Comparison of Portal Venous and Delayed Phases of Gadolinium-Enhanced Magnetic Resonance Imaging Study of Cirrhotic Liver for the Detection of Contrast Washout of Hypervascular Hepatocellular Carcinoma

Cereser, Lorenzo; Furlan, Alessandro; Bagatto, Daniele; Girometti, Rossano; Como, Giuseppe; Avellini, Claudio; ­Orsaria, Maria; Zuiani, Chiara; Bazzocchi, Massimo

doi:10.1097/rct.0b013e3181e1a88e

Cited by 34 publications

(32 citation statements)

References 36 publications

(25 reference statements)

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“…As for the sensitivity of gadoxetic acid-enhanced MRI in the diagnosis of HCCs, our study showed that relative hypointensity of the tumour was present in 70.9 % on the PVP and 86.0 % on the TP, which is comparable to a recent study on ECCM-enhanced MRI showing sensitivities of 44 % with PVP and 82 % with the delayed phase [38]. In addition, 93.8 % of HCCs in our study were seen as hypointense lesions on the HBP.…”

Section: Discussionsupporting

confidence: 90%

Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?

et al. 2015

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Section: Discussionsupporting

confidence: 90%

Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?

et al. 2015

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“…However, three included studies showed greater perceptibility of this feature in the delayed phase (22,30,73). Luca et al reported a 59% increase in HCC detection by using the delayed only a portion of the observation shows APHE, the component with washout does not need to correspond to the component that demonstrates APHE, however the component does need to enhance from earlier to later phase for this feature to be present.…”

Section: Washout Appearancementioning

confidence: 99%

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

et al. 2018

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The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS.q RSNA, 2017 Online supplemental material is available for this article.An Tang REVIEW: LI-RADS Major Features for Hepatocellular Carcinoma DiagnosisTang et al selection of five major features was based on expert opinion, the literature review was performed to ensure that imaging-based diagnostic criteria were able to achieve near-100% specificity for the noninvasive diagnosis of HCC. This review focused on the evidence supporting the inclusion of imaging features and did not attempt to gather evidence on the composition of the LI-RADS diagnostic algorithm and probability of HCC for different combinations of criteria (other than the hallmark combination of APHE and washout appearance) in the LI-RADS diagnostic table.Each subgroup was charged with developing key research questions and then critically reviewing the literature to answer research questions thematically related to its assigned topic. Search StrategyThe PICO (patient population, intervention, comparison, and outcome) format frequently used in structured reviews does not lend itself well to studies of diagnostic performance. Rather than using PICO-style questions to guide the searches, therefore, the subgroups formulated free-form questions in advance with feedback from the other subgroups. A total of 10 questions were formulated under the framework and with the understanding that their answers would inform recommendations for removing or continuing to include the corresponding LI-RADS features. After the questions were formulated, each subgroup searched the PubMed develop a standardized Liver Imaging Reporting and Data System (LI-RADS) for interpretation, reporting, and data collection of imaging studies in patients at risk for developing HCC (1). The committee was composed mainly of diagnostic radiologists, but also hepatologists, surgeons, patho...

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“…The sequence of the events is fast and it is estimated that this occurs at 2-3 min following injection of intravenous contrast agent. 8,9 This sequence of events of arterial uptake followed by washout is highly specific for diagnosis of HCC by imaging. [10][11][12] A four phase study (precontrast, or unenhanced, arterial, portal venous and delayed phase) as its sometimes called is required to properly ascertain the existence of HCC by imaging.…”

Section: Classical Imaging Featuresmentioning

confidence: 99%

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

Rao

2014

Journal of Clinical and Experimental Hepatology

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Conventional ultrasonogram of the abdomen being noninvasive, inexpensive and ubiquitously available is the first imaging modality that raises suspicion of HCC in a patient with chronic liver disease with or without cirrhosis. The lesions in liver particularly nodule are being recognized with increased frequency with the wide spread use of ultrasonogram as the initial investigation and computerized tomography and magnetic resonance imaging subsequently. Any nodule in a cirrhotic liver should be considered as hepatocellular carcinoma until otherwise proved. This approach certainly is helpful in diagnosing HCC at its earliest possible stage to offer meaningful curative measures be it transplant, resection or ablative therapy. After a nodule is detected on ultrasonogram the next imaging modality can be a contrast enhanced study (dynamic CT scan or an MRI) to see if are present or not. Two vital clues for diagnosis of HCC by contrast enhanced imaging are presence of arterial hypervascularity and washout which are considered as "classical imaging features". This sequence of events of arterial uptake followed by washout is highly specific for diagnosis of HCC by imaging. If the features are typical showing classical imaging features (i.e hypervascular in the arterial phase with washout in portal venous or delayed phase) the lesion should be treated as HCC biopsy is not necessary. Nodular lesions showing an atypical imaging pattern, such as iso-or hypovascular in the arterial phase or arterial hypervascularity alone without portal venous washout, should undergo further examinations with another contrast enhanced imaging. Biopsy is advisable for those lesions which do not show classical features on the imaging. ( J CLIN EXP HEPATOL 2014;4:S57-S62) T he diagnosis of HCC is predominantly by imaging modality. Conventional ultrasonogram of the abdomen being noninvasive, inexpensive and ubiquitously available is the first imaging modality that raises suspicion of HCC in a patient with chronic liver disease with or without cirrhosis. This could happen either on surveillance or de novo. At times, particularly in young patients with vertically transmitted HBV infection in Asia pacific and African continents it is not uncommon to come across advanced HCC at the time first presentation. The lesions in liver particularly nodule are being recognized with increased frequency with the wide spread use of ultrasonogram as the initial investigation and computerized tomography and magnetic resonance imaging subsequently. The most important question to be answered is to determine the nature of the nodule i.e. regenerating nodule, HCC, intrahepatic cholangiocarcinoma, metastatic lesion(s) or rarely an infective process. Any nodule in a cirrhotic liver should be considered as hepatocellular carcinoma until otherwise proved. This approach certainly is helpful in diagnosing HCC at its earliest possible stage to offer meaningful curative measures be it transplant, resection or ablative therapy. In this article we intend to answer two issues of ...

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Comparison of Portal Venous and Delayed Phases of Gadolinium-Enhanced Magnetic Resonance Imaging Study of Cirrhotic Liver for the Detection of Contrast Washout of Hypervascular Hepatocellular Carcinoma

Abstract: Delayed phase is superior to PVP for the washout detection of hypervascular HCC at gadobenate dimeglumine-enhanced MRI of cirrhotic liver.

Cited by 34 publications

References 36 publications

Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?

Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

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