• Hepatocellular carcinoma
• Nanocomposite hydrogel
• Radiofrequency ablation
• Small ubiquitin-like modifier 2
• TAK-981

• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/drug therapy
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/therapy
• Liver Neoplasms/drug therapy
• Liver Neoplasms/pathology
• Animals
• Hydrogels/chemistry
• Nanocomposites/chemistry
• Nanocomposites/therapeutic use
• Humans
• Mice
• Radiofrequency Ablation/methods
• Sumoylation/drug effects
• Cell Line, Tumor
• Male

• 82202277 National Natural Science Foundation of China
• 82102164 National Natural Science Foundation of China
• 2021A1515110978 Natural Science Foundation of Guangdong Province
• 2023LSYS001 Guangdong-Hong Kong-Macao University Joint Laboratory of Interventional Medicine Foundation of Guangdong Province

• Ablation
• Ablation techniques
• Carcinoma
• Catheter
• Hepatocellular
• Liver
• Medication therapy management
• RECIST
• Radio frequency ablation

• Humans
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Immunotherapy
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Ablation Techniques
• Medication Therapy Management
• Magnetic Resonance Imaging
• Tomography, X-Ray Computed

The role of imaging in the management of hepatocellular carcinoma (HCC) has significantly evolved and expanded beyond the plain radiological confirmation of the tumor based on the typical appearance in a multiphase contrast-enhanced CT or MRI examination. The introduction of hepatobiliary contrast agents has enabled the diagnosis of hepatocarcinogenesis at earlier stages, while the application of ultrasound contrast agents has drastically upgraded the role of ultrasound in the diagnostic algorithms. Newer quantitative techniques assessing blood perfusion on CT and MRI not only allow earlier diagnosis and confident differentiation from other lesions, but they also provide biomarkers for the evaluation of treatment response. As distinct HCC subtypes are identified, their correlation with specific imaging features holds great promise for estimating tumor aggressiveness and prognosis. This review presents the current role of imaging and underlines its critical role in the successful management of patients with HCC.

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related death worldwide. Radiology has traditionally played a central role in HCC management, ranging from screening of high-risk patients to non-invasive diagnosis, as well as the evaluation of treatment response and post-treatment follow-up. From liver ultrasonography with or without contrast to dynamic multiple phased CT and dynamic MRI with diffusion protocols, great progress has been achieved in the last decade. Throughout the last few years, pathological, biological, genetic, and immune-chemical analyses have revealed several tumoral subtypes with diverse biological behavior, highlighting the need for the re-evaluation of established radiological methods. Considering these changes, novel methods that provide functional and quantitative parameters in addition to morphological information are increasingly incorporated into modern diagnostic protocols for HCC. In this way, differential diagnosis became even more challenging throughout the last few years. Use of liver specific contrast agents, as well as CT/MRI perfusion techniques, seem to not only allow earlier detection and more accurate characterization of HCC lesions, but also make it possible to predict response to treatment and survival. Nevertheless, several limitations and technical considerations still exist. This review will describe and discuss all these imaging modalities and their advances in the imaging of HCC lesions in cirrhotic and non-cirrhotic livers. Sensitivity and specificity rates, method limitations, and technical considerations will be discussed.

• CT perfusion (CTP)
• Radiofrequency ablation (RFA)
• VX2 tumor
• lung tumor

• CT perfusion images
• HCC
• VX2 tumor models
• computed tomography
• radiofrequency ablation

Perfusion Computed Tomography (CTp) is an imaging technique which allows quantitative and qualitative evaluation of tissue perfusion through dynamic CT acquisitions. Since CTp is still considered a research tool in the field of abdominal imaging, the aim of this work is to provide a systematic summary of the current literature on CTp in the abdominal region to clarify the role of this technique for abdominal cancer applications.

A systematic literature search of PubMed, Web of Science, and Scopus was performed to identify original articles involving the use of CTp for clinical applications in abdominal cancer since 2011. Studies were included if they reported original data on CTp and investigated the clinical applications of CTp in abdominal cancer.

Fifty-seven studies were finally included in the study. Most of the included articles (33/57) dealt with CTp at the level of the liver, while a low number of studies investigated CTp for oncologic diseases involving UGI tract (8/57), pancreas (8/57), kidneys (3/57), and colon–rectum (5/57).

Our study revealed that CTp could be a valuable functional imaging tool in the field of abdominal oncology, particularly as a biomarker for monitoring the response to anti-tumoral treatment.

• abdominal cancer
• abdominal imaging
• computed tomography perfusion
• perfusion parameter

To evaluate the application of Arterial Enhancement Fraction (AEF) texture features in predicting the tumor response in Hepatocellular Carcinoma (HCC) treated with Transarterial Chemoembolization (TACE) by means of texture analysis.

HCC patients treated with TACE in Shengjing Hospital of China Medical University from June 2018 to December 2019 were retrospectively enrolled in this study. Pre-TACE Contrast Enhanced Computed Tomography (CECT) and imaging follow-up within 6 months were both acquired. The tumor responses were categorized according to the modified RECIST (mRECIST) criteria. Based on the CECT images, Region of Interest (ROI) of HCC lesion was drawn, the AEF calculation and texture analysis upon AEF values in the ROI were performed using CT-Kinetics (C.K., GE Healthcare, China). A total of 32 AEF texture features were extracted and compared between different tumor response groups. Multi-variate logistic regression was performed using certain AEF features to build the differential models to predict the tumor response. The Receiver Operator Characteristic (ROC) analysis was implemented to assess the discriminative performance of these models.

Forty-five patients were finally enrolled in the study. Eight AEF texture features showed significant distinction between Improved and Un-improved patients (p < 0.05). In multi-variate logistic regression, 9 AEF texture features were applied into modeling to predict “Improved” outcome, and 4 AEF texture features were applied into modeling to predict “Un-worsened” outcome. The Area Under Curve (AUC), diagnostic accuracy, sensitivity, and specificity of the two models were 0.941, 0.911, 1.000, 0.826, and 0.824, 0.711, 0.581, 1.000, respectively.

Certain AEF heterogeneous features of HCC could possibly be utilized to predict the tumor response to TACE treatment.

• AEF
• HCC
• Heterogeneity
• TACE
• Texture analysis
• Tumor response

• Aged
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/surgery
• Catheter Ablation
• Female
• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Perfusion
• Radiofrequency Ablation
• Retrospective Studies
• Tomography, X-Ray Computed
• Treatment Outcome

After hepatic microwave ablation, the differentiation between fully necrotic and persistent vital tissue through contrast enhanced CT remains a clinical challenge. Therefore, there is a need to evaluate new imaging modalities, such as CT perfusion (CTP) to improve the visualization of coagulation necrosis. MWA and CTP were prospectively performed in five healthy pigs. After the procedure, the pigs were euthanized, and the livers explanted. Orthogonal histological slices of the ablations were stained with a vital stain, digitalized and the necrotic core was segmented. CTP maps were calculated using a dual-input deconvolution algorithm. The segmented necrotic zones were overlaid on the DICOM images to calculate the accuracy of depiction by CECT/CTP compared to the histological reference standard. A receiver operating characteristic analysis was performed to determine the agreement/true positive rate and disagreement/false discovery rate between CECT/CTP and histology. Standard CECT showed a true positive rate of 81% and a false discovery rate of 52% for display of the coagulation necrosis. Using CTP, delineation of the coagulation necrosis could be improved significantly through the display of hepatic blood volume and hepatic arterial blood flow (p < 0.001). The ratios of true positive rate/false discovery rate were 89%/25% and 90%/50% respectively. Other parameter maps showed an inferior performance compared to CECT.

• Computed tomography
• Hepatocellular carcinoma
• Perfusion imaging
• Radiofrequency ablation
• Sorafenib
• Transarterial chemoembolization

• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/therapy
• Combined Modality Therapy
• Early Diagnosis
• Follow-Up Studies
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/therapy
• Perfusion Imaging/methods
• Tomography, X-Ray Computed/methods
• Treatment Outcome

• Animals
• Catheter Ablation/veterinary
• Dogs
• Elasticity Imaging Techniques/methods
• Elasticity Imaging Techniques/veterinary
• Liver/pathology
• Liver/surgery
• Perfusion Imaging
• Radiofrequency Ablation/methods
• Radiofrequency Ablation/veterinary
• Tomography, X-Ray Computed

• Liver
• alveolar echinococcosis
• computed tomography perfusion imaging

Primary liver cancer is one of the most common malignant tumors in the world, and only a few patients have the chance of surgical resection. Radiofrequency ablation (RFA) is a good treatment for patients with unresectable liver cancer. The existence of residual cancer after radiofrequency ablation has a direct impact on the prognosis of patients, so it is important to accurately determine whether there is residual cancer after RFA treatment in order to reduce the local recurrence and prolong the survival time of patients. In this paper, we discuss the evaluation of residual cancer after radiofrequency ablation of hepatocellular carcinoma by ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA) and nuclear medicine modalities.

• Hepatocellular carcinoma
• Radiofrequency ablation
• Residual cancer
• Evaluation

• Transarterial chemoembolization (TACE)
• contrast-enhanced ultrasound (CEUS)
• hepatocellular carcinoma (HCC)
• volume perfusion computed tomography (VPCT)

Early diagnosis of hepatocellular carcinoma (HCC) is crucial for optimizing treatment outcome. Ongoing advances are being made in imaging of HCC regarding detection, grading, staging, and also treatment monitoring. This review gives an overview of the current international guidelines for diagnosing HCC and their discrepancies as well as critically summarizes the role of magnetic resonance imaging (MRI) and computed tomography (CT) techniques for imaging in HCC. The diagnostic performance of MRI with nonspecific and hepatobililiary contrast agents and the role of functional imaging with diffusion-weighted imaging will be discussed. On the other hand, CT as a fast, cheap and easily accessible imaging modality plays a major role in the clinical routine work-up of HCC. Technical advances in CT, such as dual energy CT and volume perfusion CT, are currently being explored for improving detection, characterization and staging of HCC with promising results. Cone beam CT can provide a three-dimensional analysis of the liver with tumor and vessel characterization comparable to cross-sectional imaging so that this technique is gaining an increasing role in the peri-procedural imaging of HCC treated with interventional techniques.

• computed tomography
• contrast media
• diffusion-weighted imaging
• dual-energy computed tomography
• dynamic contrast-enhanced magnetic resonance imaging
• guidelines
• hepatocellular carcinoma
• hepatocyte specific contrast media
• magnetic resonance imaging
• volume perfusion computed tomography

• Hepatocellular carcinoma (HCC)
• Liver parenchymal perfusion
• Transarterial chemoembolization (TACE)
• Volume perfusion computed tomography (VPCT)

Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.

• Diffusion magnetic resonance imaging
• Perfusion imaging
• Hepatocellular carcinoma
• Liver neoplasms
• Pancreatic neoplasms

• Diagnostic Imaging/methods
• Diffusion Magnetic Resonance Imaging
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/therapy
• Multimodal Imaging
• Neoplasm Staging
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/therapy
• Positron-Emission Tomography
• Predictive Value of Tests
• Tomography, X-Ray Computed
• Treatment Outcome

• CT-perfusion
• Hepatocellular carcinoma
• MDCT
• Neoangiogenesis
• Radiofrequency ablation
• Trans-arterial chemoembolization

• Adult
• Aged
• Aged, 80 and over
• Biopsy, Fine-Needle
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Catheter Ablation
• Chemoembolization, Therapeutic/methods
• Humans
• Liver/blood supply
• Liver/diagnostic imaging
• Liver/pathology
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Middle Aged
• Multidetector Computed Tomography/methods
• Neovascularization, Pathologic/diagnostic imaging
• Prospective Studies
• Treatment Outcome

Alveolar echinococcosis (AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis (E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography (US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography (CT), magnetic resonance imaging (MRI), including magnetic resonance cholangiography (MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.

• Alveolar echinococcosis
• Liver
• Diagnosis
• Intervention
• Imaging
• Review

Percutaneous ablation using thermal or chemical methods has been widely used in the treatment of hepatocellular carcinoma (HCC). Nowadays, contrast-enhanced imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS) are widely used to evaluate local treatment response after ablation therapies. CEUS is gaining increasing attention due to its characteristics including real-time scanning, easy performance, lack of radiation, wide availability, and lack of allergy reactions. Several studies have documented that CEUS is comparable to CT or MRI in evaluating local treatment efficacy within 1 mo of treatment. However, little information is available regarding the role of CEUS in the follow-up assessment after first successful ablation treatment. Zheng et al found that in comparison with contrast-enhanced computed tomography (CECT), the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CEUS in detecting local tumor progression (LTP) were 67.5%, 97.4%, 81.8%, 94.4% and 92.3%, respectively, and were 77.7%, 92.0%, 92.4%, 76.7% and 84.0%, respectively for the detection of new intrahepatic recurrence. They concluded that the sensitivity of CEUS in detecting LTP and new intrahepatic recurrence after ablation is relatively low in comparison with CECT, and CEUS cannot replace CECT in the follow-up assessment after percutaneous ablation for HCC. These results are meaningful and instructive, and indicated that in the follow-up period, the use of CEUS alone is not sufficient. In this commentary, we discuss the discordance between CT and CEUS, as well as the underlying mechanisms involved. We propose the combined use of CT and CEUS which will reduce false positive and negative results in both modalities. We also discuss future issues, such as an evidence-based ideal imaging follow-up scheme, and a cost-effectiveness analysis of this imaging follow-up scheme.

• Hepatocellular carcinoma
• Radiofrequency ablation
• Ethanol ablation
• Contrast-enhanced ultrasound
• Follow-up
• Treatment response
• Computed tomography

• Carcinoma, Hepatocellular
• Catheter Ablation
• Humans