BACKGROUND In cases of coronavirus disease 2019(COVID-19),favipiravir is commonly included to the therapy regimen.Drug interactions between favipiravir and other COVID-19 therapy drugs are frequently researched.Howeve...BACKGROUND In cases of coronavirus disease 2019(COVID-19),favipiravir is commonly included to the therapy regimen.Drug interactions between favipiravir and other COVID-19 therapy drugs are frequently researched.However,no research on possible drug interactions between Favipiravir and radiocontrast agents,which have become almost crucial in diagnostic processes while not being part of the treatment,has been found.AIM To determine potential medication interactions between Favipiravir and radiocontrast agents.METHODS The study comprised patients who were taking Favipiravir for COVID-19 therapy and underwent a contrast-enhanced computed tomography(CT)or magnetic resonance imaging(MRI)test while taking the medicine.The computerized patient files of the cases included in the study,as well as the pharmacovigilance forms in the designated hospital,were evaluated for this purpose.RESULTS The study included the evaluation of data from 1046 patients.The study sample's mean age was 47.23±9.48 years.The mean age of cases with drug interactions was statistically significant greater than that of cases with no drug interactions(P=0.003).When evaluated with logistic regression analysis,a 1-year raises in age increases the risk of developing drug interactions by 1.63 times(P=0.023).There was no statistically significant difference in the occurrence of medication interactions between the sexes(P=0.090).Possible medication interactions were discovered in 42 cases(4%).CONCLUSION The findings of this study revealed that the most notable findings as a result of the combined use of contrast agents and favipiravir were increased creatinine and transaminase values,as well as an increase in the frequency of nausea and vomiting.The majority of drug interactions discovered were modest enough that they were not reflected in the clinic.Drug interactions become more common as people get older.展开更多
BACKGROUND Neoadjuvant chemotherapy can cause hepatic sinusoidal obstruction syndrome(SOS)in patients with colorectal cancer liver metastases and increases posto-perative morbidity and mortality.AIM To evaluate T1 map...BACKGROUND Neoadjuvant chemotherapy can cause hepatic sinusoidal obstruction syndrome(SOS)in patients with colorectal cancer liver metastases and increases posto-perative morbidity and mortality.AIM To evaluate T1 mapping based on gadoxetic acid-enhanced magnetic resonance imaging(MRI)for diagnosis of hepatic SOS induced by monocrotaline.METHODS Twenty-four mice were divided into control(n=10)and experimental(n=14)groups.The experimental groups were injected with monocrotaline 2 or 6 days before MRI.MRI parameters were:T1 relaxation time before enhancement;T1 relaxation time 20 minutes after enhancement(T_(1post));a reduction in T1 relaxation time(△T_(1)%);and first enhancement slope percentage of the liver parenchyma(ESP).Albumin and bilirubin score was determined.Histological results served as a reference.Liver parenchyma samples from the control and experimental groups were analyzed by western blotting,and organic anion transporter polypeptide 1(OATP1)was measured.RESULTS T_(1post),△T_(1)%,and ESP of the liver parenchyma were significantly different between two groups(all P<0.001)and significantly correlated with the total histological score of hepatic SOS(r=-0.70,0.68 and 0.79;P<0.001).△T_(1)%and ESP were positively correlated with OATP1 levels(r=0.82,0.85;P<0.001),whereas T_(1post) had a negative correlation with OATP1 levels(r=-0.83;P<0.001).INTRODUCTION Hepatic sinusoidal obstruction syndrome(SOS)is also known as hepatic veno-occlusive disease of the liver[1].The main pathological feature of hepatic SOS is damage to liver terminal vessels,and the clinical symptoms of it include ascites and abdominal pain[2].It was first proposed in 1979 as an early complication of hematopoietic stem cell transplantation[3].The prevalence ranges from 5%to 60%,and hepatic SOS is a potentially severe complication and can even lead to death in severe cases[4].Recently,systemic neoadjuvant chemotherapy became widely regarded as one of the causes hepatic SOS in the patients with advanced metastatic colorectal cancer[5,6],especially those were treated with oxaliplatin[7,8].Oxaliplatin-based preoperative chemotherapy is used for patients with colorectal liver metastases as the standard regimen[8,9],because it could improve tumor resection outcome by shrinking the metastatic sites and reducing recurrence rate[10].Nevertheless,chemotherapy-induced hepatic SOS has been associated with a higher risk of postresection morbidity[11],such as intraoperative bleeding,intraoperative transfusions,and postoperative liver failure[12].Therefore,it is important to detect and diagnose of hepatic SOS timely.Currently,the gold standard is still based on liver biopsy[13],but it is an invasive procedure and has several limitations and complications,such as hemorrhage[14].A noninvasive diagnostic modality is needed for the assessment of hepatic SOS.Some noninvasive tools have been used for diagnosis of hepatic SOS.Researchers have utilized a preoperative platelet count and aspartate aminotransferase to platelet ratio index[15].In addition,some imaging methods such as shear wave ultrasonography,computed tomography,and gadoxetic acid-enhanced magnetic resonance imaging(MRI)have been promoted as useful methods for evaluation of hepatic SOS[16-18].Recent studies with monocrotaline(MCT)-treated rats were conducted to investigate diagnosis and prediction of severity of SOS.For example,intravoxel incoherent motion diffusion-weighted imaging,non-Gaussian diffusion models,and T1 rho quantification[19,20].The MCT-induced hepatic SOS animal model was reproducible,with a detailed pathological scoring criteria[21].Gadoxetic acid is a hepatocyte-specific contrast substance,which can provide parenchymal contrast in the hepato-biliary phase.It is reported that gadoxetic acid is absorbed into the liver parenchyma via organic anion transporter polypeptide 1(OATP1)on the hepatocyte membranes[22-24].Recently,several authors have described the feasibility of gadoxetic acid-enhanced MRI for the diagnosis of oxaliplatin-induced hepatic SOS[25].They mainly diagnosed hepatic SOS based on the signal intensity of the hepatobiliary specific phase.However,there were several limitations due to the inconsistency between signal intensity of the liver parenchyma and the concentration of contrast agent for evaluation of the degree of hepatic SOS[26].Therefore,we measured T1 relaxation time on parametric mapping because it is linearly related to the concentration of the contrast agent and is not affected by other factors[27].Yang et al[28]demonstrated T1 mapping on gadoxetic acid-enhanced MRI for the assessment of oxaliplatin-induced liver injury in a C57BL/6 mouse model.However,the main pathological changes in their model were hepatocyte degeneration and fibrosis.Therefore,we aimed to explore the effectiveness of T1 mapping based on gadoxetic acid-enhanced MRI for the diagnosis of hepatic SOS in a C57BL/6 mouse model,as well as a possible relation between OATP1 Levels and MRI parameters.展开更多
The liver is one of the organs most commonly involved in metastatic disease,especially due to its unique vascularization.It’s well known that liver metastases represent the most common hepatic malignant tumors.From a...The liver is one of the organs most commonly involved in metastatic disease,especially due to its unique vascularization.It’s well known that liver metastases represent the most common hepatic malignant tumors.From a practical point of view,it’s of utmost importance to evaluate the presence of liver metastases when staging oncologic patients,to select the best treatment possible,and finally to predict the overall prognosis.In the past few years,imaging techniques have gained a central role in identifying liver metastases,thanks to ultrasonography,contrast-enhanced computed tomography(CT),and magnetic resonance imaging(MRI).All these techniques,especially CT and MRI,can be considered the noninvasive reference standard techniques for the assessment of liver involvement by metastases.On the other hand,the liver can be affected by different focal lesions,sometimes benign,and sometimes malignant.On these bases,radiologists should face the differential diagnosis between benign and secondary lesions to correctly allocate patients to the best management.Considering the above-mentioned principles,it’s extremely important to underline and refresh the broad spectrum of liver metastases features that can occur in everyday clinical practice.This review aims to summarize the most common imaging features of liver metastases,with a special focus on typical and atypical appearance,by using MRI.展开更多
BACKGROUND Iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence(IDEAL-IQ)is based on chemical shift-based water and fat separation technique to get proton d...BACKGROUND Iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence(IDEAL-IQ)is based on chemical shift-based water and fat separation technique to get proton density fat fraction.Multiple studies have shown that using IDEAL-IQ to test the stability and repeatability of liver fat is acceptable and has high accuracy.AIM To explore whether Gadoxetate Disodium(Gd-EOB-DTPA)interferes with the measurement of the hepatic fat content quantified with the IDEAL-IQ and to evaluate the robustness of this technique.METHODS IDEAL-IQ was used to quantify the liver fat content at 3.0T in 65 patients injected with Gd-EOB-DTPA contrast.After injection,IDEAL-IQ was estimated four times,and the fat fraction(FF)and R2* were measured at the following time points:Precontrast,between the portal phase(70 s)and the late phase(180 s),the delayed phase(5 min)and the hepatobiliary phase(20 min).One-way repeated-measures analysis was conducted to evaluate the difference in the FFs between the four time points.Bland-Altman plots were adopted to assess the FF changes before and after injection of the contrast agent.P<0.05 was considered statistically significant.RESULTS The assessment of the FF at the four time points in the liver,spleen and spine showed no significant differences,and the measurements of hepatic FF yielded good consistency between T1 and T2[95%confidence interval:-0.6768%,0.6658%],T1 and T3(-0.3900%,0.3178%),and T1 and T4(-0.3750%,0.2825%).R2* of the liver,spleen and spine increased significantly after injection(P<0.0001).CONCLUSION Using the IDEAL-IQ sequence to measure the FF,we can obtain results that will not be affected by Gd-EOB-DTPA.The high reproducibility of the IDEAL-IQ sequence makes it available in the scanning interval to save time during multiphase examinations.展开更多
BACKGROUND:Contrast agents help to improve visibility in magnetic resonance(MR)imaging.However,owing to the large interstitial spaces of the liver,there is a reduction in the natural contrast gradient between lesions ...BACKGROUND:Contrast agents help to improve visibility in magnetic resonance(MR)imaging.However,owing to the large interstitial spaces of the liver,there is a reduction in the natural contrast gradient between lesions and healthy tissue.This study was undertaken to evaluate the efficacy and safety of the liverspecific MR imaging contrast agent gadoxetate disodium(GdEOB-DTPA)in Chinese patients.METHODS:This was a single-arm,open-label,multicenter study in patients with known or suspected focal liver lesions referred for contrast-enhanced MR imaging.MR imaging was performed in 234 patients before and after a single intravenous bolus of Gd-EOB-DTPA(0.025 mmol/kg body weight).Images were evaluated by clinical study investigators and three independent,blinded radiologists.The primary efficacy endpoint was sensitivity in lesion detection.RESULTS:Gd-EOB-DTPA improved sensitivity in lesion detection by 9.46%compared with pre-contrast imaging for the average of the three blinded readers(94.78%vs 85.32%for Gd-EOB-DTPA vs pre-contrast,respectively).Improvements in detection were more pronounced in lesions less than 1cm.Gd-EOB-DTPA improved diagnostic accuracy in lesion classification.CONCLUSIONS:This open-label study demonstrated that Gd-EOB-DTPA improves diagnostic sensitivity in liver lesions,particularly in those smaller than 1 cm.Gd-EOB-DTPA also significantly improves the diagnostic accuracy in lesion classification,and furthermore,Gd-EOB-DTPA is safe in Chinese patients with liver lesions.展开更多
BACKGROUND Hepatocellular adenomas are rare tumors that can occur in patients with glycogen storage disease type I.CASE SUMMARY We herein report two cases of histologically proven hepatocellular adenomas in patients w...BACKGROUND Hepatocellular adenomas are rare tumors that can occur in patients with glycogen storage disease type I.CASE SUMMARY We herein report two cases of histologically proven hepatocellular adenomas in patients with glycogen storage disease type I.Magnetic resonance imaging(MRI)was performed after bolus injection of gadoxetate disodium,a liver-specific gadolinium-based MRI contrast agent.In the present cases,some of the hepatocellular adenomas showed unexpectedly a“bull’s eye”appearance on T2-weighted and post-contrast images,which was not previously described as imaging findings of hepatocellular adenomas in glycogen storage disease.A bull’s eye appearance on T2-weighted images can be encountered in both benign(i.e.,abscess)or malignant(i.e.,epithelioid hemangioendothelioma,cholangiocarcinoma,and metastases)hepatic lesions.CONCLUSION We present two cases of hepatocellular adenomas in patients with glycogen storage disease type 1,in which gadoxetate disodium-MRI showed atypical imaging findings for hepatocellular adenomas.At present there is no systematic study evaluating MRI findings of hepatocellular adenomas in patients with glycogen storage disease,further studies are needed to specifically investigate this issue.展开更多
Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast a...Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast agent in a patient with peliosis hepatis are presented for the first time. Methods: This is a retrospective review of the MRI findings in two patients reviewed independently by two specialized abdominal imaging radiologists. The radiological findings were correlated with clinical history and histopathology. Results: Peliosis hepatis is a rare clinical and radiological entity that is often a diagnostic dilemma due to its non-specific clinical characteristics. Unusual imaging characteristics in this rare entity make diagnosis even more challenging. Conclusions: Improved understanding of the imaging characteristics of peliosis hepatis may prevent unnecessary and potentially dangerous biopsies in select patients with peliosis hepatis. This requires a high index of suspicion for practicing radiologists due to the rarity of this disease.展开更多
To date the imaging diagnosis of liver lesions is based mainly on the identification of vascular features, which are typical of overt hepatocellular carcinoma(HCC), but the hepatocarcinogenesis is a complex and multis...To date the imaging diagnosis of liver lesions is based mainly on the identification of vascular features, which are typical of overt hepatocellular carcinoma(HCC), but the hepatocarcinogenesis is a complex and multistep event during which, a spectrum of nodules develop within the liver parenchyma, including benign small and large regenerative nodule(RN), low-grade dysplastic nodule(LGDN), high-grade dysplastic nodule(HGDN), early HCC, and well differentiated HCC. These nodules may be characterised not only on the basis of their respective different blood supplies, but also on their different hepatocyte function. Recently, in liver imaging the introduction of hepatobiliary magnetic resonance imaging contrast agent offered the clinicians the possibility to obtain, at once, information not only related to the vascular changes of liver nodules but also information on hepatocyte function. For this reasons this new approach becomes the most relevant diagnostic clue for differentiating low-risk nodules(LGDN-RN) from highrisk nodules(HGDN/early HCC or overt HCC) and consequently new diagnostic algorithms for HCC have been proposed. The use of hepatobiliary contrast agents is constantly increasing and gradually changing the standard of diagnosis of HCC. The main purpose of this review is to underline the added value of Gd-EOB-DTPA in early-stage diagnoses of HCC. We also analyse the guidelines for the diagnosis and management of HCC, the key concepts of HCC development, growth and spread and the imaging appearance of precursor nodules that eventually may transform into overt HCC.展开更多
BACKGROUND Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma(HCC) after major hepatectomy. Current available clinical indexes predicting postoperative resi...BACKGROUND Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma(HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently accurate.AIM To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major hepatectomy.METHODS For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve analyses.RESULTS Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure(area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure(area under the curve: 0.894;95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy of liver failure prediction when radiomics signature was added to the clinical prediction model(integrated discrimination improvement = 0.117, P =0.002). The calibration curve and an insignificant Hosmer-Lemeshow test statistic(P = 0.841) demonstrated good calibration of the radiomics-based model. The decision curve analysis showed that patients would benefit more from a radiomics-based prediction model than from a clinical prediction model and radiomics signature alone.CONCLUSION A radiomics-based model of preoperative gadoxetic acid–enhanced MRI can be used to predict liver failure in cirrhotic patients with HCC after major hepatectomy.展开更多
Hepatocellular carcinoma is the most common primary hepatic malignant tumor.With widespread use of liver imaging,various cirrhosis-related nodules are frequently detected in patients with chronic liver disease,while d...Hepatocellular carcinoma is the most common primary hepatic malignant tumor.With widespread use of liver imaging,various cirrhosis-related nodules are frequently detected in patients with chronic liver disease,while diverse hypervascular hepatic lesions are incidentally detected but undiagnosed on dynamic computed tomography and magnetic resonance imaging(MRI).However,use of hepatocyte-specific MR contrast agents with combined perfusion and hepatocyte-selective properties have improved diagnostic performance in detection and characterization of focal liver lesions.Meanwhile,the enhancement patterns observed during dynamic phases using hepatocyte-specific agents may be different from those observed during MRI using conventional extracellular fluid agents,leading to confusion in diagnosis.Therefore,we discuss useful tips for the differentiation of hepatocellular carcinoma from similar lesions in patients with and without chronic liver disease using liver MRI with hepatocyte-specific agents.展开更多
AIM: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imag...AIM: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imaging.展开更多
The use of liver magnetic resonance imaging is increasing thanks to itsmultiparametric sequences that allow a better tissue characterization, and the useof hepatobiliary contrast agents. This review aims to evaluate g...The use of liver magnetic resonance imaging is increasing thanks to itsmultiparametric sequences that allow a better tissue characterization, and the useof hepatobiliary contrast agents. This review aims to evaluate gadoxetic acidenhanced magnetic resonance imaging in the diagnosis and staging ofcholangiocarcinoma and its different clinical and radiological classificationsproposed in the literature. We also analyze the epidemiology, risk factors incorrelation with clinical findings and laboratory data.展开更多
AIM:To determine the added value of hepatobiliary phase(HBP)gadoxetic acid-enhanced magnetic resonance imaging(MRI)in evaluating hepatic nodules in high-risk patients.METHODS:The institutional review board approved th...AIM:To determine the added value of hepatobiliary phase(HBP)gadoxetic acid-enhanced magnetic resonance imaging(MRI)in evaluating hepatic nodules in high-risk patients.METHODS:The institutional review board approved this retrospective study and waived the requirement for informed consent.This study included 100 patients at high risk for hepatocellular carcinoma(HCC)and 105hepatic nodules that were larger than 1 cm.A blind review of two MR image sets was performed in a random order:set 1,unenhanced(T1-and T2-weighted)and dynamic images;and set 2,unenhanced,dynamic20-min and HBP images.The diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were compared for the two image sets.Univariate and multivariate analyses were performed on the MR characteristics utilized to diagnose HCC.RESULTS:A total of 105 hepatic nodules were identified in 100 patients.Fifty-nine nodules were confirmed to be HCC.The diameter of the 59 HCCs ranged from1 to 12 cm(mean:1.9 cm).The remaining 46 nodules were benign(28 were of hepatocyte origin,nine were hepatic cysts,seven were hemangiomas,one was chronic inflammation,and one was focal fat infiltration).The diagnostic accuracy significantly increased with the addition of HBP images,from 88.7%in set 1to 95.5%in set 2(P=0.002).In set 1 vs set 2,the sensitivity and NPV increased from 79.7%to 93.2%and from 78.9%to 91.8%,respectively,whereas the specificity and PPV were not significantly different.The hypointensity on the HBP images was the most sensitive(93.2%),and typical arterial enhancement followed by washout was the most specific(97.8%).The multivariate analysis revealed that typical arterial enhancement followed by washout,hyperintensity on T2-weighted images,and hypointensity on HBP images were statistically significant MRI findings that could diagnose HCC(P<0.05).CONCLUSION:The addition of HBP gadoxetic acidenhanced MRI statistically improved the diagnostic accuracy in HCCs larger than 1 cm.Typical arterial enhancement followed by washout and hypointensity on HBP images are useful for diagnosing HCC.展开更多
Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary ...Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.展开更多
AIM:To compare differences between volumetric interpolated breath-hold examination(VIBE) using two-point Dixon fat-water separation(Dixon-VIBE) and chemically selective fat saturation(FS-VIBE) with magnetic resonance ...AIM:To compare differences between volumetric interpolated breath-hold examination(VIBE) using two-point Dixon fat-water separation(Dixon-VIBE) and chemically selective fat saturation(FS-VIBE) with magnetic resonance imaging examination.METHODS:Forty-nine patients were included, who were scanned with two VIBE sequences(Dixon-VIBE and FS-VIBE) in hepatobiliary phase after gadoxetic acid administration.Subjective evaluations including sharpness of tumor, sharpness of vessels, strength and homogeneity of fat suppression, and artifacts that were scored using a 4-point scale.The liver-to-lesion contrast was also calculated and compared.RESULTS:Dixon-VIBE with water reconstruction had significantly higher subjective scores than FS-VIBE in strength and homogeneity of fat suppression(< 0.0001) but lower scores in sharpness of tumor(P < 0.0001), sharpness of vessels(P = 0.0001), and artifacts(P = 0.034).The liver-to-lesion contrast on Dixon-VIBE images was significantly lower than that on FS-VIBE(16.6% ± 9.4% vs 23.9% ± 12.1%, P = 0.0001).CONCLUSION:Dixon-VIBE provides stronger and more homogenous fat suppression than FS-VIBE, while has lower clarity of focal liver lesions in hepatobiliary phase after gadoxetic acid administration.展开更多
AIM To perform a meta-analysis assessing the value of gadoxetic acid-enhanced magnetic resonance imaging(Gd-EOB-MRI)in detecting small hepatocellular carcinoma(HCC)(≤2.0 cm)in patients with chronic liver disease.METH...AIM To perform a meta-analysis assessing the value of gadoxetic acid-enhanced magnetic resonance imaging(Gd-EOB-MRI)in detecting small hepatocellular carcinoma(HCC)(≤2.0 cm)in patients with chronic liver disease.METHODS Databases,including MEDLINE and EMBASE,were searched for relevant original articles published from January 2008 to February 2015.Data were extracted,and summary estimates of diagnostic accuracy indexes such as sensitivity,specificity,diagnostic odds ratio,predictive value,and areas under summary receiver operating characteristic curve were obtained using a random-effects model,with further exploration employing meta-regression and subgroup analyses.RESULTS In 10 studies evaluating 768 patients,pooled perlesion sensitivity of Gd-EOB-DTPA was 91%(95%CI:83%-95%),with a specificity of 95%(95%CI:87%-98%).Overall positive likelihood ratio was 18.1(95%CI:6.6-49.4),for negative likelihood ratio(NLR)of 0.10(95%CI:0.05-0.19)and diagnostic odds ratio of182(95%CI:57-581).Subgroup analysis suggested that diagnostic performance of Gd-EOB-MRI for sub-centimeter HCC(≤1.0 cm)detection was low,with a sensitivity of69%(95%CI:59%-78%).In studies with both Gd-EOBMRI and diffusion-weighted imaging(DWI)performed,Gd-EOB-MRI/DWI combination was more sensitive than Gd-EOB-DTPA alone,whether for small lesions(86%vs77%)or sub-centimeter ones(80%vs 56%).CONCLUSION A limited number of small studies suggested that GdEOB-MRI has good diagnostic performance in the detection of small HCC(≤2.0 cm)among patients with chronic liver disease,but relatively lower performance for detection of sub-centimeter HCC(≤1.0 cm).Combination of Gd-EOB-MRI and DWI can improve the diagnostic sensitivity of MRI.展开更多
Gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellula...Gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellular carcinoma(HCC) in arterial phase imagingand hypovascular early HCC(small well-differentiated HCC of the vaguely nodular type) in hepatobiliary phase imaging, and has become an indispensable imaging modality in the treatment of HCC. Early HCCs have been detected more frequently since the introduction of EOB-MRI into daily clinical practice. Early HCC is known to progress to conventional hypervascular HCC, and many risk factors have been identified for the hypervascularization of early HCC including the diameter of the tumor, presence of fat, and imaging findings of EOB-MRI. The rate of the development of hypervascular HCC was previously reported to be high in patients with chronic liver disease and early HCC. The presence of early HCC is regarded as a predictor for the recurrence of HCC following hepatic resection. On the other hand, although early HCC itself is currently not regarded as a target lesion for hepatic resection, early HCC at high risk of hypervascularity needs to be treated by local ablation therapy. If concomitant early HCC with progressed HCC is at high risk of hypervascularization and the functional liver reserve of a patient is sufficient, its simultaneous treatment at the time of hepatic resection for progressed HCC is recommended. Further studies on larger numbers of patients are needed before this strategy is adopted.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a major cause of liver disease worldwide.The diagnosis of nonalcoholic steatohepatitis(NASH),the most severe form of NAFLD,is crucial and has prognostic and therape...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a major cause of liver disease worldwide.The diagnosis of nonalcoholic steatohepatitis(NASH),the most severe form of NAFLD,is crucial and has prognostic and therapeutic implications.However,currently this diagnosis is based on liver biopsy and has several limitations.AIM To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging(GA-MRI)in differentiating isolated steatosis from NASH in patients with NAFLD.METHODS In this prospective study,56 patients with NAFLD(18 with isolated steatosis and 38 with NASH)underwent GA-MRI.The contrast enhancement index(CEI)was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA administration.Between-group differences in mean CEI were examined using Student's t test.The area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were evaluated.RESULTS The mean CEI for all subjects was 1.82±0.19.The mean CEI was significantly lower in patients with NASH than in those with isolated steatosis(P=0.008).Two CEI cut-off points were used:<1.66(94%specificity)to characterize NASH and>2.00(89%sensitivity)to characterize isolated steatosis.CEI values between 1.66 and 2.00 indicated liver biopsy,and the procedure could be avoided in 40%of patients with NAFLD.CONCLUSION GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis,and could help to avoid liver biopsy in patients with NAFLD.展开更多
BACKGROUND Although contrast-enhanced magnetic resonance imaging(MRI)using gadoxetic acid has been shown to have higher accuracy,sensitivity,and specificity for the detection and characterization of hepatic metastases...BACKGROUND Although contrast-enhanced magnetic resonance imaging(MRI)using gadoxetic acid has been shown to have higher accuracy,sensitivity,and specificity for the detection and characterization of hepatic metastases compared with other modalities,the long examination time would limit the broad indication.Several abbreviated enhanced MRI(Ab-MRI)protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases.However,an optimal protocol has not been established,and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography(CE-CT),which is the preoperative imaging of colorectal cancer staging in clinical settings,to determine the best therapeutic strategy.AIM To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.METHODS Study participants comprised 87 patients(51 males,36 females;mean age,67.2±10.8 years)who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021.Each exam was independently reviewed by two readers in three reading sessions:(1)Only single-shot fast spin echo(FSE)T2-weighted or fat-suppressed-FSE-T2-weighted,diffusion-weighted,and hepatobiliary-phase images(Ab-MRI protocol 1 or 2);(2)all acquired MRI sequences(standard protocol);and(3)a combination of an Ab-MRI protocol(1 or 2)and CE-CT.Diagnostic performance was then statistically analyzed.RESULTS A total of 380 Lesions were analyzed,including 195 metastases(51.4%).Results from the two Ab-MRI protocols were similar.The sensitivity,specificity,and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI(P>0.05),while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone,although the difference was not significant(P>0.05),and were quite similar to those from standard MRI(P>0.05).CONCLUSION The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol.Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.展开更多
Purpose: To evaluate posthepatectomy liver failure (PHLF) using gadoxetic acid-enhanced magnetic resonance imaging (MRI) with a measure of relative liver enhancement (RLE) on hepatobiliary phase images, thereby facili...Purpose: To evaluate posthepatectomy liver failure (PHLF) using gadoxetic acid-enhanced magnetic resonance imaging (MRI) with a measure of relative liver enhancement (RLE) on hepatobiliary phase images, thereby facilitating safe liver resection. Methods: Twenty patients in Child-Pugh class A underwent tumor excision surgery and indocyanine green (ICG) clearance of future remnant liver (FRL) (ICG-Krem) values were >0.05. PHLF was evaluated using the grading system of the International Study Group of Liver Surgery (ISGLS). The RLE value was defined as the signal gain percentage between the precontrast and hepatocellular images. In the whole liver and FRL, theRLE value measured the tumor-free liver parenchyma in RLE images. We examined the correlation between indocyanine green clearance (ICG-K) and MRI-based liver function in the whole liver. Preoperative PHLF evaluation was predicted using remnant hepatocellular uptake index (rHUI), remnant RLE (rRLE), coefficient variation of Rrle [Cv(rRLE)], and ICG-Krem corrected by heterogeneous liver function(HLF-ICG-Krem). Results: HLF-ICG-Krem and rRLE values correlated with INRs after postoperative day five (r = -0.55 and 0.46, p = 0.01 and 0.04, respectively). Furthermore, HLF-ICG-Krem values ≤0.05 detected two patients with higher INRs after postoperative day five. On the other hand, neither rHUI nor Cv(rRLE) was correlated with INRs after postoperative day five (r = 0.28, and -0.03, respectively;p >0.05 for both). HLF-ICG-Krem was significantly lower with PHLF than without PHLF (p = 0.005). Conclusion: HLF-ICG-Krem is useful for evaluating PHLF more correctly.展开更多
文摘BACKGROUND In cases of coronavirus disease 2019(COVID-19),favipiravir is commonly included to the therapy regimen.Drug interactions between favipiravir and other COVID-19 therapy drugs are frequently researched.However,no research on possible drug interactions between Favipiravir and radiocontrast agents,which have become almost crucial in diagnostic processes while not being part of the treatment,has been found.AIM To determine potential medication interactions between Favipiravir and radiocontrast agents.METHODS The study comprised patients who were taking Favipiravir for COVID-19 therapy and underwent a contrast-enhanced computed tomography(CT)or magnetic resonance imaging(MRI)test while taking the medicine.The computerized patient files of the cases included in the study,as well as the pharmacovigilance forms in the designated hospital,were evaluated for this purpose.RESULTS The study included the evaluation of data from 1046 patients.The study sample's mean age was 47.23±9.48 years.The mean age of cases with drug interactions was statistically significant greater than that of cases with no drug interactions(P=0.003).When evaluated with logistic regression analysis,a 1-year raises in age increases the risk of developing drug interactions by 1.63 times(P=0.023).There was no statistically significant difference in the occurrence of medication interactions between the sexes(P=0.090).Possible medication interactions were discovered in 42 cases(4%).CONCLUSION The findings of this study revealed that the most notable findings as a result of the combined use of contrast agents and favipiravir were increased creatinine and transaminase values,as well as an increase in the frequency of nausea and vomiting.The majority of drug interactions discovered were modest enough that they were not reflected in the clinic.Drug interactions become more common as people get older.
基金the National Science Foundation for Young Scientists of China,No.81701682.
文摘BACKGROUND Neoadjuvant chemotherapy can cause hepatic sinusoidal obstruction syndrome(SOS)in patients with colorectal cancer liver metastases and increases posto-perative morbidity and mortality.AIM To evaluate T1 mapping based on gadoxetic acid-enhanced magnetic resonance imaging(MRI)for diagnosis of hepatic SOS induced by monocrotaline.METHODS Twenty-four mice were divided into control(n=10)and experimental(n=14)groups.The experimental groups were injected with monocrotaline 2 or 6 days before MRI.MRI parameters were:T1 relaxation time before enhancement;T1 relaxation time 20 minutes after enhancement(T_(1post));a reduction in T1 relaxation time(△T_(1)%);and first enhancement slope percentage of the liver parenchyma(ESP).Albumin and bilirubin score was determined.Histological results served as a reference.Liver parenchyma samples from the control and experimental groups were analyzed by western blotting,and organic anion transporter polypeptide 1(OATP1)was measured.RESULTS T_(1post),△T_(1)%,and ESP of the liver parenchyma were significantly different between two groups(all P<0.001)and significantly correlated with the total histological score of hepatic SOS(r=-0.70,0.68 and 0.79;P<0.001).△T_(1)%and ESP were positively correlated with OATP1 levels(r=0.82,0.85;P<0.001),whereas T_(1post) had a negative correlation with OATP1 levels(r=-0.83;P<0.001).INTRODUCTION Hepatic sinusoidal obstruction syndrome(SOS)is also known as hepatic veno-occlusive disease of the liver[1].The main pathological feature of hepatic SOS is damage to liver terminal vessels,and the clinical symptoms of it include ascites and abdominal pain[2].It was first proposed in 1979 as an early complication of hematopoietic stem cell transplantation[3].The prevalence ranges from 5%to 60%,and hepatic SOS is a potentially severe complication and can even lead to death in severe cases[4].Recently,systemic neoadjuvant chemotherapy became widely regarded as one of the causes hepatic SOS in the patients with advanced metastatic colorectal cancer[5,6],especially those were treated with oxaliplatin[7,8].Oxaliplatin-based preoperative chemotherapy is used for patients with colorectal liver metastases as the standard regimen[8,9],because it could improve tumor resection outcome by shrinking the metastatic sites and reducing recurrence rate[10].Nevertheless,chemotherapy-induced hepatic SOS has been associated with a higher risk of postresection morbidity[11],such as intraoperative bleeding,intraoperative transfusions,and postoperative liver failure[12].Therefore,it is important to detect and diagnose of hepatic SOS timely.Currently,the gold standard is still based on liver biopsy[13],but it is an invasive procedure and has several limitations and complications,such as hemorrhage[14].A noninvasive diagnostic modality is needed for the assessment of hepatic SOS.Some noninvasive tools have been used for diagnosis of hepatic SOS.Researchers have utilized a preoperative platelet count and aspartate aminotransferase to platelet ratio index[15].In addition,some imaging methods such as shear wave ultrasonography,computed tomography,and gadoxetic acid-enhanced magnetic resonance imaging(MRI)have been promoted as useful methods for evaluation of hepatic SOS[16-18].Recent studies with monocrotaline(MCT)-treated rats were conducted to investigate diagnosis and prediction of severity of SOS.For example,intravoxel incoherent motion diffusion-weighted imaging,non-Gaussian diffusion models,and T1 rho quantification[19,20].The MCT-induced hepatic SOS animal model was reproducible,with a detailed pathological scoring criteria[21].Gadoxetic acid is a hepatocyte-specific contrast substance,which can provide parenchymal contrast in the hepato-biliary phase.It is reported that gadoxetic acid is absorbed into the liver parenchyma via organic anion transporter polypeptide 1(OATP1)on the hepatocyte membranes[22-24].Recently,several authors have described the feasibility of gadoxetic acid-enhanced MRI for the diagnosis of oxaliplatin-induced hepatic SOS[25].They mainly diagnosed hepatic SOS based on the signal intensity of the hepatobiliary specific phase.However,there were several limitations due to the inconsistency between signal intensity of the liver parenchyma and the concentration of contrast agent for evaluation of the degree of hepatic SOS[26].Therefore,we measured T1 relaxation time on parametric mapping because it is linearly related to the concentration of the contrast agent and is not affected by other factors[27].Yang et al[28]demonstrated T1 mapping on gadoxetic acid-enhanced MRI for the assessment of oxaliplatin-induced liver injury in a C57BL/6 mouse model.However,the main pathological changes in their model were hepatocyte degeneration and fibrosis.Therefore,we aimed to explore the effectiveness of T1 mapping based on gadoxetic acid-enhanced MRI for the diagnosis of hepatic SOS in a C57BL/6 mouse model,as well as a possible relation between OATP1 Levels and MRI parameters.
文摘The liver is one of the organs most commonly involved in metastatic disease,especially due to its unique vascularization.It’s well known that liver metastases represent the most common hepatic malignant tumors.From a practical point of view,it’s of utmost importance to evaluate the presence of liver metastases when staging oncologic patients,to select the best treatment possible,and finally to predict the overall prognosis.In the past few years,imaging techniques have gained a central role in identifying liver metastases,thanks to ultrasonography,contrast-enhanced computed tomography(CT),and magnetic resonance imaging(MRI).All these techniques,especially CT and MRI,can be considered the noninvasive reference standard techniques for the assessment of liver involvement by metastases.On the other hand,the liver can be affected by different focal lesions,sometimes benign,and sometimes malignant.On these bases,radiologists should face the differential diagnosis between benign and secondary lesions to correctly allocate patients to the best management.Considering the above-mentioned principles,it’s extremely important to underline and refresh the broad spectrum of liver metastases features that can occur in everyday clinical practice.This review aims to summarize the most common imaging features of liver metastases,with a special focus on typical and atypical appearance,by using MRI.
基金Supported by National Natural Science Foundation of China,No.82272053.
文摘BACKGROUND Iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence(IDEAL-IQ)is based on chemical shift-based water and fat separation technique to get proton density fat fraction.Multiple studies have shown that using IDEAL-IQ to test the stability and repeatability of liver fat is acceptable and has high accuracy.AIM To explore whether Gadoxetate Disodium(Gd-EOB-DTPA)interferes with the measurement of the hepatic fat content quantified with the IDEAL-IQ and to evaluate the robustness of this technique.METHODS IDEAL-IQ was used to quantify the liver fat content at 3.0T in 65 patients injected with Gd-EOB-DTPA contrast.After injection,IDEAL-IQ was estimated four times,and the fat fraction(FF)and R2* were measured at the following time points:Precontrast,between the portal phase(70 s)and the late phase(180 s),the delayed phase(5 min)and the hepatobiliary phase(20 min).One-way repeated-measures analysis was conducted to evaluate the difference in the FFs between the four time points.Bland-Altman plots were adopted to assess the FF changes before and after injection of the contrast agent.P<0.05 was considered statistically significant.RESULTS The assessment of the FF at the four time points in the liver,spleen and spine showed no significant differences,and the measurements of hepatic FF yielded good consistency between T1 and T2[95%confidence interval:-0.6768%,0.6658%],T1 and T3(-0.3900%,0.3178%),and T1 and T4(-0.3750%,0.2825%).R2* of the liver,spleen and spine increased significantly after injection(P<0.0001).CONCLUSION Using the IDEAL-IQ sequence to measure the FF,we can obtain results that will not be affected by Gd-EOB-DTPA.The high reproducibility of the IDEAL-IQ sequence makes it available in the scanning interval to save time during multiphase examinations.
基金supported by a grant from Bayer HealthCare/Bayer Schering Pharma AG
文摘BACKGROUND:Contrast agents help to improve visibility in magnetic resonance(MR)imaging.However,owing to the large interstitial spaces of the liver,there is a reduction in the natural contrast gradient between lesions and healthy tissue.This study was undertaken to evaluate the efficacy and safety of the liverspecific MR imaging contrast agent gadoxetate disodium(GdEOB-DTPA)in Chinese patients.METHODS:This was a single-arm,open-label,multicenter study in patients with known or suspected focal liver lesions referred for contrast-enhanced MR imaging.MR imaging was performed in 234 patients before and after a single intravenous bolus of Gd-EOB-DTPA(0.025 mmol/kg body weight).Images were evaluated by clinical study investigators and three independent,blinded radiologists.The primary efficacy endpoint was sensitivity in lesion detection.RESULTS:Gd-EOB-DTPA improved sensitivity in lesion detection by 9.46%compared with pre-contrast imaging for the average of the three blinded readers(94.78%vs 85.32%for Gd-EOB-DTPA vs pre-contrast,respectively).Improvements in detection were more pronounced in lesions less than 1cm.Gd-EOB-DTPA improved diagnostic accuracy in lesion classification.CONCLUSIONS:This open-label study demonstrated that Gd-EOB-DTPA improves diagnostic sensitivity in liver lesions,particularly in those smaller than 1 cm.Gd-EOB-DTPA also significantly improves the diagnostic accuracy in lesion classification,and furthermore,Gd-EOB-DTPA is safe in Chinese patients with liver lesions.
文摘BACKGROUND Hepatocellular adenomas are rare tumors that can occur in patients with glycogen storage disease type I.CASE SUMMARY We herein report two cases of histologically proven hepatocellular adenomas in patients with glycogen storage disease type I.Magnetic resonance imaging(MRI)was performed after bolus injection of gadoxetate disodium,a liver-specific gadolinium-based MRI contrast agent.In the present cases,some of the hepatocellular adenomas showed unexpectedly a“bull’s eye”appearance on T2-weighted and post-contrast images,which was not previously described as imaging findings of hepatocellular adenomas in glycogen storage disease.A bull’s eye appearance on T2-weighted images can be encountered in both benign(i.e.,abscess)or malignant(i.e.,epithelioid hemangioendothelioma,cholangiocarcinoma,and metastases)hepatic lesions.CONCLUSION We present two cases of hepatocellular adenomas in patients with glycogen storage disease type 1,in which gadoxetate disodium-MRI showed atypical imaging findings for hepatocellular adenomas.At present there is no systematic study evaluating MRI findings of hepatocellular adenomas in patients with glycogen storage disease,further studies are needed to specifically investigate this issue.
文摘Purpose: The aim of this report is to describe the unusual MR imaging characteristics observed in two patients with biopsy-proven peliosis hepatis. Imaging findings using gadoxetate disodium (Eovist) as the contrast agent in a patient with peliosis hepatis are presented for the first time. Methods: This is a retrospective review of the MRI findings in two patients reviewed independently by two specialized abdominal imaging radiologists. The radiological findings were correlated with clinical history and histopathology. Results: Peliosis hepatis is a rare clinical and radiological entity that is often a diagnostic dilemma due to its non-specific clinical characteristics. Unusual imaging characteristics in this rare entity make diagnosis even more challenging. Conclusions: Improved understanding of the imaging characteristics of peliosis hepatis may prevent unnecessary and potentially dangerous biopsies in select patients with peliosis hepatis. This requires a high index of suspicion for practicing radiologists due to the rarity of this disease.
文摘To date the imaging diagnosis of liver lesions is based mainly on the identification of vascular features, which are typical of overt hepatocellular carcinoma(HCC), but the hepatocarcinogenesis is a complex and multistep event during which, a spectrum of nodules develop within the liver parenchyma, including benign small and large regenerative nodule(RN), low-grade dysplastic nodule(LGDN), high-grade dysplastic nodule(HGDN), early HCC, and well differentiated HCC. These nodules may be characterised not only on the basis of their respective different blood supplies, but also on their different hepatocyte function. Recently, in liver imaging the introduction of hepatobiliary magnetic resonance imaging contrast agent offered the clinicians the possibility to obtain, at once, information not only related to the vascular changes of liver nodules but also information on hepatocyte function. For this reasons this new approach becomes the most relevant diagnostic clue for differentiating low-risk nodules(LGDN-RN) from highrisk nodules(HGDN/early HCC or overt HCC) and consequently new diagnostic algorithms for HCC have been proposed. The use of hepatobiliary contrast agents is constantly increasing and gradually changing the standard of diagnosis of HCC. The main purpose of this review is to underline the added value of Gd-EOB-DTPA in early-stage diagnoses of HCC. We also analyse the guidelines for the diagnosis and management of HCC, the key concepts of HCC development, growth and spread and the imaging appearance of precursor nodules that eventually may transform into overt HCC.
基金the Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme(2017)the Guangdong Natural Science Foundation,No.2017A030313777。
文摘BACKGROUND Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma(HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently accurate.AIM To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major hepatectomy.METHODS For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve analyses.RESULTS Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure(area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure(area under the curve: 0.894;95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy of liver failure prediction when radiomics signature was added to the clinical prediction model(integrated discrimination improvement = 0.117, P =0.002). The calibration curve and an insignificant Hosmer-Lemeshow test statistic(P = 0.841) demonstrated good calibration of the radiomics-based model. The decision curve analysis showed that patients would benefit more from a radiomics-based prediction model than from a clinical prediction model and radiomics signature alone.CONCLUSION A radiomics-based model of preoperative gadoxetic acid–enhanced MRI can be used to predict liver failure in cirrhotic patients with HCC after major hepatectomy.
文摘Hepatocellular carcinoma is the most common primary hepatic malignant tumor.With widespread use of liver imaging,various cirrhosis-related nodules are frequently detected in patients with chronic liver disease,while diverse hypervascular hepatic lesions are incidentally detected but undiagnosed on dynamic computed tomography and magnetic resonance imaging(MRI).However,use of hepatocyte-specific MR contrast agents with combined perfusion and hepatocyte-selective properties have improved diagnostic performance in detection and characterization of focal liver lesions.Meanwhile,the enhancement patterns observed during dynamic phases using hepatocyte-specific agents may be different from those observed during MRI using conventional extracellular fluid agents,leading to confusion in diagnosis.Therefore,we discuss useful tips for the differentiation of hepatocellular carcinoma from similar lesions in patients with and without chronic liver disease using liver MRI with hepatocyte-specific agents.
文摘AIM: To evaluate the feasibility of 3-Tesla magnetic resonance elastography (MRE) for hepatic fibrosis and to compare that with diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance (MR) imaging.
文摘The use of liver magnetic resonance imaging is increasing thanks to itsmultiparametric sequences that allow a better tissue characterization, and the useof hepatobiliary contrast agents. This review aims to evaluate gadoxetic acidenhanced magnetic resonance imaging in the diagnosis and staging ofcholangiocarcinoma and its different clinical and radiological classificationsproposed in the literature. We also analyze the epidemiology, risk factors incorrelation with clinical findings and laboratory data.
文摘AIM:To determine the added value of hepatobiliary phase(HBP)gadoxetic acid-enhanced magnetic resonance imaging(MRI)in evaluating hepatic nodules in high-risk patients.METHODS:The institutional review board approved this retrospective study and waived the requirement for informed consent.This study included 100 patients at high risk for hepatocellular carcinoma(HCC)and 105hepatic nodules that were larger than 1 cm.A blind review of two MR image sets was performed in a random order:set 1,unenhanced(T1-and T2-weighted)and dynamic images;and set 2,unenhanced,dynamic20-min and HBP images.The diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were compared for the two image sets.Univariate and multivariate analyses were performed on the MR characteristics utilized to diagnose HCC.RESULTS:A total of 105 hepatic nodules were identified in 100 patients.Fifty-nine nodules were confirmed to be HCC.The diameter of the 59 HCCs ranged from1 to 12 cm(mean:1.9 cm).The remaining 46 nodules were benign(28 were of hepatocyte origin,nine were hepatic cysts,seven were hemangiomas,one was chronic inflammation,and one was focal fat infiltration).The diagnostic accuracy significantly increased with the addition of HBP images,from 88.7%in set 1to 95.5%in set 2(P=0.002).In set 1 vs set 2,the sensitivity and NPV increased from 79.7%to 93.2%and from 78.9%to 91.8%,respectively,whereas the specificity and PPV were not significantly different.The hypointensity on the HBP images was the most sensitive(93.2%),and typical arterial enhancement followed by washout was the most specific(97.8%).The multivariate analysis revealed that typical arterial enhancement followed by washout,hyperintensity on T2-weighted images,and hypointensity on HBP images were statistically significant MRI findings that could diagnose HCC(P<0.05).CONCLUSION:The addition of HBP gadoxetic acidenhanced MRI statistically improved the diagnostic accuracy in HCCs larger than 1 cm.Typical arterial enhancement followed by washout and hypointensity on HBP images are useful for diagnosing HCC.
文摘Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.
基金Supported by National Natural Science Foundation of China,No.81371543
文摘AIM:To compare differences between volumetric interpolated breath-hold examination(VIBE) using two-point Dixon fat-water separation(Dixon-VIBE) and chemically selective fat saturation(FS-VIBE) with magnetic resonance imaging examination.METHODS:Forty-nine patients were included, who were scanned with two VIBE sequences(Dixon-VIBE and FS-VIBE) in hepatobiliary phase after gadoxetic acid administration.Subjective evaluations including sharpness of tumor, sharpness of vessels, strength and homogeneity of fat suppression, and artifacts that were scored using a 4-point scale.The liver-to-lesion contrast was also calculated and compared.RESULTS:Dixon-VIBE with water reconstruction had significantly higher subjective scores than FS-VIBE in strength and homogeneity of fat suppression(< 0.0001) but lower scores in sharpness of tumor(P < 0.0001), sharpness of vessels(P = 0.0001), and artifacts(P = 0.034).The liver-to-lesion contrast on Dixon-VIBE images was significantly lower than that on FS-VIBE(16.6% ± 9.4% vs 23.9% ± 12.1%, P = 0.0001).CONCLUSION:Dixon-VIBE provides stronger and more homogenous fat suppression than FS-VIBE, while has lower clarity of focal liver lesions in hepatobiliary phase after gadoxetic acid administration.
文摘AIM To perform a meta-analysis assessing the value of gadoxetic acid-enhanced magnetic resonance imaging(Gd-EOB-MRI)in detecting small hepatocellular carcinoma(HCC)(≤2.0 cm)in patients with chronic liver disease.METHODS Databases,including MEDLINE and EMBASE,were searched for relevant original articles published from January 2008 to February 2015.Data were extracted,and summary estimates of diagnostic accuracy indexes such as sensitivity,specificity,diagnostic odds ratio,predictive value,and areas under summary receiver operating characteristic curve were obtained using a random-effects model,with further exploration employing meta-regression and subgroup analyses.RESULTS In 10 studies evaluating 768 patients,pooled perlesion sensitivity of Gd-EOB-DTPA was 91%(95%CI:83%-95%),with a specificity of 95%(95%CI:87%-98%).Overall positive likelihood ratio was 18.1(95%CI:6.6-49.4),for negative likelihood ratio(NLR)of 0.10(95%CI:0.05-0.19)and diagnostic odds ratio of182(95%CI:57-581).Subgroup analysis suggested that diagnostic performance of Gd-EOB-MRI for sub-centimeter HCC(≤1.0 cm)detection was low,with a sensitivity of69%(95%CI:59%-78%).In studies with both Gd-EOBMRI and diffusion-weighted imaging(DWI)performed,Gd-EOB-MRI/DWI combination was more sensitive than Gd-EOB-DTPA alone,whether for small lesions(86%vs77%)or sub-centimeter ones(80%vs 56%).CONCLUSION A limited number of small studies suggested that GdEOB-MRI has good diagnostic performance in the detection of small HCC(≤2.0 cm)among patients with chronic liver disease,but relatively lower performance for detection of sub-centimeter HCC(≤1.0 cm).Combination of Gd-EOB-MRI and DWI can improve the diagnostic sensitivity of MRI.
文摘Gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellular carcinoma(HCC) in arterial phase imagingand hypovascular early HCC(small well-differentiated HCC of the vaguely nodular type) in hepatobiliary phase imaging, and has become an indispensable imaging modality in the treatment of HCC. Early HCCs have been detected more frequently since the introduction of EOB-MRI into daily clinical practice. Early HCC is known to progress to conventional hypervascular HCC, and many risk factors have been identified for the hypervascularization of early HCC including the diameter of the tumor, presence of fat, and imaging findings of EOB-MRI. The rate of the development of hypervascular HCC was previously reported to be high in patients with chronic liver disease and early HCC. The presence of early HCC is regarded as a predictor for the recurrence of HCC following hepatic resection. On the other hand, although early HCC itself is currently not regarded as a target lesion for hepatic resection, early HCC at high risk of hypervascularity needs to be treated by local ablation therapy. If concomitant early HCC with progressed HCC is at high risk of hypervascularization and the functional liver reserve of a patient is sufficient, its simultaneous treatment at the time of hepatic resection for progressed HCC is recommended. Further studies on larger numbers of patients are needed before this strategy is adopted.
基金Supported by D’Or Institute for Research and Education,No.CAAE-50521015.2.0000.5249
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a major cause of liver disease worldwide.The diagnosis of nonalcoholic steatohepatitis(NASH),the most severe form of NAFLD,is crucial and has prognostic and therapeutic implications.However,currently this diagnosis is based on liver biopsy and has several limitations.AIM To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging(GA-MRI)in differentiating isolated steatosis from NASH in patients with NAFLD.METHODS In this prospective study,56 patients with NAFLD(18 with isolated steatosis and 38 with NASH)underwent GA-MRI.The contrast enhancement index(CEI)was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA administration.Between-group differences in mean CEI were examined using Student's t test.The area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were evaluated.RESULTS The mean CEI for all subjects was 1.82±0.19.The mean CEI was significantly lower in patients with NASH than in those with isolated steatosis(P=0.008).Two CEI cut-off points were used:<1.66(94%specificity)to characterize NASH and>2.00(89%sensitivity)to characterize isolated steatosis.CEI values between 1.66 and 2.00 indicated liver biopsy,and the procedure could be avoided in 40%of patients with NAFLD.CONCLUSION GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis,and could help to avoid liver biopsy in patients with NAFLD.
基金approved by our institutional review board(No.20210035).
文摘BACKGROUND Although contrast-enhanced magnetic resonance imaging(MRI)using gadoxetic acid has been shown to have higher accuracy,sensitivity,and specificity for the detection and characterization of hepatic metastases compared with other modalities,the long examination time would limit the broad indication.Several abbreviated enhanced MRI(Ab-MRI)protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases.However,an optimal protocol has not been established,and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography(CE-CT),which is the preoperative imaging of colorectal cancer staging in clinical settings,to determine the best therapeutic strategy.AIM To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.METHODS Study participants comprised 87 patients(51 males,36 females;mean age,67.2±10.8 years)who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021.Each exam was independently reviewed by two readers in three reading sessions:(1)Only single-shot fast spin echo(FSE)T2-weighted or fat-suppressed-FSE-T2-weighted,diffusion-weighted,and hepatobiliary-phase images(Ab-MRI protocol 1 or 2);(2)all acquired MRI sequences(standard protocol);and(3)a combination of an Ab-MRI protocol(1 or 2)and CE-CT.Diagnostic performance was then statistically analyzed.RESULTS A total of 380 Lesions were analyzed,including 195 metastases(51.4%).Results from the two Ab-MRI protocols were similar.The sensitivity,specificity,and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI(P>0.05),while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone,although the difference was not significant(P>0.05),and were quite similar to those from standard MRI(P>0.05).CONCLUSION The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol.Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.
文摘Purpose: To evaluate posthepatectomy liver failure (PHLF) using gadoxetic acid-enhanced magnetic resonance imaging (MRI) with a measure of relative liver enhancement (RLE) on hepatobiliary phase images, thereby facilitating safe liver resection. Methods: Twenty patients in Child-Pugh class A underwent tumor excision surgery and indocyanine green (ICG) clearance of future remnant liver (FRL) (ICG-Krem) values were >0.05. PHLF was evaluated using the grading system of the International Study Group of Liver Surgery (ISGLS). The RLE value was defined as the signal gain percentage between the precontrast and hepatocellular images. In the whole liver and FRL, theRLE value measured the tumor-free liver parenchyma in RLE images. We examined the correlation between indocyanine green clearance (ICG-K) and MRI-based liver function in the whole liver. Preoperative PHLF evaluation was predicted using remnant hepatocellular uptake index (rHUI), remnant RLE (rRLE), coefficient variation of Rrle [Cv(rRLE)], and ICG-Krem corrected by heterogeneous liver function(HLF-ICG-Krem). Results: HLF-ICG-Krem and rRLE values correlated with INRs after postoperative day five (r = -0.55 and 0.46, p = 0.01 and 0.04, respectively). Furthermore, HLF-ICG-Krem values ≤0.05 detected two patients with higher INRs after postoperative day five. On the other hand, neither rHUI nor Cv(rRLE) was correlated with INRs after postoperative day five (r = 0.28, and -0.03, respectively;p >0.05 for both). HLF-ICG-Krem was significantly lower with PHLF than without PHLF (p = 0.005). Conclusion: HLF-ICG-Krem is useful for evaluating PHLF more correctly.
