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Peris Alvà H, Cano Rodríguez C, Bosch Barragan F, Framis Utset A, Novell Teixidó F, Prieto Del Rey MJ. New-onset hepatic lesions in oncological patients: A challenging diagnosis. RADIOLOGIA 2025; 67:191-201. [PMID: 40187811 DOI: 10.1016/j.rxeng.2023.07.009] [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: 05/16/2023] [Accepted: 07/02/2023] [Indexed: 04/07/2025]
Abstract
The appearance of new-onset liver lesions is frequent during imaging follow-up of oncological patients. Most of these lesions will be metastases. But in the presence of atypical radiological findings, there are other diagnoses to consider. Hepatic abscesses, focal nodular hyperplasia-like in patients treated with platinum salts, or hepatocarcinoma in cirrhotic patients are examples of lesions that may appear in the imaging follow-up and should not be confused with metastases. It is essential to establish the nature of the lesion as this will determine the therapeutic management and might avoid unnecessary invasive procedures. The evaluation of previous radiological studies and the global vision of the patient will be primordial. While liver MRI is mainly the indicated imaging technique for these cases, sometimes a biopsy will be unavoidable. In this article, we will discuss through clinical cases some new-onset liver lesions in oncological patients that generated diagnostic doubts and will explain how to orient the diagnosis.
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Affiliation(s)
- H Peris Alvà
- Servicio de Radiodiagnóstico (UDIAT), Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain.
| | - C Cano Rodríguez
- Servicio de Radiodiagnóstico (UDIAT), Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain
| | - F Bosch Barragan
- Servicio de Radiodiagnóstico (UDIAT), Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain
| | - A Framis Utset
- Servicio de Radiodiagnóstico (UDIAT), Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain
| | - F Novell Teixidó
- Servicio de Radiodiagnóstico (UDIAT), Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain
| | - M J Prieto Del Rey
- Servicio de Radiodiagnóstico (UDIAT), Consorci Sanitari Parc Taulí, Sabadell, Barcelona, Spain
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Xing S, Cool DW, Tessier D, Chen ECS, Peters TM, Fenster A. Deep regression 2D-3D ultrasound registration for liver motion correction in focal tumour thermal ablation. Healthc Technol Lett 2025; 12:e12117. [PMID: 39968337 PMCID: PMC11832595 DOI: 10.1049/htl2.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 12/01/2024] [Indexed: 02/20/2025] Open
Abstract
Liver tumour ablation procedures require accurate placement of the needle applicator at the tumour centroid. The lower-cost and real-time nature of ultrasound (US) has advantages over computed tomography for applicator guidance, however, in some patients, liver tumours may be occult on US and tumour mimics can make lesion identification challenging. Image registration techniques can aid in interpreting anatomical details and identifying tumours, but their clinical application has been hindered by the tradeoff between alignment accuracy and runtime performance, particularly when compensating for liver motion due to patient breathing or movement. Therefore, we propose a 2D-3D US registration approach to enable intra-procedural alignment that mitigates errors caused by liver motion. Specifically, our approach can correlate imbalanced 2D and 3D US image features and use continuous 6D rotation representations to enhance the model's training stability. The dataset was divided into 2388, 196, and 193 image pairs for training, validation and testing, respectively. Our approach achieved a mean Euclidean distance error of2.28 m m ± 1.81 m m and a mean geodesic angular error of ± , with a runtime of0.22 s per 2D-3D US image pair. These results demonstrate that our approach can achieve accurate alignment and clinically acceptable runtime, indicating potential for clinical translation.
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Affiliation(s)
- Shuwei Xing
- Robarts Research InstituteWestern UniversityLondonCanada
- School of Biomedical EngineeringWestern UniversityLondonCanada
| | - Derek W. Cool
- Department of Medical ImagingWestern UniversityLondonCanada
- Lawson Health Research InstituteLondonCanada
| | - David Tessier
- Robarts Research InstituteWestern UniversityLondonCanada
| | - Elvis C. S. Chen
- Robarts Research InstituteWestern UniversityLondonCanada
- School of Biomedical EngineeringWestern UniversityLondonCanada
- Department of Medical ImagingWestern UniversityLondonCanada
- Lawson Health Research InstituteLondonCanada
- Department of Medical BiophysicsWestern UniversityLondonCanada
| | - Terry M. Peters
- Robarts Research InstituteWestern UniversityLondonCanada
- School of Biomedical EngineeringWestern UniversityLondonCanada
- Department of Medical ImagingWestern UniversityLondonCanada
- Lawson Health Research InstituteLondonCanada
- Department of Medical BiophysicsWestern UniversityLondonCanada
| | - Aaron Fenster
- Robarts Research InstituteWestern UniversityLondonCanada
- School of Biomedical EngineeringWestern UniversityLondonCanada
- Department of Medical ImagingWestern UniversityLondonCanada
- Lawson Health Research InstituteLondonCanada
- Department of Medical BiophysicsWestern UniversityLondonCanada
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Wang ZD, Haitham S, Gong JP, Pen ZL. Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared: A case report. World J Clin Cases 2021; 9:5948-5954. [PMID: 34368313 PMCID: PMC8316936 DOI: 10.12998/wjcc.v9.i21.5948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/17/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Focal liver lesions (FLLs) are abnormal masses that are distinguishable from the surrounding liver parenchyma, solid or cystic and may be benign or malignant. They are usually detected incidentally on abdominal examinations. The classification of FLLs is very important as it directly determines the diagnosis and treatment of patients.
CASE SUMMARY A 46-year-old male patient was admitted into the hospital with tarry stool, during the investigation of this issue an incidental FLL was detected. Upon further investigation of this “incidentaloma” computerized tomography and magnetic resonance imaging reached contradictory conclusions. The lesion was then further investigated using contrast-enhanced ultrasound (CEUS) with an initial diagnosis of idiopathic FLL was acquired and observation of the FLL over time need for final diagnosis, however in the follow up the FLL disappeared spontaneously.
CONCLUSION CEUSs value for characterization of FLLs is undeniable, especially when other methods produce inconsistent results, is undeniable but with its limitations. Why and how the FLL disappeared is not known, and can be only hypothesized it was a pseudolesion.
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Affiliation(s)
- Zong-Ding Wang
- Department of Surgery, Fengjie People’s Hospital, Chongqing 400010, China
| | - Salameen Haitham
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jian-Ping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Zi-Li Pen
- Department of Surgery, Fengjie People’s Hospital, Chongqing 400010, China
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Grazzini G, Cozzi D, Flammia F, Grassi R, Agostini A, Belfiore MP, Borgheresi A, Mazzei MA, Floridi C, Carrafiello G, Giovagnoni A, Pradella S, Miele V. Hepatic tumors: pitfall in diagnostic imaging. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:9-17. [PMID: 32945274 PMCID: PMC7944669 DOI: 10.23750/abm.v91i8-s.9969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
On computed tomography (CT) and magnetic resonance imaging (MRI), hepatocellular tumors are characterized based on typical imaging findings. However, hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma can show uncommon appearances at CT and MRI, which may lead to diagnostic challenges. When assessing focal hepatic lesions, radiologists need to be aware of these atypical imaging findings to avoid misdiagnoses that can alter the management plan. The purpose of this review is to illustrate a variety of pitfalls and atypical features of hepatocellular tumors that can lead to misinterpretations providing specific clues to the correct diagnoses.
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Affiliation(s)
- Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Federica Flammia
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Alessandra Borgheresi
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy..
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche and Division of Special and Pediatric Radiology, Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy.
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy.
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Costa AF, Clarke SE, Stueck AE, McInnes MDF, Thipphavong S. Benign Neoplasms, Mass-Like Infections, and Pseudotumors That Mimic Hepatic Malignancy at MRI. J Magn Reson Imaging 2020; 53:979-994. [PMID: 32621572 DOI: 10.1002/jmri.27251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
A variety of conditions may mimic hepatic malignancy at MRI. These include benign hepatic tumors and tumor-like entities such as focal nodular hyperplasia-like lesions, hepatocellular adenoma, hepatic infections, inflammatory pseudotumor, vascular entities, and in the cirrhotic liver, confluent fibrosis, and hypertrophic pseudomass. These conditions demonstrate MRI features that overlap with hepatic malignancy, and can be challenging for radiologists to diagnose accurately. In this review we discuss the MRI manifestations of various conditions that mimic hepatic malignancy, and highlight features that may allow distinction from malignancy. Level of Evidence 5 Technical Efficacy Stage 3.
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Affiliation(s)
- Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley E Stueck
- Department of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew D F McInnes
- Department of Radiology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Seng Thipphavong
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
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Li HL, Liu HP, Guo GWJ, Chen ZH, Zhou FQ, Liu P, Liu JB, Wan R, Mao ZQ. Imaging findings of inflammatory pseudotumor-like follicular dendritic cell tumors of the liver: Two case reports and literature review. World J Gastroenterol 2019; 25:6693-6703. [PMID: 31832007 PMCID: PMC6906205 DOI: 10.3748/wjg.v25.i45.6693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor-like follicular dendritic cell (IPT-like FDC) tumors of the liver is an uncommon tumor with extremely low incidence. To date, the radiologic findings of this tumor in multiphase computed tomography (CT) and magnetic resonance imaging (MRI) imaging have not been described.
CASE SUMMARY Patient 1 is a 31-year-old Chinese female, whose complaining incidentally coincided with the finding of multiple liver masses. In the local hospital, an abdominal enhanced CT found two hypo-dense solid lesions, with heterogeneous sustained hypoenhancement, in the upper segment of the liver’s right posterior lobe. In our hospital, enhanced magnetic resonance imaging (MRI) with hepatocyte-specific contrast agents showed a similar enhanced pattern of lesions with patchy hyperintensity in the hepatobiliary phase (HBP). The patient underwent surgery and recovered well. The final pathology confirmed an IPT-like FDC tumor. No recurrence was found on the regular re-examination. Patient 2 is a 48-year-old Chinese male admitted to our hospital for a huge unexpected hepatic lesion. A dynamic enhanced abdominal CT revealed a huge heterogeneous enhanced solid tumor in the right lobe of the liver with a size of 100 mm × 80 mm, which showed a heterogeneous sustained hypoenhancement. In addition, enlarged lymph nodes were found in the hilum of the liver. This patient underwent a hepatic lobectomy and lymph node dissection. The final pathology confirmed an IPT-like FDC tumor. No recurrence was found upon regular re-examination.
CONCLUSION When a hepatic tumor shows heterogeneous sustained hypoenhancement with a patchy enhancement during HBP, an IPT-like FDC tumor should be considered in the differential diagnosis.
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Affiliation(s)
- Hai-Lan Li
- Department of Radiology, Hunan Provincial People's Hospital (the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Hua-Ping Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
| | - Grace Wen-Jun Guo
- Department of Radiology, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE 19803, United States
| | - Zhi-Hong Chen
- Department of Pathology, Hunan Provincial People's Hospital (the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Fu-Qing Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Peng Liu
- Department of Radiology, Hunan Provincial People's Hospital (the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Jian-Bin Liu
- Department of Radiology, Hunan Provincial People's Hospital(the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Ren Wan
- Department of Radiology, Hunan Provincial People's Hospital(the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
| | - Zhi-Qun Mao
- Department of Radiology, Hunan Provincial People's Hospital(the First Affiliate Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
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Zhang Y, Yan Y, Song B. Noninvasive imaging diagnosis of sinusoidal obstruction syndrome: a pictorial review. Insights Imaging 2019; 10:110. [PMID: 31748956 PMCID: PMC6868080 DOI: 10.1186/s13244-019-0791-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/24/2019] [Indexed: 02/08/2023] Open
Abstract
Sinusoidal obstruction syndrome (SOS) is a rare liver disorder due to hepatic vascular injury. Its rapid and accurate diagnosis is crucial for patient survival. SOS is often established clinically, based on Baltimore, modified Seattle, or European Society for Blood and Marrow Transplantation (EBMT) criteria. Unfortunately, such criteria are not highly specificity and fail to provide a timely, reliable differential diagnosis. The use of noninvasive imaging techniques, such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), has recently grown in this setting, some key imaging features offering diagnostic improvement. This review provides a synopsis of current noninvasive imaging techniques used for this purpose, summarizing accurate and reliable diagnostic features of SOS.
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Affiliation(s)
- Yun Zhang
- Department of Radiology, Sichuan University West China Hospital, No.37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yuling Yan
- Department of Gastroenterology and Hepatology, Sichuan University West China Hospital, Chengdu, 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, No.37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
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