Liver Lesions Research Articles

Intraindividual Comparison of Image Quality Between Low-Dose and Ultra-Low-Dose Abdominal CT With Deep Learning Reconstruction and Standard-Dose Abdominal CT Using Dual-Split Scan.

The aim of this study was to intraindividually compare the conspicuity of focal liver lesions (FLLs) between low- and ultra-low-dose computed tomography (CT) with deep learning reconstruction (DLR) and standard-dose CT with model-based iterative reconstruction (MBIR) from a single CT using dual-split scan in patients with suspected liver metastasis via a noninferiority design. This prospective study enrolled participants who met the eligibility criteria at 2 tertiary hospitals in South Korea from June 2022 to January 2023. The criteria included (a) being aged between 20 and 85 years and (b) having suspected or known liver metastases. Dual-source CT scans were conducted, with the standard radiation dose divided in a 2:1 ratio between tubes A and B (67% and 33%, respectively). The voltage settings of 100/120 kVp were selected based on the participant's body mass index (<30 vs ≥30 kg/m2). For image reconstruction, MBIR was utilized for standard-dose (100%) images, whereas DLR was employed for both low-dose (67%) and ultra-low-dose (33%) images. Three radiologists independently evaluated FLL conspicuity, the probability of metastasis, and subjective image quality using a 5-point Likert scale, in addition to quantitative signal-to-noise and contrast-to-noise ratios. The noninferiority margins were set at -0.5 for conspicuity and -0.1 for detection. One hundred thirty-three participants (male = 58, mean body mass index = 23.0 ± 3.4 kg/m2) were included in the analysis. The low- and ultra-low- dose had a lower radiation dose than the standard-dose (median CT dose index volume: 3.75, 1.87 vs 5.62 mGy, respectively, in the arterial phase; 3.89, 1.95 vs 5.84 in the portal venous phase, P < 0.001 for all). Median FLL conspicuity was lower in the low- and ultra-low-dose scans compared with the standard-dose (3.0 [interquartile range, IQR: 2.0, 4.0], 3.0 [IQR: 1.0, 4.0] vs 3.0 [IQR: 2.0, 4.0] in the arterial phase; 4.0 [IQR: 1.0, 5.0], 3.0 [IQR: 1.0, 4.0] vs 4.0 [IQR: 2.0, 5.0] in the portal venous phases), yet within the noninferiority margin (P < 0.001 for all). FLL detection was also lower but remained within the margin (lesion detection rate: 0.772 [95% confidence interval, CI: 0.727, 0.812], 0.754 [0.708, 0.795], respectively) compared with the standard-dose (0.810 [95% CI: 0.770, 0.844]). Sensitivity for liver metastasis differed between the standard- (80.6% [95% CI: 76.0, 84.5]), low-, and ultra-low-doses (75.7% [95% CI: 70.2, 80.5], 73.7 [95% CI: 68.3, 78.5], respectively, P < 0.001 for both), whereas specificity was similar (P > 0.05). Low- and ultra-low-dose CT with DLR showed noninferior FLL conspicuity and detection compared with standard-dose CT with MBIR. Caution is needed due to a potential decrease in sensitivity for metastasis (clinicaltrials.gov/ NCT05324046).

Class-Wise Combination of Mixture-Based Data Augmentation for Class Imbalance Learning of Focal Liver Lesions in Abdominal CT Images.

In this paper, we propose a method to address the class imbalance learning in the classification of focal liver lesions (FLLs) from abdominal CT images. Class imbalance is a significant challenge in medical image analysis, making it difficult for machine learning models to learn to classify them accurately. To overcome this, we propose a class-wise combination of mixture-based data augmentation (CCDA) method that uses two mixture-based data augmentation techniques, MixUp and AugMix. These are applied at different ratios for each class to adaptively learn features for each class. This method is tailored to handle the unique characteristics of each FLL type by adjusting the augmentation mix for major classes (e.g., cysts and metastases) and minor classes (e.g., hemangiomas). In experiments, our method was validated on the dataset consisted of portal phase CT images from 1290 colorectal cancer patients. The results showed that applying MixUp and AugMix in a class-wise manner could significantly improve the classification performance of minor classes while maintaining or slightly improving the performance of major classes. Quantitative results showed higher F1 scores for minor classes and a more balanced accuracy across classes when CCDA was used compared to other methods.

Systematic Review of the Presentation, Treatment, and Outcome of Chronic Disseminated Candidiasis in Children with Cancer or Following Hematopoietic Cell Transplant.

Chronic disseminated candidiasis (CDC) is a rare complication of immunosuppression. This review describes the presentation, management, and outcomes of CDC in pediatric patients with cancer or following hematopoietic cell transplant (HCT). PubMed, Embase, and Medline were searched identifying 32 studies, describing 95 cases of CDC. CDC occurred almost exclusively in patients with leukemia (91%), with only 5% occurring in lymphoma, 1% post HCT, and 3% in solid tumor. The most frequent presenting symptoms were fever (97%) and abdominal pain (45%), with lesions in liver in 63% and spleen in 54% (less common in kidney, lungs and skin/soft tissue). Of the 67 (71%) episodes with microbiological confirmation, Candida tropicalis (28%) was the most common causative species. Antifungal treatment durations varied from 14days to 28months. Additionally, 31 (33%) patients received an adjuvant therapy, the most common being corticosteroids. Mortality, directly attributable to CDC, occurred in nine (9%). There remains insufficient data to guide a unified approach to management.

18F-FDG PET/CT Versus 18F-FAPI PET/CT in Eosinophilic Liver Infiltration.

A 48-year-old man presented with upper abdominal discomfort for 10 days. Abdominal contrast-enhanced CT showed multiple abnormal enhanced masses in liver, suggesting a probability of malignancies. The patient was then enrolled in a clinical trial of comparison of 18F-FDG and 18F-FAPI PET/CT in hepatic lesions. Compared with 18F-FDG PET/CT, 18F-FAPI PET/CT showed higher tracer uptake, more lesions in liver. Meanwhile, peripheral blood eosinophils increased remarkably. The hepatic lesions were highly suspected as eosinophilic liver infiltration. Finally, pathologic analysis confirmed the diagnosis of eosinophilic liver infiltration.

P0136 The role of FDG PET/CT in the and identification of fibrosis related to Crohn’s disease

Abstract Background There is a constant search for non-invasive evaluation methods for the identification of fibrosis in patients treated for Crohn’s disease, since this condition can severely impact patients’ quality of life in the long run. While PET/CT is mostly used in oncological evaluation, it was previously proved that it can be useful in the evaluation of inflammation associated with Crohn’s disease activity, since segmental FDG uptake is proportional with immune cell infiltration of the bowel. However, it’s role in the detection of fibrosis needs further evaluation. Our aim was to prospectively evaluate the prognostic value of FDG/PET CT in the identification of fibrosis related to Crohn’s disease regarding global PET scores compared to other imaging techniques (i.e. MRI, CT), simple endoscopic score (SES-CD), CD Activity Index (CDAI) intraoperative findings and histological evaluation of resected bowel segment. Methods We prospectively evaluated our patients from in and outpatient care between October 2021 and October 2024 who underwent bowel segment resection due to stenosis that was identified at a follow-up colonoscopy. On PET-CT, we scored the FDG uptake in the small intestine and the 4 colon segments. Regions with increased FDG uptake were segmented with metabolically active volume (MAV), uncorrected maximal standardized uptake value (SUVmax), related to the SUVmax of the liver (as a reference for normal tissue activity) and uncorrected total lesion glycolysis (TLG). Results A total of 17 patients were selected, 11 (65 %) males and 6 (35 %) females, with a median age of 43 years (29-44). Ten patients (59 %) had Crohn’s disease affecting the small and large bowel, while in 3 (18 %) patients it affected only the small intestines and in 4 cases (23 %) it was localized solely on the large intestines. Seven (41 %) patients were bio naive, while 10 patients (59 %) received at least one biological therapy since their diagnosis. Five patients had a history of previous resection, from which three underwent endoscopic dilatation as well before the current surgery. In active disease, PET was more informative than endoscopy to access the extent of the inflammation, and small intestine involvement. FDG PET-CT proved to be statistically more efficient in the identification of affected bowel segments than MRI or colonoscopy. However, we could not find an association between FDG PET-CT scores and the presence of fibrosis in our patients. Conclusion FDG PET-CT is a non-invasive complementary method for the evaluation of the affected bowel segments in CD, however its role in the identification of fibrosis is still not evident. This needs further investigation and a larger number of patients.

Diagnostic Certainty in Characterizing Liver Lesions in Rectal Cancer: Abbreviated Liver MRI versus CT.

Early diagnosis of metastases is crucial but routine staging with contrast-enhanced multidetector computed tomography (ceMDCT) is suboptimal. A total of 20% will have indeterminate or too small to characterize (TSTC) liver lesions on CT, requiring formal characterization by magnetic resonance imaging (MRI). This UK cross-sectional study reports our experience undertaking routine abbreviated liver MRI (MRI). A total of 99 patients with rectal cancer had ceMDCT, abbreviated liver MRI, and rectal MRI at diagnosis. Liver imaging was scored for liver metastases, benign or indeterminate/TSTC lesions on a per patient basis. Primary rectal cancer was risk scored on MRI. A total of 42/99 (42%) had liver lesion(s) on ceMDCT versus 55/99 (56%) by MRI, and 46/99 (46%) had high-risk rectal cancer. ceMDCT showed 5 patients with liver metastases, 14 with benign lesions, and 23 with indeterminate/TSTC lesions. MRI showed 6 with liver metastases, 45 with benign lesions, and 4 with indeterminate/TSTC lesions. All liver metastases were in high-risk rectal cancer, OR 17.18 (p = 0.06), with 12.5% conversion rate of TSTC lesions to metastases in high-risk rectal cancer and 0% in low-risk rectal cancer. Diagnostic certainty of the liver findings was achieved in 93% of patients by MRI compared with 45% by ceMDCT (p < 0.0001). Abbreviated liver MRI diagnosed fewer indeterminate/TSTC lesions and provided greater diagnostic certainty than ceMDCT, p < 0.0001. High-risk rectal cancer is associated with a higher conversation rate of TSTC lesions to metastases than low-risk rectal cancers. Risk stratified; routine abbreviated liver MRI sequences should be investigated as part of the patient pathway for high-risk rectal cancer.

Contrast-enhanced ultrasound-based AI model for multi-classification of focal liver lesions.

Accurate multi-classification is the prerequisite for reasonable management of focal liver lesions (FLLs). Ultrasound is the common image examination, but lacks accuracy. Contrast enhanced ultrasound (CEUS) offers better performance, but highly relies on experience. Therefore, we aimed to develop a CEUS-based artificial intelligence (AI) model for FLL multi-classification and evaluate its performance in multicenter clinical tests. Since January 2017 to December 2023, CEUS videos, immunohistochemical biomarkers and clinical information of solid FLLs>1cm in adults were collected from 52 centers to build and test the model. It aimed to classify FLLs into six types: hepatocellular carcinoma, hepatic metastasis, intrahepatic cholangiocarcinoma, hepatic hemangioma, hepatic abscess and others. First, Module-Disease, Module-Biomarker and Module-Clinic were built in training set A and validation set. Then, three modules were aggregated as Model-DCB in training set B and internal test set. Model-DCB performance was compared with CEUS and MRI radiologists in three external test sets. In total 3725 FLLs from 52 centers were divided into training set A (n=2088), validation set (n=592), training set B (n=234), internal test set (n=110), external test set A (n=113), B (n=276) and C (n=312). In external test sets A, B and C, Model-DCB all achieved significantly better performance (Accuracy from 0.85 to 0.86) than junior CEUS-radiologists (0.59-0.73), and comparable to senior CEUS-radiologists (0.79-0.85) and senior MRI-radiologists (0.82-0.86). In multiple subgroup analyses on demographic characteristics, tumor characteristics and ultrasound devices, its accuracy ranged from 0.79 to 0.92. CEUS-based Model-DCB provides accurate multi-classification of FLLs. It holds promise to benefit a wide range of population, especially for patients in remote suburban areas who have difficulty accessing MRI. Ultrasound is the most common image examination for screening focal liver lesions (FLLs), but it lacks accuracy for multi-classification, which is the prerequisite for reasonable management. Contrast enhanced ultrasound (CEUS) offers better diagnostic performance, but highly relies on work experience of radiologists. We develop a CEUS-based model (Model-DCB) can assist junior CEUS radiologists to achieve comparable diagnostic ability to senior CEUS radiologists and senior MRI radiologists. The combination of ultrasound device, CEUS examination and Model-DCB enables even patients in remote areas to obtain excellent diagnostic performance through examination by junior radiologists. NCT04682886.

Can Emax and platelet count truly differentiate between benign and malignant liver lesions?

This letter critically evaluates Jiang et al 's article on the differentiation of benign and malignant liver lesions using Emax and platelet count. Despite notable findings, significant methodological and interpretative limitations are identified. The study lacks detailed assay conditions for Emax measurement, employs inadequate statistical methods without robust multivariate analysis, and does not provide clinically relevant threshold values. The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis. Moreover, the study's limitations, such as selection bias and confounding factors, are not adequately addressed. Future research should adopt more rigorous methodologies, including prospective studies with larger cohorts and standardized protocols for biomarker measurement, to enhance validity and clinical applicability.

Disparities in the Way Radiologists, Referring Physicians, and Patients See the Language Used to Report Incidental Findings

Background: Incidental findings on cross-sectional imaging are common, often causing concern due to the possibility, however remote, that they could indicate malignancy. While radiologists aim to document these findings thoroughly, the language used may lead to varying interpretations by referring physicians and patients, potentially resulting in unnecessary follow-up tests, increased costs, and patient anxiety. The language radiologists use to describe low-risk incidental findings, especially those with minimal clinical significance, is underexplored, particularly from the perspectives of radiologists, referring physicians, and patients. Methods: This study involved three anonymous surveys administered to radiologists, referring physicians, and patients at a large academic medical center. The surveys assessed how each group interprets 10 expressions used to describe a 5-mm incidental liver lesion, based on its perceived likelihood of malignancy. Radiologists, referring physicians, and patients rated their perceived likelihood of malignancy for these expressions and provided feedback on whether follow-up imaging was warranted. Data were analyzed using median responses for malignancy likelihood, follow-up imaging decisions, and descriptive statistics. Results: A total of 13 radiologists (93%), 59 referring physicians (6% response rate), and 51 patients participated. Referring physicians and patients consistently rated the likelihood of malignancy higher than radiologists, particularly for phrases like "tumor not excluded," which were associated with the highest perceived likelihood of malignancy. Regarding follow-up imaging, 75-83% of referring physicians indicated they would order follow-up for phrases with uncertainty about malignancy, while only 2-46% chose to do so for phrases indicating benign findings. Radiologists favored "cyst" to describe the lesion, while referring physicians favored "benign cyst." Radiologists unanimously agreed that no follow-up was necessary for the benign lesion. Conclusion: Both referring physicians and patients expressed greater concern than radiologists regarding incidental findings, especially when the language used suggested uncertainty about malignancy. Ambiguous terms such as "tumor not excluded" increased anxiety and the likelihood of follow-up tests. This highlights the need for radiologists to refine their terminology to improve communication clarity and reduce unnecessary patient anxiety and healthcare costs

Investigation into Drug-Induced Liver Damage Using Multimodal Mass Spectrometry Imaging.

Drug toxicity during the development of candidate pharmaceuticals is the leading cause of discontinuation in preclinical drug discovery and development. Traditionally, the cause of the toxicity is often determined by histological examination, clinical pathology, and the detection of drugs and/or metabolites by liquid chromatography-mass spectrometry (LC-MS). While these techniques individually provide information on the pathological effects of the drug and the detection of metabolites, they cannot provide specific molecular spatial information without additional experiments. Matrix-assisted laser desorption/ionization-mass spectrometry imaging (MALDI-MSI) is a powerful, label-free technique for the simultaneous detection of pharmaceuticals, metabolites, and endogenous chemical species in tissue sections, which makes it suitable for mechanistic toxicological studies to directly correlate the distribution of the drug and its metabolites with histological findings. This capability was demonstrated by the analysis of the liver from dogs dosed with discontinued drug compound B and its N-desmethyl metabolite, compound A. Histological examination showed multifocal hepatocellular necrosis, bile duct hyperplasia, periportal fibrosis, and chronic inflammation. MALDI-MSI analysis of liver tissue dosed with only compound A indicated that liver lesions were associated exclusively with the parent compound, whereas liver lesions with compound B showed the presence of the parent compound and its two metabolites (compound A and an N-oxide metabolite). Using both positive and negative ion modes, simultaneous detection and identification of endogenous molecular markers of the connective tissue, blood vessels, liver parenchyma, and bile duct epithelium was achieved, allowing optimal visualization of histological lesions by mass spectrometry imaging.

Precision in Motion Management: Long-Term Local Control and Prognostic Insights in SBRT for Oligometastatic Lung and Liver Metastases.

Background/Objectives: Inadequate dosing and respiratory motion contribute to local recurrence for oligometastatic disease (OMD). While short-term LC rates are well-documented, data on long-term LC remain limited. This study investigated long-term LC after stereotactic body radiotherapy (SBRT), using respiratory motion management techniques. Methods: This retrospective study took place at UZ Brussel with follow-up until Oct 2024. It analyzed oligometastatic patients treated with SBRT between Jul 2012 and Feb 2017. Treatment involved delivering 50 Gy in 10 fractions on the 80% isodose line, building on data from a prior prospective study. Lesion movement was managed using internal target volume (ITV) or dynamic tumor tracking (DTT) with marker. The primary endpoint of the study was long-term LC and identifying variables associated with it using a Cox proportional hazards model. Results: A total of 100 patients were treated for a total of 211 metastatic lesions. Lesions were predominantly in the lungs (74%) and treated using ITV (88%). LC rates at 1, 3, 5, and 10 years were 76.5%, 53.8%, 38.1%, and 36.3%, respectively. Improved LC was observed in locations other than lung and liver (HR: 0.309; p = 0.024) and with increasing age (HR: 0.975; p < 0.010). Worse LC was seen in liver lesions (HR: 1.808; p = 0.103) and systemic therapy post-radiotherapy (HR: 3.726; p < 0.001). No significant associations were found with tumor size or tumor motion, nor between the two motion management strategies used (DTT and ITV). Conclusions: Appropriate motion management is key in LC for OMD. No significant difference in LC was found between both techniques. Lesion location, patient age, and systemic therapy post-radiotherapy were prognostic factors for LC.

ASO Author Reflections: Diagnostic Certainty in Characterizing Liver Lesions in Rectal Cancer: Abbreviated Liver MRI Versus CT.

ASO Author Reflections: Diagnostic Certainty in Characterizing Liver Lesions in Rectal Cancer: Abbreviated Liver MRI Versus CT.

AAPM Truth-based CT (TrueCT) reconstruction grand challenge.

This Special Report summarizes the 2022, AAPM grand challenge on Truth-based CT image reconstruction. To provide an objective framework for evaluating CT reconstruction methods using virtual imaging resources consisting of a library of simulated CT projection images of a population of human models with various diseases. Two hundred unique anthropomorphic, computational models were created with varied diseases consisting of 67 emphysema, 67 lung lesions, and 66 liver lesions. The organs were modeled based on clinical CT images of real patients. The emphysematous regions were modeled using segmentations from patient CT cases in the COPDGene Phase I dataset. For the lung and liver lesion cases, 1-6 malignant lesions were created and inserted into the human models, with lesion diameters ranging from 5.6 to 21.9mm for lung lesions and 3.9 to 14.9mm for liver lesions. The contrast defined between the liver lesions and liver parenchyma was 82±12 HU, ranging from 50 to 110 HU. Similarly, the contrast between the lung lesions and the lung parenchyma was defined as 781±11 HU, ranging from 725 to 805 HU. For the emphysematous regions, the defined HU values were -950±17 HU ranging from -918 to -979 HU. The developed human models were imaged with a validated CT simulator. The resulting CT sinograms were shared with the participants. The participants reconstructed CT images from the sinograms and sent back their reconstructed images. The reconstructed images were then scored by comparing the results against the corresponding ground truth values. The scores included both task-generic (root mean square error [RMSE] and structural similarity matrix [SSIM]), and task-specific (detectability index [d'] and lesion volume accuracy) metrics. For the cases with multiple lesions, the measured metric was averaged across all the lesions. To combine the metrics with each other, each metric was normalized to a range of 0 to 1 per disease type, with "0" and "1" being the worst and best measured values across all cases of the disease type for all received reconstructions. The True-CT challenge attracted 52 participants, out of which 5 successfully completed the challenge and submitted the requested 200 reconstructions. Across all participants and disease types, SSIM absolute values ranged from 0.22 to 0.90, RMSE from 77.6 to 490.5 HU, d' from 0.1 to 64.6, and volume accuracy ranged from 1.2 to 753.1mm3. The overall scores demonstrated that participant "A" had the best performance in all categories, except for the metrics of d' for lung lesions and RMSE for liver lesions. Participant "A" had an average normalized score of 0.41±0.22, 0.48±0.32, and 0.42±0.33 for the emphysema, lung lesion, and liver lesion cases, respectively. The True-CT challenge successfully enabled objective assessment of CT reconstructions with the unique advantage of access to a diverse population of diseased human models with known ground truth. This study highlights the significant potential of virtual imaging trials in objective assessment of medical imaging technologies.

18F-FAPI-42 PET/CT and 18F-FDG PET/CT in Patients with Malignant Digestive System Neoplasms: A Head-to-Head Comparative Study.

Radionuclide-labeled fibroblast activation protein inhibitor (FAPI) is an emerging tumor tracer. We sought to assess the uptake and diagnostic performance of 18F-FAPI-42 PET/CT compared with simultaneous 2-deoxy-2[18F]fluoro-D-glucose (18F-FDG) PET/CT in primary and metastatic lesions in patients with malignant digestive system neoplasms and to determine the potential clinical benefit. Forty-two patients (men = 30, women = 12, mean age = 56.71 ± 13.26years) who underwent 18F-FDG PET/CT and 18F-FAPI-42 PET/CT simultaneously for diagnosis, staging, and restaging were enrolled. Quantitative data, including standardized uptake value (SUV), tumor-to-liver ratio (TLR), and tumor-to-blood pool ratio (TBR), were analyzed. Two independent readers performed a visual assessment of lesion number and location on PET/CT images. Interobserver agreement between two examinations was calculated using Cohen's kappa (κ). Primary tumor locations included the liver (n = 20), stomach (n = 9), pancreas (n = 5), and intestine (n = 10). More intense 18F-FAPI-42 uptake and higher tumor-to-background contrast were detected in most primary and metastatic lesions compared with 18F-FDG, contributing to improved diagnostic accuracy ranging from 95.24% to 100%. Moreover, additional lesions showing 18F-FAPI-42 uptake in primary, locoregional and distant metastatic lesions were visualized, especially in multiple liver and peritoneal metastases. Patient-based interobserver agreement varied from moderate to strong, with suboptimal outcomes observed in primary tumors (κ = 0.441, P = 0.01) and preferable results derived from metastatic liver and bone lesions (κ = 1 and 0.896, both P < 0.01). 18F-FAPI-42 PET/CT resulted in modified treatment strategies for 40.48% (17/42) of patients, while 18F-FDG PET/CT led to altered therapeutic regimens in only 4.8% (2/42) of patients. In selected patients with malignant digestive system neoplasms, our study shows that 18F-FAPI-42 PET/CT is a promising alternative for assessing primary tumors and metastases and aiding staging, restaging, and decision-making, with higher uptake and better lesion visualization compared with 18F-FDG. Additionally, it may shed light into the treatment selection and response assessment for FAP-targeted therapy or immunotherapy.

Initial experience of minimally invasive liver resection at a reference center in Mexico

Minimally invasive liver resection is employed worldwide for the management of benign and malignant liver lesions. There is no description of postoperative outcomes in the Mexican population. This study aims to report the initial experience in Mexico. A cross-sectional analysis was performed on 20 patients undergoing minimally invasive liver resection between 2018 and 2024 at a reference center in Mexico. Quantitative variables are reported as mean ± standard deviation or median with range, while qualitative variables as frequencies with percentages. The most frequently performed procedures were left lateral sectionectomy in five cases, 7/20 were classified as intermediate and 10/20 as expert difficulty, according to the IWATE scoring criteria. Additional results included major complication (35%), intrahospital mortality (5%), surgical reintervention (0%), median hospital length of stay (6 [3-54] days) and R0 resection rate (76.9%). The initial experience of minimally invasive liver resection in Mexico includes complex cases, with great difficulty according to the IWATE criteria, with comparable R0 resection rates.

A phase I clinical trial of intrahepatic artery delivery of TG6002 in combination with oral 5-fluorocytosine in patients with liver-dominant metastatic colorectal cancer.

Effective treatment for patients with metastatic cancer is limited, particularly for colorectal cancer patients with metastatic liver lesions (mCRC), where accessibility to numerous tumours is essential for favourable clinical outcomes. Oncolytic viruses (OVs) selectively replicate in cancer cells; however, direct targeting of inaccessible lesions is limited when using conventional intravenous or intratumoural administration routes. We conducted a multi-centre, dose-escalation, phase I study of vaccinia virus, TG6002, via intrahepatic artery (IHA) delivery in combination with the oral pro-drug 5-fluorocytosine to fifteen mCRC patients. Successful IHA delivery of replication-competent TG6002 was achieved, as demonstrated by virus within tumour biopsies. Functional transcription of the FCU1 transgene indicates viral replication within the tumour, with higher plasma 5-fluorouracil associated with patients receiving the highest dose of TG6002. IHA delivery of TG6002 correlated with a robust systemic peripheral immune response to virus with activation of peripheral blood mononuclear cells, associated with a proinflammatory cytokine response and release of calreticulin, potentially indicating immunogenic cell death. Gene Ontology analyses of differentially-expressed genes reveal a significant immune response at the transcriptional level in response to treatment. Moreover, an increase in the number and frequency of T-cell receptor clones against both cancer- and neo-antigens, with elevated functional activity, may be associated with improved anti-cancer activity. Despite these findings, no clinical efficacy was observed. In summary, these data demonstrate delivery of OV to tumour via IHA administration, associated with viral replication and significant peripheral immune activation. Collectively, the data supports the need for future studies using IHA administration of OVs.

Ultrafast dynamic contrast-enhanced breast MRI with quantitative perfusion parameters in differentiating breast cancer: a study focusing on triple-negative and HER2 positive breast cancer.

In the realm of breast cancer diagnosis and treatment, accurately discerning molecular subtypes is of paramount importance, especially when aiming to avoid invasive tests. The updated guidelines for diagnosing and treating HER2 positive advanced breast cancer, as presented at the 2021 National Breast Cancer Conference and the Annual Meeting of the Chinese Society of Clinical Oncology, highlight the significance of this approach. A new generation of drug-antibody combinations has emerged, expanding the array of treatment options for HER2 positive advanced breast cancer and significantly improving patient survival rates. Triple-negative breast cancer (TNBC), on the other hand, may indicate survival outcomes following multi-agent adjuvant chemotherapy. DISCO is a more recent DCE MRI technique that has achieved high spatial and temporal resolution and minimized image artifacts in cases like malignant focal liver lesions, enhanced focal breast lesions, and intracranial aneurysms. To employ the method mentioned above to differentiate between triple-negative and non-triple-negative as well as HER2 positive and HER2 negative cancer lesions, and to assess the value of quantitative and semi-quantitative parameters in molecularly typing breast cancer. All participants were scanned with a 3.0-T MR scanner (GE SIGNA™ Premier) using a 16-channel phased-array body coil. Each participant underwent a DISCO DCE-MRI with a scan time of approximately 1 minute and 40 seconds. The ROIs were outlined with the GenIQ software, avoiding regions with blood vessels, susceptibility artifacts, hemorrhage, and necrosis. We evaluated four quantitative parameters (Ktrans, kep, ve, vp) and four semi-quantitative parameters (TTP, MAX Conc, AUC, MAX Slope). The carcinomas were segregated into respective subgroups (HER2+ vs HER2-, TNBC vs non-TNBC, HER2+ vs TNBC) and we compared the eight parameters across these groups. The AUC of the models was compared using DeLong's test as per the ROC analysis. We analyzed a total of 96 female patients, revealing significant differences in the semi-quantitative parameters such as TTP, MAX Conc, AUC, and MAX Slope among different groups. HER2-positive versus HER2-negative exhibited significant differences in quantitative parameters (Ktrans: 0.22 min-1 vs. 0.43 min-1, kep: 0.11 min-1 vs. 0.35 min-1, vp: 0.01 vs. 0.04, all P < 0.05). TNBC versus non-TNBC revealed statistical variations in quantitative parameters (Ktrans: 1.03 min-1 vs. 0.15 min-1, kep: 0.61 min-1 vs. 0.19 min-1, vp: 0.18 vs. 0.01, all P < 0.05). Additionally, HER2-positive compared to TNBC demonstrated significant differences in quantitative parameters (Ktrans: 0.22 min-1 vs. 1.03 min-1, kep: 0.11 min-1 vs. 0.61 min-1, vp: 0.01 vs. 0.18, all P < 0.05). As per ROC analysis, Ktrans, kep, vp, TTP, and MAX Conc effectively differentiated TNBC from non-TNBC, with TTP being the strongest determinant for TNBC. Furthermore, these parameters successfully distinguished between HER2 positive and HER2 negative, with kep being particularly effective in identifying HER2. Importantly, Ktrans, kep, vp, TTP, and MAX Conc were effective in discriminating HER2 positive from TNBC, with kep and TTP exhibiting notable efficacy in this context. Our study suggests that DISCO DCE-MRI derived parameters could serve as reliable quantitative biomarkers for differentiating between TNBC and HER2 positive breast cancer.

Comparing quantitative imaging biomarker alliance volumetric CT classifications with RECIST response categories.

To assess agreement between CT volumetry change classifications derived from Quantitative Imaging Biomarker Alliance Profile cut-points (ie, QIBA CTvol classifications) and the Response Evaluation Criteria in Solid Tumors (RECIST) categories. Target lesions in lung, liver, and lymph nodes were randomly chosen from patients in 10 historical clinical trials for various cancers, ensuring a balanced representation of lesion types, diameter ranges described in the QIBA Profile, and variations in change magnitudes. Three radiologists independently segmented these lesions at baseline and follow-up scans using 2 software tools. Two types of predefined disagreements were assessed: Type I: substantive disagreement, where the disagreement between QIBA CTvol classifications and RECIST categories could not be attributed to the improved sensitivity of volumetry in detecting changes; and Type II: disagreement potentially arising from the improved sensitivity of volumetry in detecting changes. The proportion of lesions with disagreements between QIBA CTvol and RECIST, as well as the type of disagreements, was reported along with 95% CIs, both overall and within subgroups representing various factors. A total of 2390 measurements from 478 lesions (158 lungs, 170 livers, 150 lymph nodes) in 281 patients were included. QIBA CTvol agreed with RECIST in 66.6% of interpretations. Of the 33.4% of interpretations with discrepancies, substantive disagreement (Type I) occurred in only 1.5% (95% CI: [0.8%, 2.1%]). Factors such as scanner vendor (P = .584), segmentation tool (P = .331), and lesion type (P = .492) were not significant predictors of disagreement. Significantly more disagreements were observed for larger lesions (≥50 mm, as defined in the QIBA Profile). We conclude that QIBA CTvol classifications agree with RECIST categories.

Herbal hepatotoxicity: Difficulties in the diagnosis and treatment of liver lesions by borage oil

Introduction: The use of herbal medicines has increased over the past 20 years as a complementary therapy for various diseases. However, the commercialization of these products is not preceded by a guarantee of safety. This article aims to report the use of borage oil or Borago officinalis (BO), beneficial for menopause-related symptoms, however, it may contain pyrrolizidine alkaloids (AP), a hepatotoxic toxin. Methodology: a study of the patient's electronic medical record was conducted. Case report: 53-year-old woman admitted to emergency room with jaundice, asthenia, hyporexia and pain in the right hypochondrium (HD) for 10 days after use of the herbal medicine Niolix® (BO), being initially diagnosed with acute hepatitis induced by BO. Liver biopsy revealed intense lymphocyte inflammatory infiltrate, in addition to plasma cells, neutrophils and macrophages, with aggression to the limiting plaque and hepatocytes. After the end of the corticosteroid treatment, there was a new increase in aminotransferases and the appearance of autoantibodies, leading to the hypothesis of autoimmune hepatitis triggered by BO. Immunosuppressive treatment was instituted, with significant improvement in the condition. Conclusion: this report exemplifies the diversity of liver lesions induced by herbs, as well as drugs, supplements, and medications, calling attention to the strict follow-up of cases, with possible changes in diagnosis and conduct during treatment.

Using multimodal ultrasound technology to improve the success rate of liver tumor puncture for lesions with poor visibility on conventional ultrasound imaging.

The ability of conventional ultrasound (US)-guided liver biopsy to visualize certain liver lesions, particularly those affected by conditions like hepatitis or cirrhosis, which can obscure lesion boundaries and lead to inaccurate biopsy targeting, is limited. This study aimed to evaluate the potential of multimodal US techniques to improve the visibility of liver lesions that are indistinct under conventional US, and to enhance the success rate of percutaneous biopsies. In total, 144 patients with liver masses and lesions that were not clearly visible on conventional US from October 2018 to January 2024 were enrolled in this retrospective analysis. The lesions of these patients exhibited poor visibility on conventional US, but the tumor location was visible on abdominal computerized tomography (CT) or magnetic resonance (MR) imaging scans. After excluding patients who did not undergo biopsy or patients with lesions that were remained not clearly visible on multimodal US examinations. Ultimately, a total of 95 patients were enrolled in this study. We analyzed the clinical and imaging data for all these patients. CT/MR-US fusion imaging was performed in 55 patients, contrast-enhanced ultrasound (CEUS) was performed in 95 patients, and high-frequency US was performed in 21 patients. The visibility of the lesions using these three techniques was evaluated, and the consistency between the biopsy pathology and the final diagnosis was analyzed. In the study, the detection rates of lesions using CT/MR-US fusion imaging, CEUS, and high-frequency US were 49.1%, 96.8%, and 76.2%, respectively. After confirming the target location of the lesions, all patients underwent percutaneous US-guided biopsy. The accuracy rate of the biopsies was 91.6%, and the positive concordance rate was 91.1%. Among the 13 patients with negative pathology findings after biopsy, 8 had false-negative results (based on follow-up laboratory tests and imaging results consistent with malignant tumor characteristics), resulting in a false-negative rate of 8.9%. Multimodal US significantly improved the success of biopsies for liver lesions not clearly visible on conventional US, aiding in precise treatment planning.