Hepatic Imaging Research Articles

Etiology, Pathogenesis, Diagnosis, and Practical Implications of Hepatocellular Neoplasms.

Simple SummaryIn recent years, significant progress has been made in elucidating the mechanisms via which hepatocellular neoplasms, i.e., hepatocellular adenoma and hepatocellular carcinoma, arise. Hepatocellular carcinoma usually occurs in livers with chronic disease, due to deregulation of important intracellular pathways of signal transmission. Recent studies suggest that subclassification of hepatocellular carcinoma is practically useful. On the other hand, subclassification of hepatocellular adenomas has been well established through correlation of molecular alterations with morphology and protein expression. Advances in hepatic imaging have resulted in a new approach for diagnostic assessment of lesions arising in advanced chronic liver disease. Histologic examination, aided by immunohistochemistry, is the gold standard for the diagnosis and subclassification of hepatocellular neoplasms, while clinicopathologic correlation is essential for best patient management. We summarize the etiology and pathogenesis of hepatocellular neoplasms, provide practical information for their histologic diagnosis, and address various frequently asked questions regarding their diagnosis and practical implications.Hepatocellular carcinoma (HCC), a major global contributor of cancer death, usually arises in a background of chronic liver disease, as a result of molecular changes that deregulate important signal transduction pathways. Recent studies have shown that certain molecular changes of hepatocarcinogenesis are associated with clinicopathologic features and prognosis, suggesting that subclassification of HCC is practically useful. On the other hand, subclassification of hepatocellular adenomas (HCAs), a heterogenous group of neoplasms, has been well established on the basis of genotype–phenotype correlations. Histologic examination, aided by immunohistochemistry, is the gold standard for the diagnosis and subclassification of HCA and HCC, while clinicopathologic correlation is essential for best patient management. Advances in clinico-radio-pathologic correlation have introduced a new approach for the diagnostic assessment of lesions arising in advanced chronic liver disease by imaging (LI-RADS). The rapid expansion of knowledge concerning the molecular pathogenesis of HCC is now starting to produce new therapeutic approaches through precision oncology. This review summarizes the etiology and pathogenesis of HCA and HCC, provides practical information for their histologic diagnosis (including an algorithmic approach), and addresses a variety of frequently asked questions regarding the diagnosis and practical implications of these neoplasms.

Evaluating of the Quality of Hepatic Diffusion Weighted Imaging Using Multiband Imaging With Variable-Rate Selective Excitation.

To assess the image quality of diffusion-weighted imaging (DWI) using multiband (MB) imaging with variable-rate selective excitation (VERSE) and compare it to conventional DWI. We retrospectively evaluated hepatic DWI images of patients (n = 76) according to either the conventional method (SENSE, acceleration factor = 2) (n = 38) or fast scanning method (MB imaging with VERSE, acceleration factor = 2 × 2) (n = 38). We also conducted a volunteer study (n = 15) for those scanning methods. During quantitative analysis, the signal-to-noise ratio (SNR), apparent diffusion coefficient values, and contrast in the liver, spleen, and spinal cord were compared between the 2 groups. During qualitative analysis, all images were independently and blindly evaluated by 2 board-certified radiologists. The image contrast, noise, artifacts, and sharpness were assessed, and the performance of classification was measured using receiver operating characteristic curve analysis. In the retrospective study, the SNRs of the hepatic parenchyma and spinal cord between the 2 protocols were significantly different (liver, 8.9 [interquartile range {IQR}, 7.6-12.2] vs 13.0 [IQR, 10.0-16.7]; P < 0.001 and spinal cord, 6.0 [IQR, 4.7-9.4] vs 4.3 [IQR, 3.8-6.8]; P < 0.02). No significant differences between the 2 protocols in the other retrospective analyses were noted. In the receiver operating characteristic curve analysis, area under the curve was 0.49 (95% confidence intervals, 0.40-0.58). Multiband VERSE reduced scan time and SNR of hepatic DWI; however, subjective image quality parameters were not significantly impacted.

Correlation between hepatorenal index and attenuation imaging for assessing hepatic steatosis.

Hepatic steatosis screening is required to assess high-risk populations, identify those for intervention, monitor response and prevent disease progression and complications. Liver biopsy and magnetic resonance imaging proton density fat fraction are current gold standards, but are limited by biopsy risk factors, patient tolerance and cost. Non-invasive, cost-effective, semi-quantitative and quantitative ultrasound assessment exists. The aim of this study was to assess the correlation between the semi-quantitative hepatorenal index (HRI) to assess hepatic steatosis using the quantitative attenuation imaging (ATI) as a reference standard, in adults with varied suspected liver pathologies. Data were collected prospectively between April 2019 and March 2020 at a tertiary institution on any patient >18 years referred to US assessment of suspected liver pathology. The only exclusion criteria were absent or invalid HRI or ATI measurements. Three hundred fifty eight patients were included. There was a significant weak positive correlation between HRI and ATI (r = 0.351, P < 0.001) and between HRI steatosis grade (SG) and ATI SG (r = 0.329, P < 0.001), using previously established cut-off values. With ATI as the reference standard, there was no significant correlation between HRI and hepatic steatosis within steatosis grades, nor for no (SG = 0) or any (SG > 0) hepatic steatosis. Our study in a typical heterogeneous clinical population suggests the semi-quantitative HRI is of limited use in hepatic steatosis imaging. As HRI is the objective measure of the subjective brightness (B)-mode assessment, this imaging feature may not be as reliable as previously thought. Quantitative ATI may be the preferred non-invasive technique for hepatic steatosis assessment.

Unusual Neurological Manifestation of Langerhans Cell Histiocytosis in an Adult.

Langerhans Cell Histiocytosis is a rare disorder characterized by an abnormal proliferation of Langerhans cells in one or multiple organs. It rarely presents with a central vestibular involvement. We report a case of a multisystem Langerhans Cell Histiocytosis with mucosal, hepatic, and neurological involvement, presenting with dizziness and balance disorders. A 39-year-old woman with a histopathologically confirmed mucosal palatal Langerhans Cell Histiocytosis presented with a history of dizziness for a year. Vestibular examination revealed a saccadic eyes pursuit, an up beating spontaneous nystagmus, a bilateral gaze nystagmus and a prolonged positional nystagmus, in the supine roll test. Pure tone audiometry showed a slight left sensorineural hearing loss at the 8000Hz frequency. Computed tomography (CT) scan showed a bilateral maxillary sinus fullness and a peripheral osteosclerosis of the surrounding bony walls. Hepatic magnetic resonance imaging (MRI) showed a typical hepatic involvement with a hepatomegaly with countless cysts. Temporal bone CT scan and MRI were normal. Cerebral MRI showed an hyperintense nodular signal at T2 FLAIR weighted images lateral to the right pons, at the level of the left middle cerebellar peduncle and at the left mesencephalon. Balance disorders can rarely present a sign of a degenerative neurological cerebellar involvement. Such a rare manifestation can present in different neurological disorders such as Langerhans' cell Histiocytosis.

Clinical application of deep learning and radiomics in hepatic disease imaging: a systematic scoping review.

Artificial intelligence (AI) has begun to play a pivotal role in hepatic imaging. This systematic scoping review summarizes the latest progress of AI in evaluating hepatic diseases based on computed tomography (CT) and magnetic resonance (MR) imaging. We searched PubMed and Web of Science for publications, using terms related to deep learning, radiomics, imaging methods (CT or MR), and the liver. Two reviewers independently selected articles and extracted data from each eligible article. The Quality Assessment of Diagnostic Accuracy Studies-AI (QUADAS-AI) tool was used to assess the risk of bias and concerns regarding applicability. The screening identified 45 high-quality publications from 235 candidates, including 8 on diffuse liver diseases and 37 on focal liver lesions. Nine studies used deep learning and 36 studies used radiomics. All 45 studies were rated as low risk of bias in patient selection and workflow, but 36 (80%) were rated as high risk of bias in the index test because they lacked external validation. In terms of concerns regarding applicability, all 45 studies were rated as low concerns. These studies demonstrated that deep learning and radiomics can evaluate liver fibrosis, cirrhosis, portal hypertension, and a series of complications caused by cirrhosis, predict the prognosis of malignant hepatic tumors, and differentiate focal hepatic lesions. The latest studies have shown that deep learning and radiomics based on hepatic CT and MR imaging have potential application value in the diagnosis, treatment evaluation, and prognosis prediction of common liver diseases. The AI methods may become useful tools to support clinical decision-making in the future. Deep learning and radiomics have shown their potential in the diagnosis, treatment evaluation, and prognosis prediction of a series of common diffuse liver diseases and focal liver lesions.

A rare genetic variant in the manganese transporter SLC30A10 and elevated liver enzymes in the general population.

A genetic variant in the manganese transporter SLC30A10 (rs188273166, p.Thr95Ile) was associated with increased plasma alanine transaminase (ALT) in a recent genome-wide association study in the UK Biobank (UKB). The aims of the present study were to test the association of rs188273166 with ALT in an independent cohort, and to begin to assess the clinical, hepatic, and biochemical phenotypes associated with the variant. We included n = 334,886 white participants from UKB, including 14,462 with hepatic magnetic resonance imaging (MRI), and n = 113,612 individuals from the Copenhagen City Heart Study and the Copenhagen General Population Study combined. Genotyping SLC30A10 p.Thr95Ile identified 816 heterozygotes in the UKB and 111 heterozygotes in the Copenhagen cohort. Compared to noncarriers, heterozygotes had 4 and 5U/L higher levels of ALT in the UKB and Copenhagen cohort, respectively, and 3U/L higher plasma aspartate transaminase and gamma-glutamyl transferase in the UKB. Heterozygotes also had higher corrected T1 on liver MRI, a marker of hepatic inflammation (p = 4 × 10-7), but no change in MRI-quantified steatosis (p = 0.57). Plasma manganese was within the normal range in nine heterozygotes that provided new blood samples. SLC30A10 p.Thr95Ile heterozygotes had an eightfold increased risk of biliary tract cancer in UKB (p = 4 × 10-7), but this association was not replicated in the Copenhagen cohort. SLC30A10 p.Thr95Ile was associated with elevated liver enzymes in two large general population cohorts, and with MRI-quantified hepatic inflammation. A rare genetic variant (p.Thr95Ile) in the manganese transporter SLC30A10 is associated with elevated plasma alanine transaminase (ALT) and higher corrected T1 on liver MRI, markers of liver inflammation. These data support that the variant may increase the risk of liver disease.

Ultrasound image analysis for detection of fatty liver and grading its severity in buffaloes at Mosul, Iraq

The study aimed to (ⅰ) examines whether quantitative and qualitative digital analysis of hepatic ultrasound images can be used to detect fatty liver and grading its severity, (ⅱ) to estimate the concentration of serum β-hydroxybutyrate content in normal and diseased animals. A total of 50 buffaloes (15 clinically normal and 35 suffered from decreased milk production, loss of appetite, and loss of body weight) 2-4 weeks after parturition were studied. Buffaloes were examined by real-time ultrasound using a 3.5 MHz convex probe. Ultrasound images were saved for qualitative and quantitative analysis, using computer aid Fatty-Liver software (programmed in Matlab language). Based on the digital analysis of ultrasound images, the diseased buffaloes were classified as mild (n=20), moderate (n=7) and severe (n=8) fatty liver affection. Results indicated that the concentration of β-hydroxybutyrate estimated via ELISA were 0.409, 0.735, 0.923, 1.708 mmol/dL in normal, mild, moderate, and severe diseased buffaloes respectively. However, a significant difference has been encountered among normal and diseased animals. It has been concluded that buffaloes at Mosul suffered from fatty liver and digital analysis of ultrasound images was a suitable method for clinical diagnosis, furthermore, estimation of β-hydroxybutyrate was a suitable method for laboratory diagnosis.

Invited Commentary: Issues at the Interface of Hepatic Imaging and Hepatic Surgery.

Invited Commentary: Issues at the Interface of Hepatic Imaging and Hepatic Surgery.

Relationship Between Greyscale Ultrasound Grading of Hepatic Steatosis and Attenuation Imaging.

BackgroundNon-alcoholic fatty liver disease (NAFLD) has been rising worldwide due to the rising public health threat of metabolic syndrome. Because non-alcoholic steatohepatitis can proceed to liver fibrosis and cirrhosis, early identification and monitoring are critical for management. For the examination of NAFLD, greyscale ultrasound has been frequently employed. A relatively new technique, attenuation imaging (ATI), can quantitatively evaluate and compute the attenuation coefficient (AC). Our goal was to evaluate the performance and cutoff values of attenuation imaging to identify hepatic steatosis. As a reference standard, greyscale ultrasound was employed.MethodA total of 207 patients were assessed from June to November 2021 after getting informed consent. The association between ATI values and greyscale grading to diagnose hepatic steatosis was investigated, and the Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the data. In the analysis, the Spearman correlation and area under the receiver operating characteristic curve (AUROC) tests were performed. Receiver operating characteristic curve analysis was also used to assess ATI’s diagnostic capability and cutoff values.ResultThe correlation between ATI values and hepatic steatosis grades on greyscale was statistically significant (p < 0.05). Greyscale grading and ATI levels have a correlation coefficient (r) of 0.85, indicating a strong association. Steatosis grades 1, 2, and 3 had threshold ATI values of 0.65, 0.73, and 0.96 dB/cm/MHz, respectively. According to greyscale, the diagnostic ability of ATI for steatosis grades 1, 2, and 3 were 0.948 (95% CI: 0.917-0.979), 0.978 (95% CI: 0.961-0.995), and 1.000 (95% CI: 1.000-1.000), respectively.ConclusionsAttenuation imaging is a reliable method for identifying liver steatosis, with great performance and a strong association with the greyscale ultrasound.

GH/IGF-1 axis in a large cohort of ß-thalassemia major adult patients: a cross-sectional study

PurposeGH deficit (GHD) could represent an endocrine issue in ß-Thalassemia Major (ßTM) patients. GH/IGF-1 axis has not been extensively explored in ßTM adults, so far. We aim to assess GHD and IGF-1 deficiency prevalence in ßTM adult population, focusing on the relationship with liver disease.MethodsCross-sectional multi-centre study conducted on 81 adult ßTM patients (44 males, mean age 41 ± 8 years) on transfusion and chelation therapy. GHD was investigated by GHRH + arginine test. IGF-1 levels, routine biochemical exams, Fibroscan, Hepatic Magnetic Resonance Imaging (MRI) and pituitary MRI were collected.ResultsEighteen patients were affected by GHD and 63 were not (nGHD) according to GHRH + arginine test, while basal GH levels did not differ. GHD was associated with a higher BMI and a worse lipid profile (p < 0.05). No significant differences were observed regarding liver function between the two groups. Pituitary MRI scan was normal except for one case of empty sella. The 94.4% and 93.6% of GHD and nGHD, respectively, presented lower IGF-1 levels than the reference range, and mean IGF-1 SDS was significantly lower in GHD patients.ConclusionGHD is frequent in adult ßTM patients and is associated with higher BMI and worse lipid profile. nGHD patients present lower IGF-1 levels as well. There was no relationship between IGF-1 levels and liver disease. Further, multicentric studies with larger cohorts and standardized diagnostic protocols are needed.

Assessment of dynamic hepatic and renal imaging changes in COVID-19 survivors using T1 mapping and IVIM-DWI.

PurposeTo explore the imaging changes of the liver and kidneys in COVID-19 survivors using variable flip angle (VFA) T1 mapping and intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI).MethodsThis prospective study included 37 discharged COVID-19 participants and 24 age-matched non-COVID-19 volunteers who underwent abdominal MRI with VFA T1 mapping and IVIM-DWI sequencing as a COVID-19 group and control group, respectively. Among those discharged COVID-19 participants, 23 patients underwent two follow-up MRI scans, and were enrolled as the 3-month follow-up group and 1-year follow-up group, respectively. The demographics, clinical characteristics, and laboratory tests were collected. Imaging parameters of the liver and kidneys were measured. All collected values were compared among different groups.ResultsThe 3-month follow-up group had the lowest hepatic T1 value, which was significantly lower than the value in the control group (P < 0.001). Additionally, the 3-month follow-up group had the highest hepatic ADC and D values, cortical ADC and f values, which were significantly higher than those in the control group (for all, P < 0.05). The hepatic D value in the 1-year follow-up group decreased significantly in comparison with that in the 3-month follow-up group (P = 0.001). Compared to non-severe patients, severe cases had significantly higher hepatic D* and f*D* values (P = 0.031, P = 0.015, respectively).ConclusionThe dynamic alterations of hepatic and renal imaging parameters detected with T1 mapping and IVIM-DWI suggested that COVID-19 survivors might develop mild, non-symptomatic liver and kidney impairments, of which liver impairment could probably relieve over time and kidney impairment might be long-existing.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00261-022-03471-y.

Non-Contrast-Enhanced and Contrast-Enhanced Magnetic Resonance Angiography in Living Donor Liver Vascular Anatomy.

Background: Since the advent of a new generation of inflow-sensitive inversion recovery (IFIR) technology, three-dimensional non-contrast-enhanced magnetic resonance angiography is being used to obtain hepatic vessel images without applying gadolinium contrast agent. The purpose of this study was to explore the diagnostic efficacy of non-contrast-enhanced magnetic resonance angiography (non-CE MRA), contrast-enhanced magnetic resonance angiography (CMRA), and computed tomography angiography (CTA) in the preoperative evaluation of living liver donors. Methods: A total of 43 liver donor candidates who were evaluated for living donor liver transplantation completed examinations. Donors’ age, gender, renal function (eGFR), and previous CTA and imaging were recorded before non-CE MRA and CMRA. CTA images were used as the standard. Results: Five different classifications of hepatic artery patterns (types I, III, V, VI, VIII) and three different classifications of portal vein patterns (types I, II, and III) were identified among 43 candidates. The pretransplant vascular anatomy was well identified using combined non-CE MRA and CMRA of hepatic arteries (100%), PVs (98%), and hepatic veins (100%) compared with CTA images. Non-CE MRA images had significantly stronger contrast signal intensity of portal veins (p < 0.01) and hepatic veins (p < 0.01) than CMRA. No differences were found in signal intensity of the hepatic artery between non-CE MRA and CMRA. Conclusion: Combined non-CE MRA and CMRA demonstrate comparable diagnostic ability to CTA and provide enhanced biliary anatomy information that assures optimum donor safety.

Presentation of Congenital Portosystemic Shunts in Children.

Background: Congenital portosystemic shunts (CPSS) are rare vascular anomalies resulting in communications between the portal venous system and the systemic venous circulation, affecting an estimated 30,000 to 50,000 live births. CPSS can present at any age as a multi-system disease of variable severity mimicking both common and rare pediatric conditions. Case presentations: Case A: A vascular malformation was identified in the liver of a 10-year-old girl with tall stature, advanced somatic maturation, insulin resistance with hyperinsulinemia, hyperandrogenemia and transient hematuria. Work-up also suggested elevated pulmonary pressures. Case B: A young girl with trisomy 8 mosaicism with a history of neonatal hypoglycemia, transient neonatal cholestasis and tall stature presented newly increased aminotransferase levels at 6 years of age. Case C: A 3-year-old boy with speech delay, tall stature and abdominal pain underwent abdominal ultrasound (US) showing multiple liver nodules, diagnosed as liver hemangiomas by hepatic magnetic resonance imaging (MRI). Management and outcome: After identification of a venous malformation on liver Doppler US, all three patients were referred to a specialized liver center for further work-up within 12 to 18 months from diagnosis. Angio-computed tomography (CT) scan confirmed the presence of either an intrahepatic or extrahepatic CPSS with multiples liver nodules. All three had a hyperintense signal in the globus pallidus on T1 weighted cerebral MRI. Right heart catheterization confirmed pulmonary hypertension in cases A and C. Shunts were closed either using an endovascular or surgical approach. Liver nodules were either surgically removed if there was a risk of malignant degeneration or closely monitored by serial imaging when benign. Conclusion: These cases illustrate most of the common chief complaints and manifestations of CPSS. Liver Doppler US is the key to diagnosis. Considering portosystemic shunts in the diagnostic work-up of a patient with unexplained endocrine, liver, gastro-intestinal, cardiovascular, hematological, renal or neurocognitive disorder is important as prompt referral to a specialized center may significantly impact patient outcome.

Hepatic dual-contrast CT imaging: slow triple kVp switching CT with CNN-based sinogram completion and material decomposition.

Purpose: Dual-contrast protocols are a promising clinical multienergy computed tomography (CT) application for focal liver lesion detection and characterization. One avenue to enable multienergy CT is the introduction of photon-counting detectors (PCD). Although clinical translation is highly desired because of the diagnostic benefits of PCDs, it will still be a decade or more before they are broadly available. In our work, we investigated an alternative solution that can be implemented on widely used conventional CT systems (single source and integrating detector) to perform multimaterial spectral decomposition for dual-contrast imaging. Approach: We propose to slowly alternate the x-ray tube voltage between 3 kVp levels so each kVp level covers a few degrees of gantry rotation. This leads to the challenge of sparsely sampled projection data in each energy level. Performing the material decomposition (MD) in the sinogram domain is not directly possible as the projection images of the three energy levels are not angularly aligned. In order to overcome this challenge, we developed a convolutional neural network (CNN) framework for sparse sinogram completion (SC) and MD. To evaluate the feasibility of the slow kVp switching scheme, simulation studies of an abdominal phantom, which included liver lesions, were conducted. Results: The line-integral SC network yielded sinograms with a pixel-wise of the line-integrals compared to the ground truth. This provided acceptable image quality up to a switching angle of 9deg per kVp. The MD network we developed allowed us to differentiate iodine and gadolinium in the sinogram domain. The average relative quantification errors for iodine and gadolinium were below 10%. Conclusions: We developed a slow triple kVp switching data acquisition scheme and a CNN-based data processing pipeline. Results from a digital phantom validation illustrate the potential for future applications of dual-contrast agent protocols on practically available single-energy CT systems.

The absence of warfarin treatment and situs inversus are associated with the occurrence of hepatocellular carcinoma after Fontan surgery.

Hepatocellular carcinoma (HCC) is a long-term complication of Fontan-associated liver disease (FALD). However, risk factors for HCC in patients with FALD remain unclear. This study aimed to identify factors associated with HCC development post-Fontan procedure. We retrospectively examined 103 post-Fontan patients who underwent hepatic imaging at our institution. HCC incidence and patient characteristics were analyzed. A Cox proportional hazards model was used to identify risk factors for HCC. The median interval between Fontan surgery and final hepatic imaging was 19.6 (1.0-37.7) years. Among 103 patients, nine developed HCC. The cumulative incidence rates of HCC at 10, 20, and 30years postoperatively were 0%, 7%, and 13%, respectively. In the univariate analysis, age at Fontan surgery, situs inversus, and warfarin absence were associated with HCC occurrence. The multivariate analysis identified the warfarin absence (adjusted hazard ratio [aHR], 22.71; 95% confidence interval: 3.29-507.1; p = 0.0005) and situs inversus (aHR, 14.36; 95% confidence interval: 2.75-105.5; p = 0.002) as risk factors. The prevalence of situs inversus and the warfarin absence was 12% and 50%, respectively. The 20- and 30-year incidence rates of HCC among patients who received warfarin were 0% and 7%, respectively, while those among patients who did not receive warfarin were 14% and 21%, respectively. HCC incidence was significantly higher in the non-warfarin group than in the warfarin group (p = 0.006) and among patients with situs inversus than among those with situs solitus (p = 0.004). Warfarin absence and situs inversus were associated with HCC development post-Fontan procedure.

An Unsupervised Deep Learning Approach for Dynamic-Exponential Intravoxel Incoherent Motion MRI Modeling and Parameter Estimation in the Liver.

Dynamic-exponential intravoxel incoherent motion (IVIM) imaging is a potential technique for prediction, monitoring, and differential diagnosis of hepatic diseases, especially liver tumors. However, the use of such technique at voxel level is still limited. To develop an unsupervised deep learning approach for voxel-wise dynamic-exponential IVIM modeling and parameter estimation in the liver. Prospective. Ten healthy subjects (4 males; age 28 ± 6 years). Single-shot spin-echo echo planar imaging (SE-EPI) sequence with monopolar diffusion-encoding gradients (12 b-values, 0-800 seconds/mm2 ) at 3.0 T. The proposed deep neural network (DNN) was separately trained on simulated and in vivo hepatic IVIM datasets. The trained networks were compared to the approach combining least squares with Akaike information criterion (LSQ-AIC) in terms of dynamic-exponential modeling accuracy, inter-subject coefficients of variation (CVs), and fitting residuals on the simulated subsets and regions of interest (ROIs) in the left and right liver lobes. The ROIs were delineated by a radiologist (H.-X.Z.) with 7 years of experience in MRI reading. Comparisons between approaches were performed with a paired t-test (normality) or a Wilcoxon rank-sum test (nonnormality). P < 0.05 was considered statistically significant. In simulations, DNN gave significantly higher accuracy (91.6%-95.5%) for identification of bi-exponential decays with respect to LSQ-AIC (79.7%-86.8%). For tri-exponential identification, DNN was also superior to LSQ-AIC despite not reaching a significant level (P=0.08). Additionally, DNN always yielded comparatively low root-mean-square error for estimated parameters. For the in vivo IVIM measurements, inter-subject CVs (0.011-0.150) of DNN were significantly smaller than those (0.049-0.573) of LSQ-AIC. Concerning fitting residuals, there was no significant difference between the two approaches (P=0.56 and 0.76) in both the simulated and in vivo studies. The proposed DNN is recommended for accurate and robust dynamic-exponential modeling and parameter estimation in hepatic IVIM imaging. 2 TECHNICAL EFFICACY: Stage 1.

Statin-induced Liver Injury Patterns: A Clinical Review.

Since their introduction in 1987, hydroxymethyl glutaryl coenzyme A reductase (HMG-CoA) inhibitors, more commonly known as statins, have become some of the most widely prescribed medications in the world. Though generally considered to be safe and well tolerated, statins have been associated with several side effects including mild liver dysfunction manifested by increases in aminotransferases. Rarely, statins have been noted to induce more serious hepatic injury, including liver injury with autoimmune features. Current literature supports statin induced liver injury presenting in either hepatocellular or cholestatic patterns, though with the former being the prevailing pattern of injury. Fortunately, severe liver injury is uncommon with statin use and is generally reversible without any intervention other than offending statin cessation. When evaluating cases of suspected statin-induced liver injury, a complete medical history, laboratory tests including a complete metabolic panel, autoimmune markers, and viral panel, as well as hepatic imaging, are crucial for a complete causality analysis with validated tools such as Roussel Uclaf Causality Assessment Method. The aim of this review is to review the current evidence for statin-induced liver injury and cholestasis.

A case of hepatic hydatid disease and imaging findings

A 45-year-old female patient was admitted to our hospital due to a space-occupying lesion which was found in a physical examination. Slight tenderness was found in her right lower abdomen for 1 month. On computed tomography (CT) imaging, a round, low-density lesion was observed in the liver. Several round cysts with lower density and thin wall were scattered in the center of the lesion. Linear calcification could be found in partial cystic wall. No significant enhancement was found in the lesion on contrast-enhanced CT imaging. A laparotomy was performed to remove the mass, which was sent to a pathological examination and hepatic cystic echinococcosis was diagnosed.

Artificial Intelligence Algorithm in Classification and Recognition of Primary Hepatic Carcinoma Images under Magnetic Resonance Imaging.

This study aimed to discuss the application value of the bias field correction algorithm in magnetic resonance imaging (MRI) images of patients with primary hepatic carcinoma (PHC). In total, 52 patients with PHC were selected as the experimental group and divided into three subgroups: mild (15 cases), moderate (19 cases), and severe (18 cases) according to pathological grading. Another 52 patients with hepatic nodules in the same period were included in the control group. All the patients underwent dynamic contrast-enhanced (DCE) MRI examination, and the image qualities of MRI before and after bias field correction were compared. The DCE-MRI perfusion parameters were measured, including the transport constant Ktrans, reverse rate constant Kep, extravascular extracellular volume fraction (Ve), plasma volume (Vp), microvascular density (MVD), hepatic artery perfusion index (HPI), mean transit time of contrast agent (MTT), time to peak (TTP), blood volume (BV), hepatic arterial perfusion (HAP), full perfusion (FP), and portal venous perfusion (PVP). It was found that the sensitivity (93.63%), specificity (71.62%), positive predictive value (95.63%), negative predictive value (71.62%), and accuracy (90.01%) of MRI examination processed by the bias field correction algorithm were all significantly greater than those before processing (P < 0.05). The Ktrans, Kep, Ve, Vp, and MVD of patients in the experimental group were significantly larger than those of the control group, and severe group> moderate group> mild group (P < 0.05). HPI, MTT, TTP, BV, and HAP of patients in the experimental group were also significantly greater than those of the control group, which was shown as severe group > moderate group > mild group (P < 0.05). FP and PVP of the experimental group were significantly lower than those of the control group, and severe group < moderate group < mild group (P < 0.05). It was suggested that in MRI images of patients with PHC, the bias field correction algorithm could significantly improve the diagnosis rate. Each perfusion parameter was related to the pathological grading, which could be used to evaluate the prognosis of patients.

β-Galactosidase-activated theranostic for hepatic carcinoma therapy and imaging.

A β-galactosidase activatable fluorescent turn-on theranostic Gal-CGem exhibits gemcitabine release specifically in β-galactosidase overexpressing hepatic carcinoma cells. The cytotoxicity of Gal-CGem in cancer cells is achieved through the apoptotic cell death pathway. Overall, Gal-CGem is a new frontline prodrug in cancer therapy that has provided antineoplastic information through fluorescence imaging.