CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma: Part II. Extracellular Agents, Hepatobiliary Agents, and Ancillary Imaging Features

Choi, Jin Young; Lee, Jeong Min; Sirlin, Claude B.

doi:10.1148/radiol.14132362

Cited by 456 publications

(420 citation statements)

References 150 publications

Supporting

Mentioning

408

Contrasting

Order By: Relevance

“…Using hepatocyte-specific contrast media, especially Acidum Gadoxeticum (Fig. 1), augments these findings and facilitates nodule detection [20]. However, these "classical" imaging findings of a HCC nodule may be substantially altered in patients previously submitted to TACE, due to several factors such as the alteration of the blood flow to-and possibly from the nodule, and the appearance of granulation tissue around the nodule [21].…”

Section: Discussionmentioning

confidence: 99%

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Scheau

Lupescu

2017

JGLD

View full text Add to dashboard Cite

Background & Aims: Emerging minimally invasive treatments for hepatocellular carcinoma (HCC) can significantly improve a patient’s prognosis, but they may alter the imaging features of the treated nodules. This study focuses on a series of patients presenting with a rare pathology, the nodule-in-nodule imaging pattern of HCC, analyzes the imaging features and discusses possible approaches for the diagnosis of tumoral recurrence.Method: Nine patients recruited over two years, having HCC with nodule-in-nodule imaging pattern on diagnosis, and treated by transarterial chemoembolization were monitored by magnetic resonance imaging (MRI). Nodule morphology, dynamic contrast behavior and size progression were followed in this study.Results: All patients showed tumor recurrence. In 7 nodules, a T2 weighted-imaging hyperintense signal of the HCC foci was found, with isointensity of the background nodule. Restricted diffusion within the HCC foci was found in 6 cases but with no statistical significance. Dynamic contrast images evaluation showed a “classical” enhancement pattern in five patients. All nodules had hypointense HCC foci in the hepatobiliary phase. Four patients demonstrated progressive disease according to the mRECIST criteria.Conclusions: Due to the particularly challenging nodule characteristics, the sensitivity in diagnosing HCC foci in these nodules is about 77% when using conventional imaging criteria related to nodule morphology. Contrast media uptake curves may be altered by changes in nodule hemodynamics caused by embolization. The diagnostic rate may be significantly increased by considering the tumoral size increase in follow-up studies and completing the study with a hepatobiliary phase using Acidum Gadoxeticum.Abbreviations. ADC: Apparent diffusion coefficient; CT: Computed tomography; DEB-TACE: drug-eluting beads transarterial chemoembolization; DWI: Diffusion-weighted imaging; Gd-EOB-DTPA: acidum gadoxeticum; HCC: hepatocellular carcinoma; HBV: hepatitis virus B; HCV: hepatitis virus C; HDV: hepatitis virus D; IN-OPP: in-phase and out-of-phase; mRECIST: modified Response Evaluation Criteria in Solid Tumors; MRI: Magnetic resonance imaging; ROI: region of interest; TACE: Transarterial chemoembolization; WI: weighted imaging.

show abstract

Section: Discussionmentioning

confidence: 99%

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Scheau

Lupescu

2017

JGLD

View full text Add to dashboard Cite

show abstract

“…The surrounding parent nodule, corresponding to more well-differentiated tissue, typically is T1 hyperintense, T2 hypointense, and arterial-phase hypoenhancing or isoenhancing. 8 Mosaic architecture (Figure 9) refers to the presence within a mass of randomly distributed internal nodules or compartments differing in enhancement, attenuation, intensity, shape, and size and often separated by fibrous septations. The appearance is characteristic of and frequently observed in large HCCs and reflects the mosaic configuration observed at pathologic examination.…”

Section: Diagnosis Of Hepatocellular Carcinomamentioning

confidence: 99%

“…Intralesional fat is frequently observed histologically in early HCC, and its detection at imaging favors the diagnosis of HCC. 8 Future directions in magnetic resonance imaging for hepatocellular carcinoma With technological advances in hardware and software, diffusion-weighted imaging (DWI) can be readily applied to the liver with resulting improved image quality. Diffusion-weighted imaging is a technique based on differences in the Brownian motion (diffusibility) of water molecules within tissues.…”

Section: Diagnosis Of Hepatocellular Carcinomamentioning

confidence: 99%

“…For these reasons, the hepatobiliary phase must be evaluated in conjunction with other phases and sequences (eg, T1-weighted dual-echo, T2-weighted, or diffusionweighted imaging) to differentiate HCC from other entities that may appear hypointense in the hepatobiliary phase. 8 Superparamagnetic iron oxide-enhanced MRI helps to differentiate between regenerative nodules, dysplastic nodules, and overt HCC based on the degree of iron uptake. Therefore, the combination of superparamagnetic iron oxide and gadolinium contrast agents in one MRI examination (the socalled double-contrast technique) is considered highly useful.…”

Section: Diagnosis Of Hepatocellular Carcinomamentioning

confidence: 99%

“…As opposed to mild-to-moderate T2 hyperintensity, diffuse, marked T2 hyperintensity favors a benign cause because this signal pattern is characteristic of cysts and hemangiomas but not HCC. 8 …”

Section: Diagnosis Of Hepatocellular Carcinomamentioning

confidence: 99%

See 2 more Smart Citations

Untitled

Çoşkun

2017

Exp Clin Transplant

View full text Add to dashboard Cite

Hepatocellular carcinoma is the fifth most common tumor in patients worldwide and the third most common cause of cancer-related death, after lung and stomach cancer. Cirrhosis of the liver is the strongest predisposing factor for hepatocellular carcinoma, with approximately 80% of cases of hepatocellular carcinoma developing in a cirrhotic liver. The annual incidence of hepatocellular carcinoma is 2.0% to 6.6% in patients with cirrhosis compared with 0.4% in patients without cirrhosis. The 5-year survival rates of patients undergoing curative therapies for hepatocellular carcinoma, including liver transplant, hepatic resection, and percutaneous ablative techniques, range between 40% and 75%. Orthotropic liver transplant offers the prima facie cure for both hepatocellular carcinoma and liver cirrhosis. In hepatocellular carcinoma confined to the liver without macrovascular invasion, patients with a single tumor ≤ 5 cm or up to 3 tumors ≤ 3 cm each had a 5-year survival rate of 75% and a disease-free survival rate of 83%. In the adult population, liver transplant for hepatocellular carcinoma yields good results for patients whose tumor masses do not exceed the Milan criteria. The diagnosis of hepatocellular carcinoma using imaging tests has had a substantial impact on transplant decisions. Radiologists should be aware of this responsibility and exercise the utmost scrutiny before making a diagnosis of hepatocellular carcinoma. Erroneous diagnosis of hepatocellular carcinoma based on imaging tests could deny deserving patients the opportunity of a life-saving liver transplant and result in unnecessary liver transplants for others. Contrast-enhanced magnetic resonance imaging and helical computed tomography are the best imaging techniques currently available for the noninvasive diagnosis of hepatocellular carci noma. With technological advances in hardware and software, diffusionweighted imaging can be readily applied to the liver with resulting improved image quality.

show abstract

Stereotactic Body Radiotherapy and Liver Transplant for Liver Cancer

Lee,

Vardhanabhuti,

Wong

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceWhether stereotactic body radiotherapy (SBRT) as a bridge to liver transplant for hepatocellular carcinoma (HCC) is effective and safe is still unknown.ObjectiveTo investigate the feasibility of SBRT before deceased donor liver transplant (DDLT) for previously untreated unresectable HCC.Design, Setting, and ParticipantsIn this phase 2 nonrandomized controlled trial conducted between June 1, 2015, and October 18, 2019, 32 eligible patients within UCSF (University of California, San Francisco) criteria underwent dual-tracer (18F-fluorodeoxyglucose and 11C-acetate [ACC]) positron emission tomography with computed tomography (PET-CT) and magnetic resonance imaging (MRI) with gadoxetate followed by SBRT of 35 to 50 Gy in 5 fractions, and the same imaging afterward while awaiting DDLT. Statistical analysis was performed on an intention-to-treat basis between October 1 and 31, 2023.InterventionPatients received SBRT followed by DDLT when matched deceased donor grafts were available.Main Outcomes and MeasuresCoprimary end points were progression-free survival (PFS) and objective response rates (ORRs) by the Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), modified RECIST (mRECIST), and PET Response Criteria in Solid Tumors (PERCIST). Secondary end points were local control rate, overall survival (OS), and safety.ResultsA total of 32 patients (median age, 59 years [IQR, 54-63 years]; 22 men [68.8%]) with 56 lesions received SBRT. After a median follow-up of 74.6 months (IQR, 40.1-102.9 months), the median PFS was 17.6 months (95% CI, 6.6-28.6 months), and the median OS was 60.5 months (95% CI, 29.7-91.2 months). The 5-year PFS was 39.9% (95% CI, 19.9%-59.9%), and the 5-year OS was 51.3% (95% CI, 31.7%-70.9%). In terms of number of patients, ORRs were 62.5% ([n = 20] 95% CI, 54.2%-68.7%) by RECIST 1.1, 71.9% ([n = 23] 95% CI, 63.7%-79.0%) by mRECIST, and 78.1% ([n = 25] 95% CI, 73.2%-86.7%) by PERCIST. In terms of number of lesions, ORRs were 75.0% ([n = 42] 95% CI, 61.6%-80.8%) by RECIST 1.1, 83.9% ([n = 47] 95% CI, 74.7%-90.6%) by mRECIST, and 87.5% ([n = 49] 95% CI, 81.3%-98.6%) by PERCIST. Twenty patients with 36 lesions received DDLT, of whom 15 patients (75.0%) with 21 lesions (58.3%) exhibited pathologic complete response. Multivariable analyses revealed that pretreatment metabolic tumor volume (MTV) based on ACC (hazard ratio [HR], 1.06 [95% CI, 1.01-1.10]; P = .01) and complete metabolic response (CMR) by PERCIST (HR, 0.31 [95% CI, 0.10-0.96]; P = .04) were associated with PFS, while pretreatment MTV based on ACC (HR, 1.07 [95% CI, 1.03-1.16]; P = .01), total lesion activity based on ACC (HR, 1.01 [95% CI, 1.00-1.02]; P = .02), and CMR by PERCIST (HR, 0.21 [95% CI, 0.07-0.73]; P = .01) were associated with OS. Toxic effects associated with SBRT were reported for 9 patients (28.1%), with 1 grade 3 event.Conclusions and RelevanceThis phase 2 nonrandomized controlled trial demonstrated promising survival and safety outcomes of SBRT before DDLT for unresectable HCC. Future randomized clinical trials are warranted.

show abstract

CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma: Part II. Extracellular Agents, Hepatobiliary Agents, and Ancillary Imaging Features

Cited by 456 publications

References 150 publications

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization – a Multiparametric Magnetic Resonance Imaging Study

Untitled

Stereotactic Body Radiotherapy and Liver Transplant for Liver Cancer

Contact Info

Product

Resources

About