Focal Liver Lesions Research Articles

Color Mapping using Ultrasound System-integrated Perfusion Software for Evaluation of Focal Liver Lesions: A Possible First Step for More Independent Reading.

To assess the value of using integrated parametric ultrasound software for contrast-enhanced ultrasonography (CEUS) of liver tumors. 107 patients with liver tumors were studied. CEUS were performed to detect focal lesions. Parametric images were based on continuous CINE LOOPs, from the early-arterial phase (15 s) to the portal-venous phase (1 min) generated by perfusion software. The evaluations of the parametric images and their dignity for liver lesions were performed independently by an experienced and a less-experienced investigator. Computed tomography, magnetic resonance imaging scans or histological analysis were used as references. High parametric image quality were obtained in all patients. Among the patients, 44% lesions were benign, 56% were malignant. The experienced investigator correctly classified 46 of 47 (98%) as benign, and 60 of 60 (100%) as malignant tumors based on the parametric images. The less-experienced investigator correctly classified 39 of 47 (83%) as benign, and 49 of 60 (82%) malignant tumors, acheaving a high statistical accuracy of 98% with this type of diagnostic. Parametric imaging for grading the malignant degree of tumor may be a good complement to existing ultrasound techniques and was particularly helpful for improving the assessments of the less-experienced examiner.

Application of liver-specific contrast agents for evaluation of focal liver lesions - Expert recommendations from the Gastrointestinal and Abdominal Imaging Workgroup of the German Roentgen Society.

Contrast-enhanced MRI is the imaging modality of choice for the detection and differential diagnosis of focal liver lesions. Liver-specific contrast agents (CAs) are now well established in addition to extracellular contrast agents. However, there is a lack of explicit recommendations reflecting the pros and cons of each specific contrast agent in the daily routine. Development of recommendations for the clinical application of liver-specific CAs by members of the Gastrointestinal and Abdominal Imaging Workgroup within the Germany Radiological Society, using methodology comparable to that of an S1 guideline with informal consensus. The diagnostic criteria for the evaluation of liver lesions are intentionally outside the scope of this article, as there are already plenty of excellent publications available. The application of liver-specific CAs in the daily routine is associated with advantages and disadvantages due to the specific pharmacokinetic and pharmacodynamic properties and necessitates adjustment of the imaging technique as well consideration during image interpretation. Recommendations for the application of liver-specific CAs are presented based on different clinical scenarios, taking into account current evidence and guidelines. · Both liver-specific and extracellular contrast agents are established. · Liver-specific contrast agents make it possible to draw conclusions about the hepatocellular function of a lesion. · Recommendations for the use of liver-specific contrast agents in the daily routine are presented. · Ringe KI, Fischbach F, Grenacher L et al. Einsatz leberspezifischer Kontrastmittel in der MRT zur Beurteilung von Leberläsionen - Expertenempfehlungen der AG Gastrointestinal- und Abdominaldiagnostik der Deutschen Röntgengesellschaft. Fortschr Röntgenstr 2023; DOI: 10.1055/a-2192-9921.

Review on Pediatric Malignant Focal Liver Lesions with Imaging Evaluation: Part II.

Malignant focal liver lesions (FLLs) represent various kinds of epithelial and mesenchymal tumors. In pediatric patients, the understanding of pediatric liver diseases and associated imaging manifestations is essential for making accurate diagnosis and differential diagnosis. This paper will discuss the latest knowledge of the common pediatric malignant FLLs, including undifferentiated embryonal sarcoma, rhabdomyosarcoma, epithelioid hemangioendothelioma, angiosarcoma, and malignant rhabdoid tumor. Medical imaging features are not only helpful for clinical diagnosis, but can also be useful in the evaluation and follow-up of pre- and post-treatment. The future perspectives of contrast-enhanced ultrasound (CEUS) enhancement patterns of FLLs in pediatric patients are also mentioned.

Application of a deep learning algorithm for three-dimensional T1-weighted gradient-echo imaging of gadoxetic acid-enhanced MRI in patients at a high risk of hepatocellular carcinoma.

To evaluate the efficacy of a vendor-specific deep learning reconstruction algorithm (DLRA) in enhancing image quality and focal lesion detection using three-dimensional T1-weighted gradient-echo images in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) in patients at a high risk of hepatocellular carcinoma. In this retrospective analysis, 83 high-risk patients with hepatocellular carcinoma underwent gadoxetic acid-enhanced liver MRI using a 3-T scanner. Triple arterial phase, high-resolution portal venous phase, and high-resolution hepatobiliary phase images were reconstructed using conventional reconstruction techniques and DLRA (AIRTM Recon DL; GE Healthcare) for subsequent comparison. Image quality and solid focal lesion detection were assessed by three abdominal radiologists and compared between conventional and DL methods. Focal liver lesion detection was evaluated using figures of merit (FOMs) from a jackknife alternative free-response receiver operating characteristic analysis on a per-lesion basis. DLRA-reconstructed images exhibited significantly improved overall image quality, image contrast, lesion conspicuity, vessel conspicuity, and liver edge sharpness and reduced subjective image noise, ringing artifacts, and motion artifacts compared to conventionally reconstructed images (all P < 0.05). Although there was no significant difference in the FOMs of non-cystic focal liver lesions between the conventional and DL methods, DLRA-reconstructed images showed notably higher pooled sensitivity than conventionally reconstructed images (P < 0.05) in all phases and higher detection rates for viable post-treatment HCCs in the arterial and hepatobiliary phases (all P < 0.05). Implementing DLRA can enhance the image quality in 3D T1-weighted gradient-echo sequences of gadoxetic acid-enhanced liver MRI examinations, leading to improved detection of viable post-treatment HCCs.

Association Between Gadoxetic Acid-Enhanced Magnetic Resonance Imaging, Organic Anion Transporters, and Farnesoid X Receptor in Benign Focal Liver Lesions.

The organic anion uptake and efflux transporters [organic anion-transporting polypeptide (OATP)1B1, OATP1B3 and multidrug resistance-associated protein (MRP)2 and MRP3] that mediate the transport of the hepatobiliary-specific contrast agent gadoxetate (Gd-EOB-DTPA) are direct or indirect targets of the farnesoid X receptor (FXR), a key regulator of bile acid and lipid homeostasis. In benign liver tumors, FXR expression and activation is not yet characterized. We investigated the expression and activation of FXR and its targets in hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) and their correlation with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Gd-EOB-DTPA MRI patterns were assessed by an expert radiologist. The intensity of the lesions on the hepatobiliary phase was correlated to mRNA expression levels of OATP1B1, OATP1B3, MRP2, MRP3, FXR, and small heterodimer partner (SHP) in fresh surgical specimens of patients with FNH or HCA subtypes. Normal and tumor sample pairs of 43 HCA and 14 FNH were included. All FNH (14/14) were hyperintense. Of the 34 HCA with available Gd-EOB-DTPA-enhanced MRI, 6 were hyperintense and 28 HCA were hypointense. OATP1B3 was downregulated in the hypointense tumors compared with normal surrounding liver tissue (2.77±3.59 vs. 12.9±15.6, P < 0.001). A significant positive correlation between FXR expression and activation and OATP1B3 expression level was found in the HCA cohort. SHP showed a trend toward downregulation in hypointense HCA. In conclusion, this study suggests that the MRI relative signal in HCA may reflect expression level and/or activity of SHP and FXR. Moreover, our data confirms the pivotal role of OATP1B3 in Gd-EOB-DTPA uptake in HCA. SIGNIFICANCE STATEMENT: FXR represents a valuable target for the treatment of liver disease and metabolic syndrome. Currently, two molecules, ursodeoxycholate and obeticholate, are approved for the treatment of primary biliary cirrhosis and cholestasis, with several compounds in clinical trials for the treatment of metabolic dysfunction-associated fatty liver disease. Because FXR expression and activation is associated with gadoxetate accumulation in HCA, an atypical gadoxetate-enhanced MRI pattern might arise in patients under FXR-targeted therapy, thereby complicating the differential diagnosis.

Ultrasound tissue scatterer distribution imaging: An adjunctive diagnostic tool for shear wave elastography in characterizing focal liver lesions

ObjectivesFocal liver lesion (FLL) is a prevalent finding in cross-sectional imaging, and distinguishing between benign and malignant FLLs is crucial for liver health management. While shear wave elastography (SWE) serves as a conventional quantitative ultrasound tool for evaluating FLLs, ultrasound tissue scatterer distribution imaging (TSI) emerges as a novel technique, employing the Nakagami statistical distribution parameter to estimate backscattered statistics for tissue characterization. In this prospective study, we explored the potential of TSI in characterizing FLLs and evaluated its diagnostic efficacy with that of SWE. MethodsA total of 235 participants (265 FLLs; the study group) were enrolled to undergo abdominal examinations, which included data acquisition from B-mode, SWE, and raw radiofrequency data for TSI construction. The area under the receiver operating characteristic curve (AUROC) was used to evaluate performance. A dataset of 20 patients (20 FLLs; the validation group) was additionally acquired to further evaluate the efficacy of the TSI cutoff value in FLL characterization. ResultsIn the study group, our findings revealed that while SWE achieved a success rate of 49.43 % in FLL measurements, TSI boasted a success rate of 100 %. In cases where SWE was effectively implemented, the AUROCs for characterizing FLLs using SWE and TSI stood at 0.84 and 0.83, respectively. For instances where SWE imaging failed, TSI achieved an AUROC of 0.78. Considering all cases, TSI presented an overall AUROC of 0.81. There was no statistically significant difference in AUROC values between TSI and SWE (p > 0.05). In the validation group, using a TSI cutoff value of 0.67, the AUROC for characterizing FLLs was 0.80. ConclusionsIn conclusion, ultrasound TSI holds promise as a supplementary diagnostic tool to SWE for characterizing FLLs.

Review on Pediatric Malignant Focal Liver Lesions with Imaging Evaluation: Part I

Malignant focal liver lesions (FLLs) are commonly reported in adults but rarely seen in the pediatric population. Due to the rarity, the understanding of these diseases is still very limited. In children, most malignant FLLs are congenital. It is very important to choose appropriate imaging examination concerning various factors. This paper will outline common pediatric malignant FLLs, including hepatoblastoma, hepatocellular carcinoma, and cholangiocarcinoma and discuss them against the background of the latest knowledge on comparable/similar tumors in adults. Medical imaging features are of vital importance for the non-invasive diagnosis and follow-up of treatment of FLLs in pediatric patients. The use of CEUS in pediatric patients for characterizing those FLLs that remain indeterminate on conventional B mode ultrasounds may be an effective option in the future and has great potential to be integrated into imaging algorithms without the risk of exposure to ionizing radiation.

Liver cancer stem cell dissemination and metastasis: uncovering the role of NRCAM in hepatocellular carcinoma

BackgroundLiver cancer stem cells (LCSCs) play an important role in hepatocellular carcinoma (HCC), but the mechanisms that link LCSCs to HCC metastasis remain largely unknown. This study aims to reveal the contributions of NRCAM to LCSC function and HCC metastasis, and further explore its mechanism in detail.Methods117 HCC and 29 non-HCC patients with focal liver lesions were collected and analyzed to assess the association between NRCAM and HCC metastasis. Single-cell RNA sequencing (scRNA-seq) was used to explore the biological characteristics of cells with high NRCAM expression in metastatic HCC. The role and mechanism of NRCAM in LCSC dissemination and metastasis was explored in vitro and in vivo using MYC-driven LCSC organoids from murine liver cells.ResultsSerum NRCAM is associated with HCC metastasis and poor prognosis. A scRNA-seq analysis identified that NRCAM was highly expressed in LCSCs with MYC activation in metastatic HCC. Moreover, NRCAM facilitated LCSC migration and invasion, which was confirmed in MYC-driven LCSC organoids. The in vivo tumor allografts demonstrated that NRCAM mediated intra-hepatic/lung HCC metastasis by enhancing the ability of LCSCs to escape from tumors into the bloodstream. Nrcam expression inhibition in LCSCs blocked HCC metastasis. Mechanistically, NRCAM activated epithelial-mesenchymal transition (EMT) and metastasis-related matrix metalloproteinases (MMPs) through the MACF1 mediated β-catenin signaling pathway in LCSCs.ConclusionsLCSCs typified by high NRCAM expression have a strong ability to invade and migrate, which is an important factor leading to HCC metastasis.

Diagnosis of focal liver lesions from ultrasound images using a pretrained residual neural network.

This study aims to develop a ResNet50-based deep learning model for focal liver lesion (FLL) classification in ultrasound images, comparing its performance with other models and prior research. We retrospectively collected 581 ultrasound images from the Chulabhorn Hospital's HCC surveillance and screening project (2010-2018). The dataset comprised five classes: non-FLL, hepatic cyst (Cyst), hemangioma (HMG), focal fatty sparing (FFS), and hepatocellular carcinoma (HCC). We conducted 5-fold cross-validation after random dataset partitioning, enhancing training data with data augmentation. Our models used modified pre-trained ResNet50, GGN, ResNet18, and VGG16 architectures. Model performance, assessed via confusion matrices for sensitivity, specificity, and accuracy, was compared across models and with prior studies. ResNet50 outperformed other models, achieving a 5-fold cross-validation accuracy of 87±2.2%. While VGG16 showed similar performance, it exhibited higher uncertainty. In the testing phase, the pretrained ResNet50 excelled in classifying non-FLL, cysts, and FFS. To compare with other research, ResNet50 surpassed the prior methods like two-layered feed-forward neural networks (FFNN) and CNN+ReLU in FLL diagnosis. ResNet50 exhibited good performance in FLL diagnosis, especially for HCC classification, suggesting its potential for developing computer-aided FLL diagnosis. However, further refinement is required for HCC and HMG classification in future studies.

Application of cryogenic technologies in complicated cases of surgical treatment of colorectal cancer liver metastases. Case report

Surgical resection is a standard treatment strategy for both primary and secondary malignant liver neoplasms. Liver transplantation is considered the most effective treatment method for colorectal cancer liver metastasis. Palliative debulking liver resection is one of the optimal alternative procedures for patients ineligible for a liver transplant, as it improves overall survival. Resectability rates depend on the functional efficiency of the remaining portion of the liver, which can be improved by increasing the future liver remnant. The application of cryogenic technologies for the ablation of a residual tumour invading the intraparenchymal segments of the major hepatic vessel may have advantages in cases where it is impossible to expand the scope of the surgical intervention due to the insufficiency of the future liver remnant and/or the presence of severe concomitant pathology.&#x0D; Objective — to present a case report of cryogenic technology application in complicated cases of surgical treatment of patients with colorectal cancer liver metastases.&#x0D; Case report. The case report presents an experience of cryoablation of the metastasis tissue with invasion into the intraparenchymal portal branch of Sg III, which was revealed during the I stage of the split in situ/ligation of the portal vein (ALPPS) liver resection. Cryoablation was performed by the application method with a single cryocycle and spontaneous thawing. Device — Cryo‑Pulse (Ukraine). Cryoagent — liquid nitrogen (T ‑180...‑196°С). Exposure time was 3 min. The specific complications associated with cryoablation were not observed.&#x0D; Conclusions. The application of cryogenic technologies for combined debulking surgical treatment of malignant focal liver lesions may be a safe treatment option in cases of residual tumour invasion into portal vein branches. The study is still ongoing.

Hepatocellular Carcinoma Diagnosis Based on Ultrasound Images Using Feature Selection Techniques and K-nearest Neighbor Classifier

Background: Liver cancer is one of the most common types of cancer, in which early detection plays a significant role in preventing progression and reducing mortality. Ultrasound is one of the methods of liver examination recommended by guidelines due to its performance in detecting focal liver lesions. These small lesions may be missed in the early stages or diagnosed only when the prognosis is poor. Objectives: This study aimed to implement the best classification model for two liver stages by extracting optimal feature subsets to be used in computer-aided diagnosis systems (CAD). Methods: The model classifies the liver into two stages using B-mode ultrasound images of the liver. It involves extracting statistical texture features utilizing discrete wavelet transform (DWT) and gray level co-occurrence matrix (GLCM). This study applied two feature selection methods: t-test and sequential forward floating selection (SFFS). The subset of selected features was presented to the k-nearest neighbor classifier for incorporation into a CAD system. Results: The accuracy, sensitivity, and specificity of the k-NN classifier were 98.75%, 98.82%, and 99.1%, respectively. Conclusions: Image analysis approaches were successfully performed to extract and select useful features. Therefore, this model is recommended for classifying two liver stages, normal and HCC.

Wavelet radiomics features from multiphase CT images for screening hepatocellular carcinoma: analysis and comparison

Early detection of liver malignancy based on medical image analysis plays a crucial role in patient prognosis and personalized treatment. This task, however, is challenging due to several factors, including medical data scarcity and limited training samples. This paper presents a study of three important aspects of radiomics feature from multiphase computed tomography (CT) for classifying hepatocellular carcinoma (HCC) and other focal liver lesions: wavelet-transformed feature extraction, relevant feature selection, and radiomics features-based classification under the inadequate training samples. Our analysis shows that combining radiomics features extracted from the wavelet and original CT domains enhance the classification performance significantly, compared with using those extracted from the wavelet or original domain only. To facilitate the multi-domain and multiphase radiomics feature combination, we introduce a logistic sparsity-based model for feature selection with Bayesian optimization and find that the proposed model yields more discriminative and relevant features than several existing methods, including filter-based, wrapper-based, or other model-based techniques. In addition, we present analysis and performance comparison with several recent deep convolutional neural network (CNN)-based feature models proposed for hepatic lesion diagnosis. The results show that under the inadequate data scenario, the proposed wavelet radiomics feature model produces comparable, if not higher, performance metrics than the CNN-based feature models in terms of area under the curve.

Development and evaluation of an integrated liver nodule diagnostic method by combining the liver segment division and lesion localization/classification models for enhanced focal liver lesion detection.

The purpose of the study was to develop a liver nodule diagnostic method that accurately localizes and classifies focal liver lesions and identifies the specific liver segments in which they reside by integrating a liver segment division algorithm using a four-dimensional (4D) fully convolutional residual network (FC-ResNet) with a localization and classification model. We retrospectively collected data and divided 106 gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance examinations into Case-sets 1, 2, and 3. A liver segment division algorithm was developed using a 4D FC-ResNet and trained with semi-automatically created silver-standard annotations; performance was evaluated using manually created gold-standard annotations by calculating the Dice scores for each liver segment. The performance of the liver nodule diagnostic method was assessed by comparing the results with those of the original radiology reports. The mean Dice score between the output of the liver segment division model and the gold standard was 0.643 for Case-set 2 (normal liver contours) and 0.534 for Case-set 1 (deformed liver contours). Among the 64 lesions in Case-set 3, the diagnostic method localized 37 lesions, classified 33 lesions, and identified the liver segments for 30 lesions. A total of 28 lesions were true positives, matching the original radiology reports. The liver nodule diagnostic method, which integrates a liver segment division algorithm with a lesion localization and classification model, exhibits great potential for localizing and classifying focal liver lesions and identifying the liver segments in which they reside. Further improvements and validation using larger sample sizes will enhance its performance and clinical applicability.

Comparative Analysis of Contrast-Enhanced Ultrasound and Computed Tomography in the Differential Diagnosis of Focal Liver Lesions in Patients with a History of Advanced Cancer

Цель. Проанализировать диагностическую эффективность мультипараметрического ультразвукового исследования с контрастным усилением в дифференциальной диагностике очаговых образований печени у онкопациентов и сравнить полученные данные с компьютерной томографией и гистологическим заключением.&#x0D; Материалы и методы. Проведён ретроспективный анализ результатов исследований 123 пациентов с очаговыми изменения печени, из них 96 женщин (средний возраст 56,1 ±13,6) и 27 мужчин (средний возраст 55,0±14,0). Всем пациентам проводилось мультипараметрическое ультразвуковое исследование и компьютерная томография с контрастированием. При подозрении на злокачественный процесс выполнялась трепан-биопсия печени под ультразвуковым наведением. В случае выявления признаков, характерных для доброкачественных образований, пациент находился на динамическом контроле каждые 3 месяца в первый год наблюдения, отсутствие динамики через 6-12 месяцев свидетельствовало в пользу доброкачественного процесса. При увеличении размеров образования также выполнялась морфологическая верификация.&#x0D; Результаты. Результаты для серошкального режима составили: чуствительность (Ч)-58,1%, специфичность (С)-68,4%, точность (Т)-60,2%, прогностическая ценность положительного результата (ПЦПР)- 87,8%, прогностическая ценность отрицательного результата (ПЦОР)-29,5%. Эффективность контрастно-усиленного ультразвукового исследования (КУУЗИ) значимо превышала исследование в традиционном серошкальном режиме и составила: Ч-90,5%, С-84,2%, Т-89,2%, ПЦПР-95,7%, ПЦОР-69,6%. Для компьютерной томографии с контрастным усилением (КТ с КУ) результаты были сопоставимы с КУУЗИ и составили: Ч-83,6%, С-78,9%, Т-82,6%, ПЦПР-93,8%, ПЦОР-55,6%.&#x0D; Полученные нами значения подтверждают высокую информативность КУУЗИ в оценке очагового поражения печени, в связи с чем в ряде случаев (отсутствие технической возможности проведения или наличие противопоказаний к КТ с КУ, а также полученные неоднозначные результаты по другим методика) может выступить в качестве метода выбора.&#x0D; Заключение. Мультимодальная диагностика превосходит единый метод визуализации по чувствительности скрининга и точности диагностики. КТ с КУ и КУУЗИ дополняют друг друга при дифференциальной диагностике очагов в печени неясного генеза. Использование КТ с КУ в сочетании с КУУЗИ показывает клиническую ценность для пациентов, что особенно важно у лиц с отягощённым онкоанамнезом.

MR Fingerprinting for Contrast Agent-free and Quantitative Characterization of Focal Liver Lesions.

Purpose To evaluate the feasibility of liver MR fingerprinting (MRF) for quantitative characterization and diagnosis of focal liver lesions. Materials and Methods This single-site, prospective study included 89 participants (mean age, 62 years ± 15 [SD]; 45 women, 44 men) with various focal liver lesions who underwent MRI between October 2021 and August 2022. The participants underwent routine clinical MRI, non-contrast-enhanced liver MRF, and reference quantitative MRI with a 1.5-T MRI scanner. The bias and repeatability of the MRF measurements were assessed using linear regression, Bland-Altman plots, and coefficients of variation. The diagnostic capability of MRF-derived T1, T2, T2*, proton density fat fraction (PDFF), and a combination of these metrics to distinguish benign from malignant lesions was analyzed according to the area under the receiver operating characteristic curve (AUC). Results Liver MRF measurements showed moderate to high agreement with reference measurements (intraclass correlation = 0.94, 0.77, 0.45, and 0.61 for T1, T2, T2*, and PDFF, respectively), with underestimation of T2 values (mean bias in lesion = -0.5%, -29%, 5.8%, and -8.2% for T1, T2, T2*, and PDFF, respectively). The median coefficients of variation for repeatability of T1, T2, and T2* values were 2.5% (IQR, 3.6%), 3.1% (IQR, 5.6%), and 6.6% (IQR, 13.9%), respectively. After considering multicollinearity, a combination of MRF measurements showed a high diagnostic performance in differentiating benign from malignant lesions (AUC = 0.92 [95% CI: 0.86, 0.98]). Conclusion Liver MRF enabled the quantitative characterization of various focal liver lesions in a single breath-hold acquisition. Keywords: MR Imaging, Abdomen/GI, Liver, Imaging Sequences, Technical Aspects, Tissue Characterization, Technology Assessment, Diagnosis, Liver Lesions, MR Fingerprinting, Quantitative Characterization Supplemental material is available for this article. © RSNA, 2023.

Characterization of solid liver focal lesions by CEUS: monocentric Italian experience

Characterization of solid liver focal lesions by CEUS: monocentric Italian experience

Comments and illustrations of the WFUMB CEUS liver guidelines: Cystic fibrosis associated liver disease.

In this series of articles with comments and illustrations on the World Federation for Medicine and Biology (WFUMB) guidelines on contrast-enhanced ultrasound (CEUS) the topics of very rare focal liver lesions (FLL) are discussed. Improving the detection and characterization of the most common FLL are the main topics of these guidelines. The focus of this review is on the many manifestations of cystic fibrosis-related liver disease (CFLD). These include focal biliary fibrosis, liver cirrhosis, vascular manifestations with nodular regenerative hyperplasia and portal hypertension with or without cirrhosis. This article describes the diverse changes of liver involvement in cystic fibrosis and their appearance on ultrasound, duplex sonography, and contrast enhanced ultrasonography. This knowledge and the imaging should help to recognize liver manifestations in time and enable a correct interpretation of ultrasound images in CF in the corresponding clinical situation.

Clinical and Radiological Parameters to Discriminate Tuberculous Peritonitis and Peritoneal Carcinomatosis.

It is challenging to differentiate between tuberculous peritonitis and peritoneal carcinomatosis due to their insidious nature and intersecting symptoms. Computed tomography (CT) is the modality of choice in evaluating diffuse peritoneal disease. We conducted an ambispective analysis of patients suspected as having tuberculous peritonitis or peritoneal tuberculosis between Jan 2020 to Dec 2021. The study aimed to identify the clinical and radiological features differentiating the two entities. We included 44 cases of tuberculous peritonitis and 45 cases of peritoneal carcinomatosis, with a median age of 31.5 (23.5-40) and 52 (46-61) years, respectively (p ≤ 0.001). Fever, past history of tuberculosis, and loss of weight were significantly associated with tuberculous peritonitis (p ≤ 0.001, p = 0.038 and p = 0.001). Pain in the abdomen and history of malignancy were significantly associated with peritoneal carcinomatosis (p = 0.038 and p ≤ 0.001). Ascites was the most common radiological finding. Loculated ascites, splenomegaly and conglomeration of lymph nodes predicted tuberculous peritonitis significantly (p ≤ 0.001, p = 0.010, p = 0.038). Focal liver lesion(s) and nodular omental involvement were significantly associated with peritoneal carcinomatosis (p = 0.011, p = 0.029). The use of clinical features in conjunction with radiological findings provide better diagnostic yields because of overlapping imaging findings.

Blebbing of the plasma membrane of lymphocytes as a marker of endothelial dysfunction in the development of post-resection insufficiency in patients with focal liver lesions

Purpose of the study. To evaluate the intensity of blebbing of the plasma membrane of lymphocytes and the formation of microparticles of lymphocytic origin in patients with postresection hepatic failure. Material and methods. The study involved 54 patients with focal liver diseases. The study involved 32 (59%) women, 22 (41%) men. The average age was 59.5 [49.75; 66,00]. Patients were divided into groups, 1 group - 10 patients with developed acute liver failure and 2 group - 44 patients with a favorable course of postoperative period. The following surgical interventions were performed: 36 (67%) patients underwent surgery - laparotomy, segmental liver resection, 10 (18%) - left-sided hemihepatectomy and 8 (15%) - right-sided hemihepatectomy. Results. Predictors of early postoperative hepatic failure are a decrease in initial blebbing and an increase in terminal blebbing and free microparticles of lymphocytic origin. Conclusions. Thus, changes in lymphocyte blebbing and the presence of free microparticles of lymphocytic origin are due to the development of endothelial insufficiency and apoptosis of lymphocytes in the context of liver failure and are determined by the reduced function of residual liver volume.

Contrast-enhanced ultrasound (CEUS) for characterisation of focal liver lesions

Due to the trend towards increased use of imaging and rising awareness among high-risk patients, gastroenterologists and hepatologists are more frequently confronted with patients with focal liver lesions. In the differentiation of these lesions, CT and MRI have increasingly found their way into primary diagnostic steps in everyday clinical practice. Contrast-enhanced sonography, on the other hand, is a very effective and cost-efficient method for assessing focal liver lesions. The success of the method is not only based on the visualisation of microvascularisation in real time. If sonography is performed by the treating physician, he can use the exact knowledge of history and clinical findings to specifically adapt the examination procedure and to interpret the sonographic findings with greater accuracy ("clinical sonography"). At the same time, the method enables the practitioner to combine diagnostics and management decisions in his or her own hands. To achieve excellent results with contrast-enhanced sonography-as with any other imaging method-it is necessary that the examiner is sufficiently qualified.This article systematically presents the sonographic characteristics of the most common liver lesions and clearly shows their contrast patterns using videos (available via QR code). The article illustrates that CEUS could-and from the authors' point of view, should-have an even greater significance in the future.