Malignant Liver Masses Research Articles

Unveiling the potential of strain elastography in perihilar cholangiocarcinoma biopsies.

This study was conducted to investigate the effectiveness of strain elastography in guiding precise and sufficient tissue sampling for perihilar cholangiocarcinoma (CCA) biopsies. Our retrospective analysis included 23 liver biopsies conducted between March 2019 and July 2022 for suspected perihilar CCA. An experienced radiologist performed the biopsies via an ultrasound machine with elastography configuration. Tissue stiffness color maps were used for guiding when the biopsies were performed. Strain index value calculations were made by radiologists on recorded images. Patient demographics revealed a mean age of 65.17 ± 9.25years, with a gender distribution of six females and 17 males. Gray-scale examinations unveiled diverse echogenic characteristics in liver lesions. Elastography-guided biopsies demonstrated no need for repeats, while gray-scale biopsies necessitated re-biopsy in four patients, resulting in cholangiocarcinoma diagnosis (P = 0.037). Strain index values showcased strong inter- and intra-observer agreements (P < 0.001). Notably, no post-biopsy complications emerged in either study group. The diagnostic advantage of elastography, particularly in enhancing accuracy in challenging isoechoic lesions, was demonstrated, although the substantial overlap between strain index values of benign and malignant liver masses limits clinical usefulness of this technique.

Morphometric analysis of tumor microvessels for detection of hepatocellular carcinoma using contrast-free ultrasound imaging: A feasibility study.

A contrast-free ultrasound microvasculature imaging technique was evaluated in this study to determine whether extracting morphological features of the vascular networks in hepatic lesions can be beneficial in differentiating benign and malignant tumors (hepatocellular carcinoma (HCC) in particular). A total of 29 lesions from 22 patients were included in this work. A post-processing algorithm consisting of clutter filtering, denoising, and vessel enhancement steps was implemented on ultrasound data to visualize microvessel structures. These structures were then further characterized and quantified through additional image processing. A total of nine morphological metrics were examined to compare different groups of lesions. A two-sided Wilcoxon rank sum test was used for statistical analysis. In the malignant versus benign comparison, six of the metrics manifested statistical significance. Comparing only HCC cases with the benign, only three of the metrics were significantly different. No statistically significant distinction was observed between different malignancies (HCC versus cholangiocarcinoma and metastatic adenocarcinoma) for any of the metrics. Obtained results suggest that designing predictive models based on such morphological characteristics on a larger sample size may prove helpful in differentiating benign from malignant liver masses.

Diagnostic Accuracy of Ultrasound for Benign and Malignant Hepatic Masses Taking Computed Tomography as Gold Standard

Detection of benign and malignant liver masses is very important for the treatment. Objectives: To determine the diagnostic accuracy of ultrasound for hepatic masses taking computed tomography as gold standard Methods: It was cross a sectional analytical study to.it involves 266 patients suffering from hepatocellular cell carcinoma age group 45 to 65 years visiting Department of Radiology THQ Hospital Hazro, both genders were included. Consecutive sampling method was used. The collection of data was done through questionnaire and analysis by using SPSS version 25. Results: This study enlisted the participation of 261 patients. The average age of all patients was 59.28 14 years, with a range of 45 to 65 years. It describes that the total number of true positive disease were 228 which was also detected on ultrasound. However, the occurrence of HCC is highest on CT scan when compared with adenoma and hemangioma. There were 28 patients with multiple lesions, with 71.4 % being malignant and 28.6 % being benign. On the other hand, 22 individuals had a single lesion, of which 36.4% were malignant and 63.6 % were benign (p 0.001). CT had a sensitivity of 96 % to diagnose a malignant lesion, a specificity of 88.4 %, an accuracy of 95.78 %, a positive predictive value of 98.70 %, and a negative predictive value of 73.33 %. Conclusions: The results of the present study therefore concluded that CT is a useful modality for the diagnosis of malignant liver masses.Ultrasound had high sensitivity, specificity for the hepatic masses. females were more effected than males. Among hepatic masses, HCC is the commonest.

Hepatic mass caused by Fasciola hepatica: A case report

IntroductionFascioliasis is a zoonotic infestation which presents with a wide spectrum of clinical pictures. However, it may often be overlooked, especially in the acute phase, because of uncertain symptoms. Fasciola hepatica can have an initial presentation similar to malignant liver mass or complex hepatic cyst. Here, we report a case of a hepatic mass caused by fasciola hepatica.Case presentationA 48-year-old woman came with chief complaints of epigastric and right hypochondrial discomfort associated with nausea and vomiting. Ultrasonography (USG) showed a heterochronic lesion in the segment VIII of the liver with few cystic lesions. CECT abdomen and pelvic gave impression of ill-defined irregular hypodense lesions in the right lobe of the liver with progressive enhancing peripheral and central cystic areas suggestive parasitic liver infestation likely echinococcus alveolaris. Right hepatectomy was done and the patient was discharged without any complications.DiscussionFascioliasis is uncommon in developed countries but more commonly seen in developing countries. The identification of fasciola hepatica eggs in the stool is a standard method for the diagnosis of fascioliasis. Fascioliasis may cause a wide variety of clinical signs ranging from asymptomatic infection to severe liver cirrhosis. Surgery for complex hydatid cysts of the liver is potentially burdened by serious complications. Technique of choice for surgical management remains inconclusive.ConclusionFasciola hepatica infection can mimic a malignant liver mass or a complex hepatic cyst because of its uncertain presentation. The disease can be prevented with public education and environmental precautions.

Imaging of hepatic tumors in children and adolescents

HintergrundKindliche Lebertumoren sind relativ selten, aber die Kenntnisse über ihre bildgebende Diagnostik nicht weniger wichtig.FragestellungHäufigkeit und Bildmorphologie benigner und maligner Raumforderungen der Leber im Kindesalter.Material und MethodeAufbereitung der einschlägigen Originalarbeiten, Übersichtsarbeiten und Expertenempfehlungen betreffend die Bildgebung kindlicher Lebertumoren.ErgebnisseDie häufigsten bösartigen Lebertumoren sind das meist bei Kleinkindern auftretende Hepatoblastom sowie in manchen Regionen auch das hepatozelluläre Karzinom. Ihre Bildmorphologie ist im Gegensatz zu manchen benignen Raumforderungen, wie beispielsweise der fokalen nodulären Hyperplasie, simplen Zysten oder Steatosearealen, wenig charakteristisch. Radiologisch kommen üblicherweise die Sonographie und die Magnetresonanztomographie (MRT) zum Einsatz. Beide Methoden profitieren von einer intravenösen Kontrastmittelgabe.SchlussfolgerungKindliche Lebertumoren weisen ein breites morphologisches Spektrum auf. Manche Entitäten lassen sich mittels Bildgebung charakterisieren, manche benötigen eine multimodale Bildgebung oder eine histologische Begutachtung. Neben den bildmorphologischen Kriterien spielen insbesondere auch Alter, Laborparameter und Anamnese eine wichtige Rolle in der Diagnosefindung.

A Study to Access the Correlation between Serum Alpha Fetoprotein and Radiological Image Finding in Patients with Malignant Liver Mass

Malignant liver mass remains a major health problem worldwide. Patients with chronic liver disease, the accuracy of ultrasound scan (US), spiral computed tomography (CT), magnetic resonance imaging (MRI), and alpha-fetoprotein (AFP) in diagnosing hepatocellular carcinoma (HCC) and malignant liver disease is assessed in this study. This study helps to find out the significance of serum alpha protein in patients with malignant liver mass. Retrospective cross-sectional study was done on patients with malignant liver mass. A total of 62 patients were diagnosed with malignant liver mass, out of which 44 are male, and 18 were female. They were grouped into three age groups 30-50 years, 51-70 years and above 70 years. In this study, out of the radiologically diagnosed malignant liver mass, HPE has proven hepatocellular carcinoma where 67.7% and liver secondaries where 29.03%. 55% of malignant liver mass has raised alpha feto proteins. 74% of HCC diagnosed and confirmed on biopsy have elevated alpha feto proteins. Only 11% of multiple malignant liver lesions have elevated alpha feto proteins.AFP receptors are expressed only in the AFP-positive HCC tissues. In the AFP-negative HCC, the rate of tumour growth would probably be expected to be relatively slow, and tumour staging might be lower than in AFP-positive. Based on this study, radiological imaging has been very useful in the diagnosis of various malignant liver masses in both elevated and normal AFP.

AI-Assisted Endoscopic Ultrasound to Distinguish Benign from Malignant Liver Masses

In patients with known or suspected hepatic malignancy, the evaluation of liver lesion is often critically important: The presence of a malignant

COMPARATIVE STUDY OF CT-SCAN FINDINGS WITH BIOPSY IN LIVER MASSES DONE AT A TERTIARY CARE CENTER

Background: More than 80% of all primary hepatic malignancies are hepatocellular carcinoma. Identification of a liver lesion depends on the attenuation difference between normal liver and the lesion. CT helps in detecting tumors and their size in liver quiet successfully. Accurate detection of liver mass is crucial for the deciding the treatment regimens. Objective: The study was undertaken to compare the results of CT-scan to histopathology findings. Methodology: This cross-sectional study was carried out in the Department of Radiodiagnosis and Imaging, Dr. Vitthalrao Vikhe Patil Foundation’s Medical College, Ahmednagar in association with Department of pathology of the concerned institute for histopathological diagnosis from 01-03-2014 to 28-02-2015 for a period of one year. Patients having hepatic mass of any sex or age presenting in the hospital were included in the study. The exclusion criteria were as patients refusing consent, or CT-scan and/or biopsy, known adverse reaction to contrast agent. CT scan and histopathology were done in all the subjects. Result: 50 subjects were studied in this study. Mean age of all subjects was 52.88 ± 16.03 years with a range of 18 year to 85 years. 40 cases were male in the study group. Maximum number of cases were in the age group 40-59 years. Out of 28 confirmed malignant cases by histopathology, 27 cases were diagnosed as malignant by CT scan too. Sensitivity of CT to diagnose malignant lesion was 96.4%, specificity 86.4%, accuracy 92%, positive predictive value 90% and negative predictive value 95%. Conclusion: CT scan can be used as a tool for the detecting of malignant liver masses.

Contrast-enhanced ultrasound features of malignant focal liver masses in dogs

A total of 185 cases (150 retrospectively and 35 prospectively) of malignant liver masses were collected. In the retrospectively collected cases hyperenhancement during wash-in was the most common feature in HCCs but there was a high percentage of cases showing no enhancement or hypo/isoenhancement. ICCs displayed a large variety of contrast enhancement patterns and, although statically significant differences between ICCs and HCCs were evident, no clear distinction between these two pathologies was possible based only on their CEUS appearance. Sarcomas displayed all the possible degrees of wash-in enhancement with non-enhancing being the most common appearance. Metastases displayed all the possible contrast-enhancement patterns, with the most common being hyperenhancement in the wash-in phase followed by hypoenhancement in the wash-out phase. A decision tree was developed based on the features of the retrospectively selected cases. Based on the developed decision tree 27/35 prospectively collected cases were correctly classified. Even if some significant differences among groups were evident, all the histotypes displayed all the possible patterns of contrast enhancement, and, therefore, the differentiation of liver masses in dogs based only on their CEUS features is not feasible and, therefore, cytology or histopathology is required.

ACCURACY OF CT-SCAN FOR THE DETECTION OF MALIGNANT LIVER MASS

Background: Malignant liver mass, especially hepatocellular carcinoma (HCC), is the most common primary malignant tumour of the liver representing more than 80% of all primary hepatic malignancies.&#x0D; Methods: This cross sectional study was carried out in the Department of Radiology. All the clinically suspected patients having hepatic mass at any age with both sexes who were attended in hospital were taken as study population as per inclusion and exclusion criteria. Patients having hepatomegaly due to extra hepatic causes, patients who refused to undergo CT-scan, patients who refuse to do biopsy or whose biopsy result was not available and patients having known hypersensitivity reaction to contrast agent were excluded from this study.&#x0D; Results: Sensitivity of CT to diagnose malignant lesion was 94.12%, specificity 84.62%, accuracy 90%, positive predictive value 88.89% and negative predictive value 91.67%.&#x0D; Conclusion: The results of the present study therefore conclude that CT is a useful modality for the diagnosis of malignant liver masses. Since the CT diagnosis correlates with histopathological connection, it is a sensitive modality on the basis of the above findings.&#x0D; Keywords: Test accuracy, CT-Scan, Malignant, Liver Mass

Congestive hepatopathy.

Passive hepatic congestion may result from a variety of distinct cardiovascular conditions. Injury to the liver caused by congestion is often asymptomatic and may not be recognized clinically. Diagnosis of congestive hepatopathy is important as it has the potential to cause complications including hepatic fibrosis and development of benign and malignant liver masses. This review will summarize the pathophysiologic mechanisms of congestive hepatopathy and provide both description and examples of its multimodality imaging findings. Examples of alternative disease which may have a similar imaging appearance will be provided. Knowledge regarding the characteristic imaging findings of congestive hepatopathy will allow for its accurate identification. Reviewing both the benefits and limitations of imaging performed to evaluate congestive hepatopathy and its complications will help to avoid pitfalls and enable recommendation of appropriate next steps in diagnostic evaluation.

Differentiation of Hepatocellular Carcinoma from Other Hepatic Malignancies in Patients at Risk: Diagnostic Performance of the Liver Imaging Reporting and Data System Version 2014.

Purpose To evaluate the diagnostic performance and interrater reliability of the Liver Imaging Reporting and Data System (LI-RADS) version 2014 in differentiating hepatocellular carcinoma (HCC) from non-HCC malignancy in a population of patients at risk for HCC. Materials and Methods This retrospective HIPAA-compliant institutional review board-approved study was exempt from informed consent. A total of 178 pathology-proven malignant liver masses were identified in 178 patients at risk for HCC but without established extrahepatic malignancy from August 2012 through August 2015. Two readers blinded to pathology findings and clinical follow-up data independently evaluated a liver protocol magnetic resonance or computed tomography study for each lesion and assigned LI-RADS categories, scoring all major and most ancillary features. Statistical analyses included the independent samples t test, x2 test, Fisher exact test, and Cohen k. Results This study included 136 HCCs and 42 non-HCC malignancies. Specificity and positive predictive value of an HCC imaging diagnosis (LR-5 or LR-5V) were 69.0% and 90.5%, respectively, for reader 1 (R1) and 88.3% and 95.5%, respectively, for reader 2 (R2). Tumor in vein was a common finding in patients with non-HCC malignancies (R1, 10 of 42 [23.8%]; R2, five of 42 [11.9%]). Exclusion of the LR-5V pathway improved specificity and positive predictive value for HCC to 83.3% and 92.9%, respectively, for R1 (six fewer false-positive findings) and 92.3% and 96.4%, respectively, for R2 (one fewer false-positive finding). Among masses with arterial phase hyperenhancement, the rim pattern was more common among non-HCC malignancies than among HCCs for both readers (R1: 24 of 36 [66.7%] vs 13 of 124, [10.5%], P < .001; R2: 27 of 35 [77.1%] vs 21 of 123 [17.1%], P < .001) (k = 0.76). Exclusion of rim arterial phase hyperenhancement as a means of satisfying LR-5 criteria also improved specificity and positive predictive value for HCC (R1, two fewer false-positive findings). Conclusion Modification of the algorithmic role of tumor in vein and rim arterial phase hyperenhancement improves the diagnostic performance of LI-RADS version 2014 in differentiating HCC from non-HCC malignancy. © RSNA, 2017 Online supplemental material is available for this article.

Diagnosis of Focal Liver Masses on Ultrasonography

Ultrasonography (US) is a non-invasive, rapid, and simple examination to diagnose liver disease. The diagnosis of liver mass is often encountered on US examination and the differentiation between benign and malignant tumor is very important. We can perform the differential diagnosis of liver mass according to the sign of US. Hyperechoic rim around the edge of liver mass is shown in the hepatic hemangioma. Hypoechoic halo surrounding a tumor suggests probable malignancy, and multiple masses with target sign most often suggest hepatic metastases. A single multilocular cystic tumour with upstream bile duct dilatation or mural nodules is typically seen at the malignant cystic neoplasm. This review summarized the characteristics of US findings between benign and malignant liver mass. Keywords: Ultrasonography; Hepatic neoplasm; Diagnosis 중심 단어: 초음파; ê°„ì¢ ê´´; 진단

Malignancies after liver transplantation: Value of contrast-enhanced ultrasound (CEUS).

To evaluate the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) and computed tomography (CT) in the diagnosis of malignancies after liver transplantation. A total of 23 patients with suspicious liver masses after liver transplantation with initial imaging series between September 2006 and September 2015 were statistically analysed. CEUS and CT were compared in their diagnosis of malignancy with CT being the gold standard. Out of 23 patients 9 patients showed malignant masses in CT, which could also be detected in 7 out 9 of cases using CEUS. CEUS showed a sensitivity of 77.8%, a specificity of 100.0%, a positive predictive value (PPV) of 100.0% and a negative predictive value (NPV) of 87,5% in comparison with CT being the gold standard. In 2 cases CT showed a malignancy, contrary to the CEUS examination that was reported as normal. CEUS seems to be an alternative option for the evaluation of malignant masses in liver transplant patients. CEUS shows a high specificity and PPV in the detection of malignant liver masses.

Space Occupying Lesions in the Liver.

Space occupying liver lesions usually present with abdominal pain or abnormal physical findings, such as a palpable abdominal mass or distention. Liver lesions identified in children include benign and malignant neoplasms, inflammatory masses, cysts and metastatic lesions. Two-thirds of liver lesions in children are malignant. Hepatoblastoma accounts for two-thirds of malignant liver tumors in children. Benign lesions of the liver in children include vascular lesions, hamartomas, adenomas, and focal nodular hyperplasia. Although benign and malignant liver masses share some clinical manifestations, however treatment and prognosis differ. Evaluation involves physical examination, imaging evaluation and laboratory investigations such as serological markers [alpha-fetoprotein (AFP)] for malignant liver lesions. Ultrasound is the initial imaging modality of choice because it can detect, characterize, and provide the extent of liver lesions. However, CT or MRI are often subsequently performed for further characterization, assessment of precise extent, and detection of associated metastatic disease in cases of malignant hepatic neoplasm. Serological markers (such as alpha fetoprotein) can be useful in narrowing the differential diagnosis when they are markedly elevated but a substantial number of patients unfortunately do not have high levels of these markers at the time of presentation or cautious interpretation is warranted as AFP level is frequently elevated in infants up to 6 mo of age and may be slightly elevated with benign tumors and with hepatic insult or regeneration. Therefore, a tissue diagnosis is often required to guide subsequent management. The histology and anatomy of a pediatric liver tumor guides the treatment and prognosis.

Test Accuracy of CT-Scan for the Detection of Malignant Liver Mass

Background: Detection of malignant liver mass is very important for the treatment modalities. Objective: The purpose of the present study was to establish the usefulness of CT scan in the diagnosis of malignant hepatic mass. Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of 1st January 2006 to 31st December 2007. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 patients were recruited for this study. Mean age of all patients was 51.28 ± 14 years with a range of 17 year to 78 years. Among all patients 28 had multiple lesion, of them 71.4% was malignant and 28.6% was benign. On the other side 22 patients had solitary lesion, of them 36.4% was malignant and 63.6% was benign (p < 0.05). Sensitivity of CT to diagnose malignant lesion was 96.4%, specificity 86.4%, accuracy 92%, positive predictive value 90% and negative predictive value 95%. Conclusion: CT is a useful diagnostic tool for the detection of malignant hepatic masses.

Comparison of Intra-voxel Incoherent Motion Diffusion Magnetic Resonance Imaging and Apparent Diffusion Coefficient in the Evaluation of Focal Malignant Liver Masses

Aim: To compare the apparent diffusion coefficient (ADC) derived from conventional diffusion-weighted imaging (DWI), and parameters derived from intra-voxel incoherent motion (IVIM) diffusion, in the differentiation of common focal malignant liver masses. Methods: DWI of 53 patients with 85 focal liver masses (47 hepatocellular cancers [HCCs], 18 cholangiocarcinomas, and 20 metastases) were recruited to receive a 3.0T MR scanner with 2 b values (0, 700 s/mm [2] ) to measure the ADC values and with 7 b values (0, 50, 100, 250, 500, 750, 1000 s/mm [2] ) to measure IVIM derived parameters: true diffusion coefficient (D), perfusion related diffusion coefficient (D*) and perfusion fraction (f). The mean of each parameter was compared by the Dunnett multiple comparison test. Results: Both ADC and D were significantly higher in cholangiocarcinomas than in HCCs (ADC: 1.49 ± 0.27 × 10 −3 vs . 1.20 ± 0.26 × 10 −3 mm 2 /s and D: 0.94 ± 0.17 × 10 −3 vs . 0.53 ± 0.23 × 10 −3 mm 2 /s, respectively; P = 0.002 and P Conclusion: D improved the accuracy of differentiating HCCs and cholangiocarcinomas compared to ADC.

Hepatic neoplasms in children: A focus on differential diagnosis

Paediatric hepatic neoplasias are rare, accounting for 1-4% of all solid childhood tumors. Liver tumors in children can be classified into benign or malignant; some of the benign lesions can have the potential of malignant transformation. Two-thirds of liver tumors in children are malignant. Hepatoblastoma accounts for two-thirds of malignant liver tumors in children. Other liver malignancies in children include sarcomas, germ cell and rhabdoid tumours, and hepatocellular carcinoma. Benign tumors of the liver in children include vascular tumours, hamartomas, adenomas, and focal nodular hyperplasia. The histology and anatomy of a paediatric liver tumour guides the treatment and prognosis. Although benign and malignant liver masses share some clinical manifestations, treatment and prognosis differ.

The Contribution of Diffusion Weighted MRI (DWI) and Measured ADC Values in Differentiating Benign and Malignant Liver Masses

The Contribution of Diffusion Weighted MRI (DWI) and Measured ADC Values in Differentiating Benign and Malignant Liver Masses

Karaciğer Kitlelerinin Benign-Malign Ayrımında Difüzyon Ağırlıklı Sekansın Önemi

Purpose: We investigated the diagnostic value of diffusion weighted imaging and apperent diffusion coefficient (ADC) mapping on differential diagnosis of benign and malignant focal liver masses. Materials And Metods: Diffusion - weighted MR imaging sequence was applied on 34 patients with a focal liver mass before contrast enhanced imaging. Diffusion - weighted images were obtained by applying 3 diffusion gradients at b level (b=50, b=400, b=800 s/mm2) with single shot echo-planar spin in axial plan in 1.5 Tesla MR tool. Average ADC values were determined by placing ROI at the size of 1 cm on average over ADC maps. Results: 62 lesions (46 benign, 16 malign) greater than 1 cm, in size were evaluated. Average ADC value of 46 benign lesions was 2.17±0.55 x 10-3 mm2/s and varied between (0,98 x 10-3 mm2/s 2.65 ± 0.54 x 10-3 mm2/s) and average ADC value of 16 malignant lesion was 0.84± 0.40 x 10-3 mm2/s (0.14 x 1010-3 mm2/s -1.32 x 10-3 mm2/s). Conclusion: Diffusion - weighted MR imaging and comparison of ADC values provide additional information in differentiating benign and malignant focal liver masses and particularly help us in differential diagnosis of patients to whom we cannot deliver IV contrast