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Zhang W, Nie W, Li B, Wang H. Ultrasonography is an effective method for evaluating hepatosplenic fungal infections in pediatric onco-hematological patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:866-874. [PMID: 38761012 DOI: 10.1002/jcu.23730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This prospective study assessed the value of ultrasonography (US) in the evaluation of hepatosplenic fungal infections (HSFI). METHODS Thirty-two pediatric participants with confirmed onco-hematological diseases and HSFI were included. Lesions in the liver and/or spleen were detected by US, magnetic resonance imaging (MRI), or computed tomography (CT). RESULTS Of the participants, 11 (34%) had confirmed HSFI, while 21 (66%) had highly suspected HSFI. The US, CT, MRI, and fungal blood cultures demonstrated positive results in 31, 19, 25, and 7 patients, respectively. US had a significantly higher detection rate than CT, MRI, and fungal blood cultures (p < 0.05). The "bull's eye" phenomenon was a distinctive US feature of HSFI. Follow-up examinations indicated that after a mean of 7.7 (1-15) months, liver and/or spleen lesions disappeared in five patients. The lesion was significantly smaller in 10 patients. Residual calcifications were detected in 15 patients. Two patients died. CONCLUSION Conclusively, the US may substitute for tissue biopsy, other imaging modalities, or fungal blood culture for the confirmation of HSFI, and may guide better antifungal treatment, thus achieving better outcomes.
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Affiliation(s)
- Wenhua Zhang
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Wei Nie
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Bin Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Hui Wang
- Department of Special Examination, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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2
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Curley SA, Vecchio R. New Trends in the Surgical Treatment of Colorectal Cancer Liver Metastases. TUMORI JOURNAL 2018; 84:281-8. [PMID: 9678609 DOI: 10.1177/030089169808400301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal cancer is one of the most common solid tumors affecting people around the world. A significant proportion of patients with colorectal cancer will develop or will present with liver metastases. In some of these patients, the liver is the only site of metastatic disease. Thus, surgical treatment approaches are an appropriate and important treatment option in patients with liver-only colorectal cancer metastases. Resection of colorectal cancer liver metastases can produce long-term survival in selected patients, but the efficacy of liver resection as a solitary treatment is limited by two factors. First, a minority of patients with liver metastases have resectable disease. Second, the majority of patients who undergo successful liver resection for colorectal cancer metastases develop recurrent disease in the liver, extrahepatic sites, or both. In this paper, in addition to the results of liver resection for colorectal cancer metastases, we will review the results of cryoablation, heat ablation, and hepatic arterial chemotherapy using a surgically implanted pump. Each of these surgical treatment modalities can produce long-term survival in a subset of patients with liver-only colorectal cancer metastases, whereas systemic chemotherapy used alone rarely results in long-term survival in these patients. While surgical treatments provide the best chance for long-term survival or, in some cases, the best palliation in patients with colorectal cancer liver metastases, it is clear that further improvements in patient outcome will require multimodality therapy regimens.
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Affiliation(s)
- S A Curley
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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3
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Sawada S, Nakamura K, Tanigawa N, Kobayashi M. Computed Tomographic Percutaneous Transsplenic Portography. Acta Radiol 2016. [DOI: 10.1177/028418519303400522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis of liver tumors should be utilized for determination of not only the number of lesions, but also their size, segmental location and extent, and the relationship of the mass or masses to the hepatic vasculature. CT during arterial portography (CTAP) is the most sensitive imaging modality for precise diagnosis of hepatocellular carcinoma (1–3, 5). CTAP is thus widely used as a diagnostic imaging technique, particularly for the detection of small hepatocellular carcinomas (4, 6, 8). Conventional splenic portography has been carried out for many years using a wide diameter needle, a large amount of contrast medium and a film-screen system (7). Since the development of arterial portography, fewer splenoportograms have been performed due to the high incidence of bleeding and other complications (7). In this study a 0.6-mm (23 gauge) thin needle was used for splenic puncture and CT was used as a detector instead of a film-screen system. With this technique CT during percutaneous transsplenic portography may be performed on an outpatient basis.
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Affiliation(s)
- S. Sawada
- Department of Radiology, Tottori University Hospital, Yonago, Japan
| | - K. Nakamura
- Department of Radiology, Tottori University Hospital, Yonago, Japan
| | - N. Tanigawa
- Department of Radiology, Tottori University Hospital, Yonago, Japan
| | - M. Kobayashi
- Department of Radiology, Tottori University Hospital, Yonago, Japan
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4
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Irie T, Takeshita K, Makita K, Yamauchi T, Kusano S. A One-Stage Method for Obtaining CT during Arterial Portography and Hepatic Arteriography. Acta Radiol 2016. [DOI: 10.1177/028418519403500206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a new technique for performing CT during arterial portography (CTAP) and during hepatic arteriography (CTHA) in a one-stage procedure, using a coaxial balloon catheter system and slip-ring CT equipment. This technique was employed in 10 patients with liver neoplasms. Both CTAP and CTHA images were obtained in all patients.
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5
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Tidebrant G, Lukes P, Wihed A. CT Attenuation of Normal Liver Parenchyma on Delayed Scanning with Iohexol. Acta Radiol 2016. [DOI: 10.1177/028418519203300528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty patients were examined with CT of the liver before, during, and 4 to 6 hours after i.v. administration of 60 g iodine (200 ml iohexol). The attenuation of normal liver parenchyma was measured. The mean attenuation of normal liver parenchyma on nonenhanced scanning was 62.6 HU and on delayed scanning 78.7 HU. It seems that iohexol is a suitable contrast medium for delayed scanning of the liver.
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Affiliation(s)
- G. Tidebrant
- The Department of Radiology, Östra Sjukhuset, University of Gothenburg, Gothenburg, Sweden
| | - P. Lukes
- The Department of Radiology, Östra Sjukhuset, University of Gothenburg, Gothenburg, Sweden
| | - A. Wihed
- The Department of Radiology, Östra Sjukhuset, University of Gothenburg, Gothenburg, Sweden
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6
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Attwa MH, El-Etreby SA. Guide for diagnosis and treatment of hepatocellular carcinoma. World J Hepatol 2015; 7:1632-1651. [PMID: 26140083 PMCID: PMC4483545 DOI: 10.4254/wjh.v7.i12.1632] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/31/2014] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is ranked as the 5th common type of cancer worldwide and is considered as the 3rd common reason for cancer-related deaths. HCC often occurs on top of a cirrhotic liver. The prognosis is determined by several factors; tumour extension, alpha-fetoprotein (AFP) concentration, histologic subtype of the tumour, degree of liver dysfunction, and the patient’s performance status. HCC prognosis is strongly correlated with diagnostic delay. To date, no ideal screening modality has been developed. Analysis of recent studies showed that AFP assessment lacks adequate sensitivity and specificity for effective surveillance and diagnosis. Many tumour markers have been tested in clinical trials without progressing to routine use in clinical practice. Thus, surveillance is still based on ultrasound (US) examination every 6 mo. Imaging studies for diagnosis of HCC can fall into one of two main categories: routine non-invasive studies such as US, computed tomography (CT), and magnetic resonance imaging, and more specialized invasive techniques including CT during hepatic arteriography and CT arterial portography in addition to the conventional hepatic angiography. This article provides an overview and spotlight on the different diagnostic modalities and treatment options of HCC.
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7
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Rubin GD. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology 2015; 273:S45-74. [PMID: 25340438 DOI: 10.1148/radiol.14141356] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) has had a profound effect on the practice of medicine. Both the spectrum of clinical applications and the role that CT has played in enhancing the depth of our understanding of disease have been profound. Although almost 90 000 articles on CT have been published in peer-reviewed journals over the past 40 years, fewer than 5% of these have been published in Radiology. Nevertheless, these almost 4000 articles have provided a basis for many important medical advances. By enabling a deepened understanding of anatomy, physiology, and pathology, CT has facilitated key advances in the detection and management of disease. This article celebrates this breadth of scientific discovery and development by examining the impact that CT has had on the diagnosis, characterization, and management of a sampling of major health challenges, including stroke, vascular diseases, cancer, trauma, acute abdominal pain, and diffuse lung diseases, as related to key technical advances in CT and manifested in Radiology.
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Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute and Department of Radiology, Duke University School of Medicine, PO Box 17969, 2400 Pratt St, Durham, NC 27715
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8
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Katayama K, Ohkawa K, Imanaka K, Sakakibara M, Miyazaki M, Kimura H, Ishihara A, Matsunaga T, Murata M, Nakazawa T, Nakanishi K. Computed tomography during hepatic arteriography pattern may predict hepatocellular carcinoma recurrence following transarterial chemoembolization. Hepatol Res 2014; 44:E455-63. [PMID: 24697985 DOI: 10.1111/hepr.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 12/22/2022]
Abstract
AIM This study aimed to determine the role of morphological patterns seen on imaging in predicting hepatocellular carcinoma recurrence following transarterial chemoembolization therapy. METHODS Forty-seven patients from a single center who underwent transarterial chemoembolization to treat unresectable hepatocellular carcinomas between January 2011 and June 2012 were included in this study. We investigated whether the two pretreatment findings on computed tomography during hepatic arteriography (pattern 1, the single nodule pattern; pattern 2, at least one nodule showing the contiguous multinodular pattern) and other factors (age, sex, etiology, serum total bilirubin, serum albumin, prothrombin time, platelet count, serum level of protein induced by vitamin K absence/antagonist-II, serum α-fetoprotein, number of previous treatments for hepatocellular carcinoma, tumor number and maximum tumor size, presence of hypovascular lesions) could predict post-treatment recurrence. RESULTS In a univariate analysis using Cox's proportional hazards model, serum total bilirubin, the serum level of protein induced by vitamin K absence/antagonist-II (≤100 vs ≥101 mAU/mL), tumor morphology (pattern 1 vs 2) and tumor number (≤3 vs ≥4) showed statistical significance (≤0.05). In a multivariate analysis of these factors, morphology and tumor number showed significance. According to Kaplan-Meier estimation, the cumulative disease-free survival rates were significantly lower in patients with four or more lesions than in those with three or less lesions and in patients showing pattern 2 than in those showing pattern 1. CONCLUSION Patients with pattern 2 hepatocellular carcinoma and/or four or more lesions may have a relatively high recurrence rate after transarterial chemoembolization.
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Affiliation(s)
- Kazuhiro Katayama
- Department of Hepatobiliary and Pancreatic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Roldán-Valadez E, Cortez-Conradis D, Ríos-Hoyo A, Arrieta Ó. Variability of apparent diffusion coefficients in metastatic small cell lung carcinoma: comparisons between-within normal tissue and liver metastases. Ann Hepatol 2014; 13:297-302. [PMID: 24558224 DOI: 10.1016/s1665-2681(19)30895-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In recent years, the use of diffusion weighted MRI (DW-MRI) has increased for the diagnosis of focal liver lesions (FLLs). DW-MRI may help in the differentiation of benign and malignant FLLs by measuring the apparent diffusion coefficient (ADC) values. Unfortunately, liver metastases present different histopathologic features with variable MRI signals within each lesion; this histologic variability explains the intra- and inter-lesion variations of ADC measurements. We present the case of a 64-year-old female with diagnosis of liver metastasis from small cell lung carcinoma admitted to the emergency unit due to symptoms of inappropriate antidiuretic hormone secretion. Quantitative comparison of two liver MRI, on admission and 2-months after transcatheter arterial chemoembolization showed persistence of the hyperintense metastatic lesions with significant difference in the ADC values in the with-in metastatic lesions (p = 0.001) and between normal tissue and liver metastases only at the end of treatment (p < 0.001). Several publications state that DWMRI is capable to predict the response to chemotherapy in malignant tumors, the histologic variability of liver metastasis and their response to different treatments is reflected in intra- and inter-lesion variations of ADC measurements that might delay an accurate imaging diagnosis. We present evidence of this variability, which might encourage prospective clinical trials that would define better cut-off values, would help understand the ADC biological behaviour, and would reach consensus about the best acquisition parametersfor this promising quantitative biomarker.
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Affiliation(s)
| | | | | | - Óscar Arrieta
- Thoracic Oncology Clinic, National Cancer Institute of Mexico and Medica Sur Clinic & Foundation, Mexico City
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CHEN ELIANG, CHUNG YINUNG, CHUNG PAUCHOO, TSAI HORNGMING, HUANG YISHIUAN. USING A FUZZY ENGINE AND COMPLETE SET OF FEATURES FOR HEPATIC DISEASES DIAGNOSIS: INTEGRATING CONTRAST AND NON-CONTRAST CT IMAGES. BIOMEDICAL ENGINEERING: APPLICATIONS, BASIS AND COMMUNICATIONS 2012. [DOI: 10.4015/s1016237201000200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the diagnosis of hepatic diseases, “Contrast-Enhanced Computerized Tomography” (CECT) and “Non-Contrast CT” (NCT) are usually simultaneously adopted. In this paper, a system consisting of a fuzzy diagnosis engine and a feature quantizer, which extracts hepatic features from CECT and NCT images, is proposed for assisting hepatic disease diagnosis. Compared with existing methods, this paper differs in two folds. First, a more complete feature set composed of not only lesion textures, but also lesion morphological structure and lesion contrast to normal tissues is used. These features are described through mathematical models built inside the feature quantizer and served as the input of fuzzy diagnosis engine. Second, because of the use of the fuzzy diagnosis engine, the system is intrinsically with the capability of storing rules and may infer and adapt its rules according to learning data. Furthermore, uncertainty associated with disease diagnosis can be appropriately taken into considerations. The system has been tested using 131 sets of image data, which are to be classified into 4 types of diseases: liver cyst, hepatoma, cavernous hemagioma and metastatic liver tumor. Experimental results indicate that among these test data 78% of them are accurately classified as one type, while the remaining 22% of data are classified as more than one types of diseases. Even so, within these 22% of multiple-classified data, the correct type is always included in the output in each test, showing a promise of the system.
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Affiliation(s)
- E-LIANG CHEN
- Department of Electrical Engineering, National Cheng Kung University, Taiwan
| | - YI-NUNG CHUNG
- Department of Electrical Engineering, Da-Yeh University, Taiwan
| | - PAU-CHOO CHUNG
- Department of Electrical Engineering, National Cheng Kung University, Taiwan
| | - HORNG-MING TSAI
- Department of Radiology, Medical College and Hospital, National Cheng Kung University, Taiwan, ROC
| | - YI-SHIUAN HUANG
- Department of Electrical Engineering, National Cheng Kung University, Taiwan
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The performance of gadolinium diethylene triamine pentaacetate-pullulan hepatocyte-specific T1 contrast agent for MRI. Biomaterials 2011; 32:5187-94. [DOI: 10.1016/j.biomaterials.2011.03.069] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 03/29/2011] [Indexed: 11/19/2022]
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12
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Mizuki A, Tatemichi M, Tsukada N, Nagamatsu R, Kawaguchi M, Itoshima T, Maruyama S, Satou A, Imari Y, Kawatoko T, Shimono J, Nagata H. Addition of transcatheter arterial chemoembolization decreased local recurrence but had no survival benefit to percutaneous ethanol injection therapy for patients with small hepatocellular carcinoma: A multicenter randomized control study. Oncol Lett 2010; 1:855-859. [PMID: 22966394 DOI: 10.3892/ol_00000151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 06/18/2010] [Indexed: 12/15/2022] Open
Abstract
To assess the efficacy of the additional treatment of transcatheter arterial chemoembolization (TACE) to percutaneous ethanol injection (PEI) therapy for relatively small hepatocellular carcinomas (HCCs), a multicenter randomized control study (RCT) was performed. We conducted an RCT and follow-up study during the enrollment period from 1997 to 1999. Newly diagnosed patients with one to three HCC tumors measuring from 2 to 4 cm (4 cm maximum) in diameter were enrolled. A total of 30 patients initially underwent a combination TACE-PEI or PEI-alone therapies at eight randomly assigned Japanese hospitals. However, 3 patients withdrew. Of the 27 remaining patients, 13 were treated with the combination TACE-PEI therapy and 14 with PEI therapy alone. The patients were observed over several months [median (interquartile range) 33.2 (24.6) months]. There were no significant differences in the background of the patients between the two groups. Among the patients treated with TACE-PEI, the development of a local residual tumor was of significantly lower occurence, compared to the group receiving PEI alone (7.6 and 42.9%, respectively; P=0.024). However, the mean cancer-free time (absence of local or multiple nodule recurrence) or patient survival time was not significantly different between the two groups [PEI alone vs. TACE-PEI: cancer-free time 16.7 (95% CI 7.3-26.0) vs. 22.9 months (95% CI 12.4-33.4); survival time 57.2 (95% CI 37.2-77.2) vs. 42.4 months (95% CI 29.2-55.6)]. Although the combination of TACE and PEI had significant effects on the local tumor control, no efficacy of the addition of TACE to PEI was noted in the prognosis among patients with relatively small HCC tumors.
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Affiliation(s)
- Akira Mizuki
- Department of Internal Medicine, Saiseikai Central Hospital, Showa University, Tokyo
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Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, Kudo M, Lee JM, Choi BI, Poon RTP, Shiina S, Cheng AL, Jia JD, Obi S, Han KH, Jafri W, Chow P, Lim SG, Chawla YK, Budihusodo U, Gani RA, Lesmana CR, Putranto TA, Liaw YF, Sarin SK. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4:439-474. [PMID: 20827404 PMCID: PMC2900561 DOI: 10.1007/s12072-010-9165-7] [Citation(s) in RCA: 838] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 12/09/2009] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. METHODS The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. RESULTS Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.
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Affiliation(s)
- Masao Omata
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Laurentius A. Lesmana
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Pei-Jer Chen
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shi-Ming Lin
- Liver Research Unit, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Haruhiko Yoshida
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Masatoshi Kudo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan
| | - Jeong Min Lee
- Abdominal Radiology Section, Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Byung Ihn Choi
- Abdominal Radiology Section, Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ronnie T. P. Poon
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Shuichiro Shiina
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Ann Lii Cheng
- Department of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ji-Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 100050 Beijing, China
| | - Shuntaro Obi
- Division of Hepatology, Kyoundo Hospital, Tokyo, Japan
| | - Kwang Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Wasim Jafri
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Pierce Chow
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Gee Lim
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Yogesh K. Chawla
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Unggul Budihusodo
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rino A. Gani
- Hepatology Division, Internal Medicine Department, RSUPN Cipto Mangunkusumo, Jakarta, Indonesia
| | - C. Rinaldi Lesmana
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Yun Fan Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shiv Kumar Sarin
- Department of Gastroenterology, G. B. Pant Hospital, University of Delhi, New Delhi, India
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14
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Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, Kudo M, Lee JM, Choi BI, Poon RTP, Shiina S, Cheng AL, Jia JD, Obi S, Han KH, Jafri W, Chow P, Lim SG, Chawla YK, Budihusodo U, Gani RA, Lesmana CR, Putranto TA, Liaw YF, Sarin SK. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010. [PMID: 20827404 DOI: 10.1007/s12072-011-9165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. METHODS The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. RESULTS Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.
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15
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Improved Detection of Hepatic Metastases From Pancreatic Cancer Using Periodically Rotated Overlapping Parallel Lines With Enhanced Reconstruction (PROPELLER) Technique After SPIO Administration. Invest Radiol 2010; 45:158-64. [DOI: 10.1097/rli.0b013e3181d32139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Raman SS, Leary C, Bluemke DA, Amendola M, Sahani D, McTavish JD, Brody J, Outwater E, Mitchell D, Sheafor DH, Fidler J, Francis IR, Semelka RC, Shamsi K, Gschwend S, Feldman DR, Breuer J, United States EOB Study Group. Improved characterization of focal liver lesions with liver-specific gadoxetic acid disodium-enhanced magnetic resonance imaging: a multicenter phase 3 clinical trial. J Comput Assist Tomogr 2010; 34:163-72. [PMID: 20351497 PMCID: PMC3036163 DOI: 10.1097/rct.0b013e3181c89d87] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the safety of gadoxetic acid disodium (Gd-EOB-DTPA) magnetic resonance imaging (MRI) and its efficacy in characterizing liver lesions. METHODS Lesion characterization and classification using combined (unenhanced and Gd-EOB-DTPA-enhanced) MRI were compared with those using unenhanced MRI and contrast-enhanced spiral computed tomography (CT) using on-site clinical and off-site blinded evaluations for patients with focal liver lesions. RESULTS Gadoxetic acid disodium was well tolerated in this study. For the clinical evaluation, more lesions were correctly characterized using combined (unenhanced and Gd-EOB-DTPA-enhanced) MRI than using unenhanced MRI and spiral CT (96% vs 84% and 85%, respectively; P < or = 0.0008). For the blinded evaluation, more lesions were correctly characterized using combined MRI compared with using unenhanced MRI (61%-76% vs 48%-65%, respectively; P < or = 0.0012 for 2/3 readers); when compared with spiral CT, a similar proportion of lesions were correctly characterized. CONCLUSIONS Gadoxetic acid disodium-enhanced MRI is of clinical benefit relative to unenhanced MRI and spiral CT for a radiological diagnosis of liver lesions.
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Affiliation(s)
- Steven S Raman
- Department of Radiological Sciences, UCLA, Los Angeles, CA 90095-1721, USA.
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Miyaaki H, Ichikawa T, Taura N, Yamashima M, Arai H, Obata Y, Furusu A, Hayashi H, Kohno S, Nakao K. Diffuse liver metastasis of small cell lung cancer causing marked hepatomegaly and fulminant hepatic failure. Intern Med 2010; 49:1383-6. [PMID: 20647652 DOI: 10.2169/internalmedicine.49.3296] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 62-year-old female was admitted for examination of an abnormal liver function. Plain CT and MRI of the abdomen showed marked hepatomegaly but no visible nodular lesion in the liver. On the 3rd hospital day she had hepatic encephalopathy and was treated with a course of high-dose steroids, but ultimately died of disease progression on the 7th hospital day. An autopsy revealed a small pulmonary nodule with the histological findings showing small cell carcinoma. There was almost complete parenchymal replacement with metastatic tumor in the liver. Neoplastic involvement of the liver should be considered in the differential diagnosis of fulminant hepatic failure of unknown etiology.
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Affiliation(s)
- Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Hekimoglu K, Ustundag Y, Dusak A, Kalaycioglu B, Besir H, Engin H, Erdem O. Small colorectal liver metastases: detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging. Eur J Radiol 2009; 77:468-72. [PMID: 19781882 DOI: 10.1016/j.ejrad.2009.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 09/02/2009] [Indexed: 02/06/2023]
Abstract
The aim of this prospective study was to compare the diagnostic role of superparamagnetic iron oxide (SPIO)-enhanced liver magnetic resonance imaging (MRI) versus gadobenate dimeglumine (GbD)-enhanced MRI and computed tomography (CT) investigations for detection of small (less than 1cm) colorectal liver metastases (LMs) of colorectal cancer. Seventy-eight LMs in 16 patients were evaluated with dynamic CT imaging, GbD-enhanced dynamic MR imaging and SPIO-enhanced MR imaging. Two radiologists were reviewed the LMs separately. Agreement between the readers and three algorithms was analyzed. Differences between the lesion detection ratios of the methods were analyzed by two proportion z test. Sensitivity values of each modality were also calculated. Interobserver agreement values with kappa analysis were found to be the best for three modalities and kappa values were 0.866, 0.843, and 1.0 respectively. For all 78 LMs, SPIO-enhanced MRI detected all lesions (100% sensitivity). This sensitivity value was higher than GbD-enhanced MRI, and there was a significant difference (p < 0.05). GbD-enhanced MRI depicted 71 lesions and this modality could not detected 7 lesions (91% sensitivity). This modality had moderate sensitivity, and this value is greater than CT imaging, so there was a significant difference also (p < 0.05). Dynamic triphasic CT imaging detected 64 (R1) and 65 (R2) LMs. This modality had the lowest sensitivity (R1: 0.82, R2: 0.83 respectively). Only SPIO-enhanced MRI was able to detect all LMs less than 1cm. LMs were the best detected with SPIO-enhanced MRI. We recommend SPIO-enhanced MRI to be the primary alternative modality especially for diagnosis of small colorectal LMs.
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Affiliation(s)
- Koray Hekimoglu
- Department of Radiology, Baskent University, School of Medicine, Ankara, Turkey.
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19
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20
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Malheiros CA, Ardengh JC, Santo GC, Barata RDCB, Rahal F. [Endoscopic ultrasound in the preoperative staging of gastric cancer: correlation with the surgical and/or pathological findings]. ARQUIVOS DE GASTROENTEROLOGIA 2008; 45:22-27. [PMID: 18425224 DOI: 10.1590/s0004-28032008000100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 08/20/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gastric adenocarcinoma is the major cause of death by cancer in Brazil. For the planning of the treatment and evaluation of the prognosis, the preoperative staging according to the TNM classification is very important. AIM To evaluate the results of endoscopic ultrasound for the T and N categories. METHODS We examined 30 patients with gastric adenocarcinoma in the period of 1 year. We used a Olympus GIF UM-20. After positioning in the third portion of the duodenum, we started to evaluate the lymph node stations 16, 13, 12, 6, 5, 4, 3, 8, 7, 9, 10, 11, 1 and 2, using the frequency of 7.5 MHz. The depth of the tumor in the gastric wall was evaluated with the frequencies of 7.5 and 12 MHz. The results T and N were compared with the conclusive findings. In the unresectable cases, the correlation was made by the macroscopic findings. RESULTS We performed 16 total gastrectomies, 7 subtotal gastrectomies, 5 exploratory laparotomies and 2 laparoscopies. For T category, endoscopic ultrasound results were correct in 25/30 cases (83.3%). All the other 16.7% were overestimated. The accuracy varied from 90% to 96.7% according to the subcategories T1 to T4. For the N category, endoscopic ultrasound results were correct in 23/30 cases (76.7%). Sixteen point six percent were underestimated and 6.7% overestimated. The accuracy varied from 76.7% to 90%, in agreement with the subcategories N1 to N3. CONCLUSION There was a clear correlation between endoscopic ultrasound and the surgical and pathological findings in the evaluation of T and N categories in patients with gastric adenocarcinoma.
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Affiliation(s)
- Carlos Alberto Malheiros
- Departamento de Cirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP
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21
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Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2007; 18:457-67. [PMID: 18058107 DOI: 10.1007/s00330-007-0716-9] [Citation(s) in RCA: 311] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 03/19/2007] [Accepted: 04/17/2007] [Indexed: 12/30/2022]
Abstract
A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT.
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Nomura K, Kadoya M, Ueda K, Fujinaga Y, Miwa S, Miyagawa SI. Detection of hepatic metastases from colorectal carcinoma: comparison of histopathologic features of anatomically resected liver with results of preoperative imaging. J Clin Gastroenterol 2007; 41:789-95. [PMID: 17700429 DOI: 10.1097/01.mcg.0000225676.22218.08] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
GOALS The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MDCT), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), multidetector row computed tomography with arterioportography combined with multidetector row computed tomography with hepatic arteriography (CTAP/CTHA), and intraoperative ultrasonography (IOUS) for detecting hepatic metastases from colorectal carcinoma were evaluated based on histopathologic examination of resected livers. STUDY MDCT, SPIO-MRI, CTAP/CTHA, and IOUS were performed routinely to determine surgical indications and methods in patients with hepatic metastases from colorectal carcinoma. The resected liver specimens were then cut serially into sections 3 to 5 mm thick for routine histologic examination. RESULTS Fifty metastatic lesions were detected by histopathologic study of a large amount of anatomically resected liver from 8 patients with colorectal liver metastasis. The tumors ranged in size from 3 to 53 mm (mean 13.8 mm) and 26 lesions (52%) were less than 10 mm in diameter. Histopathologic examination of the resected liver specimens showed that CTAP/CTHA was the most sensitive imaging modality, followed in order by IOUS, SPIO-MRI, and MDCT. Among all the tumors detected by CTAP/CTHA, SPIO-MRI overlooked 5, but all of the tumors detected by SPIO-MRI were also detected by CTAP/CTHA. The number of metastatic liver tumors detected differed significantly among MDCT, SPIO-MRI, and histopathologic examination. One false-positive lesion was detected by IOUS. CONCLUSIONS CTAP/CTHA is a useful preoperative imaging modality for detecting small hepatic metastases from colorectal carcinoma.
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Affiliation(s)
- Kazuhiko Nomura
- Department of Gastroenterological Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Nagano, Japan.
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Abstract
Colorectal cancer is the fourth most common type of cancer in the West and the second leading cause of cancer-related deaths in the United States. Approximately 35 to 55% of patients with colorectal cancer develop hepatic metastases during the course of their disease. Surgical resection of colorectal liver metastases represents the only chance at potential cure, and long-term survival can be achieved in 35 to 58% of patients after resection. The goal of hepatic resection should be to resect all metastases with negative histologic margins while preserving sufficient functional hepatic parenchyma. In patients with extensive metastatic disease who would otherwise be unresectable, ablative approaches can be used instead of or combined with hepatic resection. The use of portal vein embolization and preoperative chemotherapy may also expand the population of patients who are candidates for surgical treatment. Despite these advances, many patients still experience a recurrence after hepatic resection. More active systemic chemotherapy agents are now available and are being increasingly employed as adjuvant therapy either before or after surgery. Modern treatment of colorectal liver metastasis requires a multidisciplinary approach in an effort to increase the number of patients who may benefit from surgical treatment of colorectal cancer liver metastasis.
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Affiliation(s)
- Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 22187-6681, USA
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24
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Imai Y, Murakami T, Hori M, Fukuda K, Kim T, Marukawa T, Abe H, Kuwabara M, Onishi H, Tsuda K, Sawai Y, Kurokawa M, Hayashi N, Monden M, Nakamura H. Hypervascular hepatocellular carcinoma: Combined dynamic MDCT and SPIO-enhanced MRI versus combined CTHA and CTAP. Hepatol Res 2007; 38:147-58. [PMID: 17645518 DOI: 10.1111/j.1872-034x.2007.00210.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Recently, many diagnostic modalities have been developed for the detection of hepatocellular carcinoma (HCC). Of these, a less invasive and more accurate diagnostic procedure is desirable. This study was undertaken to compare combined dynamic multidetector row helical computerized tomography (MDCT) and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) with combined CT hepatic arteriography (CTHA) and CT during arterial portography (CTAP) for the detection of hypervascular HCC. METHODS Forty-eight patients with 56 pathologically proved hypervascular HCCs (less than 5.0 cm in diameter) underwent dynamic MDCT and SPIO-enhanced MRI, as well as CTHA and CTAP. The images were reviewed by four independent and blinded readers on a tumor-by-tumor basis. RESULTS The mean areas under alternative-free response receiver operating characteristic curve (Az) for combined dynamic MDCT and SPIO-enhanced MRI (IV set) and combinedCTHA and CTAP (IA set) were comparable (0.948 and 0.969, respectively, P > 0.05), although the Az value of the IV set was significantly lower than that of the IA set in HCCs smaller than or equal to 1.5 cm (0.867 and 0.937, respectively, P = 0.033). The mean sensitivity and positive predictive value of the IV set were similar to those of the IA set. CONCLUSIONS Combined dynamic MDCT and SPIO-enhanced MRI showed a diagnostic accuracy comparable to intra-arterial contrast-enhanced CT (CTHA and CTAP) for hypervascular HCC, and may be a useful diagnostic option prior to curative treatments of hypervascular HCC, although a limitation exists in detecting HCCs smaller than or equal to 1.5 cm.
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Affiliation(s)
- Yasuharu Imai
- Department of Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan
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Namkung S, Zech CJ, Helmberger T, Reiser MF, Schoenberg SO. Superparamagnetic iron oxide (SPIO)-enhanced liver MRI with ferucarbotran: efficacy for characterization of focal liver lesions. J Magn Reson Imaging 2007; 25:755-65. [PMID: 17335040 DOI: 10.1002/jmri.20873] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the efficacy of ferucarbotran in T2-weighted (T2W) fast spin-echo (FSE) and T2*W gradient-echo (GRE) sequences for characterizing focal liver lesions. MATERIALS AND METHODS In 68 patients, 46 malignant and 22 benign focal liver lesions were evaluated. Precontrast (NCE) T2W FSE images and contrast-enhanced (CE) T2W FSE and T2*W GRE images were obtained on a 1.5T MR system. Based on signal intensity (SI) measurements in focal lesions and liver parenchyma, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated for all sequences. The percentage of SI loss (PSIL) in focal lesions after contrast agent (CA) application was calculated for the T2W FSE sequence. Qualitative analyses were performed to assess image quality and lesion conspicuity obtained with the CE-T2W FSE and CE-T2*W GRE sequences. RESULTS The mean PSIL was higher in solid benign lesions than in malignant lesions (39.6% vs. 3.2%, P<0.05). With a threshold PSIL of 25%, the sensitivity and specificity for characterizing malignant lesions were 97.8% and 92.9%, respectively. The mean CNR of the malignant lesions was higher in the CE-T2*W sequence than in the CE- and NCE-T2W FSE sequences (29.9 vs. 22.7 (P<0.01) vs. 12.8 (P<0.01)). CE-T2*W images showed a superior image quality and lesion conspicuity (P<0.05) compared to the CE-T2W FSE sequence. CONCLUSION The PSIL can be an accurate tool for characterizing benign and malignant lesions. The addition of a CE-T2*W GRE sequence is helpful for the detection and characterization of malignant lesions.
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Affiliation(s)
- Sook Namkung
- Institute of Clinical Radiology, Munich University Hospitals-Grosshadern, Munich, Germany
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26
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Abstract
Rapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases. Multi-modality imaging approach is usually the more useful in staging colorectal liver metastases. Multi-detector computed tomography (MDCT) remains the main imaging modality for preoperative planning, lesion detection and tumour surveillance. Magnetic resonance imaging (MRI) and contrast enhanced ultrasonography (US) are invaluable in problem solving for characterization indeterminate lesions, while contrast enhanced intra-operative ultrasound (CE-IOUS) may be the new gold standard staging tool prior to liver resection. Ultimately, the imaging strategy has to be tailored to the clinical situation to obtain the most relevant information for optimal use of available imaging resources.
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Affiliation(s)
- Keh Oon Ong
- Radiology Department, Royal Infirmary, Glasgow, UK
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Abstract
Conventional, single-slice helical computed tomography (SSCT) allowed for scanning the majority of the liver during the critical portal venous phase. This was often referred to as the ‘optimal temporal window’. The introduction of current day multislice CT (MSCT) now allows us to acquire images in a much shorter time and more precisely than ever before. This yields increased conspicuity between low attenuation lesions and the enhanced normal liver parenchyma and optimal imaging for the vast majority of hepatic hypovascular metastases. Most importantly, these scanners, when compared to conventional non-helical scanners, avoid impinging upon the ‘equilibrium’ phase when tumors can become isodense/invisible. MSCT also allows for true multiphase scanning during the arterial and late arterial phases for detection of hypervascular metastases. The MSCT imaging speed has increased significantly over the past years with the introduction of 32- and 64-detector systems and will continue to increase in the future volumetric CT. This provides a number of important gains that are discussed in detail.
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Affiliation(s)
- Paul M Silverman
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Hosch WP, Schmidt SM, Plaza S, Dechow C, Schmidt J, Ley S, Kauffmann GW, Hansmann J. Comparison of CT During Arterial Portography and MR During Arterial Portography in the Detection of Liver Metastases. AJR Am J Roentgenol 2006; 186:1502-11. [PMID: 16714637 DOI: 10.2214/ajr.05.0879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study compared MR during arterial portography (MRAP) with CT during arterial portography (CTAP) with regard to the detection and differentiation of liver metastases before surgery. MATERIALS AND METHODS Fifteen patients with liver metastases were enrolled before surgery according to the guidelines of our institutional review board and good clinical practice. After mesentericography, unenhanced scans (Volume Zoom) were performed initially. For CTAP, the contrast medium was injected through the superior mesenteric artery. Images were acquired in portal and delayed enhancement. The MR protocol (1.5 T; Magnetom Symphony) started with T1-weighted fast low-angle shot (FLASH) T2-weighted turbo spin echo (TSE). MRAP followed with gadolinium-enhanced dynamic T1-weighted 3D FLASH. Delayed-phase T1-weighted 2D FLASH axial images were performed 2 min after IV injection of the contrast medium. Qualitative and quantitative evaluation of CTAP and MRAP was performed by three blinded radiologists regarding the number of lesions and their size, localization, and differential diagnosis. RESULTS The overall sensitivity in detecting liver metastases was 97% with MRAP and 93% with CTAP (p > 0.05, not significant [n.s.]). The specificity was calculated to be 97% for MRAP and 82% for CTAP (p < 0.0001, statistically significant [s.s.]). The differences in sensitivity were more accentuated if only lesions 10 mm or smaller were considered (95% vs 88%, p > 0.05, n.s.), for which the respective specificities were 95% and 80% (p < 0.0014, s.s.). Improvements in sensitivity and specificity were associated with a higher lesion-to-liver contrast-to-noise ratio (59.4 +/- 51.0 for MRAP vs 10.4 +/- 7.3 for CTAP) and resulted in higher diagnostic confidence in the differential diagnosis of liver lesions (p < 0.001, s.s.) and better interobserver agreement (median kappa value, 0.88 vs 0.63). CONCLUSION MRAP proved to be a reliable method in the preoperative detection of small liver metastases in particular, with a higher sensitivity and specificity than CTAP. If organizational difficulties of MRAP can be overcome, MRAP could be considered instead of CTAP in the preoperative invasive evaluation of metastatic liver disease.
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Affiliation(s)
- W P Hosch
- Department of Radiology, University Clinic Heidelberg, INF 110, Heidelberg 69120, Germany
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Rees M, Plant G, Bygrave S. Late results justify resection for multiple hepatic metastases from colorectal cancer. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02749.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kawashima M, Furuse J, Nishio T, Konishi M, Ishii H, Kinoshita T, Nagase M, Nihei K, Ogino T. Phase II study of radiotherapy employing proton beam for hepatocellular carcinoma. J Clin Oncol 2005; 23:1839-46. [PMID: 15774777 DOI: 10.1200/jco.2005.00.620] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of proton beam radiotherapy (PRT) for hepatocellular carcinoma. PATIENTS AND METHODS Eligibility criteria for this study were: solitary hepatocellular carcinoma (HCC); no indication for surgery or local ablation therapy; no ascites; age >/= 20 years; Zubrod performance status of 0 to 2; no serious comorbidities other than liver cirrhosis; written informed consent. PRT was administered in doses of 76 cobalt gray equivalent in 20 fractions for 5 weeks. No patients received transarterial chemoembolization or local ablation in combination with PRT. RESULTS Thirty patients were enrolled between May 1999 and February 2003. There were 20 male and 10 female patients, with a median age of 70 years. Maximum tumor diameter ranged from 25 to 82 mm (median, 45 mm). All patients had liver cirrhosis, the degree of which was Child-Pugh class A in 20, and class B in 10 patients. Acute reactions of PRT were well tolerated, and PRT was completed as planned in all patients. Four patients died of hepatic insufficiency without tumor recurrence at 6 to 9 months. Three of these four patients had pretreatment indocyanine green retention rate at 15 minutes of more than 50%. After a median follow-up period of 31 months (16 to 54 months), only one patient experienced recurrence of the primary tumor, and 2-year actuarial local progression-free rate was 96% (95% CI, 88% to 100%). Actuarial overall survival rate at 2 years was 66% (48% to 84%). CONCLUSION PRT showed excellent control of the primary tumor, with minimal acute toxicity. Further study is warranted to scrutinize adequate patient selection in order to maximize survival benefit of this promising modality.
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Affiliation(s)
- Mitsuhiko Kawashima
- Division of Radiation Oncology, Hepatobiliary, and Pancreatic Medical Oncology, and Hepatobiliary Surgery, National Cancer Center Hospital East, Chiba, Japan.
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Rajvanshi P, Kowdley KV, Hirota WK, Meyers JB, Keeffe EB. Fulminant hepatic failure secondary to neoplastic infiltration of the liver. J Clin Gastroenterol 2005; 39:339-43. [PMID: 15758630 DOI: 10.1097/01.mcg.0000155123.97418.06] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Two patients with previously normal liver function, who presented with fulminant hepatic failure (FHF) of unknown etiology despite an extensive evaluation, are described. No etiology for FHF was apparent with initial evaluation. One patient was found to have nearly complete replacement of hepatic parenchyma by metastasis from an occult small cell lung carcinoma identified postmortem. The other patient had lymphomatous infiltration of the liver detected by a liver biopsy. Imaging studies were performed in the patients and did not reveal any evidence of neoplastic infiltration of the liver. Neoplastic involvement of liver should be considered in the differential diagnosis of FHF of unknown etiology. The imaging studies in this setting can be misleading.
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Affiliation(s)
- Pankaj Rajvanshi
- Division of Gastroenterology and Hepatology, University of Washington School of Medicine, Seattle, WA 98195-6424, USA
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Kim YK, Lee JM, Kim CS, Chung GH, Kim CY, Kim IH. Detection of liver metastases: gadobenate dimeglumine-enhanced three-dimensional dynamic phases and one-hour delayed phase MR imaging versus superparamagnetic iron oxide-enhanced MR imaging. Eur Radiol 2005; 15:220-228. [PMID: 15624108 DOI: 10.1007/s00330-004-2570-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Revised: 11/02/2004] [Accepted: 11/04/2004] [Indexed: 12/17/2022]
Abstract
The aim of this study was to compare the diagnostic performance of gadobenate dimeglumine (Gd-BOPTA)-enhanced MR imaging, including dynamic phases and one-hour delayed phase, versus superparamagnetic iron oxide (SPIO)-enhanced imaging for detection of liver metastases. Twenty-three patients with 59 liver metastases underwent Gd-BOPTA-enhanced MR imaging (unenhanced, arterial, portal, equilibrium and one-hour delayed phase) using three-dimensional volumetric interpolated imaging and SPIO-enhanced T2-weighted turbo spin-echo and T2*-weighted gradient-echo sequences on a 1.5-T unit. Three observers independently interpreted the three sets of images, i.e. Gd-BOPTA-enhanced dynamic MRI (set 1), delayed phase imaging (set 2) and SPIO-enhanced MRI (set 3). Diagnostic accuracy was evaluated using the alternative-free response receiver operating chracteristic (ROC) analysis. Sensitivity and positive predictive value were also evaluated. The mean accuracy (Az values) and sensitivity of Gd-BOPTA-enhanced delayed phase imaging (0.982, 95.5%) were comparable to those of SPIO-enhanced imaging (0.984, 97.2%). In addition, Az values and sensitivities of both imaging sets were significantly higher than those of Gd-BOPTA-enhanced dynamic images (0.826, 77.4%: p<0.05). There was no significant difference in the positive predictive value among the three image sets. Gd-BOPTA-enhanced delayed phase imaging showed comparable diagnostic performance to SPIO-enhanced imaging for the detection of liver metastases, and had a better diagnostic performance than Gd-BOPTA-enhanced dynamic images.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School, Seoul, Republic of Korea
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Gazelle GS, McMahon PM, Beinfeld MT, Halpern EF, Weinstein MC. Metastatic Colorectal Carcinoma: Cost-effectiveness of Percutaneous Radiofrequency Ablation versus That of Hepatic Resection. Radiology 2004; 233:729-39. [PMID: 15564408 DOI: 10.1148/radiol.2333032052] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the relative cost-effectiveness of radiofrequency (RF) ablation and hepatic resection in patients with metachronous liver metastases from colorectal carcinoma (CRC) and compare the outcomes, cost, and cost-effectiveness of a variety of treatment and follow-up strategies. MATERIALS AND METHODS A state-transition decision model for evaluating the (societal) cost-effectiveness of RF ablation and hepatic resection in patients with CRC liver metastases was developed. The model tracks the presence, number, size, location, growth, detection, and removal of up to 15 individual metastases in each patient. Survival, quality of life, and cost are predicted on the basis of disease extent. Imaging, ablation, and resection affect outcomes through detection and elimination of individual metastases. Several patient care strategies were developed and compared on the basis of cost, effectiveness, and incremental cost-effectiveness (expressed as dollars per quality-adjusted life-year [QALY]). Extensive sensitivity analysis was performed to evaluate the impact of alternative scenarios and assumptions on results. RESULTS A strategy permitting ablation of up to five metastases with computed tomographic (CT) follow-up every 4 months resulted in a gain of 0.65 QALYs relative to a no-treat strategy, at an incremental cost of $2400 per QALY. Compared with this ablation strategy, a strategy permitting resection of up to four metastases, one repeat resection, and CT follow-up every 6 months resulted in an additional gain of 0.76 QALYs at an incremental cost of $24 300 per QALY. Across a range of model assumptions, more aggressive treatment strategies (ie, ablation or resection of more metastases, treatment of recurrent metastases, more frequent follow-up imaging) were superior to less aggressive strategies and had incremental cost-effectiveness ratios of less than $35 000 per QALY. Findings were insensitive to changes in most model parameters; however, results were somewhat sensitive to changes in size thresholds for RF ablation, the number of metastases present, and surgery and treatment costs. CONCLUSION RF ablation is a cost-effective treatment option for patients with CRC liver metastases. However, in most scenarios, hepatic resection is more effective (in terms of QALYs gained) than RF ablation and has an incremental cost-effectiveness ratio of less than $35 000 per QALY.
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Affiliation(s)
- G Scott Gazelle
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 2H, Boston, MA 02114, USA
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Bhattacharjya S, Bhattacharjya T, Baber S, Tibballs JM, Watkinson AF, Davidson BR. Prospective study of contrast-enhanced computed tomography, computed tomography during arterioportography, and magnetic resonance imaging for staging colorectal liver metastases for liver resection. Br J Surg 2004; 91:1361-9. [PMID: 15376205 DOI: 10.1002/bjs.4699] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study compared the value of contrast-enhanced helical computed tomography (CT), CT during arterioportography (CTAP), and contrast-enhanced magnetic resonance imaging (MRI) for staging patients with colorectal liver metastases. METHODS One hundred and twenty patients with known or suspected colorectal liver metastases were evaluated prospectively. MRI and CTAP were performed within 3 weeks of CT in patients with potentially resectable tumours. Results of imaging were compared with findings at surgery, intraoperative ultrasonography and histological examination. RESULTS Twenty patients were not considered for liver resection following CT. The remaining 100 patients underwent CT and CTAP, 85 of whom had CT, CTAP and MRI. The sensitivity and specificity were 73.0 and 96.5 per cent for CT, 87.1 and 89.3 per cent for CTAP, and 81.9 and 93.2 per cent for MRI. Positive predictive values were 89.7, 87.5 and 87.5 per cent respectively. Receiver-operator characteristic analysis gave an accuracy on a segment-by-segment analysis of 0.73 for CT, 0.87 for CTAP and 0.82 for MRI. Combining information from CT and CTAP, CT and MRI, or all three modalities, did not significantly increase the percentage of patients staged correctly (71, 72 and 76 per cent respectively). CONCLUSION The diagnostic accuracy of spiral CT, MRI and CTAP was similar. Combining modalities did not improve accuracy.
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Affiliation(s)
- S Bhattacharjya
- Department of Surgery, Royal Free Hospital, Royal Free and University College Medical School, London, UK
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Abe Y, Murata S, Tajima H, Hayashi H, Kumazaki T. Effect of prostaglandin E1 on contrast enhanced CT of the liver: statistical analysis during arterial portography. J NIPPON MED SCH 2003; 70:307-12. [PMID: 12928710 DOI: 10.1272/jnms.70.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the diagnostic effect of prostaglandin E(1) on contrast enhancement quality of CT during arterial portography (CTAP). MATERIALS AND METHODS Our patients population included 30 patients (11 women, 19 men; age range, 41 approximately 81 years) with liver tumors (23 hepatocellular carcinoma and 7 metastatic liver tumor) who had undergone angiography. We divided the 30 patients, who had undertaken CTAP twice, into two groups at random (group A; n=15, group B; n=15). In group A, first CTAP was performed without prostaglandin E(1). Approximately 5 minutes later, a second CTAP was again initiated 30 seconds after injection of prostaglandin E(1) under the same conditions. In group B, prostaglandin E(1) was injected before the first CTAP only. We measured the mean CT numbers and standard deviation (SD) numbers of anterior, posterior, medial and lateral segments in the liver at the same section of the CTAP using the same size and location of the regions of interest, and these values with and without prostaglandin E(1) were compared. RESULTS 1) CT numbers: The CT numbers were significantly increased in the medial segment after the injection of prostaglandin E(1) (p<0.05) in all cases of both groups. On the other hand, they were clearly decreased in the posterior segment after the injection of prostaglandin E(1) (p<0.05) in both groups. There were no statistical differences in the CT numbers in the anterior and lateral segments in all patients. In addition, the CT numbers of anterior and posterior segments showed high attenuation compared with the medial and lateral segments in group A without prostaglandin E(1). 2) SD numbers: The SD numbers, which are an index of the homogeneous enhancement, were significantly decreased in the posterior, medial and lateral segments after the injection of prostaglandin E(1) (p<0.01, p<0.05, p<0.01, respectively) in both groups. There were no significant differences in the SD numbers in the anterior segment regardless of the injection of prostaglandin E(1) in all cases. CONCLUSION CTAP with injection of prostaglandin E(1) makes contrast enhancement of liver parenchyma more homogeneously than the conventional procedure, and it may be a useful technique for the detection of liver tumors.
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Affiliation(s)
- Yutaka Abe
- Department of Radiology, Nippon Medical School, Tokyo, Japan.
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Kim HC, Kim TK, Sung KB, Yoon HK, Kim PN, Ha HK, Kim AY, Kim HJ, Lee MG. Preoperative evaluation of hepatocellular carcinoma: combined use of CT with arterial portography and hepatic arteriography. AJR Am J Roentgenol 2003; 180:1593-9. [PMID: 12760926 DOI: 10.2214/ajr.180.6.1801593] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study was undertaken to determine the usefulness of combined CT during arterial portography and CT hepatic arteriography in the preoperative evaluation of patients with known or suspected hepatocellular carcinoma and to describe the findings on CT during arterial portography and CT hepatic arteriography by which hepatocellular carcinomas may be differentiated from pseudolesions. SUBJECTS AND METHODS This study included 137 patients who underwent combined CT during arterial portography and CT hepatic arteriography for the preoperative evaluation of known or suspected hepatocellular carcinoma. The images were prospectively evaluated to identify focal hepatic lesions and their differential diagnoses (hepatocellular carcinoma versus pseudolesion). We assessed the diagnostic accuracy of our prospective interpretation by comparing the interpretations with the results of histopathology or follow-up imaging. We also retrospectively analyzed imaging features seen on CT during arterial portography and CT hepatic arteriography-the size, shape, and location of the lesion within the liver; attenuation of the lesion; and opacification of the peripheral portal vein branches on CT hepatic arteriography. RESULTS One hundred and forty-nine hepatocellular carcinomas (75 lesions confirmed at histopathology and 74 lesions on follow-up imaging) were found in 120 patients, and 104 pseudolesions (15 lesions confirmed at histopathology and 89 lesions on follow-up imaging) were found in 91 patients. The sensitivity of our prospective interpretations was 98.7%, and the specificity of our prospective interpretations was 90.4%. Our positive and negative predictive values were 93.6% and 97.9%, respectively. We found that hepatocellular carcinomas were larger, more frequently nodular, and more likely to be located intraparenchymally than were the pseudolesions (p < 0.01). Opacification of the peripheral portal vein branches on CT hepatic arteriography was detected in 36 pseudolesions (34.6%) but in none of the hepatocellular carcinomas (p < 0.01). CONCLUSION Combining CT during arterial portography and CT hepatic arteriography is useful for the preoperative evaluation of patients with known or suspected hepatocellular carcinoma. Familiarity with the imaging features of hepatocellular carcinomas and pseudolesions can help in the accurate differentiation of hepatocellular carcinomas from pseudolesions.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Ku, Seoul, 138-736, Korea
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Del Frate C, Zuiani C, Londero V, Como G, Bazzocchi M, Mortele K, Ros PR. Comparing Levovist-enhanced pulse inversion harmonic imaging and ferumoxides-enhanced MR imaging of hepatic metastases. AJR Am J Roentgenol 2003; 180:1339-46. [PMID: 12704048 DOI: 10.2214/ajr.180.5.1801339] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the sensitivity of pulse inversion harmonic digital sonography, unenhanced transabdominal sonography, and ferumoxides-enhanced MR imaging in the depiction of liver metastases. In addition, pulse inversion harmonic digital sonography was performed at different scanning times after Levovist injection to define the best phase for depiction. SUBJECTS AND METHODS Twenty-six consecutive patients with findings of extrahepatic primary malignancies and liver metastases suspected on transabdominal sonography were examined with both pulse inversion harmonic imaging and ferumoxides-enhanced MR imaging within a 7-day period. Pulse inversion harmonic imaging was performed before and at 20, 100, and 180 sec after a bolus injection of Levovist. MR imaging was performed before and after ferumoxides administration, using breath-hold gradient-recalled echo T1-weighted and turbo spin-echo short tau inversion recovery T2-weighted sequences. Two radiologists independently evaluated image quality, and the number, location, and diameter of lesions scanned using both techniques. Intraoperative sonography or at least 8-month follow-up confirmed the lesions depicted. Analyses included Wilcoxon's signed rank test and Interclass correlation test. RESULTS Levovist-enhanced pulse inversion harmonic imaging revealed 104 metastases on the first scan after contrast injection, 126 on the second scan, and 118 on the third, compared with 66 on the unenhanced scan. Pulse inversion harmonic digital sonography depicted 90% of lesions shown on ferumoxides-enhanced MR imaging (140 metastases) (p = 0.001). CONCLUSION Levovist-enhanced pulse inversion harmonic digital sonography is a sensitive technique for depiction of liver metastases. Pulse inversion harmonic digital sonography may have a potential role in imaging patients with possible metastatic involvement of the liver. Further studies are needed to define its place in the workup of these patients. At present, ferumoxides-enhanced MR imaging, being more sensitive, must be performed in all patients in whom pulse inversion harmonic digital sonography is not conclusive or when after pulse inversion harmonic digital sonography, patients remain eligible for surgery.
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Affiliation(s)
- Chiara Del Frate
- Institute of Radiology, Udine University, Via Colugna 50, 33100 Udine, Italy
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Gazelle GS, Hunink MGM, Kuntz KM, McMahon PM, Halpern EF, Beinfeld M, Lester JS, Tanabe KK, Weinstein MC. Cost-effectiveness of hepatic metastasectomy in patients with metastatic colorectal carcinoma: a state-transition Monte Carlo decision analysis. Ann Surg 2003; 237:544-55. [PMID: 12677152 PMCID: PMC1514476 DOI: 10.1097/01.sla.0000059989.55280.33] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of hepatic resection ("metastasectomy") in patients with metachronous liver metastases from colorectal carcinoma (CRC), and to investigate the impact of operative and follow-up strategies on outcomes, cost, and cost-effectiveness. SUMMARY BACKGROUND DATA There is substantial evidence that resection of CRC liver metastases can result in long-term survival in some patients. However, several unresolved issues are difficult to address using currently available clinical data. These include the appropriate threshold for resection, whether to perform repeat resection, and the relative cost-effectiveness of the procedure(s). METHODS The authors developed a state-transition Monte Carlo decision model to evaluate the (societal) cost-effectiveness of hepatic metastasectomy in patients with metachronous CRC liver metastases. The model tracks the presence, number, size, location, growth, detection, and removal of up to 15 individual metastases in each patient. Survival, quality of life, and cost are predicted on the basis of disease extent. Imaging and surgery affect outcomes via detection and removal of individual metastases. Several patient management strategies were developed and compared with respect to cost, effectiveness, and incremental cost-effectiveness ($/quality-adjusted life year [QALY]). A reference strategy in which metastasectomy is not offered and imaging is not performed for the purpose of assessing resectability or operative planning ("no-surgery" strategy) was included for comparison. Extensive sensitivity analysis was performed to evaluate the impact of alternative model assumptions on results. RESULTS A strategy permitting resection of up to six metastases and one repeat resection, with CT follow-up every 6 months, resulted in a gain of 2.63 QALYs relative to the no-test/no-treat strategy, at an incremental cost of 18,100 US dollars/QALY. When additional surgical strategies were considered, the incremental cost-effectiveness ratio (ICER; relative to the next least effective strategy) of the six metastases, one repeat, 6-month strategy was 31,700 US dollars/QALY. Across a range of model assumptions, more aggressive treatment strategies (i.e., resection of more metastases, resection of recurrent metastases) were superior to less aggressive strategies and had ICERs below 35,000 US dollars/QALY. Findings were insensitive to changes in most model parameters but somewhat sensitive to changes in surgery and treatment costs. CONCLUSIONS Hepatic metastasectomy is a cost-effective option for selected patients with metachronous CRC metastases limited to the liver. When considering metastasectomy, more aggressive approaches are generally preferred to less aggressive approaches. Overall, surgeons should be encouraged to consider resection for all patients whose metastases can technically be removed.
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Affiliation(s)
- G Scott Gazelle
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 2H, Boston, MA 02114, USA.
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del Frate C, Bazzocchi M, Mortele KJ, Zuiani C, Londero V, Como G, Zanardi R, Ros PR. Detection of liver metastases: comparison of gadobenate dimeglumine-enhanced and ferumoxides-enhanced MR imaging examinations. Radiology 2002; 225:766-72. [PMID: 12461259 DOI: 10.1148/radiol.2253011854] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging with ferumoxides-enhanced MR imaging for detection of liver metastases. MATERIALS AND METHODS Twenty consecutive patients known to have malignancy and suspected of having focal liver lesions at ultrasonography (US) underwent 1.0-T MR imaging with gradient-recalled-echo T1-weighted breath-hold sequences before, immediately after, and 60 minutes after Gd-BOPTA injection. Subsequently, MR imaging was performed with turbo spin-echo short inversion time inversion-recovery T2-weighted sequences before and 60 minutes after ferumoxides administration. All patients subsequently underwent intraoperative US within 15 days, and histopathologic analysis of their resected lesion-containing specimens was performed. Separate qualitative analyses were performed to assess lesion detection with each contrast agent. Quantitative analyses were performed by measuring signal-to-noise and contrast-to-noise ratios (CNRs) on pre- and postcontrast Gd-BOPTA and ferumoxides MR images. Statistical analyses were performed with Wilcoxon signed rank and Monte Carlo tests. RESULTS Sensitivity of ferumoxides-enhanced MR imaging was superior to that of Gd-BOPTA-enhanced MR imaging for liver metastasis detection (P <.05). Ferumoxides MR images depicted 36 (97%) of 37 metastases detected at intraoperative US, whereas Gd-BOPTA MR images depicted 30 (81%) metastases during delayed phase and 20 (54%) during dynamic phase. All six metastases identified only at ferumoxides-enhanced MR imaging were 5-10 mm in diameter. There was a significant increase in CNR between the lesion and liver before and after ferumoxides administration (from 3.8 to 6.8, P <.001) but not before or after Gd-BOPTA injection (from -4.8 to -5.5, P >.05). CONCLUSION Ferumoxides-enhanced MR imaging seems to be superior to Gd-BOPTA-enhanced MR imaging for liver metastasis detection.
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Affiliation(s)
- Chiara del Frate
- Institute of Radiology, Udine University, Policlinico Universitario a Gestione diretta, via Colugna 50, 33100 Udine, Italy.
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Machado MM, Rosa ACF, Barros ND, Pugliese V, Herman P, Saad WA, Machado MC, Cerri LMDO, Gama-Rodrigues JJ, Habr-Gama A, Cerri GG. História da ultra-sonografia intra-operatória. Radiol Bras 2002. [DOI: 10.1590/s0100-39842002000600008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A ultra-sonografia intra-operatória foi realizada especialmente a partir de 1960, com alguns relatos de experiências iniciais nos anos 50. Inicialmente foram avaliados tumores cerebrais, posteriormente estudando-se também cálculos de vias biliares e cálculos renais. Entretanto, a ultra-sonografia intra-operatória em modo A ou modo B estático não adquiriu grande aceitação no meio médico. Não obstante, os primeiros estudos forneceram as bases para o desenvolvimento da moderna ultra-sonografia intra-operatória, com a utilização dos equipamentos ultra-sonográficos em modo B em tempo real. Os autores discorrem sobre a utilização da ultra-sonografia intra-operatória desde o seu início até os dias atuais.
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Takayasu K, Muramatsu Y, Wakao F, Mizuguchi Y, Iwata R, Maeda T, Moriyama N, Sakamoto M. Hepatic nodules with early enhancement during computed tomography portography: report of six cases. J Gastroenterol Hepatol 2002; 17:779-84. [PMID: 12121508 DOI: 10.1046/j.1440-1746.2002.02808.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM To study the clinicopathologic characteristics of hepatic nodular lesions with high attenuation (increased portal blood flow) compared with surrounding hepatic parenchyma on computed tomography (CT) during arterial portography (CTAP). METHODS For six lesions found in six patients demonstrated as a high-attenuated mass by CTAP, CT during hepatic arteriography (CTHA; n = 3 patients), digital subtraction hepatic arteriography (n = 6) and conventional helical CT (n = 6) were evaluated retrospectively and compared with histopathologic findings (n = 4). Pathologic diagnosis was atypical adenomatous hyperplasia, nodule-in-nodule hepatocellular carcinoma (HCC) in one resected lesion each and overt HCC in two biopsied lesions. Two patients did not undergo any therapy and were followed up. RESULTS The average size of lesions was 2.2 cm (range 1.2-3.5 cm). The CTAP revealed high attenuation in all six lesions; entirely within the lesion (n = 4 lesions) or peripherally with a central low attenuation (n = 2). In contrast, CTHA showed low attenuated lesions; entirely within the mass (n = 2) or peripherally with a central high-attenuated spot (n = 1). Hepatic arteriogram revealed only two hypervascular lesions; entirely and partially in one each. In the arterial phase of helical CT, all but one lesion were iso- or hypo-attenuated. In two patients who were followed up to 39 and 55 months without therapy, neither tumor growth nor hemodynamic change of the lesion was recognized on CT. CONCLUSIONS Even though the incidence of hepatic nodular lesions demonstrated as high attenuating on CTAP is low, all but one lesion in the current series showed iso- or hypo-attenuation on CTHA and/or helical CT, suggesting the hemodynamics are reciprocal between CTAP and CTHA. One exceptional lesion that showed high attenuation on both CTAP and conventional CT was pathologically advanced HCC. Based on the follow-up study of two untreated patients, this kind of lesion with high attenuation on CTAP seems to grow slowly.
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Affiliation(s)
- Kenichi Takayasu
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
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Bailey MA, Brunt EM. Hepatocellular carcinoma: predisposing conditions and precursor lesions. Gastroenterol Clin North Am 2002; 31:641-62. [PMID: 12134622 DOI: 10.1016/s0889-8553(02)00017-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The global incidence of HCC is rising; in the United States, its rise is in parallel to that of cirrhosis due to the HCV and obesity epidemics. The lack of adequate treatment for advanced HCC mandates both prevention and early detection of these lesions. The limitations of currently available histopathologic evaluations, serologic markers, and radiographic imaging modalities in detecting HCC and its precursors have been outlined in this review. Refinements of all of these may lead to better HCC detection, earlier intervention, and successful treatment. Randomized controlled trials are necessary to evaluate the most efficacious and cost-effective approach to screening.
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Affiliation(s)
- Marie Ann Bailey
- Division of Gastroenterology, Hospital of the Medical College of Philadelphia, 7th Floor, 3300 Henry Avenue, Philadelphia, PA 19129, USA.
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Abstract
The resection of primary and secondary liver tumors has become accepted as the only curative therapy that can be offered to patients with these cancers. Technical advances made over the last two decades have improved the ability of the surgeon to perform these procedures with decreased morbidity. This article reviews hepatic anatomy, the preoperative evaluation of patients and various technical aspects involved in liver resections. The latter includes the role of intraoperative ultrasound and techniques of vascular occlusion and hepatic parenchymal dissection.
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Affiliation(s)
- Ming-Hui Fan
- Division of Surgical Oncology, 3302 Cancer Center, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor 48109, USA
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Sica GT, Ji H, Ros PR. Computed tomography and magnetic resonance imaging of hepatic metastases. Clin Liver Dis 2002; 6:165-79, vii. [PMID: 11933587 DOI: 10.1016/s1089-3261(03)00071-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The detection and characterization of liver metastases is well performed with either computed tomography or magnetic resonance imaging. The administration of intravenous contrast is essential for almost all indications, with multiphasic imaging aiding in lesion characterization and detection. The use of multidetected CT (MDCT) provides the ability for optimized vascular and multiplanar imaging, but has also resulted in increased examination complexity. Tissue-specific MR contrast agents can yield the highest rate of lesion detection and thus may be useful in presurgical planning.
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Affiliation(s)
- Gregory T Sica
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Kim SH, Choi D, Lim JH, Lee WJ, Jang HJ, Lim HK, Lee SJ, Cho JM, Kim SK, Kim GC. Optimal pulse sequence for ferumoxides-enhanced MR imaging used in the detection of hepatocellular carcinoma: a comparative study using seven pulse sequences. Korean J Radiol 2002; 3:87-97. [PMID: 12087198 PMCID: PMC2713841 DOI: 10.3348/kjr.2002.3.2.87] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify the optimal pulse sequence for ferumoxides-enhanced magnetic resonance (MR) imaging in the detection of hepatocelluar carcinomas (HCCs). MATERIALS AND METHODS Sixteen patients with 25 HCCs underwent MR imaging following intravenous infusion of ferumoxides. All MR studies were performed on a 1.5-T MR system, using a phased-array coil. Ferumoxides (Feridex IV) at a dose of 15 micromol/Kg was slowly infused intravenously, and axial images of seven sequences were obtained 30 minutes after the end of infusion. The MR protocol included fast spin-echo (FSE) with two echo times (TR3333-8571/TE18 and 90-117), singleshot FSE (SSFSE) with two echo times (TRinfinity/TE39 and 98), T2*-weighted gradient- recalled acquisition in the steady state (GRASS) (TR216/TE20), T2*-weighted fast multiplanar GRASS (FMPGR) (TR130/TE8.4-9.5), and T2*-weighted fast multiplanar spoiled GRASS (FMPSPGR) (TR130/TE8.4-9.5). Contrast-to-noise ratios (CNRs) of HCCs determined during the imaging sequences formed the basis of quantitative analysis, and images were qualitatively assessed in terms of lesion conspicuity and image artifacts. The diagnostic accuracy of all sequences was assessed using receiver operating characteristic (ROC) analysis. RESULTS Quantitative analysis revealed that the CNRs of T2*-weighted FMPGR and T2*-weighted FMPSPGR were significantly higher than those of the other sequences, while qualitative analysis showed that image artifacts were prominent at T2*-weighted GRASS imaging. Lesion conspicuity was statistically significantly less clear at SSFSE imaging. In term of lesion detection, T2*-weighted FMPGR, T2*- weighted FMPSPGR, and proton density FSE imaging were statistically superior to the others. CONCLUSION T2*-weighted FMPGR, T2*- weighted FMPSPGR, and proton density FSE appear to be the optimal pulse sequences for ferumoxidesenhanced MR imaging in the detection of HCCs.
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Affiliation(s)
- Seung Hoon Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Chang D, Kim B, Yun Y, Hur Y, Lee Y, Choi M, Yoon J, Seong J. Superparamagnetic iron oxide-enhanced magnetic resonance imaging of the liver in beagle dogs. Vet Radiol Ultrasound 2002; 43:37-42. [PMID: 11866042 DOI: 10.1111/j.1740-8261.2002.tb00440.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The role of superparamagnetic iron oxide as a tissue-specific contrast medium has been established in humans, especially for hepatic imaging. Superparamagnetic iron oxide particles exhibit a tissue-specific biodistribution to the reticuloendothelial system, where they predominantly shorten transverse T2 relaxation time. Most hepatic tumors lack Kupffer cells; therefore, the T2 of tumors remains virtually unchanged after administration of superparamagnetic iron oxide. The resulting loss of signal intensity from the liver, with unchanged tumor signal intensity, increases lesion-to-liver contrast. In this study, MR images were acquired with fast gradient echo recalled at steady state (FGRE) in five Beagle dogs before and after injection of superparamagnetic iron oxide. The effect of superparamagnetic iron oxide on signal intensity of the liver with time was assessed. A signal intensity decrease of 65.7+/-10.0% was detected at 20 minutes, and it continued to decrease until the last time point of MR scanning (200 minutes). The liver intensity of all dogs dropped to half its value after 20 minutes. The effect of motion was minimized by breath holding. Superparamagnetic iron oxide did not have any adverse effects on the dogs.
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Affiliation(s)
- Dongwoo Chang
- Department of Laboratory Animal Medicine, Medical Research Center, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Choi D, Kim SH, Lim JH, Cho JM, Lee WJ, Lee SJ, Lim HK. Detection of hepatocellular carcinoma: combined T2-weighted and dynamic gadolinium-enhanced MRI versus combined CT during arterial portography and CT hepatic arteriography. J Comput Assist Tomogr 2001; 25:777-85. [PMID: 11584240 DOI: 10.1097/00004728-200109000-00018] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare the preoperative detectability of hepatocellular carcinomas (HCCs) using combined T2-weighted and dynamic gadolinium-enhanced MRI and combined CT during arterial portography (CTAP) and CT hepatic arteriography (CTHA). METHOD Thirty-three patients with 43 HCCs underwent T2-weighted and dynamic gadolinium-enhanced MRI and combined CTAP and CTHA. The diagnosis was established by pathologic examination following surgical resection in 26 patients and by biopsy in 7 patients. The MR protocol included fast SE with two TEs (including T2-weighted imaging) and precontrast and gadolinium-enhanced T1-weighted fast multiplanar spoiled gradient-recalled echo images with dynamic study. The MR images of all sequences and the paired CTAP and CTHA images were independently reviewed by three radiologists. Image review was conducted on a segment-by-segment basis. Diagnostic accuracy was evaluated with receiver operating characteristic analysis. RESULTS The accuracies (Az values) of MRI of all sequences and combined CTAP and CTHA for all observers were 0.960 and 0.959, respectively. The mean sensitivities of MRI and CT were 90 and 94%, respectively. The differences were not statistically significant. The mean specificity of MRI (99%) was significantly higher than that of combined CTAP and CTHA (92%). CONCLUSION Combined T2-weighted and dynamic gadolinium-enhanced MRI is as accurate as combined CTAP and CTHA for preoperative detection of HCCs.
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Affiliation(s)
- D Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi D, Kim S, Lim J, Lee W, Jang H, Lee S, Lim H. Preoperative detection of hepatocellular carcinoma: ferumoxides-enhanced mr imaging versus combined helical CT during arterial portography and CT hepatic arteriography. AJR Am J Roentgenol 2001; 176:475-82. [PMID: 11159099 DOI: 10.2214/ajr.176.2.1760475] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of this study was to compare ferumoxides-enhanced MR imaging with combined helical CT during arterial portography and CT hepatic arteriography for preoperative detection of hepatocellular carcinomas. SUBJECTS AND METHODS Twenty patients with 30 hepatocellular carcinomas underwent ferumoxides-enhanced MR imaging and combined helical CT during arterial portography and CT hepatic arteriography. The diagnosis was established by pathologic examination after surgical resection in 18 patients and by biopsy in two. The MR protocol included fast spin-echo with two echo times, T2(*)-weighted fast multiplanar gradient-recalled acquisition in the steady state, proton density-weighted fast multiplanar spoiled gradient-recalled echo, and T1-weighted fast multiplanar spoiled gradient-recalled echo images. The MR images of all sequences and the paired CT during arterial portography and CT hepatic arteriography images were independently evaluated by three radiologists on a segment-by-segment basis. Diagnostic accuracy was assessed with receiver operating characteristic analysis. RESULTS The accuracies (A(z) values) of ferumoxides-enhanced MR imaging and combined CT during arterial portography and CT hepatic arteriography for all observers were 0.964 and 0.948, respectively. The mean sensitivities of MR imaging and CT were 93% and 91%, respectively. The differences were not statistically significant. The mean specificity of MR imaging (99%) was significantly higher than that of combined CT during arterial portography and CT hepatic arteriography (94%). CONCLUSION Ferumoxides-enhanced MR imaging can be used successfully in place of combined CT during arterial portography and CT hepatic arteriography for the preoperative evaluation of patients with hepatocellular carcinomas.
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Affiliation(s)
- D Choi
- All authors: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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