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Sparks H, Rink JS, Ramakrishnan A, Sung K, Ni J, Lu DSK, Raman SS, Lee EW, Chiang J. Characterization of Microwave Generator Energy and Ablation Volumes Following Transarterial Embolization in an In Vivo Porcine Liver Model. J Vasc Interv Radiol 2024:S1051-0443(24)00339-7. [PMID: 38754759 DOI: 10.1016/j.jvir.2024.05.005] [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: 10/26/2023] [Revised: 03/24/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE This study aims to characterize the relationship between ablation zone volume (AZV) and microwave ablation (MWA) energy in an in vivo porcine liver model following arterial embolization. MATERIALS AND METHODS With animal IRB approval, eleven female swine underwent either right (n= 5) or left (n= 6) hepatic artery embolization under fluoroscopic guidance. Subsequently, ultrasound guided MWA was performed in each liver segment (left lateral, left medial, right medial, right lateral) at either 30 Watts (W) (n=4 lobes), 60W (n=4), 65W (n=20), 90W (n=8), 120W (n=4), or 140W (n=4) continuously for 5 minutes. Post-procedural volumetric segmentation was performed on standardized multiphase T1 MRI sequences. RESULTS AZVs in embolized lobes (15.8 ± 10.6 mL) were significantly larger than non-embolized lobes (11.2 ± 6.5 mL, P <0.01). MWA energy demonstrated significant positive linear correlation with both embolized (R2=0.66, P <0.01) and non-embolized lobes (R2=0.64, P < 0.01). The slope of the linear models corresponded to a 0.95 ± 0.16 and 0.54 ± 0.09 mL/kJ increase in ablation volume per applied kJ of energy (E) in embolized and non-embolized lobes, respectively. In the multivariate model, embolization status significantly modified the relationship between E and AZV as described by the interaction term: 0.42*E*(Embolization Status), (P = 0.031). CONCLUSION Linear models demonstrate a near 1.8 fold increase in ratio of AZV per unit E, R(AZV:E), when applied to embolized lobes relative to non-embolized lobes. Absolute AZV differences between embolized and non-embolized lobes were greater at higher power MWA.
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Affiliation(s)
- Hiro Sparks
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California.
| | - Johann S Rink
- Department for Radiology and Nuclear Medicine, Mannheim University Medical Centre, Mannheim, Germany
| | - Abinaya Ramakrishnan
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Kyunghun Sung
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jason Ni
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - David S K Lu
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Edward W Lee
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jason Chiang
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
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Chiang J, Rajendran PS, Hao F, Sayre J, Raman SS, Lu DSK, McWilliams JP. Combination transarterial chemoembolization and microwave ablation vs. microwave ablation monotherapy for hepatocellular carcinomas greater than 3 cm: a comparative study. Diagn Interv Radiol 2023; 29:805-812. [PMID: 37665139 PMCID: PMC10679555 DOI: 10.4274/dir.2023.232159] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/01/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To evaluate the efficacy of combination therapy using transarterial chemoembolization with microwave ablation (MWA) therapy vs. MWA monotherapy for hepatocellular carcinomas (HCCs) >3 cm in size. METHODS This two-arm retrospective observational study included patients with HCCs >3 cm who underwent either combination therapy (29 patients) or MWA monotherapy (35 patients) between 2014 and 2020. The treatment outcomes related to primary treatment efficacy, local tumor progression (LTP), tumor control rate, and overall survival were compared between each cohort. RESULTS The technical success and primary efficacy were 96.56% and 100.00% in the combination therapy cohort, and 91.42% and 100.00% in the MWA cohort, respectively, over a mean follow-up period of 27.6 months. The 1- and 3-year rates of LTP-free survival were 78.57% and 69.56% in the combination therapy cohort, vs. 72.45% and 35.44% in the MWA cohort, respectively (P = 0.001). The overall progression-free survival was longer in the combination therapy cohort compared with the MWA cohort (median: 56.0 vs. 13.0 months; P = 0.017). With the incorporation of additional locoregional therapy, the overall survival rates were not significantly different, with 1- and 3-year overall survival rates of 100.00% and 88.71% in the combination therapy cohort and rates of 90.15% and 82.76% in the MWA cohort, respectively (P = 0.235). CONCLUSION The combination therapy provided significantly longer upfront LTP-free survival in HCCs >3 cm when compared with the MWA treatment alone, albeit with similar local tumor control and overall survival rates when accounting for additional locoregional therapies.
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Affiliation(s)
- Jason Chiang
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Pradeep S. Rajendran
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Frank Hao
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - James Sayre
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Steven S. Raman
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - David S. K. Lu
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Justin P. McWilliams
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
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Tse JR, Felker ER, Cao JJ, Naini BV, Liang T, Lu DSK, Raman SS. Hepatocellular Adenoma Subtypes Based on 2017 Classification System: Exploratory Study of Gadoxetate Disodium-Enhanced MRI Features With Proposal of a Diagnostic Algorithm. AJR Am J Roentgenol 2023; 220:539-550. [PMID: 36169546 DOI: 10.2214/ajr.22.28233] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND. The classification of hepatocellular adenomas (HCAs) was updated in 2017 on the basis of genetic and molecular analysis. OBJECTIVE. The purpose of this article was to evaluate features on gadoxetate disodium-enhanced MRI of HCA subtypes on the basis of the 2017 classification and to propose a diagnostic algorithm for determining subtype using these features. METHODS. This retrospective study included 56 patients (49 women, seven men; mean age, 37 ± 13 [SD] years) with histologically confirmed HCA evaluated by gadoxetate disodium-enhanced MRI from January 2010 to January 2021. Subtypes were reclassified using 2017 criteria: hepatocyte nuclear factor-1α mutated HCA (HHCA), inflammatory HCA (IHCA), β-catenin exon 3 activated HCA (β-HCA), mixed inflammatory and β-HCA (β-IHCA), sonic hedgehog HCA (shHCA), and unclassified HCA (UHCA). Qualitative MRI features were assessed. Liver-to-lesion contrast enhancement ratios (LLCERs) were measured. Subtypes were compared, and a diagnostic algorithm was proposed. RESULTS. The analysis included 65 HCAs: 16 HHCAs, 31 IHCAs, six β-HCA, four β-IHCA, five shHCA, and three UHCAs. HHCAs showed homogeneous diffuse intralesional steatosis in 94%, whereas all other HCAs showed this finding in 0% (p < .001). IHCAs showed the "atoll" sign in 58%, whereas all other HCAs showed this finding in 12% (p < .001). IHCAs showed moderate T2 hyperintensity in 52%, whereas all other HCAs showed this finding in 12% (p < .001). The β-HCAs and β-IHCAs occurred in men in 63%, whereas all other HCAs occurred in men in 4% (p < .001). The β-HCAs and β-IHCAs had a mean size of 10.1 ± 6.8 cm, whereas all other HCAs had a mean size of 5.1 ± 2.9 cm (p = .03). The β-HCAs and β-IHCAs showed fluid components in 60%, whereas all other HCAs showed this finding in 5% (p < .001). Hepatobiliary phase iso- or hyperintensity was observed in 80% of β-HCAs and β-IHCAs versus 5% of all other HCAs (p < .001). Hepatobiliary phase LLCER was positive in nine HCAs (eight β-HCAs and β-IHCAs; one IHCA). The shHCA and UHCA did not show distinguishing features. The proposed diagnostic algorithm had accuracy of 98% for HHCAs, 83% for IHCAs, and 95% for β-HCAs or β-IHCAs. CONCLUSION. Findings on gadoxetate disodium-enhanced MRI, including hepatobiliary phase characteristics, were associated with HCA subtypes using the 2017 classification. CLINICAL IMPACT. The algorithm identified common HCA subtypes with high accuracy, including those with β-catenin exon 3 mutations.
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Affiliation(s)
- Justin R Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Ely R Felker
- Department of Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Jennie J Cao
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Bita V Naini
- Department of Pathology, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Tie Liang
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - David S K Lu
- Department of Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- Department of Radiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
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Tse JR, Felker ER, Naini BV, Shen L, Shen J, Lu DSK, Kamaya A, Raman SS. Hepatocellular Adenomas: Molecular Basis and Multimodality Imaging Update. Radiographics 2023; 43:e220134. [PMID: 36821508 DOI: 10.1148/rg.220134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Hepatocellular adenomas (HCAs) are a family of liver tumors that are associated with variable prognoses. Since the initial description of these tumors, the classification of HCAs has expanded and now includes eight distinct genotypic subtypes based on molecular analysis findings. These genotypic subtypes have unique derangements in their cellular biologic makeup that determine their clinical course and may allow noninvasive identification of certain subtypes. Multiphasic MRI performed with hepatobiliary contrast agents remains the best method to noninvasively detect, characterize, and monitor HCAs. HCAs are generally hypointense during the hepatobiliary phase; the β-catenin-mutated exon 3 subtype and up to a third of inflammatory HCAs are the exception to this characterization. It is important to understand the appearances of HCAs beyond their depictions at MRI, as these tumors are typically identified with other imaging modalities first. The two most feared related complications are bleeding and malignant transformation to hepatocellular carcinoma, although the risk of these complications depends on tumor size, subtype, and clinical factors. Elective surgical resection is recommended for HCAs that are persistently larger than 5 cm, adenomas of any size in men, and all β-catenin-mutated exon 3 HCAs. Thermal ablation and transarterial embolization are potential alternatives to surgical resection. In the acute setting of a ruptured HCA, patients typically undergo transarterial embolization with or without delayed surgical resection. This update on HCAs includes a review of radiologic-pathologic correlations by subtype and imaging modality, related complications, and management recommendations. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Justin R Tse
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Ely R Felker
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Bita V Naini
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Luyao Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jody Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - David S K Lu
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Aya Kamaya
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Wilsen CB, Patel MK, Douek ML, Masamed R, Dittmar KM, Lu DSK, Raman SS. Contrast-enhanced ultrasound for abdominal image-guided procedures. Abdom Radiol (NY) 2023; 48:1438-1453. [PMID: 36853392 DOI: 10.1007/s00261-023-03804-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Since FDA approval for contrast-enhanced ultrasound (CEUS), clinical applications have increased to include diagnostic imaging of hepatic, renal, and other abdominal lesions. The modality has also demonstrated utility in certain image-guided procedures. Intravascular ultrasound contrast agents use microbubbles to improve visibility of solid tumors. Lesions not well seen on grayscale or Doppler ultrasound may become amenable to CEUS-guided biopsy or ablation. MATERIALS AND METHODS This pictorial essay provides eleven examples to illustrate the current use of CEUS in a variety of abdominal image-guided procedures. Hepatic, renal, peritoneal, and soft tissue cases are presented. CONCLUSION CEUS can improve visualization and targeting in abdominal image-guided procedures, without nephrotoxicity or radiation exposure.
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Affiliation(s)
- Craig B Wilsen
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Maitraya K Patel
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Michael L Douek
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Rinat Masamed
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | | | - David S K Lu
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- UCLA Department of Radiological Sciences, University of California Los Angeles, David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Lee MW, Kang D, Lim HK, Cho J, Sinn DH, Kang TW, Song KD, Rhim H, Cha DI, Lu DSK. Updated 10-year outcomes of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm: emphasis on association of local tumor progression and overall survival. Eur Radiol 2020; 30:2391-2400. [PMID: 31900708 DOI: 10.1007/s00330-019-06575-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the 10-year overall survival and local tumor progression (LTP) of percutaneous radiofrequency ablation (RFA) for single nodular hepatocellular carcinoma (HCC) < 3 cm using a large longitudinal hospital registry and clinical factors associated with overall survival and LTP. METHODS A total of 467 newly diagnosed patients with single nodular HCC < 3 cm who underwent RFA as first-line therapy between January 2008 to December 2016 were analyzed. Overall survival and LTP were estimated using the Kaplan-Meier method. Cox regression and competing risks Cox regression analysis were performed to identify prognostic factors for overall survival and LTP, respectively. RESULTS The 5- and 10-year overall survival rates after RFA were 83.7% and 74.2%, respectively. LTP (hazard ratio (HR), 2.03; 95% confidence interval (CI), 1.19-3.47) was one of the important factors for overall survival after RFA. The 5- and 10-year LTP rates after RFA were 20.4% and 25.1%, respectively. Periportal location (subdistribution HR, 2.29; 95% CI, 1.25-4.21), subphrenic location (2.25, 1.34-3.86), size ≥ 1.5-< 2.0 cm (1.88, 1.05-3.39), and size ≥ 2.0 cm (2.10, 1.14-3.86) were independent factors for LTP. CONCLUSION Ten-year therapeutic outcomes of percutaneous RFA as first-line therapy were excellent for single HCC < 3 cm. LTP was an important prognostic factor for overall survival after RFA. Periportal and subphrenic location of HCCs and tumor size were predictors for the development of LTP after RFA. KEY POINTS • Updated 10-year survival outcome of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm was higher than previously reported. • Local tumor progression was an important prognostic factor for overall survival after percutaneous radiofrequency ablation. • Periportal and subphrenic location of hepatocellular carcinomas and tumor size were predictors for the development of local tumor progression after percutaneous radiofrequency ablation.
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Affiliation(s)
- Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea.
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - David S K Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Nagarajan MB, Raman SS, Lo P, Lin WC, Khoshnoodi P, Sayre JW, Ramakrishna B, Ahuja P, Huang J, Margolis DJA, Lu DSK, Reiter RE, Goldin JG, Brown MS, Enzmann DR. Building a high-resolution T2-weighted MR-based probabilistic model of tumor occurrence in the prostate. Abdom Radiol (NY) 2018; 43:2487-2496. [PMID: 29460041 DOI: 10.1007/s00261-018-1495-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We present a method for generating a T2 MR-based probabilistic model of tumor occurrence in the prostate to guide the selection of anatomical sites for targeted biopsies and serve as a diagnostic tool to aid radiological evaluation of prostate cancer. MATERIALS AND METHODS In our study, the prostate and any radiological findings within were segmented retrospectively on 3D T2-weighted MR images of 266 subjects who underwent radical prostatectomy. Subsequent histopathological analysis determined both the ground truth and the Gleason grade of the tumors. A randomly chosen subset of 19 subjects was used to generate a multi-subject-derived prostate template. Subsequently, a cascading registration algorithm involving both affine and non-rigid B-spline transforms was used to register the prostate of every subject to the template. Corresponding transformation of radiological findings yielded a population-based probabilistic model of tumor occurrence. The quality of our probabilistic model building approach was statistically evaluated by measuring the proportion of correct placements of tumors in the prostate template, i.e., the number of tumors that maintained their anatomical location within the prostate after their transformation into the prostate template space. RESULTS Probabilistic model built with tumors deemed clinically significant demonstrated a heterogeneous distribution of tumors, with higher likelihood of tumor occurrence at the mid-gland anterior transition zone and the base-to-mid-gland posterior peripheral zones. Of 250 MR lesions analyzed, 248 maintained their original anatomical location with respect to the prostate zones after transformation to the prostate. CONCLUSION We present a robust method for generating a probabilistic model of tumor occurrence in the prostate that could aid clinical decision making, such as selection of anatomical sites for MR-guided prostate biopsies.
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Affiliation(s)
- Mahesh B Nagarajan
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles (UCLA), Los Angeles, CA, 90024, USA.
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Pechin Lo
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles (UCLA), Los Angeles, CA, 90024, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Wei-Chan Lin
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan
| | - Pooria Khoshnoodi
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - James W Sayre
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Bharath Ramakrishna
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles (UCLA), Los Angeles, CA, 90024, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Preeti Ahuja
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Daniel J A Margolis
- Weill Cornell Medicine, Weill Cornell Imaging at New York-Presbyterian, New York, NY, 10021, USA
| | - David S K Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Jonathan G Goldin
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles (UCLA), Los Angeles, CA, 90024, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Matthew S Brown
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles (UCLA), Los Angeles, CA, 90024, USA
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Dieter R Enzmann
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
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Tong MJ, Rosinski AA, Huynh CT, Raman SS, Lu DSK. Long-term survival after surveillance and treatment in patients with chronic viral hepatitis and hepatocellular carcinoma. Hepatol Commun 2017; 1:595-608. [PMID: 29404481 PMCID: PMC5721434 DOI: 10.1002/hep4.1047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/11/2017] [Accepted: 04/16/2017] [Indexed: 01/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the main cause of mortality in patients with chronic viral hepatitis (CVH). We determined the impact of surveillance and treatments on long‐term outcomes in patients with CVH who developed HCC. Between 1984 and 2014, 333 patients with HCC and with hepatitis B or hepatitis C virus infection were evaluated. An adjusted lead time bias interval was added to patients with HCC who presented with HCC (no surveillance), and their survival was compared to patients whose HCC was detected by surveillance. After HCC treatments, survival rates within and beyond 3 years of follow‐up were compared. In 175 (53%) patients, HCC was detected through surveillance using alpha‐fetoprotein and abdominal ultrasound examinations. Compared to 158 (47%) patients with HCC who had no surveillance, more patients with HCC detected by surveillance received surgical and locoregional treatments (P < 0.0001 to P < 0.001), and their 1‐, 3‐, and 5‐year overall and disease‐free survival rates were significantly higher (P < 0.001 for both). During the first 3 years of follow‐up, patients with HCC receiving liver transplantation had similar survival rates as those with liver resection or radiofrequency ablation (RFA); however, due to HCC recurrence, survival in resection and RFA patients became significantly less when followed beyond 3 years (P = 0.001 to P = 0.04). Factors associated with mortality included tumors beyond University of California at San Francisco criteria (hazard ratio [HR] 2.02; P < 0.0001), Child‐Pugh class B and C (HR, 1.58‐2.26; P = 0.043 to P = 0.015, respectively), alpha‐fetoprotein per log ng/mL increase (HR, 1.30; P < 0.0001), previous antiviral therapy in hepatitis B virus patients (HR, 0.62; P = 0.032), and treatments other than liver transplantation (HR, 2.38‐6.45; P < 0.0001 to P < 0.003). Conclusion. Patients with HCC detected by surveillance had prolonged survival. Due to HCC recurrence, survival rates after liver resection and RFA were lower when followed beyond 3 years after treatments. (Hepatology Communications 2017;1:595–608)
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Affiliation(s)
- Myron J Tong
- Liver Center, Huntington Medical Research Institutes Pasadena CA.,Pfleger Liver Institute, Division of Digestive Diseases Los Angeles CA
| | | | | | - Steven S Raman
- Department of Radiologic Sciences David Geffen School of Medicine, University of California Los Angeles CA
| | - David S K Lu
- Department of Radiologic Sciences David Geffen School of Medicine, University of California Los Angeles CA
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Lee MW, Raman SS, Asvadi NH, Siripongsakun S, Hicks RM, Chen J, Worakitsitisatorn A, McWilliams J, Tong MJ, Finn RS, Agopian VG, Busuttil RW, Lu DSK. Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10-year intention-to-treat analysis. Hepatology 2017; 65:1979-1990. [PMID: 28170115 DOI: 10.1002/hep.29098] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
UNLABELLED In a long-term (10-year) study of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) as bridging therapy in patients listed for orthotopic liver transplantation (LT), we evaluated the impact of RFA on waiting list dropout rate, post-LT tumor recurrence, and long-term intention-to-treat, disease-specific survival (DSS). From March 2004 to October 2014, RFA was performed as the initial stand-alone bridge therapy to LT for 121 patients (men/women ratio, 83:38; mean age, 60.0 years) with 156 de novo HCCs (mean size, 2.4 cm). Follow-up period from initial RFA ranged from 1.3 to 128.0 months (median, 42.9 months). We assessed the overall and tumor-specific waiting list dropout rates, post-LT tumor recurrence, and 10-year post-LT and intention-to-treat survival rates. Dropout from the waiting list due to tumor progression occurred in 7.4% of patients. HCC recurrence after LT occurred in 5.6% of patients. The post-LT overall survival (OS) rate at 5 and 10 years was 75.8% and 42.2%, respectively, and the recurrence-free survival (RFS) rate was 71.1% and 39.6%, respectively. Intention-to-treat OS, RFS, and DSS rates for the entire study population at 5 and 10 years were 63.5% and 41.2%, 60.8% and 37.7%, and 89.5% and 89.5%, respectively. CONCLUSION RFA as a first-line stand-alone bridge therapy to LT achieves excellent long-term overall and tumor-specific survivals, with a low dropout rate from tumor progression despite long wait list times and a sustained low tumor recurrence rate upon post-LT follow-up of up to 10 years. (Hepatology 2017;65:1979-1990).
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Affiliation(s)
- Min Woo Lee
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Nazanin H Asvadi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Surachate Siripongsakun
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA.,Department of Radiology, Chulabhorn Hospital, Bangkok, Thailand
| | - Robert M Hicks
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Jeffrey Chen
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Akeanong Worakitsitisatorn
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA.,Department of Radiology, Chulabhorn Hospital, Bangkok, Thailand
| | - Justin McWilliams
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
| | - Myron J Tong
- Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Richard S Finn
- Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Vatche G Agopian
- Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Los Angeles, CA
| | - Ronald W Busuttil
- Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Los Angeles, CA
| | - David S K Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA
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10
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Tan N, Lin WC, Khoshnoodi P, Asvadi NH, Yoshida J, Margolis DJA, Lu DSK, Wu H, Sung KH, Lu DY, Huang J, Raman SS. In-Bore 3-T MR-guided Transrectal Targeted Prostate Biopsy: Prostate Imaging Reporting and Data System Version 2-based Diagnostic Performance for Detection of Prostate Cancer. Radiology 2016; 283:130-139. [PMID: 27861110 DOI: 10.1148/radiol.2016152827] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the diagnostic yield of in-bore 3-T magnetic resonance (MR) imaging-guided prostate biopsy and stratify performance according to Prostate Imaging Reporting and Data System (PI-RADS) versions 1 and 2. Materials and Methods This study was HIPAA compliant and institution review board approved. In-bore 3-T MR-guided prostate biopsy was performed in 134 targets in 106 men who (a) had not previously undergone prostate biopsy, (b) had prior negative biopsy findings with increased prostate-specific antigen (PSA) level, or (c) had a prior history of prostate cancer with increasing PSA level. Clinical, diagnostic 3-T MR imaging was performed with in-bore guided prostate biopsy, and pathology data were collected. The diagnostic yields of MR-guided biopsy per patient and target were analyzed, and differences between biopsy targets with negative and positive findings were determined. Results of logistic regression and areas under the curve were compared between PI-RADS versions 1 and 2. Results Prostate cancer was detected in 63 of 106 patients (59.4%) and in 72 of 134 targets (53.7%) with 3-T MR imaging. Forty-nine of 72 targets (68.0%) had clinically significant cancer (Gleason score ≥ 7). One complication occurred (urosepsis, 0.9%). Patients who had positive target findings had lower apparent diffusion coefficient values (875 × 10-6 mm2/sec vs 1111 × 10-6 mm2/sec, respectively; P < .01), smaller prostate volume (47.2 cm3 vs 75.4 cm3, respectively; P < .01), higher PSA density (0.16 vs 0.10, respectively; P < .01), and higher proportion of PI-RADS version 2 category 3-5 scores when compared with patients with negative target findings. MR targets with PI-RADS version 2 category 2, 3, 4, and 5 scores had a positive diagnostic yield of three of 23 (13.0%), six of 31 (19.4%), 39 of 50 (78.0%), and 24 of 29 (82.8%) targets, respectively. No differences were detected in areas under the curve for PI-RADS version 2 versus 1. Conclusion In-bore 3-T MR-guided biopsy is safe and effective for prostate cancer diagnosis when stratified according to PI-RADS versions 1 and 2. ©RSNA, 2016.
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Affiliation(s)
- Nelly Tan
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Wei-Chan Lin
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Pooria Khoshnoodi
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Nazanin H Asvadi
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Jeffrey Yoshida
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Daniel J A Margolis
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - David S K Lu
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Holden Wu
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Kyung Hyun Sung
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - David Y Lu
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Jaioti Huang
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
| | - Steven S Raman
- From the UCLA Prostate Imaging Research Group, Department of Radiology (N.T., W.C.L., P.K., N.H.A., D.J.A.M., D.S.K.L., H.W., K.H.S., S.S.R.), and Department of Pathology (J.H., D.Y.L.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095-7473; Department of Radiology, Cathay General Hospital, Taipei, Taiwan (W.C.L.); School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan (W.C.L.); and Department of Urologic Oncology, Hoag Family Cancer Institute, Hoag Hospital, Newport Beach, Calif (J.Y., D.Y.L.)
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Takeyama N, Vidhyarkorn S, Chung DJ, Siripongsakun S, Kim HJ, Lu DSK, Raman SS. Does hepatobiliary phase sequence qualitatively outperform unenhanced T1-weighted imaging in assessment of the ablation margin 24 hours after thermal ablation of hepatocellular carcinomas? Abdom Radiol (NY) 2016; 41:1942-55. [PMID: 27271219 DOI: 10.1007/s00261-016-0796-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To retrospectively determine whether hepatobiliary phase (HBP) sequence outperforms unenhanced T1-weighted imaging (uT1wI) in distinguishing the ablation margin (AM) from hepatocellular carcinoma (HCC) 24 h after thermoablation. MATERIAL AND METHODS Ninety-one patients [mean age, 65.7 years; 68 M/23F] with 138 HCCs (>6 months follow-up) underwent pre- and postablation gadoxetate disodium-enhanced MRI. AM showed a hyperintense middle zone (MZ) surrounding central hypo- or hyperintense HCCs on uT1wI, and an intermediate-intense MZ encompassing central hypo- or hyperintense HCCs during HBP. The visible AM was defined as persistent MZ around HCCs, which were demarcated from MZ, or peripherally band encompassing MZ, which were not demarcated from HCC. The indefinite AM was defined as no demarcating HCCs from MZ. The ability to distinguish AM from HCC was classified as visible or indefinite on axial (ax)-uT1wI, ax-HBP, coronal (cor)-HBP, and combined all images. To investigate the AM visibility during HBP, significance of differences upon comparison of ax-uT1wI with combined images was analyzed. Preablation liver-tumor contrast ratio (LTCR) on ax-uT1wI and ax-HBP sequence is compared between the visible and indefinite AM. RESULTS The McNemar test demonstrated a significant increase (p < 0.05) in visible AM from ax-uT1wI (60), to ax-HBP (70), cor-HBP (79), and combined images (83). TLCR with visible AM was significantly higher than that with indefinite AM on ax-uT1wI (0.4 vs. 0.2, p = 0.001) and ax-HBP sequence (0.9 vs. 0.6, p = 0.004). CONCLUSIONS HBP sequence might have higher feasibility to distinguish AM from tumor than ax-uT1wI. The TLCR value in visible AM was higher than that in indefinite AM on both ax-uT1wI and ax-HBP sequences.
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Thamtorawat S, Hicks RM, Yu J, Siripongsakun S, Lin WC, Raman SS, McWilliams JP, Douek M, Bahrami S, Lu DSK. Preliminary Outcome of Microwave Ablation of Hepatocellular Carcinoma: Breaking the 3-cm Barrier? J Vasc Interv Radiol 2016; 27:623-30. [PMID: 27013403 DOI: 10.1016/j.jvir.2016.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate preliminary outcomes after microwave ablation (MWA) of hepatocellular carcinoma (HCC) up to 5 cm and to determine the influence of tumor size. MATERIALS AND METHODS Electronic records were searched for HCC and MWA. Between January 2011 and September 2014, 173 HCCs up to 5 cm were treated by MWA in 129 consecutive patients (89 men, 40 women; mean age, 66.9 y ± 9.5). Tumor characteristics related to local tumor progression and primary and secondary treatment efficacy were evaluated by univariate analysis. Outcomes were compared between tumors ≤ 3 cm and tumors > 3 cm. RESULTS Technical success, primary efficacy, and secondary efficacy were 96.5%, 99.4%, and 94.2% at a mean follow-up period of 11.8 months ± 9.8 (range, 0.8-40.6 mo). Analysis of tumor characteristics showed no significant risk factor for local tumor progression, including subcapsular location (P = .176), tumor size (P = .402), and perivascular tumor location (P = .323). The 1-year and 2-year secondary or overall treatment efficacy rates for tumors measuring ≤ 3 cm were 91.2% and 82.1% and for tumors 3.1-5 cm were 92.3% and 83.9% (P = .773). The number of sessions to achieve secondary efficacy was higher in the larger tumor group (1.13 vs 1.06, P = .005). There were three major complications in 134 procedures (2.2%). CONCLUSIONS With use of current-generation MWA devices, percutaneous ablation of HCCs up to 5 cm can be achieved with high efficacy.
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Affiliation(s)
- Somrach Thamtorawat
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California; Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jenifer Yu
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | | | - Wei-Chan Lin
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California; Department of Radiology, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Justin P McWilliams
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Michael Douek
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Simin Bahrami
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - David S K Lu
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, California.
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Abstract
PURPOSE To determine which clinical variables and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging features are associated with histologically proved hepatocellular adenoma (HCA) genotypic subtypes. MATERIALS AND METHODS In this institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study, clinical information and MR images of 49 histologically proved HCAs from January 2002 to December 2013 (21 patients; mean age, 39 years; age range, 15-59 years) were retrospectively reviewed by two radiologists. Qualitative and quantitative imaging features, including the signal intensity ratio relative to liver in each phase, were studied. HCA tissues were stained with subtype-specific markers and subclassified by a pathologist. Clinical and imaging data were correlated with pathologic findings and compared by using Fisher exact or t test, with a Bonferroni correction for multiple comparisons. RESULTS Forty-nine HCAs were subclassified into 14 inflammatory, 20 hepatocyte nuclear factor (HNF)-1α-mutated, one β-catenin-activated, and 14 unclassified lesions. Intralesional steatosis was exclusively seen in HNF-1α-mutated lesions. Marked hyperintensity on T2-weighted images was seen in 12 of 14 (86%) inflammatory lesions compared with four of 21 (19%) HNF-1α-mutated, seven of 14 (50%) unclassified, and zero of one (0%) β-catenin-activated lesion. Two large lesions (one β-catenin-activated and one unclassified) transformed into hepatocellular carcinomas and were the only lesions to enhance with marked heterogeneity. In the hepatobiliary phase, all HCA subtypes were hypoenhancing compared with surrounding liver parenchyma, and they reached their nadir signal intensity by 10 minutes after the administration of contrast material before plateauing. HNF-1α-mutated lesions had the lowest lesion signal intensity ratio of 0.47 ± 0.09, compared with 0.73 ± 0.18 for inflammatory lesions (P = .0004), 0.82 for the β-catenin-activated lesion, and 0.73 ± 0.06 for the unclassified lesion (P = .00002). CONCLUSION In this study, all HCA subtypes were hypoenhancing at Gd-EOB-DTPA-enhanced MR imaging in the hepatobiliary phase and reached their nadir signal intensity at 10 minutes. HNF-1α-mutated lesions could be distinguished from other subtypes by having the lowest lesion signal intensity ratio.
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Affiliation(s)
- Justin R Tse
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
| | - Bita V Naini
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
| | - David S K Lu
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
| | - Steven S Raman
- From the Department of Radiological Sciences (J.R.T., D.S.K.L., S.S.R.) and Department of Pathology and Laboratory Medicine (B.V.N.), David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 10833 Le Conte Ave, 1P-172 CHS, Los Angeles, CA 90095-1732
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Park JK, Al-Tariq QZ, Zaw TM, Raman SS, Lu DSK. Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts. Cardiovasc Intervent Radiol 2015; 38:1211-7. [PMID: 25670215 DOI: 10.1007/s00270-015-1050-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 12/21/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPSs), in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Retrospective database review of patients with pre-existing TIPS undergoing RF ablation of HCC was conducted over a 159-month period ending in November 2013. TIPS patency pre- and post-RF ablation was assessed by ultrasound, angiography, and/or contrast-enhanced CT or MRI. Patient demographics and immediate post-RF ablation outcomes and complications were also reviewed. RESULTS 19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients, respectively. Eleven patients (58 %) ultimately underwent liver transplantation. Immediate technical success was seen in all ablation sessions without residual tumor enhancement (100 %). No patients (0 %) suffered liver failure within 1 month of ablation. Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88 %). Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100 %) at immediate post-ablation imaging and in 21/22 (95 %) at last follow-up (1 patient was incidentally noted to have occlusion 31 months later). No immediate complications were observed. CONCLUSION Ablation efficacy was similar to the cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation.
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Affiliation(s)
- Jonathan K Park
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA.
| | - Quazi Z Al-Tariq
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, 94305, CA, USA.
| | - Taryar M Zaw
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA.
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA.
| | - David S K Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, 90024, CA, USA.
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Abstract
Image-guided ablation has evolved rapidly in the past decade into a competitive technique for treating focal solid malignancies. However, as they rely mainly on thermal energy, such as radiofrequency or microwave, many tumors close to sensitive organs, such as ducts, bowel, and nerves, still remain nonablatable owing to the risk of thermal injury. Irreversible electroporation is a novel ablation modality that relies largely on a nonthermal mechanism to induce cell death, and therefore may overcome many of the shortcomings of thermal ablation. Emerging preclinical data as well as early clinical experience is showing promise for this technique in treating a variety of tumors including periportal liver masses, pancreatic cancer, perihilar renal tumors, prostate cancer, and other soft tissue tumors. However, practical limitations remain for irreversible electroporation, and its complete cancer and location-specific safety and efficacy profiles are still largely unknown. We therefore review what is known for this new ablation modality based on preclinical and preliminary clinical data, and discuss its emerging indications as well as technical challenges.
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Affiliation(s)
- David S K Lu
- Division of Abdominal Imaging and Intervention, Department of Radiology, UCLA Medical Center, Los Angeles, CA.
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Choi JW, Lu DSK, Osuagwu F, Raman S, Lassman C. Assessment of chronological effects of irreversible electroporation on hilar bile ducts in a porcine model. Cardiovasc Intervent Radiol 2013; 37:224-30. [PMID: 24196262 DOI: 10.1007/s00270-013-0731-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/23/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the chronological effects of irreversible electroporation (IRE) on large hilar bile ducts in an in vivo porcine model correlated with computed tomography (CT) cholangiography and histopathology. MATERIALS AND METHODS Twelve IRE zones were made along hilar bile ducts intraoperatively under ultrasound (US)-guidance in 11 pigs. Paired electrodes were placed either on opposing sides of the bile duct (straddle [STR]) or both on one side of the bile duct (one-sided [OSD]). The shortest electrode-to-duct distance was classified as periductal (≤ 2 mm) or nonperiductal (>2 mm). CT cholangiography and laboratory tests were performed before IRE and again at 2 days, 4 weeks, and 8 weeks after IRE. Degree of bile duct injury were graded as follows: grade 0 = no narrowing; grade 1 = ≤ 50 % duct narrowing; grade 2 = >50 % narrowing without proximal duct dilatation; grade 3 = grade 2 with proximal duct dilatation; and grade 4 = grade 3 with enzyme elevation. Pigs were selected for killing and histopathology at 2 days, 4, and 8 weeks. RESULTS Nonperiductal electrode placement produced no long-term strictures in 5 of 5 ducts. Periductal electrode placement produced mild narrowing in 6 of 7 ducts: 5 grade 1 and 1 grade 2. None showed increased enzymes. There was no significant difference between STR versus OSD electrode placement. Histopathology showed minor but relatively greater ductal mural changes in narrowed ducts. CONCLUSION In the larger hilar ducts, long-term patency and mural integrity appear resistant to IRE damage with the energy deposition used, especially if the electrode is not immediately periductal in position.
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Affiliation(s)
- Jae Woong Choi
- Department of Radiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 957437, USA,
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Choi EK, Lu DSK, Park SH, Hong JC, Raman SS, Ragavendra N. Doppler US for Suspicion of Hepatic Arterial Ischemia in Orthotopically Transplanted Livers: Role of Central versus Intrahepatic Waveform Analysis. Radiology 2013; 267:276-84. [DOI: 10.1148/radiol.12120557] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Sauk SC, Hsu MS, Margolis DJA, Lu DSK, Rao NP, Belldegrun AS, Pantuck AJ, Raman SS. Clear cell renal cell carcinoma: multiphasic multidetector CT imaging features help predict genetic karyotypes. Radiology 2011; 261:854-62. [PMID: 22025734 DOI: 10.1148/radiol.11101508] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine whether imaging characteristics at multiphasic multidetector computed tomography (CT) correlate with common karyotypic abnormalities in patients with clear cell renal cell carcinomas (ccRCCs). MATERIALS AND METHODS Institutional review board approval was obtained, and informed consent was waived for this HIPAA-compliant retrospective study. From January 2000 through September 2007, the prenephrectomy multiphasic (corticomedullary, nephrographic, and excretory phases), multidetector helical CT images of 58 histologically proved and karyotyped ccRCCs were reviewed by two readers with experience in abdominal imaging. Imaging features assessed included degree of attenuation, contour, and presence of calcifications and neovascularity. These features were independently correlated with specific karyotypic abnormalities on the resected specimens. Degree of attenuation data were analyzed with logistic regression for significance (P < .05), and morphologic characteristics were analyzed with odds ratios for assessing their diagnostic power. RESULTS On unenhanced scans, 7% (two of 28) of ccRCCs with the loss of chromosome 3p were calcified, whereas 37% (11 of 30) of lesions without this anomaly were calcified (odds ratio, 0.13). During the corticomedullary phase, ccRCCs with the loss of chromosome Y enhanced more than those without this anomaly (130.0 vs 102.5 HU, P = .04), and ccRCCs with trisomy 7 enhanced less than those without this anomaly (105.8 vs 139.3 HU, P = .04). During the excretory phase, ccRCCs with trisomy 5 enhanced more than those without this anomaly (115.5 vs 83.4 HU, P = .03). CONCLUSION The genetic makeup of ccRCCs affects their imaging features at multidetector CT examinations. Multidetector CT imaging characteristics may help suggest differences at the cytogenetic level among ccRCCs.
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Affiliation(s)
- Steven C Sauk
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, 757 Westwood Blvd, Los Angeles, CA 90095-1721, USA.
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Yu NC, Chaudhari V, Raman SS, Lassman C, Tong MJ, Busuttil RW, Lu DSK. CT and MRI improve detection of hepatocellular carcinoma, compared with ultrasound alone, in patients with cirrhosis. Clin Gastroenterol Hepatol 2011; 9:161-7. [PMID: 20920597 DOI: 10.1016/j.cgh.2010.09.017] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 09/22/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In patients with cirrhosis, hepatocellular carcinoma (HCC) is detected by ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI); US is recommended for screening and surveillance. We performed a retrospective analysis of the abilities of these cross-sectional imaging modalities to detect HCC. METHODS We analyzed data from 638 consecutive adult patients with cirrhosis who received liver transplants within 6 months of imaging at a tertiary care institution. Imaging reports and serum alpha-fetoprotein levels were compared with results from pathology analysis of explants as the reference standard. Sensitivities of US, CT, and MRI were calculated overall and in defined size categories. False-positive imaging results and patient-based specificities were evaluated. RESULTS Of the 638 patients, 225 (35%) had HCC, confirmed by pathology analysis of liver explants. In 23 cases, the lesions were infiltrative or extensively multifocal. In the remaining 202 explants (337 numerable, discrete nodules), respective lesion-based sensitivities of US, CT, and MRI were 46%, 65%, and 72% overall and 21%, 40%, and 47% for small (<2 cm) HCC. The sensitivity of US increased with the availability of CT or MRI data (P = .049); sensitivity values were 62% and 85% for lesions 2-4 and ≥ 4 cm, respectively. Patient-based specificities of US, CT, and MRI were 96%, 96%, and 87%, respectively. CONCLUSIONS US, CT, and MRI did not detect small HCC lesions with high levels of sensitivity, although CT and MRI provide substantial improvements over unenhanced US in patients with cirrhosis who received liver transplants.
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Affiliation(s)
- Nam C Yu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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Apisarnthanarak P, Raman SS, Ghobrial RM, Busuttil RW, Saab S, Lu DSK. Efficacy of CT angiography for preoperative vascular mapping in adult to adult living related liver transplant donors. J Med Assoc Thai 2011; 94:98-105. [PMID: 21425734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the utility of CT angiography (CTA) in preoperative mapping of hepatic vascular anatomy in adult-to-adult living related liver transplant (LRLT) donors. MATERIAL AND METHOD Over a 3-year period, 32 potential LRLTdonors underwent CTA with subsequent comparison studies [digital subtraction angiography (DSA) and/or transplantation] were included in this study. Their CTA reports were retrospectively correlated with available DSA and/or operative findings. RESULTS CTA correctly predicted right lobe arterial and portal venous anatomy in 32/32 (100%) donors. In 27 donors, hepatic venous anatomy on CT was compared with operative findings. The hepatic veins were well opacified in 23/27 (85.2%) donors. Of these, 15/16 (93.8%) significant (> or =5 mm) accessory right hepatic veins and 11/11 (100%) significant segment VIII vein draining to middle hepatic vein were detected. CONCLUSION CTA provided an excellent preoperative depiction of hepatic vascular anatomy in LRLT donors.
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Kaneko OF, Lee DM, Wong J, Kadell BM, Reber HA, Lu DSK, Raman SS. Performance of multidetector computed tomographic angiography in determining surgical resectability of pancreatic head adenocarcinoma. J Comput Assist Tomogr 2010; 34:732-8. [PMID: 20861777 DOI: 10.1097/rct.0b013e3181e5d6f7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the performance of multidetector computed tomographic angiography (MDCTA) in assessing the surgical resectability of pancreatic head adenocarcinoma. METHODS With institutional review board approval, radiographic, surgical, and pathological records of 203 consecutive patients with adenocarcinoma of the pancreatic head were analyzed retrospectively. Patients were imaged with MDCT scanners using our institution's CTA pancreatic protocol. Images were compared with surgical outcomes to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCTA in determining resectability. RESULTS Data were analyzed twice, once with equivocal findings on MDCTA assumed as resectable and again with equivocal cases assumed as unresectable. All equivocal cases were ultimately unresectable; when this was assumed, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were determined to be 100%, 71%, 85%,100% and 89%. Twelve patients deemed resectable by preoperative MDCTA were found to be unresectable on surgical exploration owing to vascular involvement (n = 4), liver metastases (n = 4), and peritoneal involvement (n = 4). CONCLUSIONS Multidetector CT angiography offers accurate and valuable preoperative assessment of surgical resectability of pancreatic ductal adenocarcinoma. Liver and peritoneal metastases and vascular invasion still remain important pitfalls in preoperative evaluation.
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Affiliation(s)
- Osamu F Kaneko
- Department of Radiological Science, University of California-Los Angeles, Los Angeles, CA 90095-7437, USA.
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Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DSK. Microwave liver ablation: influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol 2008; 19:1087-92. [PMID: 18589324 DOI: 10.1016/j.jvir.2008.03.023] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 03/06/2008] [Accepted: 03/24/2008] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To determine influence of hepatic vein size on perfusion-mediated attenuation in adjacent microwave thermal ablation. MATERIALS AND METHODS With approval of the institutional animal research committee, seven Yorkshire pigs underwent percutaneous (n = 2) or open (n = 5) microwave liver ablation under general anesthesia. In each, multiple ultrasound-guided, nonoverlapping thermal lesions were created within 1 cm of hepatic veins in a 5-10-minute ablation at 45 W. After euthanasia, the liver was harvested and sectioned at 0.5-cm intervals and the degree of perivascular coagulation attenuation was graded on histopathologic analysis. Correlation between venous size (small, < or =3 mm; medium, 3-6 mm; and large, >6 mm) and attenuation grade was performed with use of the Spearman rank test. RESULTS In 63 of 103 sections (61%)--29 of 37 (78%) small, 27 of 48 (56%) medium, and seven of 18 (39%) large veins--the thermal injury extended to the vein wall around the entire circumference of the coagulation front without distortion of the ablation margin. In 40 of 103 sections (38.9%), varying degrees of concave distortion of perivenous ablation margins were noted, with significant correlation between vein size and heat-sink extent (P < .01). However, thermal injury extended to the vascular wall in all sections without complete circumferential sparing of liver tissue. Around two thrombosed veins, thermal lesions encased the vessels, producing paradoxically convex ablation margins. CONCLUSIONS Although the heat-sink effect was significantly dependent on hepatic vein size, the majority of pathologic sections exhibited no or minimal effect. Further study is required to assess clinical implications.
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Affiliation(s)
- Nam C Yu
- Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Abstract
Hepatic lymphangiomatosis is a rare disease characterized by an abnormal lymphatic proliferation involving the liver alone, liver and spleen, or multiple organs. Hepatic lymphangiomatosis becomes symptomatic secondary to compression or replacement of the normal parenchyma, which can lead to liver failure. Resection and orthotopic liver transplantation (OLT) can be used as treatment for this disease. We herein describe a 42-year-old female who had undergone successful OLT for hepatic lymphangiomatosis with recurrent disease detected 19 yr later in the transplanted liver. This is, to our knowledge, the first described case of recurrent hepatic lymphangiomatosis after OLT. In conclusion, we discuss the clinical, radiologic, pathologic, and immunohistochemical findings and review other reported cases of hepatic lymphangiomatosis that have undergone OLT.
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Affiliation(s)
- Seong H Ra
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA 90095-1732, USA
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Duffy JP, Vardanian A, Benjamin E, Watson M, Farmer DG, Ghobrial RM, Lipshutz G, Yersiz H, Lu DSK, Lassman C, Tong MJ, Hiatt JR, Busuttil RW. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg 2007; 246:502-9; discussion 509-11. [PMID: 17717454 PMCID: PMC1959350 DOI: 10.1097/sla.0b013e318148c704] [Citation(s) in RCA: 333] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the impact of current staging criteria on long term survival. SUMMARY BACKGROUND DATA HCC is becoming an increasingly common indication for OLT. Medicare approves OLT only for HCCs meeting the Milan criteria, thus limiting OLT for an expanding pool of potential liver recipients. We analyzed our experience with OLT for HCC to determine if expansion of criteria for OLT for HCC is warranted. METHODS : All patients undergoing OLT for HCC from 1984 to 2006 were evaluated. Outcomes were compared for patients who met Milan criteria (single tumor < opr =5 cm, maximum of 3 total tumors with none >3 cm), University of California, San Francisco (UCSF) criteria (single tumor <6.5 cm, maximum of 3 total tumors with none >4.5 cm, and cumulative tumor size <8 cm), or exceeded UCSF criteria. RESULTS A total of 467 transplants were performed for HCC. At mean follow up of 6.6 +/- 0.9 years, recurrence rate was 21.2%, and overall 1, 3, and 5-year survival was 82%, 65%, and 52%, respectively. Patients meeting Milan criteria had similar 5-year post-transplant survival to patients meeting UCSF criteria by preoperative imaging (79% vs. 64%; P = 0.061) and explant pathology (86% vs. 71%; P = 0.057). Survival for patients with tumors beyond UCSF criteria was significantly lower and was below 50% at 5 years. Multivariate analysis showed that tumor number (P < 0.001), lymphovascular invasion (P < 0.001), and poor differentiation (P = 0.002) independently predicted poor survival. CONCLUSIONS This largest single institution experience with OLT for HCC demonstrates prolonged survival after liver transplantation for tumors beyond Milan criteria but within UCSF criteria, both when classified by preoperative imaging and by explant pathology. Measured expansion of OLT criteria is justified for tumors not exceeding the UCSF criteria.
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Affiliation(s)
- John P Duffy
- Dumont-UCLA Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Abstract
OBJECTIVE The objective of this study was to evaluate the performance of routine helical liver CT in the detection and grading of esophageal varices in cirrhotic patients. MATERIALS AND METHODS A total of 67 consecutive cirrhotic patients who underwent both upper endoscopy and helical liver CT within a 4-week interval were evaluated. The CT protocol included unenhanced, arterial, and portal phases with a collimation of 7-7.5 mm. Two blinded abdominal imagers (6 and 7 years' experience) retrospectively interpreted all CT images to detect the presence of esophageal varices on a 5-point confidence scale and measure the largest varix identified. Receiver operating characteristic (ROC) curve analysis was performed, and the correlation between CT measurements and endoscopic grading, the reference standard, was assessed. RESULTS The variceal detection rates for the observers was 92% (11/12) and 92% (11/12) for large (i.e., clinically significant) varices, 53% (16/30) and 60% (18/30) for small varices, and 64% (27/42) and 69% (29/42) for all varices. The area under the ROC curve for the detection of esophageal varices of any size was 0.77 (observer 1) and 0.80 (observer 2). CT variceal grading showed a strong correlation with endoscopic grading for both observers (p < or = 0.001). Using a variceal diameter threshold of 3 mm on CT, sensitivity, specificity, and accuracy for distinguishing large esophageal varices from small or no varices were 92% (11/12), 84% (46/55), and 85% (57/67), respectively, for both observers. CONCLUSION Liver CT is useful for the detection and grading of esophageal varices. A diameter of 3 mm may be an appropriate screening threshold for large clinically significant varices.
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Affiliation(s)
- Young Jun Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095-1721, USA
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Raman SS, Pojchamarnwiputh S, Muangsomboon K, Schulam PG, Gritsch HA, Lu DSK. Surgically Relevant Normal and Variant Renal Parenchymal and Vascular Anatomy in Preoperative 16-MDCT Evaluation of Potential Laparoscopic Renal Donors. AJR Am J Roentgenol 2007; 188:105-14. [PMID: 17179352 DOI: 10.2214/ajr.05.1002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Using 16-MDCT, we describe and quantify the frequency and types of renal anatomic variants and findings relevant for preoperative evaluation and surgical planning for potential laparoscopic renal donors. MATERIALS AND METHODS On 16-MDCT, 126 consecutive potential donors underwent scanning before contrast administration and after i.v. power injection of nonionic contrast material during the arterial, nephrographic, and excretory phases. On a 3D workstation, CT images were evaluated retrospectively in consensus by three abdominal imagers. The number and branching pattern of bilateral renal arteries and veins, including anomalies of the inferior vena cava and lumbar-gonadal axis, were categorized along with the frequency of incidental findings of the renal parenchyma and collecting system. RESULTS Major arterial variants including supernumerary and early branching arteries were present in 16% and 21%, respectively, of left kidneys and 22% and 15%, respectively, of right kidneys. Major and minor venous variants were detected in 11% and 58% of left kidneys and 24% and 3% of right kidneys. Late confluence of the venous trunk was identified in 17% of left kidneys and 10% of right kidneys. Incidental parenchymal and urothelial abnormalities, most commonly cysts and calyceal calcifications, were identified in 30% of the kidneys. Other relevant incidental findings included focal infarcts, cortical scars, atrophic scarred kidney, and bilateral papillary necrosis. Urothelial variants included bilateral simple ureteroceles and rightsided complete duplicated collecting system. CONCLUSION 16-MDCT angiography and urography allow confident detection and classification of a variety of anatomic and incidental anomalies relevant to the preoperative selection of potential laparoscopic renal donors and to surgical planning.
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Affiliation(s)
- Steven S Raman
- Department of Radiology, David Geffen School of Medicine at the University of California at Los Angeles, BL-428 CHS/Box 951721, Los Angeles, CA 90095-1721, USA.
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Simon CJ, Dupuy DE, Iannitti DA, Lu DSK, Yu NC, Aswad BI, Busuttil RW, Lassman C. Intraoperative triple antenna hepatic microwave ablation. AJR Am J Roentgenol 2006; 187:W333-40. [PMID: 16985103 DOI: 10.2214/ajr.05.0804] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Microwave ablation is emerging as a new treatment option for patients with unresectable hepatic malignancies. This two-center study shows the results of a phase 1 clinical trial of patients with known hepatic masses who underwent synchronous triple antenna microwave ablation before elective hepatic resection. SUBJECTS AND METHODS Intraoperative microwave ablation was performed before hepatic resection. Hepatic lesions were targeted using real-time intraoperative sonography with three microwave antennas positioned in a triangular configuration. Microwave ablation was performed at 45 W for 10 minutes. Hepatic resection was then completed in the standard fashion. Gross specimens were sectioned and measured to determine tumor and ablation sizes. Representative areas were stained with H and E stain and vital histochemical nicotinamide adenine dinucleotide (NADH) stain. RESULTS Ten patients with a mean age of 64 years (range, 48-79 years) were treated. Tumor histology included colorectal carcinoma metastases and hepatocellular carcinoma. The mean maximal tumor diameter was 4.4 cm (range, 2.0-5.7 cm). The mean maximal ablation diameter was 5.5 cm (range, 5.0-6.5 cm), while the average ablation zone volume was 50.8 cm3 (range, 30.3-65.5 cm3). Gross and microscopic examinations of areas after microwave ablation showed clear coagulation necrosis, even surrounding large hepatic vessels (> 3 mm in diameter). A marked thermallike effect was observed with maximal intensity closest to the antenna sites. NADH staining confirmed the uniform absence of viable tumor in the ablation zone. CONCLUSION This study shows the feasibility of using multiple microwave antennas simultaneously in the treatment of liver tumors intraoperatively. Additional percutaneous studies are currently under way to investigate the safety and efficacy in treating nonsurgical candidates.
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Affiliation(s)
- Caroline J Simon
- Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
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Raman SS, Pojchamarnwiputh S, Muangsomboon K, Schulam PG, Gritsch HA, Lu DSK. Utility of 16-MDCT angiography for comprehensive preoperative vascular evaluation of laparoscopic renal donors. AJR Am J Roentgenol 2006; 186:1630-8. [PMID: 16714653 DOI: 10.2214/ajr.05.0983] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to determine the efficacy of 16-MDCT angiography in preoperative evaluation of vascular anatomy of laparoscopic renal donors. METHODS AND MATERIALS Fifty-five consecutive renal donors (25 men and 30 women) underwent 16-MDCT angiography followed by donor nephrectomy. In the arterial and nephrographic phases, images were acquired with 60% overlap and 0.6-mm reconstruction in both phases after 120 mL of iohexol was injected at 4 mL/sec. On a 3D workstation, images were evaluated retrospectively by two abdominal imagers blinded to surgical results with respect to number and branching pattern of renal arteries and major and minor renal veins. These CT angiography results were compared with surgical findings. RESULTS The surgically confirmed sensitivity of both reviewers (1 and 2) using the MDCT data for detection of renal arteries was 98.5% (65 of 66), and accuracies were 97.0% for reviewer 1 and 95.5% for reviewer 2. Sensitivity and accuracy detection of renal veins was 97% (61 of 63) and 98% (62 of 63) for reviewer 1 and reviewer 2, respectively. Sensitivity and accuracy detection of early arterial bifurcation (< 2 cm from aorta) was 100% (14 of 14), and sensitivity in detection of late venous confluence (< 1.5 cm from aorta) was 100% (8 of 8). All major renal venous variants were identified; reviewer 1 identified 78% (18 of 23) minor venous variants, and reviewer 2 identified 83% (19 of 23) minor venous variants. There were no hemorrhagic complications at surgery. Excellent agreement between reviewers (kappa = 0.92-0.97) was achieved for detection of normal and variant anatomy. CONCLUSION 16-MDCT angiography enabled excellent preoperative detection of arterial anatomy and venous laparoscopic donor nephrectomy.
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Affiliation(s)
- Steven S Raman
- Department of Radiology, David Geffen School of Medicine at the University of California at Los Angeles, BL-428 CHS/Box 951721, Los Angeles, CA 90095-1721, USA.
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To'o KJ, Raman SS, Yu NC, Kim YJ, Crawford T, Kadell BM, Lu DSK. Pancreatic and peripancreatic diseases mimicking primary pancreatic neoplasia. Radiographics 2006; 25:949-65. [PMID: 16009817 DOI: 10.1148/rg.254045167] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A variety of anatomic variants and pathologic conditions in and around the pancreas may simulate primary pancreatic neoplasia at routine abdominal cross-sectional imaging. An ambiguous lesion whose appearance suggests a pancreatic origin requires a broad differential diagnosis that can subsequently be narrowed on the basis of both clinical history and features at optimal computed tomography (CT) and magnetic resonance (MR) imaging. Pancreas-specific multidetector CT and MR imaging techniques with thin collimation, multiplanar and multiphasic scans, and newly introduced curved planar reformation may help avoid potential diagnostic pitfalls. These techniques can help identify and characterize a mass in multiple viewing planes, thereby helping distinguish a true pancreatic neoplasm from peripancreatic adenopathy or from a tumor of the adjacent duodenum or small bowel. They can also help determine the cause of a tumor. It is important that the radiologist be familiar with the wide spectrum of anatomic variants and disease entities that can mimic primary pancreatic neoplasia in order to initiate the appropriate lesion-specific work-up and treatment and avoid unnecessary tests or procedures, including surgery.
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Affiliation(s)
- Katherine J To'o
- Department of Radiology, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, BL-428 CHS, Box 951721, Los Angeles, CA 90095-1721, USA
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Yu NC, Lu DSK, Raman SS, Dupuy DE, Simon CJ, Lassman C, Aswad BI, Ianniti D, Busuttil RW. Hepatocellular carcinoma: microwave ablation with multiple straight and loop antenna clusters--pilot comparison with pathologic findings. Radiology 2006; 239:269-75. [PMID: 16493013 DOI: 10.1148/radiol.2383041592] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to evaluate the clinical implementation of triangular and spherical designs for simultaneous multiple-antenna ablation of human hepatocellular carcinoma (HCC) with a recently engineered microwave coagulation system. Institutional review board approval and informed consent were obtained, and the study was compliant with HIPAA requirements. Nine patients (five men, four women; age range, 53-79 years; mean age, 66.2 years) with resectable HCC (diameter, 2.9-6.0 cm; mean, 4.2 cm) underwent intraoperative ultrasonography-guided tumor ablation followed by resection and pathologic examination. Standard single-straight (n = 2), triangular triple-straight (n = 4), and spherical triple-loop (n = 3) antenna configurations produced mean estimated coagulation volumes of 16.7, 51.7, and 54.3 cm(3), respectively, during a single concurrent 5-10-minute ablation cycle. The triple-loop configuration yielded the most uniformly round ablation shape. Simultaneous activation of multiple straight or loop antennae is a potentially promising technique for rapid and effective treatment of large HCCs.
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Affiliation(s)
- Nam C Yu
- Departments of Radiological Sciences, Pathology, and Surgery, David Geffen School of Medicine at UCLA, BR-158 CHS, Box 951721, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA
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Abstract
The purpose of this work is to describe our experience with single-session percutaneous ethanol injection (PEI) under the guidance of 0.2-T open MRI for hepatocellular carcinomas (HCC) that were not suitable for ablation under ultrasound (US) or computed tomography (CT) guidance. None of the lesions (N = 7) were detectable on US. MRI was chosen over CT as the guidance modality because the nodules were located in the hepatic dome (N = 4) or were invisible on noncontrast CT (N = 3). All of the nodules were targeted successfully, and apparently complete tumor necrosis was achieved in six nodules (86%). During a follow-up of one to 41 months, only one patient developed local recurrence four months after PEI. MR-guided PEI is feasible and effective for treating HCC when other imaging guidance methods are not appropriate.
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Affiliation(s)
- Young Jun Kim
- Department of Radiological Sciences, University of California-Los Angeles School of Medicine, Los Angeles, California 90095-1721, USA
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Lu DSK, Yu NC, Raman SS, Lassman C, Tong MJ, Britten C, Durazo F, Saab S, Han S, Finn R, Hiatt JR, Busuttil RW. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology 2005; 41:1130-7. [PMID: 15841454 DOI: 10.1002/hep.20688] [Citation(s) in RCA: 256] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Orthotopic liver transplantation (OLT) can be a definitive treatment for patients with hepatocellular carcinoma (HCC). Prolonged waiting times for cadaveric livers, however, may lead to dropout from the waiting list or worsened post-OLT prognosis as a result of interval tumor progression. Percutaneous radiofrequency ablation (RFA) is widely used for local control of small unresectable HCC, but its pretransplant role remains unclear. We studied the outcome of 52 consecutive patients accepted for OLT bearing 87 HCC nodules and treated with percutaneous RFA. On initial staging, the tumor burden exceeded the Milan criteria in 10 patients. Complete tumor coagulation was observed in 74 of 87 (85.1%) nodules based on postablation imaging. After a mean of 12.7 months (range: 0.3-43.5) on the waiting list, 3 of 52 patients (5.8%) had dropped out due to tumor progression. Forty-one patients had undergone transplantation, with 1- and 3-year post-OLT survival rates of 85% and 76%, respectively. No patient developed HCC recurrence. There were three major complications in 76 RFA procedures (hepatic arterial hemorrhage, small bowel perforation, and liver decompensation salvaged by OLT), without resultant death or dropout. In conclusion, percutaneous RFA is an effective bridge to OLT for patients with compensated liver function and safely accessible tumors. Tumor-related dropout rate and post-OLT outcome compared favorably with published controls of patients with early-stage disease. This can be attributed to the efficacy of RFA in producing local cure or curbing tumor progression during the waiting period.
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Affiliation(s)
- David S K Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Huang J, Raman SS, Vuong N, Sayre JW, Lu DSK. Utility of Breath-Hold Fast-Recovery Fast Spin-Echo T2 Versus Respiratory-Triggered Fast Spin-Echo T2 in Clinical Hepatic Imaging. AJR Am J Roentgenol 2005; 184:842-6. [PMID: 15728606 DOI: 10.2214/ajr.184.3.01840842] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to compare a breath-hold fat-suppressed fast-recovery fast spin-echo (FSE) T2-weighted sequence with a respiratory-triggered fat-suppressed FSE T2-weighted sequence to assess the effect on image quality and lesion detection and characterization in clinical hepatic imaging. MATERIALS AND METHODS Both the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences were acquired in 46 patients. Two radiologists, blinded to clinical data, independently evaluated randomized images from both sequences. Qualitatively, images were graded on a 5-point scale for five different characteristics. The number and location of lesions were recorded. The confidence of detection and the confidence of characterization (solid vs nonsolid) were graded on a 5-point scale. A consensus review using radiology, clinical, and pathology data served as the standard. Receiver operating characteristic (ROC) curve analysis (area under the ROC curve [A(z)]) was used to compare each reviewer's interpretation against the consensus interpretation. Quantitative analysis was performed by calculating the liver signal-to-noise ratio (SNR), liver-to-spleen contrast-to-noise ratio (CNR), and lesion-to-liver CNR. Both one- and two-tailed Student's t tests were used to check for significance. RESULTS Qualitatively, both reviewers graded the breath-hold fat-suppressed fast-recovery FSE T2-weighted sequence better than the respiratory-triggered fat-suppressed FSE T2-weighted sequence on all five characteristics (p < 0.005). Of 78 lesions detected, 29 were characterized as solid; 47, nonsolid; and two, indeterminate. On ROC analysis, there were no significant differences between the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences in lesion detection (A(z) reviewer 1, 0.77 and 0.83, respectively, [p = 0.12]; A(z) reviewer 2, 0.84 and 0.80, respectively [p = 0.12]) or in lesion characterization (A(z) reviewer 1, 0.86 and 0.92, respectively [p = 0.33]; A(z) reviewer 2, 0.90 and 0.91, respectively [p = 0.79]). Quantitatively, liver SNRs, spleen CNRs, and lesion CNRs (solid and nonsolid lesions) were significantly better on the breath-hold fat-suppressed fast-recovery FSE T2-weighted images than on the respiratory-triggered fat-suppressed FSE T2-weighted images (p < 0.005). CONCLUSION Breath-hold fat-suppressed fast-recovery FSE T2-weighted images were of better quality than respiratory-triggered fat-suppressed FSE T2-weighted images, and lesion detection and characterization were comparable.
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Affiliation(s)
- Jimmy Huang
- Department of Radiology, David Geffen School of Medicine, Center for the Health Sciences, UCLA Medical Center, BL-428 CHS, Box 951721, Los Angeles, CA 90095-1721, USA
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Lu DSK, Yu NC, Raman SS, Limanond P, Lassman C, Murray K, Tong MJ, Amado RG, Busuttil RW. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology 2005; 234:954-60. [PMID: 15681691 DOI: 10.1148/radiol.2343040153] [Citation(s) in RCA: 282] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To retrospectively evaluate the effectiveness of radiofrequency (RF) ablation of hepatocellular carcinoma (HCC) by using histologic examination of the explanted liver. MATERIALS AND METHODS The study was approved by the medical center Institutional Review Board, with waiver of informed consent. Forty-seven HCC nodules in 24 patients (18 men, six women; age range, 33-71 years; mean age, 56 years) were treated with single or double RF ablation sessions prior to liver transplantation. Histologic data from hematoxylin-eosin staining of explanted liver specimens were retrospectively reviewed to determine treatment success, which was defined as the absence of residual or recurrent viable carcinoma cells at treatment site. Tumor size and the presence of large (> or =3 mm) abutting vessels that were observed during imaging were tested as potential predictors of treatment success or failure (Fisher exact test). In patients who underwent postablation computed tomographic (CT) or magnetic resonance (MR) imaging within 3 months prior to transplantation (21 patients with 44 tumors), imaging results were analyzed for sensitivity and specificity of residual or recurrent tumor by using histologic data as the reference standard. RESULTS Thirty-five (74%) of 47 ablated tumors, including 29 (83%) of 35 tumors less than 3 cm, were found to be successfully treated on the basis of histologic findings after a mean interval of 7.5 months between RF ablation and transplantation. Nodules that were successfully treated had mean maximal diameter of 2.0 cm, and nodules that were unsuccessfully treated had mean maximal diameter of 3.1 cm (P=.014). Seven (47%) of 15 perivascular lesions were successfully treated whereas 28 (88%) of 32 nonperivascular lesions were successfully treated (P <.01). Imaging correlation showed 100% (33 of 33) specificity and 36% (four of 11) sensitivity of postablation CT and MR imaging for the depiction of residual or recurrent tumor. CONCLUSION Histologic evidence directly validates RF ablation as an effective treatment of small (<3 cm) HCC.
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Affiliation(s)
- David S K Lu
- Department of Radiology, UCLA School of Medicine, 10833 LeConte Ave, Los Angeles, CA 90095-1721, USA
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Raman SS, Aziz D, Chang X, Ye M, Sayre J, Lassman C, Lu DSK. Minimizing central bile duct injury during radiofrequency ablation: use of intraductal chilled saline perfusion--initial observations from a study in pigs. Radiology 2004; 232:154-9. [PMID: 15220500 DOI: 10.1148/radiol.2321030210] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether intraductal perfusion with chilled saline reduces thermal injury to bile ducts during radiofrequency (RF) ablation. MATERIALS AND METHODS In swine, anesthesia was induced and the common bile duct was surgically cannulated with a pediatric feeding tube. RF thermal lesions were created adjacent to bile ducts by using an expandable-hook 2-cm RF electrode and 90-W generator. In three pigs, chilled saline was perfused through the ducts at 1.5 L/h (26 mL/min), and in another pig, room-temperature saline was perfused at the same rate. In three pigs (control group), RF lesions were created without perfusion. After 48 hours, animals were sacrificed. Periductal sections from all animals were reviewed by a liver pathologist. The degree of injury to biliary epithelium and subepithelial glands was assessed on a scale of 0%-100%. Significance of differences between degrees of injury was assessed with the Mann-Whitney test. RESULTS In the control group, there was a mean of 100% injury to biliary ductal epithelium and 99.3% to subepithelial ductal glands. In the room-temperature saline group, there was a mean of 100% biliary epithelial injury and 84.4% glandular injury. In the chilled saline group, there was a mean of 52.9% ductal epithelial injury and 12.1% subepithelial glandular injury. In comparison with the control group, there was significantly less (P <.05) thermal injury to biliary epithelium in the chilled saline group and to subepithelial glands in both the room-temperature and chilled saline perfusion groups. CONCLUSION RF-induced bile duct injury may be decreased significantly with an intraductal infusion of chilled saline.
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Affiliation(s)
- Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA.
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Limanond P, Raman SS, Ghobrial RM, Busuttil RW, Lu DSK. The utility of MRCP in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant donors. J Magn Reson Imaging 2004; 19:209-15. [PMID: 14745755 DOI: 10.1002/jmri.10446] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the utility of magnetic resonance cholangiopancreatography (MRCP) in preoperative mapping of biliary anatomy in adult-to-adult living related liver transplant (LRLT) donors. MATERIALS AND METHODS From 57 potential donors with preoperative MRCP, 27 cases (16 men, 11 women, age range 22-51 years, mean 37.2 years) underwent right lobe resection and had intraoperative cholangiography (IOC) for comparison. The MRCP and IOC reports were retrospectively reviewed in all 27 cases. The MRCP was performed on 1.5 Tesla MR magnets using breath-hold heavily T2-weighted sequences in axial/coronal thin sections, and variable-thickness rotating slabs. The accuracy of preoperative MRCP for biliary mapping in potential LRLT donors was analyzed compared to the IOC findings. RESULTS Of 27 donors, 26 (96.3%) had MRCP which showed adequate information of central intrahepatic biliary anatomy. Of these, 19 had normal bifurcation confirmed by IOC, and single biliary anastomosis was created in the recipient at transplantation. MRCP correctly predicted 17 of 19 normal cases (sensitivity for normals: 89.5%). In seven donors with variant biliary anatomy, two separate biliary anastomoses were performed in the recipient. MRCP correctly predicted five of seven variants (sensitivity for variants: 71.4%). Overall, MRCP had an accuracy 84.6% (22/26). CONCLUSIONS MRCP has potential in the preoperative assessment of nondilated bile ducts in LRLT donors, however further improvements are desired to increase its quality and accuracy.
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Affiliation(s)
- Piyaporn Limanond
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90005-1721, USA
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Abstract
Because of an overwhelming demand for cadaveric livers in the United States that far outstrips supply, living related liver transplantation is increasingly being performed to help treat a cohort of patients with severe end-stage liver disease. This procedure demands careful preoperative evaluation to minimize morbidity to the healthy donor and recipient, however. As a part of the workup, radiologic assessment of the donor hepatic vascular and biliary anatomy, hepatic volume, and hepatic parenchyma (with regard to focal and diffuse liver disease) is essential. In this pictorial essay, the experience of a group of investigators at the University of California at Los Angeles is reviewed, and the essential radiologic components of the preoperative evaluation of hepatic vascular and biliary anatomy, hepatic parenchyma, and lobar volume are described. The roles of high-field magnetic resonance (MR) imaging, MR angiography, MR cholangiopancreatography, multidetector-row computed tomography (CT) angiography, and CT cholangiography in the workup are discussed.
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Affiliation(s)
- Piyaporn Limanond
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-1721, USA.
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Lu DSK, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, Sayre J. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2004; 14:1267-74. [PMID: 14551273 DOI: 10.1097/01.rvi.0000092666.72261.6b] [Citation(s) in RCA: 360] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The effect of large vessels (>/=3 mm) contiguous to hepatic tumors was evaluated with respect to clinical tumor recurrence rates after radiofrequency (RF) ablation. MATERIALS AND METHODS The first 105 malignant liver tumors treated by RF ablation therapy at our institution with pathologic analysis or a minimum of 6 months of clinical follow-up were reviewed. The original pretreatment imaging studies were reviewed by a radiologist who was blinded to the cases, and, based on lesion contiguity to vessels of at least 3 mm, the lesions were categorized as perivascular or nonperivascular. Treatment outcomes with respect to local tumor recurrence between these two groups were then compared. Logistic regression analysis was performed to take into account other variables and to determine whether this categorization was an independent predictor of treatment outcome. RESULTS There were 74 nonperivascular tumors and 31 perivascular tumors. Mean tumor size was 2.4 cm and mean follow-up was 11.3 months. Residual or locally recurrent tumors were documented in 20 of 105 cases (19%). In the nonperivascular group, five of 74 (7%) had either incompletely treated tumor (manifested within 6 months) or local recurrence beyond 6 months. In the perivascular group, 15 of 31 (48%) had incompletely treated or locally recurrent tumor (P <.001). Subanalysis of lesion size (61 tumors </=2.5 cm, 33 tumors 2.6-4 cm, and 11 tumors >4 cm), tumor type (40 hepatocellular carcinomas, 48 colorectal metastases, and 17 other metastases), access (53 intraoperative, 52 percutaneous), and RF device (45 Radiotherapeutics electrodes, 18 Rita electrodes, and 42 Radionics electrodes) showed similar results. Multivariate logistic regression analysis showed that presence or absence of a large peritumoral vessel is an independent, and the dominant, predictor of treatment outcome. CONCLUSION The presence of vessels at least 3 mm in size contiguous to hepatic tumors is a strong independent predictor of incomplete tumor destruction by RF ablation. Modified ablation strategies should be considered to improve destruction of these tumors.
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Affiliation(s)
- David S K Lu
- Department of Radiology, University of California Los Angeles School of Medicine, 10833 LeConte Avenue, Los Angeles, California 90095-1721, USA.
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Limanond P, Raman SS, Lassman C, Sayre J, Ghobrial RM, Busuttil RW, Saab S, Lu DSK. Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology 2004; 230:276-80. [PMID: 14695401 DOI: 10.1148/radiol.2301021176] [Citation(s) in RCA: 277] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess degree of macrovesicular steatosis with unenhanced computed tomography (CT) and correlate it with histologic findings in potential donors for living related liver transplantation. MATERIALS AND METHODS Forty-two candidates underwent unenhanced CT within 4 weeks of core liver biopsy. An experienced liver pathologist, blinded to both CT and surgical findings, retrospectively reviewed biopsy specimens and determined degree of macrovesicular steatosis. A radiologist blinded to histologic grading calculated mean hepatic attenuation in each donor liver by averaging 25 region-of-interest (ROI) measurements on five sections (five ROIs per section). Mean splenic attenuation was calculated with three separate ROI measurements. Liver attenuation index (LAI) was derived and defined as the difference between mean hepatic and mean splenic attenuation. Body mass index (BMI) was determined for each patient. Linear regression analysis was used to correlate degree of macrovesicular steatosis with both LAI and BMI. RESULTS LAI correctly predicted degree of macrovesicular steatosis in 38 (90%) of 42 cases. In four of four livers, LAI below -10 HU correlated with greater than 30% macrovesicular steatosis (unacceptable for liver transplantation). In nine of 11 livers, LAI was between -10 and 5 HU and correctly predicted 6%-30% steatosis (relative contraindication). In two of 11 cases, LAI overestimated degree of hepatic steatosis. LAI above 5 HU correctly predicted 0%-5% steatosis in 25 of 27 livers. In two of 27 cases, parenchymal hemosiderin deposition led to an increase in LAI into the normal range, despite mild histologically confirmed steatosis. Degree of histologic macrovesicular steatosis correlated well with LAI (r = 0.92) and marginally with BMI (r = 0.45). Of 27 potential donors with normal livers at CT and acceptable LAI levels, four (15%) were deemed poor donor candidates because core biopsy revealed subtle hepatic necrosis and nonspecific hepatitis. CONCLUSION Although unenhanced CT quantifies the degree of macrovesicular steatosis relatively well, it may preclude a liver biopsy only in a small percentage of potential donors with low LAI (unacceptable degree of steatosis). Core liver biopsy is still necessary in the majority of donors with normal LAI to identify those with both fatty liver and coexistent hemosiderin deposition or radiologically occult diffuse liver diseases.
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Affiliation(s)
- Piyaporn Limanond
- Department of Radiology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA
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Limanond P, Zimmerman P, Raman SS, Kadell BM, Lu DSK. Interpretation of CT and MRI after radiofrequency ablation of hepatic malignancies. AJR Am J Roentgenol 2004; 181:1635-40. [PMID: 14627588 DOI: 10.2214/ajr.181.6.1811635] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Piyaporn Limanond
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1721, USA
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Limanond P, Raman SS, Sayre J, Lu DSK. Comparison of dynamic gadolinium-enhanced and ferumoxides-enhanced MRI of the liver on high- and low-field scanners. J Magn Reson Imaging 2004; 20:640-7. [PMID: 15390231 DOI: 10.1002/jmri.20165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare the performance of dynamic gadolinium-enhanced and ferumoxides-enhanced MRI in the detection and characterization of hepatic lesions, on 1.5-T and 0.2-T magnets MATERIALS AND METHODS In 41 patients (23 men, 18 women), 52 hepatic MR examinations were performed and retrospectively analyzed; 39 and 13 examinations were performed on 1.5-T and 0.2-T magnets, respectively. A total of 33 of 41 patients had known malignancies, and 31 of 33 patients had biopsy of at least one lesion. First, a combination of unenhanced T2-weighted sequences and gradient-echo T1-weighted sequences were performed. Then, dynamic gadolinium-enhanced (0.1 mmol/kg) T1 GRE sequences were obtained, followed by intravenous drip infusion of ferumoxides (10 micromol/kg). The T2-weighted sequences were then repeated. The unenhanced and gadolinium-enhanced images (the Gd set) were reviewed separately from the unenhanced and ferumoxides-enhanced images (the ferumoxides set) by two abdominal imagers. The reviewers were blinded to clinical history and reviewed the individual studies in each set randomly. Each detected lesion was scored on a five-point scale for characterization scores: nonsolid (1 or 2), indeterminate (3), or solid (4 or 5). A consensus review was then performed correlating all available pathology, imaging, clinical findings, and follow-up to act as a gold standard. Receiver-operating-characteristic (ROC) curves were generated and both area-under-the-curve (Az values) and sensitivity values were calculated. Significance of Az and sensitivity differences was assessed using standard Z-test and chi-square. RESULTS Of 270 lesions detected by consensus, 211 were on 1.5-T and 59 were on 0.2-T scanners. The accuracy (Az values) of lesion detection overall, of both readers, was greater for the ferumoxides set than for the Gd set (reader 1: 0.95 vs. 0.89 (P < 0.05); reader 2: 0.91 vs. 0.78 (P < 0.05)). Az values for both readers were greater on the ferumoxides set for both the 1.5-T scans and the 0.2-T scans. Out of 270 lesions detected, 231 were characterized by consensus review as solid (185) or nonsolid (46). There was a significant improvement in lesion characterization for both readers on the GD set compared with the ferumoxides set on both high and low field scanners (Az reader 1: 0.99 vs. 0.96 (P < 0.05); Az reader 2: 0.99 vs. 0.95 (P < 0.05)), respectively. CONCLUSION At both 1.5-T and 0.2-T, ferumoxides-enhanced sequences were better for lesion detection, while gadolinium-enhanced sequences were better for lesion characterization, respectively.
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Affiliation(s)
- Piyaporn Limanond
- Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles (UCLA) Center for the Health Sciences, Los Angeles, California, USA
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Raman SS, Kadell BM, Vodopich DJ, Sayer J, Cryer H, Lu DSK. Patient gender-related performance of nonfocused helical computed tomography in the diagnosis of acute appendicitis. J Comput Assist Tomogr 2003; 27:583-9. [PMID: 12886148 DOI: 10.1097/00004728-200307000-00024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the impact of patient gender on the performance of helical computed tomography (CT) in the diagnosis of acute appendicitis. MATERIALS AND METHODS From January 1, 1996 to December 31, 2000, 650 consecutive nonfocused helical abdominal CT scans were performed in adult patients presenting with acute lower abdominal pain. In general, most patients received both intravenous and oral contrast with 5-mm scan collimation through the lower abdomen and pelvis; details regarding technique and overall accuracy have been published previously. We subanalyzed results with respect to patient gender-related differences, especially in false-positive and false-negative cases. A chi2 analysis was performed to determine if significant gender-related differences were present in major or minor CT diagnostic criteria for acute appendicitis, extra-appendiceal findings, sensitivity, specificity, and accuracy. RESULTS Of the 650 patients, 552 had adequate clinical follow-up. The sensitivity for diagnosing acute appendicitis was 100% (65/65) in men and 93.6% (74/79) in women (P < 0.05); specificity was 96.2% (130/135) in men and 98.9% (272/275) in women (P > 0.05); and accuracy was 97.5% (193/198) in men and 97.6% in women (346/354) (P > 0.05). A thickened appendix and periappendiceal stranding were seen in 92.1% of men and 84.5% of women (P = 0.15) All 5 false-negative results were in thin women. In patients without acute appendicitis, CT was able to provide a relevant alternative diagnosis in 183 of 272 women (67.3%) and 81 of 130 men (62.3%) (P > 0.05). CONCLUSION Nonfocused helical CT was highly accurate for diagnosing acute appendicitis in both men and women, although there was a slight but significant decrease in sensitivity in thin women.
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Affiliation(s)
- Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, UCLA Center for the Health Sciences, Los Angeles, CA 90095-1721, USA.
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Raman SS, Lu DSK, Kadell BM, Vodopich DJ, Sayre J, Cryer H. Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol 2002; 178:1319-25. [PMID: 12034591 DOI: 10.2214/ajr.178.6.1781319] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The clinical usefulness of routine, nonfocused helical CT was evaluated in diagnosing acute appendicitis or providing an alternative diagnosis in patients presenting to the emergency department with acute lower abdominal pain. MATERIALS AND METHODS We reviewed CT reports and clinical records of 650 consecutive adult patients who presented between January 1996 and December 2000 with right lower quadrant pain or lower abdominal pain and clinical findings suggestive of appendicitis. Helical CT was performed with oral contrast material in 610 cases (93.8%) and IV contrast in 572 cases (88.0%). Both vascular and enteric contrast media were administered in 544 cases (83.7%). Rectal contrast material was administered in 52 cases (8.0%). The abdomen was helically scanned from the dome of the diaphragm to the iliac crests with a collimation of 7 mm, from the iliac crests to the acetabular roof at a 5-mm collimation, from the acetabular roof to the symphysis pubis with a collimation of 5-10 mm. The surgical or clinical record was used for follow-up. RESULTS Of the 650 patients, 552 (84.9%) had adequate clinical follow-up. There were 137 true-positive, eight false-positive, five false-negative, and 402 true-negative cases. The sensitivity, specificity, and accuracy of nonfocused helical CT were 96.5%, 98.0%, 97.6%, respectively. The positive and negative predictive values were 94.5% and 98.8%, respectively. In patients without acute appendicitis, CT suggested an alternative diagnosis, which clinically explained the patient's acute abdominal pain in 266 patients (66.2%). CONCLUSION Nonfocused helical CT was highly accurate in diagnosing acute appendicitis or suggesting an alternative diagnosis in patients with acute lower abdominal pain or right lower quadrant pain.
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Affiliation(s)
- Steven S Raman
- Department of Radiology, UCLA Center for the Health Sciences, 10833 Le Conte Ave., Los Angeles, CA 90095-1721, USA
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Raman SS, Lu DSK, Vodopich DJ, Sayre J, Lassman C. Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic peritoneal saline injection in a porcine model. Radiology 2002; 222:819-23. [PMID: 11867807 DOI: 10.1148/radiol.2223001805] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate if a targeted subphrenic peritoneal infusion of normal saline to separate liver from diaphragm before radio-frequency (RF) ablation could minimize or eliminate diaphragmatic injury. MATERIALS AND METHODS With a 2-cm-diameter, eight-prong RF needle electrode, 37 hepatic dome RF lesions were created in 10 pigs. Seventeen lesions were created before (non-saline group) and 20 lesions after (post-saline group) intraperitoneal infusion of approximately 500 mL of normal saline. Ten non-saline lesions were created deep (centered 1-2 cm from the liver surface) and seven superficially (centered within 1 cm of the capsule). All 20 post-saline lesions were created superficially. Helical enhanced computed tomography was performed 24-48 hours after ablation. The pigs were killed immediately, and the diaphragm was visually inspected and sectioned. Diaphragmatic injury was graded as 0, no injury; 1, injury up to one-third thickness; 2, injury to two-thirds thickness; 3, full-thickness injury. Representative grade 3 injuries and all partial injuries underwent gross and histologic analysis. RESULTS All 10 deep non-saline RF lesions caused grade 0 injury. All seven superficial non-saline lesions caused grade 3 injury. Of the 20 superficial post-saline lesions, 13 (65%) caused grade 0 injury; four (20%), grade 1; and three (15%), grade 3. The post-saline group caused significantly less diaphragmatic injury (P <.05). CONCLUSION Intraperitoneal saline infusion may reduce the frequency and severity of diaphragmatic injury when adjacent liver is treated with RF ablation.
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Affiliation(s)
- Steven S Raman
- Department of Radiology, University of California Los Angeles School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA.
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Lu DSK, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the "heat sink" effect. AJR Am J Roentgenol 2002; 178:47-51. [PMID: 11756085 DOI: 10.2214/ajr.178.1.1780047] [Citation(s) in RCA: 348] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The effect of vessels and their size on radiofrequency lesion creation in the liver was evaluated with respect to potential for vascular injury and perfusion-mediated "heat sink" effect. SUBJECTS AND METHODS Radiofrequency lesions targeted to tissue adjacent to a variety of vessels were created in vivo in the liver of 10 Yorkshire pigs. Postablation contrast-enhanced CT and then histopathologic analysis of the vessels and lesions were performed after sacrifice of the pigs. Degree of vascular injury and viability of perivascular hepatocytes were recorded and tabulated according to vessel size for both CT and histologic data sets. RESULTS At CT, 42 (95%) of 44 veins greater than 3 mm remained patent, and four (20%) of 20 veins less than 3 mm were occluded. Heat sink effect, indicated by invagination of enhancing tissue between vessel and radiofrequency lesion, was observed in 32 (73%) of 44 veins greater than 3 mm and in zero of 20 veins less than 3 mm. On histopathology, 111 (100%) of 111 vessels less than 3 mm showed at least partial vessel wall injury, characterized by endothelial cell necrosis and luminal thrombus. In 24 vessels greater than 3 mm, the extent of vessel wall injury decreased with increasing vessel diameter. Viable perivascular tissue indicative of heat sink effect was identified in 12 of 24 veins greater than 3 mm, increasing to seven of seven veins greater than 5 mm. None of 96 vessels less than 2 mm and three of 111 vessels less than 3 mm showed any heat sink effect. CONCLUSION There appears to be a narrow transition zone for hepatic vessels at 2-4 mm, beyond which the heat sink effect was seen consistently and substantial vascular injury was rare.
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Affiliation(s)
- David S K Lu
- Department of Radiology, UCLA School of Medicine, 10833 LeConte Ave., Los Angeles, CA 90095-1721, USA
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