J. Fibrous central scar is of very low signal intensity (arrowheads). In the current climate of challenging health economics, the most appropriate and cost effective modality should always be utilized. Liver lesion 2005;5:S14956. Six (10.0%) nodules underwent radiofrequency ablation and their pathological diagnosis could not be established. Characterization of hepatocellular tumors: value of mangafodipir-enhanced magnetic resonance imaging. (d) The delayed phase scan reveals washout of the lesion, which is now hypoattenuating (arrow). Bile duct hamartomas are congenital malformations of the ductal plate without connections to the bile ducts. Characterisation of liver masses From a practical point of view, the approach to characterizing a focal liver lesion seen on CT begins with the determination of its density. If the lesion is of near water density, homogeneous, has sharp margins and shows no enhancement, then it is a cyst. and JavaScript. When evaluated using liver-specific contrast agents, the appearance of hemangiomas in the dynamic arterial and venous phases is similar to that with nonspecific gadolinium chelates. Therefore, the objective of this study was to observe the natural course of indeterminate hepatic nodules detected on MRI and evaluate appropriate management strategies for these lesions. Treatment response was assessed in accordance with the response evaluation criteria in solid tumor (RECIST) version 1.1 (Eisenhauer et al. ( 2 ) reported that liver lesions Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. However, even with the use of hepatocyte-specific contrast agents, some nodules may remain indeterminate or new indeterminate nodules may be identified by MRI. US reveals a cystic lesion with internal echoes. BMC Gastroenterol. World J. Surg. Specific acquisition sequences vary by manufacturer, patient compliance, and the clinical question being addressed. Appointments & Access. Small lesions (up to ~2 cm) may show immediate and complete enhancement in the arterial phase, with sustained enhancement in the venous and delayed phases (type I, flash filling) [31] (Fig. A tumor capsule/pseudocapsule may be seen on T1-weighted and, less commonly, as hypointense on T2-weighted imaging. The remaining four (12.1%) patients had more than one indeterminate nodule, which were both resected and ablated. According to the growth characteristics, CCC is classified as mass forming, periductal infiltrating, or intraductal growing, with the mass-forming type being most common in intrahepatic CCC [66]. By comparing characteristics of patients with benign or malignant nodules in the follow up group, the ratio of positive lymph nodes to total number of lymph nodes resected (pLNR) was significantly greater in patients with malignant nodules (P=0.006). CrossRef PMC Jeon SK, Lee JM, Joo I, Lee DH, Ahn SJ, Woo H, Lee MS, Jang JY, Han JK. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. AJR Am J Roentgenol. 1999;18:44551. E: Lesions (arrows) can be traced on liver sections (top) and corresponding microangiography (bottom). Although of no clinical significance, they can mimic disseminated small liver metastases in the patient with cancer. 2015 Jan;274(1):161-9. doi: 10.1148/radiol.14140796. Cellular origin of hepatocellular carcinoma. 1998;209:41726. Ann. You may search for similar articles that contain these same keywords or you may Epub 2018 Jan 19. The consultant proceeded by administering several morphine/ketamine boluses. At contrast-enhanced T1-weighted MRI, they are hypervascular, often with contrast washout in the portal venous or delayed phase. Clin. This chapter is published under an open access license. 17.15) [57]. Chandarana H, Block KT, Winfeld MJ, et al. Hepatic helical CT: contrast material injection protocol. The purpose of this study was to determine the prevalence and significance of small low attenuating hepatic lesions (SLAHs) seen on helical CT in preoperative patients with gastric and colorectal cancers and to find differentiating features of benign from malignant SLAH. Subcentimeter hypervascular nodule with typical imaging findings of hepatocellular carcinoma in patients with history of hepatocellular carcinoma: natural course on serial gadoxetic acid-enhanced MRI and diffusion-weighted imaging. Most liver cysts are present from birth and do not cause symptoms, but large ones may Eur Radiol. Mosaic pattern of hepatocellular carcinoma: histologic basis for a characteristic CT appearance. Dose-modified 256-MDCT of the abdomen using low tube current and hybrid iterative reconstruction. J.L. Recurrence was defined as radiological or pathological confirmed recurrence at the site of the previous indeterminate nodule. Overall survival by pretreatment carbohydrate antigen (CA) 19-9 level (A) and resectability (B). This allows good quality T1-weighted of the liver to be obtained in patients with poor breath holding (e.g., elderly, breathless adults, or young children) (Fig. Hepatocellular carcinoma: illustrated guide to systematic radiologic diagnosis and staging according to guidelines of the American Association for the Study of Liver Diseases. In particular, delayed enhancement is a feature of CC due to is fibrotic stroma. A substantial proportion of indeterminate liver lesions are benign entities such as hepatic cysts (prevalence, 6% to 24%) or hemangiomas (prevalence, 3% to 5%). Periductal infiltrative CCC causes early segmental dilatation of bile ducts in a stage when the tumor itself may be difficult to discern [67]. Google Scholar. T1-weighted chemical shift or DIXON imaging is useful for detecting intratumoral fat, while the presence of high T1-signal before contrast administration will raise the suspicion of spontaneous hemorrhage. This accounts for the high positive predictive value and specificity of IOUS (Fig. Investig Radiol. CRC patients treated with chemotherapy primarily underwent surgery for CRC along with liver resection if synchronous metastasis were present. 17.16). WebThe pDDR group had a higher median local PFS after radiotherapy (median 45 months vs. 9.9 months, respectively; p = 0.044), a higher ORR (88.9% vs. 36.2%, p = 0.04), and a longer median PFS (not reached vs. 6.0 months, p = 0.01) in patients treated with immune checkpoint blockade. At MR, metastases are usually hypointense on T1-weighted and hyperintense on T2-weighted images [75]. Ann. Liver-specific MR contrast agents (gadoxetic acid or gadobenate dimeglumine) can be administered to provide arterial, portal venous, and equilibrium-phase imaging but has the added advantage of revealing additional characteristics at the delayed hepatobiliary phase of contrast enhancement. Jang, H. K. Lim, W. J. Lee, S. J. Lee, J. Y. Yun, D. Choi); and Department of Radiology and Center for Liver Cancer, National Cancer Center, Gyeonggi-do, Korea (H-J Jang). Approximately 16% of these lesions represent metastases. There are multiple foci of high T2-weighted signal within the liver, suggestive of biliary hamartomas. Google Scholar. 2008;18:45767. Subcentimeter HCC may be treated by locoregional therapy, thus avoiding the morbidity and mortality associated with radical surgery. If your intended use exceeds what is permitted by the license or if 17.2), especially during dynamic contrast-enhanced acquisitions [17]. All survival curves were generated using Kalplan-Meier analyses. On MR imaging, the presence of a hypointense rim on T1- and T2-weighted images and a multiloculated appearance are diagnostic features. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We routinelyperformed PET scan for all patients with colorectal cancer. Such nodules are poorly characterized by imaging tests and are difficult to biopsy. Journal of Computer Assisted Tomography26(5):718-724, September-October 2002. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Langella, S. et al. Patients were followed up until October 2019 or until death (median, 18months; (1130months)). However, dual-energy CT technology is still not widely employed in clinical practice despite potential merits, in part because of the post-processing time required to generate the appropriate images. These criteria were developed to be specific but are only approximately 70% sensitive [60]. Lee MH, Kim SH, Park MJ, et al. 2008 Jun;29(3):241-7. doi: 10.1055/s-2008-1076744. Google Scholar. In following up patients with chronic liver disease, development of a new nodule with any of the MR signal abnormalities discussed above should be considered worrisome for HCC, even if they do not meet the AASLD [63] criteria for noninvasive diagnosis. On average, patients had 3 liver lesions. Kim T, Murakami T, Takahashi S, et al. Radiographics. Although less common than leukocytosis, leukopenia is associated with a worse prognosis.7, 18, 19Increased serum activities of liver enzymes (ALT, ALP, aminotransferase, and gamma-glutamyl transpeptidase) and increased total bilirubin are commonly reported, and sometimes reflect concurrent lipidosis or cholangitis. CAS D: Corresponding microangiography shows lesions as filling defects suggestive of necrosis (arrows). By performing diffusion-weighted imaging using two or more b-values, we can quantify the apparent diffusion coefficient (ADC) of liver tissues. Based on data from numerous studies, the American Association for the Study of Liver Disease (AASLD) and the European Association for the Study of the Liver (EASL) formed recommendations for the noninvasive diagnosis of HCC in patients with chronic liver disease [62]. Internet Explorer). In addition, there are morphologic features that can suggest the diagnosis of CCC. ; 15 and 10 years of ex- ence in intensity between the lesion and the lesion database, the similarity ref- perience in abdominal imaging, respec- the surrounding liver and the sharpness erence standard, our evaluation mea- tively) viewed each pair of images twice of the margin to characterize each profile. We next assessed which clinicopathological factors might predict the risk of malignant indeterminate nodules. Subcapsular lesions that do not exhibit mass effect or a round nature should be carefully evaluated before suggesting the diagnosis of HCC. Liver lesions predicted the occurrence of metastatic disease to the liver compared with patients without lesions (67.7% with lesions vs 44.4% without, P = .034). If only one of the two findings are present, then the guidelines require obtaining a different modality with contrast imaging to determine whether these findings can be verified. https://doi.org/10.1007/s00432-020-03233-7 (2020). AJR Am J Roentgenol. (b) Gadoxetic acid-enhanced image shows strong enhancement in the arterial phase. (a) Contrast-enhanced T1-weighted image in the arterial phase shows dilatation of the intrahepatic ducts, which extend to the hepatic hilum. 2013;20:140512. However, it is important to note some potential pitfalls of using liver-specific contrast media for HCC evaluation. Choi JW, Lee JM, Kim SJ, et al. The excess accumulation of iron in the liver may cause severe symptoms and may lead to several liver lesions and cancer complications. Jai Young Cho. Of these, nonspecific extracellular gadolinium contrast medium is still most widely used. Diffuse HCC in the right lobe with tumor thrombus in the portal vein. https://doi.org/10.1038/sj.bjc.6605049 (2009). Another useful recent implementation is non-Cartesian radial T1-weighted imaging, which allows 3D volume T1-weighted imaging of the liver to be performed in free breathing. Thus, we propose that IOUS should be used as an adjunct to preoperative imaging techniques to improve the staging of CRLM and thereby help select the most appropriate treatment. Simple hepatic cysts are common, occurring in 514% of the general population. Module 4 Chapter 8 Assignment.docx - Course Hero Crit Rev Diagn Imaging. Liver cysts are fluid-filled sacs that appear on your liver. Search for Similar Articles https://doi.org/10.1016/j.ejso.2013.12.023 (2014). However, we found no significant differences caused by the following factors: sex; age>65years; carcinoembryonic antigen>5ng/mL; more than three lesions detected by initial MRI; largest lesion of>3cm on MRI, lymphatic, perineural or venous invasion at primary surgery; presence of colonic or rectal metastasis; and more than five positive lymph nodes at primary surgery. However, the pLNR was significantly greater in patients with malignant nodules than in patients with benign nodules (P=0.006). Diffusion-weighted imaging (DWI) has become a standard technique in liver imaging, and it is now available on all scanners. PubMedGoogle Scholar. J. Radiol. Eur Radiol. Data is temporarily unavailable. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. False negatives and false positives were taken as patients where the IOUS findings and pathological findings differed. - 184.168.121.153. WebFinally, the interpreters might have been influenced by the presence of additional lesions, either in the liver or in other abdominal organs. HCA with mutations of catenin b1 may also show contrast uptake in the hepatobiliary phase of MRI using liver-specific contrast media. It has been reported that small, indeterminate liver lesions may occur in up to 16.7% of patients with CRC 11. Article The mean carcinoembryonic antigen level at diagnosis was 27.7ng/mL (range 1520ng/mL). Google Scholar. J Comput Assist Tomogr. Baron RL, Brancatelli G. Computed tomographic imaging of hepatocellular carcinoma. Hemangioma type 1. All patients underwent a routine CT scan for screening, and patients with CRLM detected by CT were further evaluated with a Gadoxetic acid MRI (Primovist, Germany). Imaging is vital for diagnosing CRLM. Altenbernd J, Heusner TA, Ringelstein A, Ladd SC, Forsting M, Antoch G. Dual-energy-CT of hypervascular liver lesions in patients with HCC: investigation of image quality and sensitivity. J. Surg. Following the intravenous (IV) bolus injection of extracellular gadolinium-based contrast agents, dynamic imaging (using volumetric T1-weigthed imaging) is performed in characterizing lesion, detecting lesion, evaluating tumor response to therapy, and detecting marginal recurrences after tumor ablation. J Comput Assist Tomogr. Article Radiology. Hepatology. It has been shown in colorectal cancer that the combination of using DWI, together with liver-specific contrast media, enhanced MRI results in the highest diagnostic accuracy for the detection of liver metastases (Fig. Approximately 16% of these lesions represent A venous phase is always necessary for tumor detection/characterization and assessment of venous structures (Fig. PubMed Central The nodules that could not be detected by IOUS were followed up, except for any that were unintentionally resected as part of a larger surgical specimen. J.C. is responsible for the concept and design of work, critical revision of the manuscript for important intellectual content, study supervision, technical support, final approval of the version to be published and is accountable for all aspects of the work.
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