Dysplastic Nodules In Cirrhotic Liver Research Articles

Diagnosis of liver tumors by multimodal ultrasound imaging.

To investigate the diagnostic value of multimodal ultrasound imaging composed of conventional ultrasonography (US), contrast-enhanced ultrasonography (CEUS), and shear wave elastography (SWE) for liver tumors.Between October 2017 and October 2019, US, CEUS, and SWE examinations of a total of 158 liver tumors in 136 patients at The First Affiliated Hospital of Nanchang University were performed. The histopathological or imaging diagnostic results were used as controls to evaluate the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US, CEUS, SWE, and multimodal ultrasound imaging, which combines these 3 modes, in the differential diagnosis of benign and malignant liver tumors.Among the 158 tumors, there were 64 benign tumors, including 55 cases of hepatic hemangioma, 3 cases of focal nodular hyperplasia of the liver, 4 cases of hepatic cyst, and 2 cases of focal nonuniform distribution of fat in the liver. There were 94 malignant tumors, including 32 cases of hepatocellular carcinoma, 22 cases of intrahepatic cholangiocellular carcinoma, 29 cases of metastatic liver cancer, and 11 cases of dysplastic nodules in cirrhotic liver. In the diagnosis of benign and malignant liver tumors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 82.56%, 68.06%, 75.96%, 75.53%, and 76.56% for US; 92.39%, 86.36%, 89.87%, 90.43%, and 89.06% for CEUS; 87.14%, 76.81%, 82.91%, 82.98%, and 82.81% for SWE; and 97.85%, 95.38%, 96.83%, 96.81%, and 96.88% for multimodal ultrasound imaging, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were all significantly higher for multimodal ultrasound imaging than those values for US, CEUS, and SWE (all P < .05). The areas under the receiver operating characteristic curve for US, CEUS, SWE, and multimodal ultrasound imaging in the diagnosis of benign and malignant liver tumors were 0.760, 0.897, 0.829, and 0.968, respectively.US, CEUS, and SWE all have diagnostic value in the diagnosis of benign and malignant liver tumors. Multimodal ultrasound imaging could significantly increase the accuracy of the diagnosis of benign and malignant liver tumors and has higher value for clinical application.

MRI in the differential diagnosis between well-differentiated hepatocellular carcinomas and high-grade dysplastic nodules in cirrhotic liver

ObjectiveTo assess the diagnostic efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between well-differentiated hepatocellular carcinomas (WD-HCCs) and high-grade dysplastic nodules (HGDNs) in cirrhotic liver. MethodsFrom January 2012 to April 2018, we retrospectively analyzed 91 cirrhotic nodules (HGDN, n = 31, WD-HCC, n = 60) which were confirmed by surgery or pathology. Each patient underwent gadobenate dimeglumine-enhanced hepatic MRI. The MRI characteristics and enhancement effects were calculated and analyzed. ResultsHyperintensity on diffusion-weighted imaging (DWI), the typical enhancement pattern and hypo-intensity on T1-Weighted imaging (T1WI)were showed with statistically significant difference between WD-HCCs and HGDNs in cirrhotic live (P = 0.002, 0.008, 0.002, respectively). And high signal intensity (SI) on DWI (sensitivity, 66.7%, specificity, 67.7%) was the most specific feature to differentiated WD-HCCs from HGDNs. The combination of DWI and the dynamic enhancement pattern improved the differentiation of WD-HCCs from HGDNs(specificity 83.9%). ConclusionDWI is the most specific technique to differentiate WD-HCCs from HGDNs. The combination of DWI and the typical dynamic enhancement pattern can improve the differentiation of WD-HCCs from HGDNs. Pre-enhanced T1WI, as well as a capsule, provides additional diagnostic values.

Differentiation of Small Hepatocellular Carcinoma From Dysplastic Nodules in Cirrhotic Liver: Texture Analysis Based on MRI Improved Performance in Comparison Over Gadoxetic Acid-Enhanced MR and Diffusion-Weighted Imaging.

Background: Accurate characterization of small (3 cm) hepatocellular carcinoma (sHCC) and dysplastic nodules (DNs) in cirrhotic liver is challenging. We aimed to investigate whether texture analysis (TA) based on T2-weighted images (T2WI) is superior to qualitative diagnosis using gadoxetic acid-enhanced MR imaging (Gd-EOB-MRI) and diffusion-weighted imaging (DWI) for distinguishing sHCC from DNs in cirrhosis.Materials and methods: Sixty-eight patients with 73 liver nodules (46 HCCs, 27 DNs) pathologically confirmed by operation were included. For imaging diagnosis, three sets of images were reviewed by two experienced radiologists in consensus: a Gd-EOB-MRI set, a DWI set, and a combined set (combination of Gd-EOB-MRI and DWI). For TA, 279 texture features resulting from T2WI were extracted for each lesion. The performance of each approach was evaluated by a receiver operating characteristic analysis. The area under the receiver operating characteristic curve (Az), sensitivity, specificity, and accuracy were determined.Results: The performance of TA (Az = 0.96) was significantly higher than that of imaging diagnosis using Gd-EOB-MRI set (Az = 0.86) or DWI set (Az = 0.80) alone in differentiation of sHCC from DNs (P = 0.008 and 0.025, respectively). The combination of Gd-EOB-MRI and DWI showed a greater sensitivity (95.6%) but reduced specificity (66.7%). The specificity of TA (92.6%) was significantly higher than that of the combined set (P < 0.001), but no significant difference was observed in sensitivity (97.8 vs. 95.6%, P = 0.559).Conclusion: TA-based T2WI showed a better classification performance than that of qualitative diagnosis using Gd-EOB-MRI and DW imaging in differentiation of sHCCs from DNs in cirrhotic liver. TA-based MRI may become a potential imaging biomarker for the early differentiation HCCs from DNs in cirrhosis.

Role of diffusion-weighted imaging, apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver.

To investigate the utility of diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and the correlation with hepatobiliary phase (delayed phase imaging, DPI) findings in the differentiation of cirrhotic hepatocellular nodules. Forty-three patients with 53 pathology-proven nodules (29 hepatocellular carcinomas (HCCs), 13 high-grade (HGDNs) and 11 low-grade dysplastic nodules (LGDNs); mean size 2.17 cm, range 1-4 cm), who underwent liver MRI with DWI and DPI sequences, were retrospectively reviewed. Lesions were classified as hypointense, isointense, or hyperintense relative to the adjacent liver parenchyma. ADC of each nodule, of the surrounding parenchyma, and lesion-to-liver ratio were calculated. Hyperintensity versus iso/hypointensity on DWI, hypointensity versus iso/hyperintensity on DPI, and the mean lesion-to-liver ratio showed a statistically significant difference both between HCCs versus DNs and between "HCCs + HGDNs" versus LGDNs (p < 0.05); sensitivity, specificity, and accuracy for the diagnosis of "HCCs + HGDNs" were 96.8 %, 100 %, 97.4 % respectively when combining hyperintensity on DWI and hypointensity on DPI, and 90.9 %, 81.0 %, 83.6 % respectively when lesion-to-liver ratio was <0.95. Hyperintensity on DWI, especially in association with hypointensity on DPI, and low lesion-to-liver ratios should raise the suspicion of HCC, or at least of HGDN, thus helping the characterization of atypically enhancing lesions. • Usefulness of DWI and ADC is shown in differential diagnosis of cirrhotic nodules. • Correlation of DWI with DPI improves differential diagnosis of cirrhotic nodules. • Characterization of atypically enhancing lesions becomes more confident.

Inverse expression of Jun activation domain binding protein 1 and cell cycle inhibitor p27 Kip1: influence on proliferation in hepatocellular carcinoma

Recently, the functional role of Jun activation domain binding protein 1 (Jab1) as a putative novel oncogene in hepatocellular carcinoma (HCC) has been postulated. We show that expression of p27(Kip1), a negative cell cycle regulator, correlates inversely with Jab1 expression in HCC (P = .014). We observed nuclear Jab1 expression in 57% (55/97) and p27(Kip1) expression in 32% (31/97) of HCCs. Neither Jab1 nor p27(Kip1) nor inverse Jab1 and p27(Kip1) expression correlated with clinicopathological parameters. However, HCCs lacking p27(Kip1) with increased proliferative activity were frequently found to express Jab1 (P = .048). Normal liver tissue, cirrhosis, and tumor-like lesions (focal nodular hyperplasia, dysplastic nodules in cirrhotic liver) showed no significant Jab1 expression. In transfection studies in the hepatoma cell line Huh 7, Jab1 overexpression resulted in reduced p27(Kip1) protein levels. We conclude that Jab1 expression may lead to down-regulation of the negative cell cycle regulator p27(Kip1), pointing to a possible mechanism that promotes hepatocarcinogenesis.

Sonography-Guided Percutaneous Microwave Ablation of High-Grade Dysplastic Nodules in Cirrhotic Liver

Our objective was to evaluate the effect of sonography-guided percutaneous microwave ablation of high-grade dysplastic nodules in the cirrhotic liver. From July 1997 to May 2003, 49 histologically proven high-grade dysplastic nodules in 30 patients with liver cirrhosis were treated by microwave ablation. Three patients had concomitant small hepatocellular carcinomas (D < 3.0 cm), whereas another three had undergone liver segmentectomy for hepatocellular carcinoma 1 year earlier. The mean size of the nodules was 1.8 cm (range, 0.9-4.6 cm). Sixty-eight insertions with 78 applications were administered to the 49 nodules. The follow-up period was 12-82 months (mean, 45.1 +/- 19.0 months). Five patients died during this study: three from advanced hepatocellular carcinoma, one from bleeding in the upper gastrointestinal tract, and another from cerebral hemorrhage. All nodules showed decreased density on unenhanced CT and no enhancement on contrast-enhanced CT after microwave ablation. Posttreatment biopsy performed in 16 patients with 18 nodules 1-3 months after microwave ablation showed no evidence of viable tissue but replacement by fibrotic tissue in all nodules. Percutaneous microwave ablation as a minimally invasive therapy is effective for ablating high-grade dysplastic nodules, thus preventing their potential malignant transformation, which may improve survival. The preliminary data warrant further prospective, randomized studies.

Classification tool for the systematic histological assessment of hepatocellular carcinoma, macroregenerative nodules, and dysplastic nodules in cirrhotic liver

To design a classification tool for the histological assessment of hepatocellular carcinoma (HCC), dysplastic nodules (DN), and macroregenerative nodules (MRN) in cirrhotic liver. Two hundred and twelve hepatocellular nodules (106 HCC; 74 MRN; 32 DN) were assessed systematically, quantitatively, and semiquantitatively as appropriate for 10 histological features that have been described as helpful in distinguishing small HCC, DN, and MRN in cirrhotic livers. The data were analyzed by multiple correspondence analysis (MCA). MCA distributed HCC, DN, and MRN as defined by traditional histological evaluation as well as the individual histological variables, in a "malignancy scale". Based on the MCA data representation, we created a classification tool, which categorizes an individual nodular lesion as MRN, DN, or HCC based on the balance of all histological features (i.e., vascular invasion, capsular invasion, tumor necrosis, tumor heterogeneity, reticulin loss, capillarization of sinusoids, trabecular thickness, nuclear atypia, and mitotic activity). The classification tool classified most (83%) of a validation set of 47 nodules in the same way as the routine histological assessment. No discrepancies were present for DN and MRN between the routine histological assignment and the classification tool. Of 25 HCC assigned by routine assessment in the validation set, 8 were assigned to the DN category by the classification tool. We have designed a classification tool for the histological assessment of HCC and its putative precursors in cirrhotic liver. Application of this tool systematically records histological features of diagnostic importance in the evaluation of small HCC.

MRI features of regenerative and dysplastic nodules in cirrhotic liver

MRI features of regenerative and dysplastic nodules in cirrhotic liver

Correlation Between the Echogenicity of Dysplastic Nodules and Their Histopathologically Determined Fat Content

To correlate the echogenicity of dysplastic nodules in cirrhotic liver with the difference in fat content between lesions and surrounding liver. This retrospective study involved 65 histopathologically proved dysplastic nodules (39 high grade and 26 low grade). Their echogenicity compared with that of surrounding parenchyma was determined sonographically, and differences in the proportions of fat globules contained in the nodules and in surrounding liver tissue were evaluated histopathologically. The sonographic and histopathologic findings were correlated. Among the 65 dysplastic nodules, echogenicity was high in 30 (46%), equal in 5 (8%), and low in 30 (46%). In all cases, there was significant correlation between echogenicity on sonographic imaging and the difference in fat content between nodules and surrounding liver tissue (P < .01). There was, however, no significant correlation between the degree of dysplasia and sonographic echogenicity (P > .05). The echogenicity of dysplastic nodules correlated with their fat content. Echogenicity did not, however, predict whether the grade of a nodule was high or low.