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Kitagawa T, Kozaka K, Matsubara T, Wakayama T, Takamatsu A, Kobayashi T, Okumura K, Yoshida K, Yoneda N, Kitao A, Kobayashi S, Gabata T, Matsui O, Heiken JP. Fat fraction and R2 * values of various liver masses: Initial experience with 6-point Dixon method on a 3T MRI system. Eur J Radiol Open 2023; 11:100519. [PMID: 37609047 PMCID: PMC10440393 DOI: 10.1016/j.ejro.2023.100519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose To assess the feasibility of the 6-point Dixon method for evaluating liver masses. We also report our initial experience with the quantitative values in various liver masses on a 3T system. Materials and methods Of 251 consecutive patients for whom 6-point Dixon was employed in abdominal magnetic resonance imaging scans between October 2020 and October 2021, 117 nodules in 117 patients with a mass diameter of more than 1 cm were included in the study. Images for measuring the proton density fat fraction (PDFF) and R2 * values were obtained using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation-quantitative technique for liver imaging. Two radiologists independently measured PDFF (%) and R2 * (Hz). Inter-reader agreement and the differences between readers were examined using intra-class correlation coefficient (ICC) and the Bland-Altman method, respectively. PDFF and R2 * values in differentiating liver masses were examined. Results The masses included hepatocellular carcinoma (n = 59), cyst (n = 20), metastasis (n = 14), hemangioma (n = 8), and others (n = 16). The ICCs for the region of interest (mm2), PDFF, and R2 * were 0.988 (95 % confidence interval (CI): 0.983, 0.992), 0.964 (95 % CI: 0.949, 0.975), and 0.962 (95 % CI: 0.941, 0.975), respectively. The differences of measurements between the readers showed that 5.1 % (6/117) and 6.0% (7/117) for PDFF and R2 * , respectively, were outside the 95 % CI. Conclusion Our observation indicates that the 6-point Dixon method is applicable to liver masses.
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Affiliation(s)
- Taichi Kitagawa
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Takashi Matsubara
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Tetsuya Wakayama
- Applied Science Laboratory Japan and Vascular MR, MR Clinical Solutions and Research Collaborations, GE HealthCare, 4-7-127, Asahigaoka, Hino, Tokyo 191-8503, Japan
| | - Atsushi Takamatsu
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Tomohiro Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Kenichiro Okumura
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Kotaro Yoshida
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Azusa Kitao
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Jay P. Heiken
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN 55905, USA
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Urhuț MC, Săndulescu LD, Ciocâlteu A, Cazacu SM, Dănoiu S. The Clinical Value of Multimodal Ultrasound for the Differential Diagnosis of Hepatocellular Carcinoma from Other Liver Tumors in Relation to Histopathology. Diagnostics (Basel) 2023; 13:3288. [PMID: 37892109 PMCID: PMC10606610 DOI: 10.3390/diagnostics13203288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Recent advances in the field of ultrasonography offer promising tools for the evaluation of liver tumors. We aim to assess the value of multimodal ultrasound in differentiating hepatocellular carcinomas (HCCs) from other liver lesions. We prospectively included 66 patients with 72 liver tumors. The histological analysis was the reference standard for the diagnosis of malignant liver lesions, and partially for benign tumors. All liver lesions were assessed by multiparametric ultrasound: standard ultrasound, contrast-enhanced ultrasound (CEUS), the point shear wave elastography (pSWE) using shear wave measurement (SWM) method and real-time tissue elastography (RTE). To diagnose HCCs, CEUS achieved a sensitivity, specificity, accuracy and positive predictive value (PPV) of 69.05%, 92.86%, 78.57% and 93.55%, respectively. The mean shear-wave velocity (Vs) value in HCCs was 1.59 ± 0.29 m/s, which was lower than non-HCC malignancies (p < 0.05). Using a cut-off value of 1.58 m/s, SWM achieved a sensitivity of 54.76%, and 82.35% specificity, for differentiating HCCs from other malignant lesions. The combination of SWM and CEUS showed higher sensitivity (79.55%) compared with each technique alone, while maintaining a high specificity (89.29%). In RTE, most HCCs (61.53%) had a mosaic pattern with dominant blue areas corresponding to type "c" elasticity. Elasticity type "c" was 70.59% predictive for HCCs. In conclusion, combining B-mode ultrasound, CEUS, pSWE and RTE can provide complementary diagnostic information and potentially decrease the requirements for other imaging modalities.
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Affiliation(s)
- Marinela-Cristiana Urhuț
- Department of Gastroenterology, Emergency County Hospital of Craiova, Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Larisa Daniela Săndulescu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.C.); (S.M.C.)
| | - Adriana Ciocâlteu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.C.); (S.M.C.)
| | - Sergiu Marian Cazacu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.C.); (S.M.C.)
| | - Suzana Dănoiu
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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Ben Abderrahim S, Chérif K, Nfikha Z, Gharsallaoui S, El Aini I, Jedidi M, Mokni M, Ben Dhiab M. Fatal rupture of hepatic adenomatosis: Autopsy case and review of the literature. J Forensic Sci 2023. [PMID: 37144741 DOI: 10.1111/1556-4029.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
Hepatic adenomatosis is a rare disease consisting of multiple adenomas in otherwise-normal liver parenchyma. Though the discovery of this entity goes back several years, its diagnosis is still challenging in terms of its definition and pathophysiology. Clinically, patients may be completely asymptomatic and the diagnosis is only made incidentally through imaging tests. The discovery could be made when complications occur such as intraperitoneal hemorrhage with hypovolemic shock due to the rupture of an adenoma. We report a fatal case of a ruptured adenoma in a case of hepatic adenomatosis discovered at autopsy. In order to achieve a better view of this disease, we conducted a literature review on this subject describing the pathogenesis, manifestations, and autopsy contribution to addressing this entity.
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Affiliation(s)
- Sarra Ben Abderrahim
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Khouloud Chérif
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Zeineb Nfikha
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Pathological Anatomy and Cytology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Sarra Gharsallaoui
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Imen El Aini
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Maher Jedidi
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Moncef Mokni
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Pathological Anatomy and Cytology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
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Bioulac-Sage P, Gouw ASH, Balabaud C, Sempoux C. Hepatocellular Adenoma: What We Know, What We Do Not Know, and Why It Matters. Histopathology 2021; 80:878-897. [PMID: 34856012 DOI: 10.1111/his.14605] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
In the last 2 decades there has been significant progress in research and diagnosis of hepatocellular adenoma (HCA), resulting in the establishment of a molecular and immunohistological HCA classification. This review aims to fine-tune the current expertise in order to enhance the histopathological diagnostic possibilities, by refining issues that are already known, addressing diagnostic difficulties and identifying still unknown aspects of HCA. We will discuss novel methods to identify HCA subtypes, in particular the sonic hedgehog HCAs and the interpretation of glutamine synthetase patterns for the recognition of beta-catenin mutated HCAs. The major complications of HCAs, bleeding and malignant transformation, will be considered, including the dilemmas of atypical and borderline lesions. Paragraphs on HCAs in different clinical and geographical settings, e.g. pregnancy, cirrhosis and non-western countries are included. The natural history of the different HCA subtypes in relation with age, sex and risk factors is a feature still insufficiently investigated. This is also true for the risks of clinical bleeding and malignant transformation in association with HCA subtypes. As HCA is a relatively rare tumor, a multicenter and multidisciplinary approach across geographical boundaries will be the appropriate method to establish prospective programs to identify, classify and manage HCAs, focusing on several aspects, e.g. etiology, underlying liver disease, complications, regression and growth. Updating what we know, identifying and addressing features that we do not know matters to warrant optimal patient management.
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Affiliation(s)
| | - Annette S H Gouw
- Departement of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Christine Sempoux
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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McGillen KL, Zaidi S, Ahmed A, Harter S, Yee NS. Contrast-Enhanced Ultrasonography for Screening and Diagnosis of Hepatocellular Carcinoma: A Case Series and Review of the Literature. Medicines (Basel) 2020; 7:E51. [PMID: 32867068 DOI: 10.3390/medicines7090051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 02/07/2023]
Abstract
Background: Contrast-enhanced ultrasound (CEUS) is a safe and noninvasive imaging technique that can characterize and evaluate liver lesions, and has been approved for this use in the Unites States since 2016. CEUS has been shown to be similar in accuracy to computed tomography (CT) and magnetic resonance imaging (MRI) for noninvasive diagnosis of hepatocellular carcinoma (HCC) and offers several advantages in certain patient populations who have contraindications for CT or MRI. However, CEUS has inherent limitations and has not been widely employed for evaluation of HCC. Methods: We present three retrospective cases of liver lesions in patients with cirrhosis, who underwent screening for HCC using concurrent, well-timed CT and CEUS. Results: In these cases, the liver lesions were better visualized and then diagnosed as malignancy via CEUS, whereas the lesions were best appreciated on CT only in retrospect. Conclusions: In some cirrhotic patients, a focal lesion may be more easily identifiable via CEUS than on CT and thus accurately characterized, suggesting an important and complementary role of CEUS with CT or MRI. Further studies are indicated to support the use of CEUS for the diagnosis and characterization of liver lesions in screening patients at risk for developing HCC.
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Zulfiqar M, Sirlin CB, Yoneda N, Ronot M, Hecht EM, Chernyak V, Matsui O, Bastati N, Ba‐Ssalamah A, Chatterjee D, Bashir M, Fowler KJ. Hepatocellular adenomas: Understanding the pathomolecular lexicon, MRI features, terminology, and pitfalls to inform a standardized approach. J Magn Reson Imaging 2019; 51:1630-1640. [DOI: 10.1002/jmri.26902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Maria Zulfiqar
- Mallinckrodt Institute of RadiologyWashington University School of Medicine St Louis Missouri USA
| | - Claude B. Sirlin
- Department of RadiologyUniversity of California San Diego San Diego California USA
| | | | - Maxime Ronot
- Department of RadiologyHôpitaux Universitaires Paris Nord Val de Seine, Cinchy France
| | | | - Victoria Chernyak
- Department of Radiology, Montefiore Medical CenterAlbert Einstein College of Medicine New York New York USA
| | - Osamu Matsui
- Department of RadiologyKanazawa University Japan
| | - Nina Bastati
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Ahmed Ba‐Ssalamah
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Deyali Chatterjee
- Department of PathologyWashington University School of Medicine St Louis Missouri USA
| | - Mustafa Bashir
- Department of RadiologyDuke University Durham North Carolina USA
| | - Kathryn J. Fowler
- Department of RadiologyUniversity of California San Diego San Diego California USA
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Sempoux C, Balabaud C, Paradis V, Bioulac-Sage P. Hepatocellular nodules in vascular liver diseases. Virchows Arch 2018; 473:33-44. [PMID: 29804132 DOI: 10.1007/s00428-018-2373-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 12/14/2022]
Abstract
Hepatocellular nodules have been recognized in vascular liver diseases for a long time and mostly described and studied in the imaging literature. Some confusions in their identification and overlap in their definitions exist, especially in this specific clinical context. Pathology descriptions report the development of nodular regenerative hyperplasia, large regenerative nodule, and focal nodular hyperplasia, as adaptive responses of the liver parenchyma to the modified blood flow. True neoplastic hepatocellular nodules such as hepatocellular adenoma and hepatocellular carcinoma can also appear, mainly in Budd-Chiari syndrome, and have to be correctly diagnosed. This is more difficult for the radiologist in these diseased livers, leading more frequently to perform liver biopsies. We describe the histology of each type of well-differentiated hepatocellular nodules and provide some clues for their differential diagnosis. A review of the literature gives an historical perspective of the problem and enlightens the frequency and the subtypes of hepatocellular nodules found in the most common vascular liver diseases.
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Affiliation(s)
- Christine Sempoux
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, 25, rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Charles Balabaud
- Inserm, UMR1053 Bordeaux Research In Translational Oncology, BaRITOn, F-33000 Bordeaux, Université de Bordeaux, 33076, Bordeaux, France
| | - Valérie Paradis
- Pathology department, Beaujon hospital, Inserm UMR 1149, Université Paris Diderot, 101 bd du Général Leclerc, 92110, Clichy, France
| | - Paulette Bioulac-Sage
- Inserm, UMR1053 Bordeaux Research In Translational Oncology, BaRITOn, F-33000 Bordeaux, Université de Bordeaux, 33076, Bordeaux, France
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