Alteration of contrast enhanced ultrasound (CEUS) of hepatocellular carcinoma in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS)

Chang, Johannes; Dumitrache, A; Böhling, Nina; Abu-Omar, J; Meyer, Carsten H.; Strobel, D; Luetkens, Julian A.; Luu, Andreas Minh; Rockstroh, Jürgen K.; Strassburg, Christian P.; Trebicka, Jonel; Gonzalez‐Carmona, Maria A.; Marinova, Milka; Praktiknjo, Michael

doi:10.1038/s41598-020-77801-9

“…It was assumed that the outflow of the vein could be neglected when contrast agents passed for the first time, and then, tissue perfusion was obtained according to the time-density curve of the artery and tissue organ. Besides, no contrast agent exosmosis occurred [ 19 ]. The concept of nondeconvolution model was simple and comprehensible, but it often underestimated BF.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Liver Cirrhosis and Liver Fibrosis by Artificial Intelligence Algorithm-Based Multislice Spiral Computed Tomography

Liexiu

¹

,

Ning

²

,

Yang

³

et al. 2022

Computational and Mathematical Methods in Medicine

View full text Add to dashboard Cite

This research was aimed at investigating the artificial intelligence (AI) segmentation algorithm-based multislice spiral computed tomography (MSCT) in the diagnosis of liver cirrhosis and liver fibrosis. Besides, it was aimed at providing new methods for the diagnosis of liver cirrhosis and liver fibrosis. All patients were divided into the control group, mild liver fibrosis group, and significant liver fibrosis group. A total of 112 patients were included, with 40 cases in the mild liver fibrosis group, 48 cases in the significant liver fibrosis group, and 24 cases who underwent computed tomography (CT) examination in the control group. In the research, deconvolution algorithm of AI segmentation algorithm was adopted to process the images. The average hepatic arterial fraction (HAF) values of patients in the control group, mild liver fibrosis group, and severe liver fibrosis group were 17.59 ± 10.03 %, 18.23 ± 5.57 %, and 20.98 ± 6.63 %, respectively. The average MTT values of patients in the control group, mild liver fibrosis group, and severe liver fibrosis group were 12.69 ± 1.78 S, 12.53 ± 2.05 S, and 12.04 ± 1.57 S, respectively. The average blood flow (BF) values of patients in the control group, mild liver fibrosis group, and severe liver fibrosis group were 105.68 ± 15.57 mL 100 g-1·min-1, 116.07 ± 16.5 mL·100 g-1·min-1, and 110.39 ± 16.32 mL·100 g-1·min-1, respectively. Besides, the average blood volume (BV) values of patients in the control group, mild liver fibrosis group, and significant liver fibrosis group were 15.69 ± 4.35 mL·log-1, 16.97 ± 2.68 mL·log-1, and 16.11 ± 4.87 mL·100 g-1, respectively. According to statistics, the differences among the average HAF, MTT, BF, and BV values showed no statistical meaning. AI segmentation algorithm-based MSCT imaging could promote the diagnosis of liver cirrhosis and liver fibrosis effectively and offer new methods to clinical diagnosis of liver cirrhosis and liver fibrosis.

show abstract

“…At present, in addition to histopathological examination which is the only gold standard for the diagnosis of liver cancer, imaging examination has become one of the important standards. Conventional ultrasound or CT examination is the first choice for the diagnosis of liver cancer, but its specificity and sensitivity are low [ 3 ]. With the development of imaging technology, the application of contract enhanced ultrasound (CEUS) and enhanced CT/MRI in the qualitative diagnosis of liver cancer is becoming more and more mature [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Ultrasonographic Features of Hepatocellular Carcinoma and the Severity of Hepatocellular Carcinoma and the Expression of PTEN and Tg737

Tang

¹

,

Zhang

²

,

Zhang

³

et al. 2022

Journal of Healthcare Engineering

View full text Add to dashboard Cite

To investigate the relationship between the ultrasonographic features of hepatocellular carcinoma (HCC) and the severity of HCC and the expression of tumor suppressor genes PTEN and Tg737, 90 patients with primary liver cancer are selected as the study subjects. The enhancement of liver tumor in arterial phase, portal venous phase, and delayed phase is observed by contrast-enhanced ultrasound (CEUS) before operation, and the echo intensity is compared with that of surrounding liver parenchyma. Immunohistochemistry is used to detect the expression of PTEN and Tg737 in hepatocellular carcinoma and paracancerous tissues. (1) In HCC, CEUS enhancement is characterized by rapid enhancement in arterial phase, enhancement in portal venous phase and delayed phase, and decreased hypoechoic changes. About 78.0% of the stage I-II liver cancer and 85.0% of the stage III-IV liver cancer show rapid enhancement and high echo in the arterial phase; only 8.0% of the stage I-II liver cancer shows moderate echo changes in the portal venous phase, while 32.5% (13/40) stage III-IV liver cancer shows moderate echo changes in the portal venous phase. (2) The positive rates of PTEN in liver cancer tissues and paracancerous tissues are 21.1% (19/90) and 70.0% (63/90), respectively, and the difference is statistically significant. The positive rates of Tg737 in liver cancer tissues and paracancerous tissues are 17.8% (16/90) and 75.6% (68/90), respectively, and the difference is statistically significant. Compared with PTEN and Tg737 negative groups, the ascending slope (RS) and initial elimination time (WT) of PTEN and Tg737 positive groups are significantly higher, indicating that the inflow velocity of contrast medium in the positive group is higher, the outflow time is shorter, and the lesions shows low enhancement rapidly. However, the expression of PTEN and Tg737 had no significant difference in maximal intensity (IMAX), peak time (TTP), and mean transit time (mTT). (3) Correlation analysis shows that the immunohistochemical scores of PTEN and Tg737 are not significantly correlated with IMAX, mTT, and TTP but positively correlated with RS (r = 0.359, P < 0.05), suggesting that the positive expressions of PTEN and Tg737 are negatively correlated with the inflow velocity of contrast medium. The immunohistochemical scores of PTEN and Tg737 are negatively correlated with WT, which indicated that the higher the expression intensity of PTEN is, the longer the outflow time of contrast medium is and the slower the outflow of contrast medium is. There is a significant correlation between the expression of PTEN and Tg737 proteins and CEUS parameters in hepatocellular carcinoma.

show abstract

“…Analogously, the presence of a transjugular intrahepatic portosystemic stent shunt (TIPSS) can affect the contrast enhancement pattern in HCC. A very recent monocentric study by Chang et al reported APHE to occur earlier in HCC in the presence of a TIPSS, whereas contrast washout tended to occur more often and with a later onset in patients with a TIPSS [20]. However, of our sample size (two patients in the subgroup of typical HCC and six patients in the subgroup of atypical HCC) was too small for definite conclusions.…”

Section: Perfusion Alterationsmentioning

confidence: 60%

HCCs lacking arterial phase hyperenhancement (APHE) on contrast-enhanced ultrasound (CEUS) – a diagnostic challenge. Findings from the prospective multicenter DEGUM CEUS HCC trial

Strobel

¹

,

Agaimy

²

,

Jesper

³

et al. 2023

Ultraschall Med

Self Cite

2

0

View full text Add to dashboard Cite

Objectives Hepatocellular carcinoma (HCC) upon contrast-enhanced ultrasound (CEUS) typically shows arterial phase hyperenhancement (APHE), followed by late (> 60 seconds) and mild contrast washout (WO). Although APHE is considered as the hallmark of HCC, it can be absent in some HCCs. Thus, we explored which sonomorphological and histopathological features of HCC are associated with a lack of APHE upon CEUS. Methods Focal liver lesions in high-risk patients for HCC were assessed with CEUS following a standardised protocol in a prospective multi-centre real-life setting. CEUS patterns in HCC were assessed, and tumour and patient characteristics were compared for HCCs with and without APHE. Results 316 patients with HCC were recruited (cirrhosis, 76.9%). APHE occurred in 271/316 HCCs (85.8%). A lack of APHE was associated with portal vein thrombosis, tumour infiltration of the liver vessels (p<0.001), larger size, multilocularity, and higher depth location upon ultrasound (p<0.01). Histological grading did not differ between HCCs with and without APHE (p=0.39). Histopathological features of HCCs without APHE included cirrhotic stromal reaction, marked tumour cell steatosis and absence of the typical surrounding dilated sinusoidal vascular channels. Conclusion Correlation with histopathological findings support the fact that HCCs with a lack of APHE in CEUS are a heterogeneous group. The examiner has to be aware that HCCs with portal vein thrombosis or macro-invasion of the liver vessels may lack APHE. Ziele Hepatozelluläre Karzinome (HCCs) zeigen in der Kontrastmittelsonographie (CEUS) typischerweise ein arterielles Hyperenhancement (APHE) mit nachfolgend spätem (> 60 Sekunden), mildem Auswaschen (WO). Obwohl APHE das Hauptkriterium in der HCC-Diagnostik darstellt, fehlt dieses Merkmal bei einigen HCCs. Die vorliegende Arbeit sollte untersuchen, welche sonomorphologischen und histopathologischen Eigenschaften mit fehlendem APHE assoziiert sind. Methoden Fokale Leberläsionen bei HCC-Hochrisikopatienten wurden nach einem standardisierten CEUS-Protokoll in einem prospektiven multizentrischen Ansatz untersucht. Die CEUS-Muster der HCCs wurden analysiert und Tumor- und Patientencharakteristika für HCCs mit und ohne APHE verglichen. Ergebnisse 316 HCC-Patienten wurden eingeschlossen (76,9% Zirrhose). APHE fand sich bei 271/316 HCCs (85,8%). Fehlendes APHE war assoziiert mit Pfortaderthrombose, Tumorinfiltration in die Lebergefäße (p<0,001), größerem Tumordurchmesser, Multilokularität und größerer Tiefenlokalisation (p<0,01). Der histologische Differenzierungsgrad unterschied sich nicht zwischen HCCs mit und ohne APHE (p=0,39). Histologisch zeigten HCCs ohne APHE zirrhotische Stromareaktionen, ausgeprägte Tumorzellverfettung und ein Fehlen der typischen umgebenden erweiterten Sinusoide. Schlussfolgerungen Die Korrelation mit histopathologischen Merkmalen belegt, dass HCCs mit fehlendem APHE im CEUS eine heterogene Gruppe darstellen. Der Untersucher sollte sich bewusst machen, dass APHE bei HCCs mit Pfortaderthrombose oder Makrogefäßinvasion fehlen kann.

show abstract

Alteration of contrast enhanced ultrasound (CEUS) of hepatocellular carcinoma in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS)

Cited by 8 publications

References 36 publications

Diagnosis of Liver Cirrhosis and Liver Fibrosis by Artificial Intelligence Algorithm-Based Multislice Spiral Computed Tomography

Diagnosis of Liver Cirrhosis and Liver Fibrosis by Artificial Intelligence Algorithm-Based Multislice Spiral Computed Tomography

The Relationship between Ultrasonographic Features of Hepatocellular Carcinoma and the Severity of Hepatocellular Carcinoma and the Expression of PTEN and Tg737

HCCs lacking arterial phase hyperenhancement (APHE) on contrast-enhanced ultrasound (CEUS) – a diagnostic challenge. Findings from the prospective multicenter DEGUM CEUS HCC trial

Contact Info

Product

Resources

About