Liver Magnetic Resonance Imaging Research Articles

Cardiac iron overload in pediatric oncology and bone marrow transplant survivors.

e22022 Background: Cardiovascular late effects are a leading cause of mortality and morbidity in childhood cancer and Bone Marrow Transplant (BMT) survivors. In patients receiving chronic red blood cell transfusions, excess iron may be deposited in the liver, heart, and pituitary gland. Iron overload cardiomyopathy is characterized as a restrictive physiology with early diastolic dysfunction ultimately progressing to end-stage dilated cardiomyopathy. Iron loading in the heart can also lead to arrhythmias and increase myocardial ischemia reperfusion injury due to increased formation of reactive oxygen species. It is not yet known whether high transfused packed red blood cell (PRBC) volumes in cancer and BMT patients leads to cardiac iron deposition, and whether iron-induced cardiac injury contributes to the known cardiovascular late effects in these patients. Methods: 83 childhood cancer and BMT survivors with elevated serum ferritin levels and subsequent liver Magnetic Resonance (MR) imaging were identified. 18 patients (21.7%) who had liver iron content of > 12mg/g (mean 16.0 ± 7.36 mg/g) also underwent Cardiac MRI (CMR) to determine cardiac iron content. Results: Median transfused blood volume was 393 ml/kg [95% Confidence Interval (CI) 170-780 ml/kg]. All 18 patients had at least one echocardiogram showing normal ventricular ejection fractions [mean 65.1 ± Standard Deviation (SD) 3.53%] and normal shortening fractions (mean 35.4 ± 3.67%). All patients had myocardial iron content within normal ranges (T2* relaxation time mean 35.1 msec ± 7.1 [normal >20 msec], mean ± SD iron content 0.63± 0.2 mg/g dry weight, range 0.5-1.1). There was no association of cardiac iron content with transfused blood volume, anthracycline dose (mg/m2) or liver iron content (Pearson Correlation Coefficients 0.27, 0.29 and 0.89 respectively). Conclusions: Childhood cancer and BMT patients receive multiple PRBC transfusions to treat symptomatic anemia. It is currently unknown whether excess iron deposition in the heart contributes to the cardiac effects of impaired diastolic function and ultimately systolic dysfunction. In this study, 11 of 18 patients (61.1%) with high levels of liver iron had at least 1 other risk factor for the development of future cardiac dysfunction (either anthracycline exposure, radiation to the chest or total body irradiation or both). Larger studies are needed to determine whether oncology patients with high levels of iron deposition in their liver are also at risk for clinically significant cardiac iron loading, and what risk factors may exist for elevated myocardial iron content.

Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings

Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings

Clinic-radiomics model using liver magnetic resonance imaging helps predict chronicity of drug-induced liver injury.

Some drug-induced liver injury (DILI) cases may become chronic, even after drug withdrawal. Radiomics can predict liver disease progression. We established and validated a predictive model incorporating the clinical characteristics and radiomics features for predicting chronic DILI. One hundred sixty-eight DILI patients who underwent liver gadolinium-diethylenetriamine pentaacetate-enhanced magnetic resonance imaging were recruited. The patients were clinically diagnosed using the Roussel Uclaf causality assessment method. Patients who progressed to chronicity or recovery were randomly divided into the training (70%) and validation (30%) cohorts, respectively. Hepatic T1-weighted images were segmented to extract 1672 radiomics features. Least absolute shrinkage and selection operator regression was used for feature selection, and Rad-score was constructed using support vector machines. Multivariable logistic regression analysis was performed to build a clinic-radiomics model incorporating clinical characteristics and Rad-scores. The clinic-radiomics model was evaluated for its discrimination, calibration, and clinical usefulness in the independent validation set. Of 1672 radiomics features, 28 were selected to develop the Rad-score. Cholestatic/mixed patterns and Rad-score were independent risk factors of chronic DILI. The clinic-radiomics model, including the Rad-score and injury patterns, distinguished chronic from recovered DILI patients in the training (area under the receiver operating characteristic curve [AUROC]: 0.89, 95% confidence interval [95% CI]: 0.87-0.92) and validation (AUROC: 0.88, 95% CI: 0.83-0.91) cohorts with good calibration and great clinical utility. The clinic-radiomics model yielded sufficient accuracy for predicting chronic DILI, providing a practical and non-invasive tool for managing DILI patients.

Development of a Suite of Gadolinium-Free OATP1-Targeted Paramagnetic Probes for Liver MRI.

Five amphiphilic, anionic Mn(II) complexes were synthesized as contrast agents targeted to organic anion transporting polypeptide transporters (OATP) for liver magnetic resonance imaging (MRI). The Mn(II) complexes are synthesized in three steps, each from the commercially available trans-1,2-diaminocyclohexane-N,N,N',N'-tetraacetic acid (CDTA) chelator, with T1-relaxivity of complexes ranging between 2.3 and 3.0 mM-1 s-1 in phosphate buffered saline at an applied field strength of 3.0 T. Pharmacokinetics were assessed in female BALB/c mice by acquiring T1-weighted images dynamically for 70 min after agent administration and determining contrast enhancement and washout in various organs. Uptake of Mn(II) complexes in human OATPs was investigated through in vitro assays using MDA-MB-231 cells engineered to express either OATP1B1 or OATP1B3 isoforms. Our study introduces a new class of Mn-based OATP-targeted contrast that can be broadly tuned via simple synthetic protocols.

Quantitative liver magnetic resonance imaging: correlation between conventional magnetic resonance imaging, laboratory values, and prognostic indices in Budd-Chiari syndrome.

In Budd-Chiari syndrome (BCS), unevenly distributed parenchymal changes and perfusion abnormalities occur due to hepatic venous outflow obstruction. This study aimed to evaluate the changes in the liver parenchyma in BCS using the quantitative magnetic resonance (MR) techniques of MR elastography, T1 and T2 mapping, and diffusion imaging and correlate the quantitative MR parameters through biochemical results and prognostic indices. Fourteen patients with BCS (seven men and seven women) were examined retrospectively. Liver stiffness (kPa), T1 relaxation times (ms) were achieved using the modified Look-Locker inversion recovery (MOLLI) 3(2)3(2)5 sequence and B1-corrected variable flip angle methods, T2 relaxation times (ms), and apparent diffusion coefficient (ADC) values (mm2/s) were measured using regions of interest placed in the same region in all quantitative methods. Measurements were repeated at the precontrast and postcontrast hepatobiliary phases. The reduction rate (RR; %) and adjusted postcontrast T1 (%) were calculated. The values obtained from different liver parenchyma areas (whole liver, caudate lobe, pathological T2 hyperintense tissue, and relatively preserved normal-appearing tissue) were compared using the Wilcoxon signed-rank test. Spearman's correlation coefficient was used to investigate the correlation between quantitative MR parameters and biochemical parameters/ prognostic scores (Child-Pugh score, Clichy score, and Rotterdam index). The parenchymal stiffness and precontrast T1 values of the caudate lobe were significantly lower than those of the remainder of the parenchyma, whereas the adjusted postcontrast T1 percentages (MOLLI) were significantly higher (P ≤ 0.027). The parenchymal stiffness value, T1 and T2 values, percentages of RR (MOLLI), and adjusted postcontrast T1 values for the pathological tissue and relatively normal tissue were significantly different (P < 0.028). No significant difference was found in terms of ADC values between any of the distinct regions of the liver. A strong correlation was detected between the Child-Pugh score, Clichy score, and precontrast T1 values obtained through the MOLLI sequence (r = 0.867, P = 0.012, r = 0.821, P = 0.023, respectively). No correlation was found between the whole liver stiffness values and the laboratory parameters, fibrosis markers, prognostic indices, or MR parameters. A significant correlation was identified between creatinine levels and several T1 parameters and the T2 relaxation time (r ≥ 0.661, P ≤ 0.052). Tissue stiffness and T1 relaxation values are high in the areas identified as fibrosis compared with those in the relatively preserved parenchyma. The T1 relaxation time can offer quantitative information for assessing segmental functional changes and prognosis in BCS.ion for assessing segmental functional changes and prognosis in BCS.

Evaluated the Correlation Between Serum Ferritin and Iron Overload of Liver, Spleen and Heart in β-Thalassemia Major Patients by MRI T2&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt; Method

β-Thalassemia major often results in an excess of iron in the body due to frequent blood transfusions and enhanced absorption of iron in the gastrointestinal tract. Early detection of this condition and administering sufficient iron chelator therapy can significantly decrease the risk of complications and fatalities resulting from iron overload. MRI (Magnetic Resonance Imaging) T2^* is an accurate non-invasive method for assessing organ iron overload in β-Thalassaemia major patients. This study evaluated the correlation between serum ferritin and iron overload of liver, spleen, and heart in β -Thalassaemia major patients by MRI T2^* method. The design was a cross-section, descriptive study. We used MRI-T2^* to evaluate the correlation between serum ferritin and iron overload of liver, spleen, and heart in 24 Thalassaemia major patients admitted in Cho Ray hospital from 10/2013 to 1/2014, using a 1.5T MRI system (Siemens) with a body coil. T2^* measurements were taken in the liver, spleen, and myocardium using different gradient echo pulse sequences. T2^* values were calculated within homogeneous regions of interest (ROI) in the liver avoiding major blood vessels, spleen, and the entire thickness of the interventricular septum in the myocardium. Pearson correlation coefficient was used to evaluate correlations in the study with a significance threshold of p < 0.05 using SPSS 16.0 software. As results, moderate negative correlation between serum ferritin and liver, spleen MRI T2^* relaxation time (r = 0.57 and 0.755) and a weak negative correlation between serum ferritin and heart MRI T2^* relaxation time (r = 0.303). Liver and heart MRI T2^* readings were poorly correlated (r = 0.28). In conclusion, MRI T2^* is useful to evaluate the iron overload status in β thalassemia patients.

Does hepatic steatosis impact chronic hepatitis B?

Does hepatic steatosis impact chronic hepatitis B?

Fatty liver disease, heart rate and cardiac remodelling: Evidence from the UK Biobank.

Growing evidence supports an association between fatty liver disease (FLD) and cardiac dysfunction and remodelling, leading to cardiovascular disease and heart failure. Herein, we investigated the independent contribution of FLD to cardiac dysfunction and remodelling in participants from the UK Biobank with cardiac magnetic resonance (CMR) data available. A total of 18 848 Europeans without chronic viral hepatitis and valvular heart diseases, with liver magnetic resonance imaging and CMR data were included in the analyses. Clinical, laboratory and imaging data were collected using standardized procedures. Multivariable regression models were used to test the association between FLD and CMR endpoints, after adjusting for several cardiometabolic risk factors. Linear regression models with regularization (Least Absolute Shrinkage and Selection Operator [LASSO], Ridge and Elastic Net) were used to generate predictive models for heart-related endpoints. FLD was independently associated with higher average heart rate, higher cardiac remodelling (higher eccentricity ratio and lower remodelling index), lower left and right ventricular volumes (end-systolic, end-diastolic and stroke volumes) as well as with lower left and right atrial maximal volumes (p < 0.001). FLD was the strongest positive predictor for average heart rate, followed by age, hypertension and type 2 diabetes. Male sex was the strongest positive predictor for eccentricity ratio followed by FLD, age, hypertension and BMI. For LV volumes, FLD was the strongest negative predictor along with age. FLD is an independent predictor of higher heart rate and early cardiac remodelling associated with reduced ventricular volumes.

Ultrasound shear wave attenuation in nonalcoholic fatty liver disease: performance of the revisited frequency-shift method with pre-clinical and human datasets

Assessment of ultrasound shear wave attenuation (SWA) can increase the accuracy of liver steatosis grading. Recent developments allowed to propose the revisited frequency shift method for SWA imaging. This method was tested on force-fed ducks for foie gras production (n = 6), and a feasibility study on patients with non-alcoholic steatohepatitis (NASH n = 27 + 13 healthy volunteers) was conducted. Liver biopsy and magnetic resonance imaging proton density fat fraction (MRI-PDFF) were available as reference standards. For the human study, shear wave dispersion (SWD) was also computed. A subset of participants had repeated measurements (&amp;lt;1-month) to assess repeatability. The mean SWA (coefficient of variation within the attenuation map) for healthy duck livers were 0.77 (0.66), 1.18 (0.22), and 1.52 Np/m/Hz (0.14), and for fatty duck livers they were higher at 3.13 (0.55), 3.16 (0.24), and 4.84 Np/m/Hz (0.23). Receiver operating characteristic (ROC) curves using biopsy as reference were compared for steatosis grades &amp;gt;0 (&amp;gt;S0), &amp;gt;S1, and &amp;gt;S2. SWA was as good as MRI-PDFF, and both were better than SWD for steatosis grading (p &amp;lt; 0.05). The repeatability of SWA was very good (mean intraclass correlation coefficient of 0.97). In summary, SWA seems promising to become an ultrasound reference standard for steatosis grading in NASH.

Comparisons of Hepatobiliary Phase Imaging Using Combinations of Parallel Imaging and Variable Degrees of Compressed Sensing With Use of Parallel Imaging Alone.

This study aimed to compare the image quality in the hepatobiliary phase images of gadoxetic acid-enhanced liver magnetic resonance imaging using parallel imaging (PI) and compressed sensing (CS) reconstruction, using variable CS factors with the standard method using the PI technique. In this study, 64 patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging at 3.0 T were enrolled. Hepatobiliary phase images were acquired 6 times using liver acquisition with volume acceleration (LAVA) and CS reconstruction with 5 CS factors 1.4, 1.6, 1.8, 2.0, and 2.5 (LAVA-CS 1.4, 1.6, 1.8, 2.0, and 2.5) and standard LAVA (LAVA-noCS). For objective analysis, the signal intensity ratios (SIRs) of the liver-to-spleen (SIR liver/spleen ), liver-to-portal vein (SIR liver/portal vein ), and liver-to-fat (SIR liver/fat ) were estimated. For subjective analysis, 2 radiologists independently evaluated the quality of all the images. The objective analysis demonstrated no significant difference in all evaluation parameters of all the images. Subjective analysis revealed that the scores of all evaluation items were higher for LAVA-noCS images than for LAVA-CS images, and only LAVA-CS 1.4 did not significantly differ from LAVA-noCS in all evaluation items ( P = 1.00 in 2 readers). A CS factor of 1.4 in the hepatobiliary phase image with combined PI and CS can reduce the scan time without degrading the image quality compared with the standard method.

Clinicopathological Characteristics of Low to Intermediate Grade Neuroendocrine Tumors with Oncocytic Features

Neuroendocrine tumors (NETs) with oncocytic features are rare. To date, few studies have described the metastatic characteristics of these tumors, most of which were limited by the low number of cases. One article characterized intermediate to high grade (G2 and G3) oncocytic NETs of the pancreas as having an ominous outcome; however, metastatic features of low-grade oncocytic NETs have, to our knowledge, been hitherto unexplored. Our study characterized the clinicopathological and metastatic features of 32 low to intermediate-grade oncocytic NETs of various organs. The most frequent metastatic site was the liver (63%). The metastatic rate of our cases was compared with Riihimaki’s study (metastatic rate of G1/G2 NETs was reported), as well as Heetfeld’s study and Lithgow’s study (metastatic rate of G3 NETs was reported). The overall metastatic rate of our cases is 84.4%, which is significantly higher than that of the G1/2 NETs from Riihimaki’s study (84.4% vs. 25%, p &lt; 0.0001), while similar to that of the G3 NETs from Heetfeld’s study (84.4% vs. 86.5%, p &gt; 0.05) and Lithgow’s study (84.4% vs. 80.8%, p &gt; 0.05). These data indicate that oncocytic features could potentially be characterized as high-risk features in addition to high Ki-67 index, mitotic count, and necrosis. Thus, imaging studies such as liver magnetic resonance imaging (MRI) may be warranted to detect liver metastases in NETs with distinctive oncocytic cytologic features even in the absence of other high-risk features.

Synthesis of Chitosan-Coated Co0.5Zn0.5Fe2O4 Nanoparticles for Contrast Enhancement in Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is an imaging technique that is widely used for the identification of internal organs, and for the medical diagnosis of tumors and cancer in the body. In general, gadolinium is used as a contrast agent to enhance image contrasting in MRI. In this study, chitosan-coated Co0.5Zn0.5Fe2O4 nanoparticles were synthesized using a co-precipitation method with a calcination temperature of 500 °C. The nanoparticles were then coated with chitosan and treated under an external magnetic field of 400 mT. X-ray diffractometer results showed that the chitosan-coated Co0.5Zn0.5Fe2O4 nanoparticles had a pure phase of Co0.5Zn0.5Fe2O4 at the (3 1 1) plane, with an average particle size of 26 nm. The presence of chitosan on the Co0.5Zn0.5Fe2O4 nanoparticles was confirmed by Fourier transform infrared spectroscopy, which showed the primary amine and secondary amine functional groups of chitosan. Here, coating the nanoparticle with chitosan not only prevented nanoparticle agglomeration, but also improved the particle surface charge and reduced the particle toxicity for in vivo testing. Vibrating sample magnetometer results showed that the maximum magnetization value of the magnetic field-assisted process was increased to 8.85 emu/g. Finally, chitosan-coated Co0.5Zn0.5Fe2O4 nanoparticles with 400 mT of magnetic field assistance increased the average brightness in MRI of mouse liver by 21% compared to using gadolinium.

Hepatobiliary and Pancreatic: Hepatic mass discovered incidentally with telangiectasia.

A 48-year-old woman with no history of alcohol use or medical history was referred to our hospital for abnormal endoscopic and liver sonography findings collected at another hospital. An gastric angiodysplasia (telangiectasia) on endoscopy and two suspicious liver echogenic masses in hepatic S4 and S6 were detected. Her laboratory tests, including liver function tests and tumor markers, were within the normal ranges and the viral markers were negative. Autoimmune antibodies related to autoimmune hepatitis were negative. As she had a severe allergic reaction to the computed tomography (CT) contrast agent, she underwent liver magnetic resonance imaging (MRI) for further evaluation. The liver MRI revealed dozens of hypervascular nodules of various sizes with a central scar and diffuse vascular abnormalities with peripheral vascular obliteration (Fig. 1a). She had experienced intermittent bleeding of the tongue and several telangiectasias were observed on her tongue (Fig. 1b). The differential diagnoses included hepatocellular adenoma and multiple focal nodular hyperplasia (FNH) syndrome with primary or secondary hepatic vascular abnormalities. Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia [HHT]) was also possible considering the diffuse vascular abnormalities in the liver and the telangiectasia on the tongue. The pathology report based on the targeted liver biopsy described a hepatocellular nodular lesion composed of bland looking hepatocytes with sinusoidal dilatation and abnormal vessels, suggesting FNH or hepatocellular adenoma; however, immunohistochemical staining did not confirm either disease (Fig. 2). On the annual MRI follow up, innumerable hypervascular nodules, irregular heterogeneous enhancement of the liver (Fig. 3a), and diffuse vascular abnormalities with peripheral vascular obliteration (Fig. 3b) were the major findings, with no changes seen from the previous exam. Given that the pathology report did not definitively diagnose hepatocellular adenoma or multiple FNH syndrome, a hepatic vascular disorder such as HHT was considered in the differential diagnosis and genetic testing was performed. HHT is an autosomal dominant inherited disorder that affects the vasculature and is considered a rare disease, with a prevalence of 1 in 5000 or 1 in 10 000 births. The pathogenesis of HHT is a heterozygous mutation in the endoglin (ENG) gene or the activin receptor-like kinase type 1 gene, both of which are associated with the transforming growth factor-β superfamily signaling pathway, expressed mostly in the vascular endothelium. As 97% of patients with definite HHT carry a mutation in one of three genes, including ENG, a mutation in a locus mapped to chromosome 5, or an activin receptor-like kinase-1 (ACVRL1), we consulted the genetics department to evaluate the patient for HHT. HHT has traditionally been diagnosed based on clinical features (the Curacao criteria), but can now also be diagnosed by genetic testing. HHT is clinically suspected if two of the four Curacao criteria are met (family history of the disease, hemorrhage, telangiectasia, and visceral involvement) and definite if more than three of the criteria are met. The presence of intrahepatic shunts, disseminated intraparenchymal telangiectases, and other vascular lesions are the typical findings of hepatic involvement. In this patient, three (epistaxis, telangiectasia, and visceral involvement) of the four Curacao criteria were satisfied, leading to a definite diagnosis of HHT. Next-generation sequencing (NGS) panel performed also showed heterozygous mutation of the ACVRL1 (ALK1) gene, which is consistent with HHT type 2.

Medical infrared thermal image based fatty liver classification using machine and deep learning

ABSTRACT Non-alcoholic fatty liver disease (NAFLD) causes accumulation of excess fat in the liver affecting people who drink little to no alcohol. Non-alcoholic steatohepatitis (NASH) is an aggressive form of fatty liver disease (inflammation in the liver), may progress to cirrhosis and liver failure. Liver function tests, ultrasound (US) and magnetic resonance imaging (MRI) are used to help diagnose and monitor liver disease or damage. In this study, the feasibility of medical infrared thermal imaging (MITI) in automatic detection of NAFLD was investigated, and 167 MITI images (44 positive) from 32 patients (7 positive) were evaluated using image processing and classification methods. Convolutional neural network (CNN) architectures and texture analysis methods were used in the feature selection phase. After feature selection and binary classification, the highest values from different setups for recall, f-score, specificity, accuracy, and area-under-curve (AUC) were 1.00, 1.00, 0.83, 1.0, 0.94, and 0.92, respectively. The highest values were achieved by CNN based methods on different datasets, however, texture analysis method performed lower. Here, it is shown that some of the CNN architectures have high potential on extracting features from thermal images. Finally, machine and deep learning approaches can be combined in detecting NAFLD using infrared thermal images.

Optimized visualization of focal liver lesions and vascular structures in real-time T1-weighted gradient echo sequences for magnetic resonance-guided liver procedures.

This study aimed to determine the optimal sequence parameters of a real-time T1-weighted (T1w) gradient echo (GRE) sequence for magnetic resonance (MR)-guided liver interventions. We included 94 patients who underwent diagnostic liver MR imaging (MRI) and acquired additional real-time T1w GRE sequences with a closed 1.5-T MRI scanner 20 min after a liver-specific contrast agent was injected. In four measurement series, one of the following four sequence parameters was changed, and repeated scans with different values for this parameter were acquired: flip angle (FA) (10-90°), repetition time (TR) (5.47-8.58 ms), bandwidth (BW) (300-700 Hz/pixel), and matrix (96 × 96-256 × 256). Two readers rated the visualizations of the target and risk structures (7-point Likert scale) and the extent of artifacts (6-point Likert scale); they also quantified the lesion-liver contrast ratio, the lesion-liver contrast-to-noise ratio (CNR), and the liver signal-to-noise ratio (SNR). Substratification analyses were performed for differences in overall visual and quantitative assessments depending on the lesion size, type, and the presence of cirrhosis. For the utilized FAs and matrix sizes, significant differences were found in the visual assessments of the conspicuity of target lesions, risk structures, and the extent of artifacts as well as in the quantitative assessments of lesion-liver contrast ratios and liver SNRs (all P < 0.001). No differences were observed for modified TR and BW. Significantly increased conspicuity of the target and vascular structures was observed for both higher FAs and matrix sizes, while the ghosting artifacts increased and decreased, respectively. For primary liver tumors compared with metastatic lesions, and for cirrhotic livers compared with normal liver parenchyma, significantly decreased conspicuity of the target lesions (P = 0.005, P = 0.005), lesion-liver CNRs (P = 0.005, P = 0.032), and lesion-liver contrast ratios (P = 0.015, P = 0.032) were found. All results showed no significant correlation with lesion size. We recommend an FA of 30°-45° and a matrix size of 128 × 128-192 × 192 for MR-guided liver interventions with real-time T1w sequences to provide a balance between good visualizations of target and risk structures, high signal intensities, and low ghosting artifacts. The visualization of the target lesion may vary due to clinical conditions, such as lesion type or associated chronic liver disease.

A case with sarcomatoid hepatocellular carcinoma and literature review

Sarcomatoid hepatocellular carcinoma (SHC) is a relatively rare subtype of liver cancer reported in 1.8–2.0% of surgically resected cases. Previous studies have found that SHC was more likely to occur in patients who received repeated anticancer therapies, but the underlying mechanism has not been exactly illustrated. We report a case of a 62-year-old man with SHC. With the initial implication of abscess suspected liver mass by radiological exams (enhanced Computed Tomography and liver Magnetic Resonance Imaging), the patient underwent a laparoscopic pus debridement and biopsy. The diagnosis of SHC was considered by pathologists. After a short recovery, a second radical resection of the liver tumor and hepatic hilar lymph node dissection were conducted. Postoperative pathology revealed a tumor-free incisal margin and negative lymph node. The recovery of the patient was uneventful. When confronting an occasional liver mass with previous Hepatitis B virus infection, SHC should be included for a candidate diagnosis. If diagnosis is confirmed, high biological malignancy and poor survival should be expected. Surgery is still a main option to treat SHC.

Adaptive MRI-guided liver SBRT planning using superparamagnetic iron oxide nanoparticles (SPION)

Background: Ferumoxytol® (Feraheme, AMAG Pharmaceuticals, Waltham, MA) is a super-paramagnetic iron oxide nanoparticle that is increasingly utilized off-label as a liver magnetic resonance imaging (MRI) contrast agent. In addition to its excellent safety profile in patients with impaired kidney function, this agent has the advantage of providing a functional assessment of the liver based upon its uptake within hepatic Kupffer cells proportionate to vascular perfusion, resulting in strong T1, T2 and T2* relaxation effects and enhanced contrast of malignant tumors, which lack Kupffer cells. The latter characteristic is especially important in patients who have undergone prior therapy, in whom the functional liver reserve may be overestimated by conventional imaging techniques. The purpose of this study was to assess visibility of liver tumors and functional hepatic parenchyma utilizing SPION-enhanced 1.5T MRI during per-fraction adaptive stereotactic body radiotherapy (SBRT) planning on Elekta Unity Hybrid MR-Linac (Elekta; Stockholm, Sweden) in patients with pre-existing liver conditions.

Usefulness of Breath-hold DWI Focused on the Hepatic Dome in EOB-MRI

Respiratory-triggered-diffusion-weighted imaging (R-DWI) of the liver often results in poor image quality under the diaphragmatic dome on the cephalic side of the liver (hepatic dome) secondary to magnetic field inhomogeneity in liver magnetic resonance imaging (MRI). Hence, the usefulness of additional breath-hold-DWI (B-DWI) focusing on the hepatic dome was investigated. A total of 22 patients (14 men and 8 women; mean age 69.0±11.7 years) who underwent ethoxybenzyl (EOB)-MRI at our hospital between July and August, 2022 using a 3.0 T MRI system were included. One radiologist and three radiology technologists visually assessed the visibility of R-DWI and B-DWI in the hepatic dome on a 4-point scale (1 to 4). Additionally, the apparent diffusion coefficient (ADC) values of the hepatic parenchyma on each DWI were compared. B-DWI improved visibility in the hepatic dome compared to R-DWI (2.67±0.71 vs. 3.25±0.43, p<0.05). No significant difference was found in the ADC values for each DWI. B-DWI has excellent visibility in the hepatic dome and is expected to complement R-DWI. Therefore, B-DWI is very useful as an additional imaging in EOB-MRI.

Efficient prediction and classification for cirrhosis disease using LBP, GLCM and SVM from MRI images

To enhance the specificity of Magnetic resonance imaging (MRI) based cirrhosis stage-diagnosis, a method of diagnosis incorporating the scan image texture discovery with classification techniques are suggested. First of all the liver MRI images are preprocessed and Region of Interest (ROI) image field is retrieved from the MRI images and the Lloyd method is compressed and quantified. Then a Local Binary Pattern (LBP) process filtering the ROI image and then extracts the texture features of the LBP images from four directions with a twenty directional Gray-Level Co-occurrence Matrix (GLCM). After that, the Support Vector Machine (SVM) technique has been used for MRI image classification and cirrhosis disease prediction. The experimental findings indicate that the procedure suggested will diagnose hepatic cirrhosis correctly.

Strategies and Techniques for Liver Magnetic Resonance Imaging: New and Pending Applications for Routine Clinical Practice.

Strategies and Techniques for Liver Magnetic Resonance Imaging: New and Pending Applications for Routine Clinical Practice.