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Abstract
BACKGROUND Early detection of hepatocellular carcinoma (HCC) is important. Advances in liver imaging techniques have facilitated the detection of HCC at an early stage. However, there is a controversial discussion on how to diagnose very small HCC by imaging. The aim of the current review is to present current published data on HCC ≤10 mm and discuss on how to best diagnose and treat such lesions. SUMMARY It is still challenging, however, to accurately characterize HCC <10 mm. The accuracy of contrast-enhanced ultrasound may be critical for early treatment decisions for cancer patients, particularly when CECT and/or CEMRI are inconclusive. Key Messages: The characterization of focal liver lesions <10 mm is frequently delayed until a follow-up imaging procedure demonstrates growth or stability. A repetition of ultrasound examination after 3 months for new nodules <1 cm should be recommended.
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Affiliation(s)
- Yi Dong
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Andreas Teufel
- Division of Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wen-Ping Wang
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland,
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Mosleh-Shirazi MA, Nasiri-Feshani Z, Ghafarian P, Alavi M, Haddadi G, Ketabi A. Tumor volume-adapted SUV N as an alternative to SUV peak for quantification of small lesions in PET/CT imaging: a proof-of-concept study. Jpn J Radiol 2021; 39:811-823. [PMID: 33880686 DOI: 10.1007/s11604-021-01112-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/13/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE SUVpeak is a recommended quantification metric except for small lesions. We aimed to assess the averaged standard uptake value (SUVN) as an alternative to SUVpeak for small-lesion quantification. MATERIALS AND METHODS NEMA-like phantom images were reconstructed using OSEM, OSEM + PSF, OSEM + TOF and OSEM + TOF + PSF with two post-smoothing Gaussian filters for different background activity levels. SUVmax, SUVN (N = 5, 10, 15, 20, 25, 30, 35 or 40 hottest voxels), and SUVpeak, relative percent error, contrast recovery, and volume recovery coefficients were quantified and assessed. RESULTS SUVN did not have the limitations of SUVpeak for smaller lesions. In the smallest insert at 2.68 kBq/ml, optimum N values for OSEM, OSEM + PSF, OSEM + TOF and OSEM + TOF + PSF were 10, 5, 15, and 10 for SUVN, respectively. The same N values were obtained for metabolic tumor volumes (MTVs) for all reconstruction algorithms. At 5.30 kBq/ml, N = 5 was optimum for SUVN and MTVs. For the larger inserts, the optimum N increased and tended towards the maximum (similar to SUVpeak). CONCLUSIONS SUVN is more accurate than SUVmax or SUVpeak for small lesions, while being as accurate in larger ones. This harmonizing capacity of SUVN can be beneficial for the quantitative analysis of small tumor volumes.
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Affiliation(s)
- Mohammad Amin Mosleh-Shirazi
- Ionizing and Non-Ionizing Radiation Protection Research Centre, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Physics Unit, Department of Radio-oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Nasiri-Feshani
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Pardis Ghafarian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.,PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrosadat Alavi
- Ionizing and Non-Ionizing Radiation Protection Research Centre, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Nuclear Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhasan Haddadi
- Ionizing and Non-Ionizing Radiation Protection Research Centre, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ketabi
- Ionizing and Non-Ionizing Radiation Protection Research Centre, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. .,Physics Unit, Department of Radio-oncology, Shiraz University of Medical Sciences, Shiraz, Iran.
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Abstract
BACKGROUND When lung cancer screening work extensively developed in recent years, more and more small lung lesions were found in clinic. The aim of this study is to analysis computed tomography (CT) guided percutaneous biopsy for lung small lesions (diameter<2 cm) on results, complications and prognosis. METHODS Choose CT guided percutaneous lung biopsy were performed in 41 cases of pulmonary peripheral lesions, single lesion in 39 cases, multiple lesions in 2 cases, 5-20 (13.1±5.2) mm in maximum diameter, depth from lung surface 1-45 (16.5±13.7) mm, ground-glass opacity (GGO) components 0%-100% (66.8%±35.2%). RESULTS 41 patients and 43 biopsies successfully obtained pathological tissue. Atypical adenomatous hyperplasia in 3 cases, squamous carcinoma in 1 case, adenocarcinoma in 37 cases( carcinoma in situ in 7 cases, micro-invasive carcinoma in 5 cases, invasive adenocarcinoma in 25 cases, double primary lung cancer in 2 cases), inflammatory lesions in 2 cases. Except 2 cases of inflammatory lesions are in follow-up, biopsy and surgical pathology alignment (specificity) was 100%. 41 patients occurred complications related to percutaneous biopsy. Pneumothorax were in 22 cases, drainage required in 2 cases. There were 17 cases with hemoptysis, accounting for 39.5% incidence are self-limited. Intracranial air embolism occurred in 2 cases by 4.6% incidence. They were fully recovered. CONCLUSIONS For small lung lesions, CT guided percutaneous biopsy is technically feasible. However, for small lung lesions especially pure GGO biopsy, it is still need to be cautious.
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Affiliation(s)
- Mu Hu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lei Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Kun Qian
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yuanbo Li
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Kinner S, Schubert TB, Nocerino EA, Hynes S, Colgan TJ, Loeffler AG, Brace C, Reeder SB, Winslow E. MR visible localization device for radiographic-pathologic correlation of surgical specimens. Magn Reson Imaging 2016; 37:159-163. [PMID: 27899330 DOI: 10.1016/j.mri.2016.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The detection of small parenchymal hepatic lesions identified by preoperative imaging remains a challenge for traditional pathologic methods in large specimens. We developed a magnetic resonance imaging (MRI) compatible localization device for imaging of surgical specimens aimed to improve identification and localization of hepatic lesions ex vivo. MATERIALS AND METHODS The device consists of two stationary and one removable MR-visible grids lined with silicone gel, creating an orthogonal 3D matrix for lesion localization. To test the device, five specimens of swine liver with a random number of lesions created by microwave ablation were imaged on a 3T MR scanner. Two readers independently evaluated lesion coordinates and size, which were then correlated with sectioning guided by MR imaging. RESULTS All lesions (n=38) were detected at/very close to the expected localization. Inter-reader agreement of lesion localization was almost perfect (0.92). The lesion size estimated by MRI matched macroscopic lesion size in cut specimen (±2mm) in 34 and 35, respectively, out of 38 lesions. CONCLUSION Use of this MR compatible device for ex vivo imaging proved feasible for detection and three-dimensional localization of liver lesions, and has potential to play an important role in the ex vivo examination of surgical specimens in which pathologic correlation is clinically important.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA; Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.
| | - Tilman B Schubert
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA; Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | | | - Shannon Hynes
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Timothy J Colgan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Agnes G Loeffler
- Pathology Clinic, University of Wisconsin-Madison, Madison, WI, USA
| | - Christopher Brace
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Emily Winslow
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
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