Malignant Liver Lesions Research Articles

Die unklare Leberraumforderung

Unknown liver lesions represent a common clinical challenge, for example in the context of routine ultrasound examinations of primary care physicians. There are different data on the prevalence of primary liver lesions in the literature. As such, a forensic autopsy series described focal liver lesions in about 50 % of all examined men between 35 and 69 years of age with an increasing incidence for older people. In the diagnostic work-up of unclear liver lesions, a careful distinction between lesions that occur in asymptomatic and healthy individuals and are benign in over 95 % of cases, and lesion found in patients with pre-existing malignant, inflammatory or cirrhotic disease must be made. The main goal in the diagnosis of unclear liver lesions is to prove the benignity of the lesion and to exclude a malignant cause as reliably as possible. In case of benign lesions, an attempt should be made to achieve an exact classification. The most common benign focal liver lesions include liver cysts, focal fatty liver deposition or sparing, haemangiomas, focal calcifications, focal nodular hyperplasia (FNH), nodular regenerative hyperplasia, biliary hamartomas (von-Meyenburg complexes) and hepatocellular adenomas. Abscesses, inflammatory infiltrations or pseudotumors as well as sites of extramedullary haematopoiesis are observed much less frequently. Among the most frequent malignant focal liver lesions are metastases of other tumor entities such as colorectal cancer or pancreatic adenocarcinoma as well as hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCA). Other entities such as hepatic lymphomas or mesenchymal malignant neoplasia are extremely rare.

Diagnostic accuracy of contrast-enhanced diffusion-weighted MRI for liver metastases of pancreatic cancer: towards adequate staging and follow-up of pancreatic cancer \u2013 DIA-PANC study: study protocol for an international, multicenter, diagnostic trial

BackgroundAt the time of surgery, approximately 10–20% of the patients with pancreatic cancer are considered unresectable because of unexpected liver metastasis, peritoneal carcinomatosis or locally advanced disease. This leads to futile surgical treatment with all the associated morbidity, mortality and costs. More than 50% of all liver metastases develop in the first six months postoperatively. These (subcentimeter) liver metastases are most likely already present at the time of diagnosis and have not been identified pre-operatively, due to the poor sensitivity of routine preoperative contrast-enhanced CT (CECT).MethodsThe DIA-PANC study is a prospective, international, multicenter, diagnostic cohort study investigating diffusion-weighted, contrast-enhanced MRI for the detection of liver metastases in patients with all stages of pancreatic cancer. Indeterminate or malignant liver lesions on MRI will be further investigated histopathologically. For patients with suspected liver lesions without histopathological proof, follow up imaging with paired CT and MRI at 3-, 6- and 12-months will serve as an alternative reference standard.DiscussionThe DIA-PANC trial is expected to report high-level evidence of the diagnostic accuracy of MRI for the detection of liver metastases, resulting in significant value for clinical decision making, guideline development and improved stratification for treatment strategies and future trials. Furthermore, DIA-PANC will contribute to our knowledge of liver metastases regarding incidence, imaging characteristics, their number and extent, and their change in time with or without treatment. It will enhance the worldwide implementation of MRI and consequently improve personalized treatment of patients with suspected pancreatic ductal adenocarcinoma.Trial registrationClinicalTrials.gov Identifier: NCT03469726. Registered on March 19th 2018 - Retrospectively registered.

Deep learning for differentiation of benign and malignant solid liver lesions on ultrasonography.

The ability to reliably distinguish benign from malignant solid liver lesions on ultrasonography can increase access, decrease costs, and help to better triage patients for biopsy. In this study, we used deep learning to differentiate benign from malignant focal solid liver lesions based on their ultrasound appearance. Among the 596 patients who met the inclusion criteria, there were 911 images of individual liver lesions, of which 535 were malignant and 376 were benign. Our training set contained 660 lesions augmented dynamically during training for a total of 330,000 images; our test set contained 79 images. A neural network with ResNet50 architecture was fine-tuned using pre-trained weights on ImageNet. Non-cystic liver lesions with definite diagnosis by histopathology or MRI were included. Accuracy of the final model was compared with expert interpretation. Two separate datasets were used in training and evaluation, one with all lesions and one with lesions deemed to be of uncertain diagnosis based on the Code Abdomen rating system. Our model trained on the complete set of all lesions achieved a test accuracy of 0.84 (95% CI 0.74-0.90) compared to expert 1 with a test accuracy of 0.80 (95% CI 0.70-0.87) and expert 2 with a test accuracy of 0.73 (95% CI 0.63-0.82). Our model trained on the uncertain set of lesions achieved a test accuracy of 0.79 (95% CI 0.69-0.87) compared to expert 1 with a test accuracy of 0.70 (95% CI 0.59-0.78) and expert 2 with a test accuracy of 0.66 (95% CI 0.55-0.75). On the uncertain dataset, compared to all experts averaged, the model had higher test accuracy (0.79 vs.0.68, p = 0.025). Deep learning algorithms proposed in the current study improve differentiation of benign from malignant ultrasound-captured solid liver lesions and perform comparably to expert radiologists. Deep learning tools can potentially be used to improve the accuracy and efficiency of clinical workflows.

Value of MRI/CT Image Fusion for Targeting "invisible" Lesions in Stereotactic Microwave Ablation (SMWA) of Malignant Liver Lesions: A Retrospective Analysis.

To assess the technical feasibility of MRI/CT image fusion and completeness of ablation treatment for primary or metastatic liver lesions invisible on contrast-enhanced CT planning scans and outcome in patients treated with stereotactic microwave ablation (SMWA). The study was approved by the local ethics committee. Patients who underwent SMWA between January 2015 and December 2018 were retrospectively analyzed. All liver lesions for which MRI/CT fusion was performed due to invisibility on pre-interventional CT planning scans were included and reassessed. The outcome measurement was successful ablation of the lesion at first follow-up imaging. During the study period, 236 patients underwent 312 SMWAs with ablation of 496 lesions. Twenty-four lesions in 15 patients (mean age, 62years; range, 43-80years) were included. Following MRI/CT image fusion, all 24 lesions could be sufficiently localized to perform SMWA. The first follow-up imaging showed complete ablation of 22 lesions. Two initially incompletely ablated lesions were hepatocellular carcinomas and were successfully re-ablated afterwards. SMWA with MRI/CT image fusion is an accurate and safe treatment option for patients with liver lesions not detectable on contrast-enhanced CT planning scans. MRI/CT image fusion may allow more patients with malignant liver lesions to benefit from local ablation treatment even if their lesions are not visible on CT planning examinations.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Hepatic Focal Lesions

Background: Diffusion-weighted imaging (DWI) is a novel imaging technique with a growing application in oncoimaging. This modality evaluates the diffusion of water molecules in various tissues, which is restricted in hypercellular regions such as malignant tissue. Apparent diffusion coefficient (ADC) is a method that can quantify the degree of restriction in tissues and can have diagnostic roles in the characterization of hepatic lesions. Aim of the Work: To study the role of diffusion-weighted MRI sequence with quantitative ADC measurements as a useful tool in the differentiation between benign and malignant liver lesions. Patients and Methods: The current study was carried out on thirty adult patients, 24 males (80%), and 6 females (20%). They were presented to Qena University Hospitals at the Radiodiagnosis Department. Results: Both, qualitative evaluation of high b-value DW-MR images and quantitative evaluation of ADC maps are employed for lesion characterization. The ADC values of benign lesions are significantly higher than those of malignant lesions, with variable degrees of overlap between the pathological entities. Conclusion: DW MR imaging has the potential to be a reasonable alternative technique to contrast-enhanced imaging.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Hepatic Focal Lesions

Background: Diffusion-weighted imaging (DWI) is a novel imaging technique with a growing application in oncoimaging. This modality evaluates the diffusion of water molecules in various tissues, which is restricted in hypercellular regions such as malignant tissue. Apparent diffusion coefficient (ADC) is a method that can quantify the degree of restriction in tissues and can have diagnostic roles in the characterization of hepatic lesions. Aim of the Work: To study the role of diffusion-weighted MRI sequence with quantitative ADC measurements as a useful tool in the differentiation between benign and malignant liver lesions. Patients and Methods: The current study was carried out on thirty adult patients, 24 males (80%), and 6 females (20%). They were presented to Qena University Hospitals at the Radiodiagnosis Department. Results: Both, qualitative evaluation of high b-value DW-MR images and quantitative evaluation of ADC maps are employed for lesion characterization. The ADC values of benign lesions are significantly higher than those of malignant lesions, with variable degrees of overlap between the pathological entities. Conclusion: DW MR imaging has the potential to be a reasonable alternative technique to contrast-enhanced imaging.

Outcome quality standards for surgery of colorectal liver metastasis.

Liver metastases are the most common malignant solid liver lesions, approximately 40% of which stem from colorectal tumors. Liver resection is currently the only curative treatment for colorectal cancer liver metastases (CRLM). However, there is a lack of consensus criteria to assess the results of this treatment. In order to evaluate the quality of surgical outcomes, it is necessary to identify quality indicators (QIs) and their corresponding quality standards (QS). We propose a simple method to determine QI and QS in CRLM surgery (CRLMS) and establish acceptable quality limits (AQL) for each QI. A systematic review of CRLMS results published from 2006 to 2016. Clinical guidelines, consensus conferences, and publications related to the CRLMS were reviewed to identify and select QIs. Once selected, a new review of the papers including the results of at least one of the QIs was performed. Statistical process control (SPC) method was applied to calculate the QS and AQL of each QI. The limits of variability were established from mean and confidence intervals at 95% and 99.8%. The most relevant QIs and its AQLs were postoperative mortality (2%, < 4.5%), overall postoperative morbidity (33%, < 41%), liver failure (5%, < 8%), postoperative hemorrhage (1%, < 3%), biliary fistula (6%, < 10%), reoperation (3%, < 6%), R1 resection margins (18%, < 25%), and overall survival at 12 and 60months (84%, > 77%; and 34%, > 25%, respectively). Despite its limitations, the present study constitutes the most extensive scientific evidence to date on QI and AQL in CRLMS and may constitute a reference in future studies.

The Value of Monomer Hydrogen Proton Magnetic Resonance Spectra in the Diagnosis of Liver Benign and Malignant Lesions

The early diagnosis and treatment of liver disease are very important in clinics. Magnetic resonance spectroscopy (MRS) provides a non-invasive 'window' on the biochemical processes in the body. This study deployed research based on application of monomer element 1HMRS in the diagnosis of benign or malignant liver lesions. Patients with different liver diseases were recruited along with healthy controls. GE Signa Twinspeed 1.5T MRI was performed on livers along with monomeric hydrogen MRS, followed by SAGE software analysis. In healthy patient's livers, both choline and lipid peaks were observed under MRS, with occasionally glutamine and glutamic acid complex (Glx) peak and glucogen and glucose complex (Glu) peak. Malignant liver lesions had significantly elevated choline peak and choline/lipid ratio compared to control or benign lesions (P &lt; 0.05). The accuracy, sensitivity and specificity of MRI against malignant tumors were 89.4%, 86.2% and 91.1%, respectively. These figures for choline/lipid and MRI plus choline/lipid were 87.2%, 92.3% and 90.1%, and 94.1%, 89.1% and 90.4%, respectively. Our study shows that monomeric hydrogen proton MRS might be used as the diagnostic evidences for malignant liver diseases, especially for choline peak level and choline/lipid ratio. However, large cohort multi-center study is required to confirm the findings in the future.

Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions

PurposeTo compare the evaluation of malignant focal liver lesions (FLLs) using a semi-automated RECIST tool with a standard and an ultra-low dose (ULD) computed tomography (CT) protocol. Materials and methodsThirty-four patients with malignant FLLs underwent two abdominal-pelvic CT examinations one using a standard protocol and one using an ULD protocol. There were 23 men and 11 women with a mean age 64.3±14.4 (SD) years (range: 22–91 years). Dosimetric indicators were recorded, and effective dose was calculated for both examinations. Mean malignant FLL attenuation, image noise and contrast-to-noise-ratio (CNR) were compared. The largest malignant FLL per patient was evaluated using the semi-automated RECIST tool to determine longest axis length, longest orthogonal axis length, volume and World Health Organisation area. ResultsDosimetric values were significantly reduced by −56% with ULD compared to standard protocol. No differences in mean malignant FLL attenuation values were found between the two protocols. Image noise was significantly increased for all locations (P<0.05) with ULD compared to standard protocol, and CNR was significantly reduced (P<0.05). On the 34 malignant FLLs analyzed, six semi-automated shapes non-concordant with radiologist's visual impression were highlighted with the software, including one FLL (1/34; 3%) with standard CT acquisition only, three FLLs (3/34; 9%) with ULD CT acquisition only and two FLLs (2/34; 6%) with both CT acquisitions. After manual editing, the concordance of the values of the studied criteria between both acquisitions was good and no significant difference was reported. ConclusionSemi-automated RECIST tool demonstrates good performances using ULD CT protocol. It could be used in routine clinical practice with a ULD protocol for follow-up studies in patients with known malignant FLL.

Semiautomatic Segmentation and Radiomics for Dual-Energy CT: A Pilot Study to Differentiate Benign and Malignant Hepatic Lesions.

OBJECTIVE. This study assessed a machine learning-based dual-energy CT (DECT) tumor analysis prototype for semiautomatic segmentation and radiomic analysis of benign and malignant liver lesions seen on contrast-enhanced DECT. MATERIALS AND METHODS. This institutional review board-approved study included 103 adult patients (mean age, 65 ± 15 [SD] years; 53 men, 50 women) with benign (60/103) or malignant (43/103) hepatic lesions on contrast-enhanced dual-source DECT. Most malignant lesions were histologically proven; benign lesions were either stable on follow-up CT or had characteristic benign features on MRI. Low- and high-kilovoltage datasets were deidentified, exported offline, and processed with the DECT tumor analysis for semiautomatic segmentation of the volume and rim of each liver lesion. For each segmentation, contrast enhancement and iodine concentrations as well as radiomic features were derived for different DECT image series. Statistical analyses were performed to determine if DECT tumor analysis and radiomics can differentiate benign from malignant liver lesions. RESULTS. Normalized iodine concentration and mean iodine concentration in the benign and malignant lesions were significantly different (p < 0.0001-0.0084; AUC, 0.695-0.856). Iodine quantification and radiomic features from lesion rims (AUC, ≤ 0.877) had higher accuracy for differentiating liver lesions compared with the values from lesion volumes (AUC, ≤ 0.856). There was no difference in the accuracies of DECT iodine quantification (AUC, 0.91) and radiomics (AUC, 0.90) for characterizing liver lesions. CONCLUSION. DECT radiomics were more accurate than iodine quantification for differentiating solid benign and malignant hepatic lesions.

Golgi Protein 73 as a Diagnostic Tool for Hepatocellular Carcinoma in Cirrhotic Hepatitis C Patients

Background and study aim: Hepatocellular carcinoma (HCC) is the commonest primary liver cancer originating from the hepatocytes. HCC nowadays considered the 3rd cause of malignancy related mortality allover the world. Small HCC, means that size of hepatic focal lesions did not exceed 5 centimeters in patients with solitary hepatoma, typically have no clinical manifestations. This makes cirrhotic liver patients a perfect target population for HCC surveillance.This study was designed to evaluate the clinical use of serum GP73 levels as a good diagnostic biomarkers for malignant liver tumours in cirrhotic patients due to HCV infection. Subjects and Methods: The study was designed as a Descriptive - Analytic study at Suez Canal University Hospital. The study included 87 individuals who were divided into four groups (healthy, chronic hepatitis, cirrhosis and HCC patients). All patients were clinically evaluated, had routine laboratory investigations and measurements of circulating levels of AFP and GP73. Abdominal ultrasonography and Triphasic CT abdomen was done for detection of hepatic focal lesions and hepatobiliary system. Results: The maximum cutoff levels for GP73 was 534.5 ng/L and in comparison the cutoff AFP level was 32 ng/mL. For GP73, the sensitivity was 88% and specificity 88% while the sensitivity of AFP was 72% and the specificity of AFP was 80%. The +v predictive value of GP73 and the -ve predictive value of GP73 were 84.6% and 87.5% while the same values of AFP were 75% and 73.1%, respectively. Conclusion: It was found that serum GP73 was up-regulated in HCC and we can use it as a good biomarker for early detection and for screening of malignant liver lesions in cirrhotic patients due chronic HCV infection and it would be more accurate and effective tool than serum AFP in discriminating the malignant liver lesion from the chronic hepatitis.

Assessment of Lesion Detectability in Dynamic Whole-Body PET Imaging Using Compartmental and Patlak Parametric Mapping.

Hybrid dynamic imaging allows not only the estimation of whole-body (WB) macroparametric maps but also the estimation of microparameters in the initial bed position targeting the blood pool region containing the pathology owing to the limited axial field of view of PET scanners. In this work, we assessed the capability of multipass WB F-FDG PET parametric imaging in terms of lesion detectability through qualitative and quantitative evaluation of simulation and clinical studies. Simulation studies were conducted by generating data incorporating 3 liver and 3 lung lesions produced by 3 noise levels and 20 noise realizations for each noise level to estimate bias and lesion detection features. The total scan time for the clinical studies of 8 patients addressed for lung and liver lesions staging, including dynamic and static WB imaging, lasted 80 minutes. An in-house-developed MATLAB code was utilized to derive the microparametric and macroparametric maps. We compared lesion detectability and different image-derived PET metrics including the SUVs, Patlak-derived influx rate constant (Ki) and distribution volume (V) and K1, k2, k3, blood volume (bv) microparameters, and Ki estimated using the generalized linear least square approach. In total, 104 lesions were detected, among which 47 were located in the targeted blood pool bed position where all quantitative parameters were calculated, thus enabling comparative analysis across all parameters. The evaluation encompassed visual interpretation performed by an expert nuclear medicine specialist and quantitative analysis. High correlation coefficients were observed between SUVmax and Kimax derived from the generalized linear least square approach, as well as Ki generated by Patlak graphical analysis. Moreover, 3 contrast-enhanced CT-proven malignant lesions located in the liver and a biopsy-proven malignant liver lesion not visible on static SUV images and Patlak maps were clearly pinpointed on K1 and k2 maps. Our results demonstrate that full compartmental modeling for the region containing the pathology has the potential of providing complementary information and, in some cases, more accurate diagnosis than conventional static SUV imaging, favorably comparing to Patlak graphical analysis.

Hepatobiliary MR contrast agents are useful to diagnose hepatocellular carcinoma in patients with Budd-Chiari syndrome.

Background & AimsHepatobiliary phase (HBP) images can discriminate between benign and malignant liver lesions, but it is unclear if this approach can be used in patients with Budd-Chiari syndrome (BCS). Thus, we aimed to assess the diagnostic utility of HBP images in patients with BCS.MethodsThis retrospective study included all patients admitted to our institution with a diagnosis of BCS and focal liver lesions on hepatobiliary contrast agent-enhanced MR imaging (HBCA-MRI) from 2000 to 2019. MR images were reviewed by 2 radiologists blinded to the diagnosis of the lesions. Patient and lesion characteristics were recorded, focusing on HBP imaging features.ResultsTwenty-six patients (mean 35 ± 11 years old [13–65]; 21 women [81%] 35 ± 12 years old [13–65]; 5 men [19%] 36 ± 10 years old [19–44]) with 99 benign liver lesions and 12 hepatocellular carcinomas (HCCs) were analyzed. Patients with HCC were significantly older than those with benign lesions (mean 50 ± 10 vs. 33 ± 9 years old, p = 0.003), with higher alpha-fetoprotein (AFP) levels (3/4 [75%] vs. 1/22 [5%] with AFP >15 ng/ml, p <0.001). Homogeneous hypointense signals were identified on HBP in 14 lesions, including 12/12 (100%) HCCs, and 2/99 (2%) benign lesions (p <0.001). Most benign liver lesions showed either peripheral (n = 52/99 [53%]) or homogeneous hyperintensity (n = 23/99 [23%]) on HBP. Lesions with signal hypointensity on HBP in patients with AFP serum levels >15 ng/ml were all HCCs.ConclusionMost benign lesions showed homogeneous or peripheral hyperintensity on HBP images while all HCCs were homogeneously hypointense. HBP images are helpful to differentiate between benign lesions and HCCs and outperform other sequences. They should be systematically acquired for the characterization of focal lesions in patients with BCS.Lay summaryHepatobiliary phase imaging is an approach that has recently been shown to discriminate between benign and malignant lesions in the liver. However, it was not known whether this imaging approach could be used effectively in patients with Budd-Chiari syndrome. Herein, we have shown that hepatobiliary phase imaging appears to be useful for differentiating between benign and malignant liver lesions in patients with Budd-Chiari syndrome.

The diagnostic value of diffusion-weighted imaging in differentiating benign from malignant hepatic lesions

BackgroundDiffusion-weighted imaging (DWI) is a novel imaging technique with growing application in onco-imaging. This modality evaluates the diffusion of water molecules in various tissues, which is restricted in hyper cellular regions such as malignant tissue. Apparent diffusion co-efficient (ADC) is a method which can quantify the degree of restriction in tissues and can have diagnostic roles in characterization of hepatic lesions. In this study, 93 patients with proven hepatic lesions were included. These patients had undergone initial evaluation via ultrasonography and dynamic CT scan, and had a definite diagnosis confirmed by biopsy. These patients underwent DW imaging and ADC values of their lesions were calculated. Patients were divided into two groups, benign and malignant groups, based on their biopsy results; and ADC values of hepatic lesions were compared in the two groups.ResultsThe two groups were gender matched. There was a significant difference in the age distribution between the two groups. Mean ADC values for benign and malignant hepatic lesions were 1.58 ± 0.35 (10-3 mm2/s) and 0.87 ± 0.16 (10-3 mm2/s), respectively. There was a statistically significant differences between benign and malignant hepatic lesions (p value < 10-3). DW imaging had a sensitivity of 97.6% and specificity of 98.7% in detecting malignant hepatic lesions from benign ones (p = 0.0001, AUC = 0.99).ConclusionDW MRI imaging can differentiate malignant and benign liver lesions with high sensitivity and specificity using ADC values generated; furthermore, each subgroup of hepatic lesions could be determined based on ADC values.

Is Glypican-3 useful Diagnostic Marker that Distinguishes Hepatocellular Carcinoma from Liver Cirrhosis?

Background and study aim: Glypican-3 (GPC3) is common kind and new type of the Glypicans group. These groups were connected to the epithelial cell membrane by a glycosyl-phosphatidylinositol bond. These proteins control the signaling action of various growth factors, especially Wnts. This reaction is predicated on the power of glypican to initiate, promote or suppress the reaction of these growth agents with their interactive signaling receptors. It is obviously proven and documented that GPC3 is secreted and released by most malignant liver cells, this glypican is not isolated from healthy hepatocyte, cirrhotic liver cells , or in even in benign liver masses. GPC3 accelerates the development of malignant liver lesions especially HCC by stimulating canonical Wnt impulses. The study aimed to characterize and assess the diagnostic accuracy of serum glypican-3 (GPC3) in early detection of HCC in cirrhotic patients and could be used as good screening marker for HCC in cirrhotic patients instead of AFP. Patients and Methods: We enrolled 60 patients which divided into 2 groups, group1 which included 30 patients diagnosed to have HCC and group 2 which included 30 patients diagnosed to have liver cirrhosis. Results: Our results revealed increased levels of Glypican-3 in hepatoma group and liver cirrhosis group with no significant difference (p=0.3). Conclusion: Serum GPC3 is not an efficient immune-marker for HCC that can be used alone to differentiate HCC from benign hepatic focal lesions, particularly hepatocellular adenoma.

Development of an Ultrasound Prediction Model to Discriminate between Malignant and Benign Liver Lesions

To discriminate between malignant and benign liver lesions, we evaluated the ultrasound features of the target lesions in 266 patients and established a prediction model using a logistic regression algorithm. The prediction model based on independent factors was expressed as predictive score = 1.129 × interaction of irregular shape and unclear boundary + 1.398 × occupying effect + 2.363 × hypo-echoic halo + 1.987 × marginal vascular sign + 3.627 × cirrhosis background + 2.976 × nodule in nodule sign + 3.690 × metastasis sign. Receiver operating characteristic curve analysis revealed that the optimal cutoff predictive score was 2.8 (area under the curve = 0.942). The specificity of the prediction model was not significantly different from that of computed tomography/magnetic resonance imaging (91.7% vs. 98.8%, p = 0.077), whereas the prediction model had a lower sensitivity (90.1% vs. 97.8%, p < 0.001) and accuracy (90.6% vs. 98.1%, p < 0.001) than computed tomography/magnetic resonance imaging. We conclude that the ultrasound prediction model exhibited good diagnostic performance in discriminating malignant from benign liver lesions.

Specific complications of liver resection and their prevention

To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.

Genetically Engineered Mouse Models for Liver Cancer.

Liver cancer is the fourth leading cause of cancer-related death globally, accounting for approximately 800,000 deaths annually. Hepatocellular carcinoma (HCC) is the most common type of liver cancer, comprising approximately 80% of cases. Murine models of HCC, such as chemically-induced models, xenograft models, and genetically engineered mouse (GEM) models, are valuable tools to reproduce human HCC biopathology and biochemistry. These models can be used to identify potential biomarkers, evaluate potential novel therapeutic drugs in pre-clinical trials, and develop molecular target therapies. Considering molecular target therapies, a novel approach has been developed to create genetically engineered murine models for HCC, employing hydrodynamics-based transfection (HT). The HT method, coupled with the Sleeping Beauty transposon system or the CRISPR/Cas9 genome editing tool, has been used to rapidly and cost-effectively produce a variety of HCC models containing diverse oncogenes or inactivated tumor suppressor genes. The versatility of these models is expected to broaden our knowledge of the genetic mechanisms underlying human hepatocarcinogenesis, allowing the study of premalignant and malignant liver lesions and the evaluation of new therapeutic strategies. Here, we review recent advances in GEM models of HCC with an emphasis on new technologies.

Comparison of free breathing and respiratory triggered diffusion-weighted imaging sequences for liver imaging.

BACKGROUNDDiffusion-weighted imaging (DWI) has become a useful tool in the detection, characterization, and evaluation of response to treatment of many cancers, including malignant liver lesions. DWI offers higher image contrast between lesions and normal liver tissue than other sequences. DWI images acquired at two or more b-values can be used to derive an apparent diffusion coefficient (ADC). DWI in the body has several technical challenges. This include ghosting artifacts, mis-registration and susceptibility artifacts. New DWI sequences have been developed to overcome some of these challenges. Our goal is to evaluate 3 new DWI sequences for liver imaging.AIMTo qualitatively and quantitatively compare 3 DWI sequences for liver imaging: free-breathing (FB), simultaneous multislice (SMS), and prospective acquisition correction (PACE).METHODSMagnetic resonance imaging (MRI) was performed in 20 patients in this prospective study. The MR study included 3 separate DWI sequences: FB-DWI, SMS-DWI, and PACE-DWI. The image quality, mean ADC, standard deviations (SD) of ADC, and ADC histogram were compared. Wilcoxon signed-rank tests were used to compare qualitative image quality. A linear mixed model was used to compare the mean ADC and the SDs of the ADC values. All tests were 2-sided and P values of < 0.05 were considered statistically significant.RESULTSThere were 56 lesions (50 malignant) evaluated in this study. The mean qualitative image quality score of PACE-DWI was 4.48. This was significantly better than that of SMS-DWI (4.22) and FB-DWI (3.15) (P < 0.05). Quantitatively, the mean ADC values from the 3 different sequences did not significantly differ for each liver lesion. FB-DWI had a markedly higher variation in the SD of the ADC values than did SMS-DWI and PACE-DWI. We found statistically significant differences in the SDs of the ADC values for FB-DWI vs PACE-DWI (P < 0.0001) and for FB-DWI vs SMS-DWI (P = 0.03). The SD of the ADC values was not statistically significant for PACE-DWI and SMS-DWI (P = 0.18). The quality of the PACE-DWI ADC histograms were considered better than the SMS-DWI and FB-DWI.CONCLUSIONCompared to FB-DWI, both PACE-DWI and SMS-DWI provide better image quality and decreased quantitative variability in the measurement of ADC values of liver lesions.

Diagnostic value of Virtual Touch Quantification (VTQ®) for differentiation of hemangiomas from malignant focal liver lesions.

To evaluate the diagnostic value of Virtual Touch Quantification (VTQ®) for characterizing benign vs. malignant focal liver lesions (FLLs). From January 2015 to January 2016 all consecutive FLLs visualized during a conventional abdominal ultrasound (US), underwent VTQ® evaluation, taking five measurements of both the lesion and the surrounding parenchyma. We studied 119 FLLs, consisting of 52 hemangiomas (HEs), 39 hepatocellular carcinomas (HCCs), and 28 liver metastases (METs). HEs showed a significantly lower shear wave velocity (SWV) values compared to malignant FLLs (HEs SWV median value 1.34 m/sec, IQR 0.9; malignant lesions SWV median value 2.69 m/sec, IQR 1.6; p<0.001). Moreover, a nodule-to-parenchyma SWV ratio showed a significant difference in HEs and METs (p<0.001) but not in HCCs (p=0.03). SWV values were able to correctly differentiate malignant lesions with c-statistics of 0.82 (95 % CI 0.74- 0.90) and sensitivity of 74.6%/specificity of 80.7% at a cut-off of 2 m/sec. Our results suggest that VTQ® is able to distinguish HEs from malignant lesions (HCCs and METs) at a SWV cut-off of 2 m/sec.