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Abstract
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA; Gadoxetic acid; Gadoxetate disodium) is a hepatocyte-specific MR contrast agent. It acts as an extracellular contrast agent in the early phase after intravenous injection, and then is taken up by hepatocytes later. Using this contrast agent, we can evaluate the hemodynamics of the liver and liver tumors, and can therefore improve the detection and characterization of hepatocellular carcinoma (HCC). Gd-EOB-DTPA helps in the more accurate detection of hypervascular HCC than by other agents. In addition, Gd-EOB-DTPA can detect hypovascular HCC, which is an early stage of the multi-stage carcinogenesis, with a low signal in the hepatobiliary phase. In addition to tumor detection and characterization, Gd-EOB-DTPA contrast-enhanced MR imaging can be applied for liver function evaluation and prognoses evaluation. Thus, Gd-EOB-DTPA plays an important role in the diagnosis of HCC. However, we have to employ optimal imaging techniques to improve the diagnostic ability. In this review, we aimed to discuss the characteristics of the contrast media, optimal imaging techniques, diagnosis, and applications.
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Affiliation(s)
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine
| | - Masatoshi Hori
- Department of Radiology, Kobe University Graduate School of Medicine
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Ünal E, İdilman İS, Akata D, Özmen MN, Karçaaltıncaba M. Microvascular invasion in hepatocellular carcinoma. Diagn Interv Radiol 2017; 22:125-32. [PMID: 26782155 DOI: 10.5152/dir.2015.15125] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microvascular invasion is a crucial histopathologic prognostic factor for hepatocellular carcinoma. We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule, irregular tumor margin, peritumoral enhancement, multifocal tumor, increased tumor size, and increased glucose metabolism on positron emission tomography-computed tomography. In the presence of typical findings, microvascular invasion may be predicted.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Hacettepe University School of Medicine Ankara, Turkey; Department of Radiology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
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Kim JH, Kim PN, Won HJ, Shin YM. Viable hepatocellular carcinoma around retained iodized oil after transarterial chemoembolization: radiofrequency ablation of viable tumor plus retained iodized oil versus viable tumor alone. AJR Am J Roentgenol 2014; 203:1127-1131. [PMID: 25341154 DOI: 10.2214/ajr.13.11870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of our study was to compare the effectiveness of radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) including areas of retained oil after transarterial chemoembolization (TACE) versus RFA treatment of viable HCC alone for ablation coverage. MATERIALS AND METHODS Eighty-five patients with 88 viable HCCs underwent RFA of residual viable HCCs around retained iodized oil after TACE. RFA of both viable HCC and retained iodized oil was performed on 47 viable tumors (group A), and RFA of viable HCC only was used to treat the remaining 41 viable tumors (group B). RESULTS After initial RFA, the endpoint of ablation was successfully achieved for 45 of 47 tumors in group A and for all 41 tumors in group B. Two residual viable tumors in group A were successfully treated by additional RFA. Major complications occurred after initial RFA treatment of one tumor each in group A (pleural effusion) and group B (collateral damage). During follow-up (mean, 37.1 months; range, 5-116.5 months), local tumor progression of treated lesions was found in 28% in group A and 59% in group B. The respective 1-, 3-, 5-, and 7-year local tumor progression rates were significantly lower in group A (15%, 32%, 32%, and 32%) than in group B (43%, 71%, 81%, and 81%) (p = 0.001). CONCLUSION In treatment of viable tumors after TACE in patients with HCC, RFA of both viable tumor and retained iodized oil may reduce rates of local tumor progression compared with RFA of viable tumor only.
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Affiliation(s)
- Jin Hyoung Kim
- 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea
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4
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Okada M, Kondo H, Sou H, Murakami T, Kanematsu M, Ichikawa T, Yoshikawa S, Shiosakai K, Hayakawa A, Awai K, Yoshimitsu K, Yamashita Y. The efficacy of contrast protocol in hepatic dynamic computed tomography: multicenter prospective study in community hospitals. SPRINGERPLUS 2013; 2:367. [PMID: 23961429 PMCID: PMC3742842 DOI: 10.1186/2193-1801-2-367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/29/2013] [Indexed: 12/05/2022]
Abstract
Purpose To investigate four different contrast protocols to detect hypervascular hepatocellular carcinoma (HCC) most adaptable for patients at any body weight (BW) in clinical practice. Materials and methods A post-marketing surveillance of liver dynamic CT was prospectively performed by four different protocols in 415 patients: Protocol-A, BW-tailored dose of contrast media (CM: iohexol 300 mgI/mL), fixed injection duration (30s), fixed scan timing at arterial phase (AP); Protocol-B, BW-tailored dose of CM, fixed injection duration (30s), by bolus tracking; Protocol-C, BW-tailored dose of CM, fixed injection flow rate, by bolus tracking; Protocol-D, 100 mL constant of CM at any BW, fixed scan timing. Scan timing and tumor conspicuity at AP was scored qualitatively. The quantitative CT values of aorta and tumor liver contrast (TLC) were obtained. Results The qualitative rate assessed “good” as scan timing of AP in Protocol-C was significantly lower than those in Protocols A and D (difference:16.6%, 17.4%, P = 0.0069, P = 0.0140, respectively). Scatter plot of Protocol-D (R2 = 0.1283) at AP showed significant inverse relationship between TLC and BW (P =0.0053), although not significant in Protocols A, B, C. Conclusion In patients with higher BW, protocols of BW-tailored dose of CM and/or fixed injection duration have no dependence on BW to diagnose hypervascular HCCs. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-2-367) contains supplementary material, which is available to authorized users.
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy, and usually develops in the setting of liver cirrhosis. The early diagnosis of HCC is essential as curative treatment (including surgical resection and liver transplantation) improves survival. While screening and surveillance are traditionally performed with ultrasound, reported accuracies of ultrasound vary greatly, and poor sensitivity for small nodules is a uniformly recognized concern. Advances in computed tomography (CT) and magnetic resonance imaging (MRI), including multidetector technology and fast breath hold sequences now allow dynamic multiphasic enhanced imaging of the liver with excellent spatial and temporal resolution, holding much promise for improved HCC detection.
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Shim JH, Lee HC, Kim SO, Shin YM, Kim KM, Lim YS, Suh DJ. Which response criteria best help predict survival of patients with hepatocellular carcinoma following chemoembolization? A validation study of old and new models. Radiology 2011; 262:708-18. [PMID: 22187634 DOI: 10.1148/radiol.11110282] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To identify differences in radiologic assessment methods and determine optimal imaging criteria for response evaluation in hepatocellular carcinoma (HCC) patients treated with chemoembolization. MATERIALS AND METHODS Institutional review board approval was obtained, and patient informed consent was waived. The present study included 332 patients with intermediate stage HCC and Child-Pugh A cirrhosis who underwent serial chemoembolization. All measurable target lesions of 1 cm or larger in diameter were uni- and bidimensionally measured both at baseline and during follow-up. Intermodel agreement among the guidelines of the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), the European Association for the Study of the Liver (EASL), and modified RECIST (mRECIST) were examined. The most reliable model was selected on the basis of the correlation with survival prediction. RESULTS The κ values of comparisons among WHO, RECIST, and mRECIST guidelines were less than 0.20, whereas the κ value for the comparison of EASL and mRECIST guidelines was 0.94. In patients with a partial response (PR), stable disease (SD), or progressive disease (PD), compared with patients with a complete response (CR), hazard ratios (HRs) for survival were 2.99 (95% confidence interval [CI]: 2.14, 4.17), 3.49 (95% CI: 1.71, 7.10), and 15.63 (95% CI: 9.51, 25.69), respectively, for EASL criteria. In patients with a PR, SD, or PD, compared with patients with a CR, the HRs were 2.75 (95% CI: 1.96, 3.87), 6.32 (95% CI: 3.67, 10.90), and 16.06 (95% CI: 9.76, 26.43), respectively, for mRECIST guidelines (P<.001). The C index for the multivariate model was 0.76 (95% CI: 0.72, 0.79) for both EASL and mRECIST guidelines, thus exhibiting satisfactory capability to help predict survival. The Cox regression model revealed that both mRECIST and EASL guidelines were independent predictors of overall survival (P<.001 for both). CONCLUSION The enhancement models more accurately helped predict long-term survival in HCC patients treated with chemoembolization.
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Affiliation(s)
- Ju Hyun Shim
- Department of Internal Medicine, Asan Liver Center, University of Ulsan College of Medicine, 388-1 Poongnap-2dong, Songpa-gu, Seoul 138-736, Korea
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Chanyaputhipong J, Low SCA, Chow PKH. Gadoxetate Acid-Enhanced MR Imaging for HCC: A Review for Clinicians. Int J Hepatol 2011; 2011:489342. [PMID: 21994860 PMCID: PMC3170825 DOI: 10.4061/2011/489342] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 02/28/2011] [Accepted: 03/31/2011] [Indexed: 12/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is increasingly being detected at an earlier stage, owing to the screening programs and regular imaging follow-up in high-risk populations. Small HCCs still pose diagnostic challenges on imaging due to decreased sensitivity and increased frequency of atypical features. Differentiating early HCC from premalignant or benign nodules is important as management differs and has implications on both the quality of life and the overall survival for the patients. Gadoxetate acid (Gd-EOB-DTPA, Primovist(®), Bayer Schering Pharma) is a relatively new, safe and well-tolerated liver-specific contrast agent for magnetic resonance (MR) imaging of the liver that has combined perfusion- and hepatocyte-specific properties, allowing for the acquisition of both dynamic and hepatobiliary phase images. Its high biliary uptake and excretion improves lesion detection and characterization by increasing liver-to-lesion conspicuity in the added hepatobiliary phase imaging. To date, gadoxetate acid-enhanced MRI has been mostly shown to be superior to unenhanced MRI, computed tomography, and other types of contrast agents in the detection and characterization of liver lesions. This review article focuses on the evolving role of gadoxetate acid in the characterization of HCC, differentiating it from other mimickers of HCC.
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Affiliation(s)
| | - Su-Chong Albert Low
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, 169608, Singapore,*Su-Chong Albert Low:
| | - Pierce K. H. Chow
- Department of General Surgery, Singapore General Hospital, 169608, Singapore ,Duke-NUS Graduate Medical School, 169857, Singapore
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Yamaguchi I, Kidoya E, Suzuki M, Kimura H. Optimizing scan timing of hepatic arterial phase by physiologic pharmacokinetic analysis in bolus-tracking technique by multi-detector row computed tomography. Radiol Phys Technol 2010; 4:43-52. [DOI: 10.1007/s12194-010-0105-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/30/2010] [Accepted: 08/31/2010] [Indexed: 11/29/2022]
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Rasalkar DD, Chu WCW, Cheng FWT, Hui SK, Ling SC, Li CK. A pictorial review of imaging of abdominal tumours in adolescence. Pediatr Radiol 2010; 40:1552-61; quiz 1589-90. [PMID: 20602098 DOI: 10.1007/s00247-010-1738-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 04/09/2010] [Accepted: 05/09/2010] [Indexed: 10/19/2022]
Abstract
Neoplastic abdominal tumours, particularly those originating from embryonal tissue (such as hepatoblastoma and nephroblastoma) and neural crest cells (such as neuroblastoma), are well-documented in young children. Neoplasms of adulthood, most commonly carcinoma of different visceral organs, are also well-documented. Abdominal tumours in adolescence constitute a distinct pathological group. The radiological features of some of these tumours have been described only in isolated reports. The purpose of this pictorial essay was to review the imaging findings of various kinds of abdominal tumours in adolescent patients (with an age range of 10-16 years) who presented to the Children Cancer Center of our institution in the past 15 years. Some tumours, though rare, have characteristic imaging appearances (especially in CT) that enable an accurate diagnosis before definite histological confirmation.
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Affiliation(s)
- Darshana D Rasalkar
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
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Park G, Kim YK, Kim CS, Yu HC, Hwang SB. Diagnostic efficacy of gadoxetic acid-enhanced MRI in the detection of hepatocellular carcinomas: comparison with gadopentetate dimeglumine. Br J Radiol 2010; 83:1010-6. [PMID: 20682591 DOI: 10.1259/bjr/66686028] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study compared the efficacy of gadoxetic acid-enhanced MRI and gadopentetate dimeglumine-enhanced MRI in the detection of small hepatocellular carcinoma (HCC). Both MRI techniques were performed on 43 patients with a total of 59 HCCs (size range, 0.5-2.0 cm), with a mean interval between the two MRI studies of 3 days (range, 2-7 days). Two observers reviewed both data sets in consensus. Diagnostic accuracy and sensitivity were evaluated using the alternative-free response receiver operator characteristic (ROC) method. The gadoxetic acid set showed a trend toward increased area under the ROC curve (Az value = 0.958) compared with the gadopentetate dimeglumine set (Az value = 0.927), but the difference was not significant (p = 0.362). The sensitivity of the gadoxetic acid set (n = 51, 86.4%) was significantly higher than that of the gadopentetate dimeglumine set (n = 38, 64.4%) (p = 0.0001). Gadoxetic acid-enhanced MRI is a more sensitive diagnostic tool for detection of HCC than gadopentetate dimeglumine-enhanced MRI.
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Affiliation(s)
- G Park
- Department of Radiology Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
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Efficacy of Double-Arterial Phase Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid-Enhanced Liver Magnetic Resonance Imaging Compared With Double-Arterial Phase Multi-Detector Row Helical Computed Tomography. J Comput Assist Tomogr 2009; 33:887-92. [DOI: 10.1097/rct.0b013e3181a1ca7e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Efficacy of double arterial phase dynamic magnetic resonance imaging with the sensitivity encoding technique versus dynamic multidetector-row helical computed tomography for detecting hypervascular hepatocellular carcinoma. Jpn J Radiol 2009; 27:229-36. [DOI: 10.1007/s11604-009-0327-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 03/30/2009] [Indexed: 01/17/2023]
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Vandecaveye V, De Keyzer F, Verslype C, Op de Beeck K, Komuta M, Topal B, Roebben I, Bielen D, Roskams T, Nevens F, Dymarkowski S. Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. Eur Radiol 2009; 19:2456-66. [PMID: 19440718 DOI: 10.1007/s00330-009-1431-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 03/02/2009] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to evaluate the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating HCC from benign cirrhotic lesions compared with conventional dynamic contrast-enhanced MRI. Fifty-five patients with cirrhosis underwent conventional and DW-MRI at 1.5 Tesla. Signal intensity ratios (SI(ratio)) of solid liver lesions to adjacent hepatic parenchyma were measured for b0, b100, b600 and b1000, and the apparent diffusion coefficients (ADC) were calculated. In 27 patients, imaging results were compared to histopathology, and in 28 patients, to imaging follow-up. Based on predetermined thresholds, sensitivity and specificity of DW-MRI and conventional MRI were compared. SI(ratio) was significantly different between malignant and benign lesions at all b-values (P < 0.0001). No significant difference in ADC was seen (P = 0.47). For detection of malignant lesions, DW-MRI with b600-SI(ratio) yielded a sensitivity of 95.2% compared to 80.6% for conventional MRI (P = 0.023) and a specificity of 82.7% compared to 65.4% (P = 0.064). The improved accuracy was most beneficial for differentiating malignant lesions smaller than 2 cm. DW-MRI with b600-SI(ratio) improved the detection of small HCC and the differentiation of pseudotumoral lesions compared with conventional MRI.
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Affiliation(s)
- Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, B-3000, Leuven, Belgium.
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Hunt SJ, Yu W, Weintraub J, Prince MR, Kothary N. Radiologic monitoring of hepatocellular carcinoma tumor viability after transhepatic arterial chemoembolization: estimating the accuracy of contrast-enhanced cross-sectional imaging with histopathologic correlation. J Vasc Interv Radiol 2009; 20:30-38. [PMID: 19028117 DOI: 10.1016/j.jvir.2008.09.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 09/25/2008] [Accepted: 09/26/2008] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Cross-sectional diagnostic imaging studies such as contrast-enhanced quadruple-phase helical computed tomography (CT) and contrast-enhanced magnetic resonance (MR) imaging are routinely performed to evaluate tumor response to transhepatic arterial chemoembolization. However, the true correlation between imaging characteristics and histopathologic tumor viability is not known. The aim of the present retrospective study was to determine the sensitivity and specificity of contrast-enhanced CT and contrast-enhanced MR imaging with use of histopathologic analysis. MATERIALS AND METHODS Between February 2002 and October 2005, a total of 31 patients (age, 51-74 years; mean, 60 y) who had undergone chemoembolization underwent follow-up diagnostic cross-sectional imaging before transplantation. The mean time interval between the imaging study and transplantation was 32 days (range, 1-117 d). Imaging studies were assessed for residual or recurrent tumor and were then correlated to the findings of histopathologic analysis performed on the surgical specimens at the time of transplantation. RESULTS The overall sensitivity and specificity rates of cross-sectional imaging studies were 35% and 64%, respectively. The overall accuracy rate of CT was 43%, with 36% sensitivity and 57% specificity. The overall accuracy rate of MR imaging was 55%, with 43% sensitivity and 75% specificity. Gross macroscopic disease was missed in one patient (9%) who underwent MR imaging and four patients (19%) who underwent CT. CONCLUSIONS Contrast-enhanced CT and MR imaging after chemoembolization are associated with high error rates. Between the two modalities, MR has higher sensitivity and specificity and may be a preferable imaging tool for patients who have undergone chemoembolization.
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Affiliation(s)
- Stephen J Hunt
- Department of Biological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Diagnosis of Hepatocellular Carcinoma: Multidetector-Row Computed Tomography and Magnetic Resonance Imaging. Liver Cancer 2009. [DOI: 10.1007/978-1-4020-9804-8_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
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Takayama T, Makuuchi M, Kojiro M, Lauwers GY, Adams RB, Wilson SR, Jang HJ, Charnsangavej C, Taouli B. Early hepatocellular carcinoma: pathology, imaging, and therapy. Ann Surg Oncol 2008; 15:972-8. [PMID: 18236118 DOI: 10.1245/s10434-007-9685-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 09/21/2007] [Accepted: 09/25/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 1987, Japanese researchers proposed to define the pathological concept of early hepatocellular carcinoma (HCC). However, there are some conceptual differences between the East and the West in the diagnosis and treatment of early HCC. METHODS To provide up-to-date data for making a worldwide consensus, this article has collected six papers focused on the management of early HCC, which were presented in the Fifth International Meeting of "Hepatocellular Carcinoma: Eastern and Western Experiences" in Houston in January 2007. RESULTS In the pathological perspective, the common criteria to discriminate early HCC from dysplastic nodule included hepatocytic invasion of portal triads and septa (stromal invasion). The current imaging modalities such as contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI) with the use of intravenous contrast material with multiphasic imaging could enhance their ability to accurately characterize early HCC. From the treatment perspective, a single early HCC had a high chance for cure by resection, ablation, or transplantation, which proved to be the earliest clinical entity (Stage 0 HCC). CONCLUSIONS Early HCC is characterized by its incipient malignant nature and by an extremely favorable clinical outcome, thereby justifying its definition.
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Affiliation(s)
- Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
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Zhao H, Yao JL, Wang Y, Zhou KR. Detection of small hepatocellular carcinoma: Comparison of dynamic enhancement magnetic resonance imaging and multiphase multirow-detector helical CT scanning. World J Gastroenterol 2007; 13:1252-6. [PMID: 17451209 PMCID: PMC4147003 DOI: 10.3748/wjg.v13.i8.1252] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the gadolinium-enhanced multiphase dynamic magnetic resonance imaging (MRI) and multiphase multirow-detector helical CT (MDCT) scanning for detection of small hepatocellular carcinoma (HCC).
METHODS: MDCT scanning and baseline MRI with SE T1-WI and T2-WI sequence combined with FMPSPGR sequence were performed in 37 patients with 43 small HCCs. Receiver operating characteristic (ROC) curves were plotted to analyze the results for modality.
RESULTS: The areas below ROC curve (Az) were calculated. There was no statistical difference in dynamic enhancement MDCT and MRI. The detection rate of small HCC was 97.5%-97.6% on multiphase MDCT scanning and 90.7%-94.7% on MRI, respectively. The sensitivity of detection for small HCC on MDCT scanning was higher than that on dynamic enhancement MRI. The sensitivity of detection for minute HCC (tumor diameter ≤ 1 cm) was 90.0%-95.0% on MDCT scanning and 70.0%-85.0% on MRI, respectively.
CONCLUSION: MDCT scanning should be performed for early detection and effective treatment of small HCC in patients with chronic hepatitis and cirrhosis during follow-up.
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Affiliation(s)
- Hong Zhao
- Department of Radiology, Affiliated Fifth Hospital, Zhongshan University, Zhuhai 519000, Guangdong Province, China.
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Ichikawa T, Nakajima H, Nanbu A, Hori M, Araki T. Effect of Injection Rate of Contrast Material on CT of Hepatocellular Carcinoma. AJR Am J Roentgenol 2006; 186:1413-8. [PMID: 16632738 DOI: 10.2214/ajr.04.0310] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effect of two injection rates of contrast material (3 mL/sec and 5 mL/sec) in hepatic arterial dominant phase MDCT for the detection of small (< 2 cm) hepatocellular carcinomas. MATERIALS AND METHODS The injection rates 3 mL/sec and 5 mL/sec were used prospectively in imaging examinations of patients with the suspected diagnosis of hepatocellular carcinoma. Each group consisted of 30 patients by chance. The group that received injections at 3 mL/sec had 35 hepatocellular carcinoma lesions, and the 5 mL/sec group had 41 lesions. In all patients the dose and concentration of contrast material were 100 mL and 350 mg/mL iodine (total dose of iodine, 35 g). In each patient a mini-test-bolus technique was used with an additional 15 mL of contrast material to determine optimal scan delay after administration of contrast material. Receiver operating characteristic analysis was used to assess diagnostic performance with the two injection rates of contrast material. RESULTS There were no statistically significant differences between the two groups in regard to area under the curve and sensitivity. These values for the 3 mL/sec group were 0.97 and 28/35 (80%) and for the 5 mL/sec group were 0.96 and 36/41 (88%). However, the specificity and positive predictive values at 3 mL/sec (236/250 [95%] and 28/42 [67%]) were significantly higher than those at 5 mL/sec (227/265 [86%] and 36/73 [49%]) (p < 0.05). These results suggest there were more false-positive findings of contrast-enhanced lesions in cirrhotic livers on hepatic arterial dominant phase images obtained after injection of contrast material at 5 mL/sec than on images obtained after injection at 3 mL/sec. CONCLUSION In the detection of small hypervascular hepatocellular carcinoma in cirrhotic liver, the risk of false-positive findings of lesions on hepatic arterial dominant phase images is significantly greater with the higher injection rate (5 mL/sec) than with the medium rate (3 mL/sec).
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Affiliation(s)
- Tomoaki Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Tamaho, Nakakoma, Yamanashi 409-3898, Japan
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Kim YK, Kim CS, Chung GH, Han YM, Lee SY, Chon SB, Lee JM. Comparison of gadobenate dimeglumine-enhanced dynamic MRI and 16-MDCT for the detection of hepatocellular carcinoma. AJR Am J Roentgenol 2006; 186:149-57. [PMID: 16357395 DOI: 10.2214/ajr.04.1206] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of our study was to compare the diagnostic performance of gadobenate dimeglumine-enhanced MRI with that of 16-MDCT for the detection of hepatocellular carcinoma using receiver operating characteristic (ROC) curve analysis. MATERIALS AND METHODS Thirty-one patients with 53 hepatocellular carcinomas underwent gadobenate dimeglumine-enhanced dynamic MRI and multiphasic CT using 16-MDCT within a mean interval of 5 days (range, 3-9 days). The dynamic MRI examination was performed using 3D fat-saturated volumetric interpolated imaging and sensitivity encoding on a 1.5-T unit. Both dynamic MRI and multiphasic MDCT included dual arterial phase images. Three observers independently interpreted the CT and MR images in random order, separately, and without patient identifiers. The diagnostic accuracy of each technique was evaluated using the alternative-free response ROC method. The sensitivity and positive predictive values were also calculated. RESULTS The sensitivities of gadobenate dimeglumine-enhanced MRI for all observers were significantly higher than those of MDCT for all the lesions and for lesions 1.0 cm or smaller (p < 0.05); however, for lesions larger than 1.0 cm, the sensitivities of the two imaging techniques were similar. The mean area under the ROC curve (A(z)) of gadobenate dimeglumine-enhanced MRI (0.87 +/- 0.03 [SD]) was higher than that of MDCT (0.83 +/- 0.04), but no significant difference was found between them (p = 0.31). The number of false-positive findings on dynamic MRI was slightly higher than on MDCT, but no significant difference in the positive predictive value between the two imaging techniques was detected (observer 1, p = 0.06; observer 2, p = 0.13; observer 3, p = 1.00). CONCLUSION Gadobenate dimeglumine-enhanced MRI has a higher sensitivity for small hepatocellular carcinomas (</= 1 cm) but a higher false-positive rate due to nonspecific enhancement of benign lesions, such as arterioportal shunt, leading to no significant difference of overall accuracy when compared with MDCT.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radiography, Chonbuk National University Hospital and Medical School, Jeonju, South Korea
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Ito K. Hepatocellular carcinoma: conventional MRI findings including gadolinium-enhanced dynamic imaging. Eur J Radiol 2006; 58:186-99. [PMID: 16413154 DOI: 10.1016/j.ejrad.2005.11.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 11/25/2005] [Accepted: 11/29/2005] [Indexed: 12/11/2022]
Abstract
A great variety of MR pulse sequences for hepatocellular carcinomas (HCCs) are now available. In this article, we reviewed the current MR imaging techniques that are routinely used for hepatic imaging, and described the optimization of these sequences as well as the utility and characteristics of each sequence for the accurate diagnosis of HCCs. Then, we reviewed various MR imaging findings of advanced and early HCCs with emphasis on signal intensity and hemodynamic patterns. Finally, we described the value of multi-arterial-phase contrast-enhanced dynamic MR imaging of the whole liver with excellent temporal resolution for evaluating transitional hemodynamics of hepatic lesions during the six arterial phases.
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Affiliation(s)
- Katsuyoshi Ito
- Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
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Abstract
Primary hepatocellular carcinoma (HCC) is a significant tumor worldwide and represents the most common primary hepatic neoplasm. Staging criteria are important for appreciation of timely work up of these neoplasms in contradiction with surgical colleagues. This article demonstrates the appearance of HCC on multiphasic, multidetector CT (MDCT) and relates these findings to current staging criteria. The variable appearance on different planes of contrast is critical to appreciate in staging this neoplasm. The hypervascular nature of the primary tumor makes MDCT and three-phase imaging a critical feature in the detection and characterization of this tumor. This is especially critical in the patients who are candidates for surgical resection. Additionally, MDCT has allowed arterial phase imaging to define the vascular supply of the tumor. An accurate representation of the size and number of lesions is critical in not only the initial staging but also the follow-up of hepatocellular carcinoma. The post-treatment features including the appearance post-surgically and after radiofrequency ablation can be well appreciated on MDCT.
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Affiliation(s)
- Paul M Silverman
- Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Mori K, Yoshioka H, Takahashi N, Yamaguchi M, Ueno T, Yamaki T, Saida Y. Triple Arterial Phase Dynamic MRI with Sensitivity Encoding for Hypervascular Hepatocellular Carcinoma: Comparison of the Diagnostic Accuracy Among the Early, Middle, Late, and Whole Triple Arterial Phase Imaging. AJR Am J Roentgenol 2005; 184:63-9. [PMID: 15615952 DOI: 10.2214/ajr.184.1.01840063] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We assessed and compared the diagnostic accuracy of the early, middle, late, and whole triple arterial phase MRI with sensitivity encoding (SENSE) for the detection of hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS Thirty-one patients with 102 HCCs underwent dynamic MRI with SENSE. The findings of CT examinations, combined with those of visceral angiography or histopathologic examination, were used as the gold standard. After acquisition of T1- and T2-weighted images, gadolinium-enhanced triple arterial, portal, and delayed phase images were obtained. Acquisition of the triple arterial phase imaging was started at the timing of peak aortic enhancement and completed within a single breath-hold. Acquisition time for each phase was 8.4 sec. Four image sets including the early, middle, late, and whole triple arterial phase imaging were interpreted separately by four observers. The mean values of area under alternative-free-response receiver operating characteristic (AFROC) curve and of sensitivity were compared among the four image sets. RESULTS The mean values of area under AFROC curve were 0.52, 0.66, 0.53, and 0.68 and of sensitivity were 45%, 64%, 48%, and 65% for the image sets with the early, middle, late, and whole triple arterial phase imaging, respectively. Both mean values were significantly higher for the image sets with the middle and whole triple arterial phase imaging than for those with the early and late arterial phase imaging. CONCLUSION The middle arterial phase imaging with k-space centered at 12.6 sec after the peak aortic enhancement was optimal for detecting HCC and showed diagnostic accuracy equivalent to that of the whole triple arterial phase imaging.
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Affiliation(s)
- Kensaku Mori
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan.
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Abstract
Hepatocellular carcinoma (HCC), the most common primary hepatic malignancy, usually develops in patients with cirrhosis, growing sequentially from low-grade dysplastic nodules to frank malignant HCC. Its recognition is critical because curative treatment and prognosis require early diagnosis. Survival in patients with HCC relates directly to the number, size, and extent of lesions at diagnosis. Imaging of HCC is complicated because the tumor has a varied imaging appearance and frequently coexists with other cirrhotic nodules. Magnetic resonance imaging (MRI), the best available diagnostic technique, offers good contrast resolution and diagnostic sensitivity ranging from 33% to 77%. The main difficulty is not in diagnosing large tumors, but rather small tumors (<2 cm), because of considerable overlap on imaging between benign (regenerative), borderline (dysplastic), and malignant nodules. Increasing degrees of histological malignancy are associated with increasing arterialization and loss of portal blood supply; therefore, recognition of HCC requires dynamic imaging with gadolinium-enhanced T1-weighted sequence. Typically, HCC is a focal lesion with high signal intensity on T2-weighted images, variable signal intensity on T1-weighted images, intense arterial phase enhancement after gadolinium injection, and isointensity or hypointensity at the portal venous phase. The sensitivity of MRI for detecting small lesions is low, and improvement is still needed. Newer contrast agents, higher field strength (3 Tesla) imaging, and perfusion and diffusion MRI techniques possibly will provide greater sensitivity and specificity for detecting small HCCs in the future.
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Affiliation(s)
- Bachir Taouli
- Department of Radiology, TCH-HW 202, New York University, 560 First Avenue, New York, New York 10016, USA.
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Wang J, Chen LT, Tsang YM, Liu TW, Shih TTF. Dynamic contrast-enhanced MRI analysis of perfusion changes in advanced hepatocellular carcinoma treated with an antiangiogenic agent: a preliminary study. AJR Am J Roentgenol 2004; 183:713-9. [PMID: 15333360 DOI: 10.2214/ajr.183.3.1830713] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the perfusion changes in advanced hepatocellular carcinoma (HCC) treated with the antiangiogenic agent thalidomide, we used dynamic contrast-enhanced MRI. SUBJECTS AND METHODS Dynamic contrast-enhanced MRI was performed before and during thalidomide treatment in seven patients with advanced unresectable HCC that had failed to respond to prior local therapy. A turbo fast low-angle shot sequence was performed in a 1.5-T MR scanner. An operator-defined region of interest was placed in the maximal enhancement region of the tumor site and adjacent tumor-free parenchyma of all patients. A time-intensity curve was plotted and analyzed. The peak enhancement in the first-pass study, the maximal enhancement, and the initial enhancement slope percentage in the first-pass study of the tumor and parenchyma were measured. The changes in these three perfusion parameters were estimated and correlated with clinical outcomes. The seven patients were categorized into two groups on the basis of their clinical outcomes: group A patients were those who had progressive disease, whereas group B patients were those who had stable disease or partial response. RESULTS Four of the seven patients were classified as group A, and the other three were classified as group B patients. When comparing the MRI parameters for the tumors before and during treatment in group A and group B patients, we found a statistically significant difference for the peak enhancement in the first-pass study, the maximal enhancement, and the enhancement slope percentage in the first-pass study. When comparing the parenchymal parameters, we found a statistically significant difference in the maximal enhancement and borderline significance in the peak enhancement in the first-pass study (p = 0.057) between group A and group B patients. CONCLUSION The dynamic MRI parameters showed significant differences between two groups of patients with different clinical outcomes.
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Affiliation(s)
- Jane Wang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan S Rd., Taipei 100, Taiwan
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Murakami T, Kim T, Kawata S, Kanematsu M, Federle MP, Hori M, Okada A, Kumano S, Sugihara E, Tomoda K, Nakamura H. Evaluation of optimal timing of arterial phase imaging for the detection of hypervascular hepatocellular carcinoma by using triple arterial phase imaging with multidetector-row helical computed tomography. Invest Radiol 2003; 38:497-503. [PMID: 12874516 DOI: 10.1097/01.rli.0000074584.12494.e3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE We evaluated the optimal timing of arterial phase imaging for detection of hypervascular hepatocellular carcinoma by using triple arterial phase imaging with multidetector-row helical computed tomography. MATERIALS AND METHODS Forty-nine patients with 90 hypervascular hepatocellular carcinomas (3 to 50 mm in diameter; mean, 18.7 mm) underwent triple arterial phase imaging of the whole liver using a multidetector-row helical computed tomography. At 20 seconds, 30 seconds, and 40 seconds after intravenous administration of 100 mL of 300 mgI/mL of nonionic contrast medium at a rate of 4 mL/s, early, middle, and late arterial phase images were obtained serially during a single breath-hold with an interscan delay of 5 seconds. Detector-row configurations of 4 mm x 4, scan pitch of 5.5, and scan time of 5 seconds for each phase were used. Forty prospective reconstruction images of 5-mm thickness for each phase were obtained. The images from each phase were interpreted separately for detection of hypervascular hepatocellular carcinoma by 3 observers independently who were unaware of tumor burden in the liver. Sensitivity, positive predictive value, and area under the receiver operating characteristic curve values for each arterial phase were calculated and compared statistically. RESULTS The mean sensitivity and positive predictive values for hypervascular hepatocellular carcinoma diagnosis of blind readers were 37% and 87% for the early arterial phase, 73% and 85% for the middle arterial phase, and 49% and 81% for the late arterial phase, respectively. The middle arterial phase imaging showed significantly superior sensitivity compared with the early and late arterial phase for detecting hepatocellular carcinoma (P < 0.05). Mean area under the receiver operating characteristic curve value of the middle arterial phase imaging (0.84) was significantly higher that that of the early (0.56) or late arterial phase (0.62; P < 0.05). CONCLUSION If a single arterial phase is used for diagnosis of hypervascular hepatocellular carcinoma, the middle phase (delay time of 30 seconds) is optimal.
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Affiliation(s)
- Takamichi Murakami
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Takahashi N, Yoshioka H, Yamaguchi M, Saida Y, Itai Y. Accelerated dynamic MR imaging with a parallel imaging technique for hypervascular hepatocellular carcinomas: usefulness of a test bolus in examination and subtraction imaging. J Magn Reson Imaging 2003; 18:80-9. [PMID: 12815643 DOI: 10.1002/jmri.10319] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the impact of the accelerated dynamic MR imaging (ADMRI) approach using parallel imaging for detecting hypervascular hepatocellular carcinomas (HCCs) and to evaluate the usefulness of a test bolus in examination and subtraction imaging in this setting. MATERIALS AND METHODS Thirty patients with 135 HCCs underwent ADMRI using a two-dimensional gradient-recalled echo sequence with parallel imaging. Seventeen patients were evaluated without a test bolus and 13 patients with a test bolus. The detectability of HCCs was calculated between the groups with and without a test bolus. ADMRI was evaluated regarding the signal-to-noise ratio (SNR) of the lesion and the liver, the contrast-to-noise ratio (CNR) of the lesion vs. the liver, and the feasibility of subtraction images. RESULTS ADMRI with and without a test bolus had almost equal sensitivity (92.5% and 92.6%). No significant difference was seen in the SNR of lesions and the CNR of lesions vs. livers between both groups. With a test bolus, ADMRI could depict the peak enhancement of nodules on the 2nd or 3rd dynamic phases and optimized the timing of peak lesion enhancement. Subtraction images could be obtained regarding minimal slice misregistration. CONCLUSION ADMRI had high detectability of HCCs with and without a test bolus.
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Affiliation(s)
- Nobuyuki Takahashi
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
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Sugihara E, Murakami T, Kim T, Hori M, Takamura M, Kawata S, Okada A, Khankan AA, Tomoda K, Nakamura H. Detection of hypervascular hepatocellular carcinoma with dynamic magnetic resonance imaging with simultaneously obtained in-phase and opposed-phase echo images. J Comput Assist Tomogr 2003; 27:110-6. [PMID: 12702998 DOI: 10.1097/00004728-200303000-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The technique of double-phase echo chemical shift gradient-echo magnetic resonance (MR) imaging with the fast low-angle shot sequence (double-echo FLASH) provides in-phase and opposed-phase (double-phase) images simultaneously. The purpose of this study was to assess whether the dynamic study with a combination of in-phase and opposed-phase (double-phase) echo images improves the detectability of hypervascular hepatocellular carcinoma (HCC) compared with that with either in-phase or opposed-phase images alone. METHOD Thirty-seven patients with 107 hypervascular HCCs who underwent the whole-liver double-phase echo dynamic MR imaging were enrolled in the study. Three radiologists blindly read in-phase images alone, opposed-phase images alone, and then double-phase images together. Sensitivity and positive predictive values as well as the areas below the alternative-free response receiver operating characteristic curve (Az values) for each imaging technique were calculated and compared statistically. RESULTS The mean sensitivity, positive predictive values, and Az values for hypervascular HCCs were 51%, 77%, and 0.52 for in-phase imaging; 55%, 86%, and 0.58 for opposed-phase imaging; and 57%, 84%, and 0.63 for double-phase imaging, respectively. The mean sensitivity for opposed-phase imaging was significantly higher than that for in-phase imaging (P < 0.05), and the mean sensitivity for double-phase imaging was higher than that for in-phase imaging (P < 0.01). The mean Az value for the double-phase imaging was significantly higher than that for in-phase imaging (P < 0.01). CONCLUSION Dynamic MR imaging with double-phase images was recommended for the detection of hypervascular HCC.
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Affiliation(s)
- Eiji Sugihara
- Department of Radiology, Osaka University Graduate School of Medicine, Suita-city, Osaka, Japan.
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Szklaruk J, Silverman PM, Charnsangavej C. Imaging in the diagnosis, staging, treatment, and surveillance of hepatocellular carcinoma. AJR Am J Roentgenol 2003; 180:441-54. [PMID: 12540450 DOI: 10.2214/ajr.180.2.1800441] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Janio Szklaruk
- Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 57, Houston, TX 77030-4009, USA
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Noguchi Y, Murakami T, Kim T, Hori M, Osuga K, Kawata S, Kumano S, Okada A, Sugiura T, Nakamura H. Detection of hepatocellular carcinoma: comparison of dynamic MR imaging with dynamic double arterial phase helical CT. AJR Am J Roentgenol 2003; 180:455-60. [PMID: 12540451 DOI: 10.2214/ajr.180.2.1800455] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Three-dimensional (3D) Fourier transformation-enhanced fast gradient-echo sequences with a special spectral inversion recovery pulse and fat suppression developed for abdominal imaging, including MR angiography, can show enhanced areas clearly. The purpose of this study was to evaluate the efficacy of dynamic MR imaging with the pulse sequences for the detection of hypervascular hepatocellular carcinoma by comparing it with that of dynamic helical CT with double arterial phase imaging. SUBJECTS AND METHODS Fifty-three patients with 103 hypervascular hepatocellular carcinoma nodules who underwent both dynamic MR imaging with 3D Fourier transformation-enhanced fast gradient-echo sequences with a special spectral inversion recovery pulse and dynamic helical CT with double arterial phase imaging were enrolled in the study. For dynamic MR imaging, unenhanced, arterial, portal venous, and equilibrium phase images were obtained before and approximately 19, 60, and 120 sec, respectively, after injection of gadopentetate dimeglumine. Three observers independently interpreted the images obtained with each technique in a blinded manner and in random order. RESULTS Mean sensitivity and positive predictive values of CT for hypervascular hepatocellular carcinoma (66% and 97%, respectively) were higher than those of MR imaging (63% and 96%, respectively), but there was no significant difference in detecting sensitivity among the observers (p < 0.05). CT and MR imaging were complementary, with some tumors undetected by CT but revealed on MR imaging. There was also no significant difference in A(z) values between CT (0.74) and MR imaging (0.71) (p < 0.05). CONCLUSION Dynamic MR imaging with 3D Fourier transformation-enhanced fast gradient-echo sequences with a special spectral inversion recovery pulse is recommended to improve the detection of hypervascular hepatocellular carcinoma nodules in addition to the use of dynamic helical CT with double arterial phase imaging.
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Affiliation(s)
- Yumi Noguchi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
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Laghi A, Iannaccone R, Rossi P, Carbone I, Ferrari R, Mangiapane F, Nofroni I, Passariello R. Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology 2003; 226:543-9. [PMID: 12563152 DOI: 10.1148/radiol.2262012043] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate whether the use of two arterial phase image acquisition series, when combined with portal venous phase imaging at multi-detector row helical computed tomography (CT), would be superior enough to use of a single arterial phase image acquisition series to warrant the increased radiation dose. MATERIALS AND METHODS Multi-detector row CT was performed in 77 patients with 140 foci of hepatocellular carcinoma (HCC). A triple-phase protocol that included an early arterial phase, a late arterial phase, and a portal venous phase was performed. Images were analyzed separately by three radiologists to document the presence and number of HCC nodules. Separate reading sessions were performed for images from the early arterial phase, images from the late arterial phase, images from both arterial phases combined, and images from all three phases. Sensitivity and positive predictive values were calculated for each reading session. RESULTS The average sensitivity and positive predictive values, respectively, for the detection of HCC were 48.5% and 96.4% for early arterial phase images, 87.1% and 94.0% for late arterial phase images, 87.1% and 94.0% for images from both arterial phases, and 88.5% and 93.4% for images from all three phases. Analysis of images from both arterial phases together yielded no improvement in either sensitivity or positive predictive value compared with analysis of late arterial phase images alone. Analysis of the combination of late arterial and portal venous phase images resulted in the highest sensitivity value. CONCLUSION The acquisition of images during two arterial contrast phases does not provide additional benefit over timed conventional biphasic CT technique.
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Affiliation(s)
- Andrea Laghi
- Department of Radiology II, University of Rome-La Sapienza, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy.
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Kanematsu M, Semelka RC, Matsuo M, Kondo H, Enya M, Goshima S, Moriyama N, Hoshi H. Gadolinium-enhanced MR imaging of the liver: optimizing imaging delay for hepatic arterial and portal venous phases--a prospective randomized study in patients with chronic liver damage. Radiology 2002; 225:407-15. [PMID: 12409573 DOI: 10.1148/radiol.2252010852] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the optimal imaging delays for hepatic arterial and portal venous phases of gadolinium-enhanced dynamic spoiled gradient-recalled-echo magnetic resonance (MR) imaging of the liver in patients with chronic liver damage. MATERIALS AND METHODS MR images were obtained after intravenous bolus injection of gadopentetate dimeglumine in 100 patients with chronic liver damage. Test bolus imaging was performed to determine the aortic transit time. A 26-second spoiled gradient-recalled-echo sequence was used. Patients were randomized into four groups so that the middle of k space was acquired at 5, 10, 15, and 20 seconds for the first phase and 45, 50, 55, and 60 seconds for the second phase, respectively, from the time of arrival of contrast material in the abdominal aorta. Mean signal intensities of the liver, spleen, and abdominal aorta were measured, and images were reviewed prospectively by three radiologists in consensus. Analysis of variance, the Scheffé criterion for continuous data, and the Kruskal-Wallis test for categorical data were used for statistical evaluation. RESULTS Intense splenic enhancement with the moiré pattern without intense hepatic enhancement occurred at 10-15 seconds. Aortic and splenic enhancement significantly decreased from 45 to 50 seconds (P <.05). Spleen-to-liver contrast-to-noise ratio began to decrease at 20 seconds and decreased constantly over time. Qualitative results correlated well with quantitative results. CONCLUSION Biphasic imaging with k space centered at 10-15 and 50 seconds or later after arrival of contrast material in the abdominal aorta may be the optimal technique to obtain ideal contrast enhancement. Empirically, delays of 28-34 and 68 seconds or later after initiating contrast material injection may be effective for biphasic imaging.
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Noguchi Y, Murakami T, Kim T, Hori M, Osuga K, Kawata S, Okada A, Sugiura T, Tomoda K, Narumi Y, Nakamura H. Detection of hypervascular hepatocellular carcinoma by dynamic magnetic resonance imaging with double-echo chemical shift in-phase and opposed-phase gradient echo technique: comparison with dynamic helical computed tomography imaging with double arterial phase. J Comput Assist Tomogr 2002; 26:981-7. [PMID: 12488747 DOI: 10.1097/00004728-200211000-00022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The technique of double-echo chemical shift gradient echo magnetic resonance imaging (MRI) with the fast low-angle shot (double-echo FLASH) sequence provides in-phase and opposed-phase images in a single breath hold. The purpose of this study was to evaluate the efficacy of dynamic MRI with double-echo FLASH imaging for the detection of hypervascular hepatocellular carcinoma by comparing it with dynamic helical computed tomography (CT) imaging with double arterial phase. MATERIALS AND METHODS Twenty-nine patients with 67 hypervascular hepatocellular carcinoma nodules who underwent both dynamic MRI with double-echo FLASH imaging (repetition time/echo time/flip angle: 160/3.6, 7.0/80 degrees ) and dynamic helical CT imaging with double arterial phase were enrolled in the study. For dynamic MRI, precontrast, arterial, portal venous, and equilibrium phase images were obtained before and approximately 19, 60, and 120 seconds, respectively, after intravenous injection of 0.1 mmol/kg of gadopentetate dimeglumine at a rate of 2 ml/s. For dynamic CT imaging, quadraphase images, including early arterial, late arterial, portal venous, and equilibrium phases, were obtained serially approximately 20, 30, 70, and 180 seconds, respectively, after intravenous administration of 2 ml/kg of 300 mgI/ml of nonionic contrast medium at a rate of 5 ml/s. Three masked observers independently interpreted images obtained with each technique in random order, separately and without patient identifiers. Sensitivity and positive predictive values as well as the area below the alternative-free response receiver operating characteristic curve (Az) for each imaging technique were calculated and compared statistically. RESULTS Mean sensitivity and positive predictive values of MRI for hypervascular hepatocellular carcinoma were 48% and 94%, respectively, and those of CT imaging were 47% and 91%, respectively. In 11 (38%) of the 29 patients, at least one observer judged dynamic MRI to be superior, whereas in 5 patients (17%), dynamic CT was judged to be superior. There was no significant difference in the sensitivity and positive predictive values between these techniques (p > 0.05). There was no significant difference either in mean Az values between CT (0.55) and MRI (0.57) (p = 0.61). CONCLUSION Dynamic MRI with double-echo FLASH imaging can detect hypervascular hepatocellular carcinoma as well as dynamic helical CT imaging with double arterial phase.
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Affiliation(s)
- Yumi Noguchi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Hori M, Murakami T, Kim T, Tsuda K, Takahashi S, Okada A, Takamura M, Nakamura H. Detection of hypervascular hepatocellular carcinoma: comparison of SPIO-enhanced MRI with dynamic helical CT. J Comput Assist Tomogr 2002; 26:701-10. [PMID: 12439302 DOI: 10.1097/00004728-200209000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to compare the diagnostic performance of superparamagnetic iron oxide (SPIO)-enhanced MRI for the detection of hypervascular hepatocellular carcinoma (HCC) with dynamic helical CT. METHODS SPIO-enhanced MR and dynamic helical CT images obtained from 41 patients with 52 hypervascular HCCs (5-130 mm; mean, 27 mm) were retrospectively analyzed. MRI were obtained with 1.5 T scanners using T2-weighted and proton density-weighted spin-echo (or fast spin-echo) sequences for all cases and a T2*-weighted gradient echo sequence for 36 cases. Four blinded observers reviewed images independently. Diagnostic accuracy was evaluated using alternative-free response receiver operating characteristic (AFROC) method. Sensitivities and positive predictive values (PPV) were also evaluated. RESULTS The areas under the AFROC curves for each observer were greater for MR than for CT (means, 0.81 and 0.76; p < 0.05). The mean sensitivities for MR and CT were 0.75 and 0.71, respectively (p = 0.13). The mean PPVs were 0.83 and 0.79 (p = 0.21). CONCLUSION SPIO-enhanced MRI showed slightly better diagnostic performance than dynamic helical CT for the detection of hypervascular HCCs.
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Affiliation(s)
- Masatoshi Hori
- Department of Radiology, Osaka University Graduate School of Medicine, D1, 2-2, Yamadaoka, Suita-city, Osaka 565-0871, Japan.
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Yoshioka H, Takahashi N, Yamaguchi M, Lou D, Saida Y, Itai Y. Double arterial phase dynamic MRI with sensitivity encoding (SENSE) for hypervascular hepatocellular carcinomas. J Magn Reson Imaging 2002; 16:259-66. [PMID: 12205581 DOI: 10.1002/jmri.10146] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the efficacy of SENSE MRI, including the double arterial phase dynamic study, to detect hypervascular hepatocellular carcinomas (HCCs). MATERIALS AND METHODS MRI of the liver was performed in 40 consecutive patients (20 by conventional MRI and 20 by SENSE MRI). The SENSE technique was used to obtain breath-hold T1-weighted FSE images (TR/TE = 556/12 msec), respiratory-triggered T2-weighted FSE images (TR/TE = 1800/90 msec) with and without fat suppression, and dynamic MR images (TR/TE/FA = 160-168/4.6 msec/70 degrees ). In each arterial dominant phase and portal dominant phase, two scans were consecutively performed with one breath-hold, leading to the double arterial phase and double portal phase images with SENSE. RESULTS The sensitivity of SENSE MRI for HCCs diagnosed from all MR images, including dynamic study, T1-weighted images, and T2-weighted images, was 91.7%, while that of conventional MRI was 76.3%. The positive predictive value of SENSE MRI for HCCs was 91.7%, while that of conventional MRI was 87.9%. In terms of HCCs < or = 10 mm, the sensitivity and positive predictive values of SENSE MRI were 78.6% and 78.6%, respectively, while those of conventional MRI were 27.3% and 60.0%, respectively. The number of detected HCCs < or = 10 mm was significantly larger in SENSE MRI than in conventional MRI (P < 0.05). The cause of false-positive lesions on SENSE MR images was an arterioportal shunt. CONCLUSION SENSE MRI with double arterial phase dynamic study showed higher sensitivity compared to the conventional technique. Therefore, SENSE MRI is a promising method for the detection of HCC.
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Affiliation(s)
- Hiroshi Yoshioka
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Kawata S, Murakami T, Kim T, Hori M, Federle MP, Kumano S, Sugihara E, Makino S, Nakamura H, Kudo M. Multidetector CT: diagnostic impact of slice thickness on detection of hypervascular hepatocellular carcinoma. AJR Am J Roentgenol 2002; 179:61-6. [PMID: 12076906 DOI: 10.2214/ajr.179.1.1790061] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the diagnostic impact of varying slice thickness on multidetector CT to optimize detection of hypervascular hepatocellular carcinoma. MATERIALS AND METHODS Forty-three patients with 87 hypervascular hepatocellular carcinomas (diameter: range, 3-80 mm; mean, 22 mm) and 19 patients with either chronic hepatitis or liver cirrhosis and without hepatocellular carcinoma who had undergone early arterial and late arterial phase imaging of the entire liver on multidetector CT were retrospectively enrolled in this study. The detector row configuration was 2.5 x 4 mm, the pitch was 6, and the scanning time was 10.5 sec for each phase. All patients received contrast medium (2 mL/kg of body weight) at a rate of 5 mL/sec; the mean scanning delay for the early arterial phase was 19.0 sec, and the mean delay for the late arterial phase was 34.5 sec. Eighty 2.5-mm-thick reconstruction images, forty 5-mm-thick reconstruction images, and twenty-six 7.5-mm-thick reconstruction images were obtained for each phase. Each image set was interpreted separately by three observers to detect hypervascular hepatocellular carcinoma by viewing images on a workstation monitor. Sensitivity, positive predictive value, and area under the receiver operating characteristic curve (A(z)) were calculated. We used retrospectively excellent follow-up and imaging or pathologic proof as the gold standard. RESULTS The mean sensitivity and positive predictive value for hypervascular hepatocellular carcinoma were 76% and 69% on 2.5-mm images, 73% and 69% on 5-mm images, and 67% and 76% on 7.5-mm images, respectively. No significant difference in sensitivity among the images was detected, except by one observer who reported a significant difference in the sensitivity between 2.5- and 7.5-mm images (p < 0.05) and between 5- and 7.5-mm images (p < 0.05). The mean A(z) values were 0.79, 0.80, and 0.78 for 2.5-, 5-, and 7.5-mm images, respectively. No significant difference in A(z) values among the images obtained with different slice thicknesses was detected. CONCLUSION For multidetector CT identification of hypervascular hepatocellular carcinoma, we found little or no advantage in reducing slice thickness to less than 5 mm.
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Affiliation(s)
- Shuji Kawata
- Department of Radiology, Osaka University Graduate School of Medicine D1, 2-2 Yamadaoka, Suita City, Osaka, 565-0871 Japan
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Abstract
Hepatic transplantation has become the treatment of choice for advanced irreversible liver disease. More than 4,000 hepatic transplantations were performed in the United States in 1997 and more than 11,000 are awaiting transplantation. Graft endurance and overall patient survival has been steadily improving, and between 1992 and 1994, 82% of the patients who received a liver transplant survived for at least a year. Today, liver transplant patients have a five-year survival rate of approximately 75%. The improvement in survival can be attributed to better patient selection and preparation, advances in organ preservation, improved immunosuppressive therapy agents and refinement of surgical techniques. In this article, we will address the hepatic parenchyma and vascular structures that should be evaluated prior to and following liver transplantation, the range of expected anomalies and abnormalities, and the utility of each of the three main imaging modalities, namely ultrasonography, computed tomography and magnetic resonance imaging in this assessment.
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Affiliation(s)
- Hero K Hussain
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Tomemori T, Yamakado K, Nakatsuka A, Sakuma H, Matsumura K, Takeda K. Fast 3D dynamic MR imaging of the liver with MR SmartPrep: comparison with helical CT in detecting hypervascular hepatocellular carcinoma. Clin Imaging 2001; 25:355-61. [PMID: 11682296 DOI: 10.1016/s0899-7071(01)00332-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dynamic magnetic resonance (MR) imaging with SmartPrep was compared with dynamic enhanced helical computed tomography (CT) for the detection of hepatocellular carcinoma (HCC). Thirty patients with 49 HCCs were studied. Arterial-phase MR images using with SmartPrep were significantly superior to arterial-phase CT in detecting small lesions (< or = 2 cm) (85.3% vs. 67.6%, P < .05). In addition, in six recurrent tumors after arterial chemoembolization, dynamic MR imaging with MR SmartPrep technique was superior to helical CT in detecting of recurrent tumors.
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Affiliation(s)
- T Tomemori
- Department of Radiology, Mie University School of Medicine, 2-174, Edobashi, Mie 514-8507, Tsu, Japan
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Murakami T, Kim T, Takamura M, Hori M, Takahashi S, Federle MP, Tsuda K, Osuga K, Kawata S, Nakamura H, Kudo M. Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT. Radiology 2001; 218:763-7. [PMID: 11230652 DOI: 10.1148/radiology.218.3.r01mr39763] [Citation(s) in RCA: 233] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess whether double arterial phase imaging with multi-detector row helical computed tomography improves detection of hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS Fifty-one patients with 96 hypervascular HCCs underwent double arterial phase imaging of the entire liver. At measured delay after intravenous administration of 2 mL/kg of contrast medium at a rate of 5 mL/sec, the early and late arterial phase images were obtained serially during a single breath hold with interscan delay of 5.0 seconds. Detector row configuration of 2.5 x 4 mm, pitch of 6, and scanning time of 10.5 seconds for each phase were used. Forty 5-mm-thick reconstruction images were obtained for each phase. Each image set was interpreted separately by three observers, who were unaware of tumor burden in the liver, to detect hypervascular HCC. Sensitivity, positive predictive value, and area below the receiver operating characteristic curve (A(z)) for early and late arterial phases separately and together were calculated. RESULTS Mean sensitivity and positive predictive value for hypervascular HCC were 54% and 85% for the early arterial phase, 78% and 83% for the late arterial phase, and 86% and 92% for the double arterial phase, respectively. Double arterial phase imaging showed significantly superior sensitivity compared with early or late arterial phase imaging alone for detecting HCC (P <.05). The mean A(z) value for double arterial phase was significantly higher than that for early or late arterial phase imaging alone (P <.05). Double arterial phase imaging showed the lowest number of false-positive lesions. CONCLUSION Double arterial phase imaging is recommended to improve detection of hypervascular HCCs and reduce false-positive lesions.
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Affiliation(s)
- T Murakami
- Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita-city, Osaka, 565-0871, Japan.
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40
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Abstract
With a recent advance of fast MR imaging techniques including fast gradient-echo (GRE), fast spin-echo (FSE), single shot FSE (SSFSE) and echo-planar imaging (EPI), and availability of a phased-array torso coil, there can be many possible pulse sequences for liver MR imaging. In clinical practice, optimization of pulse sequences is important for improving diagnostic performance of liver diseases. In this article, we review the current status of liver MR imaging, focusing on the description of standard pulse sequences, and the utility of fast scanning technique and contrast-enhancement studies.
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Affiliation(s)
- K Ito
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Hori M, Murakami T, Kim T, Takahashi S, Oi H, Tomoda K, Narumi Y, Nakamura H. Sensitivity of double-phase helical CT during arterial portography for detection of hypervascular hepatocellular carcinoma. J Comput Assist Tomogr 1998; 22:861-7. [PMID: 9843222 DOI: 10.1097/00004728-199811000-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of our work was to determine the usefulness of double-phase helical CT during arterial portography (CTAP) for the detection of hypervascular hepatocellular carcinoma (HCC). METHOD Eighty-four patients with 176 hypervascular HCC nodules underwent double-phase CTAP. Hypervascular HCCs were diagnosed by iodized oil CT after transcatheter arterial chemoembolization (TACE). The first-phase images were obtained 30 s after the initiation of injection of a nonionic iodinated contrast medium into the superior mesenteric artery or splenic artery, and the second-phase images were obtained after 70 s. These images were interpreted separately for detection of HCC. RESULTS The double-phase CTAP detected two nodules and six nodules that were missed by the first- and second-phase images, respectively. The sensitivity for hypervascular HCC nodules was 89% for the first phase, 91% for the second phase, and 93% for the first phase and second phase combined. The double-phase CTAP showed significantly superior sensitivity to the first-phase CTAP for detecting HCC nodules (p < 0.05). However, there was no statistically significant difference between the sensitivities of the double-phase CTAP and the second-phase CTAP. The positive predictive values of the double-phase images were inferior to those of either the first-phase or the second-phase images alone. CONCLUSION Double-phase helical CTAP was found to be no better than second-phase CTAP alone for the detection of hypervascular HCC nodules.
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Affiliation(s)
- M Hori
- Department of Radiology, Osaka University Medical School, Suita-city, Japan
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Ueda K, Matsui O, Kawamori Y, Kadoya M, Yoshikawa J, Gabata T, Nonomura A, Takashima T. Differentiation of hypervascular hepatic pseudolesions from hepatocellular carcinoma: value of single-level dynamic CT during hepatic arteriography. J Comput Assist Tomogr 1998; 22:703-8. [PMID: 9754101 DOI: 10.1097/00004728-199809000-00006] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of our study was to assess the efficacy of single-level dynamic CT during hepatic arteriography (D-CTA) in the differentiation between hypervascular hepatocellular carcinoma (HCC) and hypervascular pseudolesion. METHOD D-CTA was performed in nine cases with HCC and nine cases with pseudolesion. Findings on D-CTA were retrospectively analyzed. RESULTS The transition of the stain of pseudolesion on D-CTA was divided into three phases: (1) inflow of the contrast material into the portal vein within the lesion, (2) lesion staining, and (3) fading out of the stain; that of HCC was divided into four phases: (1) inflow of CM into tumor, (2) tumor staining, (3) inflow of CM into the adjacent liver, and (4) coronal stain of adjacent liver. The coronal stain was seen in all HCCs but not in any pseudolesions. CONCLUSION The present study suggest that D-CTA is a helpful option in the differentiation between HCC and pseudolesion.
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Affiliation(s)
- K Ueda
- Department of Radiology, Kanazawa University School of Medicine, Japan
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Kim T, Murakami T, Takahashi S, Tsuda K, Tomoda K, Narumi Y, Oi H, Nakamura H. Effects of injection rates of contrast material on arterial phase hepatic CT. AJR Am J Roentgenol 1998; 171:429-32. [PMID: 9694469 DOI: 10.2214/ajr.171.2.9694469] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Our goal was to assess the effects of the i.v. injection rate of contrast material on arterial phase hepatic CT. SUBJECTS AND METHODS One hundred patients were randomly divided into four groups of 25 with different injection rates of 90 ml of contrast material: 2, 3, 4, or 5 ml/sec. Single-level serial CT was performed at the level of the middle section of the main portal vein before injection and every 2 sec from 12 sec to 60 sec after injection of contrast material. The enhancement value was calculated as the difference in attenuation value between the unenhanced and contrast-enhanced images for the aorta and liver parenchyma. The duration of the arterial phase was defined as the interval beginning when the enhancement value for the aorta reached 100 H and ending when the value for the liver parenchyma reached 20 H. RESULTS Faster injection rates increased the maximum enhancement of the aorta. Although faster injection rates decreased the time from injection to the beginning and the end of the arterial phase, faster injection rates did not decrease the duration of the arterial phase itself. CONCLUSION A faster injection rate increases arterial enhancement of the liver, and the duration of the arterial phase remains the same as that occurring with a slower injection rate. We hypothesize that faster injection rates can provide better results using CT to reveal hypervascular liver tumors.
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Affiliation(s)
- T Kim
- Department of Radiology, Osaka University Medical School, Suita City, Japan
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Abstract
This article reviews the currently available MR imaging techniques that are useful for the detection and characterization of focal and diffuse liver pathology. The implementation and clinical utility of various T1-weighted, T2-weighted, T2*-weighted, and MR angiographic sequences are described.
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Affiliation(s)
- E S Siegelman
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, Philadelphia, USA
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45
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Abstract
Virus hepatitis and liver cirrhosis are found at high incidence in Asia, and they require not only biochemical examination of blood but also subsequent imaging, because they are often complicated by hepatocellular carcinoma (HCC). It is, therefore, very important to know the specific appearances of hepatitis, liver cirrhosis, and HCC when we diagnose these diffuse liver diseases. Liver necrosis due to severe hepatitis is seen as high intensity on T2-weighted spin echo images. Regeneration is seen as low intensity on T2-weighted images. Morphologic and pathologic changes of cirrhotic liver are well demonstrated by MR imaging techniques. Fibrotic septum with inflammatory cell infiltration or rich pseudo bile duct show high intensity on T2-weighted images, and regenerating nodules shows low intensity. Gradient echo images show regenerating nodules with iron deposition as low-intensity nodules due to susceptibility artifact. MRI also has the potential to evaluate function of diffuse liver disease, cirrhosis, and hepatitis. MRI can visualize and diagnose HCC objectively. Dynamic MRI is very useful for diagnosing HCC. It is also applied for evaluation of effect after transcatheter arterial chemoembolization, because it shows enhancement only in the viable region at an arterial phase. MRI is less invasive and is thus an extremely important form of liver imaging.
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Affiliation(s)
- T Murakami
- Department of Radiology, Toyonaka Municipal Hospital, Osaka, Japan
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46
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Abstract
MRI is a powerful tool in the detection and characterization of both focal and diffuse liver pathology. Because of superior soft tissue characterization, direct multi-planar capabilities and lack of ionizing radiation, current state of the art MRI is useful when contrast CT is relatively contraindicated or not definitive. This article reviews the MRI findings of the most common focal and diffuse liver diseases encountered in clinical practice. Reviews of current MR techniques and MR contrast agents used in liver imaging have been recently published. For this article, discussion of specific techniques and use of contrast is addressed for each pathological entity discussed.
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Affiliation(s)
- E S Siegelman
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA
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Semelka RC, Worawattanakul S, Kelekis NL, John G, Woosley JT, Graham M, Cance WG. Liver lesion detection, characterization, and effect on patient management: comparison of single-phase spiral CT and current MR techniques. J Magn Reson Imaging 1997; 7:1040-7. [PMID: 9400847 DOI: 10.1002/jmri.1880070616] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study compares liver lesion detection, characterization, and effect on patient management between single-phase spiral CT and MRI using spoiled gradient echo (SGE), T2-weighted fat-suppressed spin echo, and serial post gadolinium SGE. All patients with suspected liver lesions who underwent spiral CT and MRI within a 1-month period between January 1993 and September 1996 were included in the study. Spiral CT and MRI were interpreted prospectively in a blinded fashion by separate individual experienced investigators, and lesion detection and characterization were determined. Confirmation was obtained by surgery (6 patients), biopsy (18 patients), imaging follow-up (36 patients), or combined reading of all imaging studies and clinical follow-up (29 patients). Effect on patient management was determined by combined chart review and interview of the patients' physicians and by retrospective clinical assessment performed by a surgical oncologist and medical oncologist separately. Eighty-nine patients were included in the study. Regarding true positive lesion detection, 295 and 519 lesions were detected on spiral CT and MR images, respectively, which was significantly different on a patient-by-patient basis (P < .001). More lesions were detected on MR than on spiral CT in 44 of 89 patients (49.4%), and 11 of these 44 patients had lesions shown on MRI in whom no lesions were apparent on CT images. No patients had true positive lesions shown on spiral CT that were not shown on MRI. Regarding lesion characterization, 129 and 466 lesions were characterized on spiral CT and MRI images, respectively, which was significantly different on a patient-by-patient basis (P < .001). More lesions were characterized on MR than CT images in 67 patients (75.3%). Regarding effect on patient management, chart review with physician interview demonstrated that findings on MRI provided information that altered patient management as compared with findings on spiral CT in 57 patients. Retrospective clinical evaluation by the surgical and medical oncologist showed that MRI was considered to have a greater effect on patient management than spiral CT in 58 and 55 patients, respectively. Comparing current MRI technique to single-phase spiral CT, MRI detected more lesions in 49.4% and characterized more lesions in 75.3% of patients investigated for focal liver disease. MRI had a greater effect on patient management in each of the three methods than single-phase spiral CT in more than 61% of patients.
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Affiliation(s)
- R C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, USA
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Parker GJ, Suckling J, Tanner SF, Padhani AR, Revell PB, Husband JE, Leach MO. Probing tumor microvascularity by measurement, analysis and display of contrast agent uptake kinetics. J Magn Reson Imaging 1997; 7:564-74. [PMID: 9170043 DOI: 10.1002/jmri.1880070318] [Citation(s) in RCA: 160] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This paper describes a measurement protocol for acquiring quantitative dynamic MRI data and novel analysis and display software (Magnetic Resonance Imaging Workbench (MRIW)). Proton density-weighted and T1-weighted two-dimensional gradient echo images are used to quantify tissue contrast agent concentration. The dynamic studies last approximately 7 minutes, with 10-second temporal resolution. Analyses of signal and concentration changes with time are performed, allowing capillary permeability-surface area product, tissue leakage space, enhancement onset time, mean enhancement gradient and maximum enhancement level to be mapped as false-color parametric overlays registered with anatomic images. Quantification of permeability and leakage space provides a method for comparing physiology in patients between visits or for intersite comparisons.
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Affiliation(s)
- G J Parker
- Cancer Research Campaign Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, United Kingdom.
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