With the development of chemotherapy regimens, targeted therapies, and hepatic surgery, the survival of patients with colorectal liver metastases (CRLM) has dramatically improved. Imaging plays a ...central role for the diagnosis, staging, and treatment allocation in these patients. To interpret CRLM on imaging, radiologists must be familiar with the main imaging features of untreated tumors as well as the modifications induced by systemic therapies, and their meaning in relation to pathological tumor response and tumor biology. CRLM have the same histological features as the primary tumor. Most are “non-otherwise specified” (NOS) adenocarcinomas. The mucinous tumor is the most common of the rare subtypes. In NOS tumors, imaging usually differentiates central areas of necrosis from peripheral proliferating tumors and desmoplastic reaction. Areas of mucin mixed with fibrosis are seen in mucinous subtypes to help differentiate the metastases from other tumors cysts or hemangiomas. After treatment, the viable tumor is gradually replaced by ischemic-like necrosis and fibrosis, and remnants cells are mainly located on the periphery of tumors. Imaging can help predict the degree of tumor response, but changes can be difficult to differentiate from the pretherapeutic appearance. When chemotherapy is interrupted or in case of resistance to treatment, a peripheral infiltrating halo of tumor growth may appear. The purpose of the article is to illustrate the significance of the imaging features of colorectal liver metastases during systemic therapy, using radiopathological correlations.
Early diagnosis of acute mesenteric ischemia (AMI) remains a clinical challenge, and no biomarker has been consistently validated. We aimed to assess the accuracy of three promising circulating ...biomarkers for diagnosing AMI-citrulline, intestinal fatty acid-binding protein (I-FABP), and D-lactate. A cross-sectional diagnostic study enrolled AMI patients admitted to the intestinal stroke center and controls with acute abdominal pain of another origin. We included 129 patients-50 AMI and 79 controls. Plasma citrulline concentrations were significantly lower in AMI patients compared to the controls 15.3 μmol/L (12.0-26.0) vs. 23.3 μmol/L (18.3-29.8), p = 0.001. However, the area under the receiver operating curves (AUROC) for the diagnosis of AMI by Citrulline was low: 0.68 (95% confidence interval = 0.58-0.78). No statistical difference was found in plasma I-FABP and plasma D-lactate concentrations between the AMI and control groups, with an AUROC of 0.44, and 0.40, respectively. In this large cross-sectional study, citrulline, I-FABP, and D-lactate failed to differentiate patients with AMI from patients with acute abdominal pain of another origin. Further research should focus on the discovery of new biomarkers.
Objectives
To prospectively assess the frequency of severe abdominal pain during and after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) using the visual analog scale ...(VAS), and to identify predictive factors.
Methods
Ninety-eight TACE performed in 80 patients (mean 65 ± 12 years old, 60 men) were consecutively and prospectively included. Abdominal pain was considered severe if the VAS ≥ 30/100 after treatment administration, or if opioid analgesic (grades 2–3) intake was required during hospitalization. Patient and tumor characteristics as well as technical factors associated with severe pain were identified by binary logistic regression.
Results
The criterion for severe pain was met in 41/98 (42%) of procedures (peri-procedural pain 30/98 31% and opioid consumption during hospitalization 24/98 25%). Multivariate analysis identified age (odds ratio OR = 0.943 (95% confidence interval 0.895–0.994),
p
= 0.029), cirrhosis (OR = 0.284 (0.083–0.971),
p
= 0.045), and alcoholic liver disease (OR = 0.081 (0.010–0.659),
p
= 0.019) as negative predictive factors of severe abdominal pain. Severe abdominal pain occurred in or after 1/13 (8%), 8/34 (24%), 22/41 (54%), and 10/10 (100%) TACE sessions when none, one, two, and three of the protective factors were absent, respectively (
p
< 0.001). The area under the ROC curve of the combination of factors for the prediction of severe abdominal pain was 0.779 (CI 0.687–0.871).
Conclusion
Severe abdominal pain was frequent during and after TACE revealing a clinically relevant and underestimated problem. A predictive model based on three readily available clinical variables suggests that young patients without alcoholic liver disease or cirrhosis could benefit from reinforced analgesia.
Key Points
• Severe abdominal pain occurs in 43% of TACE for HCC.
• Younger age, absence of cirrhosis, and absence of alcoholic liver disease were identified as independent predictive factors of severe abdominal pain.
• A simple combination of the three abovementioned features helped predict the occurrence of severe abdominal pain.
Purpose
To identify risk factors for local and distant intrahepatic tumor progression after percutaneous ablation of HCC and to compare MWA with monopolar RFA.
Materials and Methods
Consecutive ...patients with early or very early HCC who underwent percutaneous monopolar RFA or MWA were included. Factors associated with local and distant tumor progression were identified. Propensity score matching (PSM) was used to limit bias. Statistical analyses were performed with the Kaplan–Meier method using the log-rank test and Cox regression models.
Results
One hundred ninety HCC (mean diameter 23 ± 8.6 mm) were treated by RFA (
n
= 90, 47%) or MWA (
n
= 100, 53%) in 152 patients (mean age 63 ± 11, 79% men) between 2009 and 2016. The technical success rate was 97.4% (
n
= 185 HCC). After a median follow-up of 24.6 months (IQR: 9.7–37.2), 43 (23%), HCC showed local tumor progression after a median of 13.4 months (IQR: 5.8–24.3) and 91 (63%) patients had distant intrahepatic tumor progression (after a median of 10.4 months (IQR: 5.7–22). The cox model after PSM identified treatment by RFA (HR, 2.89;
P
= 0.005), HCC size ≥ 30 mm (HR, 3.12;
P
= 0.007) and vascular contact (HR, 3.43;
P
= 0.005) as risk factors for local progression. Factors associated with distant intrahepatic progression were HCC ≥ 30 mm (HR, 1.94;
P
= 0.013), serum AFP > 100 ng/mL (HR, 2.56;
p
= 0.002), and hepatitis B carrier (HR, 0.51;
p
= 0.047).
Conclusion
The rate of local HCC progression was lower after MWA than monopolar RFA, regardless of tumor size and vascular contact. The ablation technique did not influence the risk of distant intrahepatic tumor progression.
Background
Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular ...revascularization of AMI and evaluate its impact on patient outcomes.
Methods
Patients with AAMI who underwent endovascular revascularization (2016–2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared.
Results
Fifty patients (23 men, median 72-yrs IQR 60–77) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22–48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (
p
= 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (
p
= 0.99). However, the resection rate was higher in patients with RI (32% versus 7%;
p
= 0.03).
Conclusion
RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.
Key points
Reperfusion injury of the bowel occurred in 44% of patients with acute mesenteric ischemia treated by endovascular revascularization.
A decreased bowel enhancement on initial CT (HR = 8.2), an occlusion of the superior mesenteric artery (HR = 7.0), an embolic cause (HR = 7.4), and higher initial serum lactate level (HR = 1.4) were identified as predictors of reperfusion injury.
Bowel wall hypoattenuation, hyperenhancement of the mucosa, and increase in CRP levels after revascularization were key diagnostic features of reperfusion injury.
Eastern and Western guidelines for the management of hepatocellular carcinoma (HCC) are known to significantly differ on many points, because they reflect different diagnostic and therapeutic ...approaches to this cancer. Importantly, these guidelines are primarily consensus-driven when it comes to surveillance, both in term of the tests used and surveillance program design. The main difference between East and West lies in clinical practice, as several Eastern countries implement coordinated and systematic surveillance programs, while most Western countries rely on individual adherence to surveillance recommendations. This review article presents an overview of the evidence supporting surveillance programs for HCC, with a particular focus on the efficacy, cost-effectiveness, and consequences of this approach for patient survival. Western and Eastern guideline recommendations are discussed.
Hepatobiliary 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.
This 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.
Twenty-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.
Most 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.
Hepatobiliary 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.
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•Most benign lesions showed homogeneous or peripheral hyperintensity on hepatobiliary phase images.•All HCCs were homogeneously hypointense on hepatobiliary phase images.•Hepatobiliary images are helpful to differentiate between benign lesions and HCCs in patients with Budd-Chiari syndrome.•In patients with AFP serum levels >15 ng/ml, lesions with signal hypointensity on hepatobiliary phase were all HCCs.
Gadoxetic acid is extensively used in the following 3 main clinical situations: characterization of small nodules in patients with cirrhosis, preoperative staging of liver metastases, and ...characterization of incidentally discovered focal liver lesions. Owing to the rapid entry of gadoxetic acid into hepatocytes, the traditional features of liver tumors are modified on magnetic resonance (MR) imaging, especially during delayed phase sequences. Thus, although the added value of gadoxetic acid for the detection and characterization of focal liver lesions is now clear, its unique pharmacokinetics as well as the presence of mimicking and atypical lesions may lead to misdiagnoses. The goal of this article is to illustrate common and uncommon pitfalls associated with the use of gadoxetic acid–enhanced MR imaging. Moreover, additional MR imaging features that can help establish a correct diagnosis are described.
Liver tumours are very common and malignant tumours represent a major cause of cancer‐related death. Imaging plays an important role at many different stages of the care pathway. This review ...discusses new aspects and new roles for imaging and for MRI, in particular. MRI is already the best tool for the characterization and staging of benign and malignant liver tumours and it could also become a useful screening tool, especially for hepatocellular carcinoma. Liver imaging will be increasingly quantitative in the future, integrating new approaches such as those of artificial intelligence.