Hypervascular Hepatocellular Carcinoma: Detection with Double Arterial Phase Multi-Detector Row Helical CT

Murakami, Takamichi; Kim, Tonsok; Takamura, Manabu; Hori, Masatoshi; Takahashi, Satoru; Federle, Michael P.; Tsuda, Kazuki; Osuga, Keigo; Kawata, Shigeto; Nakamura, Hajime; Kudo, Masayuki

doi:10.1148/radiology.218.3.r01mr39763

Cited by 268 publications

(169 citation statements)

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“…Histopathological studies have demonstrated a progressive increase in the arterial supply to nodules evolving toward malignancy, [28][29][30] providing the clues for the clinical diagnosis with imaging techniques. 20,[31][32][33][34][35] To give a solid basis for the noninvasive diagnosis, the EASL panel of experts determined that this pattern must be confirmed by two different imaging techniques in nodules larger than 2 cm. No reference was made to vascularity for nodules between 1 and 2 cm, and it was pointed out that these lesions require histopathological investigation.…”

Section: Discussionmentioning

confidence: 99%

Characterization of small nodules in cirrhosis by assessment of vascularity: The problem of hypovascular hepatocellular carcinoma

et al. 2005

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In a prospective study, we examined the impact of arterial hypervascularity, as established by the European Association for the Study of the Liver (EASL) recommendations, as a criterion for characterizing small (1-3 cm) nodules in cirrhosis. A total of 72 nodules (1-2 cm, n ‫؍‬ 41; 2.1-3 cm, n ‫؍‬ 31) detected by ultrasonography in 59 patients with cirrhosis were included in the study. When coincidental arterial hypervascularity was detected at contrast perfusional ultrasonography and helical computed tomography, the lesion was considered to be hepatocellular carcinoma (HCC) according to EASL criteria. When one or both techniques showed negative results, ultrasound-guided biopsy was performed. In cases with negative results for malignancy or highgrade dysplasia, biopsy was repeated when an increase in size was detected at the 3-month follow-up examination. Coincidental hypervascularity was found in 44 of 72 nodules (61%; 44% of 1-2-cm nodules and 84% of 2-3-cm nodules). Fourteen nodules (19.4%) had negative results with both techniques (hypovascular nodules). Biopsy showed HCC in 5 hypovascular nodules and in 11 of 14 nodules with hypervascularity using only one technique. All nodules larger than 2 cm finally resulted to be HCC. Not satisfying the EASL imaging criteria for diagnosis were 38% of HCCs 1 to 2 cm (17% hypovascular) and 16% of those 2 to 3 cm (none hypovascular). In conclusion, the noninvasive EASL criteria for diagnosis of HCC are satisfied in only 61% of small nodules in cirrhosis; thus, biopsy frequently is required in this setting. Relying on imaging techniques in nodules of 1 to 2 cm would miss the diagnosis of HCC in up to 38% of cases. Any nodule larger than 2 cm should be regarded as highly suspicious for HCC. (HEPATOLOGY 2005;42: 27-34.)

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Section: Discussionmentioning

confidence: 99%

Characterization of small nodules in cirrhosis by assessment of vascularity: The problem of hypovascular hepatocellular carcinoma

et al. 2005

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“…23,24 We have examined the expression of ANG2 RNA in CRC metastases in the liver and compared the results with those observed in primary CRC tissue samples using the reverse-transcription polymerase chain reaction (RT-PCR) assay. Using laser capture microdissection (LCM), RNA content data on ANG2, ANG1, TIE2, and the VEGF gene, which encodes the putative angiogenic factor VEGF (vascular endothelial growth factor), were obtained for normal liver cells and for metastatic CRC cells in the liver, with reference to vessel density in each region of the liver.…”

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confidence: 99%

Hepatic expression ofANG2 RNA in metastatic colorectal cancer

et al. 2004

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We examined the RNA content of the gene encoding angiopoietin (Ang)-2, a modifier of angiogenesis, in hepatic metastases of colorectal cancer (CRC) to explore the role of this protein in neovascularization of metastatic foci. Metastatic CRC exhibited notable blood flow and tumor vessel formation at tumor frontiers. Reverse-transcription polymerase chain reaction assays indicated that the ANG2 RNA content was greater in metastatic CRC than in primary CRC. Investigation of metastatic foci using laser capture microdissection revealed that the RNA content of ANG2, but not ANG1, increased from the bordering liver region to the periphery of the metastatic disease, and also from the periphery to the intermediate portion of the metastatic lesion; immunohistochemical analysis confirmed that there was a corresponding gradual increase in Ang-2 protein expression. Tie-2, a receptor for angiopoietins, was preferentially expressed in the bordering liver region rather than in metastatic CRC. Vascular endothelial growth factor (VEGF) also exhibited an expression pattern similar to that of Ang-2, and there was a significant correlation between the RNA content of ANG2 and that of VEGF in dissected samples (P ‫؍‬ .002). Western blot analysis suggested that expression of Ang-1, Ang-2, Tie-2, and VEGF may be regulated at a transcriptional level. C olorectal cancer (CRC) is a common malignancy worldwide. Although 84%-92% of patients with CRC are treated with surgical resection, more than half of these patients subsequently develop disease recurrence, 1 the most common type of recurrence being CRC metastatic to the liver, which often is associated with mortality. 2,3 Metastasis of CRC to the liver is a complex multistep process, which includes adherence of metastatic cells to endothelial cells (ECs), invasion across the endothelial basement membrane, cell proliferation, and neovascularization. 4 It was reported that tumor vessels appeared in human liver metastases when metastatic foci grew to 200 m in diameter and that the density of tumor vessels increased as tumor size increased. 5 Angiogenesis is essential for tumor growth and expansion, because the resulting blood vessels supply malignant cells with sufficient oxygen and nutrition. 6,7 Therefore, interruption of this process is considered to be a strategy for preventing CRC metastases to the liver.Recent studies have focused on novel endothelial growth factors such as angiopoietins (Ang), which are ligands for the endothelium-specific tyrosine kinase receptor Tie-2. 8 -10 Ang molecules play crucial roles in normal vascular development and in embryonic angio-

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“…Therefore, fixed scanning time delay may have deteriorated the quality of dynamic imaging in some patients. It is likely that the use of bolus tracking or test bolus techniques (10,21) may improve the detection of hypervascular lesions using ferucarbotran-enhanced MR imaging.…”

Section: Discussionmentioning

confidence: 99%

“…The scanning parameters were 1.25 mm ϫ 8 or 2 mm ϫ 4 detector configuration, 0.875-1.375 pitch, 5-mm slice thickness, 5-mm reconstruction interval, 120 kVp, and 300 -400 mA tube current. The scanning time delay for early arterial phase and late arterial phase imaging was determined by using a test bolus technique (10) or an automatic bolus tracking technique (11). The time from the contrast material injection until the initiation of the early arterial phase scan was 18 -36 seconds.…”

Section: Ct Imagingmentioning

confidence: 99%

Hemodynamic characterization of focal hepatic lesions: Role of ferucarbotran‐enhanced dynamic MR imaging using T2‐weighted multishot spin‐echo echo‐planar sequence

Hori

Murakami

Kim

et al. 2006

Magnetic Resonance Imaging

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Purpose:To investigate the role of ferucarbotran-enhanced dynamic MR imaging using multishot spin-echo echo-planar sequence in the evaluation of hemodynamics of focal hepatic lesions. Materials and Methods:Sixty-three focal hepatic lesions (24 benign and 39 malignant) from 53 consecutive patients who underwent both ferucarbotran-enhanced MR imaging and dynamic computed tomography (CT) were included in this study. MR imaging was performed with a 1.5-T scanner with a phased-array coil. T2-weighted multishot spin-echo echo-planar sequences (TR/TE ϭ 1714 -2813/80 msec) were obtained during a single breathhold before and 15, 60, 120, 180, and 600 seconds after intravenous injection of ferucarbotran. The enhancement patterns of lesions were classified into three categories by a study coordinator on the basis of dynamic CT images as hypervascular, hypovascular, and hemangioma type. The study coordinator created mean contrast-to-noise ratio of lesions vs. time curves for each enhancement pattern for quantitative analyses. Moreover, three radiologists separately and blindly reviewed MR images, and then assigned three confidence scores for the three enhancement patterns to each lesion. Sensitivity, specificity, and receiver operating characteristic analyses were performed. Results:Quantitative analyses showed characteristic enhancement curves for each enhancement pattern. Mean sensitivities/specificities were 0.816/0.882, 0.897/0.863, and 0.800/0.989 for hypervascular, hypovascular, and hemangioma types, respectively. Mean areas under the receiver operating characteristic curve were 0.886 for hypervascular type and 0.913 for hypovascular type. Conclusion:Ferucarbotran-enhanced dynamic MR imaging can be used to successfully characterize the hemodynamics of focal hepatic lesions.

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Hypervascular Hepatocellular Carcinoma: Detection with Double Arterial Phase Multi-Detector Row Helical CT

Abstract: Double arterial phase imaging is recommended to improve detection of hypervascular HCCs and reduce false-positive lesions.

Cited by 268 publications

References 14 publications

Characterization of small nodules in cirrhosis by assessment of vascularity: The problem of hypovascular hepatocellular carcinoma

Characterization of small nodules in cirrhosis by assessment of vascularity: The problem of hypovascular hepatocellular carcinoma

Hepatic expression ofANG2 RNA in metastatic colorectal cancer

Hemodynamic characterization of focal hepatic lesions: Role of ferucarbotran‐enhanced dynamic MR imaging using T2‐weighted multishot spin‐echo echo‐planar sequence

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