Focal Liver Lesions Research Articles

Radiomics-based automated machine learning for differentiating focal liver lesions on unenhanced computed tomography.

Enhanced computed tomography (CT) is the primary method for focal liver lesion diagnosis. We aimed to use automated machine learning (AutoML) algorithms to differentiate between benign and malignant focal liver lesions on the basis of radiomics from unenhanced CT images. We enrolled 260 patients from 2 medical centers who underwent CT examinations between January 2017 and March 2023. This included 60 cases of hepatic malignancies, 93 cases of hepatic hemangiomas, 48 cases of hepatic abscesses, and 84 cases of hepatic cysts. The Pyradiomics method was used to extract radiomics features from unenhanced CT images. By using the mljar-supervised (MLJAR) AutoML framework, clinical, radiomics, and fusion models combining clinical and radiomics features were established. In the training and validation sets, the area under the curve (AUC) values for the clinical, radiomics, and fusion models exceeded 0.900. In the external testing set, the respective AUC values for the clinical, radiomics, and fusion models were as follows: 0.88, 1.00, and 1.00 for hepatic cysts; 0.81, 0.90, and 0.97 for hepatic hemangiomas; 0.89, 0.98, and 0.92 for hepatic abscesses; and 0.23, 0.80, and 0.93 for hepatic malignancies. The diagnostic accuracy rates for hepatic cysts, hemangiomas, malignancies, and abscesses by radiologists in the external testing cohort were 0.96, 0.60, 0.79, and 0.66, respectively. The fusion model based on noninvasive radiomics and clinical features of unenhanced CT images has high clinical value for distinguishing focal hepatic lesions.

Role of Superb Microvascular Imaging (SMI) vascularity index values and vascularity patterns in the differential diagnosis of malignant liver lesions.

To evaluate the Superb Microvascular Imaging (SMI) vascular patterns and vascularity index (VI) values of malignant focal liver lesions (FLLs), assess their role in differential diagnosis, and examine interobserver agreement. A total of 107 patients (52 males, 55 females; mean age 62 ± 12.8 years, range 25-87) referred to the interventional radiology clinic for FLL biopsy between April 2022 and April 2023 were analyzed. Two radiologists independently assessed the SMI vascular patterns and calculated VI values. Differences among three lesion groups - hepatocellular carcinoma (HCC, n = 16), non-HCC primary liver malignancies (n = 16), and metastases (n = 75) - were evaluated, and interobserver agreement was assessed. Most metastases (88%) demonstrated hypovascular patterns, while HCCs predominantly exhibited hypervascular patterns (68.7-81.3%). Non-HCC primary malignancies showed no dominant vascular pattern. Significant differences in SMI patterns were observed among lesion types (p = 0.001-0.035). VI values for HCCs (7.53-7.73) were significantly higher than those for non-HCC malignancies (2.73-2.93) and metastases (1.35-1.36) (p = 0.0001). ROC analysis based on VI values yielded AUCs of 0.886-0.887, with a cutoff of 2.92 providing 81.3% sensitivity and 79.1-80.2% specificity for HCC diagnosis. The inter-reader agreement for SMI patterns had a kappa score of 0.634, while the intraclass correlation coefficient (ICC) for VI values was 0.959. HCCs displayed more hypervascular SMI patterns and significantly higher VI values compared to other malignant FLLs, emphasizing the diagnostic potential of VI in distinguishing HCC from non-HCC tumors. Although metastases primarily exhibited hypovascular patterns and low VI values, no dominant vascular pattern was identified in non-HCC primary liver malignancies. Assessing VI values provided higher interobserver agreement compared to SMI patterns, enhancing objectivity and reproducibility.

Automatic localization and deep convolutional generative adversarial network-based classification of focal liver lesions in computed tomography images: A preliminary study.

Computed tomography of the abdomen exhibits subtle and complex features of liver lesions, subjectively interpreted by physicians. We developed a deep learning-based localization and classification (DLLC) system for focal liver lesions (FLLs) in computed tomography imaging that could assist physicians in more robust clinical decision-making. We conducted a retrospective study (approval no. EMRP-109-058) on 1589 patients with 17335 slices with 3195 FLLs using data from January 2004 to December 2020. The training set included 1272 patients (male: 776, mean age 62±10.9), and the test set included 317 patients (male: 228, mean age 57±11.8). The slices were annotated by annotators with different experience levels, and the DLLC system was developed using generative adversarial networks for data augmentation. A comparative analysis was performed for the DLLC system versus physicians using external data. Our DLLC system demonstrated mean average precision at 0.81 for localization. The system's overall accuracy for multiclass classifications was 0.97 (95% confidence interval [CI]: 0.95-0.99). Considering FLLs≤3cm, the system achieved an accuracy of 0.83 (95% CI: 0.68-0.98), and for size>3cm, the accuracy was 0.87 (95% CI: 0.77-0.97) for localization. Furthermore, during classification, the accuracy was 0.95 (95% CI: 0.92-0.98) for FLLs≤3cm and 0.97 (95% CI: 0.94-1.00) for FLLs>3cm. This system can provide an accurate and non-invasive method for diagnosing liver conditions, making it a valuable tool for hepatologists and radiologists.

Application of deep learning techniques for breath-hold, high-precision T2-weighted magnetic resonance imaging of the abdomen.

To evaluate the feasibility of a high-precision single-shot fast spin-echo (SS-FSE) sequence using the deep learning-based Precise IQ Engine (PIQE) algorithm in comparison with standard SS-FSE for T2-weighted MR imaging of the abdomen, and to compare the image quality with a multi-shot (MS)-FSE sequence using the PIQE algorithm. This retrospective study included 105 patients who underwent abdominal MR including T2-weighted sequences using the PIQE reconstruction algorithm. The image quality, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in high-precision SS-FSE sequences using PIQE were compared to those in standard SS-FSE without PIQE and MS-FSE sequences using PIQE. The scores for all qualitative parameters were significantly higher in high-precision SS-FSE sequence using PIQE than in standard SS-FSE sequence without PIQE (all p < 0.001). In the comparison between two high-precision sequences using PIQE, the SS-FSE sequence showed significantly better scores for the blurring, ghosts or motion/flow artifacts, conspicuity of intrahepatic structures, focal nonsolid hepatic and pancreatic cystic lesions, and overall image quality, in comparison to the MS-FSE sequence (all p < 0.001). Additionally, the SS-FSE sequence using PIQE showed significantly higher SNR of the liver and CNR of nonsolid hepatic lesions than the MS-FSE sequence using PIQE (p < 0.001). A high-precision SS-FSE sequence using the PIQE algorithm is a feasible alternative to the standard FSE sequence in T2-weighted MR imaging of the abdomen. It can improve image quality, the SNR of the liver, and the ability to visualize nonsolid focal liver lesions and pancreatic cystic lesions in comparison to a high-precision MS-FSE sequence using PIQE although this study was limited by single-center design and lack of pathological confirmation.

MRI findings of newly present benign focal hepatic observations following chemotherapy: distinct features in early- and late-term follow-up.

To evaluate gadoxetic acid-enhanced (Gd-EOB-DTPA) MRI features of newly detected benign focal hepatic observations after chemotherapy. In this retrospective single-center case-control study, we enrolled a cohort of 43 cancer patients with 93 newly detected benign focal hepatic observations after chemotherapy between January 2010 and December 2020. We evaluated several parameters including the delay of occurrence after chemotherapy, imaging features, and imaging follow-up. These parameters were compared with those observed in a control group comprising 34 patients with 93 hepatic metastases. For focal hepatic observations occurring at early-term follow-up (delay of occurrence after chemotherapy, median 3 months, range 1-6 months) with 22 patients encompassing 45 lesions, most lesions exhibited an ill-defined margin on HBP images (64.4%), negative on diffusion-weighted images (84.4%), mottled hypo-intensity on hepatobiliary phase images (88.9%), and undistorted vessels traversing the lesions (80.0%). Follow-up imaging indicated that 91.9% of these lesions resolved within 4-20 months. For focal hepatic observations occurring at late-term follow-up (delay of occurrence after chemotherapy, median 34 months, range 12-60 months) with 21 patients encompassing 48 lesions, which were diagnosed as focal nodular hyperplasia (FNH)-like lesions based on MRI features. A hepatobiliary ring enhancement was observed in 56.3% of lesions, and 66.7% of patients showed an increase in lesion size and/or number during follow-up imaging. Focal hepatic observations occurring at early-term and late-term follow-ups after chemotherapy have distinctive imaging features at Gd-EOB-DTPA-MRI. Early-term focal observations tend to resolve spontaneously, whereas FNH-like lesions can increase in size and number during follow-up. Question Focal benign liver lesions related to chemotherapy-induced hepatic injury were reported in recent years, often leading to confusion with metastasis and resulting in misdiagnosis. Findings Chemotherapy-induced focal hepatic observations identified during early- and late-term follow-up exhibit distinct imaging characteristics on Gd-EOB-DTPA-MRI and demonstrate varying temporal changes. Clinical relevance Chemotherapy-induced hepatic observations can be differentiated from metastasis based on Gd-EOB-DTPA MRI findings and their temporal changes. A deeper understanding of their findings can avoid unnecessary biopsies or surgical resections.

Automatic Classification of Focal Liver Lesions Based on Multi-Sequence MRI.

Accurate and automated diagnosis of focal liver lesions is critical for effective radiological practice and patient treatment planning. This study presents a deep learning model specifically developed for classifying focal liver lesions across eight different MRI sequences, categorizing them into seven distinct classes. The model includes a feature extraction module that derives multi-level representations of the lesions, a feature fusion attention module to integrate contextual information from the various sequences, and an attention-guided data augmentation module to enrich the training dataset. The proposed model achieved a patient-wise classification accuracy of 0.9302 and a lesion-wise accuracy of 0.8592, along with an F1-score of 0.8395, a recall of 0.8296, and a precision of 0.8551. These findings demonstrate the effectiveness of combining multi-sequence MRI with advanced deep learning methodologies, providing a robust tool to support radiologists in accurately classifying liver lesions in clinical settings.

The Role of Diffusion - Weighted Magnetic Resonance Imaging in Characterizing Focal Liver Lesions

The Role of Diffusion - Weighted Magnetic Resonance Imaging in Characterizing Focal Liver Lesions

Ultrasound-guided percutaneous biopsy for challenging perihilar focal liver lesions: diagnostic accuracy and safety assessment.

In cases of perihilar focal liver lesions, distinguishing between benign strictures and malignancies is critical to prevent unnecessary surgery. Although the use of contrast-enhanced CT or MRI in combination with clinical and laboratory findings can aid in diagnosis, histologic examination is often necessary. Histologic specimens can be obtained through various techniques, including ERCP-guided brush cytology or intraductal biopsy, cholangioscopy-directed biopsy or endoscopic ultrasound (EUS). However, these methods have been associated with suboptimal sensitivity and specificity, sometimes leading to inconclusive results. Therefore, ultrasound-guided percutaneous biopsy (US-guided PB) may play a crucial role, but data is lacking for perihilar lesions. The objective of our study was to assess the technical feasibility and safety of US-guided PB for perihilar lesions. We included 20 consecutive patients who underwent US-guided PB of perihilar liver lesions that were not suitable for surgery between June 2018 and October 2023. All samples were obtained using a Menghini needle 20G and were adequate for histological examination, with a mean diameter of 12.3 mm (range 3-40 mm). Out of the 20 patients, 11 were diagnosed with malignancy while the remaining 9 had inflammatory or fibrotic tissue samples. No adverse events related to the procedure were reported. US-guided PB of perihilar liver lesions is a valuable and safe diagnostic approach to consider for patients who are not suitable for surgery.

Comparison of image quality and lesion conspicuity between conventional and deep learning reconstruction in gadoxetic acid-enhanced liver MRI

ObjectiveTo compare the image quality and lesion conspicuity of conventional vs deep learning (DL)-based reconstructed three-dimensional T1-weighted images in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI).MethodsThis prospective study (NCT05182099) enrolled participants scheduled for gadoxetic acid-enhanced liver MRI due to suspected focal liver lesions (FLLs) who provided signed informed consent. A liver MRI was conducted using a 3-T scanner. T1-weighted images were reconstructed using both conventional and DL-based (AIRTM Recon DL 3D) reconstruction algorithms. Three radiologists independently reviewed the image quality and lesion conspicuity on a 5-point scale.ResultsFifty participants (male = 36, mean age 62 ± 11 years) were included for image analysis. The DL-based reconstruction showed significantly higher image quality than conventional images in all phases (3.71–4.40 vs 3.37–3.99, p < 0.001 for all), as well as significantly less noise and ringing artifacts than conventional images (p < 0.05 for all), while also showing significantly altered image texture (p < 0.001 for all). Lesion conspicuity was significantly higher in DL-reconstructed images than in conventional images in the arterial phase (2.15 [95% confidence interval: 1.78, 2.52] vs 2.03 [1.65, 2.40], p = 0.036), but no significant difference was observed in the portal venous phase and hepatobiliary phase (p > 0.05 for all). There was no significant difference in the figure-of-merit (0.728 in DL vs 0.709 in conventional image, p = 0.474).ConclusionDL reconstruction provided higher-quality three-dimensional T1-weighted imaging than conventional reconstruction in gadoxetic acid-enhanced liver MRI.Critical relevance statementDL reconstruction of 3D T1-weighted images improves image quality and arterial phase lesion conspicuity in gadoxetic acid-enhanced liver MRI compared to conventional reconstruction.Key PointsDL reconstruction is feasible for 3D T1-weighted images across different spatial resolutions and phases.DL reconstruction showed superior image quality with reduced noise and ringing artifacts.Hepatic anatomic structures were more conspicuous on DL-reconstructed images.Graphical

MR Elastography for Classification of Focal Liver Lesions Using Viscoelastic Parameters: A Pilot Study Based on Intrinsic and Extrinsic Activations.

Intrinsic activation MR elastography (iMRE) uses cardiovascular pulsations to assess tissue viscoelastic properties. Applying it to focal liver lesions extends its capabilities. To assess the viscoelastic parameters of focal liver lesions measured by iMRE and compare its diagnostic performance with extrinsic MRE (eMRE) for differentiating malignant and benign lesions. Prospective. A total of 55 participants underwent MRI with research MRE sequences; 32 participants with 17 malignant and 15 benign lesions underwent both iMRE and eMRE. FIELD STRENGTH/SEQUENCE: iMRE at ~1 Hz heart rate used a 3 T scanner with a modified four-dimensional (4D)-quantitative flow gradient-echo phase contrast and low-velocity encoding cardiac-triggered technique. eMRE employed a gradient-echo sequence at 30, 40, and 60 Hz. Liver displacements were measured using 4D-phase contrast and reconstructed via a nonlinear inversion algorithm to determine shear stiffness (SS) and damping ratio (DR). iMRE parameters were normalized to the corresponding values from the spleen. Lesions were manually segmented, and image quality was reviewed. Kruskal-Wallis, Mann-Whitney, Dunn's test, and areas under receiver operating characteristic curves (AUC) were assessed. SS was significantly higher in malignant than benign lesions with iMRE at 1 Hz (3.69 ± 1.31 vs. 1.63 ± 0.45) and eMRE at 30 Hz (3.76 ± 1.12 vs. 2.60 ± 1.26 kPa), 40 Hz (3.76 ± 1.12 vs. 2.60 ± 1.26 kPa), and 60 Hz (7.32 ± 2.87 vs. 2.48 ± 1.12 kPa). DR was also significantly higher in malignant than benign lesions at 40 Hz (0.36 ± 0.11 vs. 0.21 ± 0.01) and 60 Hz (0.89 ± 0.86 vs. 0.22 ± 0.09). The AUC were 0.86 for iMRE SS, 0.87-0.98 for eMRE SS, 0.47 for iMRE DR, and 0.62-0.86 for eMRE DR. Cardiac-activated iMRE can characterize liver lesions and differentiate malignant from benign lesions through normalized SS maps. 2 TECHNICAL EFFICACY: Stage 2.

Diagnostic Test Accuracy of Contrast-Enhanced Ultrasound With Sonazoid for Assessment of Focal Liver Lesions: A Systematic Review and Meta-Analysis.

This meta-analysis examined the diagnostic accuracy of Sonazoid-enhanced ultrasonography (SZ-CEUS) in discriminating malignant from benign focal liver lesions (FLLs) and HCC from non-HCC FLLs. Finding relevant studies required a rigorous PubMed, EMBASE, and other database search. To distinguish malignant from benign FLLs, SZ-CEUS had a pooled sensitivity of 94% (95% CI: 0.91-0.95) and specificity of 84% (95%: 0.78-0.89). HCC distinction had 83% sensitivity and 96% specificity (95% CI: 0.80-0.85 and 0.95-0.97). SZ-CEUS accurately distinguishes malignant from benign FLLs and HCC from non-HCC lesions, especially smaller HCC lesions.

Non-Invasive Ultrasound Diagnostic Techniques for Steatotic Liver Disease and Focal Liver Lesions: 2D, Colour Doppler, 3D, Two-Dimensional Shear Wave Elastography (2D-SWE), and Ultrasound-Guided Attenuation Parameter (UGAP).

We conducted a comprehensive literature review to evaluate the efficacy of combining two-dimensional shear wave elastography (2D-SWE) and ultrasound-guided attenuation parameter (UGAP) in assessing the risk of progressive metabolic dysfunction-associated steatohepatitis (MASH). This narrative review explores the applications of liver ultrasound in diagnosing metabolic liver diseases, focusing on recent advancements in diagnostic techniques for steatotic liver disease (SLD). Liver ultrasound can detect a spectrum of SLD manifestations, from metabolic dysfunction-associated liver disease (MASLD) to fibrosis and cirrhosis. It is also possible to identify inflammation, hepatitis, hepatocellular carcinoma (HCC), and various other liver lesions. Innovative ultrasound applications, including elastography and UGAP, can significantly enhance the diagnostic capabilities of ultrasound in accurately interpreting liver diseases. Understanding the pathogenesis of liver diseases requires a thorough analysis of their etiology and progression in order to develop sound diagnostic and therapeutic approaches. Chronic liver diseases (CLD) vary in origin, with MASLD affecting approximately 20-25% of the general population. The insidious progression of CLD from inflammation to fibrosis and cirrhosis underscores the need for effective early detection methods. This review aims to highlight the evolving role of non-invasive ultrasound-based diagnostic tests in the early detection and staging of liver diseases. By synthesizing current evidence, we aim to provide an updated perspective on the utility of advanced ultrasound techniques in redefining the diagnostic landscape for metabolic liver diseases.

The outcomes of endoscopic ultrasound-guided tissue acquisition for small focal liver lesions measuring ≤2 cm.

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) for focal liver lesions has gained attention as an alternative to percutaneous biopsy. Although the outcomes of EUS-TA for focal liver lesions have been reported to be favorable, no studies have focused on small focal liver lesions (≤2 cm). The aim of this study was to evaluate the outcomes of EUS-TA for small focal liver lesions (≤2 cm). The details of EUS-TA performed for focal liver lesions between 2016 and 2022 were retrospectively reviewed. The outcomes were compared between cases involving ≤2 cm lesions and those involving >2 cm lesions. The primary outcomes were diagnostic ability and adverse events. EUS-TA for focal liver lesions was performed in 109 cases. Of the 109 cases, 32 (29.3%) involved ≤2 cm lesions and 77 (70.6%) involved >2 cm lesions. Right lobe lesions and transduodenal puncture were significantly fewer in the ≤2 cm group. There were no significant differences in needle gauge, needle type, or number of punctures between the groups. The sensitivity, specificity, and accuracy rates were 96.8%, 100%, and 96.8%, respectively, in the ≤2 cm group and 97.4%, 100%, and 97.4%, respectively, in the >2 cm group, with no significant differences between the groups. There was no difference in adverse events between the groups (0% in the ≤2 cm group and 2.3% in the >2 cm group). EUS-TA for small focal liver lesions measuring ≤2 cm has favorable outcomes, which are similar to those for lesions measuring >2 cm.

Guidelines in Practice: Focal Liver Lesions.

Guidelines in Practice: Focal Liver Lesions.

Analysis of risk factors for bleeding as a complication of ultrasound-guided percutaneous liver biopsy examination

Objective: To explore the independent risk factors for bleeding in patients following percutaneous liver biopsy examination. Methods: The clinicopathological data of patients who underwent percutaneous liver biopsy examination at Nanjing Second Hospital from January 2012 to December 2021 were retrospectively collected. Univariate and multivariate logistic regression analysis were used to investigate the effect of age, gender, lesion type (diffuse liver parenchymal lesions, focal liver lesions), number of biopsies, tissue length, presence or absence of cirrhosis, presence or absence of portosystemic shunt, erythrocytes, white blood cells, hemoglobin, platelets, prothrombin time, fibrinogen, international normalized ratio, and liver biochemical indicators on bleeding following liver biopsy, as well as to screen independent risk factors. Results: A total of 3 331 patients were examined by percutaneous liver biopsy, and 3 060 cases were actually included by excluding 271 cases who took consultation from other hospitals. The overall postoperative hemorrhagic rate was 1.6% (49/3 060). Of which, forty-four cases (1.4%) had overt bleeding (hemodynamic changes or hemoglobin decreased by more than 20 g/L), five cases (0.2%) had minor bleeding, three cases had subcapsular hepatic hemaotma, and two cases had local bleeding from liver biopsy. Among the overt bleeding cases, two cases were in the off-label group (platelet<50×109/L or international normalized ratio>1.5), and the rest were in the non-off-label group. The results of univariate analysis showed that factors such as focal liver lesions, portosystemic shunt, prolonged prothrombin time, increased international normalized ratio, bilirubin, and alkaline phosphatase were associated with bleeding after liver biopsy in the non-off-label group. The multivariate collinearity diagnosis revealed statistically significant differences for the indicators. Multivariate logistic regression analysis finally included factors such as lesion type, portosystemic shunt, international normalized ratio, total bilirubin, and alkaline phosphatase. The results showed that patients with focal liver lesions were more prone to bleed after surgery than patients with diffuse liver parenchymal lesions (OR=3.396, P=0.002, 95%CI: 1.596-7.228). Patients with portosystemic shunt were more prone to bleed than those without portosystemic shunt (OR=3.301, P=0.018, 95%CI: 1.232-8.845). Patients were more likely to experience bleeding following liver biopsy when their total bilirubin levels were elevated (OR=1.006, P<0.001, 95%CI:1.003-1.008). Conclusion: Focal liver lesions, portosystemic shunts, and elevated total bilirubin are independent risk factors for bleeding after percutaneous liver biopsy.

Evaluation of colorectal liver metastases using virtual monoenergetic images obtained from dual-layer spectral computed tomography.

To assess the potential of virtual monoenergetic images in assessing colorectal liver metastasis (CRLM) compared with conventional CT images. This single-center, retrospective study included 173 consecutive patients (mean age, 65.5 ± 10.6years; 106 men) who underwent dual-layer spectral CT (DLSCT) between November 2016 and April 2021. Portal venous phase images were reconstructed using hybrid iterative reconstruction (iDose) and virtual monoenergetic imaging at 50keV. Four radiologists independently and randomly reviewed the de-identified iDose and 50keV images. Lesion detection, CRLM conspicuity, and CRLM diagnosis were compared between these images using a generalized estimating equation analysis. The reference standards used were histopathology and follow-up imaging findings. The study included 797 focal liver lesions, including 463 CRLMs (median size, 18.1mm [interquartile range, 10.9-37.7mm]). Lesion detection was better with 50keV images than with iDose images (45.0% [95% confidence interval [CI]: 39-50] vs 40.0% [95% CI: 34-46], P = 0.003). CRLM conspicuity was higher in the 50keV images than in the iDose images (3.27 [95% CI: 3.09-3.46] vs 3.09 [95% CI: 2.90-3.28], P < 0.001). However, the specificity for diagnosing CRLM was lower with 50keV images than with iDose images (94.5% [95% CI: 91.6-96.4] vs 96.0% [95% CI: 93.2-98.1], P = 0.022), whereas sensitivity did not differ significantly (77.6% [95% CI: 70.3-83.5] vs 76.9% [95% CI: 70.0-82.7], P = 0.736). Indeterminate lesions were more frequently noted in 50keV images than in iDose images (13% [445/3188] vs 9% [313/3188], P = 0.005), and 56% (247/445) of the indeterminate lesions at 50keV were not CRLMs. The 50keV images obtained from DLSCT were better than the iDose images in terms of CRLM conspicuity and lesion detection. However, 50keV images did not improve CRLM diagnosis but slightly increased the reporting of indeterminate focal liver lesions associated with CRLMs.

A non-invasive predictive model based on multimodality ultrasonography images to differentiate malignant from benign focal liver lesions

We have developed a non-invasive predictive nomogram model that combines image features from Sonazoid contrast-enhanced ultrasound (SCEUS) and Sound touch elastography (STE) with clinical features for accurate differentiation of malignant from benign focal liver lesions (FLLs). This study ultimately encompassed 262 patients with FLLs from the First Hospital of Shanxi Medical University, covering the period from March 2020 to April 2023, and divided them into training set (n = 183) and test set (n = 79). Logistic regression analysis was used to identify independent indicators and develop a predictive model based on image features from SCEUS, STE, and clinical features. The area under the receiver operating characteristic (AUC) curve was determined to estimate the diagnostic performance of the nomogram with CEUS LI-RADS, and STE values. The C-index, calibration curve, and decision curve analysis (DCA) were further used for validation. Multivariate and LASSO logistic regression analyses identified that age, ALT, arterial phase hyperenhancement (APHE), enhancement level in the Kupffer phase, and Emean by STE were valuable predictors to distinguish malignant from benign lesions. The nomogram achieved AUCs of 0.988 and 0.978 in the training and test sets, respectively, outperforming the CEUS LI-RADS (0.754 and 0.824) and STE (0.909 and 0.923) alone. The C-index and calibration curve demonstrated that the nomogram offers high diagnostic accuracy with predicted values consistent with actual values. DCA indicated that the nomogram could increase the net benefit for patients. The predictive nomogram innovatively combining SCEUS, STE, and clinical features can effectively improve the diagnostic performance for focal liver lesions, which may help with individualized diagnosis and treatment in clinical practice.

The Role of Diffusion-Weighted MRI in Correlation with Contrast-Enhanced MRI and Histopathology in the Evaluation of Focal Liver Lesions.

Accurate diagnosis of focal liver lesions is of utmost importance for theinitiation ofappropriate treatment. This study aims to assess the effectiveness of diffusion-weighted imaging (DWI) in diagnosing focal liver lesions, specifically focusing on differentiating between benign and malignant lesions, distinguishing metastases from primary liver tumors, and identifying various types of both benign and malignant lesions.. The study design is that of a prospective observational study done on 28 cases withfocal liver lesions detected on ultrasound. DWI was done followed by contrast-enhanced MRI (CE-MRI). Identification of the lesion on DWI and apparent diffusion coefficient (ADC) map was madeby using the CE-MRI images as a guide. The signal intensity of the lesion on DWI is determined as either diffusion restriction or no restriction. ADC measurementswere made quantitatively over various regions of interest (ROIs) of the focal liver lesion. All the lesions were confirmed by histopathological examination (HPE) except few benign lesions like simple cysts and few hemangiomas, which were followed up by ultrasonography after six months. Our study included 28 patients with 44 focal liver lesions. Out of 28 patients in this study group (n=28), there were a total of 17 male and 11 female patients. The mean age of the sample population was 50.89±13.40 years. The lesions were more commonly seen is the age group of 41-60 years (57.14%). Out of 44 lesions(n),24 (54.5%) lesionswere benign , 20 (45.45%) were malignant. There were 17 hemangiomas (38.6%), 2 hematomas (4.5%), 2 simple cysts (4.5%), 1 hydatid cyst (2.27%), 2 hepatic adenomas (4.5%), 16 hepatocellular carcinoma (HCC) (36.36%), 3 cholangiocarcinoma (6.8%), and 1 hepatoblastoma (2.27%). DWI has 85% sensitivity and 84.7% specificity for the differentiation of benign from malignant lesions. The mean ADC value of benign lesions was 1.83x10-3mm2/s and the mean ADC of malignant liver lesions was 0.96x10-3mm2/s. In the present study, the average cut off of mean ADC to differentiate benign and malignant bone lesions is 1.3x10-3 mm2/s, with statistically significant p value of 0.001, sensitivity of 95% and specificity of 83.3%. DWI is a valuable imaging technique in the evaluation of focal liver lesions. The ability to differentiate between benign and malignant liver lesions without the need for contrast is a significant benefit, particularly in challenging cases involving uncooperative patients or when contrast administration is contraindicated.

Pictorial review of hepatic echinococcosis: Ultrasound imaging and differential diagnosis.

Echinococcosis is a zoonotic disease caused by parasites belonging to the genus Echinococcus that primarily affect the liver. The western plateau and pastoral areas of China are high-risk regions for hepatic cystic echinococcosis and hepatic alveolar echinococcosis (HAE). The high late mortality rate associated with HAE underscores the critical need for early diagnosis to improve cure rates and mitigate the disease burden in endemic areas. Currently, the World Health Organization recommends ultrasonography as the preferred initial screening method for hepatic echinococcosis. However, distinguishing between specific types of lesions, such as those of hepatic cystic echinococcosis and HAE, and other focal liver lesions is challenging. To address this issue, contrast-enhanced ultrasound is recommended as a tool to differentiate solid and cysto-solid hepatic echinococcosis from other focal liver lesions, significantly enhancing diagnostic accuracy. In this comprehensive review, we discuss the progression of hepatic echinococcosis and detail the imaging features of various types of echinococcosis using conventional, contrast-enhanced, and intraoperative ultrasound techniques. Our objective is to provide robust imaging evidence and guidance for early diagnosis, clinical decision making, and postoperative follow-up in regions with high disease prevalence.

Comparison between Magnetic Resonance Elastography and Diffusion-Weighted Imaging in Differentiation of Benign and Malignant Hepatic Focal Lesions

Abstract Background With the widespread use of cross-sectional imaging techniques, the detection of focal liver lesions (FLLs) has become increasingly common. Many FLLs are incidental, and characterization with imaging is an effective means to reduce the need for invasive biopsies for histological confirmation. Objective To compare between MRE and diffusion–weighted imaging for differentiating benign and malignant hepatic focal lesions. Methods This Prospective study was conducte at department of Radiodiagnosis of National Hepatology and Tropical Medicine Research Institute “NHTMRI” in Cairo, Egypt, on 50 patients. Results Our study results revealed that in the comparison between diffusion and MRE to detect malignant lesions, the sensitivity and specificity of diffusion was 100% and 40.9% respectively, but for MRE was 89.3% and 100%, Also showed that MRE is significantly superior to DWI for distinguishing between malignant and benign FLLs, with 89% sensitivity, 100% specificity, and accuracy for MRE. Among all FLLs. the most frequent focal lesion HCC by 48.0% followed by hemangioma and inflammatory lesions by 26% &amp; 12% respectively. Conclusion MRE provides a non-invasive quantitative parameter that may be useful for differentiating common benign and malignant FLLs. MRE performed better than DWI, and shows great promise as a non-invasive alternative to biopsy for the differentiation of benign and malignant FLLs and demonstrates additive value to conventional imaging. However, there is opportunity for further enhancement of the technique, particularly with regard to optimization of image quality and evaluation of smaller FLLs.