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Bonatti M, Valletta R, Corato V, Gorgatti T, Posteraro A, Vingiani V, Lombardo F, Avesani G, Mega A, Zamboni GA. I thought it was a hemangioma! A pictorial essay about common and uncommon liver hemangiomas' mimickers. Insights Imaging 2024; 15:228. [PMID: 39298015 DOI: 10.1186/s13244-024-01745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/16/2024] [Indexed: 09/21/2024] Open
Abstract
Focal liver lesions are frequently encountered during imaging studies, and hemangiomas represent the most common solid liver lesion. Liver hemangiomas usually show characteristic imaging features that enable characterization without the need for biopsy or follow-up. On the other hand, there are many benign and malignant liver lesions that may show one or more imaging features resembling hemangiomas that radiologists must be aware of. In this article we will review the typical imaging features of liver hemangiomas and will show a series of potential liver hemangiomas' mimickers, giving radiologists some hints for improving differential diagnoses. CRITICAL RELEVANCE STATEMENT: The knowledge of imaging features of potential liver hemangiomas mimickers is fundamental to avoid misinterpretation. KEY POINTS: Liver hemangiomas typically show imaging features that enable avoiding a biopsy. Many benign and malignant liver lesions show imaging features resembling hemangiomas. Radiologists must know the potentially misleading imaging features of hemangiomas' mimickers.
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Affiliation(s)
- Matteo Bonatti
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy.
| | - Riccardo Valletta
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Valentina Corato
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Tommaso Gorgatti
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Andrea Posteraro
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Vincenzo Vingiani
- Department of Radiology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Fabio Lombardo
- Department of Radiology, IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar (VR), Italy
| | - Giacomo Avesani
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - Andrea Mega
- Department of Gastroenterology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Giulia A Zamboni
- Department of Diagnostics and Public Health, Institute of Radiology, University of Verona, Policlinico GB Rossi, P.Le LA Scuro 10, 37134, Verona, Italy
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Rai SPV, Kumar VK, Basavaiah SH, Sreeram S, Gopal S, Tantry BV. Efficacy and Validity of Image-Guided Percutaneous Fine Needle Aspiration and Core Biopsy of Liver Pathologies: Saga of Focal Hepatic Lesions from the Nodule to the Needle to the Slide. J Cytol 2021; 38:21-30. [PMID: 33935388 PMCID: PMC8078618 DOI: 10.4103/joc.joc_70_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/21/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Context: Radiology and pathology are pivotal tools in the investigational artillery for management of wide spectrum of hepatic lesions and early detection is of a paramount importance. Aims: The study aimed at analyzing the efficacy, comparative yield and validity of image-guided aspiration cytology (FNA)/core biopsy (CB) in focal hepatic lesions. Settings and Design: A retrospective hospital-based study was conducted in departments of Pathology and Radiology and Imaging of a tertiary care center. Materials and Methods: Cases of focal hepatic lesions that underwent percutaneous image guided-FNA reported (2011-2018) were analyzed. Cytological-histopathological correlation was performed where available. FNA diagnoses were divided into four categories-positive for malignancy (group 1), atypical (group 2), negative for malignancy (group 3), and non-diagnostic (group 4). Statistical Analysis Used: Categorical data was depicted in the form of frequencies and proportions. Validity of percutaneous image-guided FNA diagnosis was collated with the final diagnosis and results were analyzed. Results: A total of 338 FNA of focal hepatic lesions were reported in which 217 (68.2%) cases in group 1; 21 (6.2%) in group 2; 58 (17.2%) in group 3 and 42 (12.4%) in group 4. CB correlation was available in 123 cases. Based on clinical, radiological and pathological findings, conclusive final diagnoses were obtained and the cases were regrouped [malignant cases-245, benign lesions-57 and uncertain lesions-36]. Metastasis was the most common malignancy (175/245; 71.4%). Sensitivity, specificity, and overall diagnostic accuracy of FNA to categorize the lesion as benign or malignant were 96.94%, 100% and 97.51%, respectively. However, the cytology-histopathology correlation revealed discordance of subtyping the lesion in 20% of cases and sensitivity and specificity reduced to 80% and 50% respectively in rendering the specific diagnosis. Conclusions: Percutaneous image-guided FNA is a sensitive and specific tool with high diagnostic accuracy in evaluating focal hepatic lesions. The study highlights the pre-eminence of interventional radiology and cytology in the care of patients with liver lesions.
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Affiliation(s)
- Santosh Phajir Vishwanath Rai
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vinay Km Kumar
- Post Graduate Student, Department of Radiodiagnosis and Imaging, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sridevi Hanaganahalli Basavaiah
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Saraswathy Sreeram
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sandeep Gopal
- Department of Gastroenterology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bailuru Vishwanath Tantry
- Department of Gastroenterology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Evaluation of texture analysis for the differential diagnosis of focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced CT images. Abdom Radiol (NY) 2019; 44:1323-1330. [PMID: 30267107 DOI: 10.1007/s00261-018-1788-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore the value of CT texture analysis (CTTA) for differentiation of focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) on contrast-enhanced CT (CECT). METHODS This is a retrospective, IRB-approved study conducted in a single institution. A search of the medical records between 2008 and 2017 revealed 48 patients with 70 HCA and 50 patients with 62 FNH. All lesions were histologically proven and with available pre-operative CECT imaging. Hepatic arterial phase (HAP) and portal venous phase (PVP) were used for CTTA. Textural features were extracted using a commercially available research software (TexRAD). The differences between textural parameters of FNH and HCA were assessed using the Mann-Whitney U test and the AUROC were calculated. CTTA parameters showing significant difference in rank sum test were used for binary logistic regression analysis. A p value < 0.05 was considered statistically significant. RESULTS On HAP images, mean, mpp, and skewness were significantly higher in FNH than in HCA on unfiltered images (p ≤ 0.007); SD, entropy, and mpp on filtered analysis (p ≤ 0.006). On PVP, mean, mpp, and skewness in FNH were significantly different from HCA (p ≤ 0.001) on unfiltered images, while entropy and kurtosis were significantly higher in FNH on filtered images (p ≤ 0.018). The multivariate logistic regression analysis indicated that the mean, mpp, and entropy of medium-level and coarse-level filtered images on HAP were independent predictors for the diagnosis of HCA and a model based on all these parameters showed the largest AUROC (0.824). CONCLUSIONS Multiple explored CTTA parameters are significantly different between FNH and HCA on CECT.
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Contrast Improvement of Ultrasound Images of Focal Liver Lesions Using a New Histogram Equalization. LECTURE NOTES IN ELECTRICAL ENGINEERING 2019. [DOI: 10.1007/978-981-10-8672-4_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pang G, Duan Z, Shao C, Zhao F, Zhong H, Shao G. Heterogeneity analysis of triphasic CT scan perfusion parameters in differential diagnosis of hepatocellular carcinoma and hemangioma. Medicine (Baltimore) 2018; 97:e12512. [PMID: 30235766 PMCID: PMC6160147 DOI: 10.1097/md.0000000000012512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study is to investigate quantitative measures and heterogeneity of perfusion parameters in the differential diagnosis of hepatocellular carcinoma (HCC) and hemangioma.In total, 32 HCC and 44 hemangioma (types 1, 2, and 3) cases were included in this retrospective study. Hepatic artery coefficient (HAC), portal vein coefficient (PVC), and arterial enhancement fraction (AEF) were calculated. Tumor heterogeneity was analyzed. Perfusion parameters and corresponding percentiles were compared between the HCC and hemangioma (especially atypical hemangioma) cases, as well as between the substantial lesion part and surrounding normal tissue.The mean value, and the 10th, 50th, 75th, and 90th percentiles of PVC were significantly lower in the HCC cases than the types 1 and 2 hemangioma cases (P < .01). Moreover, the 90th percentile PVC in the HCC cases was also significantly lower than the type 3 hemangioma case (P < .01), while the mean value, and all the percentiles of AEF in the HCC cases were higher than the types 2 and 3 hemangioma cases (P < .01). The 10th percentile HAC in the HCC cases was higher than the type 2 hemangioma cases (P < .05). The mean value, and the 10th and 50th percentile HAC in the HCC cases were higher than the type 3 hemangioma case (P < .05). However, there was no statistically significant difference in HAC between the HCC and type 1 hemangioma cases (P > .05).Quantitative measurement of perfusion parameters and heterogeneity analysis show significance differences in the early detection and differential diagnosis of HCC and hemangioma cases, which might contribute to increasing the diagnostic accuracy.
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Affiliation(s)
- Guodong Pang
- Department of Radiology, The Second Hospital of Shandong University, Jinan
| | - Zuyun Duan
- Department of Radiology, The Second People's Hospital of Dongying, Dongying
| | - Chunchun Shao
- Department of Evidence-Based Medicine, The Second Hospital of Shandong University
| | - Fang Zhao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hai Zhong
- Department of Radiology, The Second Hospital of Shandong University, Jinan
| | - Guangrui Shao
- Department of Radiology, The Second Hospital of Shandong University, Jinan
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Chiorean L, Caraiani C, Radziņa M, Jedrzejczyk M, Schreiber-Dietrich D, Dietrich CF. Vascular phases in imaging and their role in focal liver lesions assessment. Clin Hemorheol Microcirc 2016; 62:299-326. [PMID: 26444602 DOI: 10.3233/ch-151971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Liliana Chiorean
- Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
- Département d’Imagerie Médicale, Clinique des Cévennes Annonay, France
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, “Octavian Fodor” Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maija Radziņa
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - Maciej Jedrzejczyk
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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Oğul H, Kantarcı M, Genç B, Pirimoğlu B, Cullu N, Kızrak Y, Yılmaz O, Karabulut N. Perfusion CT imaging of the liver: review of clinical applications. Diagn Interv Radiol 2015; 20:379-89. [PMID: 24834487 DOI: 10.5152/dir.2014.13396] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases.
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Affiliation(s)
- Hayri Oğul
- Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey.
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Pötter-Lang S, Brancatelli G, Bastati-Huber N, Ba-Ssalamah A. [Modern diagnostics of cystic liver lesions and hemangiomas]. Radiologe 2015; 55:9-17. [PMID: 25575722 DOI: 10.1007/s00117-014-2703-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CLINICAL ISSUE Cystic liver lesions incorporate a broad heterogeneous group of mostly benign but also malignant abnormalities. The radiological aim is the non-invasive diagnosis with the use of different imaging modalities to determine the type of lesion. STANDARD RADIOLOGICAL METHODS The common generally asymptomatic incidental findings of cystic lesions on ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) must be classified on the basis of specific imaging features. Such a differentiation is essential because the clinical consequences and the appropriate therapy can vary depending on the underlying pathology. Due to the morphological overlap of many cystic lesions, conventional radiological methods are often insufficient. METHODICAL INNOVATIONS The huge advances in cross-sectional imaging (multidetector CT, MRI with special sequences and different contrast agents and MR cholangiopancreatography) in combination with the clinical history usually enable a non-invasive diagnosis. Pathognomonic morphological and hemodynamic lesion features, as well as a knowledge of the pathomechanisms, help to differentiate this broad spectrum of entities. ACHIEVEMENTS In this article the different entities of cystic liver lesions, together with the appropriate diagnostic method for detection and distinction and including their strengths and limitations, are demonstrated. PRACTICAL RECOMMENDATIONS A well-founded knowledge about the development of various cystic liver lesions and the suitable choice of imaging method facilitate a non-invasive diagnosis.
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Affiliation(s)
- S Pötter-Lang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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Maurea S, Mainenti PP, Tambasco A, Imbriaco M, Mollica C, Laccetti E, Camera L, Liuzzi R, Salvatore M. Diagnostic accuracy of MR imaging to identify and characterize focal liver lesions: comparison between gadolinium and superparamagnetic iron oxide contrast media. Quant Imaging Med Surg 2014; 4:181-9. [PMID: 24914419 DOI: 10.3978/j.issn.2223-4292.2014.01.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
To compare the diagnostic value of gadolinium (Gd) and ultrasmall superparamagnetic iron oxide (SPIO) contrast media for characterization of focal liver lesions (FLL), we retrospectively evaluated the results of magnetic resonance (MR) imaging in 68 patients (40 M, 28 F, age from 22 to 81 yrs) of which 36 with diagnosis of colo-rectal cancer, 26 with hepatic cirrhosis and 6 with incidental imaging detection of FLL. MR (Gyroscan Intera 1.5 T, Philips Medical Systems) study was performed using T1 and T2 fast-field-echo (FFE) and T2 turbo-spin-echo (TSE) sequences in axial and coronal views. Dynamic multi-phases gadolinium Gd-enhanced T1-FFE-Bh images were obtained in arterial, portal and equilibrium phases, followed by SPIO-enhanced T2-FFE scans. A qualitative analysis of pre- and post-contrast MR images to classify FLL as benign or malignant was performed using a 3-point scoring system: 0= benign; 1= suspicious for malignancy; 2= malignant. A total of 118 lesions were evaluated. In particular, histology (n=18), cytology (n=14) or clinical-imaging follow-up data (n=86) demonstrated 4 adenomas, 29 cysts, 3 focal steatosis, 25 hemangiomas, 1 focal vascular abnormality, 5 fibrotic lesions as well as 13 regenerative nodules, 6 dysplastic, 14 hepatocellular carcinomas (HCC), 17 metastasis and 1 cholangiocarcinoma. For MR imaging, diagnostic accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of Gd vs. SPIO images were respectively 83% vs. 92%, 79% vs. 74%, 85% vs. 99% (P=0.002), 68% vs. 96% (P=0.005) and 91% vs. 90%, respectively. The results suggest that SPIO-MR provides a diagnostic incremental value, as specificity and PPV, particularly to characterize FLL compared to Gd-MR; thus, we strongly recommend the use of SPIO when liver lesion characterization is requested and Gd images are uncertain.
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Affiliation(s)
- Simone Maurea
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Pier Paolo Mainenti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Annamaria Tambasco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Massimo Imbriaco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Carmine Mollica
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Ettore Laccetti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Luigi Camera
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Raffaele Liuzzi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Marco Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
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Dobeli KL, Lewis SJ, Meikle SR, Thiele DL, Brennan PC. Optimization of computed tomography protocols: limitations of a methodology employing a phantom with location-known opacities. J Digit Imaging 2013; 26:1001-7. [PMID: 23670587 DOI: 10.1007/s10278-013-9595-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study aimed to determine if phantom-based methodologies for optimization of hepatic lesion detection with computed tomography (CT) require randomization of lesion placement and inclusion of normal images. A phantom containing fixed opacities of varying size (diameters, 2.4, 4.8, and 9.5 mm) was scanned at various exposure and slice thickness settings. Two image sets were compared: All images in the first image set contained opacities with known location; the second image set contained images with opacities in random locations. Following Institutional Review Board approval, nine experienced observers scored opacity visualization using a 4-point confidence scale. Comparisons between image sets were performed using Spearman, Kappa, and Wilcoxon techniques. Observer scores demonstrated strong correlation between both approaches when all opacity sizes were combined (r = 0.92, p < 0.0001), for the 9.5 mm opacity (r = 0.96, p < 0.0001) and for the 2.4 mm opacity (r = 0.64, p < 0.05). There was no significant correlation for the 4.8 mm opacity. A significantly higher sensitivity score for the known compared with the unknown location was found for the 9.5 mm opacity and 4.8 mm opacity for a single slice thickness and exposure condition (p < 0.05). Phantom-based optimization of CT hepatic examinations requires randomized lesion location when investigating challenging conditions; however, a standard phantom with fixed lesion location is suitable for the optimization of routine liver protocols. The development of more sophisticated phantoms or methods than those currently available is indicated for the optimization of CT protocols for diagnostic tasks involving the detection of subtle change.
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Affiliation(s)
- Karen L Dobeli
- Medical Image Optimisation and Perception Group (MIOPeG), Medical Imaging & Radiation Sciences Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, Lidcombe, NSW, 2141, Australia,
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Yoo SH, Choi JY, Jang JW, Bae SH, Yoon SK, Kim DG, Yoo YK, Rha SE, Lee YJ, Jung ES. Gd-EOB-DTPA-enhanced MRI is better than MDCT in decision making of curative treatment for hepatocellular carcinoma. Ann Surg Oncol 2013; 20:2893-900. [PMID: 23649931 DOI: 10.1245/s10434-013-3001-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND We assessed the change in the therapeutic decision among curative treatments after adding Gd-EOB-DTPA-enhanced MRI to triple-phase MDCT for patients with early-stage HCC. METHODS This study retrospectively investigated two groups: 33 pathologically confirmed HCC patients after liver transplantation in group 1; 34 HCC patients without pathology in group 2. In group 1, we simulated the therapeutic decision-making process by pretransplant MDCT and Gd-EOB-DTPA-enhanced MRI. In group 2, including the 34 early-stage HCC patients consecutively enrolled, we investigated the change of therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT. RESULTS In the simulation from group 1, after adding Gd-EOB-DTPA-enhanced MRI, 33.3% (11/33 patients) of treatment decisions were changed from the decision based on MDCT alone. Among 22 patients considered eligible for resection and 33 patients for radiofrequency ablation, the therapeutic decision was changed for 10 patients in the surgical group and 4 patients for the RFA group (45.5 and 12.1%). In group 2, the rate of change in the therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT was 41.2% (14/34 patients). In group 1 with explants pathology, the median diameter of HCCs not detected by MDCT but detected by Gd-EOB-DTPA-enhanced MRI was 1.15 cm (0.3-3.0 cm). The median diameter of HCCs seen only in the explanted liver was 1.0 cm (0.3-1.7 cm), and 60.7% of them were well-differentiated HCCs. CONCLUSIONS This study suggests that performing Gd-EOB-DTPA-enhanced MRI before deciding on curative treatment for early-stage HCC may improve the accuracy of treatment decision for early-stage HCC.
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Affiliation(s)
- Sun Hong Yoo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Henninger B, Petersen J, Jaschke W. [Radiological diagnosis of primary hepatic malignancy]. Wien Med Wochenschr 2013; 163:113-22. [PMID: 23392810 DOI: 10.1007/s10354-013-0179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
Abstract
Modern radiology offers countless opportunities both in the detection but also in the characterization of primary liver malignancies. Ultrasound remains usually the first exploratory overview study whereat using ultrasound contrast agent for a further characterization of liver lesions improves this technique considerably. Advanced cross-sectional imaging methods can, in most cases, already provide an exact diagnosis. Thus, the CT is already considered a standard technique for liver imaging and magnetic resonance imaging has gained in recent years due to liver-specific contrast agents and faster sequences a central role in liver imaging. The following article provides an overview of these various radiological procedures and describes the different primary liver malignancies and their imaging characteristics.
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Affiliation(s)
- Benjamin Henninger
- Department Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich.
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Liu QY, Zhang WD, Lai DM, Ou-yang Y, Gao M, Lin XF. Hepatic focal nodular hyperplasia in children: Imaging features on multi-slice computed tomography. World J Gastroenterol 2012; 18:7048-7055. [PMID: 23323007 PMCID: PMC3531693 DOI: 10.3748/wjg.v18.i47.7048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 09/30/2012] [Accepted: 11/13/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia (FNH) in children on dynamic contrast-enhanced multi-slice computed tomography (MSCT) and computed tomography angiography (CTA) images.
METHODS: From September 1999 to April 2012, a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University, including 12 cases (5.5%) of FNH in children (age ≤ 18 years old). All the 12 pediatric patients underwent MSCT. We retrospectively analyzed the imaging features of FNH lesions, including the number, location, size, margin, density of FNH demonstrated on pre-contrast and contrast-enhanced computed tomography (CT) scanning, central scar, fibrous septa, pseudocapsule, the morphology of the feeding arteries and the presence of draining vessels (portal vein or hepatic vein).
RESULTS: All the 12 pediatric cases of FNH had solitary lesion. The maximum diameter of the lesions was 4.0-12.9 cm, with an average diameter of 5.5 ± 2.5 cm. The majority of the FNH lesions (10/12, 83.3%) had well-defined margins. Central scar (10/12, 83.3%) and fibrous septa (11/12, 91.7%) were commonly found in children with FNH. Central scar was either isodense (n = 7) or hypodense (n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase. Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases. Pseudocapsule was very rare (1/12, 8.3%) in pediatric FNH. With the exception of central scars and fibrous septa within the lesions, all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images, significantly hyperdense in the arterial phase (12/12, 100.0%), and isodense in the portal venous phase (7/12, 58.3%) and equilibrium phase (11/12, 91.7%). Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH, whereas no neovascularization of malignant tumors was noted. In 9 cases (75.0%), there was a spoke-wheel shaped centrifugal blood supply inside the tumors. The draining hepatic vein was detected in 8 cases of pediatric FNH. However, the draining vessels in the other 4 cases could not be detected. No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.
CONCLUSION: The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH. Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.
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Wang LX, Liu K, Lin GW, Zhai RY. Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI. HEPATITIS MONTHLY 2012; 12:e6212. [PMID: 23087753 PMCID: PMC3475020 DOI: 10.5812/hepatmon.6212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 05/31/2012] [Accepted: 06/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers. OBJECTIVES To analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool. PATIENTS AND METHODS This study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis. RESULTS CT AND MRI APPEARANCE AND CORRELATION WITH PATHOLOGY TYPES: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively. CONCLUSIONS In conclusion, CT and MRI are useful tools for SNN diagnosis.
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Affiliation(s)
- Li Xia Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China
| | - Kan Liu
- Department of Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guang Wu Lin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
- Corresponding author: Guang Wu Lin, Department of Radiology, Huadong Hospital, Fudan University, Shanghai 200040, Shanghai, China. Tel.: +86-2162483180, Fax: +86-2162483180, E-mail:
| | - Ren You Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China
- Corresponding author: Ren You Zhai, Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, 8 Gongtinan Road, Chaoyang District, Beijing 100020, Beijing, China. Tel.: +86-1085231908, Fax: +86-1065935214, E-mail:
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Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hapatmon.6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Eiber M, Fingerle AA, Brügel M, Gaa J, Rummeny EJ, Holzapfel K. Detection and classification of focal liver lesions in patients with colorectal cancer: Retrospective comparison of diffusion-weighted MR imaging and multi-slice CT. Eur J Radiol 2012; 81:683-91. [DOI: 10.1016/j.ejrad.2011.01.072] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/10/2011] [Accepted: 01/17/2011] [Indexed: 12/27/2022]
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Chan VO, Das JP, Gerstenmaier JF, Geoghegan J, Gibney RG, Collins CD, Skehan SJ, Malone DE. Diagnostic performance of MDCT, PET/CT and gadoxetic acid (Primovist®)-enhanced MRI in patients with colorectal liver metastases being considered for hepatic resection: initial experience in a single centre. Ir J Med Sci 2012; 181:499-509. [DOI: 10.1007/s11845-012-0805-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 02/02/2012] [Indexed: 01/11/2023]
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Abstract
A profound knowledge of the various benign focal hepatic lesions and selection of the most suitable radiological examination modality is essential for achieving an accurate characterization of a hepatic lesion and in turn will determine the further patient management. This will avoid unnecessary agitation to both patient and the referring clinician and limits time-consuming, costly and risky biopsies to an absolute minimum. The following article will discuss the typical and atypical appearances of the most frequent and clinically relevant benign focal hepatic lesions with ultrasound, computed tomography and magnetic resonance imaging.
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Affiliation(s)
- S Baroud
- Universitätsklinik für Radiodiagnostik, AKH, Medizinische Universität Wien, Wien, Österreich.
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Sixty-four multi-slice computed tomography and magnetic resonance imaging in evaluation of hepatic focal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Stang A, Keles H, Hentschke S, Seydewitz C, Keuchel M, Pohland C, Dahlke J, Weilert H, Wessling J, Malzfeldt E. Real-time ultrasonography-computed tomography fusion imaging for staging of hepatic metastatic involvement in patients with colorectal cancer: initial results from comparison to US seeing separate CT images and to multidetector-row CT alone. Invest Radiol 2011; 45:491-501. [PMID: 20458251 DOI: 10.1097/rli.0b013e3181ddd3da] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To prospectively evaluate the role of real-time ultrasonography (US)-computed tomography (CT) fusion imaging (US-CT) in comparison with US seeing separate CT images (US + CT) and multidetector-row CT (MDCT) for the correct staging of hepatic metastatic involvement in patients with colorectal cancer. METHODS Sixty-four patients with newly diagnosed colorectal cancer and who were referred for abdominopelvic staging before primary tumor resection underwent same-day MDCT, US + CT, and US-CT. Examinations were evaluated on-site by 2 investigators in consensus. Investigators recorded the size and location of detected lesions on segmental liver maps, classified them as being benign, malignant, or indeterminate, and finally assessed the M stage of the liver as being M0, M1, or Mx (indeterminate). All patients underwent surgical exploration including intraoperative US. Reference standard diagnosis was based on findings at surgery, intraoperative US, histopathology, and MDCT follow-up imaging. Differences among investigated modalities were analyzed using McNemar's test. RESULTS The reference standard verified 109 (45 < or = 1 cm) hepatic lesions in 25 patients, including 65 (25 < or = 1 cm) metastases in 16 patients (M1). Regarding the 45 < or = 1 cm liver lesions, rates for detection were significantly higher (P < 0.05) for MDCT (80%, 36/45) and US-CT (77.8%, 35/45) than for US + CT (64.4%, 29/45); the rate for correct classification by US-CT (71.1%, 32/45) was significantly higher than for US + CT (48.9%, 22/45) and MDCT (31.1%, 14/45) (all P < 0.05). On patient-based analysis, specificity of MDCT (85.4%, 41/48) was significantly lower (P < 0.05) than for US-CT (97.9%, 47/48) and US + CT (93.7%, 45/48); the positive predictive value of MDCT (63.1%, 12/19) was not significantly different (P = 0.27) compared with US + CT (82.3%, 14/17) but significantly lower (P < 0.05) than for US-CT (93.7%, 15/16). In 13 patients (59 lesions) with only benign (stage M0) or coexistent benign and malignant lesions (stage M1), indeterminate lesion ratings and indeterminate liver stagings (Mx) occurred both significantly lower (P < 0.05) with US-CT (3.4%, 2/59; and 0%, 0/13) than with US + CT (11.9%, 7/59; and 23.1%, 3/13) or with MDCT (30.5%, 18/59; and 53.8%, 7/13). CONCLUSIONS Based on these initial diagnostic experiences, complementary US-CT fusion imaging of small CT-indeterminate liver lesions may have value in staging patients with colorectal cancer, focusing on patients who were likely to harbor only benign or coexisting benign and malignant liver lesions and in whom change of M staging would change the clinical management.
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Affiliation(s)
- Axel Stang
- Department of Oncology, Asklepios Hospital Altona, Hamburg, Germany.
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Sixty-Four-Multidetector-Row Computed Tomography Angiography With Bolus Tracking to Time Arterial-Phase Imaging in Healthy Liver. J Comput Assist Tomogr 2010; 34:883-91. [DOI: 10.1097/rct.0b013e3181dd80c8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wang L. Morphological and functional MDCT: problem-solving tool and surrogate biomarker for hepatic disease clinical care and drug discovery in the era of personalized medicine. Hepat Med 2010; 2:111-24. [PMID: 24367211 PMCID: PMC3846718 DOI: 10.2147/hmer.s9052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This article explains the significant role of morphological and functional multidetector computer tomography (MDCT) in combination with imaging postprocessing algorithms served as a problem-solving tool and noninvasive surrogate biomarker to effectively improve hepatic diseases characterization, detection, tumor staging and prognosis, therapy response assessment, and novel drug discovery programs, partial liver resection and transplantation, and MDCT-guided interventions in the era of personalized medicine. State-of-the-art MDCT depicts and quantifies hepatic disease over conventional CT for not only depicting lesion location, size, and extent but also detecting changes in tumor biologic behavior caused by therapy or tumor progression before morphologic changes. Color-encoded parameter display provides important functional information on blood flow, permeability, leakage space, and blood volume. Together with other relevant biomarkers and genomics, the imaging modality is being developed and validated as a biomarker to early response to novel, targeted anti-VEGF(R)/PDGFR or antivascular/angiogenesis agents as its parameters correlate with immunohistochemical surrogates of tumor angiogenesis and molecular features of malignancies. MDCT holds incremental value to World Health Organization response criteria and Response Evaluation Criteria in Solid Tumors in liver disease management. MDCT volumetric measurement of future remnant liver is the most important factor influencing the outcome of patients who underwent partial liver resection and transplantation. MDCT-guided interventional methods deliver personalized therapies locally in the human body. MDCT will hold more scientific impact when it is fused with other imaging probes to yield comprehensive information regarding changes in liver disease at different levels (anatomic, metabolic, molecular, histologic, and other levels).
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Affiliation(s)
- Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Optimal reconstructed section thickness for the detection of liver lesions with multidetector CT. Clin Radiol 2010; 65:193-7. [DOI: 10.1016/j.crad.2009.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 09/24/2009] [Accepted: 10/18/2009] [Indexed: 12/27/2022]
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C-11 acetate does not enhance usefulness of F-18 FDG PET/CT in differentiating between focal nodular hyperplasia and hepatic adenoma. Clin Nucl Med 2010; 34:659-65. [PMID: 19893396 DOI: 10.1097/rlu.0b013e3181b53488] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF THE REPORT We assessed the usefulness of F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and C-11 acetate PET (AC PET) in distinguishing hepatic lesions due to consequential disease (hepatocellular adenoma and malignant lesions) from focal nodular hyperplasia (FNH) in patients at low risk of malignancy. MATERIALS AND METHODS Thirty-one patients with 43 lesions were prospectively enrolled. The diagnostic work-up included Doppler and contrast-enhanced ultrasonography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. Fine needle biopsy was performed if the imaging study was inconclusive. The work-up revealed 36 FNH and 7 consequential lesions (5 hepatocellular adenoma, 1 hepatoma, and 1 metastasis). All patients underwent FDG and AC PET. FDG PET with target/background ratio (T/Br) greater than 1.2 and AC PET with T/Br of less than 1.2 were considered positive test for consequential disease. RESULTS On FDG PET, we had 6 true-positive out of 7 lesions due to consequential diseases, with a sensitivity of 85.7%, and 33 true-negative out of 36 lesions with FNH, with a specificity of 91.7%. Using AC PET, there were 2 true-positive lesions out of 7 caused by neoplasms, with a sensitivity of 28.6%, and 34 true-negative lesions out of 36 FNH, with a specificity of 94.4%. CONCLUSIONS When the goal is differentiating FNH from liver neoplasms, AC PET offered no additional diagnostic advantage over what is achieved with FDG PET.
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Characterisation of focal liver lesions undetermined at grey-scale US: contrast-enhanced US versus 64-row MDCT and MRI with liver-specific contrast agent. Radiol Med 2010; 115:714-31. [PMID: 20082225 DOI: 10.1007/s11547-010-0506-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Accepted: 05/07/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to assess the role of contrast-enhanced ultrasonography (CEUS) in the characterisation of focal liver lesions in comparison with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) with liver-specific contrast agent. MATERIALS AND METHODS One hundred and eighty-seven focal liver lesions, 91 malignant and 96 benign (mean size 3.2 cm) - proved by biopsy (n=12), histology (n=4), MDCT (n=108), MRI (n=44) MDCT/MRI (n=19) - in 159 patients were studied by CEUS. Two expert radiologists consensually evaluated the contrast-enhancement patterns at CEUS. For each lesion, they assessed: (a) nature (benign, malignant, not assessable), (b) specific diagnosis and (c) need for further radiological evaluation. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were calculated. RESULTS A total of 167/187 (89.3%) lesions were correctly assessed as benign or malignant at CEUS, whereas 14/187 (7.5%) lesions remained undetermined and 6/187 (3.2%) were incorrectly assessed. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were, respectively, 89%, 89.6%, 89%, 89.6% and 89.3%. The need for further radiological evaluation decreased to 46/187 (24.6%) lesions after CEUS (p<0.001). CONCLUSIONS In selected cases, CEUS can be considered an effective alternative to MDCT and MRI and reduce the need for further radiological workup.
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Di Bisceglie AM, Befeler AS. Tumors and Cysts of the Liver. SLEISENGER AND FORDTRAN'S GASTROINTESTINAL AND LIVER DISEASE 2010:1569-1592.e6. [DOI: 10.1016/b978-1-4160-6189-2.00094-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Shunichi S, Hiroko I, Fuminori M, Waki H. Definition of contrast enhancement phases of the liver using a perfluoro-based microbubble agent, perflubutane microbubbles. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1819-1827. [PMID: 19713032 DOI: 10.1016/j.ultrasmedbio.2009.05.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 05/12/2009] [Accepted: 05/18/2009] [Indexed: 05/28/2023]
Abstract
To define the contrast enhancement phases in the liver with perflubutane microbubbles, the liver enhancement time-intensity curves were investigated in 14 healthy volunteers. The agent was injected intravenously as a bolus and the liver was imaged with an ultrasound scanner as long as 4h after the injection. Time-intensity curves from the hepatic artery, the intrahepatic portal vein, the hepatic vein and the parenchyma of the liver were obtained from the liver ultrasound images. The arrival of the agent in the hepatic artery, the portal vein and the hepatic vein were visually distinguishable and the mean arrival times were 19.2, 24.3 and 32.2 s after the injection, respectively. The signal intensity in these vessels increased rapidly after the arrival of the contrast and gradually reverted to baseline after the peak. In contrast, within 5 min after the injection, the intensity in the parenchyma increased and reached a plateau, which persisted for at least 2h. The contrast enhancement phases in the liver with perflubutane microbubbles could be defined as two major phases-a vascular phase, in which the vessels are enhanced between 15 s and 10 min after injection, and a Kupffer phase, in which the parenchyma is enhanced 10 min after injection. The vascular phase is divided into three subphases: the arterial phase (15 to 45 s after injection); the portal phase (45 s to 1 min after injection); and the vasculo-Kupffer phase (1 to 10 min after injection).
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Affiliation(s)
- Sasaki Shunichi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Liu YJ, Fan WJ, Yuan ZD, Liu PC, Wang CR, Yan WQ, Wang SM, Chen JH, Liu Z. Research on focal nodular hyperplasia with MSCT and postprocessing. World J Gastroenterol 2009; 15:4838-43. [PMID: 19824121 PMCID: PMC2761565 DOI: 10.3748/wjg.15.4838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate and evaluate the pathological features and diagnostic value of focal nodular hyperplasia (FNH) with multi-section spiral computed tomography (MSCT) and postprocessing.
METHODS: A total of 25 patients with FNH who had undergone MSCT and postprocessing were included in the investigation. All patients had been pathologically or clinically confirmed with FNH. A number of 75 cases of hepatic carcinomas, hemangiomas and adenomas were randomly selected at a same period for a comparative study.
RESULTS: There was a single focus in 22 cases and multiple foci in 3 cases. On the plain scan, 17 lesions showed hypodensity, 7 isodensity and 4 hyperdensity (the case with fatty liver). With contrast, 28 lesions were enhanced evenly or in the nodules in the arterial phase; 13 lesions still showed hyperdensity, 11 lesions isodensity and 4 lesions hypodensity in the parenchymatous phase; in the delayed phase only 5 lesions showed hyperdensity but 9 lesions showed isodensity or slight hypodensity and 14 lesions showed hypodensity. Twelve lesions of 28 had central asteroid scars. Thickened feeding arteries in postprocessing were seen in 24 lesions, and were integrated into the parenchymatous lesions with a gradual and smooth course. On the contrary, there were no artery penetrated into the lesion found in any of comparative hepatic tumors.
CONCLUSION: Doctors could make a correct diagnosis and differentiation of FNH on evaluation of the characteristic appearance on MSCT with postprocessing.
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Efficacy of perflubutane microbubble-enhanced ultrasound in the characterization and detection of focal liver lesions: phase 3 multicenter clinical trial. AJR Am J Roentgenol 2009; 193:86-95. [PMID: 19542399 DOI: 10.2214/ajr.08.1618] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the efficacy and safety of contrast-enhanced ultrasound performed with perflubutane microbubbles in comparison with unenhanced ultrasound and dynamic CT in the characterization of focal liver lesions during the vascular phase of imaging and in the detection of lesions during the Kupffer phase. SUBJECTS AND METHODS A total of 196 patients were enrolled at 15 centers in Japan. Vascular phase images were obtained before contrast injection until 1 minute after injection. Kupffer phase images were obtained 10 minutes after injection. Dual-phase CT was performed as determined by standard clinical practice at each center. Unenhanced ultrasound, contrast-enhanced ultrasound, and CT images were read by blinded reviewers, and the results they reached regarding characterization and detection were compared with reference standard findings made by onsite investigators. The safety observation period was 72 hours after contrast administration. RESULTS Among the 190 patients included in the characterization analysis, the accuracy of contrast-enhanced ultrasound (88.9%) was significantly greater than that of unenhanced ultrasound (68.4%) and dynamic CT (80.5%) (p < 0.001 and p = 0.008). Among the 191 patients in the detection analysis, the efficacy of contrast-enhanced ultrasound in detection of lesions was significantly higher than that of unenhanced ultrasound and dynamic CT (p < 0.001 and p = 0.008), predominantly because more metastatic lesions were detected (both p < 0.001). In particular, contrast-enhanced ultrasound was superior to dynamic CT in the detection of metastatic lesions measuring 1 cm or smaller. The incidence of adverse events was 49.2% and that of adverse drug reactions was 10.4%. All adverse drug reactions were mild. CONCLUSION Compared with unenhanced ultrasound and dynamic CT, contrast-enhanced ultrasound with perflubutane microbubbles improved diagnostic efficacy in both characterization and detection of focal liver lesions with no serious adverse drug reactions.
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Luo W, Numata K, Morimoto M, Kondo M, Takebayashi S, Okada M, Morita S, Tanaka K. Focal liver tumors: characterization with 3D perflubutane microbubble contrast agent-enhanced US versus 3D contrast-enhanced multidetector CT. Radiology 2009; 251:287-95. [PMID: 19221060 DOI: 10.1148/radiol.2511081324] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the potential application of contrast material-enhanced three-dimensional (3D) ultrasonography (US), as compared with contrast-enhanced 3D computed tomography (CT), for characterization of focal liver tumors. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained. One hundred thirty-nine patients with focal liver tumors-77 hepatocellular carcinomas (HCCs), 33 metastases, 23 hemangiomas, and six focal nodular hyperplasias (FNHs)-who were examined at 3D US enhanced with a perflubutane microbubble contrast agent and at 3D contrast-enhanced multidetector CT were retrospectively identified. Two readers blindly reviewed the multiplanar images and angiograms reconstructed with both modalities and classified the depicted lesions according to diagnostic criteria based on their experience and published findings. Sensitivity, specificity, positive predictive value (PPV), area under the receiver operating characteristic curve (A(z)), intermodality agreement, and interreader agreement were assessed. RESULTS Readers 1 and 2 had concordant US and CT findings for 115 (83%) and 116 (83%) of the 139 lesions, respectively, with moderate to excellent (kappa = 0.55-0.81) intermodality agreement. There were no significant differences between the two modalities: Sensitivity was 83% or greater with both modalities, specificity was 87% or greater with contrast-enhanced US and 92% or greater with contrast-enhanced CT, the PPV was 71% or greater with both modalities, and the A(z) was at least 0.89 with US and at least 0.92 with CT. Interreader agreement was good to excellent (kappa > or = 0.76) with both modalities. CONCLUSION Contrast-enhanced 3D US potentially can be used to characterize focal liver tumors.
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Affiliation(s)
- Wen Luo
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
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Three-dimensional contrast-enhanced sonography of vascular patterns of focal liver tumors: pilot study of visualization methods. AJR Am J Roentgenol 2009; 192:165-73. [PMID: 19098197 DOI: 10.2214/ajr.08.1107] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We investigated visualization methods of 3D sonography with a perflubutane-based contrast agent in the imaging evaluation of vascular patterns of focal liver tumors. MATERIALS AND METHODS Eighty-four patients with focal liver tumors underwent automatic scanning with 3D sonography 20-60 seconds after administration of a perflubutane contrast agent. The confirmed final diagnoses were 50 hepatocellular carcinomas, 20 metastatic lesions, nine hemangiomas, and five cases of focal nodular hyperplasia. Tomographic sonographic images reconstructed in 3D parallel slices and rendered sonographic images resembling angiograms were reviewed by two readers. RESULTS Sonographic angiograms rendered by maximum intensity of gray values in surface smooth mode showed tumor vessels and early tumor enhancement. The average intensity of gray values with surface texture mode showed unenhanced areas within tumors. Interobserver agreement for classifying enhancement patterns with both tomographic sonography and sonographic angiography was excellent (kappa=0.84). The main pattern, intratumoral vessels with early homogeneous or heterogeneous tumor enhancement, had a sensitivity of 97% (average of both readers), specificity of 94%, and positive predictive value (PPV) of 96% for hepatocellular carcinomas. The presence of tumor vessels with early peripheral ringlike tumor enhancement had a sensitivity of 90%, specificity of 95%, and PPV of 86% for metastatic lesions. Peripheral nodular enhancement had a sensitivity of 84%, specificity of 99%, and PPV of 89% for hemangioma. The presence of spoke-wheel arteries with early tumor enhancement had a sensitivity of 80%, specificity of 100%, and PPV of 100% for focal nodular hyperplasia. CONCLUSION Three-dimensional sonography with a perflubutane-based contrast agent is useful in the evaluation of vascular patterns of focal liver tumors.
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Balci NC, Befeler AS, Leiva P, Pilgram TK, Havlioglu N. Imaging of liver disease: comparison between quadruple-phase multidetector computed tomography and magnetic resonance imaging. J Gastroenterol Hepatol 2008; 23:1520-7. [PMID: 18713303 DOI: 10.1111/j.1440-1746.2008.05434.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIM To compare quadruple-phase multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the assessment of focal and diffuse liver disease. METHODS Quadruple-phase contrast-enhanced MDCT and MRI of 37 consecutive patients were retrospectively reviewed by two readers (R1 and R2). In patients with focal liver lesions, the gold standard was histopathology (n = 17) and/or long-term (>6 months) follow-up imaging (n = 27) or transarterial chemoembolization (n = 1). Diffuse liver disease was confirmed by histopathology in all patients, when present. RESULTS Both readers identified 60 focal liver lesions on MDCT and 56 focal liver lesions on MRI. Gold standard diagnoses revealed 48 focal liver lesions in 25 patients. Diagnosis of malignant liver lesions revealed a sensitivity of 88% (R1) and 91% (R2) for MRI; 63% (R1) and 66% (R2) for MDCT; and a specificity of 75% (R1) and 79% (R2) for MRI; 50% (R1) and 64% (R2) for MDCT. MRI was superior to MDCT for the diagnosis of malignant focal liver lesions, when the mean areas under the alternative free-response receiver operating characteristic curves (A(Z)) were compared (MRI = 0.93 vs CT = 0.69), (P < 0.00001). Thirty-three patients had histopathologically confirmed diffuse liver disease. Overall diagnosis of diffuse liver disease revealed a sensitivity of 88% (R1) and 92% (R2) for MRI; 75% (R1) and 74% (R2) for MDCT; and a specificity of 100% for both modalities by both readers. CONCLUSIONS MRI is superior for the assessment of malignant focal liver lesions and diffuse liver disease compared to quadruple-phase MDCT, and can be considered as primary diagnostic imaging modality for liver imaging.
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Affiliation(s)
- N Cem Balci
- Department of Radiology, Saint Louis University and Mallinckrodt Institute of Radiology, St Louis, MO, USA.
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MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system. Eur Radiol 2008; 18:2865-73. [DOI: 10.1007/s00330-008-1088-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 03/16/2008] [Accepted: 04/27/2008] [Indexed: 10/21/2022]
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Optimization of Low-Contrast Detectability in Thin-Collimated Modern Multidetector CT Using an Interactive Sliding-Thin-Slab Averaging Algorithm. Invest Radiol 2008; 43:229-35. [DOI: 10.1097/rli.0b013e3181614f2d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2007; 18:457-67. [PMID: 18058107 DOI: 10.1007/s00330-007-0716-9] [Citation(s) in RCA: 310] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 03/19/2007] [Accepted: 04/17/2007] [Indexed: 12/30/2022]
Abstract
A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT.
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Hamer OW, Schlottmann K, Sirlin CB, Feuerbach S. Technology Insight: advances in liver imaging. ACTA ACUST UNITED AC 2007; 4:215-28. [PMID: 17404589 DOI: 10.1038/ncpgasthep0766] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 01/26/2007] [Indexed: 12/23/2022]
Abstract
The role of diagnostic imaging in the assessment of liver disease continues to gain in importance. The classic techniques used for liver imaging are ultrasonography, CT and MRI. In the past decade, there have been significant advances in all three techniques. In this article, we discuss the advances in ultrasonography, CT and MRI that have improved assessment of focal and diffuse liver disease, including the development of hardware, software, processing algorithms and procedural innovations.
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Affiliation(s)
- Okka W Hamer
- University Hospital of Regensburg, Department of Radiology, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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