatocellular carcinoma: HCC diagnostic algorithm. Dig Dis 2014; 32:764-77. [PMID: 25376295 DOI: 10.1159/000368020] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most commonly occurring cancer in Korea and typically has a poor prognosis with a 5-year survival rate of only 28.6%. Therefore, it is of paramount importance to achieve the earliest possible diagnosis of HCC and to recommend the most up-to-date optimal treatment strategy in order to increase the survival rate of patients who develop this disease. After the establishment of the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC), Korea jointly produced for the first time the Clinical Practice Guidelines for HCC in 2003, revised them in 2009, and published the newest revision of the guidelines in 2014, including changes in the diagnostic criteria of HCC and incorporating the most recent medical advances over the past 5 years. In this review, we will address the noninvasive diagnostic criteria and diagnostic algorithm of HCC included in the newly established KLCSG-NCC guidelines in 2014, and review the differences in the criteria for a diagnosis of HCC between the KLCSG-NCC guidelines and the most recent imaging guidelines endorsed by the European Organisation for Research and Treatment of Cancer (EORTC), the Liver Imaging Reporting and Data System (LI-RADS), the Organ Procurement and Transplantation Network (OPTN) system, the Asian Pacific Association for the Study of the Liver (APASL) and the Japan Society of Hepatology (JSH).
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Affiliation(s)
- Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Ronot M, Vilgrain V. Hepatocellular carcinoma: diagnostic criteria by imaging techniques. Best Pract Res Clin Gastroenterol 2014; 28:795-812. [PMID: 25260309 DOI: 10.1016/j.bpg.2014.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/12/2014] [Accepted: 08/15/2014] [Indexed: 01/31/2023]
Abstract
Imaging plays a very important role in the diagnosis of HCC. Indeed, in high-risk patients a noninvasive diagnosis can only be obtained by imaging in presence of typical features. These features include arterial enhancement followed by washout during the portal venous and/or delayed phases on CT scan or MRI. This pattern is quite specific and has been endorsed by both Western and Asian diagnostic guidelines. However, its sensitivity is not very high, especially for small lesions. Therefore ancillary signs may be needed to increase the reliability of the diagnosis. Recent hepatobiliary MRI contrast agents seem to be interesting to improve characterization of small nodules in the cirrhotic liver.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
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Chen W, DelProposto Z, Liu W, Kassir M, Wang Z, Zhao J, Xie B, Wen Y, Wang J, Hu J. Susceptibility-weighted imaging for the noncontrast evaluation of hepatocellular carcinoma: a prospective study with histopathologic correlation. PLoS One 2014; 9:e98303. [PMID: 24879409 PMCID: PMC4039503 DOI: 10.1371/journal.pone.0098303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/01/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Specific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis. In this study, we compared susceptibility-weighted imaging (SWI) to conventional techniques and correlated our findings with histopathology to determine the role of SWI in assessing morphologic features of HCC without using a contrast agent. METHODS 86 consecutive patients with suspected HCC were imaged with MRI (including T1, T2, T2*, and SWI) and subsequently CT. 59 histologically-proven HCC lesions were identified in 53 patients. Each lesion on each imaging sequence was evaluated by two radiologists, and classified with respect to lesion morphology, signal intensity relative to surrounding hepatic parenchyma, presence of a pseudocapsule, presence of venous invasion, and internal homogeneity. RESULTS Histopathology confirmed pseudocapsules in 41/59 lesions. SWI was able to detect a pseudocapsule in 34/41 lesions; compared to conventional T1/T2 imaging (12/41) and T2* (27/41). Mosaic pattern was identified in 25/59 lesions by histopathology; SWI confirmed this in all 25 lesions, compared to T1/T2 imaging (13/25) or T2* (18/25). Hemorrhage was confirmed by histopathology in 43/59 lesions, and visible on SWI in 41/43 lesions, compared to T1/T2 (7/43) and T2* (38/43). Venous invasion was confirmed by histopathology in 31/59 patients; SWI demonstrated invasion in 28/31 patients, compared to T1/T2 (7/31) and T2* (24/31). CONCLUSIONS SWI is better at identifying certain morphologic features such as pseudocapsule and hemorrhage than conventional MRI without using a contrast agent in HCC patients.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zachary DelProposto
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Wei Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Mohammad Kassir
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Zhiyuan Wang
- Cancer Biotherapy Center, Hunan Provincial Tumor Hospital, Xiangya Medical School, Central South University, Hunan, China
| | - Jun Zhao
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bing Xie
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yaming Wen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (JH); (JW)
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (JH); (JW)
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Abstract
Cirrhosis is the main risk factor for the development of hepatocellular carcinoma (HCC). The major causative factors of cirrhosis in the United States and Europe are chronic hepatitis C infection and excessive alcohol consumption with nonalcoholic steatohepatitis emerging as another important risk factor. Magnetic resonance imaging is the most sensitive imaging technique for the diagnosis of HCC, and the sensitivity can be further improved with the use of diffusion-weighted imaging and hepatocyte-specific contrast agents. The combination of arterial phase hyperenhancement, venous or delayed phase hypointensity "washout feature," and capsular enhancement are features highly specific for HCC with reported specificities of 96% and higher. When these features are present in a mass in the cirrhotic liver, confirmatory biopsy to establish the diagnosis of HCC is not necessary. Other tumors, such as cholangiocarcinoma, sometimes occur in the cirrhotic at a much lower rate than HCC and can mimic HCC, as do other benign lesions such as perfusion abnormalities. In this article, we discuss the imaging features of cirrhosis and HCC, the role of magnetic resonance imaging in the diagnosis of HCC and other benign and malignant lesions that occur in the cirrhotic liver, and the issue of nonspecific arterially hyperenhancing nodules often seen in cirrhosis.
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Affiliation(s)
- Daniel C Barr
- From the Department of Radiology/MRI, University of Michigan Health System, Ann Arbor, MI
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Detection of recurrent hepatocellular carcinoma on post-operative surveillance: comparison of MDCT and gadoxetic acid-enhanced MRI. ACTA ACUST UNITED AC 2014; 39:291-9. [DOI: 10.1007/s00261-013-0064-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Chen GW, Song B, Li ZL, Yuan Y. Ectopic blood supply of hepatocellular carcinoma as depicted by angiography with computed tomography: associations with morphological features and therapeutic history. PLoS One 2013; 8:e71942. [PMID: 23967266 PMCID: PMC3744506 DOI: 10.1371/journal.pone.0071942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/07/2013] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the associations of ectopic blood supply of hepatocellular carcinoma (HCC) with its morphological features and therapeutic history. METHODS Three hundred and six patients with 373 HCC lesions were enrolled in this study, and underwent biphasic contrast-enhanced scans on a 64-section MDCT. The anatomy of ectopic blood supply, morphological characteristics of HCC including the size, location and pseudocapsule, and history of transcatheter arterial chemoembolization (TACE) therapy were quantitively assessed and statistically analyzed. RESULTS Ectopic blood supply was found in 30.8% (115/373) lesions. The ectopic arteries were predominantly composed of inferior phrenic artery (86/115) followed by left and right gastric artery (25/115). Tumor size, location, status of pseudocapsule, and history of TACE therapy could impact the origination of ectopic arteries (all p<0.05). CONCLUSION The ectopic feeding arteries of HCC predominantly composed of the perihepatic arteries are associated with the morphological features of the tumor and therapeutic history.
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Affiliation(s)
- Guang-wen Chen
- Department of Radiology, Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- * E-mail:
| | - Zhen-lin Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yuan Yuan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Tao R, Zhang J, Dai Y, You Z, Fan Y, Cui J, Wang J. Characterizing hepatocellular carcinoma using multi-breath-hold two-dimensional susceptibility-weighted imaging: comparison to conventional liver MRI. Clin Radiol 2012; 67:e91-7. [PMID: 22981726 DOI: 10.1016/j.crad.2012.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 07/22/2012] [Accepted: 08/06/2012] [Indexed: 11/25/2022]
Abstract
AIM To characterize the imaging manifestations of hepatocellular carcinoma (HCC) using multi-breath-hold two-dimensional susceptibility-weighted imaging (SWI) and compare to conventional liver magnetic resonance imaging (MRI). MATERIALS AND METHODS Forty-three patients with histopathologically confirmed HCC underwent conventional liver MRI, multi-breath-hold two-dimensional SWI, and contrast-enhanced CT preoperatively. The T1-weighted imaging (WI), T2WI, and SWI images were evaluated in consensus by two experienced radiologists. The tumour boundaries, blood products in the tumour, venous vessels, and non-tumour liver parenchyma were compared. RESULTS SWI demonstrated significantly better tumour boundary detection than T1WI and T2WI imaging (67.4 and 25.6%, respectively). The detection rate for intra-tumoural blood products using SWI was higher than that of T1WI and T2WI (76.7 and 16.3%, respectively). The detection rate for tumour venous vessels using SWI was 72.1%, while none was detected with conventional T1WI and T2WI. The detection rate for siderotic nodules in non-tumour liver parenchyma using SWI was higher than that of conventional T1WI and T2WI (65.1 and 20.9%, respectively). CONCLUSIONS SWI can provide more detailed information than conventional liver MRI in evaluation of tumour boundaries, blood products, venous vasculature, and non-tumour liver parenchyma. SWI is a valuable complement to conventional liver MRI.
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Affiliation(s)
- R Tao
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
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Rare hepatic malignant tumors: dynamic CT, MRI, and clinicopathologic features: with analysis of 54 cases and review of the literature. ACTA ACUST UNITED AC 2012; 38:511-26. [DOI: 10.1007/s00261-012-9918-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Rimola J, Forner A, Tremosini S, Reig M, Vilana R, Bianchi L, Rodríguez-Lope C, Solé M, Ayuso C, Bruix J. Non-invasive diagnosis of hepatocellular carcinoma ≤ 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 2012; 56:1317-23. [PMID: 22314420 DOI: 10.1016/j.jhep.2012.01.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/30/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS To prospectively assess the diagnostic accuracy of the incorporation of additional magnetic resonance imaging (MRI) parameters in those based on contrast enhancement pattern for the diagnosis of solitary nodules between 5 and 20mm, detected during surveillance in patients with cirrhosis. METHODS Between November 2003 and January 2010, we prospectively included 159 cirrhotic patients with a newly detected solitary nodule between 5 and 20mm in diameter by screening ultrasonography (US). Hepatic MRI and fine-needle biopsy were performed in all patients. RESULTS Final diagnoses were hepatocellular carcinoma (HCC) (n=103), other malignant lesions (intrahepatic cholangiocarcinoma/metastases) (n=4), and benign lesions (n=52). The specific enhancement pattern (arterial enhancement followed by washout) yielded a sensitivity and specificity of 58.3% and 96.4%, respectively. Peritumoral capsule was present in 43 HCC and in 2 non-HCC lesions. Intralesional fat was detected in 24 nodules; 5 nodules were non-HCC. Finally, the presence of both capsule and fat was observed in 10 cases, all of them HCC (100% specificity), but all of them also displayed the specific enhancement pattern, thus adding no sensitivity or specificity. CONCLUSIONS Conclusive non-invasive diagnosis of HCC in cirrhosis should be based only on the contrast enhancement pattern, while other characteristics at MRI do not increase the diagnostic accuracy.
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Affiliation(s)
- Jordi Rimola
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Spain.
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Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol 2012; 67:766-73. [PMID: 22425613 DOI: 10.1016/j.crad.2012.01.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 12/17/2022]
Abstract
AIM To examine the differential features of mass-forming intrahepatic cholangiocarcinoma (ICC) from atypical hypovascular hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI). MATERIALS AND METHODS The institutional review board approved this retrospective study and waived informed patient consent. Seventy patients with pathologically proven ICCs (35) and hypovascular atypical HCCs (35) who had undergone preoperative gadoxetic acid-enhanced MRI were enrolled in this study. Images were analysed for the shape of the lesions and presence of hyperintensity on the T1-weighted image (T1WI) and hypo- or hyperintense areas on the T2-weighted image (T2WI). In addition, images were analysed for the presence of linear hyperintensity or multifocal, tiny, hyperintense foci on T2WI and the presence of rim enhancement during early dynamic phases and a central enhancement with a hypointense rim (target appearance) on the 10 and 20 min hepatobiliary phase images. The significance of these findings was determined by the X(2) test. RESULTS Univariate analysis revealed that the following significant parameters favour ICC or hypovascular HCC; the presence of T2 hypo- and hyperintense areas and target appearance on the 10 min hepatobiliary phase images favour ICC, and the presence of T2 linear hyperintensity and T2 multifocal hyperintense foci favour hypovascular HCC (p < 0.05). Multivariate analysis revealed that only target appearance on the 10 min hepatobiliary phase was predictive of ICC (p = 0.002) as 30 ICCs (85.7%) showed this feature. However, the target appearance was also observed in all six scirrhous HCCs. CONCLUSION A target appearance on the 10 min hepatobiliary phase images is the best predictor for identifying mass-forming ICC at gadoxetic acid-enhanced MRI.
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Hypervascular hepatocellular carcinoma 1 cm or smaller in patients with chronic liver disease: characterization with gadoxetic acid-enhanced MRI that includes diffusion-weighted imaging. AJR Am J Roentgenol 2011; 196:W758-65. [PMID: 21606265 DOI: 10.2214/ajr.10.4394] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the finding most predictive for characterizing hypervascular hepatocellular carcinoma (HCC) measuring 1 cm or less at gadoxetic acid-enhanced MRI that includes diffusion-weighted images. MATERIALS AND METHODS In this retrospective study, between May 2008 and June 2009, 66 patients with 108 hypervascular HCCs 1 cm or smaller underwent gadoxetic acid-enhanced 3-T MRI that included diffusion-weighted images. The diagnosis of HCC was determined by surgical resection in 32 cases, percutaneous biopsy in three cases, or interval growth to larger than 1 cm on follow-up images in accordance with the American Association for the Study of Liver Diseases guidelines in 73 cases. MRI findings of HCC and 33 benign hypervascular lesions in a control group were analyzed by two radiologists in consensus. They based their assessments on the presence or absence of the following five findings: hyperintensity on T2-weighted images, hyperintensity on diffusion-weighted images with low b values, washout pattern, capsular enhancement, and hypointensity on gadoxetic acid-enhanced hepatobiliary phase images. The findings were compared by use of univariate and multivariate analyses. RESULTS No HCC with capsular enhancement was found. Fifty-seven HCCs (52.8%) had four findings, 36 (33.3%) had three, nine (8.3%) had two findings, and six (5.6%) had one finding. Univariate analysis showed significant differences between the HCC and control groups with respect to four findings (p < 0.0001). Multivariate analysis showed that hyperintensity on T2-weighted (p < 0.0001) and diffusion-weighted (p = 0.0081) images were statistically significant MRI findings for predicting HCC. CONCLUSION Hyperintensity on both T2- and diffusion-weighted images is helpful in the diagnosis of hypervascular HCC smaller than 1 cm in diameter.
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Khatri G, Merrick L, Miller FH. MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am 2011; 18:421-50, x. [PMID: 21094448 DOI: 10.1016/j.mric.2010.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common malignancy typically associated with chronic liver disease and is a leading cause of mortality among these patients. Prognosis is improved when detected early. MRI is the best imaging examination for accurate diagnosis. Although arterial enhancement with delayed washout, increased T2-weighted signal intensity, delayed capsular enhancement, restricted diffusion, and tumor thrombus are typical features, not all lesions demonstrate these findings. The radiologist must be familiar with these typical imaging characteristics, and less common appearances and associated findings of HCC, and must be able to differentiate them from those of lesions that mimic HCC. Knowledge of therapeutic options and how those are related to imaging findings is imperative to assist clinicians in managing these patients.
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Affiliation(s)
- Gaurav Khatri
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 800, Chicago, IL 60611, USA
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Liu QY, Li HG, Gao M, Lin XF, Li Y, Chen JY. Primary clear cell carcinoma in the liver: CT and MRI findings. World J Gastroenterol 2011; 17:946-52. [PMID: 21412505 PMCID: PMC3051146 DOI: 10.3748/wjg.v17.i7.946] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 12/01/2010] [Accepted: 12/08/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively analyze the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of primary clear cell carcinoma of the liver (PCCCL) and compare the imaging appearances of PCCCL and common type hepatocellular carcinoma (CHCC) to determine whether any differences exist between the two groups.
METHODS: Twenty cases with pathologically proven PCCCL and 127 cases with CHCC in the Second Affiliated Hospital of Sun Yat-sen University were included in this study. CT or MRI images from these patients were retrospectively analyzed. The following imaging findings were reviewed: the presence of liver cirrhosis, tumor size, the enhancement pattern on dynamic contrast scanning, the presence of pseudo capsules, tumor rupture, portal vein thrombosis and lymph node metastasis.
RESULTS: Both PCCCL and CHCC were prone to occur in patients with liver cirrhosis, the association rate of liver cirrhosis was 80.0% and 78.7%, respectively (P > 0.05). The mean sizes of PCCCL and CHCC tumors were (7.28 ± 4.25) cm and (6.96 ± 3.98) cm, respectively. Small HCCs were found in 25.0% (5/20) of PCCCL and 19.7% (25/127) of CHCC cases. No significant differences in mean size and ratio of small HCCs were found between the two groups (P = 0.658 and 0.803, respectively). Compared with CHCC patients, PCCCL patients were more prone to form pseudo capsules (49.6% vs 75.0%, P = 0.034). Tumor rupture, typical HCC enhancement patterns and portal vein tumor thrombosis were detected in 15.0% (3/20), 72.2% (13/18) and 20.0% (4/20) of patients with PCCCL and 3.1% (4/127), 83.6% (97/116) and 17.3% (22/127) of patients with CHCC, respectively. There were no significant differences between the two groups (all P > 0.05). No patients with PCCCL and 2.4% (3/127) of patients with CHCC showed signs of lymph node metastasis (P > 0.05).
CONCLUSION: The imaging characteristics of PCCCL are similar to those of CHCC and could be useful for differentiating these from other liver tumors (such as hemangioma and hepatic metastases). PCCCLs are more prone than CHCCs to form pseudo capsules.
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Khan AS, Hussain HK, Johnson TD, Weadock WJ, Pelletier SJ, Marrero JA. Value of delayed hypointensity and delayed enhancing rim in magnetic resonance imaging diagnosis of small hepatocellular carcinoma in the cirrhotic liver. J Magn Reson Imaging 2010; 32:360-6. [PMID: 20677263 DOI: 10.1002/jmri.22271] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine the diagnostic utility of delayed hypointensity and delayed enhancing rim on magnetic resonance imaging (MRI) as indicators of hepatocellular carcinoma (HCC) in arterially enhancing nodules < or =5 cm in the cirrhotic liver and determine the features that best predict HCC. MATERIALS AND METHODS Gadolinium-enhanced MRI studies performed from January 2001 to December 2004 in patients with cirrhosis were evaluated for arterially enhancing nodules measuring < or =5 cm. Verification was via explant correlation, biopsy, or imaging follow-up. Sensitivity and specificity of diagnostic features of HCC were calculated. Features predictive of HCC were determined using the Generalized Estimating Equation approach. RESULTS In all, 116 arterially enhancing nodules were identified in 80 patients (<2 cm: n = 79, 2-5 cm n = 37). Sensitivity and specificity of delayed hypointensity for HCC measuring < or =5 cm, 2-5 cm, and <2 cm were 0.54 (40 of 74) and 0.86 (36 of 42); 0.72 (23 of 32) and 0.80 (4 of 5); and 0.41 (17 of 42) and 0.87 (32 of 37). For the delayed enhancing rim sensitivity and specificity were 0.64 (47 of 74) and 0.86 (36 of 42); 0.75 (24 of 32) and 1.0 (5 of 5); and 0.55 (23 of 42) and 0.83 (31 of 37), respectively. Lesion size (> or =2 cm) and delayed enhancing rim, as main features and their interaction, were the most significant predictors of HCC. CONCLUSION Delayed hypointensity and enhancing rim improve the specificity of diagnosis of HCC of all sizes but are seen less frequently in small (<2 cm) HCC. Nodule size (> or =2 cm) and delayed enhancing rim are the strongest predictors of HCC.
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Affiliation(s)
- Asra S Khan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Comparison of portal venous and delayed phases of gadolinium-enhanced magnetic resonance imaging study of cirrhotic liver for the detection of contrast washout of hypervascular hepatocellular carcinoma. J Comput Assist Tomogr 2010; 34:706-11. [PMID: 20861773 DOI: 10.1097/rct.0b013e3181e1a88e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To retrospectively compare portal venous phase (PVP) and delayed phase (DP) for the detection of tumor washout at gadobenate dimeglumine-enhanced liver magnetic resonance imaging (MRI) in cirrhotic patients with hypervascular hepatocellular carcinoma (HCC). METHODS Thirty-three patients with 55 HCCs underwent 1.5-T MRI by means of fat-suppressed T1-weighted sequence obtained before and after gadobenate dimeglumine administration, during early and late arterial phases, PVP (70 seconds), and DP (180 seconds). Detection rates of contrast washout of hypervascular HCCs and tumor-to-liver contrast on PVP and DP were measured and compared. RESULTS Among 54 hypervascular HCCs, washout was present in 24 (44%) of 54 tumors on PVP and in 44 (82%) of 54 on DP (P < 0.001). In 20 (37%) of 54 tumors, washout was deemed present only on DP. Delayed phase images yielded significantly higher mean tumor-to-liver contrast absolute values compared with PVP images (-24.5 [56.1] vs -9.3 [52.6], P = 0.001). CONCLUSIONS Delayed phase is superior to PVP for the washout detection of hypervascular HCC at gadobenate dimeglumine-enhanced MRI of cirrhotic liver.
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Di Martino M, Marin D, Guerrisi A, Baski M, Galati F, Rossi M, Brozzetti S, Masciangelo R, Passariello R, Catalano C. Intraindividual comparison of gadoxetate disodium-enhanced MR imaging and 64-section multidetector CT in the Detection of hepatocellular carcinoma in patients with cirrhosis. Radiology 2010; 256:806-16. [PMID: 20720069 DOI: 10.1148/radiol.10091334] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To prospectively compare gadoxetate disodium-enhanced magnetic resonance (MR) imaging with multiphasic 64-section multidetector computed tomography (CT) in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained for this prospective study. Fifty-eight patients (39 men, 19 women; mean age, 63 years; age range, 35-84 years) underwent gadoxetate disodium-enhanced MR imaging and multiphasic 64-section multidetector CT. The imaging examinations were performed within 30 days of each other. The two sets of images were qualitatively analyzed in random order by three independent readers in a blinded and retrospective fashion. Using strict diagnostic criteria for HCC, readers classified all detected lesions with use of a four-point confidence scale. The reference standard was a combination of pathologic proof, conclusive imaging findings, and substantial tumor growth at follow-up CT or MR imaging (range of follow-up, 90-370 days). The diagnostic accuracy, sensitivity, and positive predictive value were compared between the two image sets. Interreader variability was assessed. The accuracy of each imaging method was determined by using an adjusted modified chi(2) test. RESULTS Eighty-seven HCCs (mean size +/- standard deviation, 1.8 cm +/- 1.5; range, 0.3-7.0 cm) were confirmed in 42 of the 58 patients. Regardless of lesion size, the average diagnostic accuracy and sensitivity for all readers were significantly greater with gadoxetate disodium-enhanced MR imaging (average diagnostic accuracy: 0.88, 95% confidence interval [CI]: 0.80, 0.97; average sensitivity: 0.85, 95% CI: 0.74, 0.96) than with multidetector CT (average diagnostic accuracy: 0.74, 95% CI: 0.65, 0.82; average sensitivity: 0.69, 95% CI: 0.59, 0.79) (P < .001 for each). No significant difference in positive predictive value was observed between the two image sets for each reader. Interreader agreement was good to excellent. CONCLUSION Compared with multiphasic 64-section multidetector CT, gadoxetate disodium-enhanced MR imaging yields significantly higher diagnostic accuracy and sensitivity in the detection of HCC in patients with cirrhosis.
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Affiliation(s)
- Michele Di Martino
- Departments of Radiological Sciences, General Surgery, Division of Organ Transplantation, Surgery P. Valdoni, and Statistics, University of Rome Sapienza, Rome, Italy
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Park G, Kim YK, Kim CS, Yu HC, Hwang SB. Diagnostic efficacy of gadoxetic acid-enhanced MRI in the detection of hepatocellular carcinomas: comparison with gadopentetate dimeglumine. Br J Radiol 2010; 83:1010-6. [PMID: 20682591 DOI: 10.1259/bjr/66686028] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study compared the efficacy of gadoxetic acid-enhanced MRI and gadopentetate dimeglumine-enhanced MRI in the detection of small hepatocellular carcinoma (HCC). Both MRI techniques were performed on 43 patients with a total of 59 HCCs (size range, 0.5-2.0 cm), with a mean interval between the two MRI studies of 3 days (range, 2-7 days). Two observers reviewed both data sets in consensus. Diagnostic accuracy and sensitivity were evaluated using the alternative-free response receiver operator characteristic (ROC) method. The gadoxetic acid set showed a trend toward increased area under the ROC curve (Az value = 0.958) compared with the gadopentetate dimeglumine set (Az value = 0.927), but the difference was not significant (p = 0.362). The sensitivity of the gadoxetic acid set (n = 51, 86.4%) was significantly higher than that of the gadopentetate dimeglumine set (n = 38, 64.4%) (p = 0.0001). Gadoxetic acid-enhanced MRI is a more sensitive diagnostic tool for detection of HCC than gadopentetate dimeglumine-enhanced MRI.
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Affiliation(s)
- G Park
- Department of Radiology Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
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