OBJECTIVE:To prospectively analyze the correlation between quantitative parameters of perfusion derived from dynamic contrast-enhanced CT (DCE-CT) and contrast-enhanced ultrasound (DCE-US) in ...patients with malignant liver tumors.
MATERIALS AND METHODS:Thirty patients (mean age59.4 ± 12.3 years) with primary malignant liver tumors or hepatic metastases of various origin underwent DCE-CT (4D spiral mode, scan range, 14.8 cm; 15 scans; cycle time, 3 seconds) and DCE-US (low mechanical index, <0.1, 2.4 mL microbubbles). DCE-CT and DCE-US images were evaluated by 2 radiologists regarding quantitative perfusion parameters including arterial liver perfusion (ALP), portal-venous perfusion (PVP), and total perfusion (P = ALP + PVP) from DCE-CT, as well as blood inflow velocity (B) and the normalized slope within the calculation range (CVan) from DCE-US.
RESULTS:Quantitative assessment was possible with DCE-CT in 12/30 (40%) patients before and in all patients after automated motion correction. With DCE-US, quantitative assessment could not be performed in 9/30 (30.0%) patients due to respiratory motion. Interreader agreements for quantitative perfusion analysis were good with DCE-CT (r = 0.640–0.892, each P < 0.001) and DCE-US (r = 0.761–0.909, each P < 0.001). Moderate significant correlations were found between the perfusion parameters from DCE-CT (P, ALP) and DCE-US (B, CVan) (r = 0.446–0.621, each P < 0.05). No significant correlations were found between PVP from CT and perfusion parameters from DCE-US (B, CVan; each P = nonsignificant).
CONCLUSIONS:Quantitative evaluation of DCE-CT data was feasible in all patients after automated motion correction, whereas DCE-US data could not be quantitatively evaluated in 30% of patients due to respiratory motion and lack of motion correction software. Quantitative arterial perfusion analysis showed moderate significant correlations for blood flow parameters among modalities.
We investigated the transmission characteristics of formalin fixed human liver samples in which normal liver tissue and malignant liver tumor were mixed using terahertz (THz) coherent synchrotron ...radiation at an infrared free-electron laser (FEL) facility at Nihon University. Infrared-FEL imaging has indicated that the amount of water molecules in the tumor tissue is not different from that in the normal tissue. However, the transmission of the incipient tumor tissue was lower than that of the normal tissue in THz imaging because the tumor tissue contained more water molecular clusters than the normal tissue. The tumor tissue became more permeable owing to the development of fibrous tissue around it. THz imaging will be more useful for discriminating liver tissues by increasing the spatial resolution.
Primary hepatic angiosarcoma (PHA) is a rare and aggressive mesenchymal liver tumor with a poor prognosis and high mortality. Treatment options are limited to palliative chemotherapy with surgical ...resection reserved for the few cases that present early. We present a case of a patient who presented with jaundice and elevated liver enzymes. Imaging identified a diffusely heterogeneous liver consistent with cirrhosis, findings of portal hypertension, and 2 ill-defined liver lesions. Biopsy results confirmed PHA. Primary hepatic angiosarcoma does not have a typical presentation but should be considered for any patient presenting with an infiltrative liver mass.
Background： Laparoscopic liver resection （LLR） has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the ...purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area. Methods： In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon. Results： During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group （4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001）. Patients who underwent anatomic resection had longer operation time （364.09 ± 131.22 vs. 252.00±135.21 min, P 〈 0.001） but less blood loss per unit area （7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm2, P = 0.018）. Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days alter the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups. Conclusions： Both anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery＇. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.
Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to ...update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB). All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.
3D dynamic contrast enhanced (DCE) MRI with parallel imaging, a novel method to understand tumor vascularization in vivo, has been applied to liver in this work. Pharmacokinetics analysis could be ...performed with the help of motion correction by non-rigid registration using the first pass data. The purpose of this study was to assess the feasibility of using this framework to differentiate benign and malignant tumor in liver with DCE-MRI.
This prospective study was approved by the institutional review board, and informed consent was given by all patients. 48 Patients (56.1 ± 12.6 years old), with 51 pathologically confirmed liver tumor, were recruited in this study. All subjects underwent DCE-MRI sequence with free-breathing, which was consisted of multi-flip angle contrast free image acquisition for T1 mapping, and a continuous multiphase acquisition to capture contrast media wash in and out. Automatic non-linear image registration was applied to both multi-flip angle data and dynamic phase data for motion correction. Parameters such as Ktrans, Vp, were then extracted by performing pharmacokinetic analysis on the first pass data. Parameters from different types of tumor were evaluated by statistical analysis.
All 48 patients successfully finished examinations and image quality was good for diagnosis purpose. Subjective comparisons between original images and motion corrected images showed that images registration used in the paper can well control liver respiration motion and ROI time–intensity curve was much smoother after registration. 51 Visible lesions from 48 patients were analyzed. Pathological results revealed that there were 15 benign (hepatic hemangioma) and 36 malignant (14 liver metastasis and 22 liver carcinomas) lesions. Statistical results showed that benign and malignant tumors demonstrated significant differences (p < 0.05) in their Ktrans values, with hepatic hemangioma (Ktrans 0.09 ± 0.04), liver metastasis (Ktrans 0.25 ± 0.08) and hepatic carcinoma (Ktrans 0.25 ± 0.10). Ktrans of malignant tumors was substantially higher than benign ones. Vp values of the three types did not have statistical significance, with hepatic hemangioma (Vp 0.124 ± 0.176), liver metastasis (Vp 0.164 ± 0.184) and hepatic carcinoma (Vp 0.162 ± 0.184).
Dynamic contrast-enhanced MRI combined with tracer kinetic model and non-rigid registration was a feasible method for diagnosing of liver lesions under free breezing mode. In our approach, the contrast agent transfer rate Ktrans was a good biomarker to differentiate benign and malignant tumors of liver.
Undifferentiated embryonal sarcoma is the third most common malignant tumor of the liver in children, accounting for 13% of hepatic malignancies in this age group. It has been considered an ...aggressive neoplasm with very poor prognosis until the late 1980s, when long-term survivors were reported after multiagent chemotherapy followed by resection. We, herein, report two pediatric cases of undifferentiated embryonal sarcoma treated successfully with surgical resection after neoadjuvant chemotherapy based on therapy used in childhood soft tissue sarcomas and in childhood hepatic malignancies. The first patient also had a concurrent cerebellar tumor (pilocytic astrocytoma), for which he first underwent craniotomy and resection, delaying the liver tumor resection by 10 weeks. They are alive and tumor free at 48 months (case no. 1) and 18 months (case no. 2) following neoadjuvant chemotherapy and liver resection.
Background
Malignant liver tumors (mostly hepatoblastoma HB and hepatocellular carcinoma HCC) are uncommon, representing 0.5%–2% of childhood malignancies worldwide. The pattern of liver tumors ...appears to differ in Southern Africa as a result of infectious factors (e.g., hepatitis B/retroviral disease (HIV). This study aimed to assess recent changes in the prevalence and surgical management of liver tumors in South African children.
Methods
Data were obtained from the tumor registry and pediatric oncology units in South African hospitals to audit and review the epidemiology, treatment, and outcome of malignant hepatic tumors in South African children.
Results
Malignant primary hepatic tumors were reported in 274 children (ages 0–14 years) from 1988 through June 2006. Of these 134 (48%) had HB; 77 (27%) had HCC (9 3% fibrolamellar subtype); 38 (13%), vascular tumors; and 17 (6%), liver sarcomas. In a further 8 patients (3%) other tumors included lymphoma and endodermal sinus tumor. Vascular tumors included hemangioendotheliomas (12), and there were 5 malignant tumors in children with HIV, including 1 angiosarcoma and 13 Kaposi sarcoma-like tumors. Hepatoblastoma occurred at a mean age of 1.47 years, and none were encountered in patients > 4 years of age. Hepatocellular carcinoma mostly occurred in the older patients (mean age: 10.48 years), but 6% presented in patients < 8 years of age (10 months, 2, 2.6, 5, 5, and 6 years). Hepatic sarcoma occurred at a mean age of 7.66 years and had a female predominance (M:F ratio: 0.4). The relative HCC prevalence (male predominant: hepatitis B related) was reflected in the low HB:HCC (1.67) ratio. However, a significant decrease in HCC was attributed to the effect of hepatitis B inoculation. There appeared to be an increase in the incidence of vascular tumors, presumably the result of an increase in Kaposi-like sarcoma in retrovirus-positive patients. The surgical resection rate was low because most patients presented late, with advanced disease. Survival was 11% and 52% for HB and HCC, respectively, and was related to chemotherapeutic response and complete surgical resection.
Conclusions
Liver tumors appear to have a different epidemiological pattern in South Africa. The observed increased HCC prevalence appears to be decreasing with hepatitis B vaccination. Retroviral disease does not yet appear to have a major influence on the distribution of liver tumors in South Africa, although it possibly affects the vascular tumor prevalence.
Abstract
Purpose: We present the initial steps for 320-detector-row computed tomography arteriography using CO2 gas (320-MDCT CO2 arteriography) to detect the vascular area of malignant liver tumors. ...Material and methods: This study was approved by the Ethics Committee of our institution. Written prior informed consent was obtained from all patients. We studied six patients with primary and metastatic liver tumors (n = 26) and allergic reactions to iodinated contrast media or a tendency for renal failure. CO2 was injected at 1 ml/sec (volume 8 ml) into the common hepatic artery and a CT scan was acquired 12 seconds after the start of injection. The detection of the vascular area of the tumor or of intratumor air was evaluated with respect to the relationship between the size and location of the tumors. Cramer's V statistic was performed to explore the relationship (p < 0.05). Results: The vascular area was detected in 17 of the 26 tumors (65.4%). There was a correlation between the detection of the adjacent vascular area on CTA images acquired with the use of CO2 and the tumor site observed on previously-acquired MRI or CT images. Conclusion: 320-MDCT CO2 arteriography with microcatheters may be useful for the detection of the vascular area.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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