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Shin S, Sohn W, Chang Y, Cho Y, Kwon MJ, Wild SH, Byrne CD, Ryu S. Potential role of Fibrosis-4 score in hepatocellular carcinoma screening: The Kangbuk Samsung Health Study. Hepatol Res 2024; 54:551-561. [PMID: 38133526 DOI: 10.1111/hepr.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
AIM Hepatocellular carcinoma (HCC) is a major cause of cancer-related death, with low survival rates worldwide. Fatty liver disease (FLD) significantly contributes to HCC. We studied the screening performance of different methods for identifying HCC in patients with FLD or with metabolic risk factors for FLD. METHODS Korean adults (n = 340 825) without a prior HCC diagnosis were categorized into four groups: normal (G1), ≥2 metabolic risk factors (G2), FLD (G3), and viral liver disease or liver cirrhosis (G4). The National Cancer Registry data were used to identify HCC cases within 12 months. We assessed the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values of individual or combined screening methods. RESULTS In 93 HCC cases, 71 were identified in G4, whereas 20 cases (21.5%) in G2 and G3 combined where ultrasound and Fibrosis-4 performed similarly to alpha-fetoprotein and ultrasound. In G2, Fibrosis-4 and ultrasound had the highest area under the receiver operating characteristic curve (0.93 [0.87-0.99]), whereas in G3, the combined screening methods had the highest area under the receiver operating characteristic curve (0.98 [0.95-1.00]). The positive predictive value was lower in G2 and G3 than in G4, but was >5% when restricted to a high Fibrosis-4 score. CONCLUSIONS More than 21% of HCC cases were observed in patients with diagnosed FLD or at risk of FLD with metabolic risk factors. Nevertheless, screening for HCC in individuals without cirrhosis or viral hepatitis yielded very low results, despite the potential value of the Fibrosis-4 score in identifying individuals at high risk of HCC.
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Affiliation(s)
- Sujeong Shin
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Sohn
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Yoosun Cho
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
- National Institute for Health and Care Research, Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
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Taiji R, Marugami N, Marugami A, Itoh T, Shimizu S, Nakano R, Hoda Y, Kunichika H, Tachiiri T, Minamiguchi K, Yamauchi S, Tanaka T. Multimodality Imaging of Primary Hepatic Lymphoma: A Case Report and a Literature Review. Diagnostics (Basel) 2024; 14:306. [PMID: 38337822 PMCID: PMC10855340 DOI: 10.3390/diagnostics14030306] [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: 12/31/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Primary hepatic lymphoma (PHL) is a rare form of non-Hodgkin lymphoma primarily affecting the liver. We present a case of an 84-year-old man diagnosed with PHL, incidentally detected during abdominal ultrasonography. The ultrasonography showed a hypoechoic nodule. When examined by CEUS, the nodule showed hyperenhancement in the arterial phase and hypoenhancement in the portal and late phases. Conversely, CECT demonstrated hypoenhancement through all the phases. The patient declined a tumor biopsy and opted for follow-up care. Ten months later, the lobular mass had increased from 15 mm to 65 mm, presenting as hypoechogenic and demonstrating the "vessel-penetrating sign" on color Doppler imaging. CEUS revealed reticulated enhancement, indicating intratumoral vessels. The mass displayed hypoattenuation on plain CT, hypointensity in T1-weighted images, and hyperintensity in T2-weighted images and exhibited significant restriction in diffusion-weighted images. Both CECT and contrast-enhanced MRI exhibited hypoenhancement. The patient underwent a partial hepatic segmentectomy, and the mass was pathologically diagnosed as a diffuse large B-cell lymphoma. Subsequent postoperative radiological examinations revealed no other lesions, confirming the diagnosis of PHL. Our report highlights specific ultrasonographic signs of PHL observed from an early stage and presents a review of the relevant literature.
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Affiliation(s)
- Ryosuke Taiji
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840 Shijo-cho, Kashihara-city, Nara 634-8522, Japan; (N.M.); (A.M.); (T.I.); (S.S.); (R.N.); (Y.H.); (H.K.); (T.T.); (K.M.); (S.Y.); (T.T.)
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Klambauer K, Cecatka S, Clevert DA. [Ultrasound diagnostics of the liver : Principles and important pathologies]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:387-402. [PMID: 37071126 DOI: 10.1007/s00117-023-01138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
Diffuse changes in the liver parenchyma, focal lesions and blood flow in hepatic vessels can be assessed using ultrasound. Screening by ultrasound can be used to detect hepatocellular carcinomas as possible malignant sequelae of liver cirrhosis. As metastases are far more frequent than primary malignant liver tumors, secondary malignant neoplasms should be taken into consideration as a differential diagnosis in the presence of focal liver lesions. This particularly concerns patients with a known metastatic disease. Benign focal liver lesions are often incidentally discovered in women of childbearing age. Cysts, hemangiomas and focal nodular hyperplasia mostly show typical morphological features in ultrasound and do not require further follow-up; however, with hepatic adenomas, regular follow-up is recommended due to the risk of bleeding and/or malignant transformation.
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Affiliation(s)
- Konstantin Klambauer
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland.
| | - Sasa Cecatka
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Dirk-André Clevert
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland
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Rónaszéki AD, Dudás I, Zsély B, Budai BK, Stollmayer R, Hahn O, Csongrády B, Park BS, Maurovich-Horvat P, Győri G, Kaposi PN. Microvascular flow imaging to differentiate focal hepatic lesions: the spoke-wheel pattern as a specific sign of focal nodular hyperplasia. Ultrasonography 2023; 42:172-181. [PMID: 36420572 PMCID: PMC9816699 DOI: 10.14366/usg.22028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022] Open
Abstract
Microvascular flow imaging (MVFI) is an advanced Doppler ultrasound technique designed to detect slow-velocity blood flow in small-caliber microvessels. This technique is capable of realtime, highly detailed visualization of tumor vessels without using a contrast agent. MVFI has been recently applied for the characterization of focal liver lesions and has revealed typical vascularity distributions in multiple types thereof. Focal nodular hyperplasia (FNH) constitutes an important differential diagnosis of malignant liver tumors. In this essay, we provide iconographic documentation of the MVFI appearance of FNH and other common solid liver lesions. Identifying the typical patterns of vascularity, including the spoke-wheel pattern with MVFI, can expedite the diagnosis, spare patients from unnecessary procedures, and save costs.
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Affiliation(s)
- Aladár David Rónaszéki
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ibolyka Dudás
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Boglarka Zsély
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bettina Katalin Budai
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Stollmayer
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Oszkár Hahn
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara Csongrády
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Byung-so Park
- Medical Affairs Manager at Samsung Medison, Samsung Medison Co., Ltd., An Affiliate of Samsung Electronics, Seoul, Korea
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gabriella Győri
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pal Novak Kaposi
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary,Correspondence to: Pál Novák Kaposi, MD, PhD, Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Korányi Sándor str. 2., H-1083 Budapest, Hungary Tel. +36-1-459-1500/61628 Fax. +36-1-459-1500/61626 E-mail:
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Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part I - Cystic lesions. Dig Liver Dis 2022; 54:1469-1478. [PMID: 36089525 DOI: 10.1016/j.dld.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/29/2022]
Abstract
Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.
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Affiliation(s)
- Maurizio Pompili
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy.
| | - Francesco Ardito
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Cliniche, Chirurgiche, Diagnostiche e Pediatriche, IRCCS Fondazione Ospedale San Matteo, Università di Pavia, Unità di Malattie Infettive e Immunologia, Pavia, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Fabrizio Calliada
- Dipartimento di Radiologia, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Italy
| | - Umberto Cillo
- Chirurgia Epatobiliare e Trapianto di Fegato, Ospedale Universitario di Padova, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Facoltà di Medicina e Chirurgia, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Rita Golfieri
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Mauro Grova
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Salvatore Gruttadauria
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMCI, Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, Università di Catania, Palermo, Italy
| | - Maria Guido
- Dipartimento di Anatomia Patologica, Azienda ULSS2 Marca Trevigiana, Treviso, Italy; Dipartimento di Medicina - DIMED, Università di Padova, Italy
| | - Massimo Iavarone
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Duilio Pagano
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMC, Palermo, Italy
| | - Irene Pettinari
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Santopaolo
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Maurizio Soresi
- Medicina Interna, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dadoun H, Rousseau AL, de Kerviler E, Correas JM, Tissier AM, Joujou F, Bodard S, Khezzane K, de Margerie-Mellon C, Delingette H, Ayache N. Deep Learning for the Detection, Localization, and Characterization of Focal Liver Lesions on Abdominal US Images. Radiol Artif Intell 2022; 4:e210110. [PMID: 35652113 DOI: 10.1148/ryai.210110] [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: 04/23/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/24/2022]
Abstract
Purpose To train and assess the performance of a deep learning-based network designed to detect, localize, and characterize focal liver lesions (FLLs) in the liver parenchyma on abdominal US images. Materials and Methods In this retrospective, multicenter, institutional review board-approved study, two object detectors, Faster region-based convolutional neural network (Faster R-CNN) and Detection Transformer (DETR), were fine-tuned on a dataset of 1026 patients (n = 2551 B-mode abdominal US images obtained between 2014 and 2018). Performance of the networks was analyzed on a test set of 48 additional patients (n = 155 B-mode abdominal US images obtained in 2019) and compared with the performance of three caregivers (one nonexpert and two experts) blinded to the clinical history. The sign test was used to compare accuracy, specificity, sensitivity, and positive predictive value among all raters. Results DETR achieved a specificity of 90% (95% CI: 75, 100) and a sensitivity of 97% (95% CI: 97, 97) for the detection of FLLs. The performance of DETR met or exceeded that of the three caregivers for this task. DETR correctly localized 80% of the lesions, and it achieved a specificity of 81% (95% CI: 67, 91) and a sensitivity of 82% (95% CI: 62, 100) for FLL characterization (benign vs malignant) among lesions localized by all raters. The performance of DETR met or exceeded that of two experts and Faster R-CNN for these tasks. Conclusion DETR demonstrated high specificity for detection, localization, and characterization of FLLs on abdominal US images. Supplemental material is available for this article. RSNA, 2022Keywords: Computer-aided Diagnosis (CAD), Ultrasound, Abdomen/GI, Liver, Tissue Characterization, Supervised Learning, Transfer Learning, Convolutional Neural Network (CNN).
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Affiliation(s)
- Hind Dadoun
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Anne-Laure Rousseau
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Eric de Kerviler
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Jean-Michel Correas
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Anne-Marie Tissier
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Fanny Joujou
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Sylvain Bodard
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Kemel Khezzane
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Constance de Margerie-Mellon
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Hervé Delingette
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
| | - Nicholas Ayache
- Université Côte d'Azur, Inria, Epione Team, Sophia Antipolis, 2004 Route des Lucioles, 06902 Valbonne, France (H. Dadoun, H. Delingette, N.A.); Department of Vascular Surgery, Georges Pompidou European Hospital APHP, Université de Paris, Paris, France (A.L.R.); NHance.ngo, Saint Germain en Laye, France (A.L.R.); Department of Radiology, Hôpital Saint Louis APHP, Université de Paris, Paris, France (E.d.K., F.J., K.K., C.d.M.M.); and Department of Adult Radiology, Université de Paris and Université de l'Hôpital Necker, Paris, France (J.M.C., A.M.T., S.B.)
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Wang Y, Ma LY, Yin XP, Gao BL. Radiomics and Radiogenomics in Evaluation of Colorectal Cancer Liver Metastasis. Front Oncol 2022; 11:689509. [PMID: 35070948 PMCID: PMC8776634 DOI: 10.3389/fonc.2021.689509] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer is one common digestive malignancy, and the most common approach of blood metastasis of colorectal cancer is through the portal vein system to the liver. Early detection and treatment of liver metastasis is the key to improving the prognosis of the patients. Radiomics and radiogenomics use non-invasive methods to evaluate the biological properties of tumors by deeply mining the texture features of images and quantifying the heterogeneity of metastatic tumors. Radiomics and radiogenomics have been applied widely in the detection, treatment, and prognostic evaluation of colorectal cancer liver metastases. Based on the imaging features of the liver, this paper reviews the current application of radiomics and radiogenomics in the diagnosis, treatment, monitor of disease progression, and prognosis of patients with colorectal cancer liver metastases.
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Affiliation(s)
| | | | - Xiao-Ping Yin
- CT-MRI Room, Affiliated Hospital of Hebei University, Baoding, China
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9
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Qin H, Wu YQ, Lin P, Gao RZ, Li X, Wang XR, Chen G, He Y, Yang H. Ultrasound Image-Based Radiomics: An Innovative Method to Identify Primary Tumorous Sources of Liver Metastases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1229-1244. [PMID: 32951217 DOI: 10.1002/jum.15506] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To develop radiomic models of B-mode ultrasound (US) signatures for determining the origin of primary tumors in metastatic liver disease. METHODS A total of 254 patients with a diagnosis of metastatic liver disease were included in this retrospective study. The patients were divided into 3 groups depending on the origin of the primary tumor: group 1 (digestive tract versus non-digestive tract tumors), group 2 (breast cancer versus non-breast cancer), and group 3 (lung cancer versus other malignancies). The patients in each group were allocated to a training or testing set (a ratio of 8:2). The region of interest of liver metastasis was determined through manual differentiation of the tumors, and radiomic signatures were acquired from B-mode US images. Optimal features were selected to develop 3 radiomic models using multiple-dimensionality reduction and classifier screening. The area under the curve (AUC) of the receiver operating characteristic curve was applied to assess each model's performance. RESULTS A total of 5936 features were extracted, and 40, 6, and 14 optimal features were sequentially identified for the development of radiomic models for groups 1, 2, and 3, respectively, with training set AUC values of 0.938, 0.974, and 0.768 and testing set AUC values of 0.767, 0.768, and 0.750. The differences in age, sex, and number of liver metastatic lesions varied greatly between the 4 primary tumors (P < .050). CONCLUSIONS B-mode US radiomic models could be effective supplemental means to identify the origin of hepatic metastatic lesions (ie, unknown primary sites).
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Affiliation(s)
- Hui Qin
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Quan Wu
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Peng Lin
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rui-Zhi Gao
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin Li
- Department of Life Sciences, GE Healthcare, Shanghai, China
| | - Xin-Rong Wang
- Department of Life Sciences, GE Healthcare, Shanghai, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yun He
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hong Yang
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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10
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Performance of Ultrasound Techniques and the Potential of Artificial Intelligence in the Evaluation of Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease. Cancers (Basel) 2021; 13:cancers13040790. [PMID: 33672827 PMCID: PMC7918928 DOI: 10.3390/cancers13040790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/14/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
Global statistics show an increasing percentage of patients that develop non-alcoholic fatty liver disease (NAFLD) and NAFLD-related hepatocellular carcinoma (HCC), even in the absence of cirrhosis. In the present review, we analyzed the diagnostic performance of ultrasonography (US) in the non-invasive evaluation of NAFLD and NAFLD-related HCC, as well as possibilities of optimizing US diagnosis with the help of artificial intelligence (AI) assistance. To date, US is the first-line examination recommended in the screening of patients with clinical suspicion of NAFLD, as it is readily available and leads to a better disease-specific surveillance. However, the conventional US presents limitations that significantly hamper its applicability in quantifying NAFLD and accurately characterizing a given focal liver lesion (FLL). Ultrasound contrast agents (UCAs) are an essential add-on to the conventional B-mode US and to the Doppler US that further empower this method, allowing the evaluation of the enhancement properties and the vascular architecture of FLLs, in comparison to the background parenchyma. The current paper also explores the new universe of AI and the various implications of deep learning algorithms in the evaluation of NAFLD and NAFLD-related HCC through US methods, concluding that it could potentially be a game changer for patient care.
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Xi IL, Wu J, Guan J, Zhang PJ, Horii SC, Soulen MC, Zhang Z, Bai HX. Deep learning for differentiation of benign and malignant solid liver lesions on ultrasonography. Abdom Radiol (NY) 2021; 46:534-543. [PMID: 32681268 DOI: 10.1007/s00261-020-02564-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The ability to reliably distinguish benign from malignant solid liver lesions on ultrasonography can increase access, decrease costs, and help to better triage patients for biopsy. In this study, we used deep learning to differentiate benign from malignant focal solid liver lesions based on their ultrasound appearance. METHODS Among the 596 patients who met the inclusion criteria, there were 911 images of individual liver lesions, of which 535 were malignant and 376 were benign. Our training set contained 660 lesions augmented dynamically during training for a total of 330,000 images; our test set contained 79 images. A neural network with ResNet50 architecture was fine-tuned using pre-trained weights on ImageNet. Non-cystic liver lesions with definite diagnosis by histopathology or MRI were included. Accuracy of the final model was compared with expert interpretation. Two separate datasets were used in training and evaluation, one with all lesions and one with lesions deemed to be of uncertain diagnosis based on the Code Abdomen rating system. RESULTS Our model trained on the complete set of all lesions achieved a test accuracy of 0.84 (95% CI 0.74-0.90) compared to expert 1 with a test accuracy of 0.80 (95% CI 0.70-0.87) and expert 2 with a test accuracy of 0.73 (95% CI 0.63-0.82). Our model trained on the uncertain set of lesions achieved a test accuracy of 0.79 (95% CI 0.69-0.87) compared to expert 1 with a test accuracy of 0.70 (95% CI 0.59-0.78) and expert 2 with a test accuracy of 0.66 (95% CI 0.55-0.75). On the uncertain dataset, compared to all experts averaged, the model had higher test accuracy (0.79 vs. 0.68, p = 0.025). CONCLUSION Deep learning algorithms proposed in the current study improve differentiation of benign from malignant ultrasound-captured solid liver lesions and perform comparably to expert radiologists. Deep learning tools can potentially be used to improve the accuracy and efficiency of clinical workflows.
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Affiliation(s)
- Ianto Lin Xi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Jing Guan
- Department of Radiology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Steven C Horii
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zishu Zhang
- Department of Radiology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
| | - Harrison X Bai
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
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12
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Abstract
Liver tumors are often incidentally found during ultrasound examinations. The decision on further diagnostic imaging depends on the clinical context and the appearance in B mode ultrasound. This review highlights the role of grey scale and contrast-enhanced ultrasound (CEUS) and summarizes the ultrasonographic key features of the most common benign and malignant liver tumors. Conventional grey scale ultrasound is recommended in several guidelines for screening and follow-up of liver tumors in certain risk populations but its ability to characterize liver tumors is limited in most cases. The CEUS has an excellent tolerability and enables liver tumor characterization with a high sensitivity and specificity. The diagnostic value of CEUS is comparable to magnetic resonance imaging. In the case of unclear lesions, inconclusive findings by different imaging methods or if molecular targeted treatment is pursued, ultrasound-guided biopsy is often mandatory. Ultrasound is a rapidly and ubiquitously available method for the detection of liver tumors and CEUS is the only imaging method that enables real-time examination of all contrast phases in the liver. It should therefore be used as the first line imaging method for liver tumor characterization.
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Affiliation(s)
- C Höner Zu Siederdissen
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - A Potthoff
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Li HL, Liu HP, Guo GWJ, Chen ZH, Zhou FQ, Liu P, Liu JB, Wan R, Mao ZQ. Imaging findings of inflammatory pseudotumor-like follicular dendritic cell tumors of the liver: Two case reports and literature review. World J Gastroenterol 2019; 25:6693-6703. [PMID: 31832007 PMCID: PMC6906205 DOI: 10.3748/wjg.v25.i45.6693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor-like follicular dendritic cell (IPT-like FDC) tumors of the liver is an uncommon tumor with extremely low incidence. To date, the radiologic findings of this tumor in multiphase computed tomography (CT) and magnetic resonance imaging (MRI) imaging have not been described.
CASE SUMMARY Patient 1 is a 31-year-old Chinese female, whose complaining incidentally coincided with the finding of multiple liver masses. In the local hospital, an abdominal enhanced CT found two hypo-dense solid lesions, with heterogeneous sustained hypoenhancement, in the upper segment of the liver’s right posterior lobe. In our hospital, enhanced magnetic resonance imaging (MRI) with hepatocyte-specific contrast agents showed a similar enhanced pattern of lesions with patchy hyperintensity in the hepatobiliary phase (HBP). The patient underwent surgery and recovered well. The final pathology confirmed an IPT-like FDC tumor. No recurrence was found on the regular re-examination. Patient 2 is a 48-year-old Chinese male admitted to our hospital for a huge unexpected hepatic lesion. A dynamic enhanced abdominal CT revealed a huge heterogeneous enhanced solid tumor in the right lobe of the liver with a size of 100 mm × 80 mm, which showed a heterogeneous sustained hypoenhancement. In addition, enlarged lymph nodes were found in the hilum of the liver. This patient underwent a hepatic lobectomy and lymph node dissection. The final pathology confirmed an IPT-like FDC tumor. No recurrence was found upon regular re-examination.
CONCLUSION When a hepatic tumor shows heterogeneous sustained hypoenhancement with a patchy enhancement during HBP, an IPT-like FDC tumor should be considered in the differential diagnosis.
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Affiliation(s)
- Hai-Lan Li
- Department of Radiology, Hunan Provincial People's Hospital (the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Hua-Ping Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
| | - Grace Wen-Jun Guo
- Department of Radiology, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE 19803, United States
| | - Zhi-Hong Chen
- Department of Pathology, Hunan Provincial People's Hospital (the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Fu-Qing Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Peng Liu
- Department of Radiology, Hunan Provincial People's Hospital (the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Jian-Bin Liu
- Department of Radiology, Hunan Provincial People's Hospital(the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Ren Wan
- Department of Radiology, Hunan Provincial People's Hospital(the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Zhi-Qun Mao
- Department of Radiology, Hunan Provincial People's Hospital(the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
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14
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Bagley JE, Paul DE, Halferty S, DiGiacinto D. The use of contrast-enhanced ultrasonography for the characterisation of focal liver lesions. SONOGRAPHY 2018. [DOI: 10.1002/sono.12158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer E. Bagley
- Department of Medical Imaging and Radiation Sciences, College of Allied Health; University of Oklahoma Health Sciences Center; Tulsa OK USA
| | | | | | - Dora DiGiacinto
- Department of Medical Imaging and Radiation Sciences, College of Allied Health; University of Oklahoma Health Sciences Center; Oklahoma City OK USA
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15
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Grgurevic I, Bokun T, Salkic NN, Brkljacic B, Vukelić-Markovic M, Stoos-Veic T, Aralica G, Rakic M, Filipec-Kanizaj T, Berzigotti A. Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions. Liver Int 2018; 38:1055-1063. [PMID: 29028279 DOI: 10.1111/liv.13611] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS To analyse elastographic characteristics of focal liver lesions (FLL)s and diagnostic performance of real-time two-dimensional shear-wave elastography (RT-2D-SWE) in order to differentiate benign and malignant FLLs. METHODS Consecutive patients diagnosed with FLL by abdominal ultrasound (US) underwent RT-2D-SWE of FLL and non-infiltrated liver by intercostal approach over the right liver lobe. The nature of FLL was determined by diagnostic work-up, including at least one contrast-enhanced imaging modality (MDCT/MRI), check-up of target organs when metastatic disease was suspected and FLL biopsy in inconclusive cases. RESULTS We analysed 196 patients (median age 60 [range 50-68], 50.5% males) with 259 FLLs (57 hepatocellular carcinomas, 17 cholangiocarcinomas, 94 metastases, 71 haemangiomas, 20 focal nodular hyperplasia) of which 70 (27%) were in cirrhotic liver. Malignant lesions were stiffer (P < .001) with higher variability in intralesional stiffness (P = .001). The best performing cut-off of lesion stiffness was 22.3 kPa (sensitivity 83%; specificity 86%; positive predictive value [PPV] 91.5%; negative predictive value [NPV] 73%) for malignancy. Lesion stiffness <14 kPa had NPV of 96%, while values >32.5 kPa had PPV of 96% for malignancy. Lesion stiffness, lesion/liver stiffness ratio and lesion stiffness variability significantly predicted malignancy in stepwise logistic regression (P < .05), and were used to construct a new Liver Elastography Malignancy Prediction (LEMP) score with accuracy of 96.1% in validation cohort (online calculator available at http://bit.do/lemps). CONCLUSION The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT-2D-SWE.
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Affiliation(s)
- Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Tomislav Bokun
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Nermin N Salkic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mirjana Vukelić-Markovic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tajana Stoos-Veic
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Medicine, University "J.J. Strossmayer", Osijek, Croatia
| | - Gorana Aralica
- Department of Pathology and Cytology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mislav Rakic
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Tajana Filipec-Kanizaj
- Department of Gastroenterology and Hepatology, University Hospital Merkur, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Annalisa Berzigotti
- Hepatology, Swiss Liver Center, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
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16
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Bagley JE, Paul DE, Halferty S, DiGiacinto D. The Use of Contrast-Enhanced Ultrasonography for the Characterization of Focal Liver Lesions. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479317729672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Focal liver lesions often occur with or without an underlying liver disease. Contrast-enhanced ultrasonography can aid in characterizing liver lesions, potentially avoiding biopsy and computed tomography procedures. Contrast-enhanced ultrasonography has a high sensitivity and specificity for differentiating characteristics of liver lesions compared with noncontrast sonography. The different contrast characteristics aid in differentiating benign and malignant lesions. Malignant lesions tend to have washout of contrast in the venous phases, whereas benign lesions have hyperenhancement during the venous phases. Therefore, contrast-enhanced ultrasonography should be considered an essential component of the diagnostic process for diagnosing and following focal liver lesions.
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Affiliation(s)
- Jennifer E. Bagley
- Department of Medical Imaging and Radiation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Tulsa, OK, USA
| | | | | | - Dora DiGiacinto
- Department of Medical Imaging and Radiation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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17
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Hann A, Bettac L, Haenle MM, Graeter T, Berger AW, Dreyhaupt J, Schmalstieg D, Zoller WG, Egger J. Algorithm guided outlining of 105 pancreatic cancer liver metastases in Ultrasound. Sci Rep 2017; 7:12779. [PMID: 28986569 PMCID: PMC5630585 DOI: 10.1038/s41598-017-12925-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Manual segmentation of hepatic metastases in ultrasound images acquired from patients suffering from pancreatic cancer is common practice. Semiautomatic measurements promising assistance in this process are often assessed using a small number of lesions performed by examiners who already know the algorithm. In this work, we present the application of an algorithm for the segmentation of liver metastases due to pancreatic cancer using a set of 105 different images of metastases. The algorithm and the two examiners had never assessed the images before. The examiners first performed a manual segmentation and, after five weeks, a semiautomatic segmentation using the algorithm. They were satisfied in up to 90% of the cases with the semiautomatic segmentation results. Using the algorithm was significantly faster and resulted in a median Dice similarity score of over 80%. Estimation of the inter-operator variability by using the intra class correlation coefficient was good with 0.8. In conclusion, the algorithm facilitates fast and accurate segmentation of liver metastases, comparable to the current gold standard of manual segmentation.
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Affiliation(s)
- Alexander Hann
- Department of Internal Medicine I, Ulm University, Ulm, Germany. .,Department of Internal Medicine and Gastroenterology, Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
| | - Lucas Bettac
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Mark M Haenle
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, Ulm University, Ulm, Germany
| | | | - Jens Dreyhaupt
- Institute of Epidemiology & Medical Biometry, Ulm University, Ulm, Germany
| | - Dieter Schmalstieg
- Institute for Computer Graphics and Vision, Graz University of Technology, Inffeldgasse 16, 8010, Graz, Austria
| | - Wolfram G Zoller
- Department of Internal Medicine and Gastroenterology, Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Jan Egger
- Institute for Computer Graphics and Vision, Graz University of Technology, Inffeldgasse 16, 8010, Graz, Austria.,BioTechMed, Krenngasse 37/1, 8010, Graz, Austria
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18
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Liver investigations: Updating on US technique and contrast-enhanced ultrasound (CEUS). Eur J Radiol 2017; 96:65-73. [PMID: 29103478 DOI: 10.1016/j.ejrad.2017.08.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/15/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
Abstract
Over the past few years, the cross sectional imaging techniques (Computed Tomography - CT and Magnetic Resonance - MR) have improved, allowing a more efficient study of focal and diffuse liver diseases. Many papers had been published about the results of a routinely clinical use of the dual source/dual energy CT techniques and the use of hepatobiliary contrast agents in MR liver studies. As a consequence, these new improvements have diverted the attention away from the Ultrasound technique and its technical and conceptual evolutions. In these years of disinterest, US and especially Contrast Enhanced Ultrasound (CEUS) have consolidated and grown in their application in clinical routine for liver pathologies. In particular, thanks to the introduction of new, dedicated software packages, CEUS has allowed not only qualitative, but also quantitative analysis of lesion microcirculation, thus opening a new era in the evaluation of lesion characterization and response to therapy. Moreover, the renewed interest in liver elastography, a baseline ultrasound-based imaging modality, has led to the development of a competitive technique to assess liver stiffness and then for the evaluation of the progression towards cirrhosis, and characterization of focal liver lesions, opening the way to avoid, in selected cases, liver biopsy. The aim of this review is to offer an up-to-date overview on the state of the art of clinical applications of US and CEUS in the study of focal and diffuse liver pathologies. Besides, it aims to highlight the emerging role of perfusion techniques in the assessment of local and systemic treatment response and to show how the liver evolution from steatosis to fibrosis can be revealed by elastography.
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19
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Interactive Outlining of Pancreatic Cancer Liver Metastases in Ultrasound Images. Sci Rep 2017; 7:892. [PMID: 28420871 PMCID: PMC5429849 DOI: 10.1038/s41598-017-00940-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/20/2017] [Indexed: 02/01/2023] Open
Abstract
Ultrasound (US) is the most commonly used liver imaging modality worldwide. Due to its low cost, it is increasingly used in the follow-up of cancer patients with metastases localized in the liver. In this contribution, we present the results of an interactive segmentation approach for liver metastases in US acquisitions. A (semi-) automatic segmentation is still very challenging because of the low image quality and the low contrast between the metastasis and the surrounding liver tissue. Thus, the state of the art in clinical practice is still manual measurement and outlining of the metastases in the US images. We tackle the problem by providing an interactive segmentation approach providing real-time feedback of the segmentation results. The approach has been evaluated with typical US acquisitions from the clinical routine, and the datasets consisted of pancreatic cancer metastases. Even for difficult cases, satisfying segmentations results could be achieved because of the interactive real-time behavior of the approach. In total, 40 clinical images have been evaluated with our method by comparing the results against manual ground truth segmentations. This evaluation yielded to an average Dice Score of 85% and an average Hausdorff Distance of 13 pixels.
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20
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Chaubal N, Joshi M, Bam A, Chaubal R. Contrast-Enhanced Ultrasound of Focal Liver Lesions. Semin Roentgenol 2016; 51:334-357. [PMID: 27743569 DOI: 10.1053/j.ro.2016.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nitin Chaubal
- Thane Ultrasound Center, Thane (W), MS, India; Jaslok Hospital & Research Centre, Mumbai.
| | - Mukund Joshi
- Thane Ultrasound Center, Thane (W), MS, India; Jaslok Hospital & Research Centre, Mumbai
| | - Anupam Bam
- Thane Ultrasound Center, Thane (W), MS, India
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21
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Preoperative detection of hepatic metastases from colorectal cancer: Prospective comparison of contrast-enhanced ultrasound and multidetector-row computed tomography (MDCT). Diagn Interv Imaging 2016; 97:851-5. [PMID: 27132590 DOI: 10.1016/j.diii.2015.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The goal of this study was to prospectively compare the sensitivity of contrast-enhanced ultrasound (CEUS) with that of multiphase multidetector-row computed tomography (MDCT) in the preoperative detection of hepatic metastases. MATERIALS AND METHOD Forty-eight patients, with a mean age of 62years old (range: 43-85years) were prospectively included. All patients underwent CEUS following intravenous administration of 2.4mL of an ultrasound contrast agent (Sonovue(®), Bracco, Milan, Italy) and multiphase MDCT. Intraoperative ultrasound examination (IOUS) was used as the standard of reference. RESULTS A total of 158 liver metastases were identified by IOUS, 127 by preoperative MDCT (sensitivity; 80.4%) and 102 by CEUS (sensitivity, 64.5%). The 15.9% difference in sensitivity between CEUS and MDCT was statistically significant (P=0.002). There was a disagreement between IOUS and CEUS in 23 patients (47%) and in 13 patients (27%) between IOUS and MDCT. MDCT identified one or more additional metastases in 10 patients (20%) resulting in a change in the surgical strategy. CONCLUSION Based on an unselected patient cohort and using multiphase MDCT, CEUS is significantly inferior to MDCT for the preoperative detection of hepatic metastases of colorectal cancer.
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22
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Choi SH, Kwon HJ, Lee SY, Park HJ, Kim MS, Sohn JH, Chung EC, Park HW. Focal hepatic solid lesions incidentally detected on initial ultrasonography in 542 asymptomatic patients. Abdom Radiol (NY) 2016; 41:265-72. [PMID: 26867908 DOI: 10.1007/s00261-015-0567-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the clinical significance of focal hepatic solid lesions incidentally detected on initial ultrasonography in asymptomatic patients. METHODS From January 2009 to December 2009, 2670 initial ultrasonographies were performed in asymptomatic population. Of these 2670 initial examinations, 681 focal hepatic solid lesions in 542 patients (mean 39.4 years, range 23-73 years) were detected. Clinical information, ultrasonography features, and the outcome of these lesions were analyzed. RESULTS Six hundred and seventy four lesions (99.0%) in 539 patients (99.4%) were benign, while seven lesions (1.0%) in three patients (0.6%) proved to be malignant. Risk factors significantly associated with malignant focal hepatic solid lesions were known history of malignancy, history of hepatitis, a positive result for the hepatitis B surface antigen, and abnormally elevated tumor markers. No malignancy was identified in patients without any one of these four risk factors. Ultrasonographic features of internal heterogeneous echotexture with peripheral hypoechoic rim showed significant associations with malignancy. CONCLUSIONS Focal hepatic solid lesions incidentally detected on initial ultrasonography were rarely malignant, especially in patients without these risk factors. Therefore, the knowledge of these risk factors and US features is important in order to make a differential diagnosis between benign and malignant focal hepatic lesions.
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Affiliation(s)
- Sang Hyun Choi
- Department of Health Resource Development, Korea Health Promotion Foundation, 173 Toegye-ro, Jung-gu, Seoul, 100-705, Korea.
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-ku, Seoul, 138-736, Korea.
| | - Heon-Ju Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
| | - So-Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
| | - Mi Sung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
| | - Eun Chul Chung
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
| | - Hae Won Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
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D'Onofrio M, Romanini L, Serra C, Magnolfi F, Bertolotto M, Quaia E, Puntel G, Colleoni A, Fiorini E, Cenci C, Santi E, Ciaravino V, Laffranchi F, Catalano O, Cantisani V, Calliada F, Derchi L. Contrast enhancement ultrasound application in focal liver lesions characterization: a retrospective study about guidelines application (SOCEUS-CEUS survey). J Ultrasound 2015; 19:99-106. [PMID: 27298641 DOI: 10.1007/s40477-015-0185-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The SOCEUS survey aims to evaluate how contrast-enhanced ultrasound (CEUS) is effectively used in the focal liver lesions characterization. MATERIALS AND METHODS In the survey were involved Verona, Brescia and Trieste Radiological Centers and Arezzo and Bologna Non-radiological Centers. Inclusion criteria were liver focal lesion detection at conventional ultrasound and studied by means of CEUS, with or without CT or MRI examinations, done previous or subsequent to CEUS. RESULTS 1069 forms were collected. Patients with benign lesions, who did not undergo any other studies, were 255/561 (45.5 %). Among patients with diagnosis of hemangioma at CEUS, those who had no other investigations were 129/267 (48.3 %). Patients with malignant lesions who had studies pre-CEUS (CT and/or MRI) were 328/508 (65 %), whereas those who had examinations post-CEUS (CT and/or MRI) were 218/508 (42.9 %). Concordance rate between CEUS and CT investigations pre- and post-CEUS was, respectively, 66 and 89 %. Concordance rate between CEUS and MRI studies pre- and post-CEUS was, respectively, 87.5 and 81.5 %. CONCLUSION This study proves contrast-enhanced ultrasound correct application in the involved centers.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona Piazzale L. A. Scuro 10, 37134 Verona, Italy
| | - Laura Romanini
- Department of Radiology, University of Brescia, Spedali Civili, Brescia, Italy
| | - Carla Serra
- Department of organ failure and transplantation, University Hospital S. Orsola, Bologna, Italy
| | | | - Michele Bertolotto
- Department of Radiology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Emilio Quaia
- Department of Radiology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Gino Puntel
- Department of Radiology, University Hospital G.B. Rossi, University of Verona Piazzale L. A. Scuro 10, 37134 Verona, Italy
| | - Alessandro Colleoni
- Department of Radiology, University of Brescia, Spedali Civili, Brescia, Italy
| | - Erica Fiorini
- Department of organ failure and transplantation, University Hospital S. Orsola, Bologna, Italy
| | - Cristina Cenci
- Department of Gastroenterology, S. Donato Hospital, Arezzo, Italy
| | - Elena Santi
- Department of Radiology, University Hospital G.B. Rossi, University of Verona Piazzale L. A. Scuro 10, 37134 Verona, Italy
| | - Valentina Ciaravino
- Department of Radiology, University Hospital G.B. Rossi, University of Verona Piazzale L. A. Scuro 10, 37134 Verona, Italy
| | | | - Orlando Catalano
- Department of Radiology, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - Vito Cantisani
- Department of Radiology, Policlinico Umberto I, University La Sapienza, Rome, Italy
| | - Fabrizio Calliada
- Department of Radiology, University Hospital S. Matteo, Pavia, Italy
| | - Lorenzo Derchi
- Department of Health Sciences (DISSAL, University of Genoa), IRCCS AOU San Martino IST, Genoa, Italy
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Skoczylas K, Pawełas A. Ultrasound imaging of the liver and bile ducts - expectations of a clinician. J Ultrason 2015; 15:292-306. [PMID: 26673784 PMCID: PMC4657394 DOI: 10.15557/jou.2015.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/25/2015] [Accepted: 08/03/2015] [Indexed: 12/12/2022] Open
Abstract
Since diseases of the liver and bile ducts are common, a clinician is faced by the need to implement an appropriate diagnostic process. It is necessary to apply diagnostic methods that enable appropriate assessment of the most common pathologies of the liver, i.e. fibrosis, steatosis and focal lesions, as well as initial assessment of the bile ducts. These goals can be achieved using ultrasound methods based on conventional sonography, contrast-enhanced sonography and elastography. The assessment of fatty liver and bile duct dilatation using ultrasound reaches satisfactory levels of sensitivity and specificity. The usage of contrast agents enables unambiguous differentiation between benign and malignant focal lesions, frequently allowing them to be identified accurately without the assistance of other imaging modalities. Elastography has enabled reliable assessment of liver fibrosis. Its results are comparable to those of the standard method, i.e. liver biopsy.
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Affiliation(s)
- Krzysztof Skoczylas
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Andrzej Pawełas
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland
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25
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Activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) related to the diagnostic impact in focal liver lesion characterisation. Insights Imaging 2015; 6:499-508. [PMID: 25953127 PMCID: PMC4519812 DOI: 10.1007/s13244-015-0402-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study was done to assess the clinical-diagnostic impact and cost of contrast-enhanced ultrasound (CEUS) versus computed tomography (CT) and magnetic resonance (MR) imaging in the characterisation of focal liver lesions. MATERIALS AND METHODS CEUS with sulphur hexafluoride-filled microbubbles (SonoVue bolus 2.4 ml) was performed in 157 patients with 160 focal liver lesions identified by other diagnostic techniques. CEUS images were obtained during the arterial (15 to 35 s from contrast injection), portal venous (40 to 70 s) and late phase (up to 300 s from microbubble injection). Contrast-enhanced CT was performed with a 64-row multidetector CT. MRI was performed before and after administration of the liver-specific contrast agent gadobenate dimeglumine (Gd-BOPTA). A patient-by-patient activity-based cost analysis was performed. RESULTS CEUS led to a change in the diagnostic workup in 131/157 patients (83.4 %) and in the therapeutic workup in 93/157 patients (59.2 %). CEUS allowed for the final diagnosis to be established in 133/157 patients (84.7 %). The full cost of CEUS was lower than that of contrast-enhanced CT and MR imaging. CONCLUSIONS CEUS determined a change in the diagnostic and therapeutic workup in the characterisation of focal liver lesions and reduced the full costs of the diagnostic process. MAIN MESSAGES • CEUS allows a correct diagnosis in more than 80 % of focal liver lesions. • CEUS has a significant impact on the diagnosis of focal liver lesions. • CEUS examination of focal liver lesions reduces total costs. • Dynamic MR with hepato-specific contrast medium remains the reference standard for lesion characterisation. • CEUS is low-cost, versatile and accurate in the characterisation of focal liver lesions.
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Active ultrasound pattern injection system (AUSPIS) for interventional tool guidance. PLoS One 2014; 9:e104262. [PMID: 25337784 PMCID: PMC4206269 DOI: 10.1371/journal.pone.0104262] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/10/2014] [Indexed: 11/19/2022] Open
Abstract
Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking.
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Lamba R, Fananazapir G, Corwin MT, Khatri VP. Diagnostic Imaging of Hepatic Lesions in Adults. Surg Oncol Clin N Am 2014; 23:789-820. [DOI: 10.1016/j.soc.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography. Eur Radiol 2014; 25:346-58. [PMID: 25231131 DOI: 10.1007/s00330-014-3370-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/24/2014] [Accepted: 07/21/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To prospectively assess the stiffness of incidentally discovered focal liver lesions (FLL) with no history of chronic liver disease or extrahepatic cancer using shearwave elastography (SWE). METHODS Between June 2011 and May 2012, all FLL fortuitously discovered on ultrasound examination were prospectively included. For each lesion, stiffness was measured (kPa). Characterization of the lesion relied on magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound, or biopsy. Tumour stiffness was analysed using ANOVA and non-parametric Mann-Whitney tests. RESULTS 105 lesions were successfully evaluated in 73 patients (61 women, 84%) with a mean age of 44.8 (range: 20‒75). The mean stiffness was 33.3 ± 12.7 kPa for the 60 focal nodular hyperplasia (FNH), 19.7 ± 9.8 k Pa for the 17 hepatocellular adenomas (HCA), 17.1 ± 7 kPa for the 20 haemangiomas, 11.3 ± 4.3 kPa for the five focal fatty sparing, 34.1 ± 7.3 kPa for the two cholangiocarcinomas, and 19.6 kPa for one hepatocellular carcinoma (p < 0.0001). There was no difference between the benign and the malignant groups (p = 0.64). FNHs were significantly stiffer than HCAs (p < 0.0001). Telangiectatic/inflammatory HCAs were significantly stiffer than the steatotic HCAs (p = 0.014). The area under the ROC curve (AUROC) for differentiating FNH from other lesions was 0.86 ± 0.04. CONCLUSION SWE may provide additional information for the characterization of FFL, and may help in differentiating FNH from HCAs, and in subtyping HCAs. KEY POINTS • SWE might be helpful for the characterization of solid focal liver lesions • SWE cannot differentiate benign from malignant liver lesions • FNHs are significantly stiffer than other benign lesions • Telangiectatic/inflammatory HCA are significantly stiffer than steatotic ones.
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Jia WR, Chai WM, Tang L, Wang Y, Fei XC, Han BS, Chen M. Three-dimensional contrast enhanced ultrasound score and dynamic contrast-enhanced magnetic resonance imaging score in evaluating breast tumor angiogenesis: Correlation with biological factors. Eur J Radiol 2014; 83:1098-1105. [DOI: 10.1016/j.ejrad.2014.03.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 03/08/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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30
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Zhang P, Zhou P, Tian SM, Qian Y, Li JL, Li RZ. Diagnostic performance of contrast-enhanced sonography and acoustic radiation force impulse imaging in solid liver lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:205-214. [PMID: 24449722 DOI: 10.7863/ultra.33.2.205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic performance of contrast-enhanced sonography and acoustic radiation force impulse imaging (ARFI) in differential diagnosis of benign and malignant liver lesions. METHODS A total of 156 patients with liver lesions were included in the study. The images from conventional sonography and contrast-enhanced sonography and the shear wave velocity values of the liver lesions were obtained. The diagnostic performance of conventional sonography, contrast-enhanced sonography, and ARFI was assessed by using pathologic examination (needle biopsy or surgery) or clinical imaging inspection as the reference standard. RESULTS The sensitivity and specificity of conventional sonography for malignant liver lesions were 57.1% and 43.1%, respectively, and the sensitivity and specificity of ARFI were 81.3% and 74.1%. When using contrast-enhanced sonography for the diagnosis of malignant liver lesions, the sensitivity and specificity were 92.9% and 89.7%. The sensitivity and specificity of contrast-enhanced sonography were significantly higher than those of ARFI and conventional sonography (P < .05). CONCLUSIONS The differential diagnostic performance of contrast-enhanced sonography is most predictive of malignant liver lesions. Contrast-enhanced sonography and ARFI have complementary effects in the differential diagnosis of benign and malignant liver lesions.
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Affiliation(s)
- Ping Zhang
- Department of Ultrasound, Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China.
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31
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D'Onofrio M, Crosara S, De Robertis R, Canestrini S, Cantisani V, Morana G, Mucelli RP. Malignant focal liver lesions at contrast-enhanced ultrasonography and magnetic resonance with hepatospecific contrast agent. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2013; 22:91-8. [PMID: 27433201 DOI: 10.1177/1742271x13513888] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to compare the diagnostic accuracy of the late phase of CEUS and the hepatobiliary phase of CE-MR with Gd-BOPTA in the characterization of focal liver lesions in terms of benignity and malignancy. A total of 147 solid focal liver lesions (38 focal nodular hyperplasias, 1 area of focal steatosis, 3 regenerative nodules, 8 adenomas, 11 cholangiocarcinomas, 36 hepatocellular carcinomas and 49 metastases) were retrospectively evaluated in a multicentre study, both with CEUS, using sulphur hexafluoride microbubbles (SonoVue, Bracco, Milan, Italy) and CE-MR, performed with Gd-BOPTA (Multihance, Bracco, Milan, Italy). All lesions thought to be malignant were cytohistologically proven, while all lesions thought to be benign were followed up. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy were calculated for the late phase of CEUS and the hepatobiliary phase of CE-MRI, respectively, and in combination. Analysis of data revealed 42 benign and 105 malignant focal liver lesions. We postulated that all hypoechoic/hypointense lesions on the two phases were malignant. The diagnostic errors were 13/147 (8.8%) by CEUS and 12/147 (8.2%) by CE-MR. Sensitivity, specificity, PPV, NPV and accuracy of the late phase of CEUS were 90%, 93%, 97%, 80% and 91%, 93%, 97%, 81% and 92% for the hepatobiliary phase of CE-MRI, respectively. If we considered both techniques, the misdiagnosis diminished to 3/147 (2%) and sensitivity, specificity, PPV, NPV and accuracy were 98%, 98%, 99%, 95% and 98%. The combination of the late phase of CEUS and the hepatobiliary phase of CE-MR in the characterization of solid focal liver lesions in terms of benignity and malignancy is more accurate than the two techniques used separately.
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Affiliation(s)
- M D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - S Crosara
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - R De Robertis
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - S Canestrini
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - V Cantisani
- Department of Radiology, University of Rome, Rome, Italy
| | - G Morana
- Department of Radiology, Treviso Hospital, Treviso, Italy
| | - R Pozzi Mucelli
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
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Stenman C, Jamil S, Thorelius L, Knutsson A, Smedby Ö. Do radiologists agree on findings in radiographer-acquired sonographic examinations? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:513-518. [PMID: 23443192 DOI: 10.7863/jum.2013.32.3.513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Sonographic examinations are usually regarded as observer dependent, but a recently introduced method using documentation with cine loops acquired in a standardized way attempts to address this problem. The aim of this study was to evaluate the intraobserver and interobserver agreement of sonographic liver examinations using strictly standardized examination protocols with cine loop documentation. METHODS Ninety-eight outpatients were examined by a radiographer using the standardized method. Three radiologists, each with 10 to 20 years of experience in sonography, reviewed the cine loops retrospectively. After 4 weeks, the review was repeated; the 3 radiologists were blinded to the initial reading. The κ coefficient was used to analyze intraobserver and interobserver agreement, and agreement in percent was also calculated. RESULTS The intraobserver agreement was highest for concrements in the gallbladder (κ= 0.91-0.96) and lowest when assessing the need for further examination (κ = 0.38-0.64). For increased liver echogenicity, κ varied between 0.73 and 0.92 and for skip areas between 0.73 and 0.90. The interobserver agreement was also highest for concrements in the gallbladder (κ = 0.84-1.00) and lowest for the need for further examination (κ = -0.12-0.46). For most other findings, substantial intraobserver agreement was found. CONCLUSIONS For sonographic examinations performed according to a standardized examination protocol by a radiographer and viewed by an experienced radiologist, good interobserver agreement was found, except for judgments of the need for further examinations.
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Affiliation(s)
- Carina Stenman
- Division of Radiological Sciences, Department of Medical and Health Sciences, Linköping University, SE-58183 Linköping Sweden.
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Di Martino M, De Filippis G, De Santis A, Geiger D, Del Monte M, Lombardo CV, Rossi M, Corradini SG, Mennini G, Catalano C. Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging. Eur Radiol 2012. [PMID: 23179521 DOI: 10.1007/s00330-012-2691-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To prospectively compare the diagnostic performance of ultrasound (US), multidetector computed tomography (MDCT) and contrast-enhanced magnetic resonance imaging (MRI) in cirrhotic patients who were candidates for liver transplantation. METHODS One hundred and forty consecutive patients with 163 hepatocellular carcinoma (HCC) nodules underwent US, MRI and MDCT. Diagnosis of HCC was based on pathological findings or substantial growth at 12-month follow-up. Four different image datasets were evaluated: US, MDCT, MRI unenhanced and dynamic phases, MRI unenhanced dynamic and hepatobiliary phase. Diagnostic accuracy, sensitivity, specificity, PPV and NPV, with corresponding 95 % confidence intervals, were determined. Statistical analysis was performed for all lesions and for three lesion subgroups (<1 cm, 1-2 cm, >2 cm). RESULTS Significantly higher diagnostic accuracy, sensitivity and NPV was achieved on dynamic + hepatobiliary phase MRI compared with US, MDCT and dynamic phase MRI alone. The specificity and PPV of US was significantly lower than that of MDCT, dynamic phase MRI and dynamic + hepatobiliary phase MRI. Similar results were obtained for all sub-group analyses, with particular benefit for the diagnosis of smaller lesions between 1 and 2 cm. CONCLUSIONS Dynamic + hepatobiliary phase MRI improved detection and characterisation of HCC in cirrhotic patients. The greatest benefit is for diagnosing lesions between 1 and 2 cm.
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Affiliation(s)
- Michele Di Martino
- Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Viale Regina Elena 324, Rome 00161, Italy
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Patel M, Shariff MIF, Ladep NG, Thillainayagam AV, Thomas HC, Khan SA, Taylor-Robinson SD. Hepatocellular carcinoma: diagnostics and screening. J Eval Clin Pract 2012; 18:335-42. [PMID: 21114800 DOI: 10.1111/j.1365-2753.2010.01599.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is the commonest primary hepatic malignancy and the third most common cause of cancer-related death worldwide. Incidence remains highest in the developing world and is steadily increasing across the developed world. The majority of HCC occurs on a background of cirrhosis, principally caused by two major risk factors, chronic hepatitis B and hepatitis C infection. Current diagnostic modalities, of ultrasound and α-fetoprotein, are expensive and lack sensitivity in tumour detection. Early diagnosis is integral to improved survival rates and there have been recent advances in technology that have enabled early identification of the process of hepatocarcinogenesis. This review outlines the epidemiological trends and risk factors for HCC; diagnostic techniques and current guidelines for screening and surveillance; and newer methods of screening.
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Affiliation(s)
- Madhvi Patel
- Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, UK
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35
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Irshad A, Anis M, Ackerman SJ. Current Role of Ultrasound in Chronic Liver Disease: Surveillance, Diagnosis and Management of Hepatic Neoplasms. Curr Probl Diagn Radiol 2012; 41:43-51. [DOI: 10.1067/j.cpradiol.2011.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Hohmann J, Skrok J, Basilico R, Jennett M, Müller A, Wolf KJ, Albrecht T. Characterisation of focal liver lesions with unenhanced and contrast enhanced low MI real time ultrasound: on-site unblinded versus off-site blinded reading. Eur J Radiol 2011; 81:e317-24. [PMID: 22100374 DOI: 10.1016/j.ejrad.2011.10.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/23/2011] [Accepted: 10/25/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare on-site and blinded off-site reading of baseline ultrasound (US) and contrast enhanced ultrasound (CEUS) for classification and characterisation of focal liver lesions. MATERIALS AND METHODS 99 patients (57 women and 42 men, age range 18-89 years, mean age: 59 years) with 53 malignant and 46 benign liver lesions were studied with unenhanced US followed by contrast enhanced US after injection of 2.4 ml SonoVue® (Bracco, Milano, Italy). Image interpretation was performed on-site with clinical information available by consensus of two readers and off-site by two independent blinded readers at two different centers. Comparison of pre and post contrast scans and of the different readers was performed. Reference examinations were histology, intraoperative US, MRI or CT. RESULTS Sensitivity for malignancy improved from 81/89/66% (on-site/off-site reader 1/2) before to 100/96/96% post contrast administration (p<0.05, except for reader 1). Specificity improved from 48/48/54% on baseline US to 89/80/76% on CEUS (p<0.05). Accuracy for specific lesion diagnosis was 62/59/50% pre and 90/77/72% post contrast (p<0.05). Classification and characterisation post contrast were mildly inferior for off-site reading. Agreement between on-site and off-site readers of unenhanced scans was fair (κ=0.29-0.39) while it was good for CEUS (κ=0.63-0.79). CONCLUSIONS CEUS improves classification and characterisation of focal liver lesions and interobserver agreement compared to conventional US. Classification and characterisation post contrast were mildly but statistically significantly better for on-site than for off-site reading.
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Affiliation(s)
- Joachim Hohmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Berzigotti A, Frigato M, Manfredini E, Pierpaoli L, Mulè R, Tiani C, Zappoli P, Magalotti D, Malavolta N, Zoli M. Liver hemangioma and vascular liver diseases in patients with systemic lupus erythematosus. World J Gastroenterol 2011; 17:4503-8. [PMID: 22110281 PMCID: PMC3218141 DOI: 10.3748/wjg.v17.i40.4503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 10/28/2010] [Accepted: 11/05/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether systemic lupus erythematosus (SLE) is associated with benign focal liver lesions and vascular liver diseases, since these have been occasionally reported in SLE patients.
METHODS: Thirty-five consecutive adult patients with SLE and 35 age- and sex-matched healthy controls were evaluated. Hepatic and portal vein patency and presence of focal liver lesions were studied by colour-Doppler ultrasound, computerized tomography and magnetic resonance were used to refine the diagnosis, clinical data of SLE patients were reviewed.
RESULTS: Benign hepatic lesions were common in SLE patients (54% vs 14% controls, P < 0.0001), with hemangioma being the most commonly observed lesion in the two groups. SLE was associated with the presence of single hemangioma [odds ratios (OR) 5.05; 95% confidence interval (CI) 1.91-13.38] and multiple hemangiomas (OR 4.13; 95% CI 1.03-16.55). Multiple hemangiomas were associated with a longer duration of SLE (9.9 ± 6.5 vs 5.5 ± 6.4 years; P = 0.04). Imaging prior to SLE onset was available in 9 patients with SLE and hemangioma, showing absence of lesions in 7/9. The clinical data of our patients suggest that SLE possibly plays a role in the development of hemangioma. In addition, a Budd-Chiari syndrome associated with nodular regenerative hyperplasia (NRH), and a NRH associated with hepatic hemangioma were observed, both in patients hospitalized for abdominal symptoms, suggesting that vascular liver diseases should be specifically investigated in this population.
CONCLUSION: SLE is associated with 5-fold increased odds of liver hemangiomas, suggesting that these might be considered among the hepatic manifestations of SLE.
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Kim TY, Kim BS, Hyun CL, Song BC. [Hepatocellular adenoma treated with radiofrequency ablation in young male]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:384-7. [PMID: 21694493 DOI: 10.4166/kjg.2011.57.6.384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Tae Yun Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Anaye A, Perrenoud G, Rognin N, Arditi M, Mercier L, Frinking P, Ruffieux C, Peetrons P, Meuli R, Meuwly JY. Differentiation of focal liver lesions: usefulness of parametric imaging with contrast-enhanced US. Radiology 2011; 261:300-10. [PMID: 21746815 DOI: 10.1148/radiol.11101866] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate whether parametric imaging with contrast material-enhanced ultrasonography (US) is superior to visual assessment for the differential diagnosis of focal liver lesions (FLLs). MATERIALS AND METHODS This study had institutional review board approval, and verbal patient informed consent was obtained. Between August 2005 and October 2008, 146 FLLs in 145 patients (63 women, 82 men; mean age, 62.5 years; age range, 22-89 years) were imaged with real-time low-mechanical-index contrast-enhanced US after a bolus injection of 2.4 mL of a second-generation contrast agent. Clips showing contrast agent uptake kinetics (including arterial, portal, and late phases) were recorded and subsequently analyzed off-line with dedicated image processing software. Analysis of the dynamic vascular patterns (DVPs) of lesions with respect to adjacent parenchyma allowed mapping DVP signatures on a single parametric image. Cine loops of contrast-enhanced US and results from parametric imaging of DVP were assessed separately by three independent off-site readers who classified each lesion as benign, malignant, or indeterminate. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for both techniques. Interobserver agreement (κ statistics) was determined. RESULTS Sensitivities for visual interpretation of cine loops for the three readers were 85.0%, 77.9%, and 87.6%, which improved significantly to 96.5%, 97.3%, and 96.5% for parametric imaging, respectively (P < .05, McNemar test), while retaining high specificity (90.9% for all three readers). Accuracy scores of parametric imaging were higher than those of conventional contrast-enhanced US for all three readers (P < .001, McNemar test). Interobserver agreement increased with DVP parametric imaging compared with conventional contrast-enhanced US (change of κ from 0.54 to 0.99). CONCLUSION Parametric imaging of DVP improves diagnostic performance of contrast-enhanced US in the differentiation between malignant and benign FLLs; it also provides excellent interobserver agreement.
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Affiliation(s)
- Anass Anaye
- Department of Diagnostic and Interventional Radiology and Center for Clinical Epidemiology, Institute for Social and Preventive Medicine, University Hospital Lausanne, Switzerland.
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Wu TJ, Shiao JSC, Lu JY. A novel Doppler spectral index for differentiating benign from malignant lung tumors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:256-262. [PMID: 21448999 DOI: 10.1002/jcu.20803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Accepted: 01/11/2011] [Indexed: 05/30/2023]
Abstract
PURPOSE It has been reported that the resistance index (RI) and pulsatility index (PI) are of limited value in differentiating lung cancers from benign lesions. We hypothesized that a vascular work index (VWI), derived from Doppler spectral waveforms, would yield better results. METHODS Forty-one patients were enrolled, 20 of them having malignancies and 21 having benign lesions. The VWI was defined as the square of peak systolic velocity times the time-velocity integral. Maximal VWI, minimal RI, and minimal PI of each tumor were used for analysis. RESULTS Significantly higher VWI values were found in malignant tumors compared with benign lesions (p < 0.0001). VWI was shown by analysis of the receiver operating characteristic curve to be a best predictor of lung malignancies than PI and RI (p < 0.05), with a 0.89 (95% confidence interval, 0.80-0.98) area under the receiver operating characteristic curve. CONCLUSIONS VWI may be a useful index to help differentiate malignant from benign lung tumors.
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Affiliation(s)
- Tsung-Ju Wu
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung City, Taiwan.
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Anis M, Irshad A. Imaging of hepatocellular carcinoma: practical guide to differential diagnosis. Clin Liver Dis 2011; 15:335-52, vii-x. [PMID: 21689617 DOI: 10.1016/j.cld.2011.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatocellular carcinoma (HCC) is most commonly seen in patients with cirrhosis. Criteria for diagnosis include arterial-phase enhancement, venous-phase washout, and a capsule on delayed sequences. Tiny HCC are best detected with magnetic resonance imaging using the new hepatocyte-specific gadolinium agents; otherwise, short-term follow up versus biopsy is considered. Diffuse HCC can be difficult to diagnose because of the inherent heterogeneous hepatic parenchyma in cirrhosis, however, portal vein expansion due to thrombosis is a helpful sign.
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Affiliation(s)
- Munazza Anis
- Department of Radiologic Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC 29425, USA.
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Congenital fibrocystic liver diseases. Best Pract Res Clin Gastroenterol 2010; 24:573-84. [PMID: 20955960 DOI: 10.1016/j.bpg.2010.08.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 08/17/2010] [Accepted: 08/23/2010] [Indexed: 02/07/2023]
Abstract
Fibrocystic diseases affecting the liver and often also other organs like the kidneys are a clinically and genetically heterogeneous group of disorders that may present in utero or remain clinically silent into late adulthood. During recent years, substantial progress has been made in unravelling the aetiology with primary cilia playing a central pathogenic role in many if not all of these diseases. The fibrocystogenic process shares some common features including proliferation and dilatation of epithelial bile ducts with concomitant abnormal apoptosis, fluid secretion and extracellular matrix deposition. In this review, we summarise clinical and diagnostic aspects, mechanisms of hepatic cystogenesis, and recent knowledge on potential therapies for these conditions.
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Radiologic signs of weapons and munitions: How will noncombatants recognize them? AJR Am J Roentgenol 2010; 195:W96-104. [PMID: 20651180 DOI: 10.2214/ajr.09.4029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this work was to show the radiologic signs named after weapons and munitions along with their military counterparts to help radiologists recognize these signs, which will allow confident interpretation and diagnosis. CONCLUSION Numerous pathologic conditions have classic radiologic manifestations that resemble weapons and ammunition. Most of these signs are highly memorable and easy to recognize. However, the names of the weapons (some of them antique and some not commonly known) may confuse radiologists who are not familiar with the appearance of such weapons as the scimitar, bayonet, or dagger. The value of the signs is reduced if the radiologist is unfamiliar with the appearance of the corresponding weapon.
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Goertz RS, Bernatik T, Strobel D, Hahn EG, Haendl T. Software-based quantification of contrast-enhanced ultrasound in focal liver lesions—A feasibility study. Eur J Radiol 2010; 75:e22-6. [DOI: 10.1016/j.ejrad.2009.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/31/2009] [Accepted: 11/04/2009] [Indexed: 02/07/2023]
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Leveillee RJ, Ramanathan R. Optimization of Image-Guided Targeting in Renal Focal Therapy. J Endourol 2010; 24:729-44. [DOI: 10.1089/end.2009.0622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Raymond J. Leveillee
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Rajan Ramanathan
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida
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Bartolotta TV, Taibbi A, Matranga D, Malizia G, Lagalla R, Midiri M. Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth and liver echogenicity. Eur Radiol 2010; 20:2248-56. [DOI: 10.1007/s00330-010-1775-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 02/15/2010] [Accepted: 03/01/2010] [Indexed: 12/11/2022]
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Characterisation of focal liver lesions undetermined at grey-scale US: contrast-enhanced US versus 64-row MDCT and MRI with liver-specific contrast agent. Radiol Med 2010; 115:714-31. [PMID: 20082225 DOI: 10.1007/s11547-010-0506-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Accepted: 05/07/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to assess the role of contrast-enhanced ultrasonography (CEUS) in the characterisation of focal liver lesions in comparison with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) with liver-specific contrast agent. MATERIALS AND METHODS One hundred and eighty-seven focal liver lesions, 91 malignant and 96 benign (mean size 3.2 cm) - proved by biopsy (n=12), histology (n=4), MDCT (n=108), MRI (n=44) MDCT/MRI (n=19) - in 159 patients were studied by CEUS. Two expert radiologists consensually evaluated the contrast-enhancement patterns at CEUS. For each lesion, they assessed: (a) nature (benign, malignant, not assessable), (b) specific diagnosis and (c) need for further radiological evaluation. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were calculated. RESULTS A total of 167/187 (89.3%) lesions were correctly assessed as benign or malignant at CEUS, whereas 14/187 (7.5%) lesions remained undetermined and 6/187 (3.2%) were incorrectly assessed. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were, respectively, 89%, 89.6%, 89%, 89.6% and 89.3%. The need for further radiological evaluation decreased to 46/187 (24.6%) lesions after CEUS (p<0.001). CONCLUSIONS In selected cases, CEUS can be considered an effective alternative to MDCT and MRI and reduce the need for further radiological workup.
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Soussan M, Aubé C, Bahrami S, Boursier J, Valla DC, Vilgrain V. Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging. Eur Radiol 2010; 20:1715-25. [PMID: 20069427 DOI: 10.1007/s00330-009-1700-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/14/2009] [Accepted: 11/20/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To prospectively assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) and MR imaging in incidental solid focal liver lesions not characterised on ultrasound. MATERIALS AND METHODS Forty-seven patients with 50 lesions underwent MR imaging and CEUS: 24 focal nodular hyperplasias (FNH), 11 adenomas, 10 haemangiomas, 1 focal fatty change and 4 malignant lesions were identified. Two experienced radiologists randomly reviewed contrast-enhanced MR imaging and CEUS data, and provided the most likely diagnosis. Sensitivity (Se), specificity (Sp), likelihood ratios (LR) and kappa value were calculated. RESULTS A histotype diagnosis was obtained in 66-52% with MR imaging and 52-53% with CEUS, respectively, for both readers. Se, Sp and LR for haemangioma were 100-100, 100-100 and 78-78 with MR imaging and 89-89, 100-100 and 68-70 with CEUS; for FNH with MR imaging they were 88-63, 96-100 and 23-34 and 74-67, 88-96 and 6-17 with CEUS. If the diagnosis of haemangioma was uncertain with CEUS, MR imaging always confirmed the diagnosis. If the diagnosis of FNH was uncertain with either CEUS or MR imaging, the other imaging technique confirmed the diagnosis in approximately half the cases. CONCLUSION Both CEUS and MR imaging have a high diagnostic performance in incidental focal liver lesions and are complementary when diagnosis is uncertain.
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Affiliation(s)
- Michael Soussan
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, APHP, Hôpital Beaujon, Clichy, France
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Quaia E, Alaimo V, Baratella E, Pizzolato R, Cester G, Medeot A, Cova MA. Effect of observer experience in the differentiation between benign and malignant liver tumors after ultrasound contrast agent injection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:25-36. [PMID: 20040772 DOI: 10.7863/jum.2010.29.1.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of the observer level of experience on the diagnostic performance of contrast-enhanced ultrasound imaging (CEUS) for differentiation between benign and malignant liver tumors. METHODS From a computerized search, we retrospectively identified 286 biopsy-proven liver tumors (105 hepatocellular carcinomas, 48 metastases, 7 intra-hepatic cholangiocarcinomas, 33 liver hemangiomas, and 93 nonhemangiomatous benign lesions) in 235 patients (140 male and 95 female; mean age +/- SD, 56 +/- 11 years) who underwent CEUS after sulfur hexafluoride-filled microbubble injection. The digital cine clips recorded during the arterial (10-35 seconds from injection), portal (50-120 seconds), and late (130-300 seconds) phases were analyzed by 6 independent observers without experience (group 1, observers 1-3) or with 2 to 10 years of experience in CEUS (group 2, observers 4-6). Specific training in the diagnostic and interpretative criteria was provided to the inexperienced observers. Each observer used a 5-point scale to grade diagnostic confidence: 1, definitely benign; 2, probably benign; 3, indeterminate; 4, probably malignant; or 5, definitely malignant on the basis of the enhancement pattern during the arterial phase and enhancement degree during the portal and late phases compared with the liver (hypoenhancement indicating malignant and isoenhancement to hyperenhancement indicating benign). RESULTS The analysis of observer diagnostic confidence revealed higher intragroup (kappa = 0.63-0.83) than intergroup (kappa = 0.47-0.63) observer agreement. The experienced observers showed higher diagnostic performance in malignancy diagnosis than did inexperienced observers (overall accuracy: group 1, 63.3%-72.8%; group 2, 75.9%-93.1%; P < .05, chi(2) test). CONCLUSIONS The diagnostic performance of CEUS in liver tumor characterization was dependant on the observer's level of experience.
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Affiliation(s)
- Emilio Quaia
- Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
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