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Horng A, Ingenerf M, Berger F, Steffinger D, Rübenthaler J, Zacherl M, Wenter V, Ricke J, Schmid-Tannwald C. Synchronous neuroendocine liver metastases in comparison to primary pancreatic neuroendocrine tumors on MRI and SSR-PET/CT. Front Oncol 2024; 14:1352538. [PMID: 38884077 PMCID: PMC11179428 DOI: 10.3389/fonc.2024.1352538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Background The study aimed to compare and correlate morphological and functional parameters in pancreatic neuroendocrine tumors (pNET) and their synchronous liver metastases (NELM), while also assessing prognostic imaging parameters. Methods Patients with G1/G2 pNET and synchronous NELM underwent pretherapeutic abdominal MRI with DWI and 68Ga-DOTATATE/TOC PET/CT were included. ADC (mean, min), SNR_art and SNT_T2 (SNR on arterial phase and on T2) and SUV (max, mean) for three target NELM and pNET, as well as tumor-free liver and spleen (only in PET/CT) were measured. Morphological parameters including size, location, arterial enhancement, cystic components, T2-hyperintensity, ductal dilatation, pancreatic atrophy, and vessel involvement were noted. Response evaluation used progression-free survival (PFS) with responders (R;PFS>24 months) and non-responders (NR;PFS ≤ 24 months). Results 33 patients with 33 pNETs and 95 target NELM were included. There were no significant differences in ADC and SUV values between NELM and pNET. 70% of NELM were categorized as hyperenhancing lesions, whereas the pNETs exhibited significantly lower rate (51%) of hyperenhancement (p<0.01) and significant lower SNR_art. NELM were qualitatively and quantitatively (SNR_T2) significantly more hyperintense on T2 compared to pNET (p=0.01 and p<0.001). NELM of R displayed significantly lower ADCmean value in comparison to the ADC mean value of pNET (0.898 versus 1.037x10-3mm²/s,p=0.036). In NR, T2-hyperintensity was notably higher in NELM compared to pNET (p=0.017). The hepatic tumor burden was significantly lower in the R compared to the NR (10% versus 30%). Conclusions Arterial hyperenhancement and T2-hyperintensity differ between synchronous NELM and pNET. These findings emphasize the importance of a multifaceted approach to imaging and treatment planning in patients with these tumors as well as in predicting treatment responses.
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Affiliation(s)
- Annie Horng
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Maria Ingenerf
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Frank Berger
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Denise Steffinger
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Matthias Zacherl
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Vera Wenter
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System at the University Hospital of Munich (GEPNET-KUM), University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Christine Schmid-Tannwald
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
- European Neuroendocrine Tumor Society (ENETS) Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System at the University Hospital of Munich (GEPNET-KUM), University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
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Target Heterogeneity in Oncology: The Best Predictor for Differential Response to Radioligand Therapy in Neuroendocrine Tumors and Prostate Cancer. Cancers (Basel) 2021; 13:cancers13143607. [PMID: 34298822 PMCID: PMC8304541 DOI: 10.3390/cancers13143607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary In the era of precision medicine, novel targets have emerged on the surface of cancer cells, which have been exploited for the purpose of radioligand therapy. However, there have been variations in the way these receptors are expressed, especially in prostate cancers and neuroendocrine tumors. This variable expression of receptors across the grades of cancers led to the concept of ‘target heterogeneity’, which has not just impacted therapeutic decisions but also their outcomes. Radiopharmaceuticals targeting receptors need to be used when there are specific indicators—either clinical, radiological, or at molecular level—warranting their use. In addition, response to these radioligands can be assessed using different techniques, whereby we can prognosticate further outcomes. We shall also discuss, in this review, the conventional as well as novel approaches of detecting heterogeneity in prostate cancers and neuroendocrine tumors. Abstract Tumor or target heterogeneity (TH) implies presence of variable cellular populations having different genomic characteristics within the same tumor, or in different tumor sites of the same patient. The challenge is to identify this heterogeneity, as it has emerged as the most common cause of ‘treatment resistance’, to current therapeutic agents. We have focused our discussion on ‘Prostate Cancer’ and ‘Neuroendocrine Tumors’, and looked at the established methods for demonstrating heterogeneity, each with its advantages and drawbacks. Also, the available theranostic radiotracers targeting PSMA and somatostatin receptors combined with targeted systemic agents, have been described. Lu-177 labeled PSMA and DOTATATE are the ‘standard of care’ radionuclide therapeutic tracers for management of progressive treatment-resistant prostate cancer and NET. These approved therapies have shown reasonable benefit in treatment outcome, with improvement in quality of life parameters. Various biomarkers and predictors of response to radionuclide therapies targeting TH which are currently available and those which can be explored have been elaborated in details. Imaging-based features using artificial intelligence (AI) need to be developed to further predict the presence of TH. Also, novel theranostic tools binding to newer targets on surface of cancer cell should be explored to overcome the treatment resistance to current treatment regimens.
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Optimization of timing of hepatocellular phase imaging after gadoxetate disodium injection for evaluation of patients with neuroendocrine tumor. Abdom Radiol (NY) 2020; 45:2358-2369. [PMID: 32270259 DOI: 10.1007/s00261-020-02515-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Metastatic gastroenteropancreatic neuroendocrine neoplasms (mGEP-NEN) are indolent malignancies which undergo frequent imaging follow-up. Hepatocellular phase (HCP) MR with hepatocellular-specific contrast agent is widely used to evaluate mGEP-NEN liver metastases but is commonly performed after a 20-min delay which prolongs scan time. The purpose of this study was to evaluate if HCP MR at 15 min offers comparable performance to 20-min delay for patients with mGEP-NEN undergoing routine imaging surveillance. MATERIALS AND METHODS In this IRB-approved retrospective study, we evaluated 52 patients with mGEP-NEN who were imaged for routine surveillance with gadoxetate disodium (Eovist®)-enhanced MR including 15- and 20-min delayed HCP. Two readers (R1, R2), blinded to HCP timing, independently reviewed each set of images in random order at least 1 month apart. Readers assessed presence and conspicuity of metastases, and subjective image quality using 5-point scales. Readers quantified the number of metastases and diameter of the largest lesion. Statistical analysis was performed to determine individual-reader and inter-reader differences for qualitative and quantitative data. RESULTS No differences were observed for subjective image quality (R1 p = 0.86, R2 p = 0.17) or lesion conspicuity (R1 p = 0.56, R2 p = 0.74) at 15 min and 20 min for either reader. Individual-reader concordance correlation coefficient between 15 and 20 min was high for number of metastases detected (R1 = 0.9842, R2 = 0.9579) and diameter of largest metastasis (R1 = 0.9629, R2 = 0.8859). CONCLUSION HCP imaging at 15 min provides similar diagnostic yield to standard 20-min delay, which may help reduce the scan time and costs, and improve throughput and patient satisfaction.
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Hayoz R, Vietti-Violi N, Duran R, Knebel JF, Ledoux JB, Dromain C. The combination of hepatobiliary phase with Gd-EOB-DTPA and DWI is highly accurate for the detection and characterization of liver metastases from neuroendocrine tumor. Eur Radiol 2020; 30:6593-6602. [PMID: 32601948 DOI: 10.1007/s00330-020-06930-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/28/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare the diagnostic accuracy of dynamic contrast-enhanced phases, hepatobiliary phase (HBP), and diffusion-weighted imaging (DWI) for the detection of liver metastases from neuroendocrine tumor (NET). METHODS Sixty-seven patients with suspected NET liver metastases underwent gadoxetic acid-enhanced MRI. Three radiologists read four imaging sets separately and independently: DWI, T2W+dynamic, T2WI+HBP, and DWI+HBP. Reference standard included all imaging, histological findings, and clinical data. Sensitivity and specificity were calculated and compared for each imaging set. Interreader agreement was evaluated by intraclass correlation coefficient (ICC). Univariate logistic regression was performed to evaluate lesion characteristics (size, ADC, and enhancing pattern) associated to false positive and negative lesions. RESULTS Six hundred twenty-five lesions (545 metastases, 80 benign lesions) were identified. Detection rate was significantly higher combining DWI+HBP than the other imaging sets (sensitivity 86% (95% confidence interval (CI) 0.845-0.878), specificity 94% (95% CI 0.901-0.961)). The sensitivity and specificity of the other sets were 82% and 65% for DWI, 88% and 69% for T2WI, and 90% and 82% for HBP+T2WI, respectively. The interreader agreement was statistically higher for both HBP sets (ICC = 0.96 (95% CI 0.94-0.97) for T2WI+HBP and ICC = 0.91 (95% CI 0.87-0.94) for DWI+HBP, respectively) compared with that for DWI (ICC = 0.76 (95% CI 0.66-0.83)) and T2+dynamic (ICC = 0.85 (95% CI 0.79-0.9)). High ADC values, large lesion size, and hypervascular pattern lowered the risk of false negative. CONCLUSION Given the high diagnostic accuracy of combining DWI+HBP, gadoxetic acid-enhanced MRI is to be considered in NET patients with suspected liver metastases. Fast MRI protocol using T2WI, DWI, and HBP is of interest in this population. KEY POINTS • The combined set of diffusion-weighted (DW) and hepatobiliary phase (HBP) images yields the highest sensitivity and specificity for neuroendocrine liver metastasis (NELM) detection. • Gadoxetic acid should be the contrast agent of choice for liver MRI in NET patients. • The combined set of HBP and DWI sequences could also be used as a tool of abbreviated MRI in follow-up or assessment of treatment such as somatostatin analogs.
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Affiliation(s)
- Roschan Hayoz
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Naïk Vietti-Violi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
| | - Jean-François Knebel
- EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) and Laboratory for Investigative Neurophysiology (The LINE), Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne, 1011, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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Tran Cao HS, Marcal LP, Mason MC, Yedururi S, Joechle K, Wei SH, Vauthey JN. Benign hepatic incidentalomas. Curr Probl Surg 2019; 56:100642. [DOI: 10.1067/j.cpsurg.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy
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Fard N, Schlemmer HP, Raue F, Jobke B. CT- and ultrasound-characteristics of hepatic lesions in patients with multiple endocrine neoplasia syndrome. A retrospective image review of 25 cases. PLoS One 2019; 14:e0212865. [PMID: 30817772 PMCID: PMC6394931 DOI: 10.1371/journal.pone.0212865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/11/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Liver metastases from neuroendocrine tumors in multiple endocrine neoplasia syndrome are common (75%) and significantly impairs the prognosis. Characterisation of liver lesions in these patients is challenging, as liver metastases are difficult to differentiate from benign liver lesions such as haemangioma. Methods In this study we aimed to characterize the radiological findings of hepatic metastases in MEN patients. The findings of contrast-enhanced CT were considered for the main diagnosis. We retrospectively evaluated 25 patients with MEN-syndrome (10 MEN1/ 15 MEN2) including 11 men and 14 women between 28–62 years of age. Results Liver metastases (48%, 12/25) and hemangioma (40%, 10/25) were the most common liver lesions among our patients. The most common primary tumors in our MEN1 and MEN2 patients with liver metastases were of pancreatic neuroendocrine tumor (70%, 7/10) und medullary thyroid carcinoma (100%, 15/15) origin, respectively. CT-characteristics were grouped into three main categories, depending on contrast dynamics. The majority of hepatic metastases (75%, 14/25) are presented as multiple lesions with a slow growth in an average 5 years of follow-up-period. We were able to find a common CT pattern and categorise these for each MEN-syndrome. Hepatic metastases in MEN1 presented commonly a blurred arterial enhancement with a low portal venous enhancement and less frequently a prominent enhancement in the arterial phase, which mimics the classical haemangioma. In MEN2 the liver metastases exhibited disseminated mixed hyper- and hypo-enhanced lesions in CT-scans. Moreover, lesion calcifications are pathognomonic in MEN2. The main limitation of this study is the missing histopathological confirmation in the majority of cases. Conclusions In this retrospective imaging study, we were able to categorise and find a common CT pattern for hepatic lesions in patients with MEN-syndrome. In order to differentiate these lesions sufficiently, a combination of a 3-phasic CT-scan with US is required. Other liver specific imaging modalities (MRI, CEUS, SMS-PET/CT) should complement the diagnosis in individual cases.
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Affiliation(s)
- Nassim Fard
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Björn Jobke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Telemedicine Clinic/Unilabs, Barcelona, Spain
- * E-mail:
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Huh J, Park J, Kim KW, Kim HJ, Lee JS, Lee JH, Jeong YK, Shinagare AB, Ramaiya NH. Optimal Phase of Dynamic Computed Tomography for Reliable Size Measurement of Metastatic Neuroendocrine Tumors of the Liver: Comparison between Pre- and Post-Contrast Phases. Korean J Radiol 2018; 19:1066-1076. [PMID: 30386138 PMCID: PMC6201971 DOI: 10.3348/kjr.2018.19.6.1066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/22/2018] [Indexed: 11/16/2022] Open
Abstract
Objective The reliability of size measurements of liver metastases from neuroendocrine tumors (NETs) on contrast-enhanced computed tomography (CT) phases made by different readers may be hampered due to transient, variable rim enhancement in arterial phase (AP) or portal venous phase (PVP) images. We aimed to assess the reliability of tumor size measurements in pre- and post-contrast scans. Materials and Methods The study coordinator selected target lesions according to Response Evaluation Criteria in Solid Tumors 1.1 guidelines in 44 consecutive patients with pathologically confirmed NET liver metastases. Two blinded readers measured the longest diameters of target lesions on pre-contrast, AP, and PVP images twice with a 4-week interval. Inter- and intra-observer agreements were evaluated using Bland-Altman plots and 95% limit of agreement (LOA) calculations. Results Of the 79 target lesions (approximate mean size of 3 cm), 45 showed rim enhancement. Inter-observer agreement assessed based on LOA was highest in pre-contrast CT images (−6.1–5.7 mm), followed by PVP (−7.9–7.1 mm) and AP (−8.5–7.4 mm) images. Intra-observer agreement showed the same trend: −2.8–2.9 mm and −2.9–2.9 mm for readers 1 and 2, respectively, on pre-contrast CT, −2.8–2.9 mm and −3.0–3.2 mm, respectively, on PVP, and −3.2–4.2 mm and −3.4–3.2 mm, respectively, on AP images. Mean tumor diameters differed significantly among the phases in the following increasing order: pre-contrast CT, PVP, and AP images. Conclusion There was better inter- and intra-observer agreement in size measurements of NET liver metastases on precontrast scans than on AP and PVP scans. Pre-contrast CT may be the optimal for measuring NET liver metastases if its accuracy is proven.
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Affiliation(s)
- Jimi Huh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.,Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, Suwon 16499, Korea
| | - Jisuk Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Hwa Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
| | - Yoong Ki Jeong
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
| | - Atul B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Kim B, Byun J, Lee J, Park B, Kwon HJ, Lee J, Lee S, Won H, Shin Y, Kim P. Imaging findings of primary hepatic angiosarcoma on gadoxetate disodium-enhanced liver MRI: comparison with hepatic haemangiomas of similar size. Clin Radiol 2018; 73:244-253. [DOI: 10.1016/j.crad.2017.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/19/2017] [Accepted: 09/29/2017] [Indexed: 12/18/2022]
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Blumhagen N, Fisher KL. Atypical Hepatic Hemangioma: A Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017; 33:325-331. [DOI: 10.1177/8756479317701965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Hemangiomas are benign vascular tumors caused by an increase of blood vessels lined with endothelium. Diagnostic imaging such as sonography, computed tomography (CT), and contrast-enhanced magnetic resonance imaging (CE-MRI) can be used to detect hepatic hemangiomas, which are typically noted as incidental findings. However, in cases where hepatic hemangiomas demonstrate atypical appearances, this may suggest a possible malignancy. In such instances, a liver biopsy may be necessary for pathologic confirmation. A case is provided of a large hepatic mass that was initially detected on CT and further evaluated with sonography. Sonographic evaluation revealed characteristics suspicious for possible malignancy, including highly enlarged size, heterogeneous echotexture, and lobular contour. A biopsy ultimately determined the mass to be a cavernous hepatic hemangioma. The atypical sonographic appearance of the hepatic hemangioma in this case is worthy of consideration such that sonographers and the interpreting physician are aware of various presentations of this pathology.
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Prevalence of hepatic lesion types defined by T2-weighted and dynamic gadolinium-enhanced MR imaging in patients with metastasized neuroendocrine tumors. Abdom Radiol (NY) 2016; 41:2132-2141. [PMID: 27315078 DOI: 10.1007/s00261-016-0814-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Identifying liver metastases from neuroendocrine tumors (NETs) is a pretherapeutic challenge in patients who are candidates for liver resection. The aims of our study are to characterize and determine the frequency of different MRI characteristics of liver metastases caused by NETs in a lesion-by-lesion analysis and to determine the frequency of monomorphous and polymorphous metastases in a patient-by-patient analysis. METHODS This retrospective study involved 47 patients with liver metastases arising from histologically confirmed NETs. In a lesion-by-lesion analysis, we classified these metastases according to their MRI characteristics as follows: hypervascular lesions with homogeneous or peripheral enhancement, hypovascular lesions, pure cystic lesions, and mixed solid/cystic lesions. In the patient-by-patient analysis, we distinguished patients whose metastases had the same MRI characteristics from patients with mixed lesion characteristics. RESULTS A total of 376 metastases were analyzed. Of these, 84.3% (n = 317) were hypervascular, with 51.9% showing homogeneous enhancement and 32.4% (n = 122) showing peripheral enhancement. Another 7.4% (n = 28) were hypovascular, 5.3% (n = 20) were pure cystic, and 2.9% (n = 11) were mixed solid/cystic. After excluding three patients with solitary lesions, 40.9% of patients (n = 18) had mixed-type lesions, consisting of hypervascular lesions with either homogeneous or peripheral enhancement in 27.3% of cases (n = 12), while 59.1% of patients (n = 26) had identical lesions. CONCLUSION Approximately 15% of metastases have atypical MRI characteristics and are either hypovascular or cystic. Metastases with different MRI characteristics coexist in 40% of patients.
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Enhancement patterns and pseudo-washout of hepatic haemangiomas on gadoxetate disodium-enhanced liver MRI. Eur Radiol 2015; 26:191-8. [DOI: 10.1007/s00330-015-3798-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 04/04/2015] [Accepted: 04/13/2015] [Indexed: 12/18/2022]
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Lewis S, Aljarallah B, Trivedi A, Thung SN. Magnetic resonance imaging of a small vessel hepatic hemangioma in a cirrhotic patient with histopathologic correlation. Clin Imaging 2015; 39:702-6. [PMID: 25748474 DOI: 10.1016/j.clinimag.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/09/2015] [Accepted: 02/05/2015] [Indexed: 02/07/2023]
Abstract
The authors report and discuss a rare case of a small vessel hepatic hemangioma in a 59-year-old patient with liver cirrhosis, which was pre-procedurally characterized as indeterminate due to atypical magnetic resonance imaging (MRI) features. This manuscript reviews the MRI features with pathologic correlation, emphasizes the importance of accurate characterization of liver lesions, and discusses the role of biopsy. We believe this is the first reported case of a small vessel hemangioma in liver cirrhosis with imaging and histopathologic correlation.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029.
| | - Badr Aljarallah
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029
| | - Anshu Trivedi
- Division of Liver Pathology, The Lillian and Henry Stratton - Hans Popper, Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029
| | - Swan N Thung
- Division of Liver Pathology, The Lillian and Henry Stratton - Hans Popper, Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029
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WARD J, MANOHARAN P. MRI assessment of focal liver lesions in the non-cirrhotic patient. IMAGING 2013. [DOI: 10.1259/imaging/16052010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ojili V, Tirumani SH, Gunabushanam G, Nagar A, Surabhi VR, Chintapalli KN, Ryan J. Abdominal Hemangiomas: A Pictorial Review of Unusual, Atypical, and Rare Types. Can Assoc Radiol J 2013; 64:18-27. [DOI: 10.1016/j.carj.2011.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/15/2011] [Accepted: 08/05/2011] [Indexed: 11/27/2022] Open
Abstract
Hemangiomas are a radiologist's dream lesions because they allow a confident diagnosis most of the time. However, within the abdomen, hemangiomas may occur in such atypical locations and can have such unusual features that they cause significant diagnostic dilemma and may end up being excised surgically. The literature is replete with isolated case reports of atypical hemangiomas in the abdominal cavity, and, to our knowledge, so far, there is no comprehensive review. We present, in this article, a pictorial review of a gamut of uncommon hemangiomas and hemangiomatosis syndromes. Knowledge of these rare types can help in limiting diagnostic errors and increase the confidence of radiologists, thus avoiding unnecessary surgeries.
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Affiliation(s)
- Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | | - Arpit Nagar
- Division of Abdominal Imaging, Department of Radiology, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Venkateswar Rao Surabhi
- Department of Radiology, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kedar N. Chintapalli
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - John Ryan
- Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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Soyer P, Corno L, Boudiaf M, Aout M, Sirol M, Placé V, Duchat F, Guerrache Y, Fargeaudou Y, Vicaut E, Pocard M, Hamzi L. Differentiation between cavernous hemangiomas and untreated malignant neoplasms of the liver with free-breathing diffusion-weighted MR imaging: Comparison with T2-weighted fast spin-echo MR imaging. Eur J Radiol 2011; 80:316-24. [DOI: 10.1016/j.ejrad.2010.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 07/20/2010] [Accepted: 08/02/2010] [Indexed: 01/18/2023]
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17
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Sommer WH, Zech CJ, Bamberg F, Auernhammer CJ, Helck A, Paprottka PM, Notohamiprodjo M, Reiser MF, Herrmann KA. Fluid-fluid level in hepatic metastases: a characteristic sign of metastases of neuroendocrine origin. Eur J Radiol 2011; 81:2127-32. [PMID: 21978774 DOI: 10.1016/j.ejrad.2011.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/07/2011] [Accepted: 09/10/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study is to determine MRI characteristics which indicate liver metastases of neuroendocrine tumors (NET) rather than metastases of other origin (non-NET). METHODS Sixty-nine patients with histopathologically proven liver metastases from NET and 69 patients with known liver metastases of other origin underwent MRI of the liver using a 1.5 T MR-scanner. Two board certified radiologists assessed presence of fluid-fluid-levels, number and distribution pattern, signal intensity (SI) characteristics, lesion homogeneity, presence of central necrosis and intratumoral hemorrhage in T2w and T1w non-contrast imaging. A multivariate logistic regression analysis was performed to determine the independent association of image findings and occurrence of NET. RESULTS Fluid-fluid-levels were identified in 19/69 of patients with NET-metastases, and in none of the patients in the control group (p<0.0001). Hyperintense SI in T1w imaging, markedly hyperintense SI in T2w imaging, a disseminated distribution pattern and intratumoral hemorrhage were indicative of NET metastases (p<0.05). After statistical adjustment for all significant MRI findings, fluid-fluid-levels (OR: 17.6, 95% CI: 1.9-166.5), strongly hyperintense SI in T2w (OR: 4.7, 95% CI: 1.8-12.7) and a disseminated distribution pattern (OR: 2.9, 95% CI: 1.1-7.4) were independent predictors for NET metastases. CONCLUSIONS The presence of fluid-fluid-levels is highly indicative of NET liver metastases and can be used as an independent predictor to distinguish them from metastases of other origin.
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Affiliation(s)
- Wieland H Sommer
- Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University, Munich, Germany.
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Müssig K, Bares R, Erckenbrecht JF, Horger M. Multimodal imaging in functional endocrine pancreatic tumors. Expert Rev Endocrinol Metab 2010; 5:855-866. [PMID: 30780827 DOI: 10.1586/eem.10.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endocrine pancreatic tumors, also known as pancreatic islet tumors, are rare entities of neuroendocrine origin that are located within the pancreas or in its close proximity. Approximately 50% of these tumors secrete biologically active substances that lead to the development of specific clinical syndromes. Once diagnosis has been established on the basis of clinical and laboratory findings, localization of the source of pathologic hormone secretion is warranted. Endocrine pancreatic tumor imaging comprises anatomical imaging modalities, such as ultrasound, computed tomography (CT) and MRI, as well as functional radiological studies, including arterial calcium stimulation with hepatic venous sampling, and functional nuclear medicine imaging modalities, such as scintigraphy and PET. The recent combination of high-resolution anatomic studies and functional imaging, such as PET/CT and single-photon emission CT/CT, allows excellent diagnostic evaluation of pancreatic islet cell tumors and has, therefore, especially high value. Given that none of these imaging methods are exclusively superior to the others, visualization of pancreatic islet cell tumors often requires the combination of different imaging modalities.
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Affiliation(s)
- Karsten Müssig
- a Department of Internal Medicine, Gastroenterology and Oncology, Florence Nightingale Hospital, Kaiserswerther Diakonie, Kreuzbergstr. 79, 40489 Düsseldorf, Germany
- d
| | - Roland Bares
- b Department of Nuclear Medicine, University Hospital of Tübingen, Otfried-Müller-Str. 14, 72076 Tübingen, Germany
| | - Joachim F Erckenbrecht
- a Department of Internal Medicine, Gastroenterology and Oncology, Florence Nightingale Hospital, Kaiserswerther Diakonie, Kreuzbergstr. 79, 40489 Düsseldorf, Germany
| | - Marius Horger
- c Department of Diagnostic Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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Solitary hepatic metastasis from medullary thyroid carcinoma mimicking atypical hemangioma: insights from multimodality diagnostic approach by MRI, F-18 FDG and F-18 FDOPA PET/CT. Clin Nucl Med 2010; 35:434-7. [PMID: 20479594 DOI: 10.1097/rlu.0b013e3181db4e45] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Soussan M, Aubé C, Bahrami S, Boursier J, Valla DC, Vilgrain V. Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging. Eur Radiol 2010; 20:1715-25. [PMID: 20069427 DOI: 10.1007/s00330-009-1700-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/14/2009] [Accepted: 11/20/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To prospectively assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) and MR imaging in incidental solid focal liver lesions not characterised on ultrasound. MATERIALS AND METHODS Forty-seven patients with 50 lesions underwent MR imaging and CEUS: 24 focal nodular hyperplasias (FNH), 11 adenomas, 10 haemangiomas, 1 focal fatty change and 4 malignant lesions were identified. Two experienced radiologists randomly reviewed contrast-enhanced MR imaging and CEUS data, and provided the most likely diagnosis. Sensitivity (Se), specificity (Sp), likelihood ratios (LR) and kappa value were calculated. RESULTS A histotype diagnosis was obtained in 66-52% with MR imaging and 52-53% with CEUS, respectively, for both readers. Se, Sp and LR for haemangioma were 100-100, 100-100 and 78-78 with MR imaging and 89-89, 100-100 and 68-70 with CEUS; for FNH with MR imaging they were 88-63, 96-100 and 23-34 and 74-67, 88-96 and 6-17 with CEUS. If the diagnosis of haemangioma was uncertain with CEUS, MR imaging always confirmed the diagnosis. If the diagnosis of FNH was uncertain with either CEUS or MR imaging, the other imaging technique confirmed the diagnosis in approximately half the cases. CONCLUSION Both CEUS and MR imaging have a high diagnostic performance in incidental focal liver lesions and are complementary when diagnosis is uncertain.
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Affiliation(s)
- Michael Soussan
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, APHP, Hôpital Beaujon, Clichy, France
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Coenegrachts K. Magnetic resonance imaging of the liver: New imaging strategies for evaluating focal liver lesions. World J Radiol 2009; 1:72-85. [PMID: 21160723 PMCID: PMC2999307 DOI: 10.4329/wjr.v1.i1.72] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 11/12/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023] Open
Abstract
The early detection of focal liver lesions, particularly those which are malignant, is of utmost importance. The resection of liver metastases of some malignancies (including colorectal cancer) has been shown to improve the survival of patients. Exact knowledge of the number, size, and regional distribution of liver metastases is essential to determine their resectability. Almost all focal liver lesions larger than 10 mm are demonstrated with current imaging techniques but the detection of smaller focal liver lesions is still relatively poor. One of the advantages of magnetic resonance imaging (MRI) of the liver is better soft tissue contrast (compared to other radiologic modalities), which allows better detection and characterization of the focal liver lesions in question. Developments in MRI hardware and software and the availability of novel MRI contrast agents have further improved the diagnostic yield of MRI in lesion detection and characterization. Although the primary modalities for liver imaging are ultrasound and computed tomography, recent studies have suggested that MRI is the most sensitive method for detecting small liver metastatic lesions, and MRI is now considered the pre-operative standard method for diagnosis. Two recent developments in MRI sequences for the upper abdomen comprise unenhanced diffusion-weighted imaging (DWI), and keyhole-based dynamic contrast-enhanced (DCE) MRI (4D THRIVE). DWI allows improved detection (b = 10 s/mm2) of small (< 10 mm) focal liver lesions in particular, and is useful as a road map sequence. Also, using higher b-values, the calculation of the apparent diffusion coefficient value, true diffusion coefficient, D, and the perfusion fraction, f, has been used for the characterization of focal liver lesions. DCE 4D THRIVE enables MRI of the liver with high temporal and spatial resolution and full liver coverage. 4D THRIVE improves evaluation of focal liver lesions, providing multiple arterial and venous phases, and allows the calculation of perfusion parameters using pharmacokinetic models. 4D THRIVE has potential benefits in terms of detection, characterization and staging of focal liver lesions and in monitoring therapy.
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Hoeffel C, Job L, Ladam-Marcus V, Vitry F, Cadiot G, Marcus C. Detection of hepatic metastases from carcinoid tumor: prospective evaluation of contrast-enhanced ultrasonography. Dig Dis Sci 2009; 54:2040-6. [PMID: 19034651 DOI: 10.1007/s10620-008-0570-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 10/02/2008] [Indexed: 12/19/2022]
Abstract
The purpose of our study was to prospectively compare unenhanced ultrasonography (US) to contrast-enhanced US (CEUS) in the detection of hepatic metastases from carcinoid tumor. Thirty patients with carcinoid tumor prospectively underwent US, CEUS, and magnetic resonance imaging (MRI). Differences in sensitivity at US and CEUS were compared using a combination of the results of MR imaging, fine-needle biopsy, and follow-up imaging. Lesion conspicuity was assessed subjectively for US and CEUS. Seventeen patients had a total of 69 hepatic metastases. The addition of CEUS improved the detection of individual metastases from 47 (Se 68%; 95% CI: 57.0, 79.0) to 68 (Se 99%; 99% CI: 96.7, 100.0). Contrast enhancement improved the subjective conspicuity of metastases in 85% of patients. CEUS showed one more metastasis than did MRI in one patient, and MRI showed one more than did CEUS in one patient. CEUS is more sensitive than US in the detection of carcinoid liver metastases.
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Affiliation(s)
- Christine Hoeffel
- Service de Radiologie, Pôle d'Imagerie, Hôpital Robert Debré, CHU Reims, 51092 Reims, France.
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Tsurusaki M, Kawasaki R, Yamaguchi M, Sugimoto K, Fukumoto T, Ku Y, Sugimura K. Atypical hemangioma mimicking hepatocellular carcinoma with a special note on radiological and pathological findings. Jpn J Radiol 2009; 27:156-60. [PMID: 19412684 DOI: 10.1007/s11604-008-0310-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 12/10/2008] [Indexed: 12/14/2022]
Abstract
We report a case of hemangioma with an atypical vascular enhancement pattern. The hemangioma showed peripheral rim enhancement at the arterial phase during dynamic magnetic resonance imaging, and the peripheral enhanced zone was still apparent during the delayed phase, as shown on double-phase computed tomography hepatic arteriography. The rim enhancement pattern of this case, mimicking that of hepatocellular carcinoma, may be due to the surrounding liver parenchymal fibrotic change caused by an active hepatitis C viral infection.
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Affiliation(s)
- Masakatsu Tsurusaki
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuo-ku, Kobe, 650-0017, Japan.
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Abstract
Incidentally discovered liver masses are becoming more common with the increasing application and power of imaging techniques for the evaluation of abdominal conditions. Although such masses are often benign, conclusive diagnoses must be established in order to provide appropriate patient care. Various imaging modalities can be utilized to accurately diagnose such masses without resort to more invasive diagnostic measures.
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Lacout A, El Hajjam M, Julie C, Lacombe P, Pelage JP. Liver metastasis of a mucinous colonic carcinoma mimicking a haemangioma in T2-weighted sequences. J Med Imaging Radiat Oncol 2008; 52:580-2. [DOI: 10.1111/j.1440-1673.2008.02014.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Boozari B, Lotz J, Galanski M, Gebel M. [Diagnostic imaging of liver tumours. Current status]. Internist (Berl) 2008; 48:8, 10-2, 14-6, 18-20. [PMID: 17216509 DOI: 10.1007/s00108-006-1773-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Nowadays, contrast enhanced ultrasound (CEUS) is an imaging technique equivalent to multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the detection and characterization of focal liver lesions. These methods have comparable sensitivity and specificity in differentiating a liver lesion as "benign" or "malignant". For benign lesions, CEUS is the recommended method of the choice. In unclear cases, or if CEUS is not available, MRI or CT are the methods of the second choice. If a benign tumor remains unclear, then a needle biopsy is recommended. In the case of a malignant tumor, it is necessary to use a second imaging technique besides CEUS. In addition to the detection and characterization of a liver tumor, CT and MRI provide information on the extrahepatic spread of a tumor, particularly into the lung or retroperitoneum. The rapid development of surgical and interventional approaches requires accurate information on the character and number of malignant liver lesions. Therefore, the combined use of CEUS and MDCT or MRI currently represents the most modern and optimal standard of imaging. The standardization of CT and MRI protocols has increased the general diagnostic level of these images. Adequate training and a certificate for the use of CEUS is recommended in order to maintain the high diagnostic level of this method (EFSUMB guide lines). An optimal interdisciplinary imaging strategy for focal liver lesions minimises unnecessary invasive or potentially harmful imaging and reduces health costs.
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Affiliation(s)
- B Boozari
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, 30625, Carl-Neuberg-Str. 1, Hannover, Germany.
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27
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Erdogan D, Busch ORC, van Delden OM, Bennink RJ, ten Kate FJW, Gouma DJ, van Gulik TM. Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol 2007; 22:1953-8. [PMID: 17914976 DOI: 10.1111/j.1440-1746.2006.04794.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Liver hemangiomas are the most common benign liver tumors. These lesions are usually incidental findings during imaging studies of the abdomen performed for other reasons. The indication for surgical resection of these lesions remains controversial. METHODS Records of patients referred for evaluation of radiologically and/or histopathologically proven liver hemangiomas, from June 1991 to February 2006, were retrospectively analyzed. Reason for referral, results of imaging studies, and surgical treatment and outcome were reviewed. RESULTS There were 34 patients identified. The hemangioma size was <5 cm in 15 patients (44%) and >5 cm in 19 patients. The most common reason for referral was right upper abdominal pain in 59% (20/34) of patients. Abdominal ultrasound was conclusive in 66.7% (16/24) and four-phase computed tomography (CT) in 82.6% (19/23) of patients. Surgical resection was undertaken in 14 patients (41%) after a mean follow-up time of 36.5 months. The indication for treatment was progressive abdominal pain in 78.6% (11/14). Mean size of resected lesions was larger compared to non-resected lesions (10.3 vs 4.8 cm; P = 0.004). Postoperative morbidity occurred in three patients (21.4%). One patient had persisting abdominal pain after resection of an 8-cm hemangioma. Twenty patients were observed and showed no complications related to the liver hemangioma during follow-up. CONCLUSIONS Liver hemangiomas can be readily diagnosed by ultrasound or multiphase contrast-enhanced helical CT. The indications for surgical resection are progressive abdominal pain in combination with size >5 cm. Observation is justified in patients with minimal or no symptoms, even in patients with giant hemangiomas.
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Affiliation(s)
- Deha Erdogan
- Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
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Abstract
Liver masses are very common and most are benign. It is therefore important to avoid unnecessary interventions for benign lesions, while at the same time ensuring accurate diagnosis of hepatic malignancies. Many cancer patients, like the general population, have incidental benign liver lesions. In planning treatment for cancer patients, it is critical to avoid inappropriate treatment decisions based on misdiagnosis of a benign lesion as a metastasis or primary liver malignancy. This article describes the salient imaging features of the common benign liver masses and outlines a general approach to distinguishing between benign and malignant hepatic lesions.
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Affiliation(s)
- Jay P Heiken
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Abstract
Metastases are the most common malignant liver lesions and the most common indication for hepatic imaging. Specific characterization of liver metastases in patients with primary non-hepatic tumors is crucial to avoid unnecessary diagnostic work-up for incidental benign liver lesions. Magnetic resonance (MR) is rapidly emerging as the imaging modality of choice for detection and characterization of liver lesions due to the high specificity resulting from optimal lesion-to-liver contrast and no radiation exposure. Improvements in breath-hold T1-weighted fast spoiled gradient echo and rapid T2-weighted single shot echo-train acquisition enable imaging of the liver in a single breath-hold with high spatial resolution. Most metastases are hypo- to isointense on T1 and iso- to hyperintense on T2-weighted images. MR contrast agents provide critical tumor characterization and can be safely used in patients with iodine contrast allergy and renal failure. Other agents, including newly developing gadolinium-chelates or iron oxide agents may provide additional benefits in selected applications. The degree and nature of tumor vascularity form the basis for liver lesion characterization based on enhancement properties. Liver metastases may be hypovascular or hypervascular. Colon, lung, breast and gastric carcinomas are the most common tumors causing hypovascular liver metastases, and typically show perilesional enhancement. Neuroendocrine tumors including carcinoid and islet cell tumors, renal cell carcinoma, breast, melanoma, and thyroid carcinoma are tumors most commonly causing hypervascular hepatic metastases, which may develop early enhancement with variable degrees of washout and peripheral rim enhancement.
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Affiliation(s)
- Saravanan Namasivayam
- Division of Abdominal Imaging, Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Present address: Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit street, White 270, Boston, MA 02114, USA
| | | | - Sanjay Saini
- Division of Abdominal Imaging, Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Present address: Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit street, White 270, Boston, MA 02114, USA
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Elsayes KM, Leyendecker JR, Menias CO, Oliveira EP, Narra VR, Chapman WC, Hassanien MH, Elsharkawy MS, Brown JJ. MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility. HPB (Oxford) 2007; 9:208-15. [PMID: 18333224 PMCID: PMC2063603 DOI: 10.1080/13651820701216950] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT. PATIENTS AND METHODS In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination. CT and MR images were reviewed independently by two separate groups of two radiologists. The value of MRI in characterizing these lesions was assessed. Diagnoses were confirmed based on histology, characteristic imaging features, and clinical follow-up. RESULTS MRI definitely characterized 73 lesions (58%) that were indeterminate on CT. MRI was accurate in 72/73 of these lesions. MRI could not definitely characterize 51 lesions (42%). Ten lesions were not visualized on MRI, and follow-up imaging confirmed that no lesion was present in eight of these cases (pseudolesions). CONCLUSION MRI is valuable for the characterization of indeterminate focal hepatic lesions detected on CT.
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Affiliation(s)
- Khaled M. Elsayes
- Department of Radiology, University of Michigan Health CenterAnn Arbor USA,Department of Radiology, Theodore Bilharz InstituteGizaEgypt
| | | | | | - Erica P. Oliveira
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
| | - Vamsidhar R. Narra
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
| | | | | | | | - Jeffrey J. Brown
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
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Affiliation(s)
- Miguel Bruguera
- Servicio de Hepatología. Hospital Clínic. Departamento de Medicina. Universidad de Barcelona. Barcelona. España.
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Kondo H, Kanematsu M, Itoh K, Ito K, Maetani Y, Goshima S, Matsuo M, Matsunaga N, Konishi J, Hoshi H, Moriyama N. Does T2-weighted MR imaging improve preoperative detection of malignant hepatic tumors? Observer performance study in 49 surgically proven cases. Magn Reson Imaging 2005; 23:89-95. [PMID: 15733793 DOI: 10.1016/j.mri.2004.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 11/05/2004] [Indexed: 01/08/2023]
Abstract
The purpose of our study was to determine whether or not the addition of T2-weighted fast spin-echo (SE) imaging to gadolinium-enhanced spoiled gradient-recalled-echo (GRE) imaging improves the observer performance in the preoperative detection of malignant hepatic tumors. Gadolinium-enhanced GRE and fat-suppressed T2-weighted fast SE images obtained in 49 patients with 82 surgically confirmed malignant hepatic tumors (40 hepatocellular carcinomas and 42 metastases) were retrospectively reviewed by three independent off-site observers. In the random review of images, gadolinium-enhanced GRE images were reviewed first; thereafter, T2-weighted fast SE images were added for combined review. Observer performance was evaluated with the McNemar's test and receiver operating characteristic curve analysis. For gadolinium-enhanced GRE images alone vs. combined images, sensitivities for detection were 78% vs. 79% for hepatocellular carcinomas (P>.05), 67% vs. 71% for metastases (P<.05) and 72% vs. 75% for tumors overall (P<.05), respectively. The Az values were 0.892 vs. 0.889 in hepatocellular carcinomas (P>.05), 0.797 vs. 0.828 in metastases (P<.05) and 0.839 vs. 0.846 in tumors overall (P>.05), respectively. Our results showed that the addition of T2-weighted fast SE imaging to gadolinium-enhanced GRE imaging improved the observer performance in the detection of metastases.
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Affiliation(s)
- Hiroshi Kondo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
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Zomerhuis MT, Hussain SM, Feelders RA, van der Lely AJ, de Herder WW. Octreotide exerts only acute, but no sustained, effects on MRI enhancement of liver metastases in carcinoid syndrome. Neuroendocrinology 2005; 82:41-8. [PMID: 16391492 DOI: 10.1159/000090636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 10/18/2005] [Indexed: 11/19/2022]
Abstract
We have investigated the acute and sustained hemodynamic effects of octreotide on hepatic metastases of midgut carcinoids using contrast-enhanced dynamic magnetic resonance imaging (MRI). Seven patients with the carcinoid syndrome and metastasized midgut carcinoid tumors underwent functional dynamic multi-phase gadolinium-enhanced MRI of selected liver metastases at baseline and 60 min after the subcutaneous (s.c.) administration of 100 microg octreotide, and also after 3 months with three times daily (t.i.d.) 100 microg octreotide s.c. Baseline MRIs showed the typical aspect of carcinoid liver metastases with a very bright signal on the T2-weighted sequences and intense enhancement in the arterial phase after injection of gadolinium-diethylenetriaminepentaacetate. MRIs 60 min after the s.c. administration of 100 microg octreotide showed a 34.9 +/- 6.2% (mean +/- SD) reduction in relative enhancement in the selected liver metastases as compared to baseline. In 2 patients, however, there was no (significant) reduction in the relative enhancement in the selected liver metastases 60 min after the s.c. administration of 100 microg octreotide as compared to baseline. Only in 2 patients did the MRIs at 3 months show a decrease in relative enhancement in one of the selected liver metastases. At 3 months, with 100 microg octreotide s.c. t.i.d., there was no correlation between the change in relative enhancement on MRI and the change in 24-hour 5-HIAA excretion. There is thus only an acute effect of octreotide on the perfusion of liver metastases. This study further shows that contrast-enhanced dynamic MRI can be a very useful tool for studying hemodynamic effects of medical therapies on liver metastases in patients with metastatic midgut carcinoids.
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Affiliation(s)
- Menno T Zomerhuis
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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Chen HC, Lee CM, Chen CS, Wu CH. A case of atypical caudate lobe hemangioma mimicking hepatocellular carcinoma: CT and angiographic manifestations. World J Gastroenterol 2004; 10:3382-4. [PMID: 15484325 PMCID: PMC4572320 DOI: 10.3748/wjg.v10.i22.3382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We report a case of caudate lobe hemangioma with an atypical CT enhancement pattern. In the present case, hemangioma exhibited a very subtle discontinuous peripheral rim enhancement at the post-enhanced arterial phase, and the peripheral enhanced zone had a moderately increased enhancement degree and with widened enhancement thickness during the portal-phase and delayed-phase. The slow enhancement rate for this caudate lobe hemangioma was due to sluggish perfusion by the small feeding arteries of caudate lobe branches as demonstrated by angiography.
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Affiliation(s)
- Hsin-Chi Chen
- Department of Radiology, Taipei Medical University Hospital, No. 252 Wu-Hsing Street, Taipei 110, Taiwan, China
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Manoharan P, Ward J. MRI in the assessment of focal liver lesions in the non-cirrhotic patient. IMAGING 2004. [DOI: 10.1259/imaging/12629402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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36
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Goshima S, Kanematsu M, Matsuo M, Murakami T, Hori M, Takamura M, Kondo H, Kako N, Moriyama N, Nakamura H, Hoshi H. Detection of malignant hepatic tumors with ferumoxide-enhanced MR imaging: usefulness of multishot and single-shot fast spin echo sequences. Magn Reson Imaging 2004; 22:379-88. [PMID: 15062933 DOI: 10.1016/j.mri.2004.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Accepted: 01/26/2004] [Indexed: 11/23/2022]
Abstract
The purpose of our study was to assess whether respiratory-triggered multishot fast spin echo (MS-FSE) and breath-hold half-Fourier single-shot fast spin echo (SS-FSE) images, in addition to breath-hold T(2)*-weighted gradient recalled echo (GRE) images, increase observer performance in the detection of malignant hepatic tumors with ferumoxide-enhanced magnetic resonance (MR) imaging. Ferumoxide-enhanced MR images obtained from 48 patients with 83 malignant hepatic tumors were retrospectively reviewed by three independent off-site readers. In the first image review, GRE images alone were reviewed. Then, MS-FSE images were added for the first combination review. Finally, SS-FSE images were added for the second combination review. Observer performances were tested by McNemar's test and receiver-operating-characteristic analysis for the clustered data. Sensitivity for hepatocellular carcinomas, metastases, and malignant hepatic tumors overall was significantly (p < 0.05) higher with GRE and MS-FSE combined and GRE, MS-FSE and SS-FSE combined than with GRE alone. For metastases, the Az value was significantly (p < 0.05) higher with GRE and MS-FSE combined, and GRE, MS-FSE and SS-FSE combined than with GRE alone. We confirmed the incremental value of ferumoxide-enhanced MR imaging by obtaining MS-FSE and SS-FSE images in addition to GRE images in the detection of malignant hepatic tumors.
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Affiliation(s)
- Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan
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Kim J, Ahmad SA, Lowy AM, Buell JF, Pennington LJ, Moulton JS, Matthews JB, Hanto DW. An algorithm for the accurate identification of benign liver lesions. Am J Surg 2004; 187:274-9. [PMID: 14769319 DOI: 10.1016/j.amjsurg.2003.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2003] [Revised: 06/16/2003] [Indexed: 01/29/2023]
Abstract
BACKGROUND Benign liver lesions may be difficult to characterize preoperatively. In most instances, determination of the etiology of a hepatic mass makes its management decisions clear-cut. We present our experience using an algorithm for the management of liver masses of suspected benign or uncertain pathology and highlight this approach along with our surgical experience in benign liver lesions. METHODS Seventy-one patients underwent hepatectomy with a preoperative diagnosis of benign disease or unknown etiology from December 1992 to February 2002. Patients were preoperatively assessed with computed tomography, along with other imaging studies, as indicated. Final pathology was reviewed to confirm the preoperative diagnosis. RESULTS Ninety-two percent (65 of 71) were correctly characterized preoperatively. Diagnosis was inaccurate in 6 patients. Of these patients, final pathology revealed focal nodular hyperplasia in 4 patients. The remaining 2 patients, who had adenoma, were found to harbor malignancy within the surgical specimens. CONCLUSIONS An algorithm to manage liver lesions resulted in a high diagnostic accuracy of a preoperative evaluation. Hepatic resection for benign disease can be performed with low morbidity and mortality and is highly successful in achieving relief for symptomatic patients.
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Affiliation(s)
- Joseph Kim
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati College of Medicine, OH 45219, USA
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Goshima S, Kanematsu M, Matsuo M, Kondo H, Kako N, Yokoyama R, Hoshi H, Moriyama N. Malignant hepatic tumor detection with ferumoxide-enhanced magnetic resonance imaging: Is chemical-shift-selective fat suppression necessary for fast spin-echo sequence? J Magn Reson Imaging 2004; 20:75-82. [PMID: 15221811 DOI: 10.1002/jmri.20091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine whether chemical-shift-selective (CSS) fat suppression is necessary for ferumoxide-enhanced T2-weighted fast spin-echo (FSE) imaging in the detection of malignant hepatic tumors. MATERIALS AND METHODS Ferumoxide-enhanced magnetic resonance (MR) images obtained in 38 patients with surgically confirmed 61 malignant hepatic tumors (36 hepatocellular carcinomas (HCCs), 25 metastases) were retrospectively reviewed by three independent readers. Three sequences of MR images with CSS fat-suppressed T2-weighted FSE, non-fat-suppressed T2-weighted FSE, and T2*-weighted gradient-recalled-echo (GRE) sequences were randomly reviewed on a segment-by-segment basis in a blind fashion. Observer performance was tested using the McNemar's test and receiver-operating-characteristic (ROC) analysis for the clustered data. Lesion-to-liver contrast-to-noise ratio (C/N) was also assessed. RESULTS The mean C/N with the CSS fat-suppressed FSE sequence was highest in HCCs, metastases, and tumors overall. Sensitivity was highest with the CSS fat-suppressed FSE sequence in HCC, was highest with the non-fat-suppressed FSE sequence in metastases, and was comparable in tumors overall. Specificity was comparable between the sequences. The area under ROC curve (Az) value was greatest with the CSS fat-suppressed FSE sequence in HCCs, was greatest with the non-fat- suppressed FSE sequence in metastases, and was comparable in tumors overall. The sensitivities and Az values were lower with the GRE sequence than the FSE sequence. CONCLUSION The CSS fat-suppressed FSE sequence was superior to the GRE sequence in the detection of HCCs, but the non-fat-suppressed FSE sequence was comparable to the GRE sequence. The non-fat-suppressed FSE sequence was superior to the CSS fat-suppressed FSE and GRE sequences in the detection of metastases. Optimal FSE imaging with CSS fat suppression or without aiming for the detection of HCCs or metastases, respectively, outperforms GRE imaging in ferumoxide-enhanced MRI.
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Affiliation(s)
- Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan
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Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH, DeMatteo RP. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 2003; 197:392-402. [PMID: 12946794 DOI: 10.1016/s1072-7515(03)00420-4] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatic hemangiomas are congenital vascular malformations and are the most common benign hepatic tumors. Because the use of cross-sectional imaging has increased, benign hepatic tumors, especially hemangiomas, are encountered more frequently, so clinicians should be familiar with the most appropriate diagnostic tests, management, and outcomes of patients with hepatic hemangioma. STUDY DESIGN All patients with a primary diagnosis of hepatic hemangioma referred for surgical evaluation at our institution between January 1992 and December 2000 were identified from a prospective database. Demographics, presentation, tumor characteristics, diagnostic studies, surgical procedures, and outcomes were analyzed. RESULTS; Of 115 patients in the study, nearly half were asymptomatic. In symptomatic patients, abdominal pain or discomfort was the most common presenting symptom. At our institution, the diagnosis of hemangioma was established by ultrasonographic studies in 57% of patients tested, by CT scan in 73%, and by MRI in 84%. In patients with large tumors considered for resection, direct angiography or, more recently, CT angiography, confirmed the diagnosis in 27 of 29 patients (93%). Enucleation was performed in 31 (60%) of the 52 patients who underwent surgical resection; 63 patients were observed. Postoperative complications occurred in 13 patients (25%), and there were no perioperative deaths. Of the patients with symptoms before resection, 96% had resolution of symptoms after operation. CONCLUSIONS Hepatic hemangioma can be diagnosed in most patients using noninvasive studies, particularly MRI. Hepatic hemangiomas can be removed safely if patients become symptomatic or when malignancy cannot be excluded. CT angiography can be a valuable preoperative study in patients with large tumors, and enucleation is the procedure of choice. In asymptomatic or minimally symptomatic patients, hepatic hemangiomas usually have a benign course and can be observed.
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Affiliation(s)
- Sam S Yoon
- Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Numminen K, Halavaara J, Isoniemi H, Tervahartiala P, Kivisaari L, Numminen J, Höckerstedt K. Magnetic resonance imaging of the liver: true fast imaging with steady state free precession sequence facilitates rapid and reliable distinction between hepatic hemangiomas and liver malignancies. J Comput Assist Tomogr 2003; 27:571-6. [PMID: 12886146 DOI: 10.1097/00004728-200307000-00022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the capability of the true fast imaging with steady state free precession (true FISP) sequence in the distinction between hemangiomas and malignant liver lesions. METHODS Sixty-eight patients with 45 hemangiomas and 51 liver malignancies were included in this study. A 1.5-T magnetic resonance system and a phased-array body coil were used. In addition to true FISP, breath-hold and fat-suppressed, T2-weighted, half-Fourier single-shot turbo spin echo (HASTE) and both unenhanced and gadolinium (Gd)-enhanced T1-weighted sequences were acquired. Two radiologists evaluated the magnetic resonance images independently in a blinded fashion. Interobserver variations with true FISP and HASTE were determined. Lesion contrast-to-noise ratios were calculated from true FISP images. RESULTS With true FISP, readers 1 and 2 made a correct distinction between hemangiomas and liver malignancies in 43 of 45 (96%) cases and 40 of 45 (89%) cases, respectively. The kappa value was 0.65. With HASTE, the success rates were 40 of 45 cases (89%) and 36 of 45 cases (80%), respectively, and the kappa value was 0.33. With a Gd-enhanced T1-weighted sequence, the correct classifications were 35 of 45 cases (78%) and 37 of 45 cases (82%), respectively. All hemangiomas appeared as bright and well-demarcated lesions on true FISP images. Malignant liver foci were heterogeneous with unsharp margins and nearly isointense relative to liver. The specificities of true FISP in lesion differentiation were 100% and 98% for readers 1 and 2, respectively. The mean contrast to noise ratio value of hemangiomas was 21.2 (standard deviation [SD] = 9.2), and that of malignant lesions was 4.9 (SD = 3.9). This difference was highly significant (P < 0.0001). CONCLUSION Noninvasive, rapid, and reliable differentiation between hemangiomas and malignant liver lesions is possible by using the true FISP sequence.
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Affiliation(s)
- Kirsti Numminen
- Department of Radiology, Helsinki University Central Hospital, Kasarmikatu 11, 00130 Helsinki, Finland.
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Mueller GC, Hussain HK, Carlos RC, Nghiem HV, Francis IR. Effectiveness of MR imaging in characterizing small hepatic lesions: routine versus expert interpretation. AJR Am J Roentgenol 2003; 180:673-80. [PMID: 12591673 DOI: 10.2214/ajr.180.3.1800673] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of our study was to compare the effectiveness of MR imaging characterization of small (<or=2 cm) hepatic lesions made in a routine clinical setting with the effectiveness of such characterization made under standardized conditions by radiologists who are expert interpreters of MR imaging. MATERIALS AND METHODS Forty-eight patients with 69 small (<or=2 cm) hepatic lesions considered indeterminate on a prior routine CT scan were included in the study. The diagnosis for all lesions had been verified by histology (n = 10), surgery and intraoperative sonography (n = 5), imaging follow-up (n = 35), or clinical follow-up (n = 19). Using the initial radiology reports, the diagnoses based on MR imaging were rated on a 5-point confidence scale. In addition, two radiologists experienced in MR imaging who were unaware of the initial interpretations of the images or the clinical histories of the patients independently analyzed the MR imaging studies and characterized the lesions using the same 5-point scale. The observer performance for the initial MR imaging interpretations and the expert interpretations were measured using receiver operating characteristic analysis. Interobserver agreement was determined with weighted kappa statistics. RESULTS Fifty-eight lesions were benign (six cysts, 22 hemangiomas, four regenerating nodules, two steatohepatitic lesions, one atypical blood vessel, three focal fat and five focal fat-sparing lesions, 13 flow-related pseudolesions, one diaphragmatic insertion, and one unspecified lesion), and 11 lesions were malignant (nine metastases and two hepatocellular carcinoma). The areas under the curve were 0.94 (initial reports), 0.88 (observer 1), and 0.84 (observer 2). Substantial agreement was found between the expert interpreters (kappa = 0.74), and moderate agreement, between the expert interpreters and initial interpreters (kappa = 0.44 each). CONCLUSION MR imaging is an effective method of characterizing small (<or=2 cm) hepatic lesions in routine clinical practice.
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Affiliation(s)
- Gisela C Mueller
- Department of Radiology/MRI B2B311, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0030, USA
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Dromain C, de Baere T, Baudin E, Galline J, Ducreux M, Boige V, Duvillard P, Laplanche A, Caillet H, Lasser P, Schlumberger M, Sigal R. MR imaging of hepatic metastases caused by neuroendocrine tumors: comparing four techniques. AJR Am J Roentgenol 2003; 180:121-8. [PMID: 12490490 DOI: 10.2214/ajr.180.1.1800121] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of our prospective study was to assess the MR imaging characteristics of hepatic metastases of neuroendocrine tumors and to determine the optimal MR sequence for their detection. SUBJECTS AND METHODS Thirty-seven consecutive patients with liver metastases from neuroendocrine tumors underwent 1.5-T MR imaging of the liver comprising T2-weighted fast spin-echo with respiratory monitoring, breath-hold T2-weighted single-shot fast spin-echo, and T1-weighted gradient-recalled echo sequences before and after the injection of gadoterate dimeglumine. Images were reviewed independently by three observers for the number, location, and pattern of signal and enhancement of metastases. RESULTS A total of 359 metastases were detected, 279 on T2-weighed fast spin-echo, 231 on T2-weighed single-shot fast spin-echo, 272 on unenhanced T1-weighted, 322 on hepatic arterial phase, and 228 on portal venous phase images. Hepatic arterial phase images revealed the greatest number of metastases in 70% of patients, including 35 metastases seen only on this sequence, and was significantly superior to the unenhanced T1-weighted and portal venous phase sequences (p < 0.01). The lesion-to-liver contrast was significantly greatest with T2-weighed fast spin-echo sequences. The enhancement patterns of metastases were predominantly hypervascular, hypovascular, peripheral with progressive fill-in, and delayed in, respectively, 27, four, four, and two patients. Most metastases with peripheral enhancement and progressive fill-in were heterogeneous on T2-weighted images and were without globular peripheral enhancement. CONCLUSION Hepatic metastases of neuroendocrine tumors had a typical hypervascular pattern in 73% of patients. Hepatic arterial phase and fast spin-echo T2-weighed sequences are the most sensitive.
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Affiliation(s)
- Clarisse Dromain
- Department of Imaging, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France
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Morana G, Grazioli L, Testoni M, Caccia P, Procacci C. Contrast agents for hepatic magnetic resonance imaging. Top Magn Reson Imaging 2002; 13:117-50. [PMID: 12357078 DOI: 10.1097/00002142-200206000-00002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The current availability of liver-specific contrast media (LSCM) allows the possibility to obtain an accurate diagnosis when studying focal liver lesions (FLL). It is necessary to have an in-depth knowledge of the biologic and histologic characteristics of FLL and the enhancement mechanism of LSCM to gain significant accuracy in the differential diagnosis of FLL. It is possible to subdivide FLL into three main groups according to the kinetics of contrast enhancement: hypervascular FLL, hypovascular FLL, and FLL with delayed enhancement. Dynamic contrast-enhanced magnetic resonance imaging is an important tool in the identification and characterization of FLL. LSCM with a first phase of extracellular distribution give both dynamic (morphologic) and late phase (functional) information useful for lesion characterization. With LSCM it is possible to differentiate with high accuracy benign from malignant lesions and hepatocellular from nonhepatocellular lesions. To understand contrast behavior after injection of LSCM, it is necessary to correlate contrast enhancement with the biologic and histologic findings of FLL.
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Affiliation(s)
- Giovanni Morana
- Radiological Department, University of Verona, Verona, Italy.
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Vitellas KM, Kangarlu A, Bova JG, Bennett WF, Vaswani K, Chakeres DW, Spigos D. Canine abdominal MRI at 8 Tesla: initial experience with conventional gradient-recalled echo and rapid acquisition with relaxation enhancement (RARE) techniques. J Comput Assist Tomogr 2001; 25:856-63. [PMID: 11711795 DOI: 10.1097/00004728-200111000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In this manuscript, we present our initial experience with MRI of the abdomen at 8 T of canine subjects both alive and dead. Our hypothesis is that abdominal imaging at 8 T should be possible and should demonstrate unique information. To our knowledge, this is the first description of imaging characteristics of the abdomen at such field strengths using a human MR scanner. METHOD An 8 T, 80 cm magnet housed in our department since 1998 was used for our study. GRE and rapid acquisition by relaxation enhancement (RARE) pulse sequences were selected to give reasonable slice profiles with relatively low power. Three dogs were imaged alive and after being killed. RESULTS Our initial results show excellent signal-to-noise ratio and good RF penetration. Structures in the center of the abdomen were well visualized. Homogeneous signal was noted throughout each image without dielectric resonance artifact. Magnetic susceptibility artifacts were most severe on the GRE sequences. On the GRE sequences, the images appeared relatively T2 weighted. Signal voids were seen due to gas in the lung and bowel and susceptibility artifact at subcutaneous fat-muscle boundaries. The liver and spleen showed similar signal intensity, hypointense to subcutaneous muscle at low TE values. There was little internal anatomy of the liver or spleen visible except for the vessels. The kidney, in contrast, demonstrated very good internal structure with visualization of the cortex and medulla. Linear signal voids were depicted in the expected location of normal renal vascular anatomy on the GRE sequences. On the RARE sequences, the images also appeared T2 weighted. Magnetic susceptibility artifacts at subcutaneous fat-muscle boundaries were absent. Signal voids were noted in vessels with blood flow and gas. The liver and spleen were of similar signal intensity and slightly hypointense to muscle. The kidney and pancreas were of higher signal intensity than liver and subcutaneous muscle. The gallbladder wall demonstrated a striated pattern of two layers, with an inner hypointense and an outer hyperintense layer on the RARE sequence. The gastric wall demonstrated a striated pattern of five layers on the RARE sequence. CONCLUSION Images of the dog abdomen with the world's first ultra high field 8 T magnet show robust image quality and excellent spatial resolution. Image contrast is greatest on the RARE sequence, and susceptibility artifact is strongest on the GRE sequence.
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Affiliation(s)
- K M Vitellas
- Department of Radiology, Ohio State University Medical Center, Columbus, OH 43210, USA.
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Charny CK, Jarnagin WR, Schwartz LH, Frommeyer HS, DeMatteo RP, Fong Y, Blumgart LH. Management of 155 patients with benign liver tumours. Br J Surg 2001; 88:808-13. [PMID: 11412249 DOI: 10.1046/j.0007-1323.2001.01771.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Benign hepatic tumours continue to represent a diagnostic and therapeutic challenge. This study evaluates the indications and results of resection compared with observation in patients with benign hepatic tumours. METHODS Patients with a primary diagnosis of benign liver tumour were identified from a prospective database and evaluated retrospectively. RESULTS From January 1992 to June 1999, 155 patients with benign hepatic tumours were evaluated. The diagnoses included haemangioma (n = 97), focal nodular hyperplasia (FNH) (n = 42), hepatic adenoma (n = 12) and cystadenoma (n = 4). Sixty-eight patients (44 per cent) underwent resection because of symptoms (n = 36), inability to exclude a malignancy (n = 31) or enlargement on serial imaging (n = 11). The operative morbidity and mortality rates were 21 per cent and zero respectively. Thirty patients had a preoperative percutaneous needle biopsy, 19 of which were either incorrect or indeterminate. Overall, 39 of 42 patients with symptoms attributed to the tumour were asymptomatic after resection and 18 of 21 patients with symptoms considered unrelated to the tumour were asymptomatic after a period of observation and/or treatment of unrelated conditions (median follow-up 16 months). CONCLUSION When indicated, resection of benign liver tumours can be performed safely. Symptomatic patients with a small FNH or haemangioma can be observed because their symptoms are unlikely to be related to the liver tumour. Percutaneous needle biopsy rarely changes management.
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Affiliation(s)
- C K Charny
- Department of Surgery, New York Presbyterian Hospital-Cornell Campus, New York, NY, USA
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Kubaska S, Sahani DV, Saini S, Hahn PF, Halpern E. Dual contrast enhanced magnetic resonance imaging of the liver with superparamagnetic iron oxide followed by gadolinium for lesion detection and characterization. Clin Radiol 2001; 56:410-5. [PMID: 11384141 DOI: 10.1053/crad.2000.0673] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM Iron oxide contrast agents are useful for lesion detection, and extracellular gadolinium chelates are advocated for lesion characterization. We undertook a study to determine if dual contrast enhanced liver imaging with sequential use of ferumoxides particles and gadolinium (Gd)-DTPA can be performed in the same imaging protocol. MATERIALS AND METHODS Sixteen patients underwent dual contrast magnetic resonance imaging (MRI) of the liver for evaluation of known/suspected focal lesions which included, metastases (n = 5), hepatocellular carcinoma (HCC;n = 3), cholangiocharcinoma(n = 1) and focal nodular hyperplasia (FNH;n = 3). Pre- and post-iron oxide T1-weighted gradient recalled echo (GRE) and T2-weighted fast spin echo (FSE) sequences were obtained, followed by post-Gd-DTPA (0.1 mmol/kg) multi-phase dynamic T1-weighted out-of-phase GRE imaging. Images were analysed in a blinded fashion by three experts using a three-point scoring system for lesion conspicuity on pre- and post-iron oxide T1 images as well as for reader's confidence in characterizing liver lesions on post Gd-DTPA T1 images. RESULTS No statistically significant difference in lesion conspicuity was observed on pre- and post-iron oxide T1-GRE images in this small study cohort. The presence of iron oxide did not appreciably diminish image quality of post-gadolinium sequences and did not prevent characterization of liver lesions. CONCLUSION Our results suggest that characterization of focal liver lesion with Gd-enhanced liver MRI is still possible following iron oxide enhanced imaging.Kubaska, S.et al. (2001). Clinical Radiology, 56, 410-415
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Affiliation(s)
- S Kubaska
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, U.S.A
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Abstract
This article focuses on the origin, diagnosis, and management of focal benign lesions of the liver. The most common lesions include cavernous hemangioma, focal nodular hyperplasia, hepatic adenoma, and nodular regenerative hyperplasia. A number of less frequent occurring lesions are also discussed. In general, the common lesions can be diagnosed by radiologic imaging, but occasionally biopsies are required, and surgical removal is often needed.
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Affiliation(s)
- J F Trotter
- University of Colorado Health Sciences Center, Division of Gastroenterology/Hepatology, Denver, Colorado, USA
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Yoshimitsu K, Honda H, Jimi M, Kuroiwa T, Irie H, Aibe H, Shinozaki K, Asayama Y, Shimada M, Masuda K. Correlation of three-dimensional gradient echo dynamic MR imaging with CT during hepatic arteriography in patients with hypervascular hepatocellular carcinomas: preliminary clinical experience. J Magn Reson Imaging 2001; 13:258-62. [PMID: 11169832 DOI: 10.1002/1522-2586(200102)13:2<258::aid-jmri1037>3.0.co;2-b] [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: 11/06/2022] Open
Abstract
The purpose of this study is to elucidate the usefulness of dynamic MR study of the whole liver using 3DFISP with double dose gadolinium (Gd) enhancement in detecting enhancing lesions in 20 patients. Twenty patients with hepatocellular carcinoma (HCC) underwent 3DFISP dynamic study with double dose Gd. The demonstration of enhancing hypervascular lesions regardless of etiology was evaluated on a segment-by-segment basis with receiver operating characteristic (ROC) analysis, using findings on CT during hepatic arteriography as a gold standard. Diagnostic accuracy of 3DFISP in the detection of HCC was also evaluated. As to the demonstration of enhancing lesions, the Az value of the ROC curve was 88%. The detection rate of HCC with 3DFISP was 98%. 57% of enhancing pseudolesions were not detected on 3DFISP. We concluded that Dynamic MR study of the whole liver using 3DFISP with double dose Gd enhancement is a useful method to demonstrate hypervascular HCC.
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Affiliation(s)
- K Yoshimitsu
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582, Japan.
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