Absence Of Pseudocapsule Research Articles

Prediction of microvascular invasion in hepatocellular carcinoma patients with MRI radiomics based on susceptibility weighted imaging and T2-weighted imaging.

The accurate identification of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) is of great clinical importance. To develop a radiomics nomogram based on susceptibility-weighted imaging (SWI) and T2-weighted imaging (T2WI) for predicting MVI in early-stage (Barcelona Clinic Liver Cancer stages 0 and A) HCC patients. A prospective cohort of 189 participants with HCC was included for model training and testing, and an additional 34 participants were enrolled for external validation. ITK-SNAP was used to manually segment the tumour, and PyRadiomics was used to extract radiomic features from the SWI and T2W images. Variance filtering, student's t test, least absolute shrinkage and selection operator regression and random forest (RF) were applied to select meaningful features. Four machine learning classifiers, including K-nearest neighbour, RF, logistic regression and support vector machine-based models, were established. Independent clinical and radiological risk factors were also determined to establish a clinical model. The best radiomics and clinical models were further evaluated in the validation set. In addition, a nomogram was constructed from the radiomic model and independent clinical factors. Diagnostic efficacy was evaluated by receiver operating characteristic curve analysis with fivefold cross-validation. AFP levels greater than 400ng/mL [odds ratio (OR) 2.50; 95% confidence interval (CI) 1.239-5.047], tumour diameter greater than 5cm (OR 2.39; 95% CI 1.178-4.839), and absence of pseudocapsule (OR 2.053; 95% CI 1.007-4.202) were found to be independent risk factors for MVI. The areas under the curve (AUCs) of the best radiomic model were 1.000 and 0.882 in the training and testing cohorts, respectively, while those of the clinical model were 0.688 and 0.6691. In the validation set, the radiomic model achieved better diagnostic performance (AUC = 0.888) than the clinical model (AUC = 0.602). The combination of clinical factors and the radiomic model yielded a nomogram with the best diagnostic performance (AUC = 0.948). SWI and T2WI-derived radiomic features are valuable for noninvasively and accurately identifying MVI in early-stage HCC. Furthermore, the integration of radiomics and clinical factors yielded a predictive nomogram with satisfactory diagnostic performance and potential clinical benefits.

High-frame-rate contrast-enhanced ultrasound to differentiate between clear cell renal cell carcinoma and angiomyolipoma

BackgroundTo investigate the diagnostic efficacy of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in differentiating between clear cell renal cell carcinoma (CCRCC) and angiomyolipoma (AML).MethodsA retrospective study was performed on the clinical data of 79 patients diagnosed with CCRCC and 31 patients diagnosed with AML at the First Affiliated Hospital of Nanchang University between October 2022 and December 2023. Conventional ultrasound (US) and H-CEUS examinations were conducted on all patients prior to surgery, dynamic images were recorded from the US, and the qualitative and quantitative parameters of H-CEUS were collected. The t-test, χ² test and non-parametric Mann-Whitney test were employed to assess differences in clinical data, US characteristics, and qualitative and quantitative parameters of H-CEUS between the CCRCC and AML groups. The independent risk factors of CCRCC were identified using binary logistic regression. The receiver operator characteristic (ROC) curve was constructed to evaluate the diagnostic effectiveness of clinical + US and H-CEUS in differentiating between CCRCC and AML.ResultsThe CCRCC group and the AML group exhibited significant differences in patient gender, operation mode, nodular echo, and nodule blood flow (χ²=11.698, -, -,=10.582; P<0.001, <0.001, <0.001, and = 0.014, respectively). In addition, the H-CEUS qualitative analysis demonstrated significant differences between the AML group and the CCRCC group with respect to enhancement mode, regression mode, peak intensity, enhancement uniformity, no enhancement, and presence or absence of pseudocapsule (χ²=41.614, -, -, = 2.758, = 42.099, -; P<0.001, <0.001, <0.001, 0.097, <0.001, and <0.001, respectively). The Arrival time (AT) in the CCRCC group was significantly shorter than that in the AML group, as determined by quantitative analysis of H-CEUS (Z=-3.266, P = 0.001). Furthermore, the Peak intensity (PI), Ascent slope (AS), and The area under the curve (AUC) exhibited significantly higher values in the CCRCC group compared to the AML group (Z=-2.043,=-2.545,=-3.565; P = 0.041, = 0.011, and <0.001, respectively). Logistic regression analysis indicated that only gender, nodule echo, the pseudocapsule, AS, and AUC of H-CEUS were independent risk factors of CCRCC. The ROC curve revealed that combining gender and nodule echo yielded a sensitivity of 92.4%, specificity of 64.5%, and an AUC of 0.847 in distinguishing between CCRCC and AML. When combining the H-CEUS parameters of pseudocapsule, AS, and AUC, the sensitivity, specificity, and AUC for distinguishing between CCRCC and AML were 84.8%, 96.8%, and 0.918, respectively. No statistically significant difference was observed in the diagnostic effectiveness of the two methods (Z=-1.286, P = 0.198). However, H-CEUS demonstrated better AUC and specificity.ConclusionsH-CEUS enhances the sensitivity and specificity of differentiating between CCRCC and AML by improving the temporal resolution, offering a more precise diagnostic foundation for identifying the most appropriate therapy for patients.

Histopathological factors versus margin size in single colorectal liver metastases: Does a 1-cm margin size matter?

The ideal margin width for surgical resection of colorectal liver metastases has been extensively studied, but not sufficiently in accordance with other pathological factors. The aim of this study was to assess for the first time the prognostic impact of margin widths according to different prognostic pathological factors in colorectal liver metastasis. We evaluated 101 patients with a single resected metastasis. Slides stained by HE were assessed for the presence of poorly differentiated clusters, peritumoral inflammatory infiltrate, tumor pseudocapsule, and tumor borders pattern. Overall survival, disease-free survival, and hepatic recurrence were evaluated. The pathologic factors prognostic impact was evaluated according to a (< or ⩾) 10-mm margin size. Factors independently associated with a shorter overall survival were absence of tumor pseudocapsule (p < 0.001) and infiltrative tumor border pattern (p = 0.019). The absence of tumor pseudocapsule was the only factor independently associated with shorter disease-free survival (p < 0.001). Hepatic recurrence was associated with infiltrative tumor border and absence of pseudocapsule. Margin width ⩾10 mm did not impact overall survival independently of the studied histological prognostic factors. In colorectal liver metastasis resection, the absence of tumor pseudocapsule was significantly associated with shorter overall survival and disease-free survival and hepatic recurrence. However, margins larger than 10 mm did not offer survival benefit when other pathologic negative prognostic factors were concomitantly analyzed, reinforcing the idea that biology, rather than margin size, is crucial for prognosis.

Histopathological prognostic factors for colorectal liver metastases: A systematic review and meta-analysis of observational studies.

Resection is the mainstay of treatment for colorectal liver metastases (CRLMs). Many different histopathological factors related to the primary colorectal tumour have been well studied; however, histopathological prognostic factors related to CRLMs are still under evaluation. To identify histopathological factors related to overall survival (OS) and disease-free survival (DFS) in patients with resected CRLMs. A systematic review was performed with the following databases up to August 2020: PubMed, EMBASE, Web of Science, SciELO, and LILACS. The GRADE approach was used to rate the overall certainty of evidence by outcome. Thirty-three studies including 4,641 patients were eligible. We found very low certainty evidence that the following histopathological prognostic factors are associated with a statistically significant decrease in OS: presence of portal vein invasion (HR, 0,50 [95% CI, 0,37 to 0,68]; I²=0%), presence of perineural invasion (HR, 0,55 [95% CI, 0,36 to 0,83]; I²=0%), absence of pseudocapsule (HR, 0,41 [CI 95%, 0,29 to 0,57], p<0,00001; I²=0%), presence of satellite nodules (OR, 0,45 [95% CI, 0,26 to 0,80]; I²=0%), and the absence of peritumoural inflammatory infiltrate (OR, 0,20 [95% CI, 0,08 to 0,54]; I²=0%). Outcome data on DFS were scarce, except for tumour borders, which did not present a significant impact, precluding the meta-analysis. Of the histopathological prognostic factors studied, low- to moderate-certainty evidence shows that vascular invasion, perineural invasion, absence of pseudocapsule, presence of satellite nodules, and absence of peritumoral inflammatory infiltrate are associated with shorter overall survival in CRLMs.

Myofibroma/myofibromatosis: MDCT and MR imaging findings in 24 patients with radiological-pathological correlation

BackgroundThe aim of this study was to characterize the radiological features of myofibroma on multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) and correlate the imaging findings with pathologic features.MethodsThe radiological findings of 24 patients with 29 myofibromas were retrospectively reviewed. All images were evaluated with emphasis on density, signal intensity, hypointense area, and enhancement, correlating these with pathologic findings.ResultsOn plain MDCT scan, 4(26.7%) tumors were homogeneous isodensity, 4(26.7%) tumors were heterogeneous hyperdensity, and 7(46.7%) tumors were heterogeneous hypodensity. On contrast-enhanced MDCT scan, all tumors (9/9) showed heterogeneous enhancement with moderate in 3(33.3%) and marked in 6(66.7%) tumors, and their enhancements were higher compared to adjacent skeletal muscle (P = 0.0001). On MRI, heterogeneous slight hyperintensity, homogeneous slight hyperintensity, and heterogeneous hypointensity on T1-weighted imaging (T1WI) were observed in 14(82.3%), 1(5.9%) and 2(11.8%) tumors, respectively. On T2-weighted imaging (T2WI) and fat-suppressed (FS) T2WI, all tumors demonstrated heterogeneous hyperintensity. All tumors showed heterogeneous marked enhancement on FS contrast-enhanced T1WI. On T1WI, T2WI, FS T2WI, and FS contrast-enhanced T1WI, irregular strip or/and patchy hypointensities were found in 16(94.1%), 12(100%), 17(100%) and 17(100%) tumors, respectively, and pseudocapsule was seen in 5(29.4%) tumors. The hypointensities and pseudocapsule on MRI were exactly corresponding to pathological interlacing collagen fibers and fibrosis. The age of the recurrent group was lower than that of the non-recurrent group (P = 0.001) and the tumors without pseudocapsule were more likely to recur than those with pseudocapsule (P = 0.034).ConclusionMyofibromas are characterized by heterogeneous density or signal intensity, with moderate or marked enhancement. The hypointensities and pseudocapsule on MRI may be helpful in diagnosis, and the absence of pseudocapsule and younger age may be risk factors for tumor recurrence.

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors.

To evaluate accuracy of MRI in detecting renal tumor pseudocapsule (PC) invasion and to propose a classification based on imaging of PC status in patients with renal cell carcinoma. From January 2017 to June 2018, 58 consecutive patients with localized renal cell carcinoma were prospectively enrolled. MRI was performed preoperatively and PC was classified, according to its features, as follows: MRI-Cap 0 (absence of PC), MRI-Cap 1 (presence of a clearly identifiable PC), MRI-Cap 2 (focally interrupted PC), and MRI-Cap 3 (clearly interrupted and infiltrated PC). A 3D image reconstruction showing MRI-Cap score was provided to both surgeon and pathologist to obtain complete preoperative evaluation and to compare imaging and pathology reports. All patients underwent laparoscopic partial nephrectomy. In surgical specimens, PC was classified according to the renal tumor capsule invasion scoring system (i-Cap). A concordance between MRI-Cap and i-Cap was found in 50/58 (86%) cases. ρ coefficient for each MRI-cap and iCap categories was: MRI-Cap 0: 0.89 (p < 0.0001), MRI-Cap1: 0.75 (p < 0.0001), MRI-Cap 2: 0.76 (p < 0.0001), and MRI-Cap3: 0.87 (p < 0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and AUC were: MRI-Cap 0: Se 97.87% Spec 83.3%, PPV 95.8%, NPV 90.9%, and AUC 90.9; MRI-Cap 1: Se 77% Spec 95.5%, PPV 83.3%, NPV 93.5%, and AUC 0.86; MRI-Cap 2- iCap 2: Se 88% Spec 90%, PPV 79%, NPV 95%, and AUC 0.89; MRI-Cap 3: Se 94% Spec 95%, PPV 88%, NPV 97%, and AUC 0.94. MRI-Cap classification is accurate in evaluating renal tumor PC features. PC features can provide an imaging-guided landmark to figure out where a minimal margin could be preferable during nephron-sparing surgery.

Does histoid leprosy represent a locally hyperimmune variant of lepromatous leprosy?

Histoid leprosy is a subtype of leprosy with distinct clinical presentation and histologic features. It accounts for <4% of leprosy cases. The exact location of histoid leprosy along the immune spectrum and its relation to other subtypes is unclear. To evaluate the local immune phenomenon which define histoid leprosy. Parallel skin biopsies from histoid lesions and from unremarkable skin in patients with histoid leprosy were evaluated and the histologic findings compared. Formalin fixed, paraffin embedded tissue sections from lesional and non-lesional biopsies were assessed for changes in epidermis and dermis; type and extent of infiltrate, presence or absence of pseudocapsule and associated reactions. Bacillary index was evaluated using Wade Fite stain for lepra bacilli. Amongst 208 leprosy cases, six cases of histoid leprosy were identified (2.88%). The cases showed presence of nodules, patches and plaques overlying clinically unremarkable skin. Fourteen skin biopsies were evaluated of which the lesional biopsies showed equal proportion of fusocellular, fusocellular epithelioid and fusocellular-vacuolated histology. A greater circumscription was noted in lesional biopsies; however the cellular content of the infiltrate was similar in lesional and non-lesional biopsies. A case of erythema nodosum leprosum in histoid leprosy was also seen. Ours is the first study comparing normal and lesional skin in histoid leprosy. Though the histoid lesions appear to have a derivation from lepromatous leprosy, the local histologic and clinical alterations may be a result of heightened local immunity or reactive local modifying factors.

Stepwise algorithm using computed tomography and magnetic resonance imaging for diagnosis of fat-poor angiomyolipoma in small renal masses: Development and external validation.

To develop a stepwise diagnostic algorithm for fat-poor angiomyolipoma in small renal masses. Two cohorts of small renal masses <4cm without an apparent fat component that was pathologically diagnosed were included: 153 cases (18 fat-poor angiomyolipomas/135 renal cell carcinomas) for model development and 71 cases (seven fat-poor angiomyolipomas/59 renal cell carcinomas/5 oncocytomas) for validation. Dynamic contrast-enhanced computed tomography, magnetic resonance imaging and clinical findings were analyzed. Based on multivariate analysis, we developed two prediction models for fat-poor angiomyolipoma, the computed tomography model and the computed tomography+magnetic resonance imaging model, and a stepwise algorithm that proposes the sequential use of computed tomography and magnetic resonance imaging. The computed tomography model, which was composed of female aged <50years, high attenuation on unenhanced computed tomography, less enhancement than the normal renal cortex and homogeneity in the corticomedullary phase, differentiated tumors with none of the factors as the low angiomyolipoma-probability group, and the others were candidates for the computed tomography+magnetic resonance imaging model. The computed tomography+magnetic resonance imaging model, consisting of the first three factors of the computed tomography model, low signal intensity and absence of pseudocapsule on T2-weighted magnetic resonance imaging, re-stratified the tumors into low, intermediate and high angiomyolipoma-probability groups. The incidence of fat-poor angiomyolipoma in each group was 0%, 26% and 93%, respectively (area under the curve 0.981). External validation by two readers showed a high area under the curve (0.912 and 0.924) for each. The interobserver agreement was good (kappa score 0.77). The present algorithm differentiates fat-poor angiomyolipoma in small renal masses with high accuracy by adding magnetic resonance imaging to computed tomography in selected patients.

PD14-06 DEVELOPMENT AND VALIDATION OF A NOVEL STEPWISE ALGORITHM USING CT AND MRI FOR DIAGNOSIS OF FAT-POOR ANGIOMYOLIPOMA IN SMALL RENAL MASSES

You have accessJournal of UrologyImaging/Radiology: Uroradiology IV1 Apr 2016PD14-06 DEVELOPMENT AND VALIDATION OF A NOVEL STEPWISE ALGORITHM USING CT AND MRI FOR DIAGNOSIS OF FAT-POOR ANGIOMYOLIPOMA IN SMALL RENAL MASSES Hajime Tanaka, Yasuhisa Fujii, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Sho Uehara, Takeshi Yuasa, Shinya Yamamoto, Hitoshi Masuda, Junji Yonese, and Kazunori Kihara Hajime TanakaHajime Tanaka More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Sho UeharaSho Uehara More articles by this author , Takeshi YuasaTakeshi Yuasa More articles by this author , Shinya YamamotoShinya Yamamoto More articles by this author , Hitoshi MasudaHitoshi Masuda More articles by this author , Junji YoneseJunji Yonese More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1003AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fat-poor angiomyolipoma (fp-AML) accounts for a large percentage of small renal masses (SRMs) which are radiologically misdiagnosed as renal cell carcinomas (RCCs) particularly in Asian patients. This study aims to propose a practical diagnostic algorithm for fp-AML with sequential use of CT and MRI. METHODS This study included 153 solid renal tumors <4 cm without an apparent fat component on unenhanced CT. Tumors were surgically removed or biopsied after dynamic contrast-enhanced CT and MRI, and pathologically, 18, 135 and 0 tumors were fp-AMLs, RCCs and oncocytoma, respectively. First, based on the CT and clinical findings, a prediction model for fp-AML was developed using multivariate analysis (CT model). With additional MRI findings, another prediction model for fp-AML was developed (CT+MRI model). The diagnostic algorithm for fp-AML with sequential use of the two models was constructed, and was externally validated using another cohort of 65 SRMs, which included 7 fp-AMLs and 5 oncocytomas. RESULTS In the CT model, independent predictors of fp-AML included female <50 years old, high attenuation on unenhanced CT, less enhancement than normal renal cortex on corticomedullary phase (CMP) of CT and homogeneity on CMP. The CT model differentiated 102 tumors, which met none of the factors, as a low AML-probability group, while the other 51 tumors were candidates for the CT+MRI model. In the CT+MRI model, the first 3 factors of the CT model, low signal intensity on T2W-MRI and absence of pseudocapsule on T2W-MRI were independent predictors. ′Female <50 years old′ was scored as 2 points and the other 4 factors were scored as 1 point each. The CT+MRI model then stratified the 51 tumors into low (total score 0-1), intermediate (2-3) and high (4-6) AML-probability groups. After the two-step stratification, the probabilities of AML were 0% (0/121 tumors), 28% (5/18) and 93% (13/14) in the low, intermediate and high AML-probability groups, respectively (AUC=0.98). In the validation cohort, the probabilities were 0% (0/43 tumors), 22% (4/18) and 75% (3/4), respectively (AUC=0.92). CONCLUSIONS Our stepwise algorithm differentiated fp-AML from RCC with high accuracy. This may be cost-effective and provide an accurate preoperative diagnosis of SRMs by adding MRI to CT in selected patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e305 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hajime Tanaka More articles by this author Yasuhisa Fujii More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Noboru Numao More articles by this author Kazutaka Saito More articles by this author Sho Uehara More articles by this author Takeshi Yuasa More articles by this author Shinya Yamamoto More articles by this author Hitoshi Masuda More articles by this author Junji Yonese More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP11-12 DEVELOPMENT AND VALIDATION OF A NOVEL PREDICTION MODEL FOR FAT-POOR ANGIOMYOLIPOMA IN SMALL RENAL MASSES BASED ON RADIOLOGICAL AND CLINICAL FEATURES

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2015MP11-12 DEVELOPMENT AND VALIDATION OF A NOVEL PREDICTION MODEL FOR FAT-POOR ANGIOMYOLIPOMA IN SMALL RENAL MASSES BASED ON RADIOLOGICAL AND CLINICAL FEATURES Hajime Tanaka, Yasuhisa Fujii, Masaya Ito, Manabu Tatokoro, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Kazutaka Saito, Junji Yonese, and Kazunori Kihara Hajime TanakaHajime Tanaka More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Masaya ItoMasaya Ito More articles by this author , Manabu TatokoroManabu Tatokoro More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Junji YoneseJunji Yonese More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies have shown that about 20% of small renal masses (SRMs) with presumed renal cell carcinomas (RCCs) are pathologically benign. In Asian patients, fat-poor angiomyolipoma (fp-AML) accounts for most of the benign lesions, because of the low incidence of oncocytoma. Renal mass biopsy (RMB) is being used increasingly, but considerable complications have been reported. The aim of this study is to develop a practical prediction model of fp-AML based on radiological and clinical features for appropriate SRM management. METHODS This retrospective study included patients with 153 solid renal tumors <4 cm, without an apparent fat component as assessed using unenhanced CT, and which were surgically removed (N=148) or biopsied (N=5) after dynamic contrast-enhanced CT (DCE-CT) and MRI. Pathologically, 18, 135 and 0 tumors were fp-AMLs, RCCs (111 clear cell RCCs and 24 others), and oncocytomas, respectively. Preoperative CT/MRI findings were reviewed, and the radiological and clinical features were statistically analyzed using multivariate analysis to determine independent predictors of fp-AML. A scoring model for prediction of fp-AML was developed and was validated using another cohort of 61 SRMs, which included 7 fp-AMLs. RESULTS Independent predictors of fp-AML were female <50 years old, high attenuation on unenhanced CT, less enhancement than normal renal cortex on corticomedullary phase of DCE-CT, low signal intensity on T2W-MRI, and absence of pseudocapsule on T2W-MRI (p=0.001, 0.037, 0.027, 0.009, and 0.009, respectively). “Female <50 years old” was scored as 2 points and the other 4 factors were scored as 1 point each (Fig. 1). The original cohort was stratified into high (total score 4–6), intermediate (2–3), and low (0–1) AML-probability groups, and the incidence of AML was 93% (13/14 tumors), 25% (5/20 tumors), and 0% (0/119 tumors), respectively (AUC=0.98). In the validation cohort, it was 75% (3/4 tumors), 24% (4/17 tumors), and 0% (0/40 tumors), respectively (AUC=0.92). CONCLUSIONS Our novel prediction model differentiated fp-AML from RCC with high accuracy. Patients in the low, intermediate, and high AML-probability groups could be considered to be good candidates for immediate operation, RMB, and initial surveillance, respectively. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e123-e124 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hajime Tanaka More articles by this author Yasuhisa Fujii More articles by this author Masaya Ito More articles by this author Manabu Tatokoro More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Noboru Numao More articles by this author Kazutaka Saito More articles by this author Junji Yonese More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Radiological prognosticators of hepatocellular carcinoma treated by hepatectomy

Hepatectomy is the main curative treatment for hepatocellular carcinoma (HCC), but postoperative long-term survival is poor. Preoperative radiological features of HCC displayed by computed tomography or magnetic resonance imaging could serve as additional prognostic factors. This study aimed to identify preoperative radiological features of HCC that may be of prognostic significance in hepatectomy. Ninety-two patients who underwent hepatectomy for HCC were included in this study. Preoperative radiological features including tumor number, size, location (peripheral, middle, central), portal vein invasion, hepatic vein invasion, and presence of pseudo-capsule were analyzed in relation to survival. With a median follow-up period of 41.7 months, the 1-, 3- and 5-year overall survival rates were 85%, 65% and 58%, respectively. Univariate analysis showed that portal vein invasion and absence of pseudo-capsule were significant prognostic factors for overall survival, while all the examined radiological features were prognostic factors for disease-free survival. Multivariate analysis for overall survival found no significant factor. On multivariate analysis for disease-free survival, patients who had tumors with portal vein invasion had poorer survival with a hazard ratio of 2.26 (95% CI, 1.05-4.91; P=0.038) and patients with single nodular HCC or pseudo-capsulated HCC had better survival with a hazard ratio of 0.50 (95% CI, 0.27-0.94; P=0.032) and 0.38 (95% CI, 0.14-0.99; P=0.048), respectively. Demonstrable pseudo-capsule of HCC and solitary HCC on imaging and absence of portal vein invasion are features associated with better disease-free survival after hepatectomy. These features may guide treatment planning for HCC.

Dual-Phase Computed Tomographic Angiography of Focal Nodular Hyperplasia

To test the clinical observation that the postcontrast attenuation level of focal nodular hyperplasia (FNH) at dual-phase computed tomography (CT) rarely exceeds 50% of aortic enhancement or absolute inferior vena cava (IVC) enhancement. Nineteen pathologically proven FNHs in 17 female patients imaged with intravenous contrast-enhanced multidetector CT, of which 15 had arterial and venous phase acquisitions, were evaluated. Two radiologists retrospectively reviewed each CT study in consensus, using axial sections, multiplanar reconstructions, and 3-dimensional rendering techniques (volume rendering and maximum intensity projection). Recorded were precontrast and postcontrast attenuation of mass, the liver, the aorta, and the IVC; lesion size; segmental location; subjective appearance; contour; and presence of central scar, pseudocapsule, septations, feeding artery, or draining vein. The mean FNH attenuation level was lower than 50% of the mean aortic attenuation during the arterial phase (115 vs 144 Hounsfield units) and also lower than the mean IVC attenuation in the portal venous phase (142 vs 153 Hounsfield units). Across cases, the FNH arterial phase attenuation was lower than 50% of the aortic attenuation in 74% (14/19). The portal venous attenuation level of FNH was lower than or equal to that of the IVC in 80% (12/15). One of the 2 enhancement patterns was present in 100% (15/15) of cases. Other common findings included feeding artery and draining vein (18/19), absence of pseudocapsule (18/19), and smooth contour (13/19). A central scar was identified in only 8 of 19 cases, and no lesion contained septations. In this series of patients imaged with contrast-enhanced multidetector CT, most FNHs demonstrated arterial attenuation levels lower than 50% of the aorta and/or portal venous attenuation levels lower than or equal to those of the IVC.

Factors influencing survival of patients undergoing hepatectomy for colorectal metastases.

The extent of surgical margin is still a matter of controversy with regard to outcome after liver resection for metastatic disease. The aim of this study was to clarify the significant prognostic factors after hepatectomy for colorectal metastases, with special reference to the surgical margin. Ninety-six patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1992 and 1994 were studied. Overall 1-, 3- and 5-year survival rates were 94, 61 and 51 per cent respectively. All of the independent factors associated with poor prognosis after hepatic resection were tumour-related factors, such as the number of tumours (four or more), presence of portal vein invasion, hepatic vein invasion and absence of a fibrous pseudocapsule. A positive resection margin was not an independent prognostic factor, because of its strong relationship with the number of tumours resected. A generous surgical margin is not essential for curative hepatic resection, although positive surgical margins should be avoided. New potential risk factors which affect survival, such as the presence of portal vein or hepatic vein invasion and the absence of a pseudocapsule, may be helpful for defining the indications for postoperative adjuvant treatment.

Clinical evaluations of tumor enucleation for incidental renal cell carcinoma

We performed tumor enucleation in 21 patients of renal tumors from Jan. 1980 to Feb. 1993. Of them 19 had renal cell carcinoma. We reviewed the results of clinical experiences. Preoperatively, all patient underwent ultrasound, computerized tomography (CT) and angiography, and evaluated tumor characteristics in terms of its localization, size and pre or absence of pseudocapsule. All cases were shown to be well encapsulated. Of them 17 were asymptomatic and detected incidentally, whereas remaining one case was bilateral renal cell carcinoma clinically characterized by gross hematuria. This case was treated by radical nephrectomy on the right side and enucleation of the tumor on the left side. All cases had localized renal cell carcinoma (stage 1) of low grade (15 cases of grade 1 and 3 of grade 2), and the diameter of the tumor averaged 3.4 cm. Of 18 cases 2 died, one died of causes unrelated to RCC and the other of the metastasis of bilateral RCC after nephrectomy. The 16 cases are presently free of disease for maximal follow up period of 92 months. We consider that tumor enucleation will be indicated for tumors found incidentally, surrounded by pseudocapsule, of small size (less than 3.0 cm in diameter), and of low grade and low stage, and that tumor enucleation for renal cell carcinoma could be curative yet preserve renal function in selected patients.