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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Recomendaciones de expertos sobre el uso de ácido gadoxético en pacientes con metástasis hepáticas en España. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain. RADIOLOGIA 2022; 64:300-309. [DOI: 10.1016/j.rxeng.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 09/03/2021] [Indexed: 10/15/2022]
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Zhou N, Meng X, Zhang Y, Yu B, Yuan J, Yu J, Zhu H, Yang Z. Diagnostic Value of Delayed PET/MR in Liver Metastasis in Comparison With PET/CT. Front Oncol 2021; 11:717687. [PMID: 34527587 PMCID: PMC8435726 DOI: 10.3389/fonc.2021.717687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/10/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives The aim of this study was to evaluate the value of a delayed positron emission tomography/magnetic resonance (PET/MR) scan relative to a single positron emission tomography/computed tomography (PET/CT) scan for liver metastasis detection. Methods In this study, 70 patients with solid malignancies and suspicious liver lesions undergoing 2-deoxy-2-[18F]fluoro-D-glucose [(18F)FDG] PET/CT and subsequent delayed liver PET/MR scans were analyzed. The histopathological analysis and/or imaging follow-up were performed as the standard of reference. Lesion maximum standardized uptake value (SUVmax), diameter, and tumor to nontumor ratio (T/N) were measured. Lesion detection sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both examinations. Results (1) The standard of reference revealed 208 liver lesions in 70 patients (metastasis in 56 patients with 196 lesions; benign in 14 patients with 12 lesions). Compared with PET/CT, PET/MR had higher accuracy (98.6% vs. 78.6%), sensitivity (98.2% vs. 76.8%), and specificity (100.0% vs. 85.7%) (2). The therapeutic strategies of 29 patients (41.4%) needed reconsideration after the additional PET/MR, including new metastases detected (13/70), new affected lobes identified (14/70), and false-positive corrected (2/70) (3). PET/MR detected significantly more metastases than PET/CT did, especially with small lesions. The SUVmax of the same lesion correlated well between the two acquisitions, while the delayed PET showed a higher T/N ratio. Conclusions In liver metastasis detection, the diagnostic value of the delayed PET/MR is validated to be superior to that of PET/CT, which may aid the clinical decision-making.
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Affiliation(s)
- Nina Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangxi Meng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Boqi Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jianmin Yuan
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Jiangyuan Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hua Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
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Ghorra C, Pommier R, Piveteau A, Rubbia-Brandt L, Vilgrain V, Terraz S, Ronot M. The diagnostic performance of a simulated "short" gadoxetic acid-enhanced MRI protocol is similar to that of a conventional protocol for the detection of colorectal liver metastases. Eur Radiol 2020; 31:2451-2460. [PMID: 33025173 DOI: 10.1007/s00330-020-07344-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare the performance of standard and simulated short gadoxetic acid-enhanced MRI protocols for the detection of colorectal liver metastases (CRLM). METHODS From 2008 to 2017, 67 patients (44 men (66%); mean age 65 ± 11 years old) who underwent gadoxetic acid-enhanced MRI during the initial work-up for colorectal cancer were included. Exams were independently reviewed by two readers blinded to clinical data in two reading sessions: (1) all acquired sequences (standard "long" protocol) and (2) only T2-weighted, diffusion-weighted, and hepatobiliary phase images (simulated "short" protocol). Readers characterized detected lesions using a 5-point scale (1-certainly benign to 5-certainly malignant). A lesion was considered a CRLM when the score was ≥ 3. The reference standard was histopathology or 12-month imaging follow-up. Chi-square, Student's t, and McNemar tests were used for comparisons. RESULTS A total of 486 lesions including 331 metastases (68%) were analyzed. The metastasis detection rate was 86.1% (95% CI 82-89.4)-86.7% (82.6-90) and 85.8% (81.6-89.2)-87% (82.9-90.2) with the short and long protocols, respectively (p > 0.99). Among detected lesions, 92.1% (89.1-94.4)-94.8% (92.2-96.6) and 84.6% (80.8-87.7)-88.8% (85.4-91.5) were correctly classified with the short and long protocols, respectively (p = 0.13 and p = 0.10). The results remained unchanged when lesions scored ≥ 4 were considered as CRLM. CONCLUSION The diagnostic performance of a simulated short gadoxetic enhanced-MR protocol including T2-weighted, diffusion-weighted, and hepatobiliary phase appears similar to that of a standard long protocol including dynamic phase images. Since this protocol shortens the duration of MR examination, it could facilitate the evaluation of patients with colorectal liver metastases. KEY POINTS • The detection rate of colorectal metastases with a simulated, short, MRI protocol was similar to that of a standard protocol. • The performance of both protocols for the differentiation of metastases and benign lesions appears to be similar. • A short MR imaging protocol could facilitate the evaluation of patients with colorectal liver metastases.
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Affiliation(s)
- Camille Ghorra
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Romain Pommier
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Arthur Piveteau
- Department of Radiology, University Hospitals of Geneva - HUG, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Department of Pathology, University Hospitals of Geneva - HUG, Geneva, Switzerland
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Sylvain Terraz
- Department of Radiology, University Hospitals of Geneva - HUG, Geneva, Switzerland
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,Université de Paris, Paris, France. .,INSERM U1149, CRI, Paris, France.
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Daza JF, Solis NM, Parpia S, Gallinger S, Moulton CA, Belley-Cote EP, Levine MN, Serrano PE. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases. Eur J Surg Oncol 2019; 45:1341-1348. [DOI: 10.1016/j.ejso.2019.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
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Anton N, Parlog A, Bou About G, Attia MF, Wattenhofer-Donzé M, Jacobs H, Goncalves I, Robinet E, Sorg T, Vandamme TF. Non-invasive quantitative imaging of hepatocellular carcinoma growth in mice by micro-CT using liver-targeted iodinated nano-emulsions. Sci Rep 2017; 7:13935. [PMID: 29066853 PMCID: PMC5655328 DOI: 10.1038/s41598-017-14270-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the only cancer for which non-invasive diagnosis is recognized by international guidelines. Contrast agent free ultrasound imaging, computed tomography (CT) and/or magnetic resonance imaging are techniques used for early detection and confirmation. Clinical evidence depicts that CT is 30% less precise as compared to MRI for detection of small tumors. In our work, we have reported some novel tools that can enhance the sensitivity and precision of CT applied to preclinical research (micro-CT). Our system, containing non-toxic nano-droplets loaded with iodine has high contrasting properties, liver and hepatocyte specificity and strong liver persistence. Micro-CT was performed on HCC model implanted in nude mice by intrahepatic injection. Contrast agent was administrated intravenously. This method allows an unprecedented high precision of detection, quantitative measurement of tumor volume and quantitative follow-up of the tumor development.
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Affiliation(s)
- Nicolas Anton
- University of Strasbourg, Faculty of Pharmacy, 74 route du Rhin 67401 Illkirch-Graffenstaden Cedex, Strasbourg, France. .,CNRS UMR 7199, Laboratoire de Conception et Application de Molécules Bioactives, équipe de Pharmacie Biogalénique, 74 route du Rhin 67401 Illkirch-Graffenstaden Cedex, Strasbourg, France.
| | - Alexandru Parlog
- CELPHEDIA, PHENOMIN, Institut Clinique de la Souris, 1 rue Laurent Fries, 67404, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Institut National de la Sante et de la Recherche Médicale, U964, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Université de Strasbourg, 1 rue Laurent Fries, 67404 Illkirch, Strasbourg, France
| | - Ghina Bou About
- CELPHEDIA, PHENOMIN, Institut Clinique de la Souris, 1 rue Laurent Fries, 67404, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Institut National de la Sante et de la Recherche Médicale, U964, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Université de Strasbourg, 1 rue Laurent Fries, 67404 Illkirch, Strasbourg, France
| | - Mohamed F Attia
- University of Strasbourg, Faculty of Pharmacy, 74 route du Rhin 67401 Illkirch-Graffenstaden Cedex, Strasbourg, France.,CNRS UMR 7199, Laboratoire de Conception et Application de Molécules Bioactives, équipe de Pharmacie Biogalénique, 74 route du Rhin 67401 Illkirch-Graffenstaden Cedex, Strasbourg, France.,National Research Center, P.O., 12622, Cairo, Egypt.,Department of Bioengineering, Clemson University, 203 Rhodes Annex, Clemson, SC, 29634, USA
| | - Marie Wattenhofer-Donzé
- CELPHEDIA, PHENOMIN, Institut Clinique de la Souris, 1 rue Laurent Fries, 67404, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Institut National de la Sante et de la Recherche Médicale, U964, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Université de Strasbourg, 1 rue Laurent Fries, 67404 Illkirch, Strasbourg, France
| | - Hugues Jacobs
- CELPHEDIA, PHENOMIN, Institut Clinique de la Souris, 1 rue Laurent Fries, 67404, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Institut National de la Sante et de la Recherche Médicale, U964, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Université de Strasbourg, 1 rue Laurent Fries, 67404 Illkirch, Strasbourg, France
| | - Isabelle Goncalves
- CELPHEDIA, PHENOMIN, Institut Clinique de la Souris, 1 rue Laurent Fries, 67404, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Institut National de la Sante et de la Recherche Médicale, U964, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Université de Strasbourg, 1 rue Laurent Fries, 67404 Illkirch, Strasbourg, France
| | - Eric Robinet
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000, Strasbourg, France
| | - Tania Sorg
- CELPHEDIA, PHENOMIN, Institut Clinique de la Souris, 1 rue Laurent Fries, 67404, Illkirch, France.,Centre National de la Recherche Scientifique, UMR7104, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Institut National de la Sante et de la Recherche Médicale, U964, 1 rue Laurent Fries, 67404 Illkirch, Paris, France.,Université de Strasbourg, 1 rue Laurent Fries, 67404 Illkirch, Strasbourg, France
| | - Thierry F Vandamme
- University of Strasbourg, Faculty of Pharmacy, 74 route du Rhin 67401 Illkirch-Graffenstaden Cedex, Strasbourg, France.,CNRS UMR 7199, Laboratoire de Conception et Application de Molécules Bioactives, équipe de Pharmacie Biogalénique, 74 route du Rhin 67401 Illkirch-Graffenstaden Cedex, Strasbourg, France
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Saing S, Haywood P, Duncan JK, Ma N, Cameron AL, Goodall S. Cost-effective imaging for resectability of liver lesions in colorectal cancer: an economic decision model. ANZ J Surg 2017; 88:E507-E511. [PMID: 28982209 DOI: 10.1111/ans.14194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/28/2017] [Accepted: 07/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to determine the cost-effectiveness of contrast-enhanced magnetic resonance imaging (CE-MRI) compared with multiphase CE computed tomography (CE-CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma. METHODS A decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE-MRI has superior sensitivity and equivalent specificity to CE-CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost-effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of the results. RESULTS The clinical evidence supports increased sensitivity of CE-MRI compared with CE-CT (0.943 versus 0.768). CE-MRI was more effective and more costly than CE-CT. The incremental cost-effectiveness ratio was estimated to be $40 548 per quality-adjusted life year gained. The model is most sensitive to the cost of MRI, cost of palliative treatment and the disutility associated with delayed palliative care. The results were also sensitive to the assumptions made about the clinical algorithm. CONCLUSION The results provide evidence of the potential cost-effectiveness associated with CE-MRI for the diagnosis of liver metastases in patients with identified colorectal carcinoma. CE-MRI can be recommended as cost-effective provided it replaces CE-CT and that improved diagnostic accuracy results in earlier, curative, disease management.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Phil Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
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Abstract
BACKGROUND The clinical efficacy of gadoxetic acid-enhanced liver MRI as a routine preoperative procedure for all patients with colorectal cancer remains unclear. OBJECTIVE The purpose of this study was to evaluate the efficacy of preoperative gadoxetic acid-enhanced liver MRI for the diagnosis of liver metastasis in patients with colorectal cancer. DESIGN This was a retrospective analysis from a prospective cohort database. SETTINGS All of the patients were from a subspecialty practice at a tertiary referral hospital. PATIENTS Patients who received preoperative gadoxetic acid-enhanced liver MRI after CT and attempted curative surgery for colorectal cancer were included. MAIN OUTCOME MEASURES The number of equivocal hepatic lesions based on CT and gadoxetic acid-enhanced liver MRI and diagnostic use of the gadoxetic acid-enhanced liver MRI were measured. RESULTS We reviewed the records of 690 patients with colorectal cancer. Equivocal hepatic lesions were present in 17.2% of patients based on CT and in 4.5% based on gadoxetic acid-enhanced liver MRI. Among 496 patients with no liver metastasis based on CT, gadoxetic acid-enhanced liver MRI detected equivocal lesions in 15 patients and metastasis in 3 patients. Among 119 patients who had equivocal liver lesions on CT, gadoxetic acid-enhanced liver MRI indicated hepatic lesions in 103 patients (86.6%), including 90 with no metastasis and 13 with metastasis. Among 75 patients who had liver metastasis on CT, gadoxetic acid-enhanced liver MRI indicated that the hepatic lesions in 2 patients were benign, in contrast to CT findings. The initial surgical plans for hepatic lesions according to CT were changed in 17 patients (3%) after gadoxetic acid-enhanced liver MRI. LIMITATIONS This study was limited by its retrospective design. CONCLUSIONS The clinical efficacy of gadoxetic acid-enhanced liver MRI as a routine preoperative procedure for all patients with colorectal cancer is low, in spite of its high diagnostic value for detecting liver metastasis. However, this study showed gadoxetic acid-enhanced liver MRI was helpful in characterizing equivocal hepatic lesions identified in CT and could lead to change in treatment plans for some patients. See Video Abstract at http://links.lww.com/DCR/A420.
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Qu J, Han S, Zhang H, Liu H, Wang Z, Kamel IR, Berthold K, Dominik NM, Zhang J, Zhang S, Dong Y, Jiang L, Liu C, Li H. Arterial Phase with CAIPIRINHA-Dixon-TWIST (CDT)-Volume-Interpolated Breath-Hold Examination (VIBE) in Detecting Hepatic Metastases. Transl Oncol 2016; 10:46-53. [PMID: 27940372 PMCID: PMC5154962 DOI: 10.1016/j.tranon.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE: To evaluate lesion enhancement performance of Multi-Arterial CAIPIRINHA-Dixon-TWIST–Volume-Interpolated Breath-Hold Examination (MA-CDT-VIBE) for the detection of hepatic metastases. MATERIALS AND METHODS: Thirty-one patients with suspicious hepatic metastases were enrolled in this retrospective study. Two independent radiologists scored visualization of each lesion on a scale of 1 (poor visualization) to 11 (excellent visualization) on 11 sets of images. These included 6 hepatic arterial sub-phases acquired in one breath-hold, 1 series of the mean of 6 hepatic arterial sub-phases, 3 subtracted arterial sub-phases, and 1 portal venous phase. The phases with good (score 8–10) and excellent (score 11) lesion visualization were identified, and the number of lesions seen on each of these phases was compared to the number of lesions that was seen best on the equivalent-to-conventional single arterial phase as well as to those that were see best on the mean of 6 hepatic arterial sub-phases. Inter-reader agreement was also calculated. RESULTS: The MA-CDT-VIBE was successfully acquired in 25 patients with hypervascular metastases (96 lesions) and 6 patients with hypovascular metastases (13 lesions). In case of hypervascular metastases, the 6th/6 arterial sub-phase had excellent lesion visualization (sore of 11) in 56 and 44 lesions for the 2 readers, respectively. Good lesion visualization (score of 8-10) was recorded in 5th/6 arterial subphases, in 81 and 67 lesions for the 2 readers, respectively. In case of hypovascular metastases, the portal venous phase had excellent lesion visualization (sore of 11) in all 13 lesions for the 2 readers. Good lesion visualization (score of 8–10) was recorded in 12 and 13 lesions on the 5th/6 and 6th/6 arterial subphases, respectively. More hypervascular lesions scored good (score of 8–10) and excellent (score of 11) on the 5th/6 and 6th/6 phases of MA-CDT-VIBE compared with the equivalent-to-conventional single arterial phase (3rd/6) and the set with mean of 6 hepatic arterial sub-phases. The results were statistically significant (t test, P < .0001). Inter-reader agreement was good for hypervascular lesions (kappa = 0.627, P < .0001) and excellent for hypovascular lesions (kappa = 1.0, P < .0001), respectively. CONCLUSIONS: The MA-CDT-VIBE improves lesion conspicuity by providing a wide observation window for hypervascular lesions. For hypovascular lesions, the advantage of multiple arterial sub-phases over the portal venous phase is not apparent.
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Affiliation(s)
- Jinrong Qu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008.
| | - Shuai Han
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Hongkai Zhang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Hui Liu
- MR Collaboration, Siemens Healthcare, Shanghai, China, 201318
| | - Zhaoqi Wang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 21205-2196
| | - Kiefer Berthold
- MR Pre-development, Siemens Healthcare, Erlangen, Germany, 91052
| | | | - Jianwei Zhang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Shouning Zhang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Yafeng Dong
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Lina Jiang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Cuicui Liu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Hailiang Li
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008.
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Vreugdenburg TD, Ma N, Duncan JK, Riitano D, Cameron AL, Maddern GJ. Comparative diagnostic accuracy of hepatocyte-specific gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging and contrast enhanced CT for the detection of liver metastases: a systematic review and meta-analysis. Int J Colorectal Dis 2016; 31:1739-1749. [PMID: 27682648 DOI: 10.1007/s00384-016-2664-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This systematic review evaluated the diagnostic accuracy and impact on patient management of hepatocyte-specific gadoxetic acid enhanced magnetic resonance imaging (GA-MRI) compared to contrast enhanced computed tomography (CE-CT) in patients with liver metastases. METHOD Four biomedical databases (PubMed, EMBASE, Cochrane Library, York CRD) were searched from January 1991 to February 2016. Studies investigating the accuracy or management impact of GA-MRI compared to CE-CT in patients with known or suspected liver metastases were included. Bias was evaluated using QUADAS-II. Univariate meta-analysis of sensitivity ratios (RR) were conducted in the absence of heterogeneity, calculated using I 2 , Tau values (τ) and prediction intervals. RESULTS Nine diagnostic accuracy studies (537 patients with 1216 lesions) and four change in management studies (488 patients with 281 lesions) were included. Per-lesion sensitivity and specificity estimates for GA-MRI ranged from 86.9-100.0 % and 80.2-98.0 %, respectively, compared to 51.8-84.6 % and 77.2-98.0 % for CE-CT. Meta-analysis found GA-MRI to be significantly more sensitive than CE-CT (RR = 1.29, 95 % CI = 1.18-1.40, P < 0.001), with equivalent specificity (RR = 0.97, 95 % CI 0.910-1.042, P = 0.44). The largest difference was observed for lesions smaller than 10 mm for which GA-MRI was significantly more sensitive (RR = 2.21, 95 % CI = 1.47-3.32, P < 0.001) but less specific (RR = 0.92, 95 % CI 0.87-0.98, P = 0.008). GA-MRI affected clinical management in 26 of 155 patients (16.8 %) who had a prior CE-CT; however, no studies investigated the consequences of using GA-MRI instead of CE-CT. CONCLUSION GA-MRI is significantly more sensitive than CE-CT for detecting liver metastases, which leads to a modest impact on patient management in the context of an equivocal CE-CT result.
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Affiliation(s)
- Thomas D Vreugdenburg
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia.
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Dagmara Riitano
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
- Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastasis: the radiologist's perspective. Abdom Radiol (NY) 2016; 41:2150-2160. [PMID: 27377899 DOI: 10.1007/s00261-016-0832-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastasis (CRLM). Many multidisciplinary approaches, including the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, have been proposed to increase the resectability rate in these patients. ALPPS is the most recently described staged liver resection technique, representing an advantageous strategy to induce a rapid and marked increase in the future liver remnant (FLR) volume. The aim of this article is to describe the radiological evaluation of this procedure and its variation. METHODS This retrospective study included 9 patients with CRLM who underwent the ALPPS procedure. Abdominal imaging studies were reviewed, with an emphasis on a rational radiological approach. The number of liver metastases, the FLR volume (pre- and postportal vein ligation), anatomical variations, potential pitfalls related to disease progression, and postoperative complications were evaluated. RESULTS The types of hepatic resection included 4 classical ALPPS cases, 3 right ALPPS variations, and 2 left ALPPS variations. The mean FLR volume calculated in the initial evaluation was 453 mL (213-790 mL). Following the first surgery, the mean FLR volume increased to 634 mL (410-957 mL), which indicated a mean volume increase of 181.1 mL (95% CI 149.7-212.5 mL; p < 0.001) and a mean absolute volume increase of 48% (19%-88%). CONCLUSION The ALPPS procedure is an emerging form of two-stage hepatectomy. In this context, radiologists should provide crucial preoperative and perioperative information that may change surgical planning and contribute to an improvement in the oncologic outcome.
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Matos AP, Altun E, Ramalho M, Velloni F, AlObaidy M, Semelka RC. An overview of imaging techniques for liver metastases management. Expert Rev Gastroenterol Hepatol 2016; 9:1561-76. [PMID: 26414180 DOI: 10.1586/17474124.2015.1092873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Evaluation of liver metastases is one of the most common indications for liver imaging. Imaging plays a key role in the of assessment liver metastases. A variety of imaging techniques, including ultrasonography, computed tomography, MRI and PET combined with CT scan are available for diagnosis, planning treatment, and follow-up treatment response. In this paper, the authors present the role of imaging for the assessment of liver metastases and the contribution of each of the different imaging techniques for their evaluation and management. Following recent developments in the field of oncology, the authors also present the importance of imaging for the assessment of liver metastases response to therapy. Finally, future perspectives on imaging of liver metastases are presented.
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Affiliation(s)
- António P Matos
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Ersan Altun
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Miguel Ramalho
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Fernanda Velloni
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Mamdoh AlObaidy
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
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13
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Karaosmanoglu AD, Onur MR, Ozmen MN, Akata D, Karcaaltincaba M. Magnetic Resonance Imaging of Liver Metastasis. Semin Ultrasound CT MR 2016; 37:533-548. [PMID: 27986172 DOI: 10.1053/j.sult.2016.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver magnetic resonance imaging (MRI) is becoming the gold standard in liver metastasis detection and treatment response assessment. The most sensitive magnetic resonance sequences are diffusion-weighted images and hepatobiliary phase images after Gd-EOB-DTPA. Peripheral ring enhancement, diffusion restriction, and hypointensity on hepatobiliary phase images are hallmarks of liver metastases. In patients with normal ultrasonography, computed tomography (CT), and positron emission tomography (PET)-CT findings and high clinical suspicion of metastasis, MRI should be performed for diagnosis of unseen metastasis. In melanoma, colon cancer, and neuroendocrine tumor metastases, MRI allows confident diagnosis of treatment-related changes in liver and enables differential diagnosis from primary liver tumors. Focal nodular hyperplasia-like nodules in patients who received platinum-based chemotherapy, hypersteatosis, and focal fat can mimic metastasis. In cancer patients with fatty liver, MRI should be preferred to CT. Although the first-line imaging for metastases is CT, MRI can be used as a problem-solving method. MRI may be used as the first-line method in patients who would undergo curative surgery or metastatectomy. Current limitation of MRI is low sensitivity for metastasis smaller than 3mm. MRI fingerprinting, glucoCEST MRI, and PET-MRI may allow simpler and more sensitive diagnosis of liver metastasis.
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Affiliation(s)
- Ali Devrim Karaosmanoglu
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Akata
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Musturay Karcaaltincaba
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
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Tsurusaki M, Sofue K, Murakami T. Current evidence for the diagnostic value of gadoxetic acid-enhanced magnetic resonance imaging for liver metastasis. Hepatol Res 2016; 46:853-61. [PMID: 26750497 DOI: 10.1111/hepr.12646] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/25/2015] [Accepted: 12/31/2015] [Indexed: 02/08/2023]
Abstract
A variety of imaging techniques, including ultrasonography (US), multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography combined with CT scan (PET/CT), are available for diagnosis and treatment planning in liver metastasis. Contrast-enhanced MDCT is a relatively non-invasive, widely available and standardized method for hepatic work-up. Gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid; EOB Primovist®]) is a recently developed liver-specific hepatobiliary MR contrast agent that offers both dynamic imaging as well as liver-specific static hepatocyte imaging, referred to as the hepatobiliary phase. Following contrast injection, this technique reveals dynamic vascular phases (arterial, portal venous and delayed phases), in addition to the hepatobiliary phase upon uptake by functional hepatocytes. The overall sensitivity of gadoxetic acid-enhanced MRI was significantly higher than that of contrast-enhanced CT. Specifically, the higher sensitivity of gadoxetic acid-enhanced MRI was observed in lesions smaller than 1 cm in diameter. Gadoxetic acid-enhanced MRI is considered an extremely useful tool for the diagnosis of liver metastases. Future studies will focus on diagnostic algorithms involving combinations of modalities such as MRI, MDCT and/or (18) F-fluorodeoxyglucose PET/CT, which may impact the treatment plan for these patients.
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Affiliation(s)
| | - Keitaro Sofue
- Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Takamichi Murakami
- Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan
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15
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Does the Gadoxetic Acid-Enhanced Liver MRI Impact on the Treatment of Patients with Colorectal Cancer? Comparison Study with ¹⁸F-FDG PET/CT. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8412071. [PMID: 27022613 PMCID: PMC4789046 DOI: 10.1155/2016/8412071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/08/2016] [Indexed: 12/14/2022]
Abstract
Objectives. We evaluated the value of Gadoxetic acid-enhanced liver MRI in the preoperative staging of colorectal cancer and estimated the clinical impact of liver MRI in the management plan of liver metastasis. Methods. We identified 108 patients who underwent PET/CT and liver MRI as preoperative evaluation of colorectal cancer, between January 2011 and December 2013. We evaluated the per nodule sensitivity of PET/CT and liver MRI for liver metastasis. Management plan changes were estimated for patients with metastatic nodules newly detected on liver MRI, to assess the clinical impact. Results. We enrolled 131 metastatic nodules (mean size 1.6 cm) in 41 patients (mean age 65 years). The per nodule sensitivities of PET/CT and liver MRI were both 100% for nodules measuring 2 cm or larger but were significantly different for nodules measuring less than 2 cm (59.8% and 95.1%, resp., P = 0.0001). At least one more metastatic nodule was detected on MRI in 16 patients. Among these, 7 patients indicated changes of management plan after performing MRI. Conclusions. Gadoxetic acid-enhanced liver MRI detected more metastatic nodules compared with PET/CT, especially for small (<2 cm) nodules. The newly detected nodules induced management plan change in 43.8% (7/16) of patients.
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Routine Preoperative Liver-specific Magnetic Resonance Imaging Does Not Exclude the Necessity of Contrast-enhanced Intraoperative Ultrasound in Hepatic Resection for Colorectal Liver Metastasis. Ann Surg 2016; 262:1086-91. [PMID: 26010441 DOI: 10.1097/sla.0000000000001085] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the usefulness of contrast-enhanced intraoperative ultrasound (CE-IOUS) during surgery for colorectal liver metastases (CRLM) when gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) is performed as a part of preoperative imaging work-up. BACKGROUND EOB-MRI is expected to supersede CE-IOUS, which is reportedly indispensable in surgery for CRLM. METHODS One hundred consecutive patients underwent EOB-MRI, contrast-enhanced computed tomography (CE-CT), and contrast-enhanced ultrasound within 1 month before surgery for CRLM. Conventional IOUS and subsequent CE-IOUS using perflubutane were performed after the laparotomy. All the nodules identified in any of the preoperative or intraoperative examinations were resected and were submitted for histological examination, in principle. RESULTS Preoperative imaging examinations identified 242 nodules; 25 additional nodules were newly identified using IOUS, 22 additional nodules were newly identified during CE-IOUS, and a histological examination further identified 4 nodules. Among the 25 nodules newly identified using IOUS, all 21 histologically proven CRLMs and 3 of the 4 benign nodules were correctly diagnosed using CE-IOUS. Among the 22 nodules newly identified using CE-IOUS, 17 nodules in 16 patients were histologically diagnosed as CRLMs. The planned surgical procedure was modified on the basis of IOUS and CE-IOUS findings in 12 and 14 patients, respectively. The sensitivity, positive-predictive value, and accuracy of CE-IOUS were 99%, 98%, and 97%, respectively. Those values of EOB-MRI (82%, 99%, 83%, respectively) were similar to CE-CT (81%, 99%, 81%, respectively). CONCLUSIONS CE-IOUS is useful in hepatic resection for CRLM, even if EOB-MRI and CE-CT are performed.
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Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aubé C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol 2016; 26:4595-4615. [PMID: 26883327 DOI: 10.1007/s00330-016-4250-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. METHODS A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. RESULTS Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. CONCLUSIONS In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. KEY POINTS • DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard.
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Affiliation(s)
- Valérie Vilgrain
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,University Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Maxime Esvan
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Maxime Ronot
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Aurore Caumont-Prim
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Christophe Aubé
- Department of Radiology, CHU d'Angers, Angers, France.,Laboratoire HIFIH, LUNAM, Université d'Angers, Angers, France
| | - Gilles Chatellier
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 75006, Paris, France
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18
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Beiderwellen K, Geraldo L, Ruhlmann V, Heusch P, Gomez B, Nensa F, Umutlu L, Lauenstein TC. Accuracy of [18F]FDG PET/MRI for the Detection of Liver Metastases. PLoS One 2015; 10:e0137285. [PMID: 26335246 PMCID: PMC4559465 DOI: 10.1371/journal.pone.0137285] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/16/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the diagnostic accuracy of [18F]FDG-PET/MRI with PET/CT for the detection of liver metastases. METHODS 32 patients with solid malignancies underwent [18F]FDG-PET/CT and subsequent PET/MRI of the liver. Two readers assessed both datasets regarding lesion characterization (benign, indeterminate, malignant), conspicuity and diagnostic confidence. An imaging follow-up (mean interval: 185±92 days) and/-or histopathological specimen served as standards of reference. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both modalities. Accuracy was determined by calculating the area under the receiver operating characteristic (ROC) curve. Values of conspicuity and diagnostic confidence were compared using Wilcoxon-signed-rank test. RESULTS The standard of reference revealed 113 liver lesions in 26 patients (malignant: n = 45; benign: n = 68). For PET/MRI a higher accuracy (PET/CT: 82.4%; PET/MRI: 96.1%; p<0.001) as well as sensitivity (67.8% vs. 92.2%, p<0.01) and NPV (82.0% vs. 95.1%, p<0.05) were observed. PET/MRI offered higher lesion conspicuity (PET/CT: 2.0±1.1 [median: 2; range 0-3]; PET/MRI: 2.8±0.5 [median: 3; range 0-3]; p<0.001) and diagnostic confidence (PET/CT: 2.0±0.8 [median: 2; range: 1-3]; PET/MRI 2.6±0.6 [median: 3; range: 1-3]; p<0.001). Furthermore, PET/MRI enabled the detection of additional PET-negative metastases (reader 1: 10; reader 2: 12). CONCLUSIONS PET/MRI offers higher diagnostic accuracy compared to PET/CT for the detection of liver metastases.
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Affiliation(s)
- Karsten Beiderwellen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Llanos Geraldo
- Department of Nuclear Medicine, University Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Verena Ruhlmann
- Clinic for Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philipp Heusch
- Department of Diagnostic and Interventional Radiology, University of Duesseldorf, Duesseldorf, Germany
| | - Benedikt Gomez
- Clinic for Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas C. Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Current Status of Imaging to Evaluate Liver Metastases From Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Merkle EM, Zech CJ, Bartolozzi C, Bashir MR, Ba-Ssalamah A, Huppertz A, Lee JM, Ricke J, Sakamoto M, Sirlin CB, Ye SL, Zeng M. Consensus report from the 7th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 2015; 26:674-82. [PMID: 26070500 PMCID: PMC4747985 DOI: 10.1007/s00330-015-3873-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/21/2015] [Accepted: 06/02/2015] [Indexed: 12/13/2022]
Abstract
Objectives Liver-specific MRI is a fast-growing field, with technological and protocol advancements providing more robust imaging and allowing a greater depth of information per examination. This article reports the evidence for, and expert thinking on, current challenges in liver-specific MRI, as discussed at the 7th International Forum for Liver MRI, which was held in Shanghai, China, in October 2013. Methods Topics discussed included the role of gadoxetic acid-enhanced MRI in the differentiation of focal nodular hyperplasia from hepatocellular adenoma and small hepatocellular carcinoma (HCC) from small intrahepatic cholangiocarcinoma (in patients with chronic liver disease), the differentiation of low-grade dysplastic nodule (DN) from pre-malignant high-grade DN and early HCC, and treatment planning and assessment of treatment response for patients with HCC and colorectal liver metastasis. Optimization of the gadoxetic acid-enhanced MRI protocol to gain robust arterial and hepatobiliary phase images was also discussed. Results and conclusions Gadoxetic acid-enhanced MRI demonstrates added value for the detection and characterization of focal liver lesions and shows promise in a number of new indications, including regional liver functional assessment and patient monitoring after therapy; however, more data are needed in some areas, and further developments are needed to translate cutting-edge techniques into clinical practice. Key Points • Liver-specific MRI is a fast-growing field, with many technological and protocol advancements. • Gadoxetic acid-enhanced MRI demonstrates value for detecting and characterizing focal liver lesions. • Gadoxetic acid-enhanced MRI shows promise in regional functional assessment and patient monitoring. • Further developments are needed to translate cutting-edge techniques into clinical practice.
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Affiliation(s)
- Elmar M Merkle
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
| | - Christoph J Zech
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | | | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Ba-Ssalamah
- Department of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | | | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, California, USA
| | - Sheng-Long Ye
- Department of Hepatic Oncology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Mengsu Zeng
- Radiologic Diagnostic Department, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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Bormann RL, da Rocha EL, Kierzenbaum ML, Pedrassa BC, Torres LR, D'Ippolito G. The role of gadoxetic acid as a paramagnetic contrast medium in the characterization and detection of focal liver lesions: a review. Radiol Bras 2015; 48:43-51. [PMID: 25798007 PMCID: PMC4366028 DOI: 10.1590/0100-3984.2013.1794] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023] Open
Abstract
Recent studies have demonstrated that the use of paramagnetic hepatobiliary contrast
agents in the acquisition of magnetic resonance images remarkably improves the
detection and differentiation of focal liver lesions, as compared with extracellular
contrast agents. Paramagnetic hepatobiliary contrast agents initially show the
perfusion of the lesions, as do extracellular agents, but delayed contrast-enhanced
images can demonstrate contrast uptake by functional hepatocytes, providing further
information for a better characterization of the lesions. Additionally, this
intrinsic characteristic increases the accuracy in the detection of hepatocellular
carcinomas and metastases, particularly the small-sized ones. Recently, a
hepatobiliary contrast agent called gadolinium ethoxybenzyl dimeglumine, that is
simply known as gadoxetic acid, was approved by the National Health Surveillance
Agency for use in humans. The authors present a literature review and a practical
approach of magnetic resonance imaging utilizing gadoxetic acid as contrast agent,
based on patients' images acquired during their initial experiment.
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Affiliation(s)
- Renata Lilian Bormann
- MDs, Fellows, Abdominal Imaging, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Eduardo Lima da Rocha
- MDs, Fellows, Abdominal Imaging, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Marcelo Longo Kierzenbaum
- MDs, Fellows, Abdominal Imaging, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Bruno Cheregati Pedrassa
- MDs, Fellows, Abdominal Imaging, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Lucas Rios Torres
- MD, Master, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Associate Professor, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Marcan M, Pavliha D, Music MM, Fuckan I, Magjarevic R, Miklavcic D. Segmentation of hepatic vessels from MRI images for planning of electroporation-based treatments in the liver. Radiol Oncol 2014; 48:267-81. [PMID: 25177241 PMCID: PMC4110083 DOI: 10.2478/raon-2014-0022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/10/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Electroporation-based treatments rely on increasing the permeability of the cell membrane by high voltage electric pulses delivered to tissue via electrodes. To ensure that the whole tumor is covered by the sufficiently high electric field, accurate numerical models are built based on individual patient geometry. For the purpose of reconstruction of hepatic vessels from MRI images we searched for an optimal segmentation method that would meet the following initial criteria: identify major hepatic vessels, be robust and work with minimal user input. MATERIALS AND METHODS We tested the approaches based on vessel enhancement filtering, thresholding, and their combination in local thresholding. The methods were evaluated on a phantom and clinical data. RESULTS Results show that thresholding based on variance minimization provides less error than the one based on entropy maximization. Best results were achieved by performing local thresholding of the original de-biased image in the regions of interest which were determined through previous vessel-enhancement filtering. In evaluation on clinical cases the proposed method scored in average sensitivity of 93.68%, average symmetric surface distance of 0.89 mm and Hausdorff distance of 4.04 mm. CONCLUSIONS The proposed method to segment hepatic vessels from MRI images based on local thresholding meets all the initial criteria set at the beginning of the study and necessary to be used in treatment planning of electroporation-based treatments: it identifies the major vessels, provides results with consistent accuracy and works completely automatically. Whether the achieved accuracy is acceptable or not for treatment planning models remains to be verified through numerical modeling of effects of the segmentation error on the distribution of the electric field.
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Affiliation(s)
- Marija Marcan
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Denis Pavliha
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | | | - Igor Fuckan
- Clinical Department for Diagnostic and Interventional Radiology, Clinical Hospital “Dubrava”, Zagreb, Croatia
| | - Ratko Magjarevic
- University of Zagreb, Faculty of Electrical Engineering and Computing, Zagreb, Croatia
| | - Damijan Miklavcic
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
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Current status of imaging and emerging techniques to evaluate liver metastases from colorectal carcinoma. Ann Surg 2014; 259:861-72. [PMID: 24509207 DOI: 10.1097/sla.0000000000000525] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. Liver is a common site of tumor spread and in approximately 30% of the cases; synchronous liver disease is present at the time of diagnosis. Early detection of liver metastases is crucial to appropriately select patients who may benefit from hepatic resection among those needing chemotherapy, to improve 5-year survival. Advances in imaging techniques have contributed greatly to the management of these patients. Multidetector computed tomography is the most useful test for initial staging and in posttreatment surveillance settings. Magnetic resonance imaging is considered superior to multidetector computed tomography and positron emission tomography for the detection and characterization of small lesions and for liver evaluation in the presence of background fatty liver changes. Positron emission tomography-computed tomography has a problem-solving role in the detection of distant metastasis and in posttreatment evaluation. The advanced imaging methods also serve a role in selecting appropriate patients for radiologically targeted therapies and in monitoring response to conventional and novel therapies.
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Thian YL, Riddell AM, Koh DM. Liver-specific agents for contrast-enhanced MRI: role in oncological imaging. Cancer Imaging 2013; 13:567-79. [PMID: 24434892 PMCID: PMC3893895 DOI: 10.1102/1470-7330.2013.0050] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
Liver-specific magnetic resonance (MR) contrast agents are increasingly used in evaluation of the liver. They are effective in detection and morphological characterization of lesions, and can be useful for evaluation of biliary tree anatomy and liver function. The typical appearances and imaging pitfalls of various tumours at MR imaging performed with these agents can be understood by the interplay of pharmacokinetics of these contrast agents and transporter expression of the tumour. This review focuses on the applications of these agents in oncological imaging.
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Affiliation(s)
- Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore 119074; Department of Diagnostic Radiology, Royal Marsden Hospital Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Angela M. Riddell
- Department of Diagnostic Imaging, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore 119074; Department of Diagnostic Radiology, Royal Marsden Hospital Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Dow-Mu Koh
- Department of Diagnostic Imaging, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore 119074; Department of Diagnostic Radiology, Royal Marsden Hospital Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
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