Cholangiocarcinoma in Cirrhosis: Value of Hepatocyte Specific Magnetic Resonance Imaging

Piscaglia, Fabio; Iavarone, M.; Galassi, M.; Vavassori, S.; Renzulli, Matteo; Forzenigo, L.V.; Granito, Alessandro; Salvatore, Veronica; Sangiovanni, A.; Golfieri, Rita; Colombo, M.; Bolondi, Luigi

doi:10.1159/000439097

Cited by 17 publications

(9 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent comparative study (18) of IHCC and HCC also reported a dramatic reduction in the misclassification rate of IHCC as HCC (from 20% to 4%) using PVP washout instead of conventional washout, although this result obtained from IHCCs mainly in noncirrhotic liver may not adequately address the findings of IHCCs in patients with cirrhosis. A prior study including 15 IHCC nodules in cirrhosis also reported that none of the IHCCs showed concurrent AP enhancement and PVP washout (32). The results in our study support a recent statement by LI-RADS that recommends determining the washout during the PVP rather than during the TP at gadoxetic acid-enhanced MR imaging for a reliable diagnosis of HCC (12,15).…”

Section: Subgroup Analysis Of Surgically Proven Ihccs and Matched Hccssupporting

confidence: 88%

Intrahepatic Cholangiocarcinoma in Patients with Cirrhosis: Differentiation from Hepatocellular Carcinoma by Using Gadoxetic Acid–enhanced MR Imaging and Dynamic CT

Choi

Sy³

et al. 2017

Radiology

View full text Add to dashboard Cite

Purpose To determine the imaging features at gadoxetic acid-enhanced magnetic resonance (MR) imaging of intrahepatic cholangiocarcinoma (IHCC) in a cirrhotic liver, with an emphasis on the distinction between IHCC and hepatocellular carcinoma (HCC) and on the comparison of nodule enhancement patterns between MR imaging and computed tomography (CT). Materials and Methods The institutional review board approved this study and waived the requirement for informed consent. Gadoxetic acid-enhanced MR and CT images in 72 consecutive patients (61 men; mean age, 56.6 years) with 78 IHCCs and one-to-one matched control patients (56 men; mean age, 56.6 years) with 77 HCCs were evaluated retrospectively by two independent readers. Findings that could differentiate IHCC from HCC were evaluated with univariate and multivariate analyses. Using the enhancement criteria and the Liver Imaging Reporting and Data System with modifications (mLI-RADS), the sensitivity and specificity for diagnosing HCC were calculated with conventional washout and portal venous phase (PVP) washout. Results At MR imaging with conventional washout, the specificities for diagnosing HCC were 94.9% (74 of 78) with the enhancement criteria and 96.2% (75 of 78) with mLI-RADS, while the use of PVP washout achieved 100% (78 of 78) specificity for diagnosing HCC with both diagnostic criteria at the expense of decreased sensitivity (from 76.6% [59 of 77] to 63.6% [49 of 77] with the enhancement criteria and from 64.9% [50 of 77] to 55.8% [43 of 77] with mLI-RADS, P ≤ .016). At CT, the sensitivities and specificities with conventional washout were 72.7% (56 of 77) and 97.4% (76 of 78), respectively, with the enhancement criteria and 67.5% (52 of 77) and 97.4% (76 of 78), respectively, with mLI-RADS. Conclusion The use of PVP washout instead of conventional washout at gadoxetic acid-enhanced MR imaging prevents the misclassification of IHCC as HCC in a cirrhotic liver but leads to a decreased sensitivity for HCC. RSNA, 2016 Online supplemental material is available for this article.

show abstract

Section: Subgroup Analysis Of Surgically Proven Ihccs and Matched Hccssupporting

confidence: 88%

Intrahepatic Cholangiocarcinoma in Patients with Cirrhosis: Differentiation from Hepatocellular Carcinoma by Using Gadoxetic Acid–enhanced MR Imaging and Dynamic CT

Choi

Sy³

et al. 2017

Radiology

View full text Add to dashboard Cite

show abstract

“…In our population MRI examination has demonstrated the high sensitivity (100%) in detecting neoplastic lesions, including in those lesions <1 cm. Our results are in line with many studies that reported a sensitivity of breast MRI between 86-97% with a high diagnostic accuracy of the early stages (19,(25)(26)(27)(28)(29)(30)(31). However, the combination of clinical breast examination, mammography and US has not sufficiently sensitive in high-risk women, as demonstrated by many series (11,25) and consequently, has a minor role in patients with hereditary predisposition to the disease.…”

Section: Discussionsupporting

confidence: 86%

Hereditary breast cancer: screening and risk reducing surgery

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: The screening modalities for women at high risk for breast cancer has received an increasing role during the last years. The aim of this study was to evaluate the performance of our screening program comparing the diagnostic sensitivity of clinical breast examination, mammography, ultrasonography (US) and magnetic resonance imaging (MRI). Methods: Clinical Breast examination, mammography, US and MRI for each patient with BRCA1 and BRCA2 mutation who underwent breast surgery in our Institution from October 2008 to April 2016 were retrospectively evaluated. The diagnostic accuracy for MRI and for the other surveillance tests in identifying early breast cancer were assessed. Results: Twenty-six female patients with genetic mutation underwent breast surgery. Twenty-two out of 26 (85%) developed cancer during the dedicated screening protocol whereas 4 women who underwent surgery did not have cancer. Imaging was able to detect cancer in all 22 patients (per patient sensibility of 100%), identifying all 35 neoplastic lesions (per lesion sensibility of 100%). The combination of Clinical Breast Examination, US and mammography aided the cancer diagnosis in 14 (64%) of patients with a sensitivity of 64% and specificity of 100%. MRI identified all the cancers, with sensibility and specificity of 100%. Moreover, in 8 (36%) of the 22 patients who developed breast cancers, the cancers were detected only by MRI, revealing a significant superiority respect to the other surveillance modalities (P<0.05). Conclusions: MRI demonstrated to be the best imaging modality in detection of breast cancer even for lesion <1 cm. Prophylactic mastectomy is the most effective risk reduction strategy in women at high risk, contributing to the reduction of anxiety related to the condition of a carrier.

show abstract

“…206,207 This definition improves the capacity of CEUS to identify malignant lesions such as CC (which are often not identified as definitively malignant by CT and MRI using the conventional vascular criteria. [208][209][210] This new CEUS criteria for HCC has already been adopted in Italy (Italian Association for the Study of the Liver 211 and by the American College of Radiology in the USA. 206,212 A very recent large retrospective study in more than 1,000 lesions in cirrhosis, showed this new definition of the typical HCC pattern (corresponding to the LR5 classification according to LI-RADS for CEUS) has a positive predictive value for HCC of almost 99% (higher than the one achieved using the previous EASL and American Association for the Study of Liver Diseases (AASLD) criteria, corresponding to 94%) and positive likelihood ratio of 15.5, with no case of misdiagnosis with intrahepatic CC.…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Galle¹,

Forner²,

Llovet³

et al. 2018

Journal of Hepatology

Self Cite

6,670

4,351

View full text Add to dashboard Cite

Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma represents about 90% of primary liver cancers and constitutes a major global health problem. The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.

show abstract

Cholangiocarcinoma in Cirrhosis: Value of Hepatocyte Specific Magnetic Resonance Imaging

Cited by 17 publications

References 48 publications

Intrahepatic Cholangiocarcinoma in Patients with Cirrhosis: Differentiation from Hepatocellular Carcinoma by Using Gadoxetic Acid–enhanced MR Imaging and Dynamic CT

Intrahepatic Cholangiocarcinoma in Patients with Cirrhosis: Differentiation from Hepatocellular Carcinoma by Using Gadoxetic Acid–enhanced MR Imaging and Dynamic CT

Hereditary breast cancer: screening and risk reducing surgery

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Contact Info

Product

Resources

About