Enhancement In Arterial Phase Research Articles

Using arterial phase hyperenhancement on CT instead of gadoxetic acid arterial phase enhancement may improve the diagnostic performance for hepatocellular carcinoma

The diagnostic performance for hepatocellular carcinoma (HCC) is hampered using gadoxetic acid-enhanced magnetic resonance (MR) imaging due to the high incidence of transient severe motion in arterial phase (AP). Dynamic contrast enhanced computed tomography (CT) imaging yield high detection rate for hepatic nodules in AP, and the combined use of CT arterial phase (CTAP) imaging with gadoxetic acid-enhanced MR imaging may improve the diagnostic performance for HCC. Thus, this study aimed to determine whether the combined use of CTAP and gadoxetic acid-enhanced MR imaging can improve the diagnostic performance for HCC based on various imaging diagnostic criteria. A total of 169 surgically histologically confirmed hepatic nodules (137 HCCs and 32 non-HCC-nodules) were retrospectively enrolled. Two different imaging protocol sets were reviewed: (I) full gadoxetic acid-enhanced magnetic resonance imaging (MRI) sequences; and (II) CTAP imaging combined with the gadoxetic acid-enhanced MRI but excluding the MR imaging AP images. Three independent reviewers followed the 2018 Liver Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), and 2018 Korean guidelines to characterize these heaptic nodules by reviewing the two imaging protocol sets and the diagnostic peformance were compared by using McNemar test. The detection rate of AP hyperenhancement (APHE) was higher in CTAP than in the MR arterial phase (MRAP) for hepatic nodules (87.57% vs. 75.15%) and HCCs (97.08% vs. 82.48%) (all P<0.001). For the LI-RADS criteria, the Protocol-II increased the sensitivity to 75.91% from 70.80% of Protocol-I (P=0.016), with a minimal decrease of the specificity to 71.88% from 75.00% (P=1.000). For the EASL criteria, the numerical increases were found of Protocol-II than Protocol-I in both sensitivity (81.02% vs. 78.10%) and specificity (75.00% vs.71.88%), but with no statistical significance. For the Korean criteria, the Protocol-II increased the sensitivity to 94.89% from 83.21% of Protocol-I (P<0.001). The specificity increased to 65.63% from 62.50%, with no statistical significance (P=1.000). Using CTAP instead of gadoxetic acid-enhanced MRAP can improve the diagnostic sensitivity for HCC and also yields a comparable specificity. Thus, the combined use of CTAP and gadoxetic acid-enhanced MR imaging may improve the diagnostic performance for HCC.

Outcomes and Imaging Analysis in Hepatocellular Carcinoma Treated With Stereotactic Body Radiation Therapy

PurposeAlthough arterial phase enhancement is commonly used to evaluate treatment response for hepatocellular carcinoma, it may not accurately describe response for lesions treated with stereotactic body radiation therapy (SBRT). We aimed to describe the post-SBRT imaging findings to better inform the optimal timing of salvage therapy after SBRT. Methods and MaterialsWe retrospectively reviewed patients with hepatocellular carcinoma treated with SBRT from 2006 to 2021 at a single institution with available imaging showing lesions with characteristic arterial enhancement and portal venous washout. Patients were then stratified into 3 groups based on treatment: (1) concurrent SBRT and transarterial chemoembolization, (2) SBRT only, and (3) SBRT followed by early salvage therapy due to persistent enhancement. Overall survival was analyzed with the Kaplan-Meier method, and cumulative incidences were calculated with competing risk analysis. ResultsWe included 82 lesions in 73 patients. The median follow-up time was 22.3 months (range, 2.2-88.1 months). The median time to overall survival was 43.7 months (95% confidence interval, 28.1-57.6 months) and median progression-free survival was 10.5 months (95% confidence interval, 7.2-14.0 months). There were 10 (12.2%) lesions that experienced local progression and there was no difference in rates of local progression between the 3 groups (P = .32). In the SBRT-only group, the median time to resolution of arterial enhancement and washout was 5.3 months (range, 1.6-23.7 months). At 3, 6, 9, and 12 months, 82%, 41%, 13%, and 8% of lesions, respectively, continued to show arterial hyperenhancement. ConclusionsTumors treated with SBRT may continue to exhibit persistence of arterial hyperenhancement. Without an increase in size of enhancement, continued surveillance may be appropriate for these patients.

Outcomes and Imaging Analysis in Hepatocellular Carcinoma Treated with Stereotactic Body Radiation Therapy

<h3>Purpose/Objective(s)</h3> Although arterial phase enhancement is commonly used to evaluate treatment response for hepatocellular carcinoma (HCC), it may not accurately describe response for lesions treated with stereotactic body radiation therapy (SBRT). We aimed to describe the post-SBRT imaging findings to better understand the kinetics of radiographic resolution of HCC and to better inform the optimal timing of salvage therapy after SBRT. <h3>Materials/Methods</h3> We retrospectively reviewed the records of patients with HCC treated with SBRT from 2006 to 2021 at a single institution with available triphasic imaging. We included lesions with characteristic arterial enhancement and portal venous and delayed venous phase washout on initial staging scans. Patients were then stratified into three groups based on treatment: 1) concurrent SBRT and TACE, 2) SBRT only, and 3) SBRT followed by early salvage therapy due to persistent enhancement. Overall survival (OS) was analyzed with Kaplan-Meier, and cumulative incidence of local failure (LF) was calculated with competing risk analysis with death. <h3>Results</h3> We included 82 liver lesions in 73 patients. Median follow-up time was 22.3 months (range 2.2-88.1 months). Median time to OS for the entire cohort was 43.7 months (95% CI 18.1-57.6 months) and median progression free survival was 9.5 months (95% CI 6.3-14.0 months). There are a total of 11 (13.4%) lesions that experienced LF in the entire cohort, and cumulative incidence of LF was not significantly different between the 3 groups (<i>p</i>=0.3257). In the SBRT only group, the median time to resolution of arterial enhancement and washout was 5.3 months (range 1.6-23.7 months). At 3, 6, 9, and 12 months, 82%, 41%, 13%, and 8% of lesions continued to show arterial hyperenhancement. <h3>Conclusion</h3> Tumors treated with SBRT may continue to exhibit persistence of arterial hyperenhancement. Without an increase in size of enhancement, continued surveillance, rather than early salvage therapy, may be appropriate for these patients.

Effect of Patient Factors on Portal Vein and Hepatic Contrast Enhancement at Computed Tomography Scan With Protocol Combining Fixed Injection Duration and Patients' Body Weight Tailored Dose of Contrast Material.

IntroductionFixed injection duration with patients’ body weight tailored dose of contrast material was recommended as the practical scan protocol in multiphasic contrast-enhanced abdominal computed tomography (CT). This study evaluated the effect of the demographic variables on portal vein and hepatic contrast enhancement in hepatic arterial phase (HAP), aiming to reduce the patient-to-patient variability and optimize the HAP images.MethodsThis retrospective analysis included 87 patients who underwent abdominal enhancement multiphase CT from April to June 2022. All the patients were examined using protocol combining fixed injection duration and patients’ body weight tailored dose of contrast material. Univariate and multivariate linear regression analyses were performed between all patient characteristics and the contrast-enhanced CT number of portal vein and hepatic parenchyma during HAP.ResultsUnivariate linear regression analysis demonstrated statistically significant correlations between the CT number of hepatic parenchyma, and the body mass index (BMI), body surface area (BSA), and total body weight (TBW) (all P < 0.001) during HAP. However, multivariate linear regression analysis showed that the BMI or BMI and age were of independent predictive values (P < 0.001). Also, only the age was independently and negatively related to the CT number of portal vein enhancement during HAP (r = 0.240, P < 0.05) according to univariate linear regression analysis.ConclusionsUnivariate linear regression analysis revealed a significant inverse correlation between portal vein CT value and age. By multivariate linear regression analysis, only the BMI and age were significantly correlated with liver parenchymal enhancement, while gender, TBW, BSA, and HT were not.

Serum alanine aminotransferase to hemoglobin ratio and radiological features predict the prognosis of postoperative adjuvant TACE in patients with hepatocellular carcinoma.

ObjectiveTo explore the prognostic value of radiological features and serum indicators in patients treated with postoperative adjuvant transarterial chemoembolization (PA-TACE) and develop a prognostic model to predict the overall survival (OS) of patients with hepatocellular carcinoma (HCC) treated with PA-TACE.MethodWe enrolled 112 patients (75 in the training cohort and 37 in the validation cohort) with HCC treated with PA-TACE after surgical resection at the Affiliated Hospital of Nantong University between January 2012 and June 2015. The independent OS predictors were determined using univariate and multivariate regression analyses. Decision curve analyses and time-dependent receiver operating characteristic curve analysis was used to verify the prognostic performance of the different models; the best model was selected to establish a multi-dimensional nomogram for predicting the OS of HCC patients treated with PA-TACE.ResultMultivariate regression analyses indicated that rim-like arterial phase enhancement (IRE), peritumor capsule (PTC), and alanine aminotransferase to hemoglobin ratio (AHR) were independent predictors of OS after PA-TACE. The combination of AHR had the best clinical net benefit and we constructed a prognostic nomogram based on IRE, PTC, and AHR. The calibration curve showed good fit between the predicted nomogram’s curve and the observed curve.ConclusionOur preliminary study confirmed the prognostic value of AHR, PTC, and IRE and established a nomogram that can predict the OS after PA-TACE treatment in patients with HCC.

Role of preoperative prediction of microvascular invasion in hepatocellular carcinoma based on the texture of FDG PET image: A comparison of quantitative metabolic parameters and MRI.

Objective: To investigate the role of prediction microvascular invasion (mVI) in hepatocellular carcinoma (HCC) by 18F-FDG PET image texture analysis and hybrid criteria combining PET/CT and multi-parameter MRI. Materials and methods: Ninety-seven patients with HCC who received the examinations of MRI and 18F-FDG PET/CT were retrospectively included in this study and were randomized into training and testing cohorts. The lesion image texture features of 18F-FDG PET were extracted using MaZda software. The optimal predictive texture features of mVI were selected, and the classification procedure was conducted. The predictive performance of mVI by radiomics classier in training and testing cohorts was respectively recorded. Next, the hybrid model was developed by integrating the 18F-FDG PET image texture, metabolic parameters, and MRI parameters to predict mVI through logistic regression. Furthermore, the diagnostic performance of each time was recorded. Results: The 18F-FDG PET image radiomics classier showed good predicted performance in both training and testing cohorts to discriminate HCC with/without mVI, with an AUC of 0.917 (95% CI: 0.824–0.970) and 0.771 (95% CI: 0.578, 0.905). The hybrid model, which combines radiomics classier, SUVmax, ADC, hypovascular arterial phase enhancement pattern on contrast-enhanced MRI, and non-smooth tumor margin, also yielded better predictive performance with an AUC of 0.996 (95% CI: 0.939, 1.000) and 0.953 (95% CI: 0.883, 1.000). The differences in AUCs between radiomics classier and hybrid classier were significant in both training and testing cohorts (DeLong test, both p < 0.05). Conclusion: The radiomics classier based on 18F-FDG PET image texture and the hybrid classier incorporating 18F-FDG PET/CT and MRI yielded good predictive performance, which might provide a precise prediction of HCC mVI preoperatively.

Interpretable Machine Learning for Characterization of Focal Liver Lesions by Contrast-Enhanced Ultrasound.

This work proposes an interpretable radiomics approach to differentiate between malignant and benign focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS). Although CEUS has shown promise for differential FLLs diagnosis, current clinical assessment is performed only by qualitative analysis of the contrast enhancement patterns. Quantitative analysis is often hampered by the unavoidable presence of motion artifacts and by the complex, spatiotemporal nature of liver contrast enhancement, consisting of multiple, overlapping vascular phases. To fully exploit the wealth of information in CEUS, while coping with these challenges, here we propose combining features extracted by the temporal and spatiotemporal analysis in the arterial phase enhancement with spatial features extracted by texture analysis at different time points. Using the extracted features as input, several machine learning classifiers are optimized to achieve semiautomatic FLLs characterization, for which there is no need for motion compensation and the only manual input required is the location of a suspicious lesion. Clinical validation on 87 FLLs from 72 patients at risk for hepatocellular carcinoma (HCC) showed promising performance, achieving a balanced accuracy of 0.84 in the distinction between benign and malignant lesions. Analysis of feature relevance demonstrates that a combination of spatiotemporal and texture features is needed to achieve the best performance. Interpretation of the most relevant features suggests that aspects related to microvascular perfusion and the microvascular architecture, together with the spatial enhancement characteristics at wash-in and peak enhancement, are important to aid the accurate characterization of FLLs.

The Relationship between Ultrasonographic Features of Hepatocellular Carcinoma and the Severity of Hepatocellular Carcinoma and the Expression of PTEN and Tg737.

To investigate the relationship between the ultrasonographic features of hepatocellular carcinoma (HCC) and the severity of HCC and the expression of tumor suppressor genes PTEN and Tg737, 90 patients with primary liver cancer are selected as the study subjects. The enhancement of liver tumor in arterial phase, portal venous phase, and delayed phase is observed by contrast-enhanced ultrasound (CEUS) before operation, and the echo intensity is compared with that of surrounding liver parenchyma. Immunohistochemistry is used to detect the expression of PTEN and Tg737 in hepatocellular carcinoma and paracancerous tissues. (1) In HCC, CEUS enhancement is characterized by rapid enhancement in arterial phase, enhancement in portal venous phase and delayed phase, and decreased hypoechoic changes. About 78.0% of the stage I-II liver cancer and 85.0% of the stage III-IV liver cancer show rapid enhancement and high echo in the arterial phase; only 8.0% of the stage I-II liver cancer shows moderate echo changes in the portal venous phase, while 32.5% (13/40) stage III-IV liver cancer shows moderate echo changes in the portal venous phase. (2) The positive rates of PTEN in liver cancer tissues and paracancerous tissues are 21.1% (19/90) and 70.0% (63/90), respectively, and the difference is statistically significant. The positive rates of Tg737 in liver cancer tissues and paracancerous tissues are 17.8% (16/90) and 75.6% (68/90), respectively, and the difference is statistically significant. Compared with PTEN and Tg737 negative groups, the ascending slope (RS) and initial elimination time (WT) of PTEN and Tg737 positive groups are significantly higher, indicating that the inflow velocity of contrast medium in the positive group is higher, the outflow time is shorter, and the lesions shows low enhancement rapidly. However, the expression of PTEN and Tg737 had no significant difference in maximal intensity (IMAX), peak time (TTP), and mean transit time (mTT). (3) Correlation analysis shows that the immunohistochemical scores of PTEN and Tg737 are not significantly correlated with IMAX, mTT, and TTP but positively correlated with RS (r = 0.359,P < 0.05), suggesting that the positive expressions of PTEN and Tg737 are negatively correlated with the inflow velocity of contrast medium. The immunohistochemical scores of PTEN and Tg737 are negatively correlated with WT, which indicated that the higher the expression intensity of PTEN is, the longer the outflow time of contrast medium is and the slower the outflow of contrast medium is. There is a significant correlation between the expression of PTEN and Tg737 proteins and CEUS parameters in hepatocellular carcinoma.

Computed tomography findings in canine cholangiocellular carcinoma

AbstractAlthough triple‐phase computed tomography is used for differentiating canine liver neoplasms, there is limited information on the computed tomography features of cholangiocellular carcinoma. This retrospective case series assessed the computed tomography features of nine canine cholangiocellular carcinomas. The following computed tomography features were recorded: lesion shape (massive, multiple nodular or diffuse lesions), lesion location, rim enhancement (present or absent), enhancement pattern (stable, progressive or washout), lymphadenopathy (presence or absence) and pulmonary metastasis (presence or absence). Massive lesions, multiple nodular lesions and diffuse lesions were detected in two (22%), five (56%) and two (22%) patients, respectively. Rim enhancement in the arterial phase was observed in eight (89%) patients. Progressive enhancement was detected in six (67%) of the patients. Rim enhancement in the arterial phase and progressive enhancement may be characteristic of cholangiocellular carcinoma in dogs.

Experience of using contrast-enhanced ultrasound examination in the most common malignant neoplasms of the liver

Aim. To study the features of contrast enhancement of malignant neoplasms of the liver in patients with and without cirrhosis (LC), to study the differences in the dynamics of contrast enhancement of liver are metastatic lesions (MTS) and hepatocellular carcinoma (HCC).Material and methods. A retrospective analysis results 58 patients with HCC (group 1) and 51 patients with liver metastases (group 2) was carried out based on morphological data. According to the criterion for the presence of LC, group 1 was divided into two subgroups. The main method of radiological diagnostics was contrast enhancement ultrasound (CEUS).Results. The indicators of the dynamics of the Wash-in of an ultrasound contrast agent into the HCC node and the dynamics of the drug WASH-OUT from the focus in patients with LC did not significantly differ from those in patients without cirrhosis. HCC is characterized by the onset of leaching of the ultrasound contrast agent after 62 seconds from the beginning of the study, which significantly differs from MTS (p &lt;0.05). The parameters in predicting the G3 stage of the tumor were as follows: the parameter “onset of WASH-OUT” of the from the focus &gt;&lt;79 sec, the parameter “time of maximum WASH-OUT” of the ultrasound contrast agent &gt;&lt;270 seconds. In our opinion, certain difficulties are presented by the diagnosis of highly differentiated carcinomas due to the absence of the WASH-OUT phenomenon in 50% of patients. Differential diagnosis of metastases should be based on a combination of a number of signs, the most important of which, in our opinion, are: early onset of elution of ultrasound contrast agent, “black hole” symptom, peripheral ring-shaped enhancement in arterial phase.&gt;Conclusion. The data obtained with the help of CEUS confirm the effect of “arterialization of hepatic blood flow” in patients with LC. Differences in the parameters of contrasting HCC nodes in subgroups of patients with and without LC are not statistically significant. The polymorphism of the signs detected in MTS in the liver is due to the morphology of the primary tumor and the size of the neoplasms. Differential diagnosis should be based on a combination of signs of the dynamics of ultrasound contrast agents.

Clinical characteristics and CT features of hepatic epithelioid haemangioendothelioma and comparison with those of liver metastases

BackgroundTo analyse clinical characteristics and computer tomography (CT) findings of hepatic epithelioid haemangioendothelioma (HEH) and to determine differential features compared with liver metastasis (LM).MethodsThis retrospective study included 80 patients with histopathologically confirmed HEH (n = 20) and LM (n = 60) of different primary tumours who underwent dynamic contrast-enhanced CT scans. CT findings included the location, contour, size, number, margin, and density of lesions, the patterns and degree of contrast enhancement of lesions, vascular invasion and changes in other organs. The enhancement ratio (ER) and tumour-to-normal parenchyma ratio (TNR) were calculated. Receiver operating characteristic curves (ROCs) were used to determine areas under the curve (AUCs).ResultsAbout 65% of HEH lesions were located in submarginal areas. Significant differences were observed between HEH and LM patients in age, sex, and tumour marker positivity (p < 0.05). HEH showed minimal to slight enhancement, thin ring-like enhancement in arterial phase, and slight, homogeneous, progressive enhancement in the portal phase. HEH presented capsule retraction, and the “target” sign and the “lollipop” sign were significantly more frequent than in LM (p < 0.05). The ER and TNR in the arterial phase of HEH were lower than those of LM (p < 0.05). AUCs of ER and TNR in the arterial phase were 0.74 and 0.73, respectively.ConclusionLesions in subcapsular locations, capsular retraction, slight and thin ring-like enhancement, “target” and “lollipop” signs and lower ER and TNR in the arterial phase may represent important features of HEH compared with LM.

Diagnostic performance of MRI in detecting locally recurrent soft tissue sarcoma: systematic review and meta-analysis.

To systematically review the diagnostic criteria and performance of MRI in detecting locally recurrent soft tissue sarcoma. Medline and Embase were searched for original studies on the diagnostic performance of MRI detecting locally recurrent soft tissue sarcoma. Study quality was assessed using QUADAS-2. Sensitivity and specificity were pooled using a bivariate random-effects model. Ten studies were included. There was a high risk of bias with respect to patient selection in 2 studies and a high risk of bias with respect to flow and timing in 8 studies. The presence of a mass yielded a pooled sensitivity of 80.9% and a pooled specificity of 77.0%. Hyperintensity at T2-weighted imaging yielded a pooled sensitivity of 82.4% and a pooled specificity of 11.0%. Hypo- or isointensity at T1-weighted imaging yielded a pooled sensitivity of 82.0% and a pooled specificity of 14.3%. Contrast enhancement images yielded a pooled sensitivity of 95.9% and a pooled specificity of 12.3%. Low signal mass on the apparent diffusion coefficient (ADC) map yielded a pooled sensitivity of 67.5% and a pooled specificity of 95.3%. Early and rapid arterial phase enhancement at dynamic contrast-enhanced (DCE) MRI yielded a pooled sensitivity of 91.3% and a pooled specificity of 84.7%. The presence of a mass appears a useful criterion to diagnose locally recurrent soft tissue sarcoma. Signal characteristics at standard T2- and T1-weighted imaging and contrast enhancement seem less useful because they lack specificity. Functional MRI techniques, including DWI with ADC mapping and DCE, may help to make a correct diagnosis. • The presence of a mass at MRI appears useful to diagnose locally recurrent soft tissue sarcoma, because both sensitivity and specificity are fairly high. • Signal characteristics at standard T2- and T1-weighted sequences and contrast enhancement suffer from poor specificity. • DWI with ADC mapping and DCE may help to make a correct diagnosis, but further research is needed to better understand the value of these functional MRI techniques.

Correlation between imaging features on computed tomography and combined positive score of PD-L1 expression in patients with gastric cancer.

To explore the correlation between computed tomography (CT) features and combined positive score (CPS) of programmed cell death ligand 1 (PD-L1) expression in patients with gastric cancer (GC). This study reviewed an institutional database of patients who underwent GC operation without neoadjuvant chemotherapy between December 2019 and September 2020. The CPS results of PD-L1 expression of postoperative histological examination were recorded by pathology. Baseline CT features were measured, and their correlation with CPS 5 or 10 score groups of PD-L1 expression was analyzed. Data for 153 patients with GC were collected. Among them, 124 were advanced GC patients, and 29 were early GC patients. None of the CT features significantly differed between CPS groups with a cutoff score of 5 and a score of 10 in patients with early GC. In advanced GC, the presence of lymph nodes with short diameters >10 mm was significantly different (P=0.024) between the CPS<5 and CPS≥5 groups. CT features such as tumor attenuation in the arterial phase, long and short diameter of the largest lymph node, the sum of long diameter of the two largest lymph nodes, the sum of short diameter of the two largest lymph nodes, and the presence of lymph nodes with short diameters >10 mm significantly differed between the CPS<10 and CPS≥10 groups in advanced GC. The sensitivity, specificity and area under receiver operating characteristic (ROC) curve of logistic regression model for predicting CPS≥10 was 71.7%, 50.0% and 0.671, respectively. Microsatellite instability (MSI) status was significantly different in CPS groups with cutoff score of 5 and 10 in advanced GC patients. CT findings of advanced GC patients with CPS≥10 showed greater arterial phase enhancement and larger lymph nodes. CT has the potential to help screen patients suitable for immunotherapy.

Pancreatic cyst-solid mass: tuberculosis.

Question: A 29-year-old Chinese male was admitted to our department with a history of right upper quadrant pain for two months, anorexia, weight loss about 5 kg and without fever. The pain radiated to the back and it got worst lately. He didn’t have a history of tuberculosis. The sclera was mild icteric. Laboratory test results showed total bilirubin level increased to 58 umol/L (normal level &lt;28 umol/L) and tumor markers were normal. Chest X-ray was normal. Abdominal contrastenhanced CT showed a 25 x 30 mm cyst-solid mass in the head of pancreas (Figure1. A) and the lesion was mild enhancement in arterial phase. Pancreatic tumor was considered. Endoscopic ultrasonography confirmed the mass with uneven echo in the pancreatic head and the boundary of the mass was not clear (Figure1. B). The lesion may invade the portal vein. As the patient was young and the operation was very traumatic, the patient refused surgery unless the lesion was proved to be a tumor.

Diagnostic Value of CEUS LI-RADS Version 2017 in Differentiating AFP-Negative Hepatocellular Carcinoma from Other Primary Malignancies of the Liver.

Purpose: To explore the diagnostic value of Contrast-enhanced Ultrasound Liver Imaging Reporting and Data System version 2017 (CEUS LI-RADS v2017) in differentiating alpha-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC) from other primary malignancies (OM) of the liver. Methods: The data of 99 patients with primary liver malignant tumors confirmed by surgical pathology and AFP-negative from January 2018 to January 2021 were retrospectively analyzed, and the lesions were divided into 61 cases in the AFP-negative HCC group and 38 cases in the OM group according to the pathological findings, the CEUS features of the lesions were analyzed and the lesions were classified according to the CEUS LI-RADS v2017. Comparison of CEUS features between the two groups was performed using the χ2 test. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of CEUS LI-RADS v2017 for the diagnosis of AFP-negative HCC and OM were calculated using pathological findings as the gold standard. Results: The differences in features of arterial phase enhancement and wash-out between the HCC and OM groups were statistically significant (p < 0.05). The sensitivity of diagnosing HCC by LR-5 was 62.3% and the specificity was 92.1%. The sensitivity of diagnosing OM by LR-M was 92.1% and the specificity was 83.6%. Conclusions: When AFP is negative in patients with intrahepatic focal lesions, LR-5 has high specificity but low sensitivity in the diagnosis of HCC, and LR-M has high sensitivity and specificity in the diagnosis of OM. CEUS LI-RADS is a tool to differentiate AFP-negative HCC and OM effectively.

An ectopic adrenocortical oncocytic adenoma in the liver highly mimicking hepatocellular carcinoma: case report and literature review

BackgroundEctopic adrenocortical tissue is a lesion usually found incidentally during autopsy or inguinal surgery. Here, we demonstrate an extremely unusual case of intrahepatic adrenocortical adenoma which highly mimicks hepatocellular carcinoma (HCC) and brings challenges for clinicians and pathologists. The diagnostic pitfalls have been discussed in detail to provide clues for guiding differential diagnosis and future treatment.Case presentationA 44-year-old man was admitted into our hospital for evaluation of a hepatic mass identified during routine examination. Enhanced CT revealed its margin displayed apparent enhancement in arterial phase, but hypointensity in portal and delayed phase. HCC was suspected and partial hepatectomy was performed. Microscopically, cells were arranged in solid sheets. Most of the tumor cells were large, polygonal, had prominent nucleoli and were rich in eosinophilic cytoplasm. Pleomorphic nucleus was frequently found. Focally, smaller cells were found with small nuclei and granular cytoplasm. Immunohistochemically, tumor cells were negative for Arg-1, glypican-3 (GPC3), hepatocyte specific antigen (HSA), and positive for synaptophysin (Syn), α-inhibin, and Melan A. The Ki-67 index was 1 %. The final diagnosis was ectopic adrenocortical oncocytic adenoma and the patient was uneventful after the surgery.Conclusion Intrahepatic adrenocortical adenoma in the liver can hardly be diagnosed through radiology and little experience in pathology has been reported. In the present case, massive oncocytic changes and huge pleomorphism add greatly to the difficulties of making correct diagnosis. This lesion should be carefully kept in mind and a combination of markers is suggested for differentiating from HCC.

Study on correlation between two-dimensional ultrasound, contrast-enhanced ultrasound and microvascular invasion in hepatocellular carcinoma.

To explore the correlation between two-dimensional ultrasound (2D-US), contrast-enhanced ultrasound (CEUS) and microvascular invasion (MVI) in hepatocellular carcinoma (HCC). In this retrospective study, 56 patients with surgically pathologically confirmed HCC lesions were included. Patients were classified according to the presence of MVI: MVI positive group (n = 17) and MVI negative group (n = 39). 2D-US and CEUS examinations were performed within two weeks before surgery. The 2D-US and CEUS features were analyzed for correlation with MVI. Statistically significant parameters of ultrasound characteristic were scored, and the results of the scores were analyzed by ROC curve. There were statistically significant differences in tumor shape, boundary, capsule, CEUS portal phase and delayed phase enhancement pattern, time to wash out, and tumor margin after enhancement (P < 0.05), while there were no statistically significant differences in tumor location and size, CEUS arterial phase enhancement pattern, initial time, time to peak, and peritumor enhancement (P > 0.05). When diagnosing the presence of MVI in HCC patients with cut-off value of the score combined 2D-US and CEUS features≥3, the maximum Jorden index was 0.58, and its diagnostic sensitivity and specificity were 94.10% and 64.1%, respectively, meaning that the total score≥3 was highly suspicious of the presence of MVI. 2D-US and CEUS are feasible methods for preoperative prediction of MVI in HCC, and can provide some theoretical basis for individualized clinical treatment.

Contrast media dose adjustment to allometric parameters of body mass in multiphasic CT of the liver: A comparison of different metrics

PurposeTo assess correlations of lean body weight (LBW) calculated with various formulas, total body weight (TBW), body height (BH), body mass index (BMI), body surface area (BSA) and fat-free mass (FFM) with vascular and parenchymal enhancement in multiphasic CT of the liver. MethodThirty consecutive patients underwent multiphasic CT of the liver using constant iodine dose and flow rate. Contrast enhancement of aorta, portal vein and liver was calculated by measuring mean vascular and parenchymal attenuation in pre-contrast and post-contrast phases. Correlations of TBW, BH, BMI, BSA, FFM, and LBW (calculated with formulas of Boer, Hume, James and Green&Duffull) with enhancement were tested using Spearman’s correlation coefficient. The method of Fieller et al. was used to calculate 95 % confidence intervals. A p-value ≤ 0.05 was considered statistically significant. ResultsAortal enhancement correlated strongly with TBW, BSA, LBWBoer and LBWHume and moderately with BH, BMI, FFM, LBWJames and LBWGreen&Duffull. Liver enhancement in the late arterial phase correlated moderately with TBW, FFM, LBWBoer, LBWHume and LBWGreen&Duffull and weakly with BSA. Liver enhancement in the portal venous phase correlated strongly with TBW, BSA, FFM, LBWBoer, LBWHume and LBWGreen&Duffull, whereby overlap of the 95 % CI graphs demonstrated that the differences in the correlation coefficients were not statistically significant. Liver enhancement in the delayed phase correlated moderately with BH but did not correlate significantly with any other parameter. ConclusionRegardless of the form used for calculation, LBW did not correlate statistically significantly stronger than TBW with vascular or parenchymal enhancement of the liver.

The added value of contrast-enhanced ultrasound in evaluation of indeterminate small solid renal masses and risk stratification of cystic renal lesions.

To investigate accuracy of contrast-enhanced ultrasound (CEUS) to characterize indeterminate small solid renal masses (sSRMs), excluding lipid-rich AMLs, and cystic renal masses (CRMs) according to the proposed Bosniak Classification 2019 MATERIALS AND METHODS: CEUS of pathology-proven CRMs and sSRMs (without definite enhancement or macroscopic fat on CT/MRI), and CRMs with ≥18 months follow-up were retrospectively reviewed. Two radiologists blindly categorized CRMs according to new Bosniak Classification on CT/MRI. On CEUS, two other radiologists evaluated arterial-phase enhancement of sSRMs relative to renal cortex and categorized CRMs following new Bosniak Classification. Fisher's exact/chi-squared test was used to compare categorical variables, and Cohen κ statistics for inter-observer agreement RESULTS: A total of 237 patients had 241 lesions: 161 pathology-proven sSRMs (122 malignant and 39 benign), 29 pathology-proven CRMs, 51 CRMs with adequate follow-up. Arterial-phase enhancement < renal cortex predicted malignancy with specificity of 97.4% (38/39) (CI 85.6-99.9%), and positive predictive value (PPV) of 98.2% (54/55) (CI 90.4-99.9%). Inter-observer kappa was 0.95. In pathology-proven CRMS, sensitivity of CEUS vs CT/MRI was 100% (15/15) (CI 79.6-100%) vs 60% (9/15) (CI 35.8-80.1%) (p value = .002) and negative predictive value (NPV) 100% (2/2) (CI 17.8-100%) vs 25% (2/8 ) (CI 4.4-59.1%) (p value < 0.0001), with similar specificity (50%) and PPV- 88.2% (15/17) (CI 65.7-97.9%) vs 81.8% (9/11) (CI 52.3-96.8%) ( p value = 0.586). Bosniak Classification inter-observer kappa was 0.92 for CEUS vs 0.68 for CT/MRI (p value = 0.009). In our cohort, CEUS had high specificity and PPV to diagnose RCC in sSRMs excluding lipid-rich AML. CEUS had significantly higher sensitivity/NPV to diagnose malignancy in CRMs as compared to CT/MRI. • Once lipid-rich AML is excluded by the other modalities, sSRM arterial phase hypo-enhancement relative to renal cortex on CEUS yielded high specificity (97.4%) and PPV (98.2%) to diagnose RCC. • When applying the proposed Bosniak Classification 2019, CEUS showed higher sensitivity compared to CT/MRI (100% vs 60%), p value=.0024, in the stratification of cystic renal masses to diagnose malignancy. • CEUS may reduce the number of CT/MRI Bosniak IIF lesions by assigning them to either II or III/IV categories.

The value of MRI in identifying pancreatic neuroendocrine tumour G3 and carcinoma G3

To explore the magnetic resonance imaging (MRI) differences between pancreatic neuroendocrine tumour grade 3 (pNET-G3) and pancreatic neuroendocrine carcinoma grade 3 (pNEC-G3). Between 2009 and 2019, 31 patients underwent pNEN-G3 resection with preoperative MRI in two local hospitals in China. The 31 patients were assigned to a pNET-G3 group (n=13) or a pNEC-G3 group (n=18). The MRI findings between the groups were compared. There was no statistically significant difference between the two groups in lesion size, clinical characteristics, or laboratory indexes. The lesions showed high or slightly higher signal on diffusion-weighted imaging and decreased apparent diffusion coefficient (ADC) values, which differed between the two groups (p=0.013). The difference between the groups regarding positive enhancement integral, arterial phase and portal phase signal enhancement ratio were statistically significant; however, the delayed phase signal enhancement ratio was not significantly different. pNET-G3 and pNEC-G3 showed different characteristics on MRI. In particular, the ADC value and dynamic enhanced imaging could have an important role in distinguishing between the two.