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1
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Liberini V, Peano S, Fabbro E, Laudicella R, Papaleo A, Balma M. [ 11C]Choline PET/CT in a Patient with Prostate Cancer Biochemical Recurrence Showing Two Suspicious Findings in the Breast and Liver. Nucl Med Mol Imaging 2024; 58:42-46. [PMID: 38261849 PMCID: PMC10796308 DOI: 10.1007/s13139-023-00817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 01/25/2024] Open
Abstract
A 79-year-old man with prostate cancer (PCa) was referred to our center to perform a [11C]Choline PET/CT for biochemical recurrence. Positron emission tomography/computed tomography (PET/CT) scan detected PCa recurrence in the prostate gland and several pelvic and abdominal lymph nodes. Two abnormal uptakes were also identified in the right breast and in the liver, respectively. Breast histological findings turned out to be gynecomastia, while the liver lesion resulted in a benign perfusion anomaly at follow-up magnetic resonance imaging (MRI). Although incidental findings were benign in this case, it is important to always investigate abnormal uptakes of [11C]Choline, as it could be an expression of further metastases or synchronous malignancies such as breast cancer and hepatocellular carcinoma.
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Affiliation(s)
- Virginia Liberini
- Nuclear Medicine Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Simona Peano
- Nuclear Medicine Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Emanuele Fabbro
- Radiology Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Riccardo Laudicella
- Unit of Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Alberto Papaleo
- Nuclear Medicine Department, S. Croce e Carle Hospital, Cuneo, Italy
| | - Michele Balma
- Nuclear Medicine Department, S. Croce e Carle Hospital, Cuneo, Italy
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2
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Lesion or Pseudolesion? A Comprehensive Description of Perfusion-Based Liver Alterations on Contrast-Enhanced Computed Tomography and Literature Review. J Comput Assist Tomogr 2023; 47:9-23. [PMID: 36584106 DOI: 10.1097/rct.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Pseudolesions on contrast-enhanced computed tomography represent a diagnostic challenge for radiologists because they could be difficult to distinguish from true space-occupying lesions. This article aims to provide a detailed overview of these entities based on radiological criteria (hyperattenuation or hypoattenuation, localization, morphology), as well as a brief review of the hepatic vascular anatomy and pathophysiological process. Relevant examples from hospital case series are reported as helpful hints to assist radiologists in recognizing and correctly diagnosing these abnormalities.
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3
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Shetty AS, Fraum TJ, Ludwig DR, Hoegger MJ, Zulfiqar M, Ballard DH, Strnad BS, Rajput MZ, Itani M, Salari R, Lanier MH, Mellnick VM. Body MRI: Imaging Protocols, Techniques, and Lessons Learned. Radiographics 2022; 42:2054-2074. [DOI: 10.1148/rg.220025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anup S. Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Tyler J. Fraum
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Daniel R. Ludwig
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mark J. Hoegger
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - David H. Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Benjamin S. Strnad
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mohamed Z. Rajput
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Reza Salari
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael H. Lanier
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Vincent M. Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Magnetic Resonance Features of Liver Mucinous Colorectal Metastases: What the Radiologist Should Know. J Clin Med 2022; 11:jcm11082221. [PMID: 35456314 PMCID: PMC9027866 DOI: 10.3390/jcm11082221] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: The aim of this study is to assess MRI features of mucinous liver metastases compared to non-mucinous metastases and hepatic hemangioma. Methods: A radiological archive was assessed from January 2017 to June 2021 to select patients subjected to liver resection for CRCLM and MRI in the staging phase. We selected 20 patients with hepatic hemangioma (study group B). We evaluated (a) the maximum diameter of the lesions, in millimeters, on T1-W flash 2D in phase and out phase, on axial HASTE T2-W and on portal phase axial VIBE T1 W; and (b) the signal intensity (SI) in T1-W sequences, in T2-W sequences, Diffusion-Weighted Imaging (DWI) sequences and apparent diffusion coefficient (ADC) maps so as to observe (c) the presence and the type of contrast enhancement during the contrast study. The chi-square test was employed to analyze differences in percentage values of the categorical variable, while the non-parametric Kruskal−Wallis test was used to test for statistically significant differences between the median values of the continuous variables. A p-value < 0.05 was considered statistically significant. Results: The final study population included 52 patients (33 men and 19 women) with 63 years of median age (range 37−82 years) and 157 metastases. In 35 patients, we found 118 non-mucinous type metastases (control group), and in 17 patients, we found 39 mucinous type metastases (study group A). During follow-up, recurrence occurred in 12 patients, and three exhibited mucinous types among them. In the study group, all lesions (100%) showed hypointense SI on T1-W, very high SI (similar to hepatic hemangioma) in T2-W with restricted diffusion and iso-hypointense signals in the ADC map. During the contrast study, the main significant feature is the peripheral progressive enhancement.
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Renzulli M, Brandi N, Argalia G, Brocchi S, Farolfi A, Fanti S, Golfieri R. Morphological, dynamic and functional characteristics of liver pseudolesions and benign lesions. Radiol Med 2022; 127:129-144. [PMID: 35028886 DOI: 10.1007/s11547-022-01449-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022]
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide and one of the most common causes of death among patients with cirrhosis, developing in 1-8% of them every year, regardless of their cirrhotic stage. The radiological features of HCC are almost always sufficient for reaching the diagnosis; thus, histological confirmation is rarely needed. However, the study of cirrhotic livers remains a challenge for radiologists due to the developing of fibrous and regenerative tissue that cause the distortion of normal liver parenchyma, changing the typical appearances of benign lesions and pseudolesions, which therefore may be misinterpreted as malignancies. In addition, a correct distinction between pseudolesions and malignancy is crucial to allow appropriate targeted therapy and avoid treatment delays.The present review encompasses technical pitfalls and describes focal benign lesions and pseudolesions that may be misinterpreted as HCC in cirrhotic livers, providing the imaging features of regenerative nodules, large regenerative nodules, siderotic nodules, hepatic hemangiomas (including rapidly filling and sclerosed hemangiomas), segmental hyperplasia, arterioportal shunts, focal confluent fibrosis and focal fatty changes. Lastly, the present review explores the most promising new imaging techniques that are emerging and that could help radiologists differentiate benign lesions and pseudolesions from overt HCC.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia.
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia
| | - Giulia Argalia
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia
| | - Andrea Farolfi
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia
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Ramanathan S, Raghu V, Virmani V, Sheikh A, Al Heidous M, Tirumani S. Unveiling the unreal: Comprehensive imaging review of hepatic pseudolesions. Clin Imaging 2021; 80:439-453. [PMID: 34560516 DOI: 10.1016/j.clinimag.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
Hepatic pseudolesions are defined as non-neoplastic focal abnormalities of the liver which can mimic or conceal true liver lesions. It is particularly common in liver due to its unique dual blood supply and the existence of multilevel anastomosis between them. Because of the recent advances in CT and MRI technology, they are being increasingly encountered in daily practice. Broadly they can be categorised in to (1) Focal parenchymal abnormalities like focal fatty change, focal fat sparing, focal confluent fibrosis, segmental hypertrophy and regenerative nodules, (2) Perfusion abnormalities which include transient hepatic parenchymal enhancement in portal vein obstruction, third inflow, intrahepatic shunts, hepatic arterial occlusion and hepatic venous obstruction, (3) Imaging pitfalls like parenchymal compression, unenhanced vessels and pseudolipoma. It is essential for the radiologists to be familiar with the typical and atypical imaging features of pseudolesions to avoid mistaking them for sinister pathologies and also to avoid overlooking underlying hidden pathologies.
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Affiliation(s)
- Subramaniyan Ramanathan
- Department of Clinical imaging, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar; Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - Vineetha Raghu
- Department of Radiology, Columbia Asia Referral Hospital, Yeshwanthpur, India
| | - Vivek Virmani
- Department of Radiology, Dr. Everett Chalmers Hospital, Fredericton, Canada
| | - Adnan Sheikh
- Department of Emergency and Trauma Radiology, University of British Columbia, Vancouver, Canada
| | - Mahmoud Al Heidous
- Department of Clinical imaging, Al-Wakra Hospital, Hamad Medical Corporation, PO Box: 82228, Doha, Qatar; Department of Radiology, Weil Cornell Medical College, Doha, Qatar
| | - SreeHarsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Centre, Case Western Reserve University, Cleveland, OH, USA
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7
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Sofia C, Cattafi A, Silipigni S, Pitrone P, Carerj ML, Marino MA, Pitrone A, Ascenti G. Portal vein thrombosis in patients with chronic liver diseases: From conventional to quantitative imaging. Eur J Radiol 2021; 142:109859. [PMID: 34284232 DOI: 10.1016/j.ejrad.2021.109859] [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] [Received: 04/27/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Portal vein thrombosis is a pathological condition characterized by the lumen occlusion of the portal vein and its intrahepatic branches, commonly associated to chronic liver diseases. Portal vein thrombosis is often asymptomatic and discovered as an incidental finding in the follow-up of chronic hepatopathy. Imaging plays a pivotal role in the detection and characterization of portal vein thrombosis in patients with hepatocellular carcinoma. Ultrasound and Color-Doppler ultrasound are usually the first-line imaging modalities for its detection, but they have limits related to operator-experience, patient size, meteorism and the restrained field-of view. Unenhanced cross-sectional imaging doesn't provide specific signs of portal vein thrombosis except under certain specific circumstances. Conventional contrast-enhanced imaging can depict portal vein thrombosis as an endoluminal filling defect best detected in venous phase and can differentiate between non-neoplastic and neoplastic thrombus based on the contrast enhanced uptake, but not always rule-out the malignant nature. Functional and quantitative imaging techniques and software seem to be more accurate. The purpose of this work is to provide the reader with an accurate overview focused on the main imaging features of portal vein thrombosis.
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Affiliation(s)
- C Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy.
| | - A Cattafi
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy
| | - S Silipigni
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy
| | - P Pitrone
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy
| | - M L Carerj
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy
| | - M A Marino
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy
| | - A Pitrone
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy
| | - G Ascenti
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G.Martino, University of Messina, Messina, Italy
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8
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Incidental Liver Findings on Cross-sectional Imaging. Radiol Clin North Am 2021; 59:569-590. [PMID: 34053606 DOI: 10.1016/j.rcl.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hepatic incidental findings often are seen on cross-sectional imaging examinations of the chest, spine, pelvis, or other nondedicated hepatic imaging. Radiologists are tasked with appropriately triaging, which requires further evaluation, even in the setting of an otherwise limited evaluation. This article reviews common benign entities encountered on ultrasound, computed tomography, or magnetic resonance imaging, along with their characteristic imaging features. Imaging features that are suspicious for malignancy or suggest the need for further evaluation also are discussed. Two algorithms are proposed to guide radiologists in their recommendations based on patient risk factors, focal hepatic abnormality size, and available imaging features.
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Renzulli M, Brocchi S, Ierardi AM, Milandri M, Pettinari I, Lucidi V, Balacchi C, Muratori P, Marasco G, Vara G, Tovoli F, Granito A, Carrafiello G, Piscaglia F, Golfieri R. Imaging-based diagnosis of benign lesions and pseudolesions in the cirrhotic liver. Magn Reson Imaging 2021; 75:9-20. [PMID: 32926993 DOI: 10.1016/j.mri.2020.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
Liver cirrhosis is a leading cause of death worldwide, with 1-year mortality rates of up to 57% in decompensated patients. Hepatocellular carcinoma (HCC) is the most common primary tumor in cirrhotic livers and the second leading cause of cancer-related mortality worldwide. Annually, up to 8% of patients with cirrhosis develop HCC. The diagnosis of HCC rarely requires histological confirmation: in fact, according to the most recent guidelines, the imaging features of HCC are almost always sufficient for a certain diagnosis. Thus, the role of the radiologist is pivotal because the accurate detection and characterization of focal liver lesions in patients with cirrhosis are essential in improving clinical outcomes. Despite recent technical innovations in liver imaging, several issues remain for radiologists regarding the differentiation of HCC from other hepatic lesions, particularly benign lesions and pseudolesions. It is important to avoid misdiagnosis of benign liver lesions as HCC (false-positive cases) because this diagnostic misinterpretation may lead to ineligibility of a patient for potentially curative treatments or inappropriate assignment of high priority scores to patients on waiting lists for liver transplantation. This review presents a pocket guide that could be useful for the radiologist in the diagnosis of benign lesions and pseudolesions in cirrhotic livers, highlighting the imaging features that help in making the correct diagnosis of macroregenerative nodules; siderotic nodules; arterioportal shunts; hemangiomas, including fast-filling hemangiomas, hemangiomas with pseudowashout, and sclerosed hemangiomas; confluent fibrosis; pseudomasses in chronic portal vein thrombosis; and focal fatty changes.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Anna Maria Ierardi
- Unit of Radiology, IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Milandri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Irene Pettinari
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Vincenzo Lucidi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Paolo Muratori
- Department of the Science for the quality of life (QUVI), University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Francesco Tovoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Granito
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
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10
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Yang B, Si G, He Q, Liu S, Wang S, Xian R, Zhang J, Yu F, Guan J. Multislice Computed Tomographic Manifestation of Transient Hepatic Attenuation Difference in the Left Lobe of the Liver: A Retrospective Study. Adv Ther 2020; 37:3954-3966. [PMID: 32715380 DOI: 10.1007/s12325-020-01428-5] [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] [Received: 05/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Transient hepatic attenuation differences (THAD) are areas of high parenchymal enhancement observed during the hepatic arterial phase on computed tomography (CT). THAD in the left lobe of the liver can lead to surgical complications. METHODS A retrospective study was conducted on patients who underwent multislice computed tomography (MSCT) examination of the upper abdomen to understand the morphology, distribution, and causes of THAD and their correlation with hepatic artery variation. RESULTS Among 179 cases, 65 and 114 belonged to diseased and normal groups, respectively. THAD as observed in MSCT demonstrated various shapes: lobe/segment (127 cases; 70.9%), irregular sheet (31; 17.3%), strip shape (9; 5.02%), arc/semicircle (7; 3.9%), and segment + flaky (5; 2.79%). THAD were found to be caused by liver tumor (32.3%), hepatic inflammatory lesions (6.15%), biliary tract diseases (13.8%), perihepatic disease compression (9.23%), portal vein obstructive disease (1.53%), and lesion in left hepatic lobe with hepatic artery variation (29.2%). THAD exhibited variation in distribution in the left lobe of the liver. Among 114 cases, THAD in 18 (15.7%) cases were observed in the S2 segment, six (5.26%) in the S3 segment, and 90 (78.9%) in multiple segments of the liver, that is, 50 cases in S2 and S3 segments and 40 cases in S2, S3, and S4 segments. The hepatic artery of 179 cases was of various types based on Hiatt classification: 57 cases of Hiatt I (31%), 65 cases of Hiatt II (37%), 11 cases of Hiatt III (6%), 17 cases of Hiatt IV (10%), 7 cases of Hiatt V (4%), 12 cases of large left hepatic artery (7%), 6 cases of right hepatic artery originating from the celiac trunk (3%), and 4 cases (2%) of superior mesenteric artery originating from the celiac trunk. CONCLUSION THAD can occur as a result of specific pathological causes and hence should be considered as a diagnostic sign in liver pathologies.
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Affiliation(s)
- Bin Yang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Guangyan Si
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China.
| | - Qizhou He
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Shulan Liu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Sikai Wang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Rong Xian
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Jie Zhang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Fei Yu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, 646000, Sichuan, People's Republic of China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital of Zhongshan University, Guang Zhou, 510080, Guangdong, People's Republic of China
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11
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Elsayes KM, Kielar AZ, Chernyak V, Morshid A, Furlan A, Masch WR, Marks RM, Kamaya A, Do RKG, Kono Y, Fowler KJ, Tang A, Bashir MR, Hecht EM, Jambhekar K, Lyshchik A, Rodgers SK, Heiken JP, Kohli M, Fetzer DT, Wilson SR, Kassam Z, Mendiratta-Lala M, Singal AG, Lim CS, Cruite I, Lee J, Ash R, Mitchell DG, McInnes MDF, Sirlin CB. LI-RADS: a conceptual and historical review from its beginning to its recent integration into AASLD clinical practice guidance. J Hepatocell Carcinoma 2019; 6:49-69. [PMID: 30788336 PMCID: PMC6368120 DOI: 10.2147/jhc.s186239] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Liver Imaging Reporting and Data System (LI-RADS®) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver observations in individuals at high risk for hepatocellular carcinoma (HCC). LI-RADS is supported and endorsed by the American College of Radiology (ACR). Upon its initial release in 2011, LI-RADS applied only to liver observations identified at CT or MRI. It has since been refined and expanded over multiple updates to now also address ultrasound-based surveillance, contrast-enhanced ultrasound for HCC diagnosis, and CT/MRI for assessing treatment response after locoregional therapy. The LI-RADS 2018 version was integrated into the HCC diagnosis, staging, and management practice guidance of the American Association for the Study of Liver Diseases (AASLD). This article reviews the major LI-RADS updates since its 2011 inception and provides an overview of the currently published LI-RADS algorithms.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
| | - Ania Z Kielar
- Department of Radiology, University of Toronto, ON, Canada
| | | | - Ali Morshid
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William R Masch
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Robert M Marks
- Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuko Kono
- Department of Radiology, University of California San Diego, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, CA, USA
| | - An Tang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Mustafa R Bashir
- Department of Radiology, Center for Advanced Magnetic Resonance Development, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Kedar Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrej Lyshchik
- Department of Radiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Jay P Heiken
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Marc Kohli
- Department of Radiology, University of California San Francisco, CA, USA
| | - David T Fetzer
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Zahra Kassam
- Department of Diagnostic Imaging, Schulich School of Medicine, London, ON, Canada
| | | | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christopher S Lim
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Irene Cruite
- Department of Radiology, Inland Imaging, Spokane, WA, USA
| | - James Lee
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Ryan Ash
- Department of Radiology, University of Kansas, Kansas City, KS, USA
| | - Donald G Mitchell
- Department of Radiology, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Claude B Sirlin
- Department of Radiology, University of California San Diego, CA, USA
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12
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Thompson SM, Wells ML, Andrews JC, Ehman EC, Menias CO, Hallemeier CL, Roberts LR, Venkatesh SK. Venous invasion by hepatic tumors: imaging appearance and implications for management. Abdom Radiol (NY) 2018; 43:1947-1967. [PMID: 28929197 DOI: 10.1007/s00261-017-1298-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Venous invasion by hepatic tumors most commonly occurs with hepatocellular carcinoma and is associated with worse patient prognosis. Imaging plays an important role in the diagnosis of tumor thrombus in the liver. Moreover, differentiating between bland and tumor thrombus in the liver has important diagnostic, staging, therapeutic, and prognostic implications and may require a multimodal imaging approach including ultrasound, computed tomography, and/or magnetic resonance imaging. Treatment of hepatic malignancies with associated tumor thrombus is dependent on tumor type, disease extent within the liver, liver hemodynamics, and underlying liver function. Treatment of such tumors may involve surgical, locoregional and/or systemic therapies. The current review will focus on the imaging characteristics of venous invasion by hepatic tumors. The imaging findings most useful for differentiating hepatic venous tumor thrombus and bland thrombus will be highlighted and demonstrated with imaging examples. Imaging findings with implications for subsequent patient management will be described.
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Affiliation(s)
- Scott M Thompson
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Michael L Wells
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - James C Andrews
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Christopher L Hallemeier
- Department of Radiation Oncology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic School of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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13
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Cao QY, Zou ZM, Wang Q, He CN, Zou Q, Wang B. MRI manifestations of hepatic perfusion disorders. Exp Ther Med 2018; 15:5199-5204. [PMID: 29805544 PMCID: PMC5958701 DOI: 10.3892/etm.2018.6090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/06/2017] [Indexed: 12/25/2022] Open
Abstract
The present study aimed to analyze the magnetic resonance imaging (MRI) results from patients with hepatic perfusion disorders (HPD) and liver diseases, in order to assess the pathogenetic mechanisms. This was completed byanalyzing the causes of HPD in 35 patients to assess if they were associated with arterioportal shunt, and classify the patients according to results from the MRI scans. Of the 35 patients, 26 (74.3%) with HPD presented with hepatocellular carcinoma, a major cause of HPD. The HPD phenomenon in 35 patients was not identified as obvious abnormal lesions on T2WI and T1WI according to the isointensity on diffusion weighted images. Enhanced scanning showed hyperintense signals on the arterial phase images, isointense or hyperintense signals on portal phase and delayed phase images. According to their MRI findings, hepatic perfusion disorders may be divided into different types, as follows: Diffuse, lobe or segment type, wedge type and platy. The HPD phenomenon may herald an underlying abnormality of liver disease and MRI may accurately diagnose HPDs in liver diseases.
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Affiliation(s)
- Qing-Yong Cao
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Zhi-Meng Zou
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Qi Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Chun-Ni He
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Qing Zou
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China
| | - Bin Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, P.R. China.,Medical Imaging Center, Binzhou Medical University, Yantai, Shandong 264100, P.R. China
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14
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Elsayes KM, Hooker JC, Agrons MM, Kielar AZ, Tang A, Fowler KJ, Chernyak V, Bashir MR, Kono Y, Do RK, Mitchell DG, Kamaya A, Hecht EM, Sirlin CB. 2017 Version of LI-RADS for CT and MR Imaging: An Update. Radiographics 2018; 37:1994-2017. [PMID: 29131761 DOI: 10.1148/rg.2017170098] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is a reporting system created for the standardized interpretation of liver imaging findings in patients who are at risk for hepatocellular carcinoma (HCC). This system was developed with the cooperative and ongoing efforts of an American College of Radiology-supported committee of diagnostic radiologists with expertise in liver imaging and valuable input from hepatobiliary surgeons, hepatologists, hepatopathologists, and interventional radiologists. In this article, the 2017 version of LI-RADS for computed tomography and magnetic resonance imaging is reviewed. Specific topics include the appropriate population for application of LI-RADS; technical recommendations for image optimization, including definitions of dynamic enhancement phases; diagnostic and treatment response categories; definitions of major and ancillary imaging features; criteria for distinguishing definite HCC from a malignancy that might be non-HCC; management options following LI-RADS categorization; and reporting. ©RSNA, 2017.
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Affiliation(s)
- Khaled M Elsayes
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Jonathan C Hooker
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Michelle M Agrons
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Ania Z Kielar
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - An Tang
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Kathryn J Fowler
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Victoria Chernyak
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Mustafa R Bashir
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Yuko Kono
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Richard K Do
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Donald G Mitchell
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Aya Kamaya
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Elizabeth M Hecht
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Claude B Sirlin
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
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15
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Gore RM, Pickhardt PJ, Mortele KJ, Fishman EK, Horowitz JM, Fimmel CJ, Talamonti MS, Berland LL, Pandharipande PV. Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017; 14:1429-1437. [DOI: 10.1016/j.jacr.2017.07.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 02/06/2023]
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Sheybani A, Gaba RC, Lokken RP, Berggruen SM, Mar WA. Liver Masses: What Physicians Need to Know About Ordering and Interpreting Liver Imaging. Curr Gastroenterol Rep 2017; 19:58. [PMID: 29044439 DOI: 10.1007/s11894-017-0596-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This paper reviews diagnostic imaging techniques used to characterize liver masses and the imaging characteristics of the most common liver masses. RECENT FINDINGS The role of recently adopted ultrasound and magnetic resonance imaging contrast agents will be emphasized. Contrast-enhanced ultrasound is an inexpensive exam which can confirm benignity of certain liver masses without ionizing radiation. Magnetic resonance imaging using hepatocyte-specific gadolinium-based contrast agents can help confirm or narrow the differential diagnosis of liver masses.
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Affiliation(s)
- Arman Sheybani
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA
| | - Ron C Gaba
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA
| | - R Peter Lokken
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA
| | - Senta M Berggruen
- Department of Radiology, Northwestern University, NMH/Arkes Family Pavilion Suite 800, 676 N Saint Clair, Chicago, IL, 60611, USA
| | - Winnie A Mar
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St Rm 2483, MC 931, Chicago, IL, 60612, USA.
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17
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Kim HB, Park SG. Arterioportal shunt incidental to treatment with oxaliplatin that mimics recurrent gastric cancer. World J Gastroenterol 2017; 23:6187-6193. [PMID: 28970735 PMCID: PMC5597511 DOI: 10.3748/wjg.v23.i33.6187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/04/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023] Open
Abstract
Arterioportal shunt (APS) is an organic communication between the hepatic arterial system and the portal venous system. The APS is one of the major causes of transient hepatic attenuation differences on dynamic computed tomography (CT) or magnetic resonance imaging (MRI). This condition is usually associated with trauma, liver cirrhosis, and malignancies of the liver. However, there has been no report about oxaliplatin-induced APS. A 41-year-old male was diagnosed with Stage IIIB gastric cancer. The patient initially underwent neoadjuvant chemotherapy with capecitabine and oxaliplatin After 3 cycles of therapy, the mass had markedly decreased, and a total gastrectomy with splenectomy was performed. Since the malignancy was locally invasive, the patient was continued on the same regimen of the adjuvant chemotherapy. After 3 more cycles, a computed tomography revealed a 1 cm sized arterial-enhancing nodule in the right lobe of the liver. An MRI revealed an arterial enhancing lesion, and a positron emission tomography CT scan showed a hypermetabolic lesion in the same portion of the liver. We tried to perform a liver biopsy; however, an ultrasonography could not detect any mass. A presumptive diagnosis of an APS due to a recurred cancer was made. We found a similar but slightly different case report of an oxaliplatin-induced liver injury, mimicking a metastatic tumor on an MRI. Based on a prior report, the patient was continued on treatment with adjuvant chemotherapy following discontinuation of oxaliplatin. After 2 cycles, the arterial enhancing liver mass resolved, supporting the final diagnosis of an APS, related to oxaliplatin-induced sinusoidal injury. The patient has not experienced any a relapse after two years of additional follow up recurrent gastric cancer upon interpretation of multiple imaging modalities.
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Affiliation(s)
- Hong-Beum Kim
- Department of Premedical Course, Chosun University School of Medicine, Gwangju 501-717, South Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
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Elsayes KM, Shaaban AM, Rothan SM, Javadi S, Madrazo BL, Castillo RP, Casillas VJ, Menias CO. A Comprehensive Approach to Hepatic Vascular Disease. Radiographics 2017; 37:813-836. [DOI: 10.1148/rg.2017160161] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Khaled M. Elsayes
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Akram M. Shaaban
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Sarah M. Rothan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Sanaz Javadi
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Beatrice L. Madrazo
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Rosa P. Castillo
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Victor J. Casillas
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
| | - Christine O. Menias
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.)
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Granata V, Fusco R, Avallone A, Catalano O, Filice F, Leongito M, Palaia R, Izzo F, Petrillo A. Major and ancillary magnetic resonance features of LI-RADS to assess HCC: an overview and update. Infect Agent Cancer 2017; 12:23. [PMID: 28465718 PMCID: PMC5410075 DOI: 10.1186/s13027-017-0132-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/21/2017] [Indexed: 12/23/2022] Open
Abstract
Liver Imaging Reporting and Data System (LI-RADS) is a system for interpreting and reporting of imaging features on multidetector computed tomography (MDCT) and magnetic resonance (MR) studies in patients at risk for hepatocellular carcinoma (HCC). American College of Radiology (ACR) sustained the spread of LI-RADS to homogenizing the interpreting and reporting data of HCC patients. Diagnosis of HCC is due to the presence of major imaging features. Major features are imaging data used to categorize LI-RADS-3, LI-RADS-4, and LI-RADS-5 and include arterial-phase hyperenhancement, tumor diameter, washout appearance, capsule appearance and threshold growth. Ancillary are features that can be used to modify the LI-RADS classification. Ancillary features supporting malignancy (diffusion restriction, moderate T2 hyperintensity, T1 hypointensity on hapatospecifc phase) can be used to upgrade category by one or more categories, but not beyond LI-RADS-4. Our purpose is reporting an overview and update of major and ancillary MR imaging features in assessment of HCC.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Roberta Fusco
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Antonio Avallone
- Abdominal Oncology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Orlando Catalano
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Francesco Filice
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Maddalena Leongito
- Hepatobiliary Surgery Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgery Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgery Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
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Elsayes KM, Kielar AZ, Agrons MM, Szklaruk J, Tang A, Bashir MR, Mitchell DG, Do RK, Fowler KJ, Chernyak V, Sirlin CB. Liver Imaging Reporting and Data System: an expert consensus statement. J Hepatocell Carcinoma 2017; 4:29-39. [PMID: 28255543 PMCID: PMC5322844 DOI: 10.2147/jhc.s125396] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The increasing incidence and high morbidity and mortality of hepatocellular carcinoma (HCC) have inspired the creation of the Liver Imaging Reporting and Data System (LI-RADS). LI-RADS aims to reduce variability in exam interpretation, improve communication, facilitate clinical therapeutic decisions, reduce omission of pertinent information, and facilitate the monitoring of outcomes. LI-RADS is a dynamic process, which is updated frequently. In this article, we describe the LI-RADS 2014 version (v2014), which marks the second update since the initial version in 2011.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ania Z Kielar
- Department of Diagnostic Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Michelle M Agrons
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mustafa R Bashir
- Department of Diagnostic Radiology, Duke University School of Medicine, Durham, NC
| | - Donald G Mitchell
- Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO
| | - Victoria Chernyak
- Department of Radiology Albert Einstein College of Medicine, Bronx, New York, NY
| | - Claude B Sirlin
- Department of Diagnostic Radiology, University of California, San Diego, CA, USA
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Percutaneous ablation therapy of hepatocellular carcinoma with irreversible electroporation: MRI findings. AJR Am J Roentgenol 2015; 204:1000-7. [PMID: 25905934 DOI: 10.2214/ajr.14.12509] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Irreversible electroporation is a new ablation modality. Our purpose was to describe the MRI findings after irreversible electroporation treatment of hepatocellular carcinoma (HCC). SUBJECTS AND METHODS In an 18-month period, we treated 24 HCC lesions in 20 patients who were not candidates for surgery. MRI was performed before and 1 month after irreversible electroporation. We used the liver-specific contrast medium gadoxetic acid. We evaluated the size, shape, signal intensity (T1-weighted, T2-weighted, and diffusion-weighted imaging), dynamic contrast enhancement pattern, and signal behavior during the liver-specific phase. Changes in the perilesional parenchyma, perfusion abnormalities, and complications were also recorded. RESULTS According to the modified Response Evaluation Criteria in Solid Tumors system, 22 of 24 lesions had a complete response, and two lesions showed a partial response and were retreated. The lesions showed a mean size increase of 10%, with a round or oval shape. On the T1-weighted images, we observed a hyperintense core and a hypointense rim. On the T2-weighted sequences, the signal was heterogeneously hypointense. On diffusion-weighted images, 83% of lesions showed restricted diffusion, with b values of 0-800 s/mm(2), whereas in 17% of the lesions, the signal was not clearly discernible for different b values. The apparent diffusion coefficient values did not show statistically significant differences between the baseline (800-1020 × 10(-3) mm(2)/s) and the reassessment after 1 month (900-1100 × 10(-3) mm(2)/s). The necrotic area did not show a signal increase after contrast material injection. Perfusion abnormalities, such as areas of transient hepatic intensity difference, were present in the tissue adjacent to six treated lesions. In two patients, a reduced or absent concentration of the contrast medium was observed during the liver-specific phase around the ablation zone. One patient had an arteriovenous shunt and another had biliary duct dilatation. CONCLUSION MRI detects characteristic morphologic and functional changes after irreversible electroporation treatment.
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Legha RS, Elsayes KM, Hussain HK. Cirrhosis and Hepatocellular Carcinoma. CROSS-SECTIONAL IMAGING OF THE ABDOMEN AND PELVIS 2015:77-96. [DOI: 10.1007/978-1-4939-1884-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Tang W, Zhang XM, Zhai ZH, Zeng NL. Hepatic abnormal perfusion visible by magnetic resonance imaging in acute pancreatitis. World J Radiol 2013; 5:491-497. [PMID: 24379936 PMCID: PMC3874506 DOI: 10.4329/wjr.v5.i12.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/26/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To study the prevalence and patterns of hepatic abnormal perfusion (HAP) visible by magnetic resonance imaging (MRI) in acute pancreatitis (AP). METHODS Enhanced abdominal MRI was performed on 51 patients with AP. These patients were divided into two groups according to the MRI results: those with signs of gallstones, cholecystitis, common bile duct (CBD) stones or dilatation of the CBD on MRI and those without. The prevalence, shape and distribution of HAP in the two groups were analyzed and compared. The severity of AP was graded using the MR severity index (MRSI). The correlation between the MRSI and HAP was then analyzed. RESULTS Of the 51 patients with AP, 32 (63%) showed at least one sign of gallbladder and CBD abnormalities on the MR images, while 19 (37%) showed no sign of gallbladder or CBD abnormalities. Nineteen patients (37%) had HAP visible in the enhanced images, including strip-, wedge- or patch-shaped HAP distributed in the hepatic tissue adjacent to the gallbladder and left and right liver lobes. There were no significant differences in the prevalence of HAP (χ (2) = 0.305, P = 0.581 > 0.05) or HAP distribution in the liver (χ (2) = 2.181, P = 0.536 > 0.05) between patients with and without gallbladder and CBD abnormalities. There were no significant differences in the MRSI score between patients with and without HAP (t = 0.559, P = 0.552 > 0.05). HAP was not correlated with the MRSI score. CONCLUSION HAP is common in patients with AP and appears strip-, patch- or wedge-shaped on MRI. HAP on MRI cannot be used to indicate the severity of AP.
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Purysko AS, Remer EM, Coppa CP, Leão Filho HM, Thupili CR, Veniero JC. LI-RADS: a case-based review of the new categorization of liver findings in patients with end-stage liver disease. Radiographics 2013; 32:1977-95. [PMID: 23150853 DOI: 10.1148/rg.327125026] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hepatocellular carcinoma (HCC) is a global health problem, with the burden of disease expected to increase in the coming years. Patients who are at increased risk for developing HCC undergo routine imaging surveillance, and once a focal abnormality is detected, evaluation with multiphasic contrast material-enhanced computed tomography or magnetic resonance imaging is necessary for diagnosis and staging. Currently, findings at liver imaging are inconsistently interpreted and reported by most radiologists. The Liver Imaging-Reporting and Data System (LI-RADS) is an initiative supported by the American College of Radiology that aims to reduce variability in lesion interpretation by standardizing report content and structure; improving communication with clinicians; and facilitating decision making (eg, for transplantation, ablative therapy, or chemotherapy), outcome monitoring, performance auditing, quality assurance, and research. Five categories that follow the diagnostic thought process are used to stratify individual observations according to the level of concern for HCC, with the most worrisome imaging features including a masslike configuration, arterial phase hyperenhancement, portal venous phase or later phase hypoenhancement, an increase of 10 mm or more in diameter within 1 year, and tumor within the lumen of a vein. LI-RADS continues to evolve and is expected to integrate a series of improvements in future versions that will positively affect the care of at-risk patients.
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Affiliation(s)
- Andrei S Purysko
- Abdominal Imaging Section, Imaging Institute, HB6, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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Jang HJ, Khalili K, Yu H, Kim TK. Perfusion and parenchymal changes related to vascular alterations of the liver. ACTA ACUST UNITED AC 2012; 37:404-21. [PMID: 21667327 DOI: 10.1007/s00261-011-9767-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Imaging plays a significant role in the diagnosis of vascular abnormalities of the liver and sometimes provides the only clue to the correct diagnosis. With advances of imaging techniques and multiphasic acquisition of liver imaging, various perfusion changes are frequently encountered. Correct imaging diagnosis of significant vascular diseases can prompt appropriate work-up and timely management. Accurate differentiation of clinically insignificant perfusion phenomena from clinically significant findings including neoplastic conditions and in the setting of post-transplantation is essential. This pictorial essay illustrates various perfusion and parenchymal changes associated with portal venous inflow, hepatic venous outflow, and non-portal venous third inflow and describes brief background pathophysiology and differential points.
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Affiliation(s)
- Hyun-Jung Jang
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, ON, Canada.
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26
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Gore RM, Thakrar KH, Wenzke DR, Newmark GM, Mehta UK, Berlin JW. That liver lesion on MDCT in the oncology patient: is it important? Cancer Imaging 2012; 12:373-84. [PMID: 23023318 PMCID: PMC3485646 DOI: 10.1102/1470-7330.2012.9028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Multidetector-row computed tomography (MDCT) has become the primary imaging test for the staging and follow-up of most malignancies that originate outside of the central nervous system. Technical advances in this imaging technique have led to significant improvement in the detection of metastatic disease to the liver. An unintended by-product of this improving diagnostic acumen is the discovery of incidental hepatic lesions in oncology patients that in the past remained undetected. These ubiquitous, incidentally identified hepatic lesions have created a management dilemma for both clinicians and radiologists: are these lesions benign or do they represent metastases? Naturally, the answer to this question has profound prognostic and therapeutic implications. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidental lesions detected in patients with extrahepatic malignancies are presented.
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Affiliation(s)
- Richard M Gore
- Department of Radiology, NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, IL, USA.
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Colagrande S, Pradella S, Lucarini S, Marra F. Transient Hepatic Parenchymal Enhancement detected at dynamic imaging: a short instruction manual for the clinician. Dig Liver Dis 2012; 44:363-368. [PMID: 22153702 DOI: 10.1016/j.dld.2011.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 10/25/2011] [Accepted: 10/30/2011] [Indexed: 12/14/2022]
Abstract
Basic knowledge in the interpretation of hepatic imaging is essential for the clinical hepatologist. In recent years, the availability of dynamic imaging studies of the liver using computed tomography or magnetic resonance has led to appreciate the importance of early changes in arterial perfusion for the interpretation of hepatic lesions. Transient Hepatic Parenchymal Enhancement (THPE) is defined as a normal area of liver parenchyma that enhances after injection of contrast agent during the arterial phase of perfusion. Appearance of this sign is mostly associated with a reduction in portal perfusion or with inflammation, and appears in different morphologic patterns. THPE should not be considered a radiological artefact, and its interpretation is essential to avoid misclassification of hepatic lesions that may have clinical significance, such as hepatocellular carcinoma or hepatic metastases. In this short review we provide essential information on the causes, pathophysiology and morphology of THPE, and discuss the relevance of these findings in a clinical perspective.
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Affiliation(s)
- Stefano Colagrande
- Dipartimento di Fisiopatologia Clinica-Radiodiagnostica, University of Florence, Italy.
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Koyasu S, Isoda H, Tsuji Y, Yamamoto H, Matsueda K, Watanabe Y, Chiba T, Togashi K. Hepatic arterial perfusion increases in the early stage of severe acute pancreatitis patients: evaluation by perfusion computed tomography. Eur J Radiol 2012; 81:43-46. [PMID: 21123016 DOI: 10.1016/j.ejrad.2010.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/01/2010] [Accepted: 11/03/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE Although hepatic perfusion abnormalities have been reported in patients with acute pancreatitis, hepatic perfusion with severe acute pancreatitis (SAP) has not been quantitatively evaluated in humans. Therefore, we investigated hepatic perfusion in patients with SAP using perfusion CT. MATERIALS AND METHODS Hepatic perfusion CT was performed in 67 patients with SAP within 3 days after symptom onset. The patients were diagnosed as having SAP according to the Atlanta criteria. Fifteen cases were established as a control group. Perfusion CT was obtained for 54s beginning with a bolus injection of 40 ml of contrast agent (600-630 mgI/kg) at a flow rate of 4 ml/s. Perfusion data were analyzed by the dual-input maximum slope method to obtain hepatic arterial perfusion (HAP) and hepatic portal perfusion (HPP). Finally, we compared HAP and HPP in SAP patients with those in the control group, respectively. RESULTS Average HAP was significantly higher in SAP patients than in the control group (75.1 ± 38.0 vs. 38.2 ± 9.0 ml/min/100ml; p<0.001). There was no significant difference in average HPP between SAP patients and the control group (206.7 ± 54.9 vs. 204.4 ± 38.5 ml/min/100ml; p=0.92). CONCLUSION Using quantitative analysis on perfusion CT, we first demonstrated an increase of HAP in the right hepatic lobe in SAP patients.
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Affiliation(s)
- Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Davis GL, Dempster J, Meler JD, Orr DW, Walberg MW, Brown B, Berger BD, O'Connor JK, Goldstein RM. Hepatocellular carcinoma: management of an increasingly common problem. Proc (Bayl Univ Med Cent) 2011; 21:266-80. [PMID: 18628926 DOI: 10.1080/08998280.2008.11928410] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cancer that typically occurs in the setting of cirrhosis and chronic hepatitis virus infections. Hepatitis B and C account for approximately 80% of cases worldwide. HCC is currently the fifth most common malignancy in men and the eighth in women worldwide; its incidence is increasing dramatically in many parts of the world. Recognition of those at risk and early diagnosis by surveillance with imaging, with or without serologic testing, are extremely important. Many highly effective and even curative therapies are now available and include resection, liver transplantation, and local ablation. Appropriate application of these interventions offers hope of prolonged survival to many patients with this otherwise lethal complication of liver disease.
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Affiliation(s)
- Gary L Davis
- Division of Hepatology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA.
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Abstract
Recent advances in multidetector-row computed tomography, magnetic resonance imaging, and ultrasonography have led to the detection of incidental hepatic lesions in both the oncology and nononcology patient population that in the past remained undiscovered. These incidental hepatic lesions have created a management dilemma for both clinicians and radiologists. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidentalomas are presented.
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Fruehwald-Pallamar J, Bastati-Huber N, Fakhrai N, Jantsch M, Puchner S, Herneth AM, Ba-Ssalamah A. Confident non-invasive diagnosis of pseudolesions of the liver using diffusion-weighted imaging at 3T MRI. Eur J Radiol 2011; 81:1353-9. [PMID: 21507591 DOI: 10.1016/j.ejrad.2011.03.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 12/27/2022]
Abstract
PURPOSE Pseudolesions of the liver including focal steatosis or non-steatosis and THID (transient hepatic intensity differences) are often challenging, especially when imaging patients with underlying malignant disease. We evaluated the efficacy of diffusion-weighted imaging (DWI) in the diagnostic work-up of pseudolesions. MATERIALS AND METHODS Forty-eight patients with pseudolesions of the liver were consecutively examined and the images were retrospectively analyzed. MRI was performed on a clinical 3T scanner using T1-GRE in-phase and opposed phase images, T2-TSE-FS, diffusion-weighted sequences (b-value 50, 300, 600), ADC mapping, and dynamic post-contrast T1-VIBE-FS sequences (32 patients received Gd-EB-DTPA and 16 patients received gadolinium chelates). All images were analyzed by two experienced radiologists in consensus. As a standard of reference, we used the T1-w GRE, in-phase and out of phase, and the contrast enhanced series, as well as long-term follow-up. RESULTS In the 48 patients, a total of 116 liver lesions were found. Of these, 40 were benign and eleven were malignant focal lesions. Benign lesions included one FNH, 26 simple cysts, and twelve hemangiomas. In addition, 65 pseudolesions (20 focal steatosis, 13 focal non-steatosis, and 32 THIDs) were found. All pseudolesions could be identified either on the T1-GRE in-phase and opposed phase images or on the contrast-enhanced series, or on both. However, none of them were visible on the diffusion-weighted images. CONCLUSION Pseudolesions are invisible on DWI (negative predictive value = 1); therefore, DWI can be used as an additional sequence to significantly increase diagnostic confidence in the differentiation between pseudolesions and other focal liver lesions.
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Affiliation(s)
- Julia Fruehwald-Pallamar
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Khatri G, Merrick L, Miller FH. MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am 2011; 18:421-50, x. [PMID: 21094448 DOI: 10.1016/j.mric.2010.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common malignancy typically associated with chronic liver disease and is a leading cause of mortality among these patients. Prognosis is improved when detected early. MRI is the best imaging examination for accurate diagnosis. Although arterial enhancement with delayed washout, increased T2-weighted signal intensity, delayed capsular enhancement, restricted diffusion, and tumor thrombus are typical features, not all lesions demonstrate these findings. The radiologist must be familiar with these typical imaging characteristics, and less common appearances and associated findings of HCC, and must be able to differentiate them from those of lesions that mimic HCC. Knowledge of therapeutic options and how those are related to imaging findings is imperative to assist clinicians in managing these patients.
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Affiliation(s)
- Gaurav Khatri
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 800, Chicago, IL 60611, USA
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Parrinello G, Torres D, Licata G. Giant area of transient hepatic attenuation difference, mimicking incidentaloma at liver ultrasound. Intern Emerg Med 2011; 6:177-9. [PMID: 20589453 DOI: 10.1007/s11739-010-0414-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 05/12/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Gaspare Parrinello
- Biomedical Department of Internal and Specialty Medicine, Di.Bi.Mi.S., Internistic and Cardiovascular Diagnostic Ultrasound Laboratory, A.O.U Policlinico Paolo Giaccone, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
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Patel KD, Abeysekera KWM, Marlais M, McPhail MJW, Thomas HC, Fitzpatrick JA, Lim AKP, Taylor-Robinson SD, Thomas EL. Recent advances in imaging hepatic fibrosis and steatosis. Expert Rev Gastroenterol Hepatol 2011; 5:91-104. [PMID: 21309675 DOI: 10.1586/egh.10.85] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Liver disease is an increasing cause of morbidity and mortality worldwide. Currently, the gold standard for diagnosis and assessment of parenchymal disease is histopathological assessment of a percutaneous or transjugular liver biopsy. The risks and limitations of this technique are well recognized and as a result, significant effort has gone into the development of novel noninvasive methods of diagnosis and longitudinal assessment. Imaging techniques have improved significantly over the past decade and new technologies are beginning to enter clinical practice. Ultrasound, computed tomography and MRI are the main modalities currently used, but novel MRI-based techniques will have an increasing role. While there has been extensive research into the imaging of focal liver disease, the evidence base for imaging in diffuse disease has also undergone recent rapid development, particularly in the assessment of fibrosis and steatosis. Both of these abnormalities of the parenchyma can lead to cirrhosis and/or hepatocellular carcinoma and represent an important opportunity for detection of early liver disease. We discuss the recent advances in liver imaging techniques and their role in the diagnosis and monitoring of diffuse liver disease, with a focus on their current and potential clinical relevance and whether they may replace or augment liver biopsy. We also discuss techniques currently under development and their potential clinical applications in the future.
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Affiliation(s)
- Kayur D Patel
- Liver Unit, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, 10th Floor Queen Elizabeth the Queen Mother Wing, St Mary's Hospital Campus, Imperial College London, South Wharf Street, London W2 1NY, UK
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36
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Colagrande S, Centi N, Pradella S, Duranti B, Belli G, Villari N. Transient Hepatic Attenuation Differences and Focal Liver Lesions. J Comput Assist Tomogr 2009; 33:259-265. [DOI: 10.1097/rct.0b013e31818050bc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Torabi M, Hosseinzadeh K, Federle MP. CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics 2009; 28:1967-82. [PMID: 19001652 DOI: 10.1148/rg.287085067] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The unique dual blood supply of the liver (75% portal venous, 25% hepatic arterial) makes multiphase helical computed tomography (CT) a highly suitable technique for hepatic evaluation with imaging in two (arterial and portal venous) or more phases. Multiphase helical CT has become an important tool in the detection and characterization of hepatic tumors. In some situations, hemodynamic changes might mimic neoplastic or inflammatory lesions and evoke diagnostic uncertainty. To confidently identify hepatic conditions such as venous outflow obstruction (Budd-Chiari syndrome), arterioportal shunts, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), peliosis hepatis, passive congestion, and hepatic infarction, radiologists must be familiar with the disease-specific CT appearances and related clinical manifestations.
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Affiliation(s)
- Maha Torabi
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Bonekamp S, Kamel I, Solga S, Clark J. Can imaging modalities diagnose and stage hepatic fibrosis and cirrhosis accurately? J Hepatol 2009; 50:17-35. [PMID: 19022517 DOI: 10.1016/j.jhep.2008.10.016] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The accurate diagnosis and staging of hepatic fibrosis is crucial for prognosis and treatment of liver disease. The current gold standard, liver biopsy, cannot be used for population-based screening, and has well known drawbacks if used for monitoring of disease progression or treatment success. Our objective was to assess performance and promise of radiologic modalities and techniques as alternative, noninvasive assessment of hepatic fibrosis. A systematic review was conducted. Six hundred twenty-eight studies were identified via electronic search. One hundred fifty-three papers were reviewed. Most described techniques that could differentiate between cirrhosis or severe fibrosis and normal liver. Accurate staging of fibrosis or diagnosis of mild fibrosis was often not achievable. Ultrasonography is the most common modality used in the diagnosis and staging of hepatic fibrosis. Elastographic measurements, either ultrasonography-based or magnetic resonance-based, and magnetic resonance diffusion weighted imaging, show the most promise for accurate staging of hepatic fibrosis. Most currently available imaging techniques can detect cirrhosis or significant fibrosis reasonably accurately. However, to date only magnetic resonance elastography has been able to stage fibrosis or diagnose mild disease. Utrasonographic elastography and magnetic resonance diffusion weighted appear next most promising.
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Affiliation(s)
- Susanne Bonekamp
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hwang SH, Yu JS, Chung J, Chung JJ, Kim JH, Kim KW. Transient hepatic attenuation difference (THAD) following transcatheter arterial chemoembolization for hepatic malignancy: changes on serial CT examinations. Eur Radiol 2008; 18:1596-603. [PMID: 18351345 DOI: 10.1007/s00330-008-0916-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 12/20/2007] [Accepted: 01/06/2008] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to investigate the natural history of transcatheter arterial chemoembolization (TACE)-induced, transient hepatic attenuation difference (THAD). Among the patients who underwent TACE for treatment of hepatocellular carcinomas during a 32-month period, 32 patients with 40 newly developed THADs defined as localized, transient, peripheral hepatic parenchymal enhancement during the hepatic arterial phase of dynamic CT (axial dimension, 1.9-8.8 cm; mean, 4.9 cm) in the vicinity of iodized-oil accumulation were subjected to a retrospective analysis of serial follow-up CT examinations. Among the 40 TACE-induced THADs, 18 (45%) and 9 (23%) were accompanied with arterial-portal venous fistula (APF) and portal venous stenosis (PVS), respectively, while 2 (5%) THADs showed both APF and PVS simultaneously. Thirty-eight (95%) THADs disappeared spontaneously during the follow-up period (range, 4-26 months; mean, 9 months), and 11 (29%) of them showed progressive atrophy of the corresponding hepatic parenchyma. Regardless of the presence of APF, 10 (91%) of 11 THADs of following parenchymal atrophy had shown PVSs (P<0.001). During the long-term follow-up period after TACE, almost all of the TACE-induced THADs spontaneously disappeared and either had or did not have corresponding parenchymal atrophy, which is strongly related to the presence of PVS. Understanding the nature of these CT features would be helpful for radiologists in determining the prognosis of the TACE-induced hepatic injuries as well as in distinguishing them from the recurrent tumour.
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Affiliation(s)
- Sung Ho Hwang
- Department of Diagnostic Radiology, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dogok-Dong, Gangnam-Gu, Seoul, 135-720, Republic of Korea
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Transient Homogeneously Enhancing Hepatic Masses: Can Size Predict Benignity? AJR Am J Roentgenol 2008; 190:300-7. [DOI: 10.2214/ajr.07.2787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Colagrande S, Centi N, Galdiero R, Ragozzino A. Transient hepatic intensity differences: part 2, Those not associated with focal lesions. AJR Am J Roentgenol 2007; 188:160-166. [PMID: 17179359 DOI: 10.2214/ajr.05.1367] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of our study was to evaluate and to show the range of appearance of transient hepatic signal intensity differences when not associated with focal lesions, and to correlate morphology, cause, and pathogenesis. CONCLUSION Hepatic arterial phenomena, visualized on MRI and CT, must be considered important signs of underlying liver disorders, which these phenomena contribute to evaluate. Accordingly, the hepatic arterial phase must always be performed on MRI as well as on CT, even if no focal lesion is expected.
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Affiliation(s)
- Stefano Colagrande
- Department of Clinical Physiopathology, Section of Radiodiagnostics, University of Florence, Viale Morgagni 85, Florence 50134, Italy.
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