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Qiao S, Xue M, Zuo Y, Zheng J, Jiang H, Zeng X, Peng D. Four-phase CT lesion recognition based on multi-phase information fusion framework and spatiotemporal prediction module. Biomed Eng Online 2024; 23:103. [PMID: 39434126 PMCID: PMC11492744 DOI: 10.1186/s12938-024-01297-x] [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: 05/09/2024] [Accepted: 10/02/2024] [Indexed: 10/23/2024] Open
Abstract
Multiphase information fusion and spatiotemporal feature modeling play a crucial role in the task of four-phase CT lesion recognition. In this paper, we propose a four-phase CT lesion recognition algorithm based on multiphase information fusion framework and spatiotemporal prediction module. Specifically, the multiphase information fusion framework uses the interactive perception mechanism to realize the channel-spatial information interactive weighting between multiphase features. In the spatiotemporal prediction module, we design a 1D deep residual network to integrate multiphase feature vectors, and use the GRU architecture to model the temporal enhancement information between CT slices. In addition, we employ CT image pseudo-color processing for data augmentation and train the whole network based on a multi-task learning framework. We verify the proposed network on a four-phase CT dataset. The experimental results show that the proposed network can effectively fuse the multi-phase information and model the temporal enhancement information between CT slices, showing excellent performance in lesion recognition.
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Affiliation(s)
- Shaohua Qiao
- HDU-ITMO Joint Institute, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Mengfan Xue
- School of Automation, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Yan Zuo
- School of Automation, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Jiannan Zheng
- School of Automation, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Haodong Jiang
- School of Automation, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Xiangai Zeng
- School of Automation, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Dongliang Peng
- School of Automation, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China.
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Alshareefy Y, Shen CY, Prekash RJ. Exploring the molecular pathogenesis, diagnosis and treatment of fibrolamellar hepatocellular carcinoma: A state of art review of the current literature. Pathol Res Pract 2023; 248:154655. [PMID: 37429175 DOI: 10.1016/j.prp.2023.154655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
This paper aims to present a detailed overview of fibrolamellar carcinoma (FLC), a variant of hepatocellular carcinoma (HCC) that accounts for approximately 1-9% of all cases a. according to the SEER database. Despite ongoing research, the aetiology of FLC tumours remains unclear. Nevertheless, FLC is believed to have a better overall prognosis than other primary liver tumours, such as hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma. This study aims to present a comprehensive overview of fibrolamellar carcinoma (FLC), with a focus on its epidemiology, pathogenesis, diagnosis, treatment, and prognosis. FLC frequently incorporate features of stomach pain, weight loss, and malaise in their clinical signs and symptoms, which are generally nonspecific Ultimately, the most common physical finding is an abdominal mass or hepatomegaly. With this said, several unusual presentations have been documented such as Budd Chiari syndrome, severe anaemia, non-bacterial thrombotic endocarditis and many more. In regards to this tumour's genetic analysis, it is characterised by a 400 kb deletion on chromosome 19 leading to a functional DNAJB1-PRKACA chimeric transcript in addition to tetraploidy in 50% of cases. FLC is chromosomally stable as compared to typical HCC. mTOR pathway activation has also been found to play a critical role in 47% of these tumours and EFGR over-expression is also evident. Fibrolamellar carcinomas (FLCs) exhibit a distinctive gross appearance, characterized by a yellow to pale tan colour, with a consistency that can vary from soft to firm and hard. In addition, a central scar is observed in 60-70% of FLC cases. The central scar is typically white or grey in colour and has a fibrous appearance, which is often surrounded by nodular, tumour-like tissue. Its histologic appearance is characterized by large polygonal cells with abundant eosinophilic cytoplasm, large vesiculated nuclei, large nucleoli, and arranged in lamellar bands of collagen fibres. Lamellar bands of fibrosis, consisting of collagen type I, III and IV, have also been identified as a distinctive histologic feature that is observed under low power magnification. Ultrasound, CT and MRI along with image guided biopsy are the primary modalities in diagnosis. Current management options include systemic therapy which has thus far been unremarkable with platinum-based therapies as well combination therapy with interferon alpha-2b being the most successful options. Surgical resection remains the primary treatment modality and there have been no advances in targeted therapies. Although the prognosis for FLC is favourable as compared to other hepatic cancer subtypes such as intrahepatic cholangiocarcinoma, there is a high rate of recurrence ranging from 33% to 100% with a median recurrence-free survival of 20-48 months. As a result of this there is a low overall cure rate associated with this tumour type and much more research is required to gain an in-depth understanding of the molecular mechanisms occurring in order to provide more adequate treatment to patients who suffer from this condition.
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Affiliation(s)
- Yasir Alshareefy
- School of Medicine, Trinity College Dublin, University of Dublin, Ireland.
| | - Chai Yu Shen
- Department of Medicine, Manipal University College, Malaysia
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Abdelhamed W, El-Kassas M. Fibrolamellar hepatocellular carcinoma: A rare but unpleasant event. World J Gastrointest Oncol 2022; 14:1103-1114. [PMID: 35949219 PMCID: PMC9244987 DOI: 10.4251/wjgo.v14.i6.1103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/19/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
Fibrolamellar carcinoma (FLC) is a rare variant of hepatocellular carcinoma (HCC), comprising 1%-9% of all HCCs. FLC is a poorly understood malignancy, which seems to be more prevalent in young patients with no underlying liver diseases. The term "fibrolamellar" is derived from thick fibrous collagen bands surrounding the tumor cells. Unlike HCC, cirrhosis and viral hepatitis infection are not predisposing to FLC, and it is not associated with elevations in serum alpha-fetoprotein. FLC patients often present with vague abdominal pain, nausea, malaise, and weight loss. Most cases present are at an advanced stage at the time of initial diagnosis. However, curative treatment options can still be offered to up to 70% of patients. Surgery (resection/liver transplantation) is the mainstay of treatment and the only potentially curative option. FLCs have been less chemo-responsive than the conventional HCC, however, in advanced cases, multimodality treatments can be effective. Recent advances in molecular studies of FLC have found a unique DNAJB1-PRKACA fusion transcript in most of the cases studied. The review aims to describe clinical characteristics, diagnostic methods, and therapeutic modalities for this rare tumor to raise awareness among clinicians and surgeons.
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Affiliation(s)
- Walaa Abdelhamed
- Department of Endemic Medicine, Sohag University, Sohag 14322, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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Takahashi A, Imamura H, Ito R, Kawano F, Gyoda Y, Ichida H, Yoshioka R, Mise Y, Fukumura Y, Sano K, Saiura A. A case report of fibrolamellar hepatocellular carcinoma, with particular reference to preoperative diagnosis, value of molecular genetic diagnosis, and cell origin. Surg Case Rep 2021; 7:208. [PMID: 34533614 PMCID: PMC8448801 DOI: 10.1186/s40792-021-01295-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/10/2021] [Indexed: 01/12/2023] Open
Abstract
Background Fibrolamellar hepatocellular carcinoma (FL-HCC) is a liver tumor that occurs almost exclusively in young adults without underlying liver disease. In spite of its distinct clinical characteristics and specific imaging findings, preoperative diagnosis is often difficult due to the extremely low incidence of the tumor. Although FL-HCC shows particular morphological features on H&E-stained tissue sections, differential diagnosis from ordinary HCC, especially the scirrhous variant of HCC, and intrahepatic cholangiocarcinoma needs additional immunohistochemical (IHC) analyses and/or molecular genetic testing. Case presentation A 21-year-old male patient was referred to our hospital for further evaluation of a large liver mass. Abdominal ultrasound examination, contrast-enhanced computed tomography, and magnetic resonance imaging revealed a well-defined hypervascular lobulated liver mass, 11 × 11 cm in diameter, with a central scar and calcification, in segments 5/8. Under the diagnosis of FL-HCC, we carried out extended anterior sectorectomy, including a part of segment 4. On microscopic examination, the tumor was composed of proliferating polygonal cells with abundant eosinophilic granular cytoplasm containing nuclei with vesicular chromatin and enlarged nucleoli, in an abundant stroma. Collagen fibers arranged in a parallel lamellar pattern were seen in the tumor stroma. These findings, together with the results of subsequent IHC analyses using HAS, CK7, and CD 67, we made the diagnosis of FL-HCC, which was further confirmed by detection of the DNAJB1-PRKACA fusion gene in the tumor cells by RT-PCR. Conclusion FL-HCC shows distinct imaging appearances. Although it also has characteristic morphological features, combined use of IHC and/or molecular genetic studies are necessary for the final diagnosis.
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Affiliation(s)
- Atsushi Takahashi
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Hiroshi Imamura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Ryota Ito
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Fumihiro Kawano
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yu Gyoda
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Hirofumi Ichida
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Ryuji Yoshioka
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yoshihiro Mise
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yuki Fukumura
- Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsuhiro Sano
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
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Abstract
Malignant primary liver tumors are rare in children. Yet a wide histologic spectrum is seen, particularly in hepatoblastoma, the most common malignant liver tumor in children. Furthermore, there can be significant morphologic overlap with hepatocellular carcinoma, the second most common pediatric liver malignancy, and tumors with hybrid features of hepatoblastoma and hepatocellular carcinoma are also reported (currently placed in the provisional category of malignant hepatocellular neoplasm, not otherwise specified). This review provides detailed morphologic descriptions and updates in the evolving clinical context of these tumors, and presents recent molecular advances that may further help in accurate classification of these tumors, which is critical in their management.
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Affiliation(s)
- Soo-Jin Cho
- Department of Pathology, University of California San Francisco, 1825 4th Street Room M2369, Box 4066, San Francisco, CA 94143, USA.
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Ballotin VR, Bigarella LG, Soldera J, Soldera J. Deep learning applied to the imaging diagnosis of hepatocellular carcinoma. Artif Intell Gastrointest Endosc 2021; 2:127-135. [DOI: 10.37126/aige.v2.i4.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/05/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
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Zheng Y, Wang S, Chen Y, Du HQ. Deep learning with a convolutional neural network model to differentiate renal parenchymal tumors: a preliminary study. Abdom Radiol (NY) 2021; 46:3260-3268. [PMID: 33656574 DOI: 10.1007/s00261-021-02981-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE With advancements in medical imaging, more renal tumors are detected early, but it remains a challenge for radiologists to accurately distinguish subtypes of renal parenchymal tumors. We aimed to establish a novel deep convolutional neural network (CNN) model and investigate its effect on identifying subtypes of renal parenchymal tumors in T2-weighted fat saturation sequence magnetic resonance (MR) images. METHODS This retrospective study included 199 patients with pathologically confirmed renal parenchymal tumors, including 77, 46, 34, and 42 patients with clear cell renal cell carcinoma (ccRCC), chromophobe renal cell carcinoma (chRCC), angiomyolipoma (AML), and papillary renal cell carcinoma (pRCC), respectively. All enrolled patients underwent kidney MR scans with the field strength of 1.5 Tesla (T) or 3.0 T before surgery. We selected T2-weighted fat saturation sequence images of all patients and built a deep learning model to determine the type of renal tumors. Receiver operating characteristic (ROC) curve was depicted to estimate the performance of the CNN model; the accuracy, precision, sensitivity, specificity, F1-score, and area under the curve (AUC) were calculated. One-way analysis of variance and χ2 tests of independent samples were used to analyze the variables. RESULTS The experimental results demonstrated that the model had a 60.4% overall accuracy, a 61.7% average accuracy, and a macro-average AUC of 0.82. The AUCs for ccRCC, chRCC, AML, and pRCC were 0.94, 0.78, 0.80, and 0.76, respectively. CONCLUSION Deep CNN model based on T2-weighted fat saturation sequence MR images was useful to classify the subtypes of renal parenchymal tumors with a relatively high diagnostic accuracy.
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Affiliation(s)
- Yao Zheng
- Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuai Wang
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China
| | - Yan Chen
- Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Hui-Qian Du
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China.
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8
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Dong Y, Wang WP, Mao F, Zhang Q, Yang D, Tannapfel A, Meloni MF, Neye H, Clevert DA, Dietrich CF. Imaging Features of Fibrolamellar Hepatocellular Carcinoma with Contrast-Enhanced Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:306-313. [PMID: 32102105 DOI: 10.1055/a-1110-7124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Fibrolamellar hepatocellular carcinoma (f-HCC) is a rare primary liver tumor. Imaging plays an important role in diagnosis. The aim of this retrospective study was to analyze contrast-enhanced ultrasound (CEUS) features of histologically proven f-HCC in comparison to benign focal nodular hyperplasia (FNH). MATERIALS & METHODS 16 patients with histologically proven f-HCC lesions and 30 patients with FNH lesions were retrospectively reviewed regarding CEUS features to determine the malignant or benign nature of the focal liver lesions (FLL). Five radiologists assessed the CEUS enhancement pattern and came to a consensus using the EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) guideline criteria. RESULTS Fibrolamellar hepatocellular carcinoma manifested as a single and huge FLL. On CEUS, f-HCC showed heterogeneous hyperenhancement in the arterial phase and hypoenhancement (16/16, 100 %) in the portal venous and late phases (PVLP) as a sign of malignancy. In contrast to the hypoenhancement of f-HCC in the PVLP, all patients with FNH showed hyperenhancement as the most distinctive feature (P < 0.01). 8 f-HCC lesions showed a central scar as an unenhanced area (8/16, 50.0 %), which could also be detected in 53.3 % (16/30) of FNH lesions (P > 0.05). CONCLUSION By analyzing the hypoenhancement in the PVLP, CEUS imaging reliably diagnosed f-HCC as a malignant FLL. CEUS also showed differentiation between f-HCC and FNH lesions, showing similar non-enhanced central scars, whereas f-HCC lesions showed peripheral hyperenhancement in the arterial phase and early washout in the PVLP.
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Affiliation(s)
- Yi Dong
- Ultrasound, Zhongshan-Hospital Fudan-University, Shanghai, China
| | - Wen-Ping Wang
- Ultrasound, Zhongshan-Hospital Fudan-University, Shanghai, China
| | - Feng Mao
- Ultrasound, Zhongshan-Hospital Fudan-University, Shanghai, China
| | - Qi Zhang
- Ultrasound, Zhongshan-Hospital Fudan-University, Shanghai, China
| | - Daohui Yang
- Ultrasound, Zhongshan-Hospital Fudan-University, Shanghai, China
| | | | | | - Holger Neye
- Department of Internal Medicine II, Helios Hospital Emil von Behring, Berlin, Germany
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University Hospital Munich, München, Germany
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Switzerland
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Abstract
Benign liver tumors in children are far less frequent than their malignant counterparts. Recently, there have been advances of diagnostic procedures and novel treatments with improved classification as a result. While malignant pediatric liver tumors have been comprehensively addressed by multicenter international tumor trials, benign tumors have more usually relied upon individualised workup and treatment. Due to the rarity and heterogeneity of these different entities, large studies are lacking. In this article the authors highlight the spectrum of benign liver tumors with special focus on specific clinical features, pathology, and treatment.
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Affiliation(s)
- J Fuchs
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany.
| | - S W Warmann
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany
| | - C Urla
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany
| | - J F Schäfer
- Department of Interventional and Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany
| | - A Schmidt
- Department of Pediatric Surgery and Pediatric Urology, Children´s Hospital, University of Tuebingen, Hoppe-Seyler-Str. 03, 72076 Tuebingen, Germany
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Anysz-Grodzicka A, Podgorska J, Cieszanowski A. State-of-the-art MR Imaging of Uncommon Hepatocellular Tumours: Fibrolamellar Hepatocellular Carcinoma and Combined Hepatocellularcholangiocarcinoma. Curr Med Imaging 2020; 15:269-280. [PMID: 31989878 DOI: 10.2174/1573405614666180927113622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fibrolamellar Carcinoma (FLC) and Combined Hepatocellular- Cholangiocarcinoma (CHC) are rare primary liver tumours, which are related to different clinical settings. In both tumours, correlation with clinical data and laboratory tests are extremely important. DISCUSSION Typically, FLC is diagnosed in young patients without any chronic disease and with normal biochemical tests, whereas CHC arises in cirrhotic patients with elevated tumour markers: AFP and/or CA 19-9. The review describes epidemiology, aetiology, pathogenesis, radiological features and treatment of these tumours. Imaging features typical for FLC are: The presence of central scar, calcifications, the large size, heterogeneous and early contrast-enhancement. CONCLUSION The diagnosis of CHC may be suggested in case of elevation of both AFP and CA 19- 9 or inconsistency between elevated tumour markers and imaging findings (i.e., elevated CA 19-9 and radiological features of HCC, or elevated AFP with imaging findings characteristic of ICC).
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Affiliation(s)
- Agnieszka Anysz-Grodzicka
- Department of Radiology, Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
| | - Joanna Podgorska
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Cieszanowski
- Department of Radiology, Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
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11
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Zhen SH, Cheng M, Tao YB, Wang YF, Juengpanich S, Jiang ZY, Jiang YK, Yan YY, Lu W, Lue JM, Qian JH, Wu ZY, Sun JH, Lin H, Cai XJ. Deep Learning for Accurate Diagnosis of Liver Tumor Based on Magnetic Resonance Imaging and Clinical Data. Front Oncol 2020; 10:680. [PMID: 32547939 PMCID: PMC7271965 DOI: 10.3389/fonc.2020.00680] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Early-stage diagnosis and treatment can improve survival rates of liver cancer patients. Dynamic contrast-enhanced MRI provides the most comprehensive information for differential diagnosis of liver tumors. However, MRI diagnosis is affected by subjective experience, so deep learning may supply a new diagnostic strategy. We used convolutional neural networks (CNNs) to develop a deep learning system (DLS) to classify liver tumors based on enhanced MR images, unenhanced MR images, and clinical data including text and laboratory test results. Methods: Using data from 1,210 patients with liver tumors (N = 31,608 images), we trained CNNs to get seven-way classifiers, binary classifiers, and three-way malignancy-classifiers (Model A-Model G). Models were validated in an external independent extended cohort of 201 patients (N = 6,816 images). The area under receiver operating characteristic (ROC) curve (AUC) were compared across different models. We also compared the sensitivity and specificity of models with the performance of three experienced radiologists. Results: Deep learning achieves a performance on par with three experienced radiologists on classifying liver tumors in seven categories. Using only unenhanced images, CNN performs well in distinguishing malignant from benign liver tumors (AUC, 0.946; 95% CI 0.914–0.979 vs. 0.951; 0.919–0.982, P = 0.664). New CNN combining unenhanced images with clinical data greatly improved the performance of classifying malignancies as hepatocellular carcinoma (AUC, 0.985; 95% CI 0.960–1.000), metastatic tumors (0.998; 0.989–1.000), and other primary malignancies (0.963; 0.896–1.000), and the agreement with pathology was 91.9%.These models mined diagnostic information in unenhanced images and clinical data by deep-neural-network, which were different to previous methods that utilized enhanced images. The sensitivity and specificity of almost every category in these models reached the same high level compared to three experienced radiologists. Conclusion: Trained with data in various acquisition conditions, DLS that integrated these models could be used as an accurate and time-saving assisted-diagnostic strategy for liver tumors in clinical settings, even in the absence of contrast agents. DLS therefore has the potential to avoid contrast-related side effects and reduce economic costs associated with current standard MRI inspection practices for liver tumor patients.
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Affiliation(s)
- Shi-Hui Zhen
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.,State Key Laboratory of CAD&CG, Zhejiang University, Hangzhou, China
| | - Ming Cheng
- State Key Laboratory of CAD&CG, Zhejiang University, Hangzhou, China
| | - Yu-Bo Tao
- State Key Laboratory of CAD&CG, Zhejiang University, Hangzhou, China
| | - Yi-Fan Wang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Sarun Juengpanich
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Zhi-Yu Jiang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yan-Kai Jiang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.,State Key Laboratory of CAD&CG, Zhejiang University, Hangzhou, China
| | - Yu-Yu Yan
- State Key Laboratory of CAD&CG, Zhejiang University, Hangzhou, China
| | - Wei Lu
- Department of Radiology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.,Department of Medical Imaging, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jie-Min Lue
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jia-Hong Qian
- State Key Laboratory of CAD&CG, Zhejiang University, Hangzhou, China
| | - Zhong-Yu Wu
- Department of Surgical Oncology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Ji-Hong Sun
- Department of Radiology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Hai Lin
- State Key Laboratory of CAD&CG, Zhejiang University, Hangzhou, China
| | - Xiu-Jun Cai
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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12
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Current Imaging Standards for Nonmetastatic Benign and Malignant Liver Tumors. Surg Oncol Clin N Am 2019; 28:539-572. [PMID: 31472905 DOI: 10.1016/j.soc.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The accurate diagnosis of a liver mass can usually be established with a thorough history, examination, laboratory inquiry, and imaging. The necessity of a liver biopsy to determine the nature of a liver mass is rarely necessary. Contrast-enhanced computed tomography and magnetic resonance are the standard of care for diagnosing liver lesions and high-quality imaging should be performed before performing a biopsy. This article discusses current consensus guidelines for imaging of liver masses, as well as masses found on surveillance imaging. The ability to accurately characterize lesions requires proper use and understanding of the technology and expert interpretation.
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Ganeshan D, Szklaruk J, Kaseb A, Kattan A, Elsayes KM. Fibrolamellar hepatocellular carcinoma: multiphasic CT features of the primary tumor on pre-therapy CT and pattern of distant metastases. Abdom Radiol (NY) 2018; 43:3340-3348. [PMID: 29948061 DOI: 10.1007/s00261-018-1657-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of our study is to describe the multiphasic CT features of fibrolamellar hepatocellular carcinomas (FLHCCs) and pattern of distant metastases. MATERIALS AND METHODS 33 patients (mean age 28 years: 17M/16F) with pathologically confirmed FLHCC and pre-treatment multiphasic CT were included in the study. Two abdominal radiologists evaluated the multiphasic CT imaging features of these 33 FLHCC patients in consensus. RESULTS Solitary hepatic mass was seen in 67% (22/33). Mean tumor size was 11.3 cm (range 4.6-22 cm). Tumor was well-defined in 64% (21/33). In the pre-contrast CT, 91% (30/33) were hypoattenuating. Central stellate scar was present in 73% (24/33). In FLHCC having central stellate scar, calcification within the central scar was seen in 88% (21/24). In the hepatic arterial phase, 82% (27/33) were hyperattenuating relative to liver. In the portal venous phase, 36% (12/33) were hyperattenuating, 46% (15/33) were isoattenuating, and 18% (6/33) were hypoattenuating. In the delayed phase images, 24% (8/23) were hyperattenuating, 67% (22/33) were isoattenuating, and 9% (3/33) were hypoattenuating. Delayed enhancement of the central stellate scar was seen in 12% (4/33). Distant metastases were seen in 54% (18/33). The most common site of metastases was lungs and was seen in 89% (16/18) of the patients with metastatic disease. CONCLUSION FLHCC typically manifests as a large, solitary mass demonstrating heterogeneous hypervascular enhancement in the arterial phase. Most tend to be isoattenuating in delayed phase. Central stellate scar with internal calcification is a useful imaging feature that can help in the diagnosis of FLHCC. Lungs are the most common site of distant metastases in FLHCC.
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Affiliation(s)
- Dhakshinamoorthy Ganeshan
- Division of Diagnostic Imaging, Body Imaging Section, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
| | - Janio Szklaruk
- Division of Diagnostic Imaging, Body Imaging Section, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 426, Houston, TX, 77030, USA
| | - Ahmad Kattan
- Division of Diagnostic Imaging, Body Imaging Section, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA
| | - Khaled M Elsayes
- Division of Diagnostic Imaging, Body Imaging Section, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA
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Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT. AJR Am J Roentgenol 2018; 211:76-86. [DOI: 10.2214/ajr.18.19704] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Han SB, Kim YK, Min JH, Ha SY, Jeong WK, Lee WJ. Hepatocellular carcinoma with central scar on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging. Acta Radiol 2018; 59:393-401. [PMID: 28760004 DOI: 10.1177/0284185117723040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Central scars are rarely reported in conventional hepatocellular carcinoma (HCC). The presence of central scars on imaging might lead to erroneous diagnosis of hepatic tumors. Purpose To determine imaging features of HCC with central scars on magnetic resonance imaging (MRI) including gadoxetic acid-enhanced and diffusion-weighted imaging (DWI). Material and Methods Fifty-one patients with 51 surgically confirmed HCCs with central scars (fibrotic scar: n = 50; myxoid scar: n = 1; range = 1.2-15 cm; mean = 3.7 cm) underwent liver MRI that consisted of T1- and T2-weighted (T2W) imaging, gadoxetic acid-enhanced arterial, portal, 3-min late phase, and 20-min hepatobiliary phase (HBP), and DWI. Two reviewers evaluated morphology, signal intensity, and enhancement features of tumors and central scars for each image and reached consensus. Results Lobulated contour was seen for 30 tumors (58.8%); the rest were round or oval masses. Central scars (range = 0.2-6.0 cm; mean = 0.9 cm) were most commonly seen as defects within hyperenhancement on arterial phase images (n = 47, 92.2%), bright (n = 28, 54.9%) or dark areas (n = 15, 29.4%) on T2W imaging, areas of central darkness on high b-value DWI (b = 800) (n = 31, 60.8%), and/or central enhancement on HBP (n = 36, 70.6%), mimicking a target appearance. Tumor capsule was seen in 35 (39 pathology, 74.5%) and intratumoral septum in 35 (41 pathology, 78.4%) tumors on gadoxetic acid-enhanced MRI. Conclusion Non-fibrolamellar HCC may show central scar. HCC with central scar mimics cholangiocarcinoma by showing a target appearance on HBP and DWI. Tumor capsule and intratumoral septum might be useful for characterizing HCC with central scar.
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Affiliation(s)
- Sol Bee Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Kyung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Yasaka K, Akai H, Abe O, Kiryu S. Deep Learning with Convolutional Neural Network for Differentiation of Liver Masses at Dynamic Contrast-enhanced CT: A Preliminary Study. Radiology 2017; 286:887-896. [PMID: 29059036 DOI: 10.1148/radiol.2017170706] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To investigate diagnostic performance by using a deep learning method with a convolutional neural network (CNN) for the differentiation of liver masses at dynamic contrast agent-enhanced computed tomography (CT). Materials and Methods This clinical retrospective study used CT image sets of liver masses over three phases (noncontrast-agent enhanced, arterial, and delayed). Masses were diagnosed according to five categories (category A, classic hepatocellular carcinomas [HCCs]; category B, malignant liver tumors other than classic and early HCCs; category C, indeterminate masses or mass-like lesions [including early HCCs and dysplastic nodules] and rare benign liver masses other than hemangiomas and cysts; category D, hemangiomas; and category E, cysts). Supervised training was performed by using 55 536 image sets obtained in 2013 (from 460 patients, 1068 sets were obtained and they were augmented by a factor of 52 [rotated, parallel-shifted, strongly enlarged, and noise-added images were generated from the original images]). The CNN was composed of six convolutional, three maximum pooling, and three fully connected layers. The CNN was tested with 100 liver mass image sets obtained in 2016 (74 men and 26 women; mean age, 66.4 years ± 10.6 [standard deviation]; mean mass size, 26.9 mm ± 25.9; 21, nine, 35, 20, and 15 liver masses for categories A, B, C, D, and E, respectively). Training and testing were performed five times. Accuracy for categorizing liver masses with CNN model and the area under receiver operating characteristic curve for differentiating categories A-B versus categories C-E were calculated. Results Median accuracy of differential diagnosis of liver masses for test data were 0.84. Median area under the receiver operating characteristic curve for differentiating categories A-B from C-E was 0.92. Conclusion Deep learning with CNN showed high diagnostic performance in differentiation of liver masses at dynamic CT. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Koichiro Yasaka
- From the Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan 113-8655
| | - Hiroyuki Akai
- From the Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan 113-8655
| | - Osamu Abe
- From the Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan 113-8655
| | - Shigeru Kiryu
- From the Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan 113-8655
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Typical and atypical benign liver lesions: A review. Clin Imaging 2017; 44:79-91. [PMID: 28486156 DOI: 10.1016/j.clinimag.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/10/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
Abstract
Focal liver lesions are routinely encountered by clinical radiologists and represent a wide spectrum of pathology. Majority of these lesions are likely to be benign in nature, especially in the absence of chronic liver disease or primary cancer. A radiologist must be aware of common and uncommon imaging features of benign lesions across the various imaging modalities. This review discusses pathognomonic imaging features of common benign focal liver lesions seen on ultrasound, computed tomography and magnetic resonance, and adds to existing knowledge with the recent updates to have emerged in this area.
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18
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Romano A, Grassia M, Esposito G, Petrillo M, Pezzella M, Romano FM, Esposito F, Torelli F, Di Martino N. An unusual case of left hepatectomy for Focal Nodular Hyperplasia (FNH) linked to the use of Anabolic Androgenic Steroids (AASs). Int J Surg Case Rep 2016; 30:169-171. [PMID: 28012338 PMCID: PMC5217789 DOI: 10.1016/j.ijscr.2016.10.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/29/2016] [Accepted: 10/29/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Focal Nodular Hyperplasia (FNH) is the second most common benign tumor of the liver. Clinically FNH is asymptomatic and discovered incidentally . The pathogenesis is unclear; FNH is usually asymptomatic. When the tumor is large, it may be painful. Surgery is recommended only in the case of complications such as compression of adjacent organs, lesion progression with tumor size >5cm and presence of symptoms. PRESENTATION OF CASE A 30 years old man, was evaluated during a routine visit, for diffuse abdominal pain and weight loss; Abdominal ultrasound showed no evidence of biliary obstruction but the US shows a hypoechoic, well defined focal lesion in the left liver. For a more accurate diagnosis a Magnetic Resonance detected a focal area about 14×9 cm in diameter, hypointense. Liver biopsy was not done.We could not diagnose it definitively as FNH from the results of imaging studies; so for the size of symptomatic lesion, the undefined diagnosis of FNH ,and due to the great increase in the size of the mass located in the left lobe, during such a short period , the surgery was been recommended. DISCUSSION FNH is the second most common hepatic lesion, but clinically relevant cases of FNH are rare with a reported prevalence in US studies of 0,03%. In our case the young patient was taking dietary supplements including anabolic androgenic steroids (AASs), carnitine and l-arginine. CONCLUSION The particularity of our case is the increasing of the lesion in two years in which the patient made use of anabolic steroids. under use of . This could be the explanation for increasing of nodule.
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Affiliation(s)
- Angela Romano
- Department of general surgery, Second University of Naples, Italy.
| | - Michele Grassia
- Department of general surgery, Second University of Naples, Italy.
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19
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Hu HJ, Qu YJ, Tian ZX, Zhang ZP. Clinical and radiographic observations from four patients with primary hepatic lymphoma. Exp Ther Med 2015; 11:381-386. [PMID: 26893619 PMCID: PMC4734166 DOI: 10.3892/etm.2015.2940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 02/23/2015] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to delineate the radiographic and clinical features of primary hepatic lymphoma (PHL). Four histopathologically confirmed cases of PHL were analyzed with respect to the radiological, clinical and pathological characteristics. The main clinical manifestations included upper right quadrant pain and lymphoma-associated B symptoms, such as fever, night sweating and weight loss. All the patients had elevated serum levels of lactate dehydrogenase. Furthermore, all the patients underwent plain and enhanced computed tomography examinations, which identified low-density lesions without marked enhancement. Solitary masses were observed in two cases, while multiple focal lesions were noted in one case and diffuse multi-speckled nodules were observed in one case. Two patients underwent abdominal magnetic resonance imaging, which revealed lesions that were hyperintense on T1-weighted imaging (WI) scans and hypointense on T2WI scans, and exhibited slight to moderate enhancement with a dynamic contrast-enhanced protocol. In one case, vessels were visible within the lesion. Therefore, the present study concluded that PHL is a rare condition that exhibits non-specific clinical and radiological features. A combination of imaging results and clinical manifestations can be used to facilitate a diagnosis of PHL.
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Affiliation(s)
- Hui-Juan Hu
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yan-Juan Qu
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Zhi-Xiong Tian
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Zai-Peng Zhang
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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20
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Lafaro KJ, Pawlik TM. Fibrolamellar hepatocellular carcinoma: current clinical perspectives. J Hepatocell Carcinoma 2015; 2:151-7. [PMID: 27508204 PMCID: PMC4918295 DOI: 10.2147/jhc.s75153] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Fibrolamellar carcinoma (FLC) is a variant of hepatocellular carcinoma (HCC), which comprises ∼1%–9% of all HCCs. Although FLC is a variant of HCC, it is distinct from HCC in that it most often affects younger patients (10–35 years of age) with no underlying liver disease. FLC often presents with vague abdominal pain, nausea, abdominal fullness, malaise, and weight loss. Surgery is the current mainstay of treatment for FLC and remains the only potentially curative option. While FLCs are considered less responsive to chemotherapy than their classic HCC counterparts, there have been suggestions that multimodality treatments may be effective, especially in advanced cases. Further research is necessary to determine effective systemic therapies as an adjunct to surgery for FLC.
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Affiliation(s)
- Kelly J Lafaro
- Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Abstract
Different imaging modalities including ultrasonography, computed tomography (CT), and MR imaging may be used in the liver depending on the clinical situation. The ability of dedicated contrast-enhanced liver MR imaging or CT to definitively characterize lesions as benign is crucial in avoiding unnecessary biopsy. Liver imaging surveillance in patients with cirrhosis may allow for detection of hepatocellular carcinoma at an earlier stage, and therefore may improve outcome. This article reviews the different imaging modalities used to evaluate the liver and focal benign and malignant hepatic lesions, and the basic surveillance strategy for patients at increased risk for hepatocellular carcinoma.
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Affiliation(s)
- Erin K O'Neill
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Jonathan R Cogley
- Department of Radiology, VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215, USA
| | - Frank H Miller
- Body Imaging Section, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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22
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Pinotti E, Ratti F, Cipriani F, Paganelli M, Catena M, Finazzi R, Aldrighetti L. Focal Nodular Hyperplasia. BENIGN TUMORS OF THE LIVER 2015:159-168. [DOI: 10.1007/978-3-319-12985-3_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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23
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Legha RS, Elsayes KM, Hussain HK. Cirrhosis and Hepatocellular Carcinoma. CROSS-SECTIONAL IMAGING OF THE ABDOMEN AND PELVIS 2015:77-96. [DOI: 10.1007/978-1-4939-1884-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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25
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26
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Do RKG, McErlean A, Ang CS, DeMatteo RP, Abou-Alfa GK. CT and MRI of primary and metastatic fibrolamellar carcinoma: a case series of 37 patients. Br J Radiol 2014; 87:20140024. [PMID: 24896196 DOI: 10.1259/bjr.20140024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Fibrolamellar carcinoma (FLC) is a rare disease, with limited radiographic reported information. We assessed the imaging patterns of primary and metastatic FLC. METHODS CT and MR examinations of patients with FLC were retrospectively reviewed. Imaging features were assessed for primary and recurrent liver tumours, including dimension, enhancement characteristics, and presence or absence of central scars. Locations of nodal and extranodal metastases were also recorded. RESULTS Of 37 patients (18 males and 19 females; average age, 23.5 years) with FLC, 24 had imaging of their primary tumour; 13 had metastases at presentation and 7 developed metastases on follow-up. The remaining 13 patients had follow-up imaging of metastatic disease. Primary FLC had a mean diameter >11 cm, with central scars in ten (46%) patients. Most tumours enhanced heterogeneously (96%) and showed arterial enhancement (81%). On MRI, 62% of FLCs were hypointense on T1 weighted imaging and 54% were hyperintense on T2 weighted imaging. 13 patients (54%) had nodal metastases at presentation, mostly in the upper abdomen (92%) and commonly in the chest (38%). Extrahepatic metastases were most frequently pulmonary or peritoneal. Predominantly small and homogeneous intrahepatic recurrences were detected on follow-up in 15 patients. CONCLUSION FLC often presents as a large hepatic tumour with nodal and distant metastases. Thoracic adenopathy and lung metastases were frequently found in our series, suggesting the need for pre-operative and follow-up chest imaging. ADVANCES IN KNOWLEDGE Thoracic nodal and lung metastases are common in FLC; therefore, dedicated chest imaging should be part of the evaluation of a patient with FLC.
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Affiliation(s)
- R K G Do
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Focal liver lesions (FLLs) are commonly encountered on routine imaging studies. Most lesions detected are benign, but many are indeterminate at the time of initial imaging. This article reviews the important role of MR imaging for the detection and characterization of various benign FLLs while illustrating typical imaging appearances and potential pitfalls in interpretation. The utility of diffusion-weighted imaging and hepatocyte-specific contrast agents is also discussed.
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Affiliation(s)
- Jonathan R Cogley
- Section of Body Imaging, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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28
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Ganeshan D, Szklaruk J, Kundra V, Kaseb A, Rashid A, Elsayes KM. Imaging features of fibrolamellar hepatocellular carcinoma. AJR Am J Roentgenol 2014; 202:544-552. [PMID: 24555590 DOI: 10.2214/ajr.13.11117] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Fibrolamellar hepatocellular carcinoma (HCC) is a rare primary liver tumor, which significantly differs from conventional HCC. This article reviews the molecular cytogenetics, pathology, imaging features, and management of this relatively rare tumor. CONCLUSION Fibrolamellar HCC predominantly occurs in young patients without underlying hepatitis or cirrhosis. Serum α-fetoproteins are not elevated in most cases, and hence imaging plays an important role in diagnosis, staging, and surveillance.
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Affiliation(s)
- Dhakshinamoorthy Ganeshan
- 1 Division of Diagnostic Imaging, Body Imaging Section, Unit 1473, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009
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Fukushima N, Tsurumi Y, Jujo K, Fukushima K, Sekiguchi H, Honda A, Yumino D, Kawana M, Hagiwara N. Impact of myocardial reperfusion status on QT dispersion after successful recanalization of the infarct-related artery in acute myocardial infarction. J Interv Cardiol 2014; 27:252-9. [PMID: 24450339 DOI: 10.1111/joic.12093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine whether adequate myocardial perfusion status after transluminal recanalization is associated with prompt improvement of QT dispersion (QTd). BACKGROUND Transluminal recanalization of the infarct-related coronary artery in acute myocardial infarction aims to promptly restore myocardial perfusion, to maximize electrical and mechanical recovery. QTd represents the heterogeneity of ventricular repolarization, which may affect electrical stability. METHODS Forty patients who underwent primary percutaneous coronary intervention for their first anterior acute ST-elevation myocardial infarction were prospectively enrolled. Myocardial reperfusion status was assessed by myocardial blush grade (MBG) on the final angiogram after successful recanalization (Thrombolysis In Myocardial Infarction Grade 3 flow). RESULTS Preprocedural QTd was similar in patients with final MBG 0-1, 2, and 3 (76 ± 24, 67 ± 13, and 69 ± 13 milliseconds, respectively; P = 0.661). After recanalization, QTd decreased in patients with MBG 3 (39 ± 16 milliseconds, P < 0.001) but not in patients with MBG 0-1 (74 ± 20 milliseconds) or MBG 2 (82 ± 16 milliseconds). Multivariate analysis showed that postprocedural MBG was an independent predictor of QTd after recanalization (standardized regression coefficient = -0.628, P < 0.001). CONCLUSIONS Adequate tissue perfusion may be crucial for electrical stability of the myocardium after reperfusion.
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Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management. Updates Surg 2013; 66:9-21. [DOI: 10.1007/s13304-013-0222-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/16/2013] [Indexed: 12/25/2022]
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Benign hepatocellular tumors in children: focal nodular hyperplasia and hepatocellular adenoma. Int J Hepatol 2013; 2013:215064. [PMID: 23555058 PMCID: PMC3608344 DOI: 10.1155/2013/215064] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/05/2013] [Indexed: 12/11/2022] Open
Abstract
Benign liver tumors are very rare in children. Most focal nodular hyperplasia (FNH) remain sporadic, but predisposing factors exist, as follows: long-term cancer survivor (with an increasing incidence), portal deprivation in congenital or surgical portosystemic shunt. The aspect is atypical on imaging in two-thirds of cases. Biopsy of the tumor and the nontumoral liver is then required. Surgical resection will be discussed in the case of large tumors with or without symptoms. In the case of associated vascular disorder with portal deprivation, restoration of the portal flow will be discussed in the hope of seeing the involution of FNH. HepatoCellular Adenoma (HCA) is frequently associated with predisposing factors such as GSD type I and III, Fanconi anemia especially if androgen therapy is administered, CPSS, and SPSS. Adenomatosis has been reported in germline mutation of HNF1- α . Management will depend on the presence of a predisposing factor and may include metabolic control, androgen therapy withdrawn, or closure of the shunt when appropriate. Surgery is usually performed on large lesions. In the case of adenomatosis or multiple lesions, surgery will be adapted. Close followup is required in all cases.
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Liu QY, Zhang WD, Lai DM, Ou-yang Y, Gao M, Lin XF. Hepatic focal nodular hyperplasia in children: Imaging features on multi-slice computed tomography. World J Gastroenterol 2012; 18:7048-7055. [PMID: 23323007 PMCID: PMC3531693 DOI: 10.3748/wjg.v18.i47.7048] [Citation(s) in RCA: 11] [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: 09/13/2012] [Revised: 09/30/2012] [Accepted: 11/13/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia (FNH) in children on dynamic contrast-enhanced multi-slice computed tomography (MSCT) and computed tomography angiography (CTA) images.
METHODS: From September 1999 to April 2012, a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University, including 12 cases (5.5%) of FNH in children (age ≤ 18 years old). All the 12 pediatric patients underwent MSCT. We retrospectively analyzed the imaging features of FNH lesions, including the number, location, size, margin, density of FNH demonstrated on pre-contrast and contrast-enhanced computed tomography (CT) scanning, central scar, fibrous septa, pseudocapsule, the morphology of the feeding arteries and the presence of draining vessels (portal vein or hepatic vein).
RESULTS: All the 12 pediatric cases of FNH had solitary lesion. The maximum diameter of the lesions was 4.0-12.9 cm, with an average diameter of 5.5 ± 2.5 cm. The majority of the FNH lesions (10/12, 83.3%) had well-defined margins. Central scar (10/12, 83.3%) and fibrous septa (11/12, 91.7%) were commonly found in children with FNH. Central scar was either isodense (n = 7) or hypodense (n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase. Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases. Pseudocapsule was very rare (1/12, 8.3%) in pediatric FNH. With the exception of central scars and fibrous septa within the lesions, all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images, significantly hyperdense in the arterial phase (12/12, 100.0%), and isodense in the portal venous phase (7/12, 58.3%) and equilibrium phase (11/12, 91.7%). Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH, whereas no neovascularization of malignant tumors was noted. In 9 cases (75.0%), there was a spoke-wheel shaped centrifugal blood supply inside the tumors. The draining hepatic vein was detected in 8 cases of pediatric FNH. However, the draining vessels in the other 4 cases could not be detected. No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.
CONCLUSION: The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH. Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.
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"Incidentaloma" of the liver: management of a diagnostic and therapeutic dilemma. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2012; 2012:891787. [PMID: 22927707 PMCID: PMC3423934 DOI: 10.1155/2012/891787] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/20/2012] [Accepted: 05/05/2012] [Indexed: 12/15/2022]
Abstract
The continuous development of highly sensitive clinical imaging increased the detection of focal lesions of the liver. These accidentally detected liver tumors without liver-specific symptoms such as cholestasis have been named “incidentalomas.” Diagnostic tools such as sonography, computed tomography, or magnetic resonance imaging are used increasingly in asymptomatic individuals without defined suspected diagnoses in the setting of general prevention or followup after a history of malignancy. But despite continuous improvement of diagnostics, some doubt regarding the benign or malign behavior of a tumor remains. In case an asymptomatic hemangioma or FNH can be preoperatively detected with certainty, the indication for surgery must be very strict. In case of symptomatic liver lesions surgical resection should only be indicated with tumor-specific symptoms. In the remaining cases of benign lesions of the liver, a “watch and wait” strategy is recommended. In case of uncertain diagnosis, especially in patients with positive history of a malignant tumor or the suspected diagnosis of hepatocellular adenoma, surgical resection is indicated. Due to the continuous improvement of surgical techniques, liver resection should be done in the laparoscopic technique. Laparoscopic surgery has lower morbidity and shorter hospitalization than open technique.
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Fielding L. Current imaging strategies of primary and secondary neoplasms of the liver. Semin Intervent Radiol 2011; 23:3-12. [PMID: 21326715 DOI: 10.1055/s-2006-939836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This article details the diagnosis and imaging of primary and secondary neoplasms of the liver. Benign conditions that can mimic malignancy are also discussed, such as focal nodular hyperplasia and adenoma. Considerable attention is given to hepatoma, which is the most common primary hepatic tumor in the United States. The roles of magnetic resonance imaging, computed tomography, and ultrasound are evaluated, with recommendations for their effective use. Pitfalls in imaging related to posttreatment changes and unusual patterns of metastatic disease are illustrated.
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Affiliation(s)
- Linda Fielding
- Visiting Associate Professor of Radiology, Denver Health Medical Center, Denver, Colorado
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Dual-phase computed tomographic angiography of focal nodular hyperplasia: defining predictable postcontrast attenuation levels relative to aorta and inferior vena cava. J Comput Assist Tomogr 2010; 34:720-4. [PMID: 20861775 DOI: 10.1097/rct.0b013e3181e23af8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To test the clinical observation that the postcontrast attenuation level of focal nodular hyperplasia (FNH) at dual-phase computed tomography (CT) rarely exceeds 50% of aortic enhancement or absolute inferior vena cava (IVC) enhancement. MATERIALS AND METHODS Nineteen pathologically proven FNHs in 17 female patients imaged with intravenous contrast-enhanced multidetector CT, of which 15 had arterial and venous phase acquisitions, were evaluated. Two radiologists retrospectively reviewed each CT study in consensus, using axial sections, multiplanar reconstructions, and 3-dimensional rendering techniques (volume rendering and maximum intensity projection). Recorded were precontrast and postcontrast attenuation of mass, the liver, the aorta, and the IVC; lesion size; segmental location; subjective appearance; contour; and presence of central scar, pseudocapsule, septations, feeding artery, or draining vein. RESULTS The mean FNH attenuation level was lower than 50% of the mean aortic attenuation during the arterial phase (115 vs 144 Hounsfield units) and also lower than the mean IVC attenuation in the portal venous phase (142 vs 153 Hounsfield units). Across cases, the FNH arterial phase attenuation was lower than 50% of the aortic attenuation in 74% (14/19). The portal venous attenuation level of FNH was lower than or equal to that of the IVC in 80% (12/15). One of the 2 enhancement patterns was present in 100% (15/15) of cases. Other common findings included feeding artery and draining vein (18/19), absence of pseudocapsule (18/19), and smooth contour (13/19). A central scar was identified in only 8 of 19 cases, and no lesion contained septations. CONCLUSIONS In this series of patients imaged with contrast-enhanced multidetector CT, most FNHs demonstrated arterial attenuation levels lower than 50% of the aorta and/or portal venous attenuation levels lower than or equal to those of the IVC.
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Napel SA, Beaulieu CF, Rodriguez C, Cui J, Xu J, Gupta A, Korenblum D, Greenspan H, Ma Y, Rubin DL. Automated retrieval of CT images of liver lesions on the basis of image similarity: method and preliminary results. Radiology 2010; 256:243-52. [PMID: 20505065 DOI: 10.1148/radiol.10091694] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a system to facilitate the retrieval of radiologic images that contain similar-appearing lesions and to perform a preliminary evaluation of this system with a database of computed tomographic (CT) images of the liver and an external standard of image similarity. MATERIALS AND METHODS Institutional review board approval was obtained for retrospective analysis of deidentified patient images. Thereafter, 30 portal venous phase CT images of the liver exhibiting one of three types of liver lesions (13 cysts, seven hemangiomas, 10 metastases) were selected. A radiologist used a controlled lexicon and a tool developed for complete and standardized description of lesions to identify and annotate each lesion with semantic features. In addition, this software automatically computed image features on the basis of image texture and boundary sharpness. Semantic and computer-generated features were weighted and combined into a feature vector representing each image. An independent reference standard was created for pairwise image similarity. This was used in a leave-one-out cross-validation to train weights that optimized the rankings of images in the database in terms of similarity to query images. Performance was evaluated by using precision-recall curves and normalized discounted cumulative gain (NDCG), a common measure for the usefulness of information retrieval. RESULTS When used individually, groups of semantic, texture, and boundary features resulted in various levels of performance in retrieving relevant lesions. However, combining all features produced the best overall results. Mean precision was greater than 90% at all values of recall, and mean, best, and worst case retrieval accuracy was greater than 95%, 100%, and greater than 78%, respectively, with NDCG. CONCLUSION Preliminary assessment of this approach shows excellent retrieval results for three types of liver lesions visible on portal venous CT images, warranting continued development and validation in a larger and more comprehensive database.
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Affiliation(s)
- Sandy A Napel
- Department of Radiology, Stanford University School of Medicine, James H. Clark Center S323, Stanford, CA 94305-5450, USA.
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He J, Zeng ZC, Tang ZY, Fan J, Zhou J, Zeng MS, Wang JH, Sun J, Chen B, Yang P, Pan BS. Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy. Cancer 2009; 115:2710-20. [PMID: 19382203 DOI: 10.1002/cncr.24300] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The current study was performed to identify clinical features and independent predictors of survival in patients with bone metastases from hepatocellular carcinoma (HCC). METHODS Patients (n = 205) with bone metastases from HCC received external beam radiotherapy (EBRT) between 1997 and 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined before EBRT. The total radiation dose ranged from 32 to 66 grays (Gy) (median, 50 Gy) and was focused on the involved bone. RESULTS In 80 of 205 (39.0%) patients with bone metastasis from HCC, tumors were characterized by osteolytic, expansile soft-tissue masses. Overall pain relief from EBRT occurred in 204 patients (99.5%). No consistent dose-response relation was found for palliation of bone metastases with doses between 32 and 66 Gy (P = .068), but the retreatment rate was higher in patients with expansile soft tissue. On univariate analysis, shorter survival was associated with poorer Karnofsky performance status (KPS), higher gamma-glutamyltransferase and alpha-fetoprotein levels, tumor size >5 cm, uncontrolled intrahepatic tumors, multifocal bone lesions, involvement of spinal vertebrae, extraosseous metastases, and a shorter disease-free interval after an initial diagnosis of HCC. On multivariate analysis, pretreatment-unfavorable predictors were associated with lower KPS, higher tumor markers, and uncontrolled intrahepatic tumor when KPS was considered. The median survival was 7.4 months. CONCLUSIONS The results of the current study provide detailed information regarding clinical features, survival outcomes, and prognostic factors for HCC with bone metastases in a relatively large cohort of patients treated with EBRT. These prognostic factors will help in determining which dose and fraction are appropriate.
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Affiliation(s)
- Jian He
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Abstract
Incidentally discovered liver masses are becoming more common with the increasing application and power of imaging techniques for the evaluation of abdominal conditions. Although such masses are often benign, conclusive diagnoses must be established in order to provide appropriate patient care. Various imaging modalities can be utilized to accurately diagnose such masses without resort to more invasive diagnostic measures.
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Anderson SW, Kruskal JB, Kane RA. Benign hepatic tumors and iatrogenic pseudotumors. Radiographics 2009; 29:211-29. [PMID: 19168846 DOI: 10.1148/rg.291085099] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Myriad benign tumors may be found in the liver; they can be classified according to their cell of origin into tumors of hepatocellular, cholangiocellular, or mesenchymal origin. Common benign hepatic tumors may pose a diagnostic dilemma when they manifest with atypical imaging features. Less frequently encountered benign hepatic tumors such as inflammatory pseudotumor or biliary cystadenoma demonstrate less specific imaging features; however, awareness of their findings is useful in narrowing differential diagnostic considerations. In addition, certain iatrogenically induced abnormalities of the liver may be confused with more ominous findings such as infection or neoplasia. However, knowledge of their common imaging appearances, in addition to the clinical history, is critical in correctly diagnosing and characterizing iatrogenic abnormalities of the liver. Familiarity with both expected and unexpected imaging appearances of common benign hepatic tumors, less commonly encountered benign hepatic tumors, and iatrogenic abnormalities potentially masquerading as hepatic tumors allows the radiologist to achieve an informed differential diagnosis.
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Affiliation(s)
- Stephan W Anderson
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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Zeng ZC, Fan J, Tang ZY, Zhou J, Wang JH, Wang BL, Guo W. Prognostic factors for patients with hepatocellular carcinoma with macroscopic portal vein or inferior vena cava tumor thrombi receiving external-beam radiation therapy. Cancer Sci 2008; 99:2510-7. [PMID: 19032365 PMCID: PMC11158789 DOI: 10.1111/j.1349-7006.2008.00981.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Prognostic factors in patients with hepatocellular carcinoma (HCC) with tumor thrombosis are not well established, especially for those given external-beam radiation therapy (EBRT). Patients (n = 136) with HCC who had portal vein (PV) or inferior vena cava (IVC) tumor thrombus received EBRT between January 1998 and October 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined at diagnosis and before EBRT. The total radiation dose ranged from 30 to 60 Gy (median, 50 Gy) and was focused on the tumor thrombi. Predictors of survival were identified using the univariate and multivariate analysis. Of the 136 patients, the tumor thrombus completely disappeared in 41 patients (30.1%), 36 patients (26.5%) had a partial response, 49 patients (36%) had stable disease, and 10 patients (7.4%) had progressive disease. On multivariate analysis, pretreatment unfavorable predictors were associated with lower albumin, higher gamma-glutamyltransferase and alpha-fetoprotein levels, poorer Child-Pugh classification, intrahepatic multifocality, lymph node metastases, poorer response to EBRT, and 2-dimension EBRT technique. Survival rates at 1, 2, and 3 years were 31.8%, 17.5%, and 8.8% for patients with PV tumor thrombi; 66.3%, 21.1%, and 15.8% for IVC tumor thrombi; and 25%, 8.3%, and 0% for PV plus IVC tumor thrombi, respectively. Overall median survival was 9.7 months. This study provides detailed information about the survival outcomes and prognostic factors of HCC with tumor thrombi in a relatively large cohort of patients treated with radiation, and the results will help in understanding the potential factors that influence survival for patients with HCC after EBRT.
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Affiliation(s)
- Zhao-Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 136 Yi Xue Road, Shanghai 200032, China.
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Laurent V, Corby S, Antunes L, Barbary C, Corby-Ciprian S, Kermarrec E, Béot S, Régent D. [Liver and focal liver contrast: radiologic-pathologic correlation]. ACTA ACUST UNITED AC 2007; 88:1036-47. [PMID: 17762833 DOI: 10.1016/s0221-0363(07)89917-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Knowledge of the histological features of different components of a liver lesion greatly assists radiologists because it provides understanding of the correspondingimaging features. The imaging characteristics of lesions depend on variations of the extracellular architecture, mainly surrounding stromal tissue. Until histological imaging techniques become available, cellular analysis relies on optical microscopy and immunohistochemistry. Recent advances in imaging techniques now provide additional information on lesions due to improved spatial, temporal and contrast resolution. Correct interpretation of these imaging features should improve diagnosis.
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Affiliation(s)
- V Laurent
- Service de Radiologie Adultes, Hôpital de Brabois, Allée du Morvan, 54500 Vandoeuvre les Nancy.
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Lin MCH, Tsay PK, Ko SF, Lui KW, Tseng JH, Hung CF, Hsueh C, Wan YL. Triphasic dynamic CT findings of 63 hepatic focal nodular hyperplasia in 46 patients: correlation with size and pathological findings. ACTA ACUST UNITED AC 2007; 33:301-7. [PMID: 17632749 DOI: 10.1007/s00261-007-9258-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND To correlate the dynamic computed tomography (CT) of hepatic focal nodular hyperplasia (FNH) with its size and pathology. METHODS The clinical data, pathological and dynamic CT findings of 36 FNHs in 24 males and 27 lesions in 22 females were reviewed. The pathological and CT findings of the 32 small FNHs (diameter < 3 cm) and 31 large FNHs (diameter >or= 3 cm) were compared and analyzed. RESULTS All FNHs were hypervascular at arterial phase except for central scarring. The mean diameter of FNHs with hypoattenuating, isoattenuating, hyperattenuating on delayed scans were 5.05 cm, 3.06 cm, and 2.70 cm, respectively (p = 0.026). As compared with small FNHs, large ones were significantly more likely to reveal central scarring (p = 0.005), vascular displacement (p < 0.001), and abnormal vessels around lesions (p < 0001). Coexistent bile ductile proliferation and bridging septa were more commonly observed in small FNHs (p = 0.028 for both). FNHs without aberrant vessels tended to feature hyperattenuating during the portal venous phase (p = 0.041). CONCLUSIONS FNHs with different tumor sizes may manifest various dynamic CT findings that are more or less related to the different pathological findings.
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Affiliation(s)
- Michael Che-Hung Lin
- Department of Radiology, Cardinal Tien Hospital, Yung Ho Branch, Yungho City, Taiwan
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Lockhart ME, Tessler FN, Canon CL, Smith JK, Larrison MC, Fineberg NS, Roy BP, Clements RH. Internal hernia after gastric bypass: sensitivity and specificity of seven CT signs with surgical correlation and controls. AJR Am J Roentgenol 2007; 188:745-50. [PMID: 17312063 DOI: 10.2214/ajr.06.0541] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the sensitivity and specificity of seven CT signs in the diagnosis of internal hernia after laparoscopic Roux-en-Y gastric bypass. MATERIALS AND METHODS With institutional review board approval, the CT scans of 18 patients (17 women, one man) with surgically proven internal hernia after laparoscopic Roux-en-Y gastric bypass were retrieved, as were CT studies of a control group of 18 women who had undergone gastric bypass but did not have internal hernia at reoperation. The scans were reviewed by three radiologists for the presence of seven CT signs of internal hernia: swirled appearance of mesenteric fat or vessels, mushroom shape of hernia, tubular distal mesenteric fat surrounded by bowel loops, small-bowel obstruction, clustered loops of small bowel, small bowel other than duodenum posterior to the superior mesenteric artery, and right-sided location of the distal jejunal anastomosis. Sensitivity and specificity were calculated for each sign. Stepwise logistic regression was performed to ascertain an independent set of variables predictive of the presence of internal hernia. RESULTS Mesenteric swirl was the best single predictor of hernia; sensitivity was 61%, 78%, and 83%, and specificity was 94%, 89%, and 67% for the three reviewers. The combination of swirled mesentery and mushroom shape of the mesentery was better than swirled mesentery alone, sensitivity being 78%, 83%, and 83%, and specificity being 83%, 89%, and 67%, but the difference was not statistically significant. CONCLUSION Mesenteric swirl is the best indicator of internal hernia after laparoscopic Roux-en-Y gastric bypass, and even minor degrees of swirl should be considered suspicious.
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Affiliation(s)
- Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, 619 19th St. S, Birmingham, AL 35249-6830, USA.
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Yen YH, Wang JH, Lu SN, Chen TY, Changchien CS, Chen CH, Hung CH, Lee CM. Contrast-enhanced ultrasonographic spoke-wheel sign in hepatic focal nodular hyperplasia. Eur J Radiol 2006; 60:439-44. [PMID: 16916591 DOI: 10.1016/j.ejrad.2006.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 06/18/2006] [Accepted: 06/27/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND To determine the utility of contrast-enhanced ultrasonography (CEUS) in assessing hepatic tumors with central feeding arteries found by color/power Doppler ultrasonograophy (CDUS/PDUS). METHODS We prospectively studied 37 hepatic tumors (34 patients), with a mean size of 2.9cm and each having a central feeding artery, by CDUS/PDUS. The CEUS was performed with a galactose-based microbubble contrast agent. The detection of a spoke-wheel sign was interpreted as evidence of focal nodular hyperplasia (FNH). All patients underwent tumor biopsies or surgical resection. RESULTS CEUS showed a central feeding artery with a spoke-wheel sign in 36 tumors, including 34 FNHs and 2 hepatocellular carcinomas. The remaining tumor was demonstrated to be FNH despite the absence of a spoke-wheel sign as detected by CEUS. The sensitivity of the spoke-wheel sign or central scar for FNH was 97.1% (34/35), 40% (14/35), 28.6% (10/35), 50% (8/16) and 0% (0/15) for CEUS, CDUS/PDUS, dynamic computed tomography (CT) or magnetic resonance imaging (MRI), hepatic angiography and liver scintigraphy, respectively. The two hepatocellular carcinomas showed scirrhous changes histologically. CONCLUSIONS CEUS is more sensitive than CDUS/PDUS, dynamic CT, MRI, hepatic angiography and liver scintigraphy in the detection of the spoke-wheel sign or central scar in FNH. Scirrhous hepatocellular carcinoma should be included in the differential diagnosis for liver tumors with spoke-wheel sign detected by CEUS.
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Affiliation(s)
- Yi-Hao Yen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Kaohsiung 833, Taiwan
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Okumura E, Sanada S, Suzuki M, Matsui O. A computer-aided temporal and dynamic subtraction technique of the liver for detection of small hepatocellular carcinomas on abdominal CT images. Phys Med Biol 2006; 51:4759-71. [PMID: 16985269 DOI: 10.1088/0031-9155/51/19/003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It is often difficult for radiologists to identify small hepatocellular carcinomas (HCCs) due to insufficient contrast enhancement. Therefore, we have developed a new computer-aided temporal and dynamic subtraction technique to enhance small HCCs, after automatically selecting images set at the same anatomical position from the present (non-enhanced and arterial-phase CT images) and previous images. The present study was performed with CT images from 14 subjects. First, we used template-matching based on similarities in liver shape between the present (non-enhanced and arterial-phase CT images) and previous arterial-phase CT images at the same position. Temporal subtraction images were then obtained by subtraction of the previous image from the present image taken at the same position of the liver. Dynamic subtraction images were also obtained by subtraction of non-enhanced CT images from arterial-phase CT images taken at the same position of the liver. Twenty-one of 22 nodules (95.5%) with contrast enhancement were visualized in temporal and dynamic subtraction images. Compared with present arterial-phase CT images, increases of 150% and 140% in nodule-to-liver contrast were observed on dynamic and temporal subtraction images, respectively. These subtraction images may be useful as reference images in the detection of small moderately differentiated HCCs.
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Affiliation(s)
- E Okumura
- Department of Radiological Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
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Yamauchi M, Asayama Y, Yoshimitsu K, Irie H, Tajima T, Hirakawa M, Ishigami K, Nakayama T, Kakihara D, Yamaguchi K, Nishihara Y, Aishima S, Honda H. Hepatocellular carcinoma with a prominent vascular scar in the center: MR imaging findings. ACTA ACUST UNITED AC 2006; 24:467-70. [PMID: 16958431 DOI: 10.1007/s11604-006-0052-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 02/16/2006] [Indexed: 12/13/2022]
Abstract
We report herein a case of hepatocellular carcinoma (HCC) with a prominent central scar. Dynamic CT and MRI studies revealed a hypervascular liver mass and a washout of contrast material in the delayed phase. The tumor center showed particular hyperintensity on T2-weighted images and delayed or prolonged enhancement. The surgical specimen revealed moderately differentiated HCC with a central scar. The central scar consisted of prominent vascular channels and loose fibrous tissue, indicative of a vascular scar. We should understand MR imaging findings of this type of central scar in the HCC.
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Affiliation(s)
- Madoka Yamauchi
- Department of Clinical Radiology, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-8582, Japan
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Matake K, Yoshimitsu K, Kumazawa S, Higashida Y, Irie H, Asayama Y, Nakayama T, Kakihara D, Katsuragawa S, Doi K, Honda H. Usefulness of artificial neural network for differential diagnosis of hepatic masses on CT images. Acad Radiol 2006; 13:951-62. [PMID: 16843847 DOI: 10.1016/j.acra.2006.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Revised: 04/18/2006] [Accepted: 04/19/2006] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVE Our purpose in this study is to apply an artificial neural network (ANN) for differential diagnosis of certain hepatic masses on computed tomographic (CT) images and evaluate the effect of ANN output on radiologist diagnostic performance. MATERIALS AND METHODS We collected 120 cases of hepatic disease. We used a single three-layer feed-forward ANN with a back-propagation algorithm. The ANN is designed to differentiate four hepatic masses (hepatocellular carcinoma, intrahepatic peripheral cholangiocarcinoma, hemangioma, and metastasis) by using nine clinical parameters and 24 radiological findings in dual-phase contrast-enhanced CT images. Thus, the ANN consisted of 33 input units and four output units. Subjective ratings for the 24 radiological findings were provided independently by two attending radiologists. All clinical cases were used for training and testing of the ANN by implementation of a round-robin technique. In the observer test, CT images of all 120 cases (30 cases for each disease) were used. CT images were viewed by seven radiologists first without and then with ANN output. Radiologist performance was evaluated by using receiver operating characteristic (ROC) analysis on a continuous rating scale. RESULTS Averaged area under the ROC curve for ANN alone was 0.961. The diagnostic performance of seven radiologists increased from 0.888 to 0.934 (P < .02) when they used ANN output. CONCLUSION The ANN can provide useful output as a second opinion to improve radiologist diagnostic performance in the differential diagnosis of hepatic masses seen on contrast-enhanced CT.
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Affiliation(s)
- Kunishige Matake
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Fukuoka, 812-8582, Japan.
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D'Ippolito G, Appezzato LF, Ribeiro ACR, Abreu Junior LD, Borri ML, Galvão Filho MDM, Hartmann LGC, Wolosker AMB. Apresentações incomuns do hemangioma hepático: ensaio iconográfico. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000300013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
O nosso objetivo foi descrever e ilustrar aspectos incomuns do hemangioma hepático na ultra-sonografia (US), tomografia computadorizada (TC) e ressonância magnética (RM). A partir da análise retrospectiva de 300 casos de pacientes com diagnósticos de hemangioma hepático, por meio da análise combinada de exames de imagem, biópsia ou acompanhamento clínico, selecionamos aqueles com apresentação atípica em um ou mais métodos de imagem ou aqueles com evolução não usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hemangiomas: hipoecogênicos na US; hipovasculares ou avasculares na TC e RM; com calcificações grosseiras; gigantes e medindo mais de 20 cm de diâmetro; predominantemente exofíticos; hipointensos em T2; promovendo defeito de perfusão; com cicatriz central e simulando hiperplasia nodular focal; com crescimento evolutivo. O hemangioma hepático é o tumor mais comum do fígado e geralmente tem apresentação típica. Porém, os seus diversos aspectos não usuais precisam ser conhecidos para auxiliar na orientação diagnóstica e conduta.
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