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Mohebbi A, Mohammadzadeh S, Mohebbi S, Mohammadi A, Tavangar SM. Diagnostic performance of ultrasound elastography in differentiating hepatocellular carcinoma and intrahepatic cholangiocarcinoma: a systematic review and meta-analysis. Abdom Radiol (NY) 2025; 50:633-645. [PMID: 39138663 DOI: 10.1007/s00261-024-04502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To evaluate the diagnostic value of ultrasound elastography (USE) for characterizing hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). METHODS The protocol was pre-registered a priori at ( https://osf.io/namvk/ ). Using PubMed, Web of Science, Embase, and Cochrane Library, we found studies up to April 20, 2024 by searching HCC, ICC, and USE as keywords. Parameters of USE were directly compared between HCC and ICC patients using random-effects bivariate model on STATA 17.0, MedCalc 20.0, and Psychometrica. Trim & fill method and sensitivity analysis were also performed. RESULTS Eighteen studies were included with 1057 patients, consisting of 863 HCC lesions, 188 ICC lesions, and 6 mixed lesions. The pooled Emean values of HCC and ICC were 28.3 (CI = 19.8 to 36.8) and 44.0 (CI = 20.9 to 67.2). HCC tumors were 34.3% softer than ICC while peritumoral tissue in HCC lesions was 75% stiffer than ICC lesions based on Emean. The strain value index (tumoral-to-peritumoral ratio) in HCC patients was 49.4% less than that of ICC patients. USE demonstrated a pool sensitivity of 87% (CI = 73-95%), specificity of 82% (CI = 65-92%), positive likelihood ratio of 4.8 (CI = 2.2 to 10.3), negative likelihood ratio of 0.16 (CI = 0.07 to 0.37), and diagnostic odds ratio of 31 (CI = 7 to 127) in differentiation of ICC from HCC. CONCLUSION By evaluating tumoral and pre-tumoral stiffness, along with strain value index, USE may provide a valuable quantitative diagnostic tool for accurately differentiating HCC and ICC.
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Affiliation(s)
- Alisa Mohebbi
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences., Tehran, Iran
| | - Saeed Mohammadzadeh
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences., Tehran, Iran
| | - Sadra Mohebbi
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences., Tehran, Iran
| | - Afshin Mohammadi
- Department of Radiology, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran
| | - Seyed Mohammad Tavangar
- Department of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Shen Q, Wu W, Wang R, Zhang J, Liu L. A non-invasive predictive model based on multimodality ultrasonography images to differentiate malignant from benign focal liver lesions. Sci Rep 2024; 14:23996. [PMID: 39402127 PMCID: PMC11473797 DOI: 10.1038/s41598-024-74740-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 09/30/2024] [Indexed: 10/17/2024] Open
Abstract
We have developed a non-invasive predictive nomogram model that combines image features from Sonazoid contrast-enhanced ultrasound (SCEUS) and Sound touch elastography (STE) with clinical features for accurate differentiation of malignant from benign focal liver lesions (FLLs). This study ultimately encompassed 262 patients with FLLs from the First Hospital of Shanxi Medical University, covering the period from March 2020 to April 2023, and divided them into training set (n = 183) and test set (n = 79). Logistic regression analysis was used to identify independent indicators and develop a predictive model based on image features from SCEUS, STE, and clinical features. The area under the receiver operating characteristic (AUC) curve was determined to estimate the diagnostic performance of the nomogram with CEUS LI-RADS, and STE values. The C-index, calibration curve, and decision curve analysis (DCA) were further used for validation. Multivariate and LASSO logistic regression analyses identified that age, ALT, arterial phase hyperenhancement (APHE), enhancement level in the Kupffer phase, and Emean by STE were valuable predictors to distinguish malignant from benign lesions. The nomogram achieved AUCs of 0.988 and 0.978 in the training and test sets, respectively, outperforming the CEUS LI-RADS (0.754 and 0.824) and STE (0.909 and 0.923) alone. The C-index and calibration curve demonstrated that the nomogram offers high diagnostic accuracy with predicted values consistent with actual values. DCA indicated that the nomogram could increase the net benefit for patients. The predictive nomogram innovatively combining SCEUS, STE, and clinical features can effectively improve the diagnostic performance for focal liver lesions, which may help with individualized diagnosis and treatment in clinical practice.
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Affiliation(s)
- Qianqian Shen
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Wei Wu
- Department of Anorectal Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, 030001, China
| | - Ruining Wang
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Jiaqi Zhang
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Liping Liu
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China.
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China.
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Sharafi SN, Moarefzadeh M, Moradi MT. The Horizon of Thyroid Imaging Reporting and Data System in the Diagnostic Performance of Thyroid Nodules: Clinical Application and Future Perspectives. TOUCHREVIEWS IN ENDOCRINOLOGY 2024; 20:81-90. [PMID: 39526062 PMCID: PMC11548367 DOI: 10.17925/ee.2024.20.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/20/2024] [Indexed: 11/16/2024]
Abstract
The widespread occurrence of thyroid nodules and the typically slow progression of thyroid cancer have led to the development of the thyroid imaging reporting and data system (TI-RADS). The primary objectives behind the development of TI-RADS were to minimize unnecessary biopsies of non-cancerous nodules, enhance the overall precision of diagnosis and establish a uniform risk-stratification framework based on the lexicon to notify healthcare professionals of nodules that require a biopsy. The identification and precise diagnosis of thyroid nodules have led to improved clinical practice examination reports within the general population. TI-RADS is a risk-stratification system related to thyroid lesions and based on ultrasound characteristics and is similar to the structure of the breast imaging reporting and data system. There are various versions of TI-RADS, with some being widely used and adequately validated, while others lacking thorough evaluation. TI-RADS uses a numerical scoring system for characteristics, and its categories are determined by the cumulative score of a thyroid nodule, indicating the likelihood of it being benign or malignant. In this article, the various TI-RADS systems were examined as a successful method for producing precise and comprehensive documentation, with a particular emphasis on their functionality, similarities, distinctions and potential future developments.
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Zhao M, Zhang B, Shi J, Tang X, Li H, Li S, Yang Y, Han Y, Wang R, Xun J, Zhang K, Wu X, Zhao J. HCC portal hypertension imaging score derived from CT predicts re-bleeding and mortality after acute variceal bleeding. Cancer Imaging 2024; 24:45. [PMID: 38549132 PMCID: PMC10976815 DOI: 10.1186/s40644-024-00689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND/PURPOSE Risk factors for re-bleeding and death after acute variceal bleeding (AVB) in cirrhotic HCC patients are not fully understood.We aimed to (1) explore how the combination of high-risk esophageal varices, HCC status, and portal vein tumor thrombus (i.e., HCC Portal Hypertension Imaging Score [HCCPHTIS]) helps predict increased risk of variceal re-bleeding and mortality; (2) assess predictability and reproducibility of the identified variceal re-bleeding rules. METHODS This prospective study included 195 HCC patients with first-time AVB and liver cirrhosis, and conducted multivariable Cox regression analysis and Kaplan-Meier analysis. Receiver operating characteristic curve analysis was calculated to find the optimal sensitivity, specificity, and cutoff values of the variables. The reproducibility of the results obtained was verified in a different but related group of patients. RESULTS 56 patients (28.7%) had re-bleeding within 6 weeks; HCCPHTIS was an independent risk factor for variceal re-bleeding after AVB (Odd ratio, 2.330; 95% confidence interval: 1.728-3.142, p < 0.001). The positive predictive value of HCCPHTIS cut off value > 3 was 66.2%, sensitivity 83.9%, and specificity 82.3%. HCCPHTIS area under the curve was higher than Child-Pugh score (89% vs. 75%, p < 0.001). 74(37.9%) death occurred within 6 weeks; HCCPHTIS > 4 was associated with increased risk of death within 6 weeks after AVB (p < 0.001). CONCLUSION HCCPHTIS > 3 is a strong predictor of variceal re-bleeding within the first 6 weeks. However, patients with HCCPHTIS > 4 were at increased risk of death within 6 weeks.
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Affiliation(s)
- Mingyuan Zhao
- Department of Oncology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, Taiyuan, 030012, China
| | - Binyue Zhang
- Department of surgery, Shanxi Medical University, Taiyuan, 030001, China
| | - Jianqiang Shi
- Department of Radiology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, Taiyuan, 030012, China
| | - Xiaoxian Tang
- Department of Radiology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, Taiyuan, 030012, China
| | - Hongxia Li
- Department of Oncology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, Taiyuan, 030012, China
| | - Shengwen Li
- Department of Oncology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, Taiyuan, 030012, China
| | - Yunfeng Yang
- Department of Hepatology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, 99 Shuang Ta street, Taiyuan, 030012, China
| | - Yi Han
- Department of Hepatology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, 99 Shuang Ta street, Taiyuan, 030012, China
| | - Rong Wang
- Department of Hepatology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, 99 Shuang Ta street, Taiyuan, 030012, China
| | - Jian Xun
- Department of Hepatology, Taiyuan No.3 Hospital Affiliated to Shanxi Medical University, Taiyuan, 030012, China
| | - Kai Zhang
- Department of Radiology, Taiyuan No.3 Hospital Affiliated to Shanxi Medical University, Taiyuan, 030012, China
| | - Xirun Wu
- Department of Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Jiang Zhao
- Department of Hepatology, Shanxi Provincial People's Hospital, Affiliated to Shanxi Medical University, 99 Shuang Ta street, Taiyuan, 030012, China.
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Cheng X, Tang Y, He Q, Song J, Wang K, Li H, Huang J, Wang W, Li J, Wang H, Tu M, Chen J, Yuan G, Kang S, Liu H, Zhang X, Luo W, Ji Y, Lan X, Zhou L, Lai Q, Luo X, Wu Q, Zhou D, Tan Y, Chen J, Zhang X. Spleen-dedicated stiffness measurement performed well to rule out high-risk varices in HBV-related hepatocellular carcinoma: Screening for high-risk varices in HCC. Aliment Pharmacol Ther 2024; 59:680-691. [PMID: 38155565 DOI: 10.1111/apt.17850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/06/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Esophagogastroduodenoscopy (EGD) is required to screen for high-risk varices (HRV) in patients with hepatocellular carcinoma (HCC), especially since overall survival rates have dramatically improved with new systemic therapies. AIM To assess the Baveno VI and Baveno VII algorithms' ability to rule out HRV in hepatitis B virus (HBV)-related HCC METHODS: We prospectively enrolled consecutive patients with HBV related, compensated cirrhosis and newly diagnosed HCC who underwent liver stiffness measurement, spleen stiffness measurement (SSM) using a 100-Hz shear wave frequency, and EGD. RESULTS From September 2021 to August 2023, we enrolled 219 patients with HCC, with 107 (48.9%) Barcelona Clinic Liver Cancer (BCLC) A, 28 (12.8%) BCLC B and 84 (38.3%) BCLC C, respectively. HRV prevalence was 28.8% (63/219). Baveno VI criteria safely (HRV missing rate, 3.2%) avoided 27.4% unnecessary EGDs, while the Baveno VII algorithm avoided 49.3% with HRV missing rate at 7.9% (5/63). The SSM ≤40 kPa avoided 47.5% of EGDs safely (HRV missing rate, 4.8%), significantly better than the Baveno VI criteria (p < 0.001) and comparable to the Baveno VII algorithm (p = 0.390). The SSM ≤40 kPa safely avoided EGDs in patient subgroups within Milan criteria, with portal vein tumour thrombosis or BCLC B/C or candidates for systemic therapy. CONCLUSIONS We validated that the SSM ≤40 kPa using a 100-Hz probe could safely eliminate more unnecessary EGDs than the Baveno VI criteria in patients with HBV-related HCC. However, the efficacy of the Baveno VII algorithm in patients with HCC requires further investigation.
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Affiliation(s)
- Xiao Cheng
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yujun Tang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qinjun He
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiankang Song
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kunyuan Wang
- Liver Tumor Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Li
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Huang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weibin Wang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junying Li
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haiyu Wang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Minghan Tu
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinzhang Chen
- Liver Tumor Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guosheng Yuan
- Liver Tumor Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Kang
- Liver Tumor Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongyan Liu
- Liver Tumor Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyong Zhang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenfan Luo
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yali Ji
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoqin Lan
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Zhou
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qintao Lai
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoqin Luo
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiaoping Wu
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Damei Zhou
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yingqi Tan
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinjun Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Hepatology Unit, Department of Infectious Diseases, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaofeng Zhang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Zhong X, Long H, Chen L, Xie Y, Shi Y, Peng J, Zheng R, Su L, Duan Y, Xie X, Lin M. Stiffness on shear wave elastography as a potential microenvironment biomarker for predicting tumor recurrence in HBV-related hepatocellular carcinoma. Insights Imaging 2023; 14:147. [PMID: 37697029 PMCID: PMC10495298 DOI: 10.1186/s13244-023-01505-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND To explore the pathologic basis and prognostic value of tumor and liver stiffness measured pre-operatively by two-dimensional shear wave elastography (2D-SWE) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients who undergo hepatic resection. METHODS A total of 191 HBV-infected patients with solitary resectable HCC were prospectively enrolled. The stiffness of intratumoral tissue, peritumoral tissue, adjacent liver tissue, and distant liver tissue was evaluated by 2D-SWE. The correlations between stiffness and pathological characteristics were analyzed in 114 patients. The predictive value of stiffness for recurrence-free survival (RFS) was evaluated, and Cutoff Finder was used for determining optimal cut-off stiffness values. Cox proportional hazards analysis was used to identify independent predictors of RFS. RESULTS Pathologically, intratumoral stiffness was associated with stroma proportion and microvascular invasion (MVI) while peritumoral stiffness was associated with tumor size, capsule, and MVI. Adjacent liver stiffness was correlated with capsule and liver fibrosis stage while distant liver stiffness was correlated with liver fibrosis stage. Peritumoral stiffness, adjacent liver stiffness, and distant liver stiffness were all correlated to RFS (all p < 0.05). Higher peritumoral stiffness (> 49.4 kPa) (HR = 1.822, p = 0.023) and higher adjacent liver stiffness (> 24.1 kPa) (HR = 1.792, p = 0.048) were significant independent predictors of worse RFS, along with tumor size and MVI. The nomogram based on these variables showed a C-index of 0.77 for RFS prediction. CONCLUSIONS Stiffness measured by 2D-SWE could be a tumor microenvironment and tumor invasiveness biomarker. Peritumoral stiffness and adjacent liver stiffness showed important values in predicting tumor recurrence after curative resection in HBV-related HCC. CLINICAL RELEVANCE STATEMENT Tumor and liver stiffness measured by two-dimensional shear wave elastography serve as imaging biomarkers for predicting hepatocellular carcinoma recurrence, reflecting biological behavior and tumor microenvironment. KEY POINTS • Stiffness measured by two-dimensional shear wave elastography is a useful biomarker of tumor microenvironment and invasiveness. • Higher stiffness indicated more aggressive behavior of hepatocellular carcinoma. • The study showed the prognostic value of peritumoral stiffness and adjacent liver stiffness for recurrence-free survival. • The nomogram integrating peritumoral stiffness, adjacent liver stiffness, tumor size, and microvascular invasion showed a C-index of 0.77.
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Affiliation(s)
- Xian Zhong
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Haiyi Long
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yuhua Xie
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yifan Shi
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Jianyun Peng
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Ruiying Zheng
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Liya Su
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yu Duan
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Xiaoyan Xie
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Manxia Lin
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China.
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Thabut D, Kudo M. Treatment of portal hypertension in patients with HCC in the era of Baveno VII. J Hepatol 2023; 78:658-662. [PMID: 36460163 DOI: 10.1016/j.jhep.2022.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
Portal hypertension (PHT) and hepatocellular carcinoma (HCC) often coexist, and their association impairs the prognosis of patients with cirrhosis. The interplay between these two conditions is of major therapeutic significance, both from the perspective of offering adequate treatment for HCC and for preventing or managing the complications of PHT. Recommendations on the management of PHT were heavily revised at the last Baveno VII conference, redefining screening and extending the indications for prophylaxis. PHT can preclude locoregional therapies, and TIPS placement can be discussed in patients with HCC. New systemic therapies for HCC can influence the level of PHT and favour bleeding. Complications of PHT should be prevented and treated adequately in all patients, especially those presenting with advanced HCC. Specific aspects of the management of both conditions will be discussed in the present expert opinion, which considers very recent data in the HCC field.
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Affiliation(s)
- Dominique Thabut
- Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Service d'hépato-gastroentérologie, Unité de Soins Intensifs d'hépatologie, Paris, France; Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de Recherche Saint-Antoine, Maladies Métaboliques, Biliaires et Fibro-inflammatoire du Foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama Osaka, Japan
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Dong Y, Koch J, Alhyari A, Safai Zadeh E, Görg C, Wang WP, Berzigotti A, Dietrich CF. Ultrasound Elastography for Characterization of Focal Liver Lesions. ZEITSCHRIFT FÜR GASTROENTEROLOGIE 2022; 61:399-410. [PMID: 36516951 DOI: 10.1055/a-1957-7370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractFocal liver lesions (FLL) are typically detected by conventional ultrasound or other
imaging modalities. After the detection of FLL, further characterization is essential, and
this can be done by contrast-enhanced imaging techniques, e.g., contrast-enhanced ultrasound
(CEUS) and magnetic resonance imaging (MRI) or by means of biopsy with histological
evaluation. Elastographic techniques are nowadays integrated into high-end ultrasound systems
and their value for the detection of severe liver fibrosis and cirrhosis has been shown in
studies and meta-analyses. The use of an ultrasound elastographic technique for the
differentiation of malignant and benign liver tumors is less well-established. This review
summarizes the current data on utility and performance of ultrasound elastography for the
characterization of FLL.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jonas Koch
- Department Allgemeine Innere Medizin, Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai, China
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Berne, Switzerland
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Gu JH, Zhu L, Jiang TA. Quantitative Ultrasound Elastography Methods in Focal Liver Lesions Including Hepatocellular Carcinoma: From Diagnosis to Prognosis. Ultrasound Q 2021; 37:90-96. [PMID: 34057911 DOI: 10.1097/ruq.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT The ability of ultrasound elastography to diagnose focal liver lesions and determine their prognoses including hepatocellular carcinoma (HCC) is unclear. At present, radiofrequency ablation and liver resection are the most common treatments for HCC. However, the survival rate remains disappointing because of recurrences and postoperative liver failure, necessitating the development of noninvasive approaches. There is currently no systematic definition of an elastic technique for measuring liver stiffness to predict the recurrence of HCC after radiofrequency ablation and postoperative liver failure. In this review, recent advances in ultrasound elastography for the diagnosis and prognosis of focal liver lesions are discussed including HCC.
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Affiliation(s)
- Jiong-Hui Gu
- Department of Ultrasonography, First Affiliated Hospital of Zhejiang University, Hangzhou, China
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Is There a Place for Elastography in the Diagnosis of Hepatocellular Carcinoma? J Clin Med 2021; 10:jcm10081710. [PMID: 33921086 PMCID: PMC8071375 DOI: 10.3390/jcm10081710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background and Aims: Elastography can provide information regarding tissue stiffness (TS). This study aimed to analyze the elastographic features of hepatocellular carcinoma (HCC) and the factors that influence intratumoral elastographic variability in patients with liver cirrhosis. Methods: This prospective study included 115 patients with liver cirrhosis and hepatocellular carcinoma evaluated between June 2016–November 2019. A total of 88 HCC nodules visualized in conventional abdominal ultrasound (US) met the inclusion criteria and underwent elastographic evaluation. Elastographic measurements (EM) were performed in HCC and liver parenchyma using VTQ (Virtual Touch Quantification), a point shear wave elastography (pSWE) technique. In all patients, we performed contrast-enhanced ultrasound (CEUS), and the final diagnosis of HCC was established by contrast-enhanced-CT or contrast-enhanced-MRI. Results: The mean VTQ values in HCCs were 2.16 ± 0.75 m/s. TS was significantly lower in HCCs than in the surrounding liver parenchyma 2.16 ± 0.75 m/s vs. 2.78 ± 0.92 (p < 0.001). We did not find significant differences between the first five and the last five EM, and the intra-observer reproducibility was excellent ICC: 0.902 (95% CI: 0.87–0.950). However, the tumor size, heterogeneity, and depth correlated with higher intralesional stiffness variability (p < 0.001). Conclusions: VTQ brings additional information for HCC characterization. Intra-observer reproducibility for both HCC and liver parenchyma was excellent. Knowing the stiffness of HCC’s might endorse an algorithm-based approach towards focal liver lesions (FLLs) in liver cirrhosis.
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11
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Update on ACR TI-RADS: Successes, Challenges, and Future Directions, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2021; 216:570-578. [PMID: 33112199 DOI: 10.2214/ajr.20.24608] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is an ultrasound-based risk stratification system (RSS) for thyroid nodules that was released in 2017. Since publication, research has shown that ACR TI-RADS has a higher specificity than other RSSs and reduces the number of unnecessary biopsies of benign nodules compared with other systems by 19.9-46.5%. The risk of missing significant cancers using ACR TI-RADS is mitigated by the follow-up recommendations for nodules that do not meet criteria for biopsy. In practice, after a nodule's ultrasound features have been enumerated, the ACR TI-RADS points-based approach leads to clear management recommendations. Practices seeking to implement ACR TI-RADS must engage their radiologists in understanding how the system addresses the problems of thyroid cancer overdiagnosis and unnecessary surgeries by reducing unnecessary biopsies. This review compares ACR TI-RADS to other RSSs and explores key clinical questions faced by practices considering its implementation. We also address the challenge of reducing interobserver variability in assigning ultrasound features. Finally, we highlight emerging imaging techniques and recognize the ongoing international effort to develop a system that harmonizes multiple RSSs, including ACR TI-RADS.
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12
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Zhou J, Sun H, Wang Z, Cong W, Wang J, Zeng M, Zhou W, Bie P, Liu L, Wen T, Han G, Wang M, Liu R, Lu L, Ren Z, Chen M, Zeng Z, Liang P, Liang C, Chen M, Yan F, Wang W, Ji Y, Yun J, Cai D, Chen Y, Cheng W, Cheng S, Dai C, Guo W, Hua B, Huang X, Jia W, Li Y, Li Y, Liang J, Liu T, Lv G, Mao Y, Peng T, Ren W, Shi H, Shi G, Tao K, Wang W, Wang X, Wang Z, Xiang B, Xing B, Xu J, Yang J, Yang J, Yang Y, Yang Y, Ye S, Yin Z, Zhang B, Zhang B, Zhang L, Zhang S, Zhang T, Zhao Y, Zheng H, Zhu J, Zhu K, Liu R, Shi Y, Xiao Y, Dai Z, Teng G, Cai J, Wang W, Cai X, Li Q, Shen F, Qin S, Dong J, Fan J. Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition). Liver Cancer 2020; 9:682-720. [PMID: 33442540 PMCID: PMC7768108 DOI: 10.1159/000509424] [Citation(s) in RCA: 527] [Impact Index Per Article: 105.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary liver cancer, around 90% are hepatocellular carcinoma in China, is the fourth most common malignancy and the second leading cause of tumor-related death, thereby posing a significant threat to the life and health of the Chinese people. SUMMARY Since the publication of Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) in 2018, additional high-quality evidence has emerged with relevance to the diagnosis, staging, and treatment of liver cancer in and outside China that requires the guidelines to be updated. The new edition (2019 Edition) was written by more than 70 experts in the field of liver cancer in China. They reflect the real-world situation in China regarding diagnosing and treating liver cancer in recent years. KEY MESSAGES Most importantly, the new guidelines were endorsed and promulgated by the Bureau of Medical Administration of the National Health Commission of the People's Republic of China in December 2019.
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Affiliation(s)
- Jian Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huichuan Sun
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zheng Wang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenming Cong
- Department of Pathology, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jianhua Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiping Zhou
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Ping Bie
- Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Lianxin Liu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianfu Wen
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Maoqiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China
| | - Ruibao Liu
- Department of Interventional Radiology, The Tumor Hospital of Harbin Medical University, Harbin, China
| | - Ligong Lu
- Department of Interventional Oncology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhengang Ren
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minshan Chen
- Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhaochong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Changhong Liang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Min Chen
- Editorial Department of Chinese Journal of Digestive Surgery, Chongqing, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingping Yun
- Department of Pathology, Tumor Prevention and Treatment Center, Sun Yat-sen University, Guangzhou, China
| | - Dingfang Cai
- Department of Integrative Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongjun Chen
- Department of Hematology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwu Cheng
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuqun Cheng
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Chaoliu Dai
- Department of Hepatobiliary and Spleenary Surgery, The Affiliated Shengjing Hospital, China Medical University, Shenyang, China
| | - Wenzhi Guo
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baojin Hua
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowu Huang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weidong Jia
- Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei, China
| | - Yaming Li
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Tianshu Liu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoyue Lv
- Department of General Surgery, The First Hospital of Jilin University, Jilin, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Peng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weixin Ren
- Department of Interventional Radiology The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoming Shi
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kaishan Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wentao Wang
- Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoying Wang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiming Wang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Bangde Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Baocai Xing
- Department of Hepato-Pancreato-Biliary Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianming Xu
- Department of Gastrointestinal Oncology, Affiliated Hospital Cancer Center, Academy of Military Medical Sciences, Beijing, China
| | - Jiamei Yang
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jianyong Yang
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yefa Yang
- Department of Hepatic Surgery & Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yunke Yang
- Department of Integrative Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shenglong Ye
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhengyu Yin
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, China
| | - Bixiang Zhang
- Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Boheng Zhang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Leida Zhang
- Department of Hepatobiliary Surgery Institute, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Shuijun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, ZhengZhou, China
| | - Ti Zhang
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yongfu Zhao
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, ZhengZhou, China
| | - Honggang Zheng
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiye Zhu
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
| | - Kangshun Zhu
- Department of Minimally Invasive Interventional Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yinghong Shi
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongsheng Xiao
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi Dai
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gaojun Teng
- Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jianqiang Cai
- Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weilin Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Qiang Li
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Feng Shen
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Shukui Qin
- Department of Medical Oncology, PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China
| | - Jiahong Dong
- Department of Hepatobiliary and Pancreas Surgery, Beijing Tsinghua Changgung Hospital (BTCH), School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jia Fan
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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Lupsor-Platon M, Serban T, Silion AI, Tirpe A, Florea M. Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease: A Step Forward for Better Evaluation Using Ultrasound Elastography. Cancers (Basel) 2020; 12:cancers12102778. [PMID: 32998257 PMCID: PMC7601664 DOI: 10.3390/cancers12102778] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Non-alcoholic fatty liver disease (NAFLD) attracts a lot of attention, due to the increasing prevalence and progression to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Consequently, new non-invasive, cost-effective diagnostic methods are needed. This review aims to explore the diagnostic performance of ultrasound (US) elastography in NAFLD and NAFLD-related HCC, adding a new dimension to the conventional US examination—the liver stiffness quantification. The vibration controlled transient elastography (VCTE), and 2D-Shear wave elastography (2D-SWE) are effective in staging liver fibrosis in NAFLD. VCTE presents the upside of assessing steatosis through the controlled attenuation parameter. Hereby, we critically reviewed the elastography techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography and 2D-SWE. 2D-SWE presents a great potential to differentiate malignant from benign FLLs, guiding the clinician towards the next diagnostic steps. As a disease-specific surveillance tool, US elastography presents prognostic capability, improving the NAFLD-related HCC monitoring. Abstract The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population prompts for a quick response from physicians. As NAFLD can progress to liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), new non-invasive, rapid, cost-effective diagnostic methods are needed. In this review, we explore the diagnostic performance of ultrasound elastography for non-invasive assessment of NAFLD and NAFLD-related HCC. Elastography provides a new dimension to the conventional ultrasound examination, by adding the liver stiffness quantification in the diagnostic algorithm. Whilst the most efficient elastographic techniques in staging liver fibrosis in NAFLD are vibration controlled transient elastography (VCTE) and 2D-Shear wave elastography (2D-SWE), VCTE presents the upside of assessing steatosis through the controlled attenuation parameter (CAP). Hereby, we have also critically reviewed the most important elastographic techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography (pSWE) and 2D-SWE. As our paper shows, elastography should not be considered as a substitute for FLL biopsy because of the stiffness values overlap. Furthermore, by using non-invasive, disease-specific surveillance tools, such as US elastography, a subset of the non-cirrhotic NAFLD patients at risk for developing HCC can be detected early, leading to a better outcome. A recent ultrasomics study exemplified the wide potential of 2D-SWE to differentiate benign FLLs from malignant ones, guiding the clinician towards the next steps of diagnosis and contributing to better long-term disease surveillance.
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Affiliation(s)
- Monica Lupsor-Platon
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
- Correspondence:
| | - Teodora Serban
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (T.S.); (A.-I.S.); (A.T.)
| | - Alexandra-Iulia Silion
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (T.S.); (A.-I.S.); (A.T.)
| | - Alexandru Tirpe
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (T.S.); (A.-I.S.); (A.T.)
| | - Mira Florea
- Community Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania;
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14
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Dong Y, Qiu Y, Zhang Q, Yang D, Yu L, Wang WP, Dietrich CF. Preliminary Clinical Experience with Shear Wave Dispersion Imaging for Liver Viscosity in Preoperative Diagnosis of Focal Liver Lesions. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:847-854. [PMID: 32947630 DOI: 10.1055/a-1217-7465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs. METHODS Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21-74 years, 37 males) with 58 FLLs located on the right lobe of liver were prospectively studied. The Aplio i900 series diagnostic ultrasound system (Canon Medical systems) equipped with a curvilinear PV1-475BX transducer (1-8 MHz) was used. SWD slope and viscosity measurements were expressed as mean ± standard deviation for both liver tumors and background liver parenchyma. Histopathological results after surgery were regarded as the gold standard for diagnosis. RESULTS Final diagnosis included 40 cases of malignant and 18 cases of benign FLLs. The mean viscosity value were 14.78 ± 1.86 m/s/kHz for hepatocellular carcinoma (n = 30), 14.81 ± 2.35 m/s/kHz for liver metastasis lesions (n = 10), 13.23 ± 1.31 m/s/kHz for hemangioma (n = 13), and 13.67 ± 2.72 m/s/kHz for focal nodular hyperplasia (n = 5). Malignant FLLs showed higher mean viscosity values (14.79 ± 3.15 m/s/KHz) than benign FLLs (13.36 ± 2.76 m/s/KHz) (p < 0.05). The best performing cut-off value of lesion viscosity was 13.15 m/s/kHz (sensitivity 83.3 %; specificity 56.5 %; area under the curve (AUC) 0.71) for malignancy) (p < 0.05). CONCLUSIONS The analysis of SWD slope and liver viscosity parameters provide additional viscoelastic information about FLLs before operation.
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Affiliation(s)
- Yi Dong
- Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yijie Qiu
- Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qi Zhang
- Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Daohui Yang
- Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Lingyun Yu
- Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Ultrasound Department, Zhongshan Hospital Fudan University, Shanghai, China
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15
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Xie DY, Ren ZG, Zhou J, Fan J, Gao Q. 2019 Chinese clinical guidelines for the management of hepatocellular carcinoma: updates and insights. Hepatobiliary Surg Nutr 2020; 9:452-463. [PMID: 32832496 DOI: 10.21037/hbsn-20-480] [Citation(s) in RCA: 311] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Approximately half of newly-diagnosed hepatocellular carcinoma (HCC) cases in the world occur in China, with hepatitis B virus (HBV) infection being the predominant risk factor. Recently, the guidelines for the management of Chinese HCC patients were updated. Objective The past decade has witnessed a great improvement in the management of hepatocellular carcinoma (HCC). This study reviews the recommendations in the 2019 Chinese guidelines and makes comparison with the practices from the Western world. Evidence Review The updated recommendations on the surveillance, diagnosis, and treatment algorithm of HCC in the 2019 Chinese guidelines were summarized, and comparisons among the updated Chinese guidelines, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) guidelines were made. Findings Besides imaging and pathological diagnoses, novel biomarkers like the seven-micro-RNA panel are advocated for early diagnoses and therapeutic efficacy evaluation in the updated Chinese guidelines. The China liver cancer (CNLC) staging system, proposed in the 2017 guidelines, continues to be the standard model for patient classification, with subsequent modifications and updates being made in treatment allocations. Compared to the Barcelona Clinic Liver Cancer (BCLC) system, the CNLC staging system employs resection, transplantation, and transarterial chemoembolization (TACE) for more progressed HCC. TACE in combination with other regional therapies like ablation or with systemic therapies like sorafenib are also encouraged in select patients in China. The systemic treatments for HCC have evolved considerably since lenvatinib, regorafenib, carbozantinib, ramucirumab and immune checkpoint inhibitors (ICIs)were first prescribed as first-line or second-line agents. Conclusions and Relevances Novel biomarkers, imaging and operative techniques are recommended in the updated Chinese guideline. More aggressive treatment modalities are suggested for more progressed HBV-related HCC in China.
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Affiliation(s)
- Di-Yang Xie
- Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China
| | - Zheng-Gang Ren
- Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China
| | - Jian Zhou
- Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China.,Institute of Biomedical Sciences, Fudan University, Shanghai, China
| | - Jia Fan
- Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China.,Institute of Biomedical Sciences, Fudan University, Shanghai, China
| | - Qiang Gao
- Liver Cancer Institute, Zhongshan Hospital, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China
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16
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Martelletti C, Armandi A, Caviglia GP, Saracco GM, Pellicano R. Elastography for characterization of focal liver lesions: current evidence and future perspectives. Minerva Gastroenterol (Torino) 2020; 67:196-208. [PMID: 32677420 DOI: 10.23736/s2724-5985.20.02747-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Focal liver lesions (FLLs) are a common finding during routine abdominal ultrasound (US). The differential diagnosis between diverse types of FLLs, especially between benign and malignant ones, is extremely important and can often be particularly challenging. Radiological techniques with contrast administration and/or liver biopsy are mostly necessary for establishing diagnosis, but they have several contraindications or complications. Due to limitations of these tools, there is urgent and still unmet need to develop a first line, non-invasive and simple method to diagnose FLLs. Elastography is an US-based imaging modality that provides information about the physical parameter corresponding to the tissue stiffness and can be considered a virtual biopsy. Several elastographic approaches have been developed, such as transient elastography, strain imaging and share wave imaging, which include point shear wave elastography and 2D shear wave elastography. These tools are already in use for evaluating liver fibrosis and in the assessment of focal lesions in other organs, like breast and thyroid gland. This review aims to assess the current evidence of different techniques based on elastography in the setting of FLLs, in order to evaluate accuracy, limitations and future perspectives. In particular, we focused on two contexts: the ability of discriminating between benign and malignant lesions, especially hepatocellular carcinoma and liver metastasis, and the surveillance after percutaneous therapy. This could have a high clinical impact making elastography crucial to identify the appropriate management of FLLs.
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Affiliation(s)
- Carolina Martelletti
- School of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Angelo Armandi
- School of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Giorgio M Saracco
- School of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Gastroenterology, Molinette-SGAS Hospital, Turin, Italy
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17
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Wu M, Zhou RH, Xu F, Li XP, Zhao P, Yuan R, Lan YP, Zhou WX. Multi-parameter ultrasound based on the logistic regression model in the differential diagnosis of hepatocellular adenoma and focal nodular hyperplasia. World J Gastrointest Oncol 2019; 11:1193-1205. [PMID: 31908724 PMCID: PMC6937441 DOI: 10.4251/wjgo.v11.i12.1193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/13/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) has very low potential risk, and a tendency to spontaneously resolve. Hepatocellular adenoma (HCA) has a certain malignant tendency, and its prognosis is significantly different from FNH. Accurate identification of HCA and FNH is critical for clinical treatment.
AIM To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.
METHODS Thirty-one patients with HCA were included in the HCA group. Fifty patients with FNH were included in the FNH group. The clinical data were collected and recorded in the two groups. Conventional ultrasound, shear wave elastography, and contrast-enhanced ultrasound were performed, and the lesion location, lesion echo, Young’s modulus (YM) value, YM ratio, and changes of time intense curve (TIC) were recorded. Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH. A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH. The value of the combined indicators for distinguishing HCA and FNH were explored.
RESULTS Multivariate logistic regression analysis showed that lesion echo (P = 0.000), YM value (P = 0.000) and TIC decreasing slope (P = 0.000) were the potential indicators identifying HCA and FNH. In the ROC curve analysis, the accuracy of the YM value distinguishing HCA and FNH was the highest (AUC = 0.891), which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope (P < 0.05). The accuracy of the combined diagnosis was the highest (AUC = 0.938), which was significantly higher than the AUC of the indicators diagnosing HCA individually (P < 0.05). This sensitivity was 91.23%, and the specificity was 83.33%.
CONCLUSION The combination of lesion echo, YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.
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Affiliation(s)
- Meng Wu
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Ru-Hai Zhou
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Feng Xu
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
- Department of Gastroenterology, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Xian-Peng Li
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
- Department of Gastroenterology, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Ping Zhao
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Rui Yuan
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Yu-Peng Lan
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
| | - Wei-Xia Zhou
- Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
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18
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Hwang JA, Jeong WK, Song KD, Kang KA, Lim HK. 2-D Shear Wave Elastography for Focal Lesions in Liver Phantoms: Effects of Background Stiffness, Depth and Size of Focal Lesions on Stiffness Measurement. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3261-3268. [PMID: 31493955 DOI: 10.1016/j.ultrasmedbio.2019.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to determine the factors influencing stiffness and conspicuity of focal lesions in deep organs by focusing on target properties using 2-D shear wave elastography (SWE). Two normal (4 ± 1 kPa) and cirrhotic (16 ± 2 kPa) liver-mimicking phantoms with spherical inclusions (23 ± 3 kPa) were used. Inclusions of three sizes (20, 15 and 10 mm in diameter) were arranged in a row at depths of 3, 5 and 7 cm. Two observers acquired quantitative stiffness values and a qualitative five-grade morphologic score at each inclusion using SWE. The coefficients of variation (CVs) of stiffness were calculated to assess measurement reliability. The generalized estimating equation was used to identify whether stiffness, CV and morphologic score were independent of background stiffness, depth and size of inclusions and observer. In the quantitative assessment, stiffness of the inclusion and CV were dependent on the type of phantom and depth of inclusion (p < 0.001). There were no significant differences in stiffness and CV according to the observer. Morphologic score differed significantly only in the size of the inclusion (p < 0.001). When the depth of the inclusion was 7 cm, the stiffness was the highest, and the 10 mm-sized inclusions had lower morphologic scores than the other inclusions (all p values < 0.001). In conclusion, 2-D SWE assessment of focal lesions could be affected by background stiffness and depth of focal lesions, and may be limited in evaluating focal hepatic lesions.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Chungcheongnam-do, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo K Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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19
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Hepatic metastatic paraganglioma 12 years after retroperitoneal paraganglioma resection: a case report. BMC Gastroenterol 2019; 19:142. [PMID: 31395026 PMCID: PMC6688228 DOI: 10.1186/s12876-019-1061-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/31/2019] [Indexed: 11/25/2022] Open
Abstract
Background Paragangliomas, also known as chemodectomas, are rare tumors arise from chemoreceptor tissue, and most commonly locate at the bifurcation of the common carotid, the jugular foramen, aortic arch, and retroperitoneum. Paragangliomas generally are considered to be benign tumors, and rarely produce local or distant metastases. Metastasis to liver is extremely rare. Case presentation We report the case of a 39-year-old woman, who had undergone resection of a retroperitoneal paraganglioma at her local hospital for 12 years. She was referred to our hospital for further evaluation of a hepatic mass, which was misdignosed as hepatocellular carcinoma (HCC) and was treated by transarterial chemoembolization (TACE) in the local hospital 6 years ago. At admission, CT scan revealed a huge hypervascular mass with many feeding arteries, almost the same size as 5 years ago. Ultrasound-guided biopsy of the liver tumor was performed and immunohistochemical examination confirmed the diagnosis of hepatic metastatic paraganglioma. Though liver metastasis failed to achieve complete response or partial response to TACE treatment, it remained stable without progression during the 7-year follow-up. Conclusion Paragangliomas are slow growing tumors and metastasis may develop decades after resection of the primary lesion. Long-term follow-up is necessary, and curative or palliative treatment should be considered to control symptoms, improve life quality, reduce complications and prolong survival. Electronic supplementary material The online version of this article (10.1186/s12876-019-1061-6) contains supplementary material, which is available to authorized users.
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20
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Yu M, Mahtabfar A, Beelen P, Demiryurek Y, Shreiber DI, Zahn JD, Foty RA, Liu L, Lin H. Coherent Timescales and Mechanical Structure of Multicellular Aggregates. Biophys J 2019; 114:2703-2716. [PMID: 29874619 DOI: 10.1016/j.bpj.2018.04.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023] Open
Abstract
Multicellular aggregates are an excellent model system to explore the role of tissue biomechanics in specifying multicellular reorganization during embryonic developments and malignant invasion. Tissue-like spheroids, when subjected to a compressive force, are known to exhibit liquid-like behaviors at long timescales (hours), largely because of cell rearrangements that serve to effectively dissipate the applied stress. At short timescales (seconds to minutes), before cell rearrangement, the mechanical behavior is strikingly different. The current work uses shape relaxation to investigate the structural characteristics of aggregates and discovers two coherent timescales: one on the order of seconds, the other tens of seconds. These timescales are universal, conserved across a variety of tested species, and persist despite great differences in other properties such as tissue surface tension and adhesion. A precise mathematical theory is used to correlate the timescales with mechanical properties and reveals that aggregates have a relatively strong envelope and an unusually "soft" interior (weak bulk elastic modulus). This characteristic is peculiar, considering that both layers consist of identical units (cells), but is consistent with the fact that this structure can engender both structural integrity and the flexibility required for remodeling. In addition, tissue surface tension, elastic modulus, and viscosity are proportional to each other. Considering that these tissue-level properties intrinsically derive from cellular-level properties, the proportionalities imply precise coregulation of the latter and in particular of the tension on the cell-medium and cell-cell interfaces.
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Affiliation(s)
- Miao Yu
- Department of Mechanical and Aerospace Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Aria Mahtabfar
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Paul Beelen
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Yasir Demiryurek
- Department of Mechanical and Aerospace Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - David I Shreiber
- Department of Biomedical Engineering, The State University of New Jersey, Piscataway, New Jersey
| | - Jeffrey D Zahn
- Department of Biomedical Engineering, The State University of New Jersey, Piscataway, New Jersey
| | - Ramsey A Foty
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Liping Liu
- Department of Mechanical and Aerospace Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey; Department of Mathematics, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Hao Lin
- Department of Mechanical and Aerospace Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey.
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21
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Wang Y, Jia L, Wang X, Fu L, Liu J, Qian L. Diagnostic Performance of 2-D Shear Wave Elastography for Differentiation of Hepatoblastoma and Hepatic Hemangioma in Children under 3 Years of Age. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1397-1406. [PMID: 30979592 DOI: 10.1016/j.ultrasmedbio.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 05/25/2023]
Abstract
The aim of the present study was to prospectively evaluate the clinical efficiency of 2-D shear wave elastography (2-D-SWE) for differentiating hepatoblastoma and hepatic hemangioma in children under 3 y of age. 2-D-SWE was performed in 109 consecutive patients with confirmed hepatic neoplasms by pathologic analysis or contrast-enhanced computed tomography plus follow-up observation, in which 71 patients were defined as the test group, and the remaining 38 patients were defined as the validation group. An elasticity value was obtained from each lesion. The diagnostic performance and optimal cut-off value were determined by receiver operating characteristic (ROC) analysis in the test group, and the accuracy of this threshold was analyzed in the validation group. The interclass correlation coefficient (ICC) and Spearman rank correlation tests were applied to assess the reproducibility of elastic measurement and the relationship between the elasticity value and potential influencing parameters. The mean elasticity values were 58.4 ± 19.5 kPa for hepatoblastoma and 19.0 ± 16.0 kPa for hemangioma (Z = -7.685, p = 0.000). The cut-off value in the test group was 39.5 kPa with an area under the ROC curve for differentiation of 0.915, sensitivity of 88.1% and specificity of 86.2%. The accuracy of this threshold in the validation group was 86.8%. The ICCs for inter- and intra-observer reproducibility for acquisition of the elastic measurement were 0.946 and 0.971, respectively. No significant correlation was found between the elasticity value and age for either hemangioma (r = 0.205, p = 0.167) or hepatoblastoma (r = 0.047, p = 0.715). The elasticity value was positively correlated with lesion size (r = 0.332, p = 0.023) in patients with hemangioma but not in patients with hepatoblastoma (r = 0.222, p = 0.082). As a complementary method, 2-D-SWE may aid the differentiation of hepatoblastoma and hemangioma.
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Affiliation(s)
- Yu Wang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Liqun Jia
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaoman Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jibin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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22
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Hu X, Huang X, Chen H, Zhang T, Hou J, Song A, Ding L, Liu W, Wu H, Meng F. Diagnostic effect of shear wave elastography imaging for differentiation of malignant liver lesions: a meta-analysis. BMC Gastroenterol 2019; 19:60. [PMID: 31023234 PMCID: PMC6485138 DOI: 10.1186/s12876-019-0976-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background Shear wave elastography (SWE) imaging have been proposed for characterization of focal liver lesions. We conducted a meta-analysis to evaluate the accuracy and clinical utility of SWE imaging for differentiation of malignant and benign hepatic lesions. Methods PubMed, Embase, Web of Science, and the Cochrane Library were systematically reviewed to search for studies published between January 1, 1990, and November 30, 2018. The studies published in English relating to the evaluation the diagnostic accuracy of SWE imaging for distinguishing malignant and benign liver lesions were retrieved and examined for pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios, using bivariate random-effects models. The hierarchical summary receiver operating characteristic (HSROC) curve was estimated to assess the SWE imaging accuracy. The clinical utility of SWE imaging for differentiation of malignant liver lesions was evaluated by Fagan plot. Results A total of 15 studies, involving 1894 liver lesions in 1728 patients, were eligible for the meta-analysis. The pooled sensitivity and specificity for identification of malignant liver lesions were 0.82 (95% CI: 0.77–0.86) and 0.82 (95% CI: 0.76–0.87), respectively. The AUC was 0.89 (95% CI: 0.86–0.91). When the pre-test probability was 50%, after SWE imaging measurement over the cut-off value (positive result), the corresponding post-test probability for the presence of malignant liver lesions was 82%; the post-test probability was 18% after negative measurement. Conclusions SWE imaging showed high sensitivity and specificity in differentiating malignant and benign liver lesions and may be promising for noninvasive evaluation of liver lesions. Trial registration The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42018104510. Electronic supplementary material The online version of this article (10.1186/s12876-019-0976-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xing Hu
- Ultrasound and Functional Diagnosis Center, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China
| | - Xiaojie Huang
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China
| | - Jianhua Hou
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China
| | - Aixin Song
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China
| | - Lei Ding
- Ultrasound and Functional Diagnosis Center, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China
| | - Weiyuan Liu
- Ultrasound and Functional Diagnosis Center, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China
| | - Hao Wu
- Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China.
| | - Fankun Meng
- Ultrasound and Functional Diagnosis Center, Beijing Youan Hospital, Capital Medical University, No 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China.
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23
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Grgurevic I, Tjesic Drinkovic I, Pinzani M. Multiparametric ultrasound in liver diseases: an overview for the practising clinician. Postgrad Med J 2019; 95:425-432. [PMID: 30665903 DOI: 10.1136/postgradmedj-2018-136111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 12/18/2022]
Abstract
Ultrasound (US) is usually the first and most commonly used tool in the diagnostic algorithm for liver disease. It is widely available, non-invasive and offers a real-time assessment of the liver in several anatomic planes, using different US modalities such as greyscale imaging, Doppler, elastography and contrast-enhanced US. This multiparametric ultrasound (MPUS) provides more information of the examined structures and allows for a faster and more accurate diagnosis, usually at the point of care, thus reducing the requirement for some invasive and more expensive methods. Current data on the MPUS in hepatology are summarised in this review, mostly focused on its use for non-invasive staging of liver fibrosis, detection and classification of portal hypertension and oesophageal varices, prognosis in chronic liver diseases and characterisation of focal liver lesions (FLLs). Based on the available data, we propose practical algorithms for clinical use of MPUS in chronic liver disease and FLL.
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Affiliation(s)
- Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia .,Department of Medicine, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ida Tjesic Drinkovic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia.,Department of Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health, Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
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Jeong JY, Cho YS, Sohn JH. Role of two-dimensional shear wave elastography in chronic liver diseases: A narrative review. World J Gastroenterol 2018; 24:3849-3860. [PMID: 30228779 PMCID: PMC6141332 DOI: 10.3748/wjg.v24.i34.3849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
Liver biopsy is the gold standard for evaluating the degree of liver fibrosis in patients with chronic liver disease. However, due to the many limitations of liver biopsy, there has been much interest in the use of noninvasive techniques for this purpose. Among these techniques real-time two-dimensional shear wave elastography (2D-SWE) has the advantage of measuring tissue elasticity with the guidance of B-mode images. Recently, many studies have been conducted on the application of 2D-SWE in patients with various liver diseases, and their validity has been confirmed. Here, we briefly discuss the role of 2D-SWE in patients with chronic liver diseases, particularly aspects of the examination techniques and clinical applications.
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Affiliation(s)
- Jae Yoon Jeong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
| | - Young Seo Cho
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, South Korea
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25
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Xie LT, Yan CH, Zhao QY, He MN, Jiang TA. Quantitative and noninvasive assessment of chronic liver diseases using two-dimensional shear wave elastography. World J Gastroenterol 2018; 24:957-970. [PMID: 29531460 PMCID: PMC5840471 DOI: 10.3748/wjg.v24.i9.957] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 02/06/2023] Open
Abstract
Two-dimensional shear wave elastography (2D-SWE) is a rapid, simple and novel noninvasive method that has been proposed for assessing hepatic fibrosis in patients with chronic liver diseases (CLDs) based on measurements of liver stiffness. 2D-SWE can be performed easily at the bedside or in an outpatient clinic and yields immediate results with good reproducibility. Furthermore, 2D-SWE was an efficient method for evaluating liver fibrosis in small to moderately sized clinical trials. However, the quality criteria for the staging of liver fibrosis are not yet well defined. Liver fibrosis is the main pathological basis of liver stiffness and a key step in the progression from CLD to cirrhosis; thus, the management of CLD largely depends on the extent and progression of liver fibrosis. 2D-SWE appears to be an excellent tool for the early detection of cirrhosis and may have prognostic value in this context. Because 2D-SWE has high patient acceptance, it could be useful for monitoring fibrosis progression and regression in individual cases. However, multicenter data are needed to support its use. This study reviews the current status and future perspectives of 2D-SWE for assessments of liver fibrosis and discusses the technical advantages and limitations that impact its effective and rational clinical use.
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Affiliation(s)
- Li-Ting Xie
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Chun-Hong Yan
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Qi-Yu Zhao
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Meng-Na He
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Tian-An Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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26
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Praktiknjo M, Krabbe V, Pohlmann A, Sampels M, Jansen C, Meyer C, Strassburg CP, Trebicka J, Gonzalez Carmona MA. Evolution of nodule stiffness might predict response to local ablative therapy: A series of patients with hepatocellular carcinoma. PLoS One 2018; 13:e0192897. [PMID: 29444164 PMCID: PMC5812654 DOI: 10.1371/journal.pone.0192897] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/31/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early information on treatment response of HCC to local ablative therapy is crucial. Elastography as a non-invasive method has recently been shown to play a potential role in distinguishing between benign and malignant liver lesions. Elastography of hepatocellular carcinoma (HCC) in early response to local ablative therapy has not been studied to date. METHODS We prospectively included a cohort of 14 patients with diagnosis of HCC who were treated with local ablative therapy (transarterial chemoembolization, TACE and/or radiofrequency ablation, RFA). We used 2D shear-wave elastography (RT 2D-SWE) to examine stiffness of HCC lesion before and 3, 30 and 90 days after local ablative therapy. Contrast-enhanced imaging after 90 days was performed to evaluate treatment response. Primary endpoint was stiffness of HCC in response to local ablative therapy. Secondary end point was tumor recurrence. RESULTS Stiffness of HCC nodules and liver showed no significant difference prior to local ablative therapy. As early as three days after treatment, stiffness of responding HCC was significantly higher compared to non-responding. Higher stiffness before treatment was significantly associated with tumor recurrence. CONCLUSION Nodule stiffness in general and RT 2D-SWE in particular could provide a useful tool for early prediction of HCC response to local ablative therapy.
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Affiliation(s)
| | - Viktoria Krabbe
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | | | - Matthias Sampels
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
- European Foundation for the Study of Chronic Liver Failure - EF CLIF, Barcelona, Spain
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