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Dong J, Wang Z, Wang SR, Zhao H, Li J, Ma T. Application value of different imaging methods in the early diagnosis of small hepatocellular carcinoma: a network meta-analysis. Front Oncol 2025; 14:1510296. [PMID: 39876892 PMCID: PMC11772129 DOI: 10.3389/fonc.2024.1510296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 12/09/2024] [Indexed: 01/31/2025] Open
Abstract
Objective To determine the diagnostic value of ultrasound, multi-phase enhanced computed tomography, and magnetic resonance imaging of small hepatocellular carcinoma. Methods Experimental studies on diagnosing small hepatocellular carcinoma in four databases: PubMed, Cochrane Library, Web of Science, and Embase, were comprehensively searched from October 2007 to October 2024. Relevant diagnostic accuracy data were extracted and a Bayesian model that combined direct and indirect evidence was used for analysis. Results 16 original studies were included and data from 2,447 patients were collated to assess the diagnostic value of 10 different methods. The methodological quality of the included studies was good and there was no obvious publication bias. The pooled DOR of all diagnostic methods was 19.61, which was statistically significant (I2 = 76.0%, P < 0.01, 95% CI:13.30 - 28.92). Normal US + CEUS + ultrasonic elastic imaging had the highest specificity (92.9), accuracy (93.6), and positive predictive value (94.4). Unenhanced MRI + Contrast-enhanced MRI had the highest sensitivity (96.6) and negative predictive value (96.6), but specificity (12.5) and positive predictive value (34.4) were extremely poor. Contrast-enhanced MRI had the highest diagnostic value in individual imaging methods (sensitivity: 66, specificity: 55.5, accuracy: 67.9, positive predictive value: 64.4, negative predictive value: 66.5). There was significant inconsistency and high heterogeneity in this study. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024507883.
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Affiliation(s)
| | | | | | | | - Jun Li
- Department of Ultrasound Medicine, the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Ting Ma
- Department of Ultrasound Medicine, the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
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Maung ST, Tanpowpong N, Satja M, Treeprasertsuk S, Chaiteerakij R. MRI for hepatocellular carcinoma and the role of abbreviated MRI for surveillance of hepatocellular carcinoma. J Gastroenterol Hepatol 2024; 39:1969-1981. [PMID: 38899804 DOI: 10.1111/jgh.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) constitutes the majority of liver cancers and significantly impacts global cancer mortality. While ultrasound (US) with or without alpha-fetoprotein is the mainstay for HCC surveillance, its limitations highlight the necessity for more effective surveillance tools. Therefore, this review explores evolving imaging modalities and abbreviated magnetic resonance imaging (MRI) (AMRI) protocols as promising alternatives, addressing challenges in HCC surveillance. AREAS COVERED This comprehensive review delves into the evaluation and challenges of HCC surveillance tools, focusing on non-contrast abbreviated MRI (NC-AMRI) and contrast-enhanced abbreviated MRI protocols. It covers the implementation of AMRI for HCC surveillance, patient preferences, adherence, and strategies for optimizing cost-effectiveness. Additionally, the article provides insights into prospects for HCC surveillance by summarizing meta-analyses, prospective studies, and ongoing clinical trials evaluating AMRI protocols. EXPERT OPINION The opinions underscore the transformative impact of AMRI on HCC surveillance, especially in overcoming US limitations. Promising results from NC-AMRI protocols indicate its potential for high-risk patient surveillance, though prospective studies in true surveillance settings are essential for validation. Future research should prioritize risk-stratified AMRI protocols and address cost-effectiveness for broader clinical implementation, alongside comparative analyses with US for optimal surveillance strategies.
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Affiliation(s)
- Soe Thiha Maung
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Ma Har Myaing Hospital, Yangon, Myanmar
| | - Natthaporn Tanpowpong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Minchanat Satja
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Xu Z, Yang D, Luo J, Xu H, Jia J, Yang Z. Diagnosis of Sarcopenia Using the L3 Skeletal Muscle Index Estimated From the L1 Skeletal Muscle Index on MR Images in Patients With Cirrhosis. J Magn Reson Imaging 2023; 58:1569-1578. [PMID: 36932680 DOI: 10.1002/jmri.28690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Cirrhotic patients with sarcopenia have poor prognoses and higher mortality. The third lumbar vertebra (L3) skeletal muscle index (SMI) is widely used to assess sarcopenia. However, L3 is generally outside the scanning volume on standard liver MRI. PURPOSE To investigate SMIs change between slices in cirrhotic patients and the relationships between SMI at the 12th thoracic vertebra (T12), the first lumbar vertebra (L1) and the second lumbar vertebra (L2) levels and L3-SMI and assess the accuracy of the estimated L3-SMIs in diagnosing sarcopenia. STUDY TYPE Prospective. SUBJECTS A total of 155 cirrhotic patients (109 with sarcopenia, 67 male; 46 without sarcopenia, 18 male). FIELD STRENGTH/SEQUENCE A 3.0 T, 3D dual-echo T1-weighted gradient echo sequence (T1WI). ASSESSMENT Two observers analyzed T12 to L3 skeletal muscle area (SMA) in each patient based on T1W water images and calculated the SMI (SMA/height2 ). Reference standard was L3-SMI. STATISTICAL TESTS Intraclass correlation coefficient (ICC), Pearson correlation coefficients (r), and Bland-Altman plots. Models relating L3-SMI to the SMI at T12, L1, and L2 levels were constructed using 10-fold cross-validation. Accuracy, sensitivity, and specificity were calculated for the estimated L3-SMIs for diagnosing sarcopenia. P < 0.05 was considered statistically significant. RESULTS Intraobserver and interobserver ICCs were 0.998-0.999. The L3-SMA/L3-SMI were correlated with the T12 to L2 SMA/SMI (r = 0.852-0.977). T12-L2 models had mean-adjusted R2 values of 0.75-0.95. The estimated L3-SMI from T12 to L2 levels to diagnose sarcopenia had good accuracy (81.4%-95.3%), sensitivity (88.1%-97.0%), and specificity (71.4%-92.9%). The recommended L1-SMI threshold of 43.24 cm2 /m2 in males and 33.73 cm2 /m2 in females. DATA CONCLUSION The estimated L3-SMI from T12, L1 and L2 levels had good diagnostic accuracy in assessing sarcopenia in cirrhotic patients. Although L2 was best associated with L3-SMI, L2 is generally not included in standard liver MRI. L3-SMI estimate from L1 may therefore be most clinically applicable. EVIDENCE LEVEL 1. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Zhengyu Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Medical Technology, Shaanxi University of Chinese Medicine, Middle section of Century Avenue, Xianyang, Shaanxi, China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jia Luo
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jidong Jia
- Beijing Key Laboratory of Translational Medicine On Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Grazzini G, Chiti G, Zantonelli G, Matteuzzi B, Pradella S, Miele V. Imaging in Hepatocellular Carcinoma: what's new? Semin Ultrasound CT MR 2023; 44:145-161. [PMID: 37245881 DOI: 10.1053/j.sult.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Zhang G, Mou Y, Fan H, Li W, Cao Y, Bao H. 7T Small Animal MRI Research for Hepatic Alveolar Echinococcosis. Top Magn Reson Imaging 2022; 31:53-59. [PMID: 36469640 DOI: 10.1097/rmr.0000000000000297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES 7T small animal magnetic resonance imaging (MRI) was used to analyze the growth characteristics of hepatic alveolar echinococcosis (HAE). METHODS A mouse model of HAE was established by intraperitoneal injection of alveolar Echinococcus tissue suspension. Ten mouse models successfully inoculated by ultrasound screening were selected. The mouse model was scanned with T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI) sequence by 7T small animal MRI. Size, morphology, boundary, signal, and relationship with surrounding tissues of the lesions were recorded as characteristic alterations. Mice were killed at the end of the experiment, and the pathological specimens were taken for routine hematoxylin and eosin staining. RESULTS Lesions were mainly located in the right lobe of the liver. The multivesicular structure is the characteristic manifestation of this disease. In the liver, lesions invaded the portal vein and were mainly distributed at the hepatic hilum. The left branch of the portal vein was mainly invaded. The mean diameter of the lesions in the left lobe of the liver was larger than in other parts of the liver. The mean diameter of the cystic solid lesions was greater than the multilocular cystic lesions. HAE showed hypointense on T1WI, hyperintense on T2WI, and hypointense on DWI; the marginal zone of the lesion showed hyperintensity on DWI and grew toward the hilum. The MRI features of intraperitoneal lesions were similar to those of intrahepatic lesions. Intraperitoneal lesions increased faster than intrahepatic lesions in the same period. CONCLUSION Polyvesicular structure is a characteristic manifestation of hepatic alveolar echinococcosis in mice. The noninvasive monitoring of liver HAE in mice by 7T small animal MRI provides a visual basis for the diagnosis and treatment integration of HAE.
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Affiliation(s)
- Guanmi Zhang
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Yalin Mou
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Weixia Li
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Yuntai Cao
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Haihua Bao
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
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Xu Z, Luo J, Yang D, Xu H, Jia J, Yang Z. Agreement and correlation of abdominal skeletal muscle area measured by CT and MR imaging in cirrhotic patients. BMC Med Imaging 2022; 22:205. [DOI: 10.1186/s12880-022-00932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
CT-based abdominal skeletal muscle area (SMA) serves as a standard for assessing muscle mass in patients with cirrhosis. Few studies have used MR imaging to measure SMA in cirrhotic patients. The purpose of this study was to investigate the agreement and correlation of the SMA measured by MRI and CT in cirrhotic patients.
Methods
CT and MR images from 38 cirrhotic patients were analyzed using the Slice-O-Matic V5.0 software. One observer independently measured SMA at the mid-third lumbar vertebral (L3) level on CT and MR images. The intraclass correlation coefficient (ICC), Pearson correlation coefficient, and Bland–Altman plot were used to evaluate the agreement and correlation between CT and MRI SMA and their relationship with the sarcopenia severity and Child–Pugh grades.
Results
CT and MRI had a high intraobserver agreement, with ICCs ranging from 0.991 to 0.996. CT and MRI measurements were closely correlated (r = 0.991–0.998, all for P < 0.01), and the bias of the measurements was 0.68–3.02%. Among all MR images, T1w water images had the strongest correlation (r = 0.998, P < 0.01) and the minimum bias of 0.68%. The measurements of mid-L3 SMA on CT and T1w water images remained highly consistent in cirrhotic patients with different severities of sarcopenia and Child–Pugh grades.
Conclusions
MRI and CT showed high agreement and correlation for measuring mid-L3 SMA in cirrhotic patients. In addition to CT, MR images can also be used to assess muscle mass in cirrhotic patients, regardless of the severity of sarcopenia and Child–Pugh grades.
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Vogl TJ, Mader C, Michalik S, Hammerstingl R, Koch V. [Small hepatocellular carcinoma : Diagnostics according to guidelines and established in the clinical setting]. Radiologe 2022; 62:239-246. [PMID: 35037980 DOI: 10.1007/s00117-021-00965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE The diagnosis of hepatocellular carcinoma (HCC)-especially the characterization of small lesions <2 cm-continues to be a radiological challenge. STANDARD RADIOLOGICAL METHODS In the current S3 guideline on diagnosis and therapy of HCC, contrast-enhanced imaging examinations, such as contrast-enhanced ultrasonography (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI), are still the diagnostic standard. METHODOLOGICAL INNOVATIONS HCC in the cirrhotic liver should be diagnosed by its typical contrast-enhanced pattern in the MRI. In addition, the use of quality assurance instruments such as LI-RADS (Liver Imaging Reporting and Data System) contributes to the desired consistency of findings, even with small ambiguous findings. PERFORMANCE Many studies have shown that the LI-RADS classification reflects the likelihood of HCC and other malignant liver lesions. ACHIEVEMENTS Guidelines and quality assurance instruments contribute to a more precise diagnosis in patients with suspected HCC. PRACTICAL RECOMMENDATIONS A guideline-compliant diagnostic algorithm and the LI-RADS should be used across the board for accurate HCC diagnostics.
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Affiliation(s)
- Thomas J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Christoph Mader
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Sabine Michalik
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Renate Hammerstingl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Vitali Koch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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Lan H, Lin G, Zhong W. A meta-analysis of the added value of diffusion weighted imaging in combination with contrast-enhanced magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma lesser or equal to 2 cm. Oncol Lett 2020; 20:2739-2748. [PMID: 32782590 PMCID: PMC7400770 DOI: 10.3892/ol.2020.11805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
Diffusion weighted imaging (DWI) has been found to increase the sensitivity in the diagnosis of small hepatocellular carcinoma (HCC), although additional studies are required to confirm its value. The aim of the present study was to explore the diagnostic performance of DWI combined with contrast-enhanced magnetic resonance imaging (MRI) for small HCC by performing a meta-analysis. Literature databases (PubMed, Embase, Web of Science and Cochrane Library databases) were searched to identify studies reporting the sensitivity and specificity of MRI with DWI for the diagnosis of small HCCs. Pooled sensitivity and specificity were generated using a bivariate random effect model. Multilevel mixed-effects logistic regression analysis was used to examine the value of DWI combined with conventional MRI. A total of 837 small HCCs and 545 benign liver lesions from 10 studies were included. The overall sensitivity and specificity of DWI combined with contrast-enhanced MRI was 0.88 (95% CI, 0.80-0.93) and 0.90 (95% CI, 0.81-0.95), respectively. Compared with that in contrast-enhanced MRI, DWI with contrast-enhanced MRI had a significantly higher sensitivity for the diagnosis of small HCC (P=0.01) while there was no significant difference in the specificity (P=0.603). The present meta-analysis suggests that DWI combined with contrast-enhanced MRI may increase the sensitivity, whilst maintaining high specificity for the diagnosis of small HCCs with a diameter ≤2 cm.
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Affiliation(s)
- Hailong Lan
- Department of Radiology, Wuchuan People's Hospital, Wuchuan, Guangdong 524500, P.R. China
- Department of Radiology, Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan, Guangdong 528000, P.R. China
- Correspondence to: Dr Hailong Lan, Department of Radiology, Wuchuan People's Hospital, 12 Jiefang North Road, Wuchuan, Guangdong 524500, P.R. China, E-mail:
| | - Guisen Lin
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, P.R. China
| | - Weizhi Zhong
- Department of Radiology, Wuchuan People's Hospital, Wuchuan, Guangdong 524500, P.R. China
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Yang Y, Liu C, Qi L, Zhao T, Feng Y, Ai X, Zhao X, Li J, Zhu Q. Diagnosis of Pre-HCC Disease by Hepatobiliary-Specific Contrast-Enhanced Magnetic Resonance Imaging: A Review. Dig Dis Sci 2020; 65:2492-2502. [PMID: 31808004 DOI: 10.1007/s10620-019-05981-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
We first proposed a new concept, pre-hepatocellular carcinoma (HCC) disease, to describe the precancerous condition of HCC, which has received scant attention from clinicians. Pre-HCC disease is defined as chronic liver injury concurrent with hepatic low- or high-grade dysplastic nodular lesions. Precise diagnosis of pre-HCC disease may prevent or arrest HCC and contribute to relieving the HCC burden worldwide, although noninvasive diagnosis is difficult and biopsy is generally required. Fortunately, recent advances and extensive applications of hepatobiliary-specific contrast-enhanced magnetic resonance imaging will facilitate the noninvasive identification and characterization of pre-HCC disease. This review briefly discusses the new concept of pre-HCC disease and offers an overview of the role of hepatobiliary-specific contrast-enhanced magnetic resonance imaging for the diagnosis of pre-HCC disease.
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Affiliation(s)
- Yao Yang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Chenxi Liu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Linyu Qi
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Tong Zhao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Xin Ai
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Jie Li
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China.
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Delli Pizzi A, Mastrodicasa D, Cianci R, Serafini FL, Mincuzzi E, Di Fabio F, Giammarino A, Mannetta G, Basilico R, Caulo M. Multimodality Imaging of Hepatocellular Carcinoma: From Diagnosis to Treatment Response Assessment in Everyday Clinical Practice. Can Assoc Radiol J 2020; 72:714-727. [PMID: 32436394 DOI: 10.1177/0846537120923982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is a recently developed classification aiming to improve the standardization of liver imaging assessment in patients at risk of developing hepatocellular carcinoma (HCC). The LI-RADS v2017 implemented new algorithms for ultrasound (US) screening and surveillance, contrast-enhanced US diagnosis and computed tomography/magnetic resonance imaging treatment response assessment. A minor update of LI-RADS was released in 2018 to comply with the American Association for the Study of the Liver Diseases guidance recommendations. The scope of this review is to provide a practical overview of LI-RADS v2018 focused both on the multimodality HCC diagnosis and treatment response assessment.
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Affiliation(s)
- Andrea Delli Pizzi
- ITAB-Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | | | - Roberta Cianci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | | | - Erica Mincuzzi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Francesca Di Fabio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Alberto Giammarino
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Gianluca Mannetta
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Massimo Caulo
- ITAB-Institute of Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
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Kovac JD, Milovanovic T, Dugalic V, Dumic I. Pearls and pitfalls in magnetic resonance imaging of hepatocellular carcinoma. World J Gastroenterol 2020; 26:2012-2029. [PMID: 32536771 PMCID: PMC7267693 DOI: 10.3748/wjg.v26.i17.2012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy, which usually arises in cirrhotic liver. When the typical enhancement pattern, consisting of late arterial hyperenhancement followed by washout, is present in nodules larger than 1 cm, HCC can be confidently diagnosed without the need for tissue biopsy. Nevertheless, HCC can display an atypical enhancement pattern, either as iso or hypovascular lesion, or hypervascular lesion without washout. Not only the enhancement pattern of HCC could be atypical, but also a variety of histological types of HCC, such as steatotic, scirrhous, fibrolamellar, or combined hepatocellular-cholangiocellular carcinoma could raise diagnostic dilemmas. In addition, distinct morphological types of HCC or different growth pattern can occur. Awareness of these atypical and rare HCC presentations on magnetic resonance imaging is important for accurate differentiation from other focal liver lesions and timely diagnosis, which allows optimal treatment of patients.
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Affiliation(s)
- Jelena Djokic Kovac
- Departament of Radiology, Clinical Center Serbia, Belgrade 11000, Serbia
- School of Medicine, Belgrade University, Belgrade 11000, Serbia
| | - Tamara Milovanovic
- Departament of Hepatology, Clinical Center Serbia, Belgrade 11000, Serbia
- School of Medicine, Belgrade University, Belgrade 11000, Serbia
| | - Vladimir Dugalic
- Departament of Surgery, Clinical Center Serbia, Belgrade 11000, Serbia
- School of Medicine, Belgrade University, Belgrade 11000, Serbia
| | - Igor Dumic
- Divison of Hospital Medicine, Mayo Clinic College of Medicine and Sciences, Mayo Clinic Health System, New York, NY 10029, United States
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A proposal for a useful algorithm to diagnose small hepatocellular carcinoma on MRI. Eur J Gastroenterol Hepatol 2020; 32:74-79. [PMID: 31211723 DOI: 10.1097/meg.0000000000001476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To assess MRI features for the diagnosis of small hepatocellular carcinomas (HCCs) and especially for nodules not showing both of the typical hallmarks. PATIENTS AND METHODS Three hundred and sixty-four cirrhotic patients underwent liver MRI for 10-30 mm nodules suggestive of HCC. The diagnostic performances of MRI features [T1, T2; diffusion-weighted (DW) imaging signal, enhancement, capsule, fat content] were tested, both individually and in association with both typical hallmarks and as substitutions for one hallmark. The diagnostic reference was obtained using a multifactorial algorithm ensuring high specificity (Sp). RESULTS Four hundred and ninety-three nodules were analyzed. No alternative features, associations or substitutions outperformed the typical hallmarks for the diagnosis of HCC. For 10-20 mm nodules not displaying one of the typical hallmarks, hyperintensity on DW images was the most accurate substitutive sign, providing a sensitivity of 71.4% and Sp of 75% for nodules without arterial enhancement and sensitivity = 65.2% and Sp = 66% for nodules without washout on the portal or delayed phases. A new diagnostic algorithm, including typical hallmarks as a first step then the best-performing substitutive signs (capsule presence or DW hyperintensity) in combination with the nonmissing typical hallmark as a second step, enabled the correct classification of 77.7% of all nodules, regardless of size. CONCLUSION Using MRI, the typical hallmarks remain the best criteria for the diagnosis of small HCCs. However, by incorporating other MRI features, it is possible to build a simple algorithm enabling the noninvasive diagnosis of HCCs displaying both or only one of the typical hallmarks.
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Ji X, Zhou S, Yang P, Liu F, Li Y, Li H. Value of ultrasound combined with MRI in the diagnosis of primary and recurrent hepatocellular carcinoma. Oncol Lett 2019; 18:6180-6186. [PMID: 31788093 PMCID: PMC6864961 DOI: 10.3892/ol.2019.10945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
Ultrasound (US) combined with magnetic resonance imaging (MRI) in the diagnosis of primary hepatocellular carcinoma (PHCC) and recurrent hepatocellular carcinoma (RHCC) were compared. The clinical data of 329 patients with hepatocellular carcinoma (HCC) admitted to Qingdao Women and Children's Hospital from June 2015 to December 2017 were collected. One hundred and sixty patients with PHCC were regarded as the PHCC group, and the other 169 patients with RHCC were regarded as the RHCC group. US and MRI were used in the imaging diagnosis of both groups and the results of US combined with MRI, US, and MRI alone were compared. The lesion size in the PHCC group was significantly higher than that in the RHCC group (P<0.05). The MRI fast-in and fast-out rates of the two groups were significantly higher than those of the other three methods (P<0.05). The coincidence rate of MRI in the two groups was higher than that of computed tomography (CT), US, and US combined with MRI (P<0.05). The coincidence rates of CT, US, MRI, and US combined with MRI in PHCC group were significantly higher than those in RHCC group. In PHCC group, MRI was superior to the other methods in the detection of micro HCC (P<0.05). In RHCC group, MRI was significantly better than US in the detection of micro HCC (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of MRI were significantly better than the other three methods (P<0.05). MRI alone has the best diagnostic efficacy for micro HCC-type lesions. The diagnostic efficacy of MRI, US, CT, and US combined with MRI in PHCC was better than those in RHCC. In addition to imaging examination, the diagnosis of RHCC should be combined with other indicators for comprehensive diagnosis.
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Affiliation(s)
- Xiaoli Ji
- Department of Special Inspection (Ultrasound in Obstetrics and Gynecology), Qingdao Women and Children's Hospital, Qingdao, Shandong 266034, P.R. China
| | - Shisheng Zhou
- Department of Ultrasound, Yantaishan Hospital, Yantai, Shandong 264000, P.R. China
| | - Peng Yang
- Administrative Department (Outpatient), The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Faqin Liu
- Department of Operating Room, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Yan Li
- Department of Operating Room, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Hong Li
- Department of Ultrasound, Jining No. 1 People's Hospital, Jining, Shandong 272111, P.R. China
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Horvat N, Monti S, Oliveira BC, Rocha CCT, Giancipoli RG, Mannelli L. State of the art in magnetic resonance imaging of hepatocellular carcinoma. Radiol Oncol 2018; 52:353-364. [PMID: 30511939 PMCID: PMC6287184 DOI: 10.2478/raon-2018-0044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022] Open
Abstract
Background Liver cancer is the sixth most common cancer worldwide and the second leading cause of cancer mortality. Chronic liver disease caused by viral infection, alcohol abuse, or other factors can lead to cirrhosis. Cirrhosis is the most important clinical risk factor for hepatocellular carcinoma (HCC) whereby the normal hepatic architecture is replaced by fibrous septa and a spectrum of nodules ranging from benign regenerative nodules to HCC, each one of them with different imaging features. Conclusions Furthermore, advanced techniques including the quantification of hepatic and intralesional fat and iron, magnetic resonance elastography, radiomics, radiogenomics, and positron emission tomography (PET)-MRI are highly promising for the extraction of new imaging biomarkers that reflect the tumor microenvironment and, in the future, may add decision-making value in the management of patients with HCC.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, Brazil
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | | | - Brunna Clemente Oliveira
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, Brazil
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | - Camila Carlos Tavares Rocha
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | | | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
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Kuai ZX, Sang XQ, Yao YF, Chu CY, Zhu YM. Evaluation of non-monoexponential diffusion models for hepatocellular carcinoma using b values up to 2000 s/mm 2 : A short-term repeatability study. J Magn Reson Imaging 2018; 50:297-304. [PMID: 30447032 DOI: 10.1002/jmri.26563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Non-monoexponential diffusion models are being used increasingly for the characterization and curative effect evaluation of hepatocellular carcinoma (HCC). But the fitting quality of the models and the repeatability of their parameters have not been assessed for HCC. PURPOSE To evaluate kurtosis, stretched exponential, and statistical models for diffusion-weighted imaging (DWI) of HCC, using b-values up to 2000 s/mm2 , in terms of fitting quality and repeatability. STUDY TYPE Prospective. POPULATION Eighteen patients with HCC. FIELD STRENGTH/SEQUENCE Conventional and DW images (b = 0, 200, 500, 1000, 1500, 2000 s/mm2 ) were acquired at 3.0T. ASSESSMENT The parameters of the kurtosis, stretched exponential, and statistical models were calculated on regions of interest (ROIs) of each lesion. STATISTICAL TESTS The fitting quality was evaluated through comparing the fitting residuals produced on the average data of ROI between different models using a paired t-test or Wilcoxon rank-sum test. Repeatability of the fitted parameters at the median values on the voxelwise data of ROI was assessed using the within coefficient of variation (WCV), the intraclass correlation coefficient (ICC), and the 95% Bland-Altman limits of agreements (BA-LA). The repeatability was divided into four levels: excellent, good, acceptable, and poor, referring to the values of ICC and WCV. RESULTS Among three models, the stretched exponential model provided the best fit to HCC (P < 0.05), whereas the statistical model produced the largest fitting residuals (P < 0.05). The repeatability of K from the kurtosis model was excellent (ICC 0.915; WCV 8.79%), while the distributed diffusion coefficient (DDC) from the stretched model was just acceptable (ICC 0.477; WCV 27.83%). The repeatability was good for other diffusion-related parameters. DATA CONCLUSION Considering the model fit and repeatability, the kurtosis and stretched exponential models are the preferred models for the description of the DW signals of HCC with respect to the statistical model. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:297-304.
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Affiliation(s)
- Zi-Xiang Kuai
- Imaging Center, Harbin Medical University Cancer Hospital, Harbin, P.R. China
| | - Xi-Qiao Sang
- Division of Respiratory Disease, Fourth Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yuan-Fei Yao
- Imaging Center, Harbin Medical University Cancer Hospital, Harbin, P.R. China
| | - Chun-Yu Chu
- College of Engineering, Bohai University, Jinzhou, P.R. China
| | - Yue-Min Zhu
- CREATIS, CNRS UMR 5220-INSERM U1206-University Lyon 1-INSA Lyon-University, Lyon, France
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16
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Cerny M, Chernyak V, Olivié D, Billiard JS, Murphy-Lavallée J, Kielar AZ, Elsayes KM, Bourque L, Hooker JC, Sirlin CB, Tang A. LI-RADS Version 2018 Ancillary Features at MRI. Radiographics 2018; 38:1973-2001. [DOI: 10.1148/rg.2018180052] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chernyak V, Tang A, Flusberg M, Papadatos D, Bijan B, Kono Y, Santillan C. LI-RADS ® ancillary features on CT and MRI. Abdom Radiol (NY) 2018. [PMID: 28647768 DOI: 10.1007/s00261-017-1220-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) uses an algorithm to assign categories that reflect the probability of hepatocellular carcinoma (HCC), non-HCC malignancy, or benignity. Unlike other imaging algorithms, LI-RADS utilizes ancillary features (AFs) to refine the final category. AFs in LI-RADS v2017 are divided into those favoring malignancy in general, those favoring HCC specifically, and those favoring benignity. Additionally, LI-RADS v2017 provides new rules regarding application of AFs. The purpose of this review is to discuss ancillary features included in LI-RADS v2017, the rationale for their use, potential pitfalls encountered in their interpretation, and tips on their application.
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Affiliation(s)
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Demetri Papadatos
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Bijan Bijan
- Sutter Imaging (SMG)/University of California Davis (UCD), Sacramento, CA, USA
| | - Yuko Kono
- Department of Medicine, Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Cynthia Santillan
- Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA
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18
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ACR Appropriateness Criteria ® Chronic Liver Disease. J Am Coll Radiol 2017; 14:S391-S405. [DOI: 10.1016/j.jacr.2017.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 02/07/2023]
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19
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Bae JS, Kim JH, Yu MH, Lee DH, Kim HC, Chung JW, Han JK. Diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma and the concordance rate of Liver Imaging Reporting and Data System (LI-RADS). PLoS One 2017; 12:e0178495. [PMID: 28558068 PMCID: PMC5448778 DOI: 10.1371/journal.pone.0178495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background & aims To assess diagnostic accuracy of gadoxetic acid–enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS). Methods In this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid–enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS. Results Mean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%). Conclusion Diagnostic accuracy of gadoxetic acid–enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Mi Hye Yu
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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20
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Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Hindman NM, Kaur H, McNamara MM, Noto RB, Qayyum A, Lalani T. ACR Appropriateness Criteria ® Chronic Liver Disease. J Am Coll Radiol 2017; 14:S103-S117. [DOI: 10.1016/j.jacr.2017.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 02/07/2023]
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Willatt J, Ruma JA, Azar SF, Dasika NL, Syed F. Imaging of hepatocellular carcinoma and image guided therapies - how we do it. Cancer Imaging 2017; 17:9. [PMID: 28259177 PMCID: PMC5336669 DOI: 10.1186/s40644-017-0110-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/14/2017] [Indexed: 02/08/2023] Open
Abstract
Treatment options for hepatocellular carcinoma have evolved over recent years. Interventional radiologists and surgeons can offer curative treatments for early stage tumours, and locoregional therapies can be provided resulting in longer survival times. Early diagnosis with screening ultrasound is the key. CT and MRI are used to characterize lesions and determine the extent of tumour burden. Imaging techniques are discussed in this article as the correct imaging protocols are essential to optimise successful detection and characterisation. After treatment it is important to establish regular imaging follow up with CT or MRI as local residual disease can be easily treated, and recurrence elsewhere in the liver is common.
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Affiliation(s)
- Jonathon Willatt
- Veterans Administration, University of Michigan, Ann Arbor, MI, USA.
| | - Julie A Ruma
- Veterans Administration, University of Michigan, Ann Arbor, MI, USA
| | - Shadi F Azar
- Veterans Administration, University of Michigan, Ann Arbor, MI, USA
| | - Nara L Dasika
- Veterans Administration, University of Michigan, Ann Arbor, MI, USA
| | - F Syed
- Veterans Administration, University of Michigan, Ann Arbor, MI, USA
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22
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Sutherland T, Watts J, Ryan M, Galvin A, Temple F, Vuong J, Little AF. Diffusion-weighted MRI for hepatocellular carcinoma screening in chronic liver disease: Direct comparison with ultrasound screening. J Med Imaging Radiat Oncol 2016; 61:34-39. [PMID: 27558976 DOI: 10.1111/1754-9485.12513] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/30/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Ultrasound is a widely utilized method of screening patients with chronic liver disease for hepatocellular carcinoma (HCC). However, the sensitivity of ultrasound for small tumours is limited. We have prospectively compared ultrasound screening with diffusion-weighted (DWI) MRI for detecting HCC. METHODS Patients with chronic liver disease referred for ultrasound screening underwent a liver ultrasound and a liver MRI comprising free breathing DWI. Each test was independently read to determine the accuracy of each modality for detecting HCC. RESULTS One hundred and ninety-two patients were recruited and HCC was diagnosed in six patients (3%); all of whom were detected at ultrasound screening, and five detected at MRI screening. Ultrasound had false-positive studies 20 times (10%) while DWI MRI had three false-positive examinations (2%) p≥0.05. The sensitivity, specificity, positive predictive value and negative predictive values for ultrasound are 100%, 90%, 23% and 100%, respectively, while for MRI are 83%, 98%, 63% and 99%. CONCLUSION In patients with chronic liver disease undergoing surveillance for hepatocellular carcinoma, DWI MRI screening shows similar sensitivity to screening ultrasound but with a significantly lower false-positive rate.
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Affiliation(s)
- Tom Sutherland
- Medical Imaging Department, St Vincents Hospital, Fitzroy, Victoria, Australia
| | - Jane Watts
- Medical Imaging Department, St Vincents Hospital, Fitzroy, Victoria, Australia
| | - Marno Ryan
- Gastroenterology Department, St Vincents Hospital, Fitzroy, Victoria, Australia
| | - Angela Galvin
- Medical Imaging Department, Monash Health, Clayton, Victoria, Australia
| | - Faye Temple
- Medical Imaging Department, St Vincents Hospital, Fitzroy, Victoria, Australia
| | - Jason Vuong
- Medical Imaging Department, St Vincents Hospital, Fitzroy, Victoria, Australia
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Gluskin JS, Chegai F, Monti S, Squillaci E, Mannelli L. Hepatocellular Carcinoma and Diffusion-Weighted MRI: Detection and Evaluation of Treatment Response. J Cancer 2016; 7:1565-1570. [PMID: 27471573 PMCID: PMC4964141 DOI: 10.7150/jca.14582] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/22/2016] [Indexed: 12/11/2022] Open
Abstract
Differentiating between cancerous tissue and healthy liver parenchyma could represent a challenge with the only conventional Magnetic Resonance (MR) imaging. Diffusion weighted imaging (DWI) exploits different tissue characteristics to conventional Magnetic Resonance Imaging (MRI) sequences that enhance hepatocellular carcinoma (HCC) detection, characterization, and post-treatment evaluation. Detection of HCC is improved by DWI, infact this technology increases conspicuity of lesions that might otherwise not be identified due to obscuration by adjacent vessels or due to low contrast between the lesion and background liver. It is important to remember that DWI combined with contrast-enhanced MRI has higher sensitivity than DWI alone, and that some patients are not eligible for use of contrast on CT and MRI; in these patients DWI has a prominent role. MRI has advanced beyond structural anatomic imaging to now showing pathophysiologic processes. DWI is a promising way to characterize lesions utilizing the inherent contrast within the liver and has the benefit of not requiring contrast injection. DWI improves detection and characterization of HCC. Proposed clinical uses for DWI include: assessing prognosis, predicting response, monitoring response to therapy, and distinguishing tumor recurrence from treatment effect. Ideally, DWI will help risk stratify patients and will participate in prognostic modeling.
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Affiliation(s)
- Jill S Gluskin
- 1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C276, New York, NY 10065, USA
| | - Fabrizio Chegai
- 2. Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Ettore Squillaci
- 2. Department of Diagnostic and Molecular Imaging, Radiation Therapy and Interventional Radiology, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Lorenzo Mannelli
- 1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C276, New York, NY 10065, USA
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Kahraman AS, Kahraman B, Ozdemir ZM, Gormeli CA, Ozdemir F, Dogan M. Diffusion-weighted imaging (DWI) of the liver in assessing chronic liver disease: effects of the presence and the degree of ascites on ADC values. Abdom Radiol (NY) 2016; 41:56-62. [PMID: 26830612 DOI: 10.1007/s00261-015-0613-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to determine the correlation between the liver and spleen apparent diffusion coefficient (ADC) values of patients with chronic liver disease and the presence and the degree of ascites. MATERIALS AND METHOD In this retrospective study, we assessed 107 patients with chronic liver disease and 39 control subjects who underwent upper abdominal MR imaging including echo-planar diffusion-weighted imaging (DWI). Among the 107 cirrhotic patients, 56 were classified as group 1, 25 as group 2, and 26 as group 3 according to the absence, the presence of minimal, and the presence of massive ascites, respectively. The scores of model for end-stage liver disease (MELD) were matched between groups as the standard reference. The liver ADC, spleen ADC, and normalized liver ADC values were compared between the control group and patients' groups. RESULTS Patients with massive ascites had significantly higher MELD score compared with the other groups. The MELD score was also significantly higher in patient groups than in control group. The liver and normalized liver ADCs of patients' groups were significantly lower than that of the control group. With some overlap among groups, the measured ADC values decreased as the amount of the ascites increased, and these relationships were statistically significant. Furthermore, compared to control group, patients with massive ascites had significantly higher spleen ADCs. CONCLUSION Our results indicate that the ADC value of the liver and spleen correlates with the presence and the degree of ascites in patients with chronic liver disease, and merits further study.
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Affiliation(s)
- Aysegul Sagir Kahraman
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
| | - Bayram Kahraman
- Department of Radiology, Private Malatya Hospital, Malatya, Turkey.
| | - Zeynep Maras Ozdemir
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
| | - Cemile Ayse Gormeli
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
| | - Fatih Ozdemir
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey.
| | - Metin Dogan
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
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Yoon JH, Park JW, Lee JM. Noninvasive Diagnosis of Hepatocellular Carcinoma: Elaboration on Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guidelines Compared with Other Guidelines and Remaining Issues. Korean J Radiol 2016; 17:7-24. [PMID: 26798212 PMCID: PMC4720815 DOI: 10.3348/kjr.2016.17.1.7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/30/2015] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed based on characteristic findings of arterial-phase enhancement and portal/delayed "washout" in cirrhotic patients. Several countries and major academic societies have proposed varying specific diagnostic criteria for HCC, largely reflecting the variable HCC prevalence in different regions and ethnic groups, as well as different practice patterns. In 2014, a new version of Korean practice guidelines for management of HCC was released by the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC). According to the KLCSG-NCC Korea practice guidelines, if the typical hallmark of HCC (i.e., hypervascularity in the arterial phase with washout in the portal or 3 min-delayed phases) is identified in a nodule ≥ 1 cm in diameter on either dynamic CT, dynamic MRI, or MRI using hepatocyte-specific contrast agent in high-risk groups, a diagnosis of HCC is established. In addition, the KLCSG-NCC Korea practice guidelines provide criteria to diagnose HCC for subcentimeter hepatic nodules according to imaging findings and tumor marker, which has not been addressed in other guidelines such as Association for the Study of Liver Diseases and European Association for the Study of the Liver. In this review, we briefly review the new HCC diagnostic criteria endorsed by the 2014 KLCSG-NCC Korea practice guidelines, in comparison with other recent guidelines; we furthermore address several remaining issues in noninvasive diagnosis of HCC, including prerequisite of sonographic demonstration of nodules, discrepancy between transitional phase and delayed phase, and implementation of ancillary features for HCC diagnosis.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Joong-Won Park
- Center for Liver Cancer, National Cancer Center, Goyang 10408, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
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Hoffmann R, Rempp H, Schraml C, Schwenzer N, Grözinger G, Blumenstock G, Rothgang E, Pereira PL, Claussen CD, Clasen S. Diffusion-weighted imaging during MR-guided radiofrequency ablation of hepatic malignancies: analysis of immediate pre- and post-ablative diffusion characteristics. Acta Radiol 2015; 56:908-16. [PMID: 25182804 DOI: 10.1177/0284185114545148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/28/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Previous studies have shown a benefit of magnetic resonance (MR)-diffusion-weighted imaging (DWI) for follow-up after liver radiofrequency (RF) ablation. However, no data are available concerning acute changes of DWI characteristics immediately after RF ablation. PURPOSE To analyze and compare the MR-diffusion characteristics of pre-interventional hepatic malignancies and the ablation zone during successful MR-guided RF ablation. MATERIAL AND METHODS This retrospective study was conducted in accordance with the guidelines of the local institutional review board. Forty-seven patients with 29 HCC (24 patients) and 30 hepatic metastases (23 patients) underwent MR-guided radiofrequency ablation including DWI before and immediately after ablation (b = 0, 400, 800 s/mm(2)). Two reviewers (A and B) analyzed DWI with focus on detectability of the tumor before ablation and characteristics of the coagulative area after treatment. Mean apparent diffusion coefficient (ADC) was compared between liver, untreated tumor, and hyperintense areas in post-ablative DWI (b = 800 s/mm(2)) with the paired Student's t-test. RESULTS Pre-ablative: the reviewers classified 19/29 (A) and 23/29 (B) HCC and 25/30 (A and B) metastases as detectable in DWI. Post-ablative: a hyperintense rim surrounding the ablation zone was observed in 28/29 treated HCC and 30/30 treated metastases (A and B). A homogenous hypointense central ablation zone was found in 18/29 (A) and 20/29 (B) treated HCC and 17/30 (A & B) treated metastases in DWI. ADC of the rim was significantly lower than ADC of the liver (P < 0.001). CONCLUSION DWI enables visualization of the target tumor in MR-guided liver radiofrequency ablation in most cases. A common post-ablative DWI finding is a hyperintense rim with decreased ADC surrounding the ablation zone.
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Affiliation(s)
- Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Hansjörg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Christina Schraml
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Nina Schwenzer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard Karls University, Tübingen, Germany
| | - Eva Rothgang
- Center for Applied Medical Imaging, Siemens Corporate Research, Germany and Baltimore, MD, USA
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclear Medicine, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Claus D Claussen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
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Arif-Tiwari H, Kalb B, Chundru S, Sharma P, Costello J, Guessner RW, Martin DR. MRI of hepatocellular carcinoma: an update of current practices. Diagn Interv Radiol 2015; 20:209-21. [PMID: 24808419 DOI: 10.5152/dir.2014.13370] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and liver transplantation is the optimal treatment for selected patients with HCC and chronic liver disease (CLD). Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. In patients with CLD, the MRI findings of an arterial-enhancing mass with subsequent washout and enhancing capsule on delayed interstitial phase images are diagnostic for HCC. Major organizations with oversight for organ donor distribution, such as The Organ Procurement and Transplantation Network (OPTN), accept an imaging diagnosis of HCC, no longer requiring tissue biopsy. In patients that are awaiting transplantation, or are not candidates for liver transplantation, localized therapies such as transarterial chemoembolization and radiofrequency ablation may be offered. MRI can be used to monitor treatment response. The purpose of this review article is to describe the role of imaging methods in the diagnosis, staging, and follow-up of HCC, with particular emphasis on established and evolving MRI techniques employing nonspecific gadolinium chelates, hepatobiliary contrast agents, and diffusion weighted imaging. We also briefly review the recently developed Liver Imaging Reporting and Data System (LI-RADS) formulating a standardized terminology and reporting structure for evaluation of lesions detected in patients with CLD.
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Affiliation(s)
- Hina Arif-Tiwari
- From the Departments of Medical Imaging University of Arizona College of Medicine, Tucson, Arizona, USA.
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Kierans AS, Kang SK, Rosenkrantz AB. The Diagnostic Performance of Dynamic Contrast-enhanced MR Imaging for Detection of Small Hepatocellular Carcinoma Measuring Up to 2 cm: A Meta-Analysis. Radiology 2015; 278:82-94. [PMID: 26098460 DOI: 10.1148/radiol.2015150177] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the performance of dynamic contrast material-enhanced magnetic resonance (MR) imaging in the diagnosis of small (≤2-cm) hepatocellular carcinoma (HCC) and to identify factors that influence this performance. MATERIALS AND METHODS Medline and Embase databases were searched for studies performed from January 2000 to March 2014 in which the performance of MR imaging was reported for the detection of HCC up to 2 cm on either a lesion- or patient-based level, with sufficient data to construct 2 × 2 contingency tables. Diagnostic performance was quantitatively pooled for all studies by using a bivariate random-effects model with exploration involving subgroup analysis, meta-regression, and determination of study heterogeneity. RESULTS Twenty-two studies with 1387 small HCC lesions in 1908 patients met inclusion criteria. Heterogeneity was higher for sensitivity (range, 30%-99%) than specificity (range, 61%-100%). Overall sensitivity was 78% (95% confidence interval [CI]: 68%, 85%; I(2) = 89%), and overall specificity was 92% (95% CI: 88%, 95%; I(2) = 69%). The primary potential source of bias was use of explant as the reference standard in only 13% of studies, although lower sensitivity in such studies was not significant (59% vs 80%, P = .165). Sensitivities were significantly higher for studies that originated from Asia compared with those that originated elsewhere (89% vs 71%, P = .028), those performed with hepatobiliary phase imaging compared with those without (87% vs 65%, respectively; P = .004), and those in which gadoxetate disodium was used versus an extracellular agent (92% vs 67%, P ≤ .001). Specificity was not significantly different between subgroups (P ≥ .122). At pairwise meta-regression analysis with either study origin from Asia or performance of hepatobiliary phase imaging, only gadoxetate disodium contrast agent showed significant independent association with higher sensitivity (P = .002-.007). CONCLUSION Results of this meta-analysis suggest that dynamic contrast-enhanced MR imaging has moderate sensitivity and excellent specificity in the detection of HCC up to 2 cm. Gadoxetate disodium contrast agent showed the strongest association with increased sensitivity.
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Affiliation(s)
- Andrea S Kierans
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, 550 First Ave, New York, NY 10016
| | - Stella K Kang
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, 550 First Ave, New York, NY 10016
| | - Andrew B Rosenkrantz
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, 550 First Ave, New York, NY 10016
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Chilla GS, Tan CH, Xu C, Poh CL. Diffusion weighted magnetic resonance imaging and its recent trend-a survey. Quant Imaging Med Surg 2015; 5:407-22. [PMID: 26029644 DOI: 10.3978/j.issn.2223-4292.2015.03.01] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 12/14/2022]
Abstract
Since its inception in 1985, diffusion weighted magnetic resonance imaging has been evolving and is becoming instrumental in diagnosis and investigation of tissue functions in various organs including brain, cartilage, and liver. Even though brain related pathology and/or investigation remains as the main application, diffusion weighted magnetic resonance imaging (DWI) is becoming a standard in oncology and in several other applications. This review article provides a brief introduction of diffusion weighted magnetic resonance imaging, challenges involved and recent advancements.
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Affiliation(s)
- Geetha Soujanya Chilla
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Cher Heng Tan
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Chenjie Xu
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Chueh Loo Poh
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Inchingolo R, De Gaetano AM, Curione D, Ciresa M, Miele L, Pompili M, Vecchio FM, Giuliante F, Bonomo L. Role of diffusion-weighted imaging, apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver. Eur Radiol 2015; 25:1087-1096. [PMID: 25430005 DOI: 10.1007/s00330-014-3500-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 11/09/2014] [Accepted: 11/12/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To investigate the utility of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and the correlation with hepatobiliary phase (delayed phase imaging, DPI) findings in the differentiation of cirrhotic hepatocellular nodules. METHODS Forty-three patients with 53 pathology-proven nodules (29 hepatocellular carcinomas (HCCs), 13 high-grade (HGDNs) and 11 low-grade dysplastic nodules (LGDNs); mean size 2.17 cm, range 1-4 cm), who underwent liver MRI with DWI and DPI sequences, were retrospectively reviewed. Lesions were classified as hypointense, isointense, or hyperintense relative to the adjacent liver parenchyma. ADC of each nodule, of the surrounding parenchyma, and lesion-to-liver ratio were calculated. RESULTS Hyperintensity versus iso/hypointensity on DWI, hypointensity versus iso/hyperintensity on DPI, and the mean lesion-to-liver ratio showed a statistically significant difference both between HCCs versus DNs and between "HCCs + HGDNs" versus LGDNs (p < 0.05); sensitivity, specificity, and accuracy for the diagnosis of "HCCs + HGDNs" were 96.8 %, 100 %, 97.4 % respectively when combining hyperintensity on DWI and hypointensity on DPI, and 90.9 %, 81.0 %, 83.6 % respectively when lesion-to-liver ratio was <0.95. CONCLUSIONS Hyperintensity on DWI, especially in association with hypointensity on DPI, and low lesion-to-liver ratios should raise the suspicion of HCC, or at least of HGDN, thus helping the characterization of atypically enhancing lesions. KEY POINTS • Usefulness of DWI and ADC is shown in differential diagnosis of cirrhotic nodules. • Correlation of DWI with DPI improves differential diagnosis of cirrhotic nodules. • Characterization of atypically enhancing lesions becomes more confident.
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Affiliation(s)
- Riccardo Inchingolo
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, "Agostino Gemelli" Hospital, Catholic University of the Sacred Heart, Rome, Italy,
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Di Pietropaolo M, Briani C, Federici GF, Marignani M, Begini P, Delle Fave G, Iannicelli E. Comparison of diffusion-weighted imaging and gadoxetic acid-enhanced MR images in the evaluation of hepatocellular carcinoma and hypovascular hepatocellular nodules. Clin Imaging 2015; 39:468-75. [PMID: 25748089 DOI: 10.1016/j.clinimag.2014.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/13/2014] [Accepted: 12/20/2014] [Indexed: 01/16/2023]
Abstract
PURPOSE To compare diffusion-weighted imaging (DWI) and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI) in the evaluation of hepatocellular carcinoma (HCC) and nodules at high risk of HCC transformation. MATERIALS AND METHODS We evaluated nodules' size, vascular pattern, and signal intensity on hepatobiliary phase images and on DWI of 105 nodules (41 cirrhotic patients). RESULTS A total of 35/66 HCCs identified on Gd-EOB-DTPA MRI showed hyperintensity on DWI. A total of 25/39 nodules (hypovascular and hypointense nodule on hepatobiliary phase images) progressed to HCC (higher risk for nodules ≥10mm in size and hyperintense on DWI, P<.05). CONCLUSION Gd-EOB-DTPA MRI demonstrated a significant role in the identification of nodule at higher risk of HCC transformation, and hyperintensity on DWI was associated with progression to HCC.
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Affiliation(s)
- Marco Di Pietropaolo
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
| | - Chiara Briani
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Giulia Francesca Federici
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Massimo Marignani
- Digestive and Liver Disease Unit, Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Paola Begini
- Digestive and Liver Disease Unit, Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Gianfranco Delle Fave
- Digestive and Liver Disease Unit, Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Elsa Iannicelli
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
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Lee YJ, Lee JM, Lee JS, Lee HY, Park BH, Kim YH, Han JK, Choi BI. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology 2015; 275:97-109. [PMID: 25559230 DOI: 10.1148/radiol.14140690] [Citation(s) in RCA: 380] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis of the diagnostic performance of computed tomography (CT) and magnetic resonance (MR) imaging as noninvasive modalities for evaluating hepatocellular carcinoma (HCC) in patients with chronic liver disease. MATERIALS AND METHODS A search of the MEDLINE, EMBASE, and Cochrane Library databases was performed to identify studies providing per-patient or per-lesion diagnostic accuracies of multidetector CT and MR imaging for HCCs in patients with chronic liver disease. Studies published from January 2000 to December 2012 that used a reference standard based on histopathologic findings and/or findings at follow-up were included. Summary estimates of diagnostic accuracy were obtained by using a random-effects model with further exploration with meta-regression and subgroup analyses. RESULTS Forty studies (six on multidetector CT, 22 on MR imaging, and 12 on both CT and MR imaging) were included. The studies evaluated a total of 1135 patients with multidetector CT and 2489 patients with MR imaging. The overall per-patient sensitivity of MR imaging was 88% (95% confidence interval [CI]: 83%, 92%), with a specificity of 94% (95% CI: 85%, 98%). The overall per-lesion sensitivity of MR imaging was higher than that of multidetector CT when the paired data of the 11 available studies were pooled (80% vs 68%, P = .0023). Gadoxetic acid-enhanced MR imaging showed significantly higher per-lesion sensitivity than MR imaging performed with other contrast agents (87% vs 74%, P = .03). Per-lesion sensitivity was significantly lower for HCCs smaller than 1 cm than that for HCCs 1 cm or larger (P < .001 for CT, P = .02 for MR imaging) and for those in explanted livers (P = .04 for CT, P < .001 for MR imaging). CONCLUSION MR imaging showed higher per-lesion sensitivity than multidetector CT and should be the preferred imaging modality for the diagnosis of HCCs in patients with chronic liver disease.
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Affiliation(s)
- Yoon Jin Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Korea (Y.J.L., Y.H.K.); Department of Radiology, Institute of Radiation Medicine, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.M.L., J.K.H., B.I.C.); Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Korea (J.S.L.); and Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea (H.Y.L., B.H.P.)
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Liu W, Delabrousse É, Blagosklonov O, Wang J, Zeng H, Jiang Y, Wang J, Qin Y, Vuitton DA, Wen H. Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones. ACTA ACUST UNITED AC 2014; 21:74. [PMID: 25531446 PMCID: PMC4273719 DOI: 10.1051/parasite/2014072] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/11/2014] [Indexed: 12/12/2022]
Abstract
Hepatic Alveolar Echinococcosis (HAE), caused by larvae of Echinococcus multilocularis, is a rare but potentially lethal parasitic disease. The first diagnostic suspicion is usually based on hepatic ultrasound exam performed because of abdominal symptoms or in the context of a general checkup; HAE diagnosis may thus also be an incidental finding on imaging. The next step should be Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). They play an important role in the initial assessment of the disease; with chest and brain imaging, they are necessary to assess the PNM stage (parasite lesion, neighboring organ invasion, metastases) of a patient with AE. Performed at least yearly, they also represent key exams for long-term follow-up after therapeutic interventions. Familiarity of radiologists with HAE imaging findings, especially in the endemic regions, will enable earlier diagnosis and more effective treatment. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is currently considered to be the only noninvasive, albeit indirect, tool for the detection of metabolic activity in AE. Delayed acquisition of images (3 hrs after FDG injection) enhances its sensitivity for the assessment of lesion metabolism and its reliability for the continuation/withdrawal of anti-parasite treatment. However, sophisticated equipment and high cost widely limit PET/CT use for routine evaluation. Preliminary studies show that new techniques, such as contrast-enhanced ultrasound (US), Dual Energy CT or Spectral CT, and Diffusion-Weighted MRI, might also be useful in detecting the blood supply and metabolism of lesions. However, they cannot be recommended before further evaluation of their reliability in a larger number of patients with a variety of locations and stages of AE lesions.
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Affiliation(s)
- Wenya Liu
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Éric Delabrousse
- Department of Visceral Radiology, University Hospital Jean Minjoz, 25030 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France
| | - Oleg Blagosklonov
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France - Department of Nuclear Medicine, University Hospital Jean Minjoz, 25030 Besançon, France
| | - Jing Wang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Hongchun Zeng
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China
| | - Yi Jiang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Jian Wang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Yongde Qin
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Dominique Angèle Vuitton
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France
| | - Hao Wen
- Department of Hepatic surgery, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China
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Hwang J, Kim YK, Kim JM, Lee WJ, Choi D, Hong SS. Pretransplant diagnosis of hepatocellular carcinoma by gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging. Liver Transpl 2014; 20:1436-46. [PMID: 25103727 DOI: 10.1002/lt.23974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/19/2014] [Accepted: 07/31/2014] [Indexed: 01/12/2023]
Abstract
We sought to evaluate the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with and without additional diffusion-weighted imaging (DWI) in the detection of hepatocellular carcinoma (HCC) in pretransplant patients. We included 63 liver transplant patients (54 men and 9 women; mean age = 52 years) who had undergone gadoxetic acid-enhanced MRI with DWI at 3.0 T within 90 days before transplantation. Two image sets were reviewed for HCC in 2 separate sessions by 2 independent observers: the gadoxetic acid set and the combined set (gadoxetic acid plus DWI). The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each image set. In all, 113 HCCs (size range = 0.5-7.8 cm, mean = 2.0 ± 1.3 cm) were identified in the 52 liver explants. The per-lesion sensitivity of the combined set (78.8% for both observers) was higher than the sensitivity of the gadoxetic acid set [71.7% (P = 0.02) and 72.6% (P = 0.03) for the 2 observers], with the highest trend for Child-Pugh class A (94.4% and 97.2% for gadoxetic acid and 97.2% for combined), which was followed by class B (73.2% for gadoxetic acid and 82.9% for combined) and then class C (47.2% for gadoxetic acid and 55.6% for combined, P = 0.01). The per-patient negative predictive value of the combined set was higher than that of the gadoxetic acid set for both observers (P = 0.046). There was no difference in specificity between the 2 image sets (P > 0.05). The addition of DWI to gadoxetic acid-enhanced MRI resulted in significantly higher sensitivity to detect HCC. However, the sensitivity decreased with increasing cirrhosis severity for both imaging types.
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Affiliation(s)
- Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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Higaki A, Ito K, Tamada T, Sone T, Kanki A, Noda Y, Yasokawa K, Yamamoto A. Prognosis of small hepatocellular nodules detected only at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging as hypointensity in cirrhosis or chronic hepatitis. Eur Radiol 2014; 24:2476-81. [PMID: 25030460 DOI: 10.1007/s00330-014-3293-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/12/2014] [Accepted: 06/26/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the prognosis of "strict" high-risk nodules (small hepatocellular nodules detected only in the hepatobiliary phase of initial Gd-EOB-DTPA-enhanced MR examination) in patients with cirrhosis or chronic hepatitis. METHODS AND MATERIALS The study included thirty-three patients with 60 "strict" high-risk nodules showing hypointensity at the hepatobiliary phase that was undetectable at the vascular phase and other conventional sequences of initial Gd-EOB-DTPA-enhanced MR imaging. These nodules were observed on follow-up MR examinations until hypervascularity was detected. The potential predictive factors for hypervascular transformation were compared between two groups (group A showing hypervascular transformation, group B not showing hypervascularization). RESULTS Ten (16.7 %) of 60 "strict" high-risk nodules showed hypervascular transformation during follow-up periods (group A). The growth rates of the nodules in group A (6.3 ± 4.5 mm/year) were significantly higher than those in group B (3.4 ± 7.2 mm/year) (p = 0.003). Additionally, the median observation period in group A (177.5 ± 189.5 day) was significantly shorter than in group B (419 ± 372.2 day) (p = 0.045). The other predictive factors were not significantly correlated with hypervascularization. CONCLUSIONS Subsets of "strict" high-risk nodules showed hypervascular transformation during follow-up periods in association with increased growth rates, indicating that nodule growth rate is an important predictive factor for hypervascularization. KEY POINTS • "Strict" high-risk nodules are defined as hepatocellular nodules detected only in the hepatobiliary-phase. • Subsets of "strict" high-risk nodules showed hypervascular transformation during follow-up periods. • Increased growth rate is an important predictive factor for hypervascular transformation. • Management of patients with "strict" high-risk nodules becomes more appropriate.
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Affiliation(s)
- Atsushi Higaki
- Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan,
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Di Martino M, Di Miscio R, De Filippis G, Lombardo CV, Saba L, Geiger D, Catalano C. Detection of small (≤2 cm) HCC in cirrhotic patients: added value of diffusion MR-imaging. ACTA ACUST UNITED AC 2014; 38:1254-62. [PMID: 23857505 DOI: 10.1007/s00261-013-0009-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the usefulness of the diffusion-weighted sequence in the detection of small (≤2 cm) hepatocellular carcinoma (HCC) in patients with cirrhosis. METHODS Seventy cirrhotic patients with 93 HCCs underwent MR-Imaging at 1.5 T. MR acquisitions comprised unenhanced T1- and T2-weighted images and post-contrast Gd-BOPTA-enhanced T1W GRE-3D images acquired after approximately 25, 60, 180 s (dynamic phases) and 90 min (hepatobiliary phase). DWI was performed by a SSEPI sequence (b values 0, 50, 400, 800 s/mm(2)). Quantitative analysis was performed to establish significant difference of ADC values of benign lesions compared with that of HCC. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of two different protocols with and without diffusion MRI sequence were also calculated and compared each other. RESULTS A good inverse correlation was found between reference standard and ADC values (ρ = -0.688). The mean ADC value of HCC was significantly lower than the mean value of benign focal liver lesions (p < 0.0001). No significant difference was reported in term of sensitivity, specificity, PPV, NPV and diagnostic accuracy between the two datasets. A trend to a better sensitivity was found when DWI images were considered. CONCLUSIONS The adjunction of DWI does not significantly improve the diagnostic accuracy in the detection of small HCC.
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Affiliation(s)
- Michele Di Martino
- Department of Radiological Sciences, Oncology and Anatomical Pathology "Sapienza", Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy,
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Le Moigne F, Boussel L, Haquin A, Bancel B, Ducerf C, Berthezène Y, Rode A. Grading of small hepatocellular carcinomas (≤2 cm): correlation between histology, T2 and diffusion-weighted imaging. Br J Radiol 2014; 87:20130763. [PMID: 25007142 DOI: 10.1259/bjr.20130763] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the capacity of diffusion-weighted imaging (DWI) to determine the histological grade of small-sized hepatocellular carcinomas (HCCs) in liver cirrhosis in comparison with T2 weighted imaging. METHODS 51 cirrhotic patients with 63 histologically proven HCCs ≤2 cm underwent abdominal MRI, including DWI (b-values 50, 400 and 800 s mm(-2)) and T2 weighted sequences. HCCs were classified into well-differentiated HCCs (n = 37) and moderately differentiated HCCs (n = 26). Relative contrast ratios (RCRs) between the lesions and the surrounding liver were performed and compared between the two groups for T2 weighted images, each b-value and apparent diffusion coefficients (ADCs). A receiver operating characteristic (ROC) analysis was performed to compare RCRs in T2 and diffusion-weighted images. RESULTS We found significant differences in RCRs between well-differentiated vs moderately differentiated HCCs for b = 50, 400 and 800 s mm(-2) and T2 weighted images (1.35 ± 0.36 vs 1.86 ± 0.62; 1.35 ± 0.38 vs 1.82 ± 0.60; 1.27 ± 0.30 vs 1.74 ± 0.53; 1.14 ± 0.18 vs 1.43 ± 0.28, respectively; p < 0.001), whereas no significant differences were observed in ADC and ADC RCR (1.05 ± 0.19 vs 0.99 ± 0.15 and 1.1 ± 0.22 vs 1.09 ± 0.23; p = 0.16 and p = 0.82, respectively). No significant difference was found in the areas under the ROC curve for RCRs of T2 weighted images and every DWI b-value (p = 0.18). CONCLUSION The RCR measurement performed in DWI 50, 400 and 800 b-values and T2 demonstrated a significant difference between well-differentiated and moderately differentiated small-sized HCCs. Furthermore, no difference was shown by using either ADC or ADC RCR. ADVANCES IN KNOWLEDGE DWI with RCR measurement may be a valuable tool for non-invasively predicting the histological grade of small HCCs.
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Affiliation(s)
- F Le Moigne
- 1 Department of Radiology, Desgenettes Military Teaching Hospital, Lyon, France
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Hepatocellular carcinoma (HCC) in non-cirrhotic liver: clinical, radiological and pathological findings. Eur Radiol 2014; 24:1446-54. [DOI: 10.1007/s00330-014-3173-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/17/2014] [Accepted: 04/02/2014] [Indexed: 01/10/2023]
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Abstract
Cirrhosis is the main risk factor for the development of hepatocellular carcinoma (HCC). The major causative factors of cirrhosis in the United States and Europe are chronic hepatitis C infection and excessive alcohol consumption with nonalcoholic steatohepatitis emerging as another important risk factor. Magnetic resonance imaging is the most sensitive imaging technique for the diagnosis of HCC, and the sensitivity can be further improved with the use of diffusion-weighted imaging and hepatocyte-specific contrast agents. The combination of arterial phase hyperenhancement, venous or delayed phase hypointensity "washout feature," and capsular enhancement are features highly specific for HCC with reported specificities of 96% and higher. When these features are present in a mass in the cirrhotic liver, confirmatory biopsy to establish the diagnosis of HCC is not necessary. Other tumors, such as cholangiocarcinoma, sometimes occur in the cirrhotic at a much lower rate than HCC and can mimic HCC, as do other benign lesions such as perfusion abnormalities. In this article, we discuss the imaging features of cirrhosis and HCC, the role of magnetic resonance imaging in the diagnosis of HCC and other benign and malignant lesions that occur in the cirrhotic liver, and the issue of nonspecific arterially hyperenhancing nodules often seen in cirrhosis.
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Affiliation(s)
- Daniel C Barr
- From the Department of Radiology/MRI, University of Michigan Health System, Ann Arbor, MI
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Chen ML, Zhang XY, Qi LP, Shi QL, Chen B, Sun YS. Diffusion-weighted images (DWI) without ADC values in assessment of small focal nodules in cirrhotic liver. Chin J Cancer Res 2014; 26:38-47. [PMID: 24653625 DOI: 10.3978/j.issn.1000-9604.2014.01.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/04/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess if diffusion-weighted magnetic resonance (MR) imaging without apparent diffusion coefficient (ADC) values provides added diagnostic value in combination with conventional MR imaging in the detection and characterization of small nodules in cirrhotic liver. METHODS Two observers retrospectively and independently analyzed 86 nodules (≤3 cm) certified pathologically in 33 patients with liver cirrhosis, including 48 hepatocellular carcinoma (HCC) nodules, 13 high-grade dysplastic nodules (HDN), 10 low-grade dysplastic nodules (LDNs) and 15 other benign nodules. All these focal nodules were evaluated with conventional MR images (T1-weighted, T2-weighted and dynamic gadolinium-enhanced images) and breath-hold diffusion-weighted images (DWI) (b=500 s/mm(2)). The nodules were classified by using a scale of 1-3 (1, not seen; 3, well seen) on DWI for qualitative assessment. These small nodules were characterized by two radiologists. ADC values weren't measured. The diagnostic performance of the combined DWI-conventional images and the conventional images alone was evaluated using receiver operating characteristic (ROC) curves. The area under the curves (Az), sensitivity and specificity values for characterizing different small nodules were also calculated. RESULTS Among 48 HCC nodules, 33 (68.8%) were graded as 3 (well seen), 6 (12.5%) were graded as 2 (partially obscured), and 9 weren't seen on DWI. Among 13 HDNs, there were 3 (23.1%) and 4 (30.8%) graded as 3 and 2 respectively. Five (50%) of 10 benign nodules were partially obscured and slightly hyperintense. For 86 nodules, the average diagnostic accuracy of combined DWI-conventional images was 82.56%, which was increased significantly compared with conventional MR images with 76.17%. For HCC and HDN, the diagnostic accuracy of combined DWI-conventional images increased from 78.69% to 86.07%. CONCLUSIONS Diffusion-weighted MR imaging does provide added diagnostic value in the detection and characterization of HDN and HCC, and it may not be helpful for LDN and regenerative nodule (RN) in cirrhotic liver.
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Affiliation(s)
- Mai-Lin Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Li-Ping Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Qing-Lei Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Bin Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Si J, Huang S, Shi H, Liu Z, Hu Q, Wang G, Shen G, Zhang D. Usefulness of 3T diffusion-weighted MRI for discrimination of reactive and metastatic cervical lymph nodes in patients with oral squamous cell carcinoma: a pilot study. Dentomaxillofac Radiol 2014; 43:20130202. [PMID: 24408820 DOI: 10.1259/dmfr.20130202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To study the diagnostic accuracy of 3T diffusion-weighted MRI (DW-MRI) for the discrimination of reactive and metastatic cervical lymph nodes in patients with oral squamous cell carcinoma. METHODS DW T1 and T2 weighted MRI was performed in 25 patients with biopsy-proved primary oral squamous cell carcinoma. The mean apparent diffusion coefficient (ADC) values of 30 histopathologically proved reactive lymph nodes and 21 histopathologically proved metastatic lymph nodes were compared using an unpaired t-test. A cut-off ADC value with optimal diagnostic sensitivity, specificity and area under the curve in discrimination of the two groups was determined using a receiver operating characteristic curve analysis. RESULTS The mean ADC values of reactive lymph node and metastatic lymph node groups were (1.037 ± 0.149) × 10(-3) and (0.702 ± 0.197) × 10(-3) mm(2) s(-1), respectively. A statistically significant difference in ADC values of the two groups was certified (p < 0.0001). An optimal ADC threshold value of 0.887 × 10(-3) mm(2) s(-1) was suggested as the cut-off point, which resulted in 93.33% sensitivity, 80.95% specificity, 88.20% accuracy and area under curve of 0.887. CONCLUSIONS Our preliminary study indicates that the addition of 3T DW-MRI may be useful for discriminating between reactive lymph nodes and metastatic lymph nodes in patients with oral squamous cell carcinoma. However, larger studies are still required to validate our results and to standardize this imaging technique for daily clinical practice.
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Affiliation(s)
- J Si
- Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Attariwala R, Picker W. Whole body MRI: improved lesion detection and characterization with diffusion weighted techniques. J Magn Reson Imaging 2013; 38:253-68. [PMID: 23960006 PMCID: PMC3795449 DOI: 10.1002/jmri.24285] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 05/24/2013] [Indexed: 12/21/2022] Open
Abstract
Diffusion-weighted imaging (DWI) is an established functional imaging technique that interrogates the delicate balance of water movement at the cellular level. Technological advances enable this technique to be applied to whole-body MRI. Theory, b-value selection, common artifacts and target to background for optimized viewing will be reviewed for applications in the neck, chest, abdomen, and pelvis. Whole-body imaging with DWI allows novel applications of MRI to aid in evaluation of conditions such as multiple myeloma, lymphoma, and skeletal metastases, while the quantitative nature of this technique permits evaluation of response to therapy. Persisting signal at high b-values from restricted hypercellular tissue and viscous fluid also permits applications of DWI beyond oncologic imaging. DWI, when used in conjunction with routine imaging, can assist in detecting hemorrhagic degradation products, infection/abscess, and inflammation in colitis, while aiding with discrimination of free fluid and empyema, while limiting the need for intravenous contrast. DWI in conjunction with routine anatomic images provides a platform to improve lesion detection and characterization with findings rivaling other combined anatomic and functional imaging techniques, with the added benefit of no ionizing radiation.
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Cartier V, Aubé C. Gastrointestinal imaging: tips and traps in the diagnosis of small HCC. Diagn Interv Imaging 2013; 94:697-712. [PMID: 23751226 DOI: 10.1016/j.diii.2013.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Improvement in survival of patients with HCC depends on detecting small lesions. This is possible by screening all patients with cirrhosis for HCC. However, these small lesions are difficult to characterise as only 50 to 80% of lesions less than 3cm have a typical HCC appearance, depending on the imaging technique used. MRI, with its various possibilities (dynamic sequences, diffusion-weighting, liver-specific contrast agents), is currently the most effective imaging technique for characterising these small HCCs, but at present we do not know the best combination of imaging examinations for diagnosing the condition.
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Affiliation(s)
- V Cartier
- Radiology Department A, CHU Angers, 4, rue Larrey, 49933 Angers cedex, France
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Mannelli L, Bhargava P, Osman SF, Raz E, Moshiri M, Laffi G, Wilson GJ, Maki JH. Diffusion-weighted imaging of the liver: a comprehensive review. Curr Probl Diagn Radiol 2013; 42:77-83. [PMID: 23683849 DOI: 10.1067/j.cpradiol.2012.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
Diffusion-weighted magnetic resonance imaging is based on the Brownian motion of water and enables quantification of the apparent diffusion coefficient throughout the body. This article discusses the principles of diffusion-weighted magnetic resonance imaging, as well as the possible applications and limitations as they apply to liver imaging. This will introduce the readers to this novel magnetic resonance imaging tool, which has a promising future.
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Affiliation(s)
- Lorenzo Mannelli
- Department of Radiology, University of Washington, Seattle, WA 98104, USA.
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Liu K, Peng W, Zhou Z. The effect of gadolinium chelate contrast agent on diffusion-weighted imaging of pancreatic ductal adenocarcinoma. Acta Radiol 2013; 54:364-8. [PMID: 23386737 DOI: 10.1177/0284185112471795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are only two studies that discuss the effect of a gadolinium chelate contrast agent on pancreatic diffusion-weighted imaging (DWI). However, both studies only included normal pancreas and/or pancreas with pancreatitis and did not include pancreatic ductal adenocarcinoma (PDA). PURPOSE To investigate the effect of gadolinium chelate contrast agent on DWI of PDA. MATERIAL AND METHODS Twenty-two patients (13 men, 9 women; mean age 62 years) with histopathologically proven PDA were included in this study. DWI was acquired before and after administration of gadopentetate dimeglumine (Magnevist) with two b-values: 0 and 1000 s/mm(2). The signal intensity (SI), signal-to-noise ratio (SNR), and the apparent diffusion coefficient (ADC) of the lesion were recorded for comparison. RESULTS The mean time interval between the initiation of contrast administration and the start of the postcontrast DWI series was 393 s (range, 350-510 s). The SIs and SNRs of lesions of b1000 and b0 images of enhanced images were significantly higher than non-enhanced images (P < 0.001, P < 0.001 for b1000 s/mm(2); P = 0.001, P = 0.001 for b0 s/mm(2)). The ADC of all PDAs revealed no statistically significant difference between non-enhanced and enhanced images (P = 0.709). There was also no significant difference between non-enhanced and enhanced images in subgroups based on grades of differentiation and locations of lesion. CONCLUSION With increasing SI and SNR of PDA, intravenous contrast administration does not result in a significant difference in quantitative ADC measurements when comparing precontrast to postcontrast DWI when acquired approximately 6-7 min after administration.
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Affiliation(s)
- Kefu Liu
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengrong Zhou
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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An C, Choi GH, Lee HS, Kim MJ. Assessment of preoperative magnetic resonance imaging staging in patients with hepatocellular carcinoma undergoing resection compared with the seventh American Joint Committee on Cancer System. Invest Radiol 2013; 47:634-41. [PMID: 22814590 DOI: 10.1097/rli.0b013e3182630e8d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to compare the prognostic utility of a staging system using magnetic resonance imaging (MRI) with the seventh American Joint Committee on Cancer (AJCC) staging system in patients with hepatocellular carcinoma (HCC) who underwent hepatic resection. MATERIALS AND METHODS A total of 175 consecutive patients with HCC who underwent curative hepatic resection after MRI between January 2000 and December 2007 were analyzed. In lieu of microvascular invasion, which is used by the AJCC staging system, we devised an MRI staging system in which a size criterion of 2 cm was used to differentiate between tumor stages 1 and 2. All patients were retrospectively staged using the seventh AJCC staging system and the preoperative MRI staging system. Differences in disease-free and overall survival rates between different stages by the MRI and AJCC staging systems were analyzed using the Kaplan-Meier method with log-rank testing. The predictive accuracy of the 2 staging systems was directly compared using the time-dependent receiver operating characteristic curve analysis. RESULTS Median follow-up period was 222.9 weeks. During the follow-up period, 74 (42.3%) patients experienced tumor recurrence and 22 (12.6%) died. The median disease-free survival and overall survival were 131.1 and 222.9 weeks, respectively. Both staging systems were excellent for the prediction of disease-free survival across different tumor stages but failed to predict overall survival differences between stages 1 and 2. For disease-free and overall survivals, the time-dependent receiver operating characteristic curve analysis revealed no significant differences in predictive accuracy between the 2 staging systems. CONCLUSION A preoperative MRI staging system using a size threshold instead of microvascular invasion may predict the prognosis of HCC patients undergoing hepatic resection as accurately as the seventh AJCC tumor-node-metastasis staging system.
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Affiliation(s)
- Chansik An
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Medical Research Center, Yonsei University College of Medicine, Seoul, 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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