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Kudo M. Management of Hepatocellular Carcinoma in Japan as a World-Leading Model. Liver Cancer 2018; 7:134-147. [PMID: 29888204 PMCID: PMC5985410 DOI: 10.1159/000484619] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Garbagnati F, Spreafico C, Marchianò A, Frigerio LF, Patelli G, Gervasoni M, Giovannardi G, Damascelli B. Carbon Dioxide Digital Subtraction Angiography in Oncological-Interventional Radiology. TUMORI JOURNAL 2018; 81:52-5. [PMID: 7754543 DOI: 10.1177/030089169508100113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims and background The aim of this work is to demonstrate the usefulness of carbon dioxide, used as contrast agent, in special indications in vascular interventional oncological procedures. Methods We studied 40 patients with digital subtraction angiography enhanced with CO2 as a contrast agent. At the same time we utilized also, in all cases, jodinated contrast agent to evaluate the different opacification gradient, the different viscosity range and the different perfusion. Results The low viscosity of CO2 allows demonstration of the presence of even minimal blood losses in gastrointestinal tumors and enhances arteriovenous shunts in hepatocellular carcinoma. Carbon dioxide can also be employed to assess the patency of small-sized catheters for chemotherapy infusion which do not allow easy injection of the traditional iodinated contrast agents characterized by high viscosity. Conclusion Carboangiographic study combined to digital subtraction angiography can clear some diagnostic problems and is further method to assess the outcome of angiographic interventional procedures in oncology.
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Affiliation(s)
- F Garbagnati
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common type of cancer and the third leading cause of cancer-related death worldwide. HCC is most common in Asia, but its prevalence is rapidly increasing in Western countries; consequently, HCC is a global medical issue that urgently needs to be addressed. Japan is the only developed country that has experienced both hepatitis B-related and hepatitis C-related HCC and has a long history of innovation when it comes to new diagnostic and therapeutic modalities, such as computed tomography angiography, anatomical resection, ablation, and transarterial chemoembolization. Among these innovations, a nationwide surveillance program was well established by the 1980s, and such a long-term national program does not exist anywhere else in the world. SUMMARY More than 60% of the initially detected HCCs in Japan are Barcelona Clinic Liver Cancer stage 0 or A, which can undergo curative therapies such as resection, ablation, or transplantation. The recent 5-year survival rate of HCC patients in Japan was 43% and the median survival time was 50 months. In addition, both incidence and mortality rates are drastically declining as a result of the successful surveillance program, careful diagnostic flow, and extensive repeated treatments. KEY MESSAGE Japan's successful model in the surveillance, diagnosis, and treatment of HCC should be adopted as widely as possible to improve the survival of HCC patients worldwide.
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Affiliation(s)
- Masatoshi Kudo
- *Masatoshi Kudo, MD, PhD, Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohnohigashi, Osaka-Sayama 589-8511 (Japan), Tel. +81 72 366 0221, E-Mail
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Takayasu K, Arii S, Sakamoto M, Matsuyama Y, Kudo M, Ichida T, Nakashima O, Matsui O, Izumi N, Ku Y, Kokudo N, Makuuchi M. Clinical implication of hypovascular hepatocellular carcinoma studied in 4,474 patients with solitary tumour equal or less than 3 cm. Liver Int 2013; 33:762-70. [PMID: 23445409 DOI: 10.1111/liv.12130] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 01/21/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS To clarify the biological behaviour of small hypovascular hepatocellular carcinoma (HCC) because of insufficient evidence even though frequently encountered. METHODS The study covered naïve 4,474 patients who met solitary HCC ≤ 3 cm (mean, 2.1 cm), histopathologically proven and Child Pugh A or B. Macroscopic vascular invasion and distant metastasis were excluded. The hypovascularity of tumour was defined as hypo- or iso-enhancement in arterial phase of multiple dynamic imaging techniques. RESULTS Of them, 802 (18%) were hypovascular. The ratio of hypovascular HCC decreased as tumour size increased (P < 0.001) and most of them developed to hypervascular type when they grew over 1.5 cm. Hypovascular group showed a significantly higher ratio of well differentiated grade (P < 0.001) and marginally less incidence of microvascular invasion and metastases compared with hypervascular group. The histologic dedifferentiation (less differentiation) developed step-by-step as tumour size increased in hyper- and even hypovascular group. The des-γ-carboxy prothrombin (DCP) value ≥ 300 mAU/ml was closely correlated with increase of tumour size in both groups. Logistic regression analysis revealed five variables were independent predictors for hypovascular HCC; tumour size ≤ 1.5 cm, alpha-fetoprotein < 200 ng/ml, DCP < 40 mAU/ml, well differentiated grade, and positivity for hepatitis C virus antibody. CONCLUSIONS Hypovascular HCC was biologically less aggressive and developed with stepwise dedifferentiation and transformation to hypervascular appearance along with tumour growth. These results will help in leading correct diagnosis of small hypovascular tumour and assessing optimal treatment for hypovascular HCC ≤ 3 cm.
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Affiliation(s)
- Kenichi Takayasu
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
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Donadon M, Torzilli G. Intraoperative ultrasound in patients with hepatocellular carcinoma: from daily practice to future trends. Liver Cancer 2013; 2:16-24. [PMID: 24159592 PMCID: PMC3747551 DOI: 10.1159/000346421] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Starting from the end of the 1970s, intraoperative ultrasound was introduced and developed to stage liver disease and guide the surgical interventions in patients with hepatocellular carcinoma. Without intraoperative ultrasound, it would probably be impossible to correctly define the hepatic segments as well as the limits of a tumor, also because of the existing wide variations in the anatomy. More importantly, intraoperative ultrasound allows for three-dimensional reconstruction of the relationships between the tumor, hepatic veins, and Glissonian pedicles. Such reconstruction is essential for planning the surgical strategy, which should be individualized in each patient with the aim to spare functional liver parenchyma. This work focuses on the role of intraoperative ultrasound to stage liver disease and to plan surgical resection, describing the most recent technical achievements.
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Affiliation(s)
| | - Guido Torzilli
- *Guido Torzilli, MD, PhD, Liver Surgery Unit, Department of General Surgery, University of Milan School of Medicine, Humanitas Cancer Center, Via Manzoni 56, IT–20089 Rozzano (Italy), E-Mail
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Kitano M, Sakamoto H, Kudo M. Endoscopic ultrasound: contrast enhancement. Gastrointest Endosc Clin N Am 2012; 22:349-58, xi. [PMID: 22632956 DOI: 10.1016/j.giec.2012.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The development of ultrasound contrast agents has allowed for the evaluation of vascularity in digestive organs by contrast-enhanced endoscopic ultrasonography (EUS). Contrast-enhanced Doppler EUS and contrast-enhanced harmonic EUS (CH-EUS) have improved characterization of pancreatic tumors, lymph nodes, and gastrointestinal submucosal tumors and compliment EUS fine-needle aspiration (FNA) in identifying malignant tumors. Moreover, CH-EUS can be used to identify the target for EUS-guided FNA by clearly depicting the outline of the lesions.
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Affiliation(s)
- Masayuki Kitano
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohnohigashi, Osakasayama, 589-8511 Japan.
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Minami Y, Kudo M. Review of dynamic contrast-enhanced ultrasound guidance in ablation therapy for hepatocellular carcinoma. World J Gastroenterol 2011; 17:4952-9. [PMID: 22174544 PMCID: PMC3236587 DOI: 10.3748/wjg.v17.i45.4952] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 06/09/2011] [Accepted: 06/16/2011] [Indexed: 02/06/2023] Open
Abstract
Local ablative techniques-percutaneous ethanol injection, microwave coagulation therapy and radiofrequency ablation (RFA)-have been developed to treat unresectable hepatocellular carcinoma (HCC). The success rate of percutaneous ablation therapy for HCC depends on correct targeting of the tumor via an imaging technique. However, probe insertion often is not completely accurate for small HCC nodules, which are poorly defined on conventional B-mode ultrasound (US) alone. Thus, multiple sessions of ablation therapy are frequently required in difficult cases. By means of two breakthroughs in US technology, harmonic imaging and the development of second-generation contrast agents, dynamic contrast-enhanced harmonic US imaging with an intravenous contrast agent can depict tumor vascularity sensitively and accurately, and is able to evaluate small hypervascular HCCs even when B-mode US cannot adequately characterize the tumors. Therefore, dynamic contrast-enhanced US can facilitate RFA electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of dynamic contrast-enhanced US guidance in ablation therapy for liver cancer is an efficient approach. Here, we present an overview of the current status of dynamic contrast-enhanced US-guided ablation therapy, and summarize the current indications and outcomes of reported clinical use in comparison with that of other modalities.
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Chen RC, Chou CT, Chen WT, Chen T, Lii JM, Chu D. Delineation of the Watershed between Right and Left Hepatic Arterial Territories with Carbon Dioxide–enhanced Ultrasonography. J Vasc Interv Radiol 2011; 22:667-72. [DOI: 10.1016/j.jvir.2010.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 11/30/2010] [Accepted: 12/07/2010] [Indexed: 12/15/2022] Open
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Kondo F. Assessment of stromal invasion for correct histological diagnosis of early hepatocellular carcinoma. Int J Hepatol 2011; 2011:241652. [PMID: 22007311 PMCID: PMC3170744 DOI: 10.4061/2011/241652] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/10/2011] [Indexed: 12/14/2022] Open
Abstract
Stromal invasion (invasive growth of tumor tissue into portal tracts and fibrous septa) is now recognized as the most important finding in the diagnosis of the well-differentiated type of early hepatocellular carcinomas (HCCs). In differentiating stromal invasion from pseudoinvasion (benign hepatic tissue in fibrous stroma), the following 5 items are useful: (1) macroscopic or panoramic views of the histological specimen, (2) the amount of fibrous components of stroma, (3) destruction of the structure of portal tracts, (4) loss of reticulin fibers around cancer cells, and (5) cytokeratin 7 immunostaining for ductular proliferation. Knowledge of stromal invasion is also useful for a better understanding of the vasculature (hypovascular HCCs) and histological features (fatty change) of early HCCs. Invasion of preexisting arteries and portal veins causes hypo-vascularity of HCCs. Further, hypovascularity causes fatty change as a hypoxic change of cancer tissues.
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Affiliation(s)
- Fukuo Kondo
- Department of Pathology, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan,*Fukuo Kondo:
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Minami Y, Kudo M. Contrast-enhanced harmonic ultrasound imaging in ablation therapy for primary hepatocellular carcinoma. World J Radiol 2009; 1:86-91. [PMID: 21160724 PMCID: PMC2999306 DOI: 10.4329/wjr.v1.i1.86] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/10/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
The success rate of percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) depends on correct targeting via an imaging technique. However, RF electrode insertion is not completely accurate for residual HCC nodules because B-mode ultrasound (US), color Doppler, and power Doppler US findings cannot adequately differentiate between treated and viable residual tumor tissue. Electrode insertion is also difficult when we must identify the true HCC nodule among many large regenerated nodules in cirrhotic liver. Two breakthroughs in the field of US technology, harmonic imaging and the development of second-generation contrast agents, have recently been described and have demonstrated the potential to dramatically broaden the scope of US diagnosis of hepatic lesions. Contrast-enhanced harmonic US imaging with an intravenous contrast agent can evaluate small hypervascular HCC even when B-mode US cannot adequately characterize tumor. Therefore, contrast-enhanced harmonic US can facilitate RF ablation electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of contrast-enhanced harmonic US in ablation therapy for liver cancer is an efficient approach.
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Hu YZ, Zhu JA, Jiang YG, Hu B. Ultrasound microbubble contrast agents: application to therapy for peripheral vascular disease. Adv Ther 2009; 26:425-34. [PMID: 19381521 DOI: 10.1007/s12325-009-0020-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Indexed: 10/20/2022]
Abstract
Ultrasound contrast agents are not only effective in ultrasonic imaging but are also important tools for drug or gene delivery. Ultrasound beams can disrupt microbubbles and cell membranes, offering the opportunity to locally deliver drugs or genes. Liposome-shelled microbubbles have many advantages and are widely used in many applications, while Lipofectamine (Invitrogen, Life Technologies, Carlsbad, CA, USA), as a material of microbubble membranes, has been used to enhance the effects of gene delivery. Ultrasound contrast agents that have therapeutic effects can be used for treating peripheral vascular diseases, particularly in thrombotic and angiogenic diseases. A combination of targeted contrast agent and drug-carrying contrast agent may be safer and more effective in treating thrombosis. Vascular endothelial growth factor-loaded microbubbles are expected to treat a variety of neovascular diseases such as severe limb ischemia and other diseases. Although there are several limitations in the application of therapeutic ultrasound microbubble contrast agents, it will offer a new hope for the treatment of peripheral vascular disease.
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Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 2009; 49:658-64. [PMID: 19177576 DOI: 10.1002/hep.22709] [Citation(s) in RCA: 556] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Maruyama H, Yoshikawa M, Yokosuka O. Current role of ultrasound for the management of hepatocellular carcinoma. World J Gastroenterol 2008; 14:1710-9. [PMID: 18350602 PMCID: PMC2695911 DOI: 10.3748/wjg.14.1710] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) has a decisive influence on the prognosis of cirrhotic patients. Although α-fetoprotein (AFP) is a known and specific tumor maker for HCC, it is not suitable for the screening and surveillance of HCC because of its poor predictive value and low sensitivity. The use of imaging modalities is essential for the screening, diagnosis and treatment of HCC. Ultrasound (US) plays a major role among them, because it provides real-time and non-invasive observation by a simple and easy technique. In addition, US-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of HCC. The development of digital technology has led to the detection of blood flow by color Doppler US, and the sensitivity for detecting tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents. Moreover, near real-time 3-dimensional US images are now available. As for the treatment of HCC, high intensity focused ultrasound (HIFU) was developed as a novel technology that provides a transcutaneous ablation effect without needle puncture. These advancements in the US field have led to rapid progress in HCC management, and continuing advances are expected. This article reviews the current application of US for HCC in clinical practice.
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Miyamoto N, Hiramatsu K, Tsuchiya K, Sato Y. Carbon dioxide microbubbles-enhanced sonographically guided radiofrequency ablation: treatment of patients with local progression of hepatocellular carcinoma. ACTA ACUST UNITED AC 2008; 26:92-7. [PMID: 18301986 DOI: 10.1007/s11604-007-0198-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 10/09/2007] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of our study was to evaluate the usefulness of percutaneous radiofrequency ablation (RFA) using CO2 microbubbles-enhanced sonography for patients with local tumor progression of hepatocellular carcinoma (HCC). MATERIALS AND METHODS The tumors of 14 patients with local progression of HCC were treated with CO2 microbubbles-enhanced RFA ablation via a catheter that had been placed in the hepatic artery. We assessed tumor detectability and technical effectiveness. The mean follow-up period was 14.1 months. RESULTS Only 6 of the tumors could be found on conventional sonography, whereas 14 tumors were detected on CO2 microbubbles-enhanced sonography. These 14 lesions were successfully treated with RFA guided by CO2 microbubbles-guided sonography. Technical effectiveness was complete in all patients. No serious complications were observed, and there was no local tumor progression during the follow-up period. CONCLUSION RFA guided by CO2 microbubbles-guided sonography is a feasible technique for treating local progression of HCC lesions that cannot be adequately depicted by conventional sonography.
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Affiliation(s)
- Noriyuki Miyamoto
- Department of Radiology, JA Hokkaido Koseiren Obihiro Kosei General Hospital, W6 S8, Obihiro, 080-0013, Japan.
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Fukunaga T, Kudo M, Tochio H, Okabe Y, Orino A. Natural course of small nodular lesions with intranodular preserved portal supply in cirrhotic liver. Oncology 2007; 72 Suppl 1:24-9. [PMID: 18087179 DOI: 10.1159/000111704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Due to recent advances in imaging technology, small nodules or lesions in cirrhotic liver are now seen easily. Intranodular blood supply is useful in characterizing these nodules. However, nodules with preserved portal blood supply may be malignant or benign, and it is unknown how often these nodules develop into overt hepatocellular carcinoma (HCC). This study was performed to clarify the rate of malignant transformation in such lesions with preserved portal perfusion in cirrhotic liver. METHODS From 1995 to 1997, in 98 patients, we performed CT during arterial portography and ultrasound angiography with intra-arterial CO2 injection for 113 nodules <3 cm in diameter to determine the intranodular blood supply. Of these, 48 nodules in 36 patients were diagnosed as 'benign nature nodules' on the basis of the blood supply of the nodules, which included arterial hypovascularity with preserved portal supply. Percutaneous biopsy of the nodule was undertaken for all nodules for histopathologic diagnosis. Thirty-two nodules in 22 patients that were not diagnosed as early HCC were followed-up clinically without any treatment to clarify the natural course of the nodules. RESULTS Twelve nodules in 14 patients did not increase in size and no new nodules appeared in any part of the liver. Ten nodules in 7 patients did not increase in size or arterial vascularity but typical overt HCC appeared in other areas of the liver. Only two nodules in 2 patients increased in size and developed into hypervascular overt HCC during the 15- and 34-month observation periods, respectively. CONCLUSION Nodules with preserved portal perfusion in cirrhotic liver have a low risk of malignant transformation compared with the surrounding liver parenchyma.
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Affiliation(s)
- Toyokazu Fukunaga
- Division of Gastroenterology, Department of Internal Medicine, Kitano Hospital, Osaka, Japan
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Salem N, MacLennan GT, Kuang Y, Anderson PW, Schomisch SJ, Tochkov IA, Tennant BC, Lee Z. Quantitative evaluation of 2-deoxy-2[F-18]fluoro-D-glucose-positron emission tomography imaging on the woodchuck model of hepatocellular carcinoma with histological correlation. Mol Imaging Biol 2007; 9:135-43. [PMID: 17308952 DOI: 10.1007/s11307-007-0092-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The Eastern woodchuck (Marmota monax) is considered as a naturally occurring animal model of hepatocellular carcinoma (HCC). The performance of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) for imaging HCC on the woodchuck using Positron emission tomography (PET) was investigated in this study. PROCEDURES Dynamic FDG-PET scans were performed on five woodchucks with HCC and one healthy woodchuck before removal and processing of the liver tissues for histology. The parameters of a two-tissue compartment model with dual input were estimated using weighted least squares (WLS). RESULTS Ten HCCs were confirmed histologically. Six HCCs had a tumor-to-liver standardized uptake value (SUV) ratio < or =1.15, a k (4) / k (3) ratio similar to that in hepatic tissues and were well-differentiated. Four HCCs had a tumor-to-liver SUV ratio >1.15, a lower k (4) / k (3) ratio than the hepatic tissues and were moderately differentiated. CONCLUSIONS Increased FDG uptake was observed in HCCs that were the least differentiated and correlated with a lower k (4) / k (3) ratio.
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Affiliation(s)
- Nicolas Salem
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
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Nagaoka S, Itano S, Nagamatsu H, Akiyoshi J, Kurogi J, Tajiri N, Kajiwara M, Sata M. Temporary indwelling catheter system via the left brachial artery: evaluation in 83 patients with hepatic tumors. AJR Am J Roentgenol 2007; 188:652-8. [PMID: 17312050 DOI: 10.2214/ajr.05.0693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate retrospectively the usefulness and complications associated with a temporary indwelling catheter system through the brachial artery for patients with liver tumors. CONCLUSION The temporary indwelling catheter system via the left brachial artery can be used not only for CO2-enhanced sonographically guided aspiration biopsy, radiofrequency ablation, and percutaneous ethanol injection, but also for short-term hepatic arterial infusion chemotherapy and transcatheter arterial chemoembolization.
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Affiliation(s)
- Sakae Nagaoka
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Asahimachi 67, Kurume, Fukuoka 830-0011, Japan.
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Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Kawase T, Yoshida K, Kuboki M, Yamamoto S. CO2-enhanced sonographically guided radiofrequency ablation and transcatheter arterial chemoembolization for small hepatocellular carcinoma poorly defined on conventional sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:78-81. [PMID: 17195192 DOI: 10.1002/jcu.20273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We report a case of hepatocellular carcinoma located just below the right hemidiaphragm that was diagnosed as having hepatitis C virus-related cirrhosis 12 years ago. Although the lesion was not clear on conventional sonography, it was clearly defined on CO(2)-enhanced sonography, allowing safe and accurate radiofrequency ablation. By combining radiofrequency ablation with transcatheter arterial chemoembolization, extensive cauterization and complete tumor necrosis were obtained with only 1 session of treatment. The patient had no serious adverse effects and has shown no recurrence during 35 months of follow-up.
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Affiliation(s)
- Kenji Ohmoto
- Division of Hepatology, Department of Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
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Maruyama H, Ebara M. Recent applications of ultrasound: diagnosis and treatment of hepatocellular carcinoma. Int J Clin Oncol 2007; 11:258-67. [PMID: 16937299 DOI: 10.1007/s10147-006-0585-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Indexed: 12/23/2022]
Abstract
Ultrasound (US) has the advantages of real-time observation, simple technique, and a noninvasive procedure compared to other imaging modalities. The recent development of digital technologies has enabled the observation of sonograms with improved signal-to-noise ratio, penetration, and spatial and contrast resolutions. Furthermore, microbubble contrast agents have increased the diagnostic ability of US examination, and the use of three-dimensional sonograms is now not unusual. These advances have furthered the usefulness of US for liver tumors in clinical practice. This article reviews the recent applications of US in the diagnosis and treatment of hepatocellular carcinoma.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
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Hagiwara S, Kudo M, Kawasaki T, Nagashima M, Minami Y, Chung H, Fukunaga T, Kitano M, Nakatani T. Prognostic factors for portal venous invasion in patients with hepatocellular carcinoma. J Gastroenterol 2006; 41:1214-9. [PMID: 17287901 DOI: 10.1007/s00535-006-1950-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 09/12/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Factors involved in portal venous invasion (PVI) must be clarified to enable better determination of therapeutic strategies and outcomes in patients with hepatocellular carcinoma (HCC). METHODS Of 365 patients with HCC who consulted our department between January 1999 and January 2003, 53 with PVI at the initial consultation were excluded, and the other 312 without PVI were included in this study. Of these patients, we compared liver function, tumor markers, and initial treatment between 287 patients without PVI during follow-up (until December 2004) and 25 patients who developed PVI, and investigated prognostic factors. RESULTS Multivariate analysis using a COX regression model showed that a Lens culinaris A-reactive fraction of alpha-fetoprotein (AFP-L3) rate of 15% or more, a des-gamma-carboxy prothrombin (DCP) level of 100 mAU/ml or more, multiple tumors, and a platelet count of 130 000/mm(3) or more were correlated with PVI. CONCLUSIONS HCC frequently infiltrated the portal vein in patients with a high rate of AFP-L3, a high level of DCP, or multiple tumors. Furthermore, the incidence of PVI was significantly higher in patients with a platelet count of 130 000/mm(3) or more.
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Affiliation(s)
- Satoru Hagiwara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan
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Takeshima K, Kumada T, Toyoda H, Kiriyama S, Tanikawa M, Ichikawa H, Kawachi T, Ogawa S. Comparison of IV Contrast-Enhanced Sonography and Histopathology of Pancreatic Cancer. AJR Am J Roentgenol 2005; 185:1193-200. [PMID: 16247133 DOI: 10.2214/ajr.04.1588] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We compared contrast-enhanced sonography findings with pathologic findings in pancreatic cancer to evaluate the ability of contrast-enhanced sonography to depict the pathologic changes associated with pancreatic cancer. SUBJECTS AND METHODS Thirty-four patients with pancreatic cancer who underwent surgery were investigated. Sonography was performed with contrast material (Levovist) for all patients before surgery. Pathologic findings were evaluated on the basis of the resected cancer specimens. We compared contrast-enhanced sonography findings with pathologic findings. RESULTS All tumors that were hyperechoic on contrast-enhanced sonography were papillary adenocarcinoma, and all tumors that were hypoechoic on contrast-enhanced sonography were ductal adenocarcinoma. Among ductal adenocarcinomas, five (71.4%) of seven tumors for which the size of the hypoechoic area was unchanged on contrast-enhanced sonography had clear tumor margins with no infiltration or inflammation in the margin. In contrast, all tumors for which the size of the hypoechoic area was reduced on contrast-enhanced sonography had unclear tumor margins with infiltration of cancerous cells and inflammation. Nine (90%) of 10 tumors that showed partial contrast enhancement or a vascular shadow in a hypoechoic area had large or medium-sized vessels within a tumor at pathology. In contrast, only one (4.8%) of 21 tumors that did not show the vascular shadow in a hypoechoic area had no large or medium-sized vessels in a tumor. CONCLUSION Contrast-enhanced sonography well reflects the pathologic changes of pancreatic cancer and will provide useful information in a pretreatment evaluation. Further studies with a large number of patients will be required to confirm this finding.
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Affiliation(s)
- Kenji Takeshima
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, 4-86 Minaminhokawa, Ogaki, Gifu 503-8502, Japan
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Yamamoto K, Shiraki K, Nakanishi S, Fuke H, Nakano T, Hashimoto A, Shimizu A, Hamataki T. 1.5 Harmonic Imaging Sonography with microbubble contrast agent improves characterization of hepatocellular carcinoma. World J Gastroenterol 2005; 11:5607-13. [PMID: 16237752 PMCID: PMC4481475 DOI: 10.3748/wjg.v11.i36.5607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the usefulness of 1.5 Harmonic Imaging Sonography with the use of the contrast agent Levovist for the diagnosis of hepatocellular carcinoma (HCC) and for the evaluation of therapeutic response.
METHODS: Phantom experiments were performed to compare the contrast effects of 2nd harmonic imaging and 1.5 Harmonic Imaging Sonography. 1.5 Harmonic Imaging Sonography was employed to examine 36 patients with HCC (42 nodules) before and after the treatment and to compare against the findings obtained using other diagnostic imaging modalities.
RESULTS: In 1.5 Harmonic Imaging Sonography, the tumor vessels of HCCs were clearly identified during the early phase, and late-phase images clearly demonstrated the differences in contrast enhancement between the tumor and surrounding hepatic parenchyma. Blood flow within the tumor was detected in 36 nodules (85.7%) during the early phase and in all 42 nodules (100%) during the late phase using 1.5 Harmonic Imaging Sonography, in 38 nodules (90.5%) using contrast-enhanced CT, in 34 nodules (81.0%) using digital subtraction angiography (DSA), and in 42 nodules (100%) using US CO2 angiography. Following transcatheter arterial embolization, 1.5 Harmonic Imaging Sonography detected blood flow and contrast enhancement within the tumors that were judged to contain viable tissue in 20 of 42 nodules (47.6%). However, 6 of these 20 cases were not judged in contrast-enhanced CT. 1.5 Harmonic Imaging Sonography was compared with the US CO2 angiography findings as the gold standard, and the sensitivity and specificity of these images for discerning viable and nonviable HCC after transcatheter arterial embolization were 100% and 100%, respectively.
CONCLUSION: 1.5 Harmonic Imaging Sonography permits the vascular structures of HCCs to be identified and blood flow within the tumor to be clearly demonstrated. Furthermore, 1.5 Harmonic Imaging Sonography is potentially useful for evaluating the therapeutic effects of transcatheter arterial embolization on HCC.
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Affiliation(s)
- Kouji Yamamoto
- First Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Kudo M. Early Detection and Characterization of Hepatocellular Carcinoma: Value of Imaging Multistep Human Hepatocarcinogenesis. Intervirology 2005; 49:64-9. [PMID: 16166791 DOI: 10.1159/000087265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The method for early detection of hepatocellular carcinoma (HCC) has been well established in Japan, by means of regularly screening patients at risk for developing HCC by imaging and serological markers of tumor. The principal screening protocol includes performing ultrasonography (US) every 3 months and testing for tumor markers every month in patients at high risk for HCC. There has been another important issue of accurate characterization of nodular lesions found in cirrhotic liver. This problem has been solved by the development of imaging modalities such as US angiography with intra-arterial injection of CO(2), computed tomography during hepatic arteriography and computed tomography during arterial portography. It is most important to differentiate the typical hemodynamic patterns of a low-grade dysplastic nodule having arterial hypovascularity with portal perfusion preserved from those of HCC characterized by arterial hypervascularity with decreased portal perfusion. At present, these findings are easily obtained by contrast-enhanced phase invasion harmonic imaging, which is a noninvasive US technology.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
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Minami Y, Kudo M, Kawasaki T, Chung H, Ogawa C, Shiozaki H. Treatment of hepatocellular carcinoma with percutaneous radiofrequency ablation: usefulness of contrast harmonic sonography for lesions poorly defined with B-mode sonography. AJR Am J Roentgenol 2004; 183:153-6. [PMID: 15208130 DOI: 10.2214/ajr.183.1.1830153] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the usefulness of contrast harmonic sonography guidance in percutaneous radiofrequency ablation of hepatocellular carcinomas that could not be adequately depicted by B-mode sonography. SUBJECTS AND METHODS. Twenty-one patients with 21 hepatocellular carcinomas prospectively underwent radiofrequency ablation treatment with contrast harmonic sonography as guidance. Twenty-five patients with 25 hepatocellular carcinomas were retrospectively selected as the historical control group under the same conditions as the study group; the control group patients were treated under B-mode sonography guidance. RESULTS Twenty (95.2%) of the 21 patients were successfully treated during a single treatment session, and the remaining patient (4.8%) required two treatment sessions with contrast harmonic guidance. On the other hand, only eight (32%) of the 25 control subjects were successfully treated during a single treatment session using B-mode sonographic guidance without contrast imaging. The difference between these two groups was statistically significant (p = 0.002). CONCLUSION Contrast harmonic sonography helps in the placement of radiofrequency ablation electrodes in hypervascular hepatocellular carcinomas that cannot be adequately depicted by B-mode sonography.
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Affiliation(s)
- Yasunori Minami
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan
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Kumada T, Nakano S, Toyoda H, Hayashi K, Kiriyama S, Sone Y, Tanikawa M, Hisanaga Y, Yamamoto A, Takeshima K, Hibi T, Yabashi T, Noda T, Sassa T, Furukawa M, Ogawa S. Assessment of tumor hemodynamics in small hepatocellular carcinoma: comparison of Doppler ultrasonography, angiography-assisted computed tomography, and pathological findings. Liver Int 2004; 24:425-31. [PMID: 15482338 DOI: 10.1111/j.1478-3231.2004.0932.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
AIM We evaluated the usefulness of Doppler ultrasonography (DUS) for the analysis of tumor hemodynamics in small hepatocellular carcinoma (HCC). METHODS We compared Doppler ultrasound (DUS) findings with angiography-assisted computed tomography (Angio-CT) such as CT during arterial portography and during hepatic arteriography in the evaluation of the intratumoral hemodynamics, and with pathologic findings in 45 small HCC nodules (< or =3.0 cm in diameter) of 43 patients. DUS flow pattern of each nodule was categorized into three types: afferent continuous flow (Type 1), afferent pulsatile flow with afferent continuous flow (Type 2), and afferent pulsatile flow without afferent continuous flow (Type 3). Intratumoral blood supply was determined by Angio-CT, and pathologic findings were evaluated on resected or biopsied specimen. RESULTS Based on Angio-CT findings, Type 1 nodules showed decreased arterial blood supply (ABS) without decreased portal blood supply (PBS). Type 2 nodules showed unchanged ABS but decreased PBS. Type 3 nodules showed both increased ABS and decreased PBS. DUS findings well represented blood supply of HCC evaluated by Angio-CT. In addition, all Type 1 and 2 nodules were well-differentiated HCC, and all Type 3 nodules were moderately or poorly differentiated HCC; DUS findings well reflected differentiation of HCC. CONCLUSIONS DUS is a non-invasive imaging method and can be used for the evaluation of the stage of malignancy of small HCC.
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Affiliation(s)
- Takashi Kumada
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu 503-8502, Japan.
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Kim SR, Maekawa Y, Imoto S, Sugano M, Kudo M. Hypervascular Liver Nodules in Heavy Drinkers of Alcohol. Alcohol Clin Exp Res 2004. [DOI: 10.1111/j.1530-0277.2004.tb03239.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Murakami T, Hori M, Kim T, Hashimoto K, Dono K, Hayashi S, Sugihara E, Nagano H, Sase S, Sakon M, Monden M, Nakamura H. Xenon-Inhalation Computed Tomography for Noninvasive Quantitative Measurement of Tissue Blood Flow in Hepatocellular Carcinoma. Invest Radiol 2004; 39:210-5. [PMID: 15021324 DOI: 10.1097/01.rli.0000119147.62137.fd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to separately measure the arterial and portal venous tissue blood flow (TBF) of hepatocellular carcinoma (HCC) with a noninvasive method using xenon inhalation CT (xenon-CT) and to differentiate between well-differentiated HCCs and moderately and poorly differentiated HCCs. MATERIALS AND METHODS Total, arterial and portal venous TBFs of 38 surgically proven HCC nodules from 38 patients were measured by means of xenon-CT. Serial abdominal CT scans were obtained before and after inhalation of nonradioactive xenon gas. TBF was computed using the Fick principle, after which the correlation between TBF and pathologic features of the tumors was determined. RESULTS Total, arterial, and portal venous TBFs of HCC were 125.7 +/- 59.9 mL/min/100g, 102.5 +/- 37.3, and 22.2 +/- 11.4, respectively, and the corresponding findings for hepatic parenchyma were 67.3 +/- 13.1, 25.2 +/-9.6, and 42.4 +/- 11.0. Total and arterial TBFs of HCC were significantly higher than those of the hepatic parenchyma (P < 0.01), whereas portal venous TBF of HCC was significantly lower than that of hepatic parenchyma (P < 0.01). Arterial TBF of moderately or poorly differentiated HCC (120.4 +/- 38.2) was significantly higher than that of well-differentiated HCC (60.4 +/- 43.5) (P < 0.01). CONCLUSIONS Arterial and portal venous TBFs of HCC could be measured separately, noninvasively, and safely with xenon-CT. Correlation between TBF and pathologic features of tumors indicate that xenon-CT can be used to differentiate between well-differentiated HCCs and moderately and poorly differentiated HCCs.
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Affiliation(s)
- Takamichi Murakami
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Ando E, Tanaka M, Yamashita F, Kuromatsu R, Takada A, Fukumori K, Yano Y, Sumie S, Okuda K, Kumashiro R, Sata M. Diagnostic clues for recurrent hepatocellular carcinoma: comparison of tumour markers and imaging studies. Eur J Gastroenterol Hepatol 2003; 15:641-8. [PMID: 12840676 DOI: 10.1097/00042737-200306000-00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To elucidate the usefulness of monitoring Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) and des-gamma-carboxy prothrombin detected with a revised kit (DCP-R) as clues to the diagnosis of recurrent hepatocellular carcinoma (HCC). METHODS A total of 57 patients with HCC were enrolled in the study. They were classified into two groups: group A comprised 27 patients in whom the diagnostic clue to recurrent HCC appeared before November 1997; these patients were monitored by ultrasonography, computed tomography (CT), AFP and des-gamma-carboxy prothrombin detected with a conventional kit (DCP-C). Group B comprised 30 patients in whom the diagnostic clue to recurrent HCC was detected after November 1997; these patients were monitored by ultrasound, CT, AFP, AFP-L3 and DCP-R. RESULTS In group A, 22 and five HCC recurrences were recognized initially by imaging studies and tumour markers, respectively. In group B, 17 and 13 HCC recurrences were recognized initially by imaging studies and tumour markers, respectively. The number of patients in whom tumour markers were the first clue to the diagnosis of recurrent HCC was significantly higher in group B than in group A. CONCLUSIONS Periodic examination of AFP-L3 and DCP-R may be useful for the early detection of recurrent HCC.
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Affiliation(s)
- Eiji Ando
- Second Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka-ken, Japan.
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Vilana R, Llovet JM, Bianchi L, Sanchez M, Pagés M, Sala M, Gilabert R, Nicolau C, Garcia A, Ayuso C, Bruix J, Bru C. Contrast-enhanced power Doppler sonography and helical computed tomography for assessment of vascularity of small hepatocellular carcinomas before and after percutaneous ablation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:119-128. [PMID: 12594796 DOI: 10.1002/jcu.10151] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE We compared the usefulness of Levovist-enhanced power Doppler imaging (PDI) and helical CT in the depiction of tumor vascularity before and after percutaneous ablation of small hepatocellular carcinomas (HCCs). METHODS Thirty-one cirrhotic patients with solitary unresectable HCCs smaller than 5 cm (mean size, 2.7 +/- 0.8 cm; range, 1.5-5.0 cm) recruited over a 15-month period were treated with percutaneous ethanol injection (n = 9) or radiofrequency ablation (n = 22). PDI, contrast-enhanced PDI (using Levovist), and multiphase contrast-enhanced helical CT were performed before and after percutaneous ablation, and vascularity findings were compared. RESULTS Levovist significantly increased baseline intratumoral Doppler signals on PDI compared to non-contrast PDI. The most frequent tumor vascularity pattern was heterogeneous (45%). Vascularity was identified in all tumors by both contrast-enhanced PDI and helical CT before ablation. After percutaneous ablation, intratumoral vascularity was detected in 11 tumors by contrast-enhanced PDI and in 15 tumors by CT. The sensitivity, specificity, and diagnostic accuracy of contrast-enhanced PDI in demonstrating intratumoral vascularity, with CT being the gold standard, were 66%, 93%, and 81%, respectively. There was significant agreement between the 2 modalities in the depiction of tumor vascularity after ablation (kappa = 0.6, p = 0.001). However, there were 5 false negatives and 1 false positive with contrast-enhanced PDI. Complete tumor necrosis was achieved in 21 patients (68%). CONCLUSIONS There was a good concordance between contrast-enhanced PDI and helical CT in the depiction of HCC vascularity before and after percutaneous ablation. However, although contrast-enhanced PDI may be useful for real-time guidance of treatment, its low sensitivity makes it inadequate to accurately assess the completeness of ablation.
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Affiliation(s)
- Ramon Vilana
- Radiology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Calle Villarroel, 170, 08036 Barcelona, Spain
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Chen RC, Chen WT, Liao LY, Cheng NY, Wang CK, Tu HY, Wang CS, Chen PH. Intravenous contrast-enhanced Doppler sonography and intra-arterial carbon dioxide-enhanced sonography in the assessment of hepatocellular carcinoma vascularity before and after treatment. Acta Radiol 2002. [PMID: 12225484 DOI: 10.1034/j.1600-0455.2002.430412.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare i.v. contrast-enhanced sonography (CEUS), power Doppler sonography (PDUS) and i.a. carbon dioxide-enhanced sonography (CO2US) in assessing hepatocellular carcinoma (HCC) vascularities before and after treatment. Differences between PDUS and CEUS with the aid of CO2US were also observed. MATERIAL AND METHODS In all, 43 patients with 67 histologically proved HCCs were examined with PDUS, CEUS, and CO2US. Among these tumors, 36 were HCCs before treatment and 31 were HCCs treated by transcatheter arterial chemoembolization or percutaneous ethanol injection or a combination of these two treatments. CO2US was used as the gold standard when comparing the PDUS and CEUS. RESULTS Of the 36 untreated HCC tumors, 20 (55.6%) were hypervascular compared with the liver parenchyma at PDUS, 28 (77.8%) at CEUS, 31 (86.1%) at the early phase of CO2US and 32 (88.9%) at the late phase of CO2US. Of the 31 post-treatment HCCs, 11 (35.5%) showed hypervascularity at PDUS, 25 (80.6%) at CEUS, 25 (80.6%) at the early phase of CO2US and 26 (83.9%) at the late phase of CO2US. CONCLUSION CO2US was superior to CEUS and CEUS was superior to PDUS for the detection of tumor vascularity in both untreated and treated HCCs. The duration of enhancement at CEUS was shorter than at CO2US. The ability of CO2US to detect additional small tumors was not possible with PDUS and CEUS.
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Affiliation(s)
- R-C Chen
- Department of Radiology, Taipei Municipal Jen-Ai Hospital, Taipei, Taiwan
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Tajima T, Honda H, Taguchi K, Asayama Y, Kuroiwa T, Yoshimitsu K, Irie H, Aibe H, Shimada M, Masuda K. Sequential hemodynamic change in hepatocellular carcinoma and dysplastic nodules: CT angiography and pathologic correlation. AJR Am J Roentgenol 2002; 178:885-97. [PMID: 11906868 DOI: 10.2214/ajr.178.4.1780885] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to clarify the hemodynamic changes associated with hepatocarcinogenesis using CT angiography. MATERIALS AND METHODS Eighty-six hepatocellular lesions were confirmed at pathology in 49 patients who underwent CT with both hepatic arteriography and arterioportography. These images were compared with lesion-to-liver vascular ratios of cumulative arteries, preexisting hepatic arteries, and portal veins in resected specimens. Lesions were classified in five groups according to intranodular hemodynamics determined by CT hepatic arteriography and CT during arterioportography: group 1, isoattenuating on both procedures; group 2, hypoattenuating on CT hepatic arteriography and isoattenuating on CT during arterioportography; group 3, hypoattenuating on both procedures; group 4, isoattenuating on CT hepatic arteriography and hypoattenuating on CT during arterioportography; and group 5, hyperattenuating on CT hepatic arteriography and hypoattenuating on CT during arterioportography. RESULTS Among 86 lesions, we identified seven low-grade dysplastic nodules, eight high-grade dysplastic nodules, 14 well-differentiated hepatocellular carcinomas, 45 moderately differentiated hepatocellular carcinomas, and 12 poorly differentiated hepatocellular carcinomas. The lesions were classified as group 1 (n = 5), group 2 (n = 13), group 3 (n = 6), group 4 (n = 2), or group 5 (n = 60). Intranodular hemodynamics was significantly correlated with pathologic grading (p < 0.001). For correlations between combinations of the groups and pathologic gradings, the order "groups 1-2-3-4-5" was the most significant (p < 0.001). CONCLUSION During hepatocarcinogenesis, most hepatocellular nodules show deterioration of arterial blood flow before loss of portal blood flow. Vascular imaging of hepatic nodules may predict malignant abnormality via the early loss of hepatic arterial flow seen before portal flow changes.
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Affiliation(s)
- Tsuyoshi Tajima
- Department of Radiology, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Leen E, Angerson WJ, Yarmenitis S, Bongartz G, Blomley M, Del Maschio A, Summaria V, Maresca G, Pezzoli C, Llull JB. Multi-centre clinical study evaluating the efficacy of SonoVue (BR1), a new ultrasound contrast agent in Doppler investigation of focal hepatic lesions. Eur J Radiol 2002; 41:200-6. [PMID: 11861094 DOI: 10.1016/s0720-048x(01)00457-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES SonoVue is a new ultrasound contrast agent, which consists of stabilised microbubbles of a sulphur hexafluoride gas. The aim of the study was to assess its efficacy in the Doppler investigation of focal hepatic lesions. MATERIALS AND METHODS Seventy patients with focal liver tumours were studied. Four doses (0.3, 0.6, 1.2 and 2.4 ml) of SonoVue were administered intravenously with at least 10 min delay between each injection. A complete colour/power and spectral Doppler imaging investigation of the lesions was performed at baseline pre-dosing and after each SonoVue injection. All examinations were recorded on SVHS videotapes. Baseline and post contrast videotapes were reviewed by the on-site (un-blinded) investigators and by two off-site blinded readers (a) to grade the global quality of the Doppler scans of the focal lesions vascularity and the normal parenchymal vessels (b) to measure the duration of clinically useful Doppler signal enhancement and (c) to determine the diagnostic accuracy and performance of the enhanced versus unenhanced scans using histopathology, tumour markers, CT and/or MR as the reference standard. RESULTS A statistically significant improvement was observed at all four SonoVue doses in the off site assessment of global quality of the Doppler examination of tumoral and normal parenchymal vessels in comparison with the baseline (P < 0.05). The median duration of clinically useful enhancement was significantly increased with increasing doses (P < 0.001), ranging between 1.4-2.2 min for the lowest dose and 3.2-3.8 min for the highest dose for the off-site readers. On-site assessment of diagnostic accuracy showed a significant increase in the specificity of the Doppler diagnoses (P < 0.0016) with an increase in the positive and negative predictive values and in the likelihood ratio in differentiating between benign and malignant lesions. Off-site evaluation showed a significant increase in the accuracy of enhanced Doppler diagnosis in comparison with the baseline performance. CONCLUSION The results suggest that SonoVue is effective in improving the display of tumoral vascularisation and may be useful in the characterisation of focal liver lesions.
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Affiliation(s)
- E Leen
- Radiology Department, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
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Chen RC, Chen WT, Tu HY, Cheng NY, Wang CK, Liao LY, Wang CS, Chen PH. Assessment of vascularity in hepatic tumors: comparison of power Doppler sonography and intraarterial CO(2)-enhanced sonography. AJR Am J Roentgenol 2002; 178:67-73. [PMID: 11756089 DOI: 10.2214/ajr.178.1.1780067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of the study was to compare power Doppler sonography with intraarterial CO(2)-enhanced sonography for revealing vascularity in treated and untreated hepatic tumors. SUBJECTS AND METHODS Fifty-five patients with 93 liver tumors were prospectively examined with power Doppler sonography and CO(2)-enhanced sonography. These tumors included 29 hepatocellular carcinomas in patients with no previous treatment, 26 treated hepatocellular carcinomas, and 38 hemangiomas. The vascular depiction of power Doppler sonography was compared with that obtained in the early phase of CO(2)-enhanced sonography. The results of angiography were also recorded for comparison. RESULTS In the hepatocellular carcinomas, power Doppler sonography was the same as CO(2)-enhanced sonography in 18 (62%) of 29 tumors, was inferior to CO(2)-enhanced sonography in nine (31%) of 29 tumors, and was superior to CO(2)-enhanced sonography in two (7%) of 29 tumors. In the treated hepatocellular carcinomas, power Doppler sonography was the same as CO(2)-enhanced sonography in 15 (58%) of 26 tumors and was inferior in 11 (42%) of 26 tumors. In hemangiomas, the same vascularity was found in both studies in 15 (39%) of 38 tumors, CO(2)-enhanced sonography was superior in 22 (58%) of 38 tumors, and power Doppler sonography was superior in one (3%) of 38 tumors. As a whole, 45% of the 93 tumors showed better vascular depiction on CO(2)-enhanced sonography. However, 19.4% of tumors were hypovascular using power Doppler sonography but hypervascular using CO(2)-enhanced sonography. CONCLUSION Power Doppler sonography is a useful technique for screening hepatic tumor vascularity. CO(2)-enhanced sonography is superior to power Doppler sonography in depicting tumor vascularity in treated hepatocellular carcinomas and in hemangiomas, especially small hemangiomas.
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MESH Headings
- Adult
- Aged
- Angiography, Digital Subtraction
- Carbon Dioxide
- Carcinoma, Hepatocellular/blood supply
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/therapy
- Contrast Media
- Embolization, Therapeutic
- Ethanol/administration & dosage
- Female
- Hemangioma/blood supply
- Hemangioma/diagnostic imaging
- Hemangioma/therapy
- Humans
- Image Enhancement
- Infusions, Intra-Arterial
- Injections, Intralesional
- Liver Neoplasms/blood supply
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/therapy
- Male
- Middle Aged
- Neovascularization, Pathologic/diagnostic imaging
- Sensitivity and Specificity
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Pulsed
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Affiliation(s)
- Ran-Chou Chen
- Department of Radiology, Taipei Municipal Jen-Ai Hospital, 10, Sec. 4, Jen-Ai Rd., 106, Taipei, Taiwan
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Numata K, Tanaka K, Kiba T, Matsumoto S, Iwase S, Hara K, Kirikoshi H, Morita K, Saito S, Sekihara H. Nonresectable hepatocellular carcinoma: improved percutaneous ethanol injection therapy guided by CO(2)-enhanced sonography. AJR Am J Roentgenol 2001; 177:789-98. [PMID: 11566674 DOI: 10.2214/ajr.177.4.1770789] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of our study was to evaluate the usefulness of percutaneous ethanol installation using CO(2)-enhanced sonography for patients with nonresectable hepatocellular carcinoma (HCC). SUBJECTS AND METHODS Forty-six patients with 65 HCC lesions were examined with contrast-enhanced sonography with direct injection of CO(2) into the proper hepatic artery during arteriography. We performed percutaneous ethanol injection guided by CO(2)-enhanced sonography for the treatment of hypervascular HCC lesions that could not be treated with conventional percutaneous ethanol injection or with transcatheter arterial embolization. RESULTS CO(2)-enhanced sonography detected five additional small HCC lesions before treatment (p<0.05) and 14 new lesions during follow-up (p<0.01), than conventional sonography detected. CO(2)-enhanced sonography showed positive enhancement of residual lesions after initial treatment (n = 3) and incomplete local treatment (n = 5) that were not detected on conventional sonography. These 27 lesions were successfully treated with percutaneous ethanol injection using a mixture of iodized oil and ethanol and guided by CO(2)-enhanced sonography. CONCLUSION CO(2)-enhanced sonography is a sensitive method for detecting residual viable lesions and small new HCC lesions that cannot be detected with conventional sonography. Percutaneous ethanol injection guided by CO(2)-enhanced sonography can treat hypervascular HCC lesions that cannot be treated with conventional percutaneous ethanol injection or transcatheter arterial embolization.
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Affiliation(s)
- K Numata
- Third Department of Internal Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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36
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Contrast harmonic ultrasound is a breakthrough technology in the diagnosis and treatment of hepatocellular carcinoma. J Med Ultrason (2001) 2001. [DOI: 10.1007/bf02481273] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Tamano M, Oguma M, Iijima M, Murohisa T, Suzuki O, Matsumura A, Kojima K, Kuniyoshi T, Sugaya H, Terano A. Tumor cell proliferation of hepatocellular carcinoma, with special reference to ultrasonographic findings and arterial vascularity by US angiography. J Med Ultrason (2001) 2001. [DOI: 10.1007/bf02481279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Hara K, Numata K, Tanaka K, Saito S, Morimoto M, Ikeda M, Iwase S, Matsumoto S, Yonezawa H, Kubota T, Sekihara H. Diagnosis of advanced hepatocellular carcinoma using contrast-enhanced harmonic gray-scale imaging with enhancement agents (Levovist): Correlation with helical CT and US angiography. J Med Ultrason (2001) 2001. [DOI: 10.1007/bf02481280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Ding H, Kudo M, Onda H, Suetomi Y, Minami Y, Maekawa K. Hepatocellular carcinoma: depiction of tumor parenchymal flow with intermittent harmonic power Doppler US during the early arterial phase in dual-display mode. Radiology 2001; 220:349-56. [PMID: 11477236 DOI: 10.1148/radiology.220.2.r01au07349] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the effectiveness of contrast material-enhanced intermittent harmonic Doppler ultrasonography (US) in depicting tumor vessels and tumor parenchymal flow (stain) in hepatocellular carcinoma (HCC). MATERIALS AND METHODS Fifty-eight patients with 65 HCC nodules were examined by using intermittent harmonic power Doppler US and digital subtraction harmonic B-mode US, both with intravenous administration of SH U 508A. Vascular findings at early arterial phase harmonic US were classified as positive enhancement or nonenhancement, depending on the tumor vascularity relative to the surrounding liver parenchyma. These results were compared with those of three-phase helical dynamic computed tomography (CT). RESULTS For hypervascular HCCs, there was excellent depiction of tumor vessels and tumor stain with the two intermittent harmonic US methods. The sensitivity and specificity for depiction of tumor vascularity were 93% (41 of 44 nodules) and 100% (21 of 21), respectively, with intermittent harmonic power Doppler US and 86% (38 of 44) and 100% (21 of 21), respectively, with subtraction US, as compared with these values at dynamic CT. Attenuation was an important factor in the depictability of tumor vascularity at harmonic US. CONCLUSION Contrast-enhanced intermittent harmonic US enables noninvasive demonstration of tumor vessels and especially tumor stain in HCC.
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Affiliation(s)
- H Ding
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
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40
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Tissue harmonic imaging in the diagnosis of small hepatocellular carcinoma: Usefulness for detecting posterior acoustic enhancement. J Med Ultrason (2001) 2001. [DOI: 10.1007/bf02481358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Abstract
Ultrasound contrast agents consist of microbubbles, which are the most effective acoustic backscatters. The interaction between the insonating ultrasound beam and the microbubbles is very complex and basic understanding of their behavior under various sound fields has been fundamental to the development of improved methods of visualizing and displaying the contrast agents. Although echo enhancers have been under development for a long time, their clinical applications have been limited to enhancing the Doppler signals in difficult cases. However, recent advances in harmonic imaging and the development of new tissue-specific contrast agents stand to broaden the scope of ultrasound diagnostic potential beyond simply rescuing failed Doppler examinations. This article reviews the current and potential applications of ultrasound contrast harmonic imaging in the abdomen.
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Affiliation(s)
- E Leen
- Radiology Department, Royal Infirmary, University of Glasgow, Scotland.
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42
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Furuse J, Maru Y, Yoshino M, Mera K, Sumi H, Sekiguchi R, Satake M, Hasebe T, Ochiai A. Assessment of arterial tumor vascularity in small hepatocellular carcinoma. Comparison between color doppler ultrasonography and radiographic imagings with contrast medium: dynamic CT, angiography, and CT hepatic arteriography. Eur J Radiol 2000; 36:20-7. [PMID: 10996754 DOI: 10.1016/s0720-048x(00)00185-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hepatocellular carcinoma (HCC) is characterized by tumor vascularization from the hepatic artery. The objective of our work was to compare color Doppler ultrasonography (CDU), including power Doppler ultrasonography (PDU) with radiographic imagings with contrast medium in regard to the detection of the arterial tumor vascularity of small hepatocellular carcinomas (HCC). We examined 42 small HCC lesions 2 cm or less in diameter in 37 patients for arterial tumor vascularity by conventional CDU, PDU, dynamic computed tomography (dCT), digital subtraction angiography (DSA), and CT hepatic arteriography (CTA). Color images were detected in 25 (59.5%) and 28 (66.7%) of the 42 lesions with conventional CDU and PDU, respectively, and tumor vascularity was detected in 26 (61.9%) by dCT, 23 (54.8%) by DSA, and 29 (69.0%) by CTA. Tumor vascularity could be detected in 51.9% by PDU and CTA, more than by conventional CDU, dCT, and DSA (44.4, 44.4, and 33.3%, respectively) in well-differentiated HCC, whereas the detection rates by these techniques were almost equal (86.7% by CDU, 93.3% by PDU, dCT, and DSA, 100% by CTA, respectively) in moderately and poorly differentiated HCC. PDU is superior to CDU, dCT and DSA and equal to CTA for the detection of tumor vascularity in small HCC, particularly in well-differentiated HCC.
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Affiliation(s)
- J Furuse
- Department of Internal Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Chiba, Japan.
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43
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Imai Y, Murakami T, Yoshida S, Nishikawa M, Ohsawa M, Tokunaga K, Murata M, Shibata K, Zushi S, Kurokawa M, Yonezawa T, Kawata S, Takamura M, Nagano H, Sakon M, Monden M, Wakasa K, Nakamura H. Superparamagnetic iron oxide-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading. Hepatology 2000; 32:205-12. [PMID: 10915725 DOI: 10.1053/jhep.2000.9113] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging has been used for the detection of hepatic tumors. However, little is known about this technique in relation to hepatocellular carcinoma (HCC). The aim of this study was to investigate whether SPIO-enhanced MR imaging can be useful in assessing histological grades of HCC. The authors studied histologically proven tumors including 31 HCCs and 6 dysplastic nodules. The ratio of the Kupffer-cell count in the tumorous tissue relative to that in the nontumorous tissue (Kupffer-cell-count ratio) decreased as HCCs became less well differentiated. The ratio of the intensity of the tumorous lesion to that of the nontumorous area on SPIO-enhanced MR images (SPIO intensity ratio) correlated inversely with Kupffer-cell-count ratio in HCCs and dysplastic nodules (r = -.826, P <.001) and increased as the degree of differentiation of HCCs decreased, indicating that the uptake of SPIO in HCCs decreased as the degree of differentiation of HCCs declined. All of the dysplastic nodules and some well-differentiated HCCs showed hypointense or isointense enhancement, relative to the surrounding liver parenchyma, indicating greater or similar uptake of SPIO in the tumor when compared with nontumorous areas. These results suggest that SPIO-enhanced MR imaging reflects Kupffer-cell numbers in HCCs and dysplastic nodules, and is useful for estimation of histological grading in HCCs, although uncertainties persist in differentiating dysplastic nodules from well-differentiated HCCs.
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Affiliation(s)
- Y Imai
- Departments of Internal Medicine, Ikeda Municipal Hospital, Osaka, Japan.
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44
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Abstract
Hepatocellular carcinoma (HCC) is increasing in many countries as a result of an increase in hepatitis C virus (HCV) infection since World War II. The epidemiology of HCC varies with the global region. There have been conflicting observations from different parts of the world concerning the frequency of HCC in patients who in the distant past had post-transfusion non-A, non-B hepatitis. The genetic basis of hepatocarcinogenesis is still poorly understood. In hepatitis B virus (HVB) associated HCC, codon 249 mutation in the p 53 gene seems more related to exposure to aflatoxin B1 than to hepatocarcinogenesis itself. HCC that occurs in children in high HBV endemic regions could be associated with germ-line mutations, but little information is available; not much is known about chemical hepatocarcinogens in the environment other than aflatoxins. The X gene of HBV seems to play an important role in HBV-associated hepatocarcinogenesis. There are preliminary observations on the molecular mechanism of HCV-associated HCC, such as HCV core protein inducing HCC in transgenic mice and the NS3 genome transforming NIH 3T3 cells. Pathological distinction between preneoplastic and very early transformed lesions still depends on classical morphology, and a more genetically oriented differential diagnosis is required. Clinical diagnosis based on modern imaging has improved greatly, but is still unsatisfactory in the differential diagnosis of preneoplastic and early transformed nodules, because the vasculature changes that occur within the nodule are not accurately discerned with the current imaging. Use of sensitive des-gamma-carboxy prothrombin (PIVKA II) assay, and lectin affinity chromatography separating HCC specific subspecies of AFP molecules with a more practical biochemical technique will further improve diagnosis. Early diagnosis and transplantation are the best treatment at the moment, but transplantation is not widely available because of the donor shortage. Despite successful resection, the remnant cirrhotic liver frequently develops new HCC lesions, seriously curtailing long-term survival. All-out efforts should be directed to the prevention of HCC, through prevention of viral hepatitis, prevention of acute hepatitis from becoming chronic, prevention of chronic hepatitis from progressing to cirrhosis, and prevention of the cirrhotic liver from developing HCC (chemoprevention). At the moment, very few such studies exist.
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Affiliation(s)
- K Okuda
- Department of Medicine, Chiba University School of Medicine, Japan
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45
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Lim JH, Cho JM, Kim EY, Park CK. Dysplastic nodules in liver cirrhosis: evaluation of hemodynamics with CT during arterial portography and CT hepatic arteriography. Radiology 2000; 214:869-74. [PMID: 10715060 DOI: 10.1148/radiology.214.3.r00mr12869] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the portal and arterial blood supplies to dysplastic nodules in the cirrhotic liver with computed tomography (CT) during arterial portography (CTAP) and CT hepatic arteriography (CTHA). MATERIALS AND METHODS Nineteen histopathologically proved low-grade dysplastic nodules and 13 high-grade dysplastic nodules in 17 patients with liver cirrhosis were evaluated with CTAP and CTHA for the presence of portal and arterial blood supplies to the nodules. The nodules ranged from 0.4 to 4.5 cm in diameter (mean, 1.6 cm). RESULTS The portal supply was present in 14 of the 19 (74%) low-grade dysplastic nodules and in seven of the 13 (54%) high-grade dysplastic nodules. The hepatic arterial supply was increased in four of the 19 (21%) low-grade dysplastic nodules, present in nine (47%), and absent in six (32%). The arterial supply was increased in four of the 13 (31%) high-grade dysplastic nodules, present in four (31%), and absent in five (38%). CONCLUSION The portal and arterial supplies to the low- and high-grade dysplastic nodules were variable and inconsistent. Therefore, it is difficult to detect and characterize the dysplastic nodules on the radiologic images on the basis of the blood supply.
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Affiliation(s)
- J H Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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46
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Hayashi K, Kumada T, Nakano S, Takeda I, Sugiyama K, Kiriyama S, Sone Y, Miyata A, Shimizu H, Satomura S. Usefulness of measurement of Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein as a marker of prognosis and recurrence of small hepatocellular carcinoma. Am J Gastroenterol 1999; 94:3028-33. [PMID: 10520864 DOI: 10.1111/j.1572-0241.1999.01378.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3%) is a recently described marker of hepatocellular carcinoma (HCC), and its usefulness has been demonstrated in many studies. We evaluated the usefulness of serial measurement of AFP-L3% as a marker of prognosis and recurrence after treatment of small HCC. METHODS AFP-L3% was measured before and after initial treatment in 60 patients with small HCC (maximum diameter < or = 2 cm). AFP-L3% was taken as the ratio of AFP-L3 to total AFP and multiplied by 100%, and levels > or = 10% were considered positive. Outcomes and recurrence were compared between patients AFP-L3%-negative after initial treatment (Group A, n = 43) and patients who were AFP-L3%-positive after initial treatment (Group B, n = 17). RESULTS Before treatment, AFP-L3% was positive in 14 (23.3%) of the 60 patients. The cumulative survival rate of Group A was significantly longer (p = 0.0091) than that of Group B. The recurrence rate was significantly higher in Group B (p = 0.0104) than in Group A. When recurrence was limited to intrahepatic metastasis, the recurrence rate was significantly higher in Group B (p = 0.0064). However, the recurrence rate of multicentric occurrence did not differ significantly between Groups A and B. CONCLUSIONS Measurement of AFP-L3% after treatment may be useful for understanding prognosis and recurrence of HCC.
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Affiliation(s)
- K Hayashi
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
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47
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Kim SR, Hayashi Y, Kudo M, Matsuoka T, Imoto S, Sasaki K, Shintani S, Song KB, Park SY, Kim JH, Ando K, Koterazawa T, Kim KI, Ninomiya T. Inflammatory pseudotumor of the liver in a patient with chronic hepatitis C: difficulty in differentiating it from hepatocellular carcinoma. Pathol Int 1999; 49:726-30. [PMID: 10504540 DOI: 10.1046/j.1440-1827.1999.00927.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A case of an inflammatory pseudotumor of the liver in a 75-year-old female with chronic hepatitis C whose radiologic features simulated that of hepatocellular carcinoma (HCC) is presented. On imaging studies, hypervascularity by CO2 ultrasound (US) angiography, enhancement at an early phase and isodensity at a late phase by incremental dynamic computed tomography (CT), perfusion defect by CT during arteriography (CTAP), and clinical background of hepatitis C virus (HCV) infection strongly suggested HCC. A US-guided needle biopsy revealed a mainly diffuse and polyclonal proliferation of lymphocytes positive for leukocyte common antigen (pan-lymphocyte cells), L-26 (B cell lymphocytes), and UCHL-1 (T cell lymphocytes), negative for both kappa and lambda light chains and sparsely distributed neutrophils and histiocytes. No lymphoid follicles were observed. The liver tissue around this tumor showed chronic hepatitis with mild activity and mild fibrosis. These histopathologic findings suggested that the diagnosis of inflammatory pseudotumor of the liver was tenable. As it is difficult to differentiate between inflammatory pseudotumor of the liver and HCC by imaging studies alone, supplemental biopsy, where possible, should be obtained when diagnostic imaging of tumors suggesting HCC is carried out. We emphasize that histopathology is a true gold standard in the diagnosis of this disease.
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Affiliation(s)
- S R Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Japan.
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48
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Nakashima Y, Nakashima O, Hsia CC, Kojiro M, Tabor E. Vascularization of small hepatocellular carcinomas: correlation with differentiation. LIVER 1999; 19:12-8. [PMID: 9928760 DOI: 10.1111/j.1478-3231.1999.tb00003.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is generally considered a hypervascular tumor when visualized by angiography. However, small HCCs are not always found to be hypervascular. METHODS To evaluate this, 50 HCCs < or =3 cm in diameter were studied. The 50 tumors consisted of 16 well-differentiated HCCs, 25 moderately differentiated HCCs, and 9 that were each a mixture of well- and moderately differentiated HCC. RESULTS The mean number of portal tracts in the well-differentiated HCCs was 34% of the number in the surrounding nontumorous liver, and few intratumoral arterioles were seen. In contrast, the mean number of portal tracts in the moderately differentiated HCCs was 0.6% of the number in the surrounding nontumorous liver, and abundant intratumoral arterioles were seen. For HCCs that contained both well-differentiated and moderately differentiated tumor, the distribution of portal tracts and intratumoral arterioles in each portion was similar to that seen in well-differentiated or moderately differentiated HCC alone, respectively. HCCs that were larger than 1.5 cm in diameter had fewer portal tracts and more intratumoral arterioles than HCCs whose diameters were < or =1.5 cm. CONCLUSIONS As small HCCs increase in size and become increasingly dedifferentiated, the number of portal tracts apparently decreases and intratumoral arterioles develop. These findings may reflect changes in the hemodynamics as the HCC develops.
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Affiliation(s)
- Y Nakashima
- Division of Transfusion Transmitted Diseases, Food and Drug Administration, Bethesda, MD, USA
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49
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Kumada T, Nakano S, Takeda I, Kiriyama S, Sone Y, Hayashi K, Katoh H, Endoh T, Sassa T, Satomura S. Clinical utility of Lens culinaris agglutinin-reactive alpha-fetoprotein in small hepatocellular carcinoma: special reference to imaging diagnosis. J Hepatol 1999; 30:125-30. [PMID: 9927159 DOI: 10.1016/s0168-8278(99)80016-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Blood concentration levels of alpha-fetoprotein like the Lens culinaris agglutinin-reactive fraction (AFP-L3) are a useful marker for predicting the long-term prognosis of hepatocellular carcinoma. This study investigated the relationship between serum AFP-L3 and various imaging modalities. METHODS Sixty-three patients with small hepatocellular carcinomas < or = 2 cm in diameter were studied. Serum AFP-L3 concentrations were measured by lectin-affinity electrophoresis coupled with antibody-affinity blotting and expressed as % AFP-L3 (the percent of AFP-L3 as total AFP). A clinical "cutoff level" of 10% was used in this study to indicate the presence of hepatocellular carcinoma. Selective hepatic intraarterial digital subtraction angiography (DSA), ultrasonographic angiography with carbon dioxide microbubbles (USAG), and computed tomography during arterial portography (CTAP) were performed to evaluate the hemodynamics of hepatic nodules. RESULTS Fourteen (22.2%) of the 63 patients were positive for % AFP-L3. The % AFP-L3 levels (n=45, 4.4%) of patients with hypervascular tumors were significantly higher than those (n=15, 0.0%) of patients with isovascular or hypovascular tumors as determined by USAG (p=0.0061). The % AFP-L3 levels (n=53, 4.4%) of patients with a negative portal blood supply were significantly higher than the % AFP-L3 levels (n=7, 0.0%) of patients with a positive portal blood supply as determined by CTAP (p=0.0140). The % AFP-L3 levels of patients with tumors with a long doubling time (DT) were significantly lower than for patients with tumors with a short DT (p=0.0176). CONCLUSION AFP-L3 is a positive indicator which may be more specific for small advanced hepatocellular carcinoma.
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Affiliation(s)
- T Kumada
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki City, Gifu, Japan
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50
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Kawasaki T, Itani T, Nakase H, Mimura J, Komori H, Sugimoto K. Power Doppler imaging of hepatic tumours: differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma. J Gastroenterol Hepatol 1998; 13:1152-60. [PMID: 9870805 DOI: 10.1111/j.1440-1746.1998.tb00593.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We evaluated the usefulness of power Doppler imaging in the differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma. Forty-seven patients with hepatocellular carcinoma and 18 patients with metastatic adenocarcinoma were evaluated using power Doppler imaging. The colour signals of hepatic tumours were graded as follows: 1, colour signals only in the marginal area; 2, small dot or dotted line colour signals within the tumours; 3, continuous solid line colour signals within the tumours. The grade 3 colour signals were classified in the following three patterns; winding line pattern, stretched line pattern and mixed pattern. The colour signals of hepatocellular carcinoma were grade 1 in seven patients, grade 2 in 11 and grade 3 in 29. The colour signals of metastatic adenocarcinoma were grade 1 in three patients and grade 3 in 15. Of the 29 hepatocellular carcinoma patients with a grade 3 signal, 26 patients had winding line patterns and three had mixed patterns. Of the 15 metastatic adenocarcinoma patients with a grade 3 signal, 12 patients had stretched line patterns and three had mixed patterns. In conclusion, power Doppler imaging is useful in the differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma to evaluate the colour signal pattern within the tumour.
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Affiliation(s)
- T Kawasaki
- Gastroenterology Division, Nishi-Kobe Medical Center, Kobe, Japan.
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