A young patient with type 2 diabetes associated non-alcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma.
Z Gastroenterol. 2020 Jan;58(1):57-62
Authors: Michel M, Kalliga E, Labenz C, Straub BK, Wörns MA, Galle PR, Schattenberg JM
The rising prevalence of the metabolic syndrome has led to an increase of non-alcoholic fatty liver disease (NAFLD), and its progressive-inflammatory form called non-alcoholic steatohepatitis (NASH). In recent years, NAFLD and NASH have become major risk factors for developing liver cirrhosis and hepatocellular carcinoma (HCC). In this case, we report a 46-year-old patient with type 2 diabetes mellitus and metabolic comorbidities including obesity and arterial hypertension, who was referred because of rising liver enzymes. After clinical and diagnostic evaluation, the patient was diagnosed with NASH-associated liver cirrhosis, Child-Pugh stage B. A normal blood sugar level was difficult to achieve, and the patient presented with consistently elevated HbA1c-levels irresponsive to insulin therapy. Due to the underlying liver cirrhosis, the patient was enrolled in the HCC-surveillance program. Sonography during follow up showed a focal lesion. On magnetic resonance imaging (MRI), the diagnosis of HCC (BCLC stage A) was confirmed based on typical contrast enhancement and portal-venous wash-out. The patient was evaluated for liver transplantation with a labMELD of 17, and an intermittent therapy with TACE was initiated. Only 2 months after liver transplantation, the patient developed severe and lethal complications. Overall, this case highlights the different medical issues of patients with metabolic syndrome developing a chronic liver disease. In this patient, a rapid progression from NASH-associated liver cirrhosis to HCC was seen, and therefore highlights the importance of close surveillance to identify and treat potential risk factors early in the course of the disease.
PMID: 31931541 [PubMed - indexed for MEDLINE]
[Monocentric experiences of stereotactic body radiation therapy (SBRT) for advanced hepatocellular carcinomas (BCLC-C)].
Z Gastroenterol. 2020 Jan;58(1):39-47
Authors: Czauderna C, Stockinger M, Ebersberger A, Schmidberger H, Müller L, Kloeckner R, Düber C, Weinmann A, Galle PR, Marquardt JU
Hepatocellular carcinomas (HCCs) are highly malignant primary liver cancers with poor prognosis and limited treatment options in advanced stages of disease. Treatment of HCC requires interdisciplinary discussion and multimodal therapy approaches. Beside established loco-regional and systemic therapies, stereotactic body radiation therapy (SBRT) gained increasing importance over recent years. First results of early clinical studies indicate high rates of local control with a good safety profile. In the present work, we evaluated our single center experiences with SBRT in patients with advanced HCCs.Ten patients with 16 SBRTs were included and retrospectively analyzed in this case collection. All patients presented in advanced tumor stages with vascular invasion and/or metastases, but preserved liver function. Two patients were treated only with SBRT, two after TACE and six patients received SBRT in addition to systemic therapy. In most of the cases SBRT were applied to intrahepatic lesions. Large tumor thromboses, lymph nodes as well as bone metastases were irradiated in one, three and five fractions with a median overall dose of 38 Gy. We observed a good local tumor control with a good safety profile in all cases. No severe complications occurred in combination to sequential as well as additive approach to loco-regional or systemic treatments.In conclusion, our experiences confirm results of early clinical studies indicating safe use and good local control rates also in advanced stages of HCC with preserved liver function.
PMID: 31931539 [PubMed - indexed for MEDLINE]
[The Effects of PKCι on Anti-tumor Activity of Cytokine-induced Killer Cells Against Pancreatic Cancer Cells and the Possible Underlying Mechanisms].
Sichuan Da Xue Xue Bao Yi Xue Ban. 2019 Dec;50(6):821-826
Authors: Zhang HM, Wang YR, Yang JH, Leng XH, Wang PP, Li ZX, Zhu TB
OBJECTIVE: To study the impact of atypical protein kinase Cι (PKCι) isoform PKC on the pancreatic cancer cells towards the tumoricidal effect of cytokine-induced killer (CIK) cells and explore its mechanisms.
METHODS: CIK cells were prepared by inducing mononuclear cells isolated from the peripheral blood of healthy people with interleukin-2 (IL-2), interferon (IFN) and CD3 mAb and subsequently co-cultured with pancreatic epithelial cell HPDE6-C7, pancreatic cancer cells MiaPaCa and PANC-1 with or without PKC inhibitor named sodium thiomalate (ATM). All cells were divided into control group, ATM group, co-culture group with CIK and co-culture group with CIK+ATM. Cell count was used to detect the growth of each group from 1 to 8 d. Flow cytometry was used to detect the death rate of the cell lines after 48 h cell culture in each group. The small hairpin RNA (shRNA) was used for PKCι knockdown and the recombinant plasmid transfection was for PKCι overexpression in pancreatic cancer cells. Western blot and real-time fluorescent quantitative PCR (qRT-PCR) were utilized to determine the expression of PKCι protein and the impact on gene expression of transforming growth factor-β (TGF-β), a downstream effector modulated by PKC. Different mass concentrations of TGF-β (1, 10, 20 ng/mL) were added into the co-culture of MiaPaCa and PANC-1 with CIK. The cell death rate was detected by flow cytometry 48 h later, so as to explore the possible mechanisms of the impact of PKCι on the tumoricidal effects of CIK cells.
RESULTS: ATM and CIK were shown to suppress the growth and induce apoptosis or death of pancreatic cancer cells, meanwhile, ATM can enhance the tumoricidal effect of CIK on pancreatic cancer cells. Moreover, we found that PKCι knockdown in pancreatic cancer cells can down-regulate the gene expression of TGF-β. In return, PKCι overexpression in pancreatic cancer cells can increase the gene expression of TGF-β. The death rate of cancer cells with 10, 20 ng/mL TGF-β was lower compared with the control group (P < 0.05).
CONCLUSIONS: PKCι knockdown in pancreatic cancer cells can not only inhibit the growth of pancreatic cancer cells, but also enhance the tumoricidal effects of CIK on cancer cells. The possible mechanism of PKCι is to affect the immune escape of tumor cells by regulating the expression of TGF-β.
PMID: 31880112 [PubMed - indexed for MEDLINE]
Downregulation of LncRNA GAS5 promotes liver cancer proliferation and drug resistance by decreasing PTEN expression.
Mol Genet Genomics. 2020 Jan;295(1):251-260
Authors: Wang C, Ke S, Li M, Lin C, Liu X, Pan Q
Accumulating evidence has shown that the long noncoding RNAs (lncRNAs) play a crucial role in the regulation of hepatocellular carcinoma (HCC) progression and drug resistance. In this study, we aimed to investigate the biological function roles of lncRNAs growth arrest-specific 5 (GAS5) and its underlying molecular mechanism in the development of HCC. qRT-PCR was used to detect GAS5, miR-21, and PTEN levels. MTT, cell counting assays, and xenograft mouse model were applied to measure cell proliferation rate in vitro and in vivo. The luciferase reporter assay and RNA immune-precipitation assay were introduced to evaluate the relationship between GAS5 and miR-21. We found that GAS5 was downregulated in HCC cell lines and tumor tissues. Knockdown of GAS5 enhanced HCC cell proliferation in vitro and in vivo and increased HCC cell resistance to doxorubicin. GAS5 acted as a sponge for miR-21 silencing and consequently led to the elevation of PTEN expression. Our data demonstrated that GAS5 functioned as a tumor suppressor role in HCC through regulation of miR-21-PTEN singling pathways, suggesting a potential application of GAS5 in HCC therapy.
PMID: 31705194 [PubMed - indexed for MEDLINE]
Focus on Very Late Hepatocellular Carcinoma Recurring After Liver Transplantation: A Case Report and Literature Review.
Transplant Proc. 2019 Nov;51(9):2998-3000
Authors: Invernizzi F, Maggi U, Mazza S, Baia M, Nosotti M, Mendogni P, Muiesan P, Cannata A, Iavarone M, Damarco F, Lampertico P, Donato MF, Rossi G
Hepatocellular carcinoma (HCC) recurring after liver transplantation (LT) is a major clinical concern, occurring in up to 20% and being the most frequent cause of death in this setting. Usually recurrence occurs within the first 2 years, whereas late and very late recurrences are rare. We report a 71-year-old woman with HCC recurrence after 25 years from LT, an event never reported before. Diagnosis was achieved with a progressive increase of alpha-fetoprotein (AFP) followed by a computed tomography scan, showing a mediastinal, upper diaphragmatic, right paracaval mass of 5 cm in size. The lesion was treated with a surgical approach involving a multidisciplinary team including hepatobiliary, thoracic, and cardiovascular surgeons. A sternotomy and mass removal was performed without the need of an extracorporeal bypass. A complete resection of the tumor was achieved, with a drop in AFP and without signs of recurrence after 1-year follow up. In conclusion, the possibility of late HCC recurrences after LT, despite being rare, underlines the need of a standardized, cost-benefit, optimal strategy of a long-term surveillance. From a surgical point of view, our case is unusual for the site and the character of the lesion, and for the absence of the need of an extracorporeal bypass during the operation.
PMID: 31607618 [PubMed - indexed for MEDLINE]
Early Experience of Trans-arterial Chemo-Embolisation for Hepatocellular Carcinoma with a Novel Radiopaque Bead.
Cardiovasc Intervent Radiol. 2019 Nov;42(11):1563-1570
Authors: Reicher J, Mafeld S, Priona G, Reeves HL, Manas DM, Jackson R, Littler P
AIMS: To evaluate early outcomes of patients with hepatocellular carcinoma (HCC) treated with a novel radiopaque bead, the 75-150 μm DC Bead LUMI™ (Biocompatibles UK Ltd).
MATERIALS AND METHODS: This was a retrospective review of the first 40 consecutive patients at a UK tertiary hepato-biliary centre, treated for HCC with TACE using radiopaque beads, between May 2017 and March 2019. Information regarding complications, mortality, lesion response and subsequent ablation procedures was collected from electronic records and case notes. Intra- and post-operative imaging was reviewed for visibility of the embolised territory.
RESULTS: Fifty-five TACE procedures were performed in 40 patients, with a median age of 70 years (range 28-88) and median lesion size of 3.8 cm (range 1.5-7.8). The median follow-up period was 30 weeks (range 6-101). Mean post-procedure hospital stay was 1.2 days. Complications of CIRSE Grade II or above occurred after 4/55 procedures (7.3%). Mortality at 30 days was zero. Objective response rates (mRECIST) at 1, 3 and 6 months were 32/35 (91.4%), 21/24 (87.5%) and 12/15 (80%), respectively. Complete response rates at 1, 3 and 6 months were 16/35 (45.7%), 12/24 (50%) and 9/15 (60%). The embolised territory was visible on intra-operative and follow-up CT imaging in all patients. The radiopaque beads were used as a fiducial marker to guide ablation in 5/40 patients (12.5%).
CONCLUSION: TACE with radiopaque beads shows promising tolerability and efficacy. The radiopaque beads ensure visualisation of the embolised lesion on intra- and post-operative imaging and, in selected cases, can act as a marker for CT-guided ablation.
PMID: 31455987 [PubMed - indexed for MEDLINE]
Percutaneous Laser Ablation of Liver Metastases from Neuroendocrine Neoplasm. A Retrospective Study for Safety and Effectiveness.
Cardiovasc Intervent Radiol. 2019 Nov;42(11):1571-1578
Authors: Sartori S, Tombesi P, Di Vece F, Bianchi L, Ambrosio R
PURPOSE: To retrospectively assess safety and efficacy of laser ablation (LA) of multiple liver metastases (LM) from neuroendocrine neoplasms (NEN).
METHODS: Twenty-one patients with NEN and at least 3 LM ≤ 4 cm in diameter underwent ultrasonography-guided LA. Up to seven LM were ablated in a single session; if the number of LM exceeded seven, the remaining LM were ablated in further LA sessions with a time interval of 3-4 weeks. LA was performed according to the multifiber technique. The patients underwent contrast-enhanced CT 1 month after LA, and were subsequently monitored every 3 months for the first 2 years and then every 6 months.
RESULTS: In total, 189 LM were treated in 21 patients (mean 9 ± 8.2, median 6) in 41 LA sessions (range 1-5). The diameter of LM ranged from 5 to 35 mm (median 19 mm, mean 17.9 ± 6.4 mm). One grade 4 complication occurred (0.53%): a bowel perforation managed by surgery. Technical efficacy was 100%, primary efficacy rate 94.7%, and secondary efficacy rate 100%. Complete relief of hormone-related symptoms was obtained in all the 13 symptomatic patients. Median follow-up was 39 months (range 12-99). 1-, 2-, 3-, and 5-year survival rates were 95%, 86%, 66%, and 40%, respectively. Overall survival resulted higher for patients with Ki-67 expression ≤ 7% than for those with Ki-67 > 7% (p = 0.0347).
CONCLUSIONS: LA is a promising and safe technique to treat LM from NEN. A longer follow-up should provide definitive information on the long-term efficacy of this liver-directed therapy.
LEVEL OF EVIDENCE: Retrospective study, local non-random sample, level 3.
PMID: 31410534 [PubMed - indexed for MEDLINE]
Five-Years Outcome Analysis of 142 Consecutive Hepatocellular Carcinoma Patients Treated with Doxorubicin Eluting Microspheres 30-60 μm: Results from a Single-Centre Prospective Phase II Trial.
Cardiovasc Intervent Radiol. 2019 Nov;42(11):1551-1562
Authors: Malagari K, Moschouris H, Kiakidis T, Harward S, Kelekis A, Vrakas S, Koundouras D, Filipiadis D, Glantzounis G, Emmanouil E, Chatziioannou A, Vergadis V, Elefsiniotis I, Koskinas J, Dourakis S, Kelekis N
PURPOSE: To assess prospectively long-term results of doxorubicin-loaded HepaSphere 30-60 μm in consecutive patients with hepatocellular carcinoma (HCC) not amenable to curative treatments.
PATIENTS AND METHODS: Single-center study from June 2011 to December 2015 in 151 patients treated with 75 mg of doxorubicin per HepaSphere vial. Baseline: Barcelona Clinic Liver Cancer BCLC A/B was 49.3%/50.7%, and median diameter 6.1 cm (mean 6.7 ± 2.0). Liver function, local response (mRECIST), liver time to progression (LTTP), progression-free survival (PFS), overall survival (OS) and adverse events (AEs) were recorded.
RESULTS: Final analysis included 142 patients with median follow-up of 46.8 months (range 4-72) without grade 4/5 AEs, and 30-day mortality was 0%. Mean number of scheduled treatments was 2.6 (range 1-3) and on demand 3 (range 1-8). Complete response for single tumor ≤ 5 cm was 75.0% and 66.7% for Child A and Child B, while for > 5 cm was 28.6% and 11.8%, respectively. OS was 31.0 months (mean 33.3 ± 15.2; range 8-69), notably for BCLC A 41 months (mean 41.1 ± 15.3; range 13-69) and for BCLC B 26.0 (mean 26.0 ± 10.5; range 8-51). OS at 1, 3 and 5 years: 95.8%, 75.7% and 21.4% for BCLC A, and 94.4%, 36.1% and 2.7% for BCLC B. Median LTTP for BCLC A was 11 months (mean 11.9 ± 4.7; range 3-24) and 7.5 for BCLC B (mean 7.9 ± 2.9). Local response was significant for OS and LTTP (p < 0.0001), while size and lesion number affected LPFS and OS (p < 0.001).
CONCLUSIONS: HepaSphere 30-60 μm loaded with doxorubicin provides a safe and effective treatment option for patients with HCC.
PMID: 31321482 [PubMed - indexed for MEDLINE]
Propofol Compared to Midazolam Sedation and to General Anesthesia for Percutaneous Microwave Ablation in Patients with Hepatic Malignancies: A Single-Center Comparative Analysis of Three Historical Cohorts.
Cardiovasc Intervent Radiol. 2019 Nov;42(11):1597-1608
Authors: Puijk RS, Ziedses des Plantes V, Nieuwenhuizen S, Ruarus AH, Vroomen LGPH, de Jong MC, Geboers B, Hoedemaker-Boon CJ, Thöne-Passchier DH, Gerçek CC, de Vries JJJ, van den Tol PMP, Scheffer HJ, Meijerink MR
PURPOSE: In percutaneous ablation procedures, periprocedural pain, unrest and respiratory concerns can be detrimental to achieve a safe and efficacious ablation and impair treatment outcome. This study aimed to compare the association between anesthetic technique and local disease control in patients undergoing percutaneous microwave ablation (MWA) of colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC).
MATERIALS AND METHODS: This IRB-exempted single-center comparative, retrospective analysis of three cohorts analyzed 90 patients treated for hepatic malignancies from January 2013 until September 2018. The local tumor progression-free survival (LTPFS), safety and periprocedural pain perception were assessed using univariate and multivariate Cox proportional hazard regression analyses to correct for potential confounders.
RESULTS: In 114 procedures (22 general anesthesia; 32 midazolam; 60 propofol), 171 liver tumors (136 CRLM; 35 HCC) were treated with percutaneous MWA. Propofol and general anesthesia were superior to midazolam/fentanyl sedation regarding LTPFS (4/94 [4.3%] vs. 19/42 [45.2%] vs. 2/35 [5.7%]; P < 0.001, respectively). Local tumor progression rate was 14.6% (25/171). Eighteen tumors (72.0%) were retreated by ablation. Of them, 14 (78%) were previously treated with midazolam. Propofol versus midazolam (P < 0.001), general anesthesia versus midazolam (P = 0.016), direct postprocedural visual analog pain score above 5 (P = 0.050) and more than one tumor per procedure (P = 0.045) were predictors for LTPFS. Multivariate analysis revealed that propofol versus midazolam (HR 7.94 [95% CI 0.04-0.39; P < 0.001]) and general anesthesia versus midazolam (HR 6.33 [95% CI 0.04-0.69; P = 0.014]) were associated with LTPFS. Pain during and directly after treatment was significantly worse in patients who received midazolam sedation (P < 0.001).
CONCLUSIONS: Compared to propofol and general anesthesia, midazolam/fentanyl sedation was associated with an increased periprocedural perception of pain and lower local tumor progression-free survival. To reduce the number of repeat procedures required to eradicate hepatic malignancies, general anesthesia and propofol sedation should be favored over midazolam.
PMID: 31243542 [PubMed - indexed for MEDLINE]
Radiation Exposure During Transarterial Chemoembolization: Angio-CT Versus Cone-Beam CT.
Cardiovasc Intervent Radiol. 2019 Nov;42(11):1609-1618
Authors: Piron L, Le Roy J, Cassinotto C, Delicque J, Belgour A, Allimant C, Beregi JP, Greffier J, Molinari N, Guiu B
INTRODUCTION: Cone-beam computed tomography (CBCT) has been developed to improve reliability of many interventional radiology (IR) procedures performed with Angio system, such as transarterial chemoembolization (TACE). Angio-CT has emerged as a new imaging technology that combines a CT scanner with an Angio system in the same IR suite. The purpose of our study was to compare Angio system with CBCT capability and Angio-CT in terms of patient radiation exposure during TACE procedures.
MATERIALS AND METHODS: Consecutive TACE procedures performed between January 2016 and September 2017 with the two imaging modalities (Artis Zeego defining the CBCT group and Infinix-i 4D-CT defining the Angio-CT group) were reviewed. TACE and patient's characteristics and patient radiation exposure parameters were collected. Dose-area products (DAP) and dose-length products (DLP) were converted into effective doses (ED) using conversion factors. Accuracy of tumor targeting and response was retrospectively assessed.
RESULTS: A total of 114 TACE procedures in 96 patients were included with 57 procedures in each group. The total ED in the Angio-CT group was 2.5 times lower than that in the CBCT group (median 15.4 vs. 39.2 mSv, p < 0.001). Both 2D ED and 3D ED were lower in the Angio-CT group than in the CBCT group (5.1 vs. 20 mSv, p < 0.001, and 7.4 vs. 17.9 mSv, p < 0.001, respectively). There was no significant difference neither in terms of classes of tumor targeting (p = 0.509) nor in terms of classes of tumor response (p = 0.070) between both groups.
CONCLUSION: Angio-CT provides significant decrease in patient effective dose during TACE procedures compared to Angio system with CBCT.
PMID: 31222382 [PubMed - indexed for MEDLINE]
Combination of intratumoural micellar paclitaxel with radiofrequency ablation: efficacy and toxicity in rodents.
Eur Radiol. 2019 Nov;29(11):6202-6210
Authors: Wu H, Fan ZP, Jiang AN, Di XS, He B, Wang S, Goldberg SN, Ahmed M, Zhang Q, Yang W
OBJECTIVES: To determine whether radiofrequency ablation (RFA) is more effective when combined with intratumoural injection (IT) than with intravenous injection (IV) of micelles.
MATERIALS AND METHODS: Balb/c mice bearing 4T1 breast cancer were used. The tumour drug accumulation and biodistribution in major organs were evaluated at different time points after IT, IV, IT+RFA and IV+RFA. Periablational drug penetration was evaluated by quantitative analysis and pathologic staining after different treatments. For long-term outcomes, mice bearing tumours were randomised into six groups (n = 7/group): the control, IV, IT, RFA alone, IV+RFA and IT+RFA groups. The end-point survival was estimated for the different treatment groups.
RESULTS: In vivo, intratumoural drug accumulation was always much higher for IT than for IV within 48 h (p < 0.001). The IT+RFA group (3084.7 ± 985.5 μm) exhibited greater and deeper drug penetration than the IV+RFA group (686.3 ± 83.7 μm, p < 0.001). Quantitatively, the intratumoural drug accumulation in the IT+RFA group increased approximately 4.0-fold compared with that in the IV+RFA group (p < 0.001). In addition, compared with the IT treatment, the IT+RFA treatment further reduced the drug deposition in the main organs. Survival was longer in the IT+RFA group than in the IV+RFA (p = 0.033) and RF alone (p = 0.003) groups.
CONCLUSION: The use of IT+RFA achieved much deeper and greater intratumoural drug penetration and accumulation, resulting in better efficacy, and decreased the systemic toxicity of nanoparticle-delivered chemotherapy.
KEY POINTS: • Association of IT+RFA achieved much deeper and greater intratumoural drug penetration than of IV+RFA, leading to better therapeutic efficacy. • Compared with IV or IT chemotherapy alone, the combination with RFA decreased toxicity, especially in the IT+RFA group.
PMID: 30993436 [PubMed - indexed for MEDLINE]
Deep learning reconstruction improves image quality of abdominal ultra-high-resolution CT.
Eur Radiol. 2019 Nov;29(11):6163-6171
Authors: Akagi M, Nakamura Y, Higaki T, Narita K, Honda Y, Zhou J, Yu Z, Akino N, Awai K
OBJECTIVES: Deep learning reconstruction (DLR) is a new reconstruction method; it introduces deep convolutional neural networks into the reconstruction flow. This study was conducted in order to examine the clinical applicability of abdominal ultra-high-resolution CT (U-HRCT) exams reconstructed with a new DLR in comparison to hybrid and model-based iterative reconstruction (hybrid-IR, MBIR).
METHODS: Our retrospective study included 46 patients seen between December 2017 and April 2018. A radiologist recorded the standard deviation of attenuation in the paraspinal muscle as the image noise and calculated the contrast-to-noise ratio (CNR) for the aorta, portal vein, and liver. The overall image quality was assessed by two other radiologists and graded on a 5-point confidence scale ranging from 1 (unacceptable) to 5 (excellent). The difference between CT images subjected to hybrid-IR, MBIR, and DLR was compared.
RESULTS: The image noise was significantly lower and the CNR was significantly higher on DLR than hybrid-IR and MBIR images (p < 0.01). DLR images received the highest and MBIR images the lowest scores for overall image quality.
CONCLUSIONS: DLR improved the quality of abdominal U-HRCT images.
KEY POINTS: • The potential degradation due to increased noise may prevent implementation of ultra-high-resolution CT in the abdomen. • Image noise and overall image quality for hepatic ultra-high-resolution CT images improved with deep learning reconstruction as compared to hybrid- and model-based iterative reconstruction.
PMID: 30976831 [PubMed - indexed for MEDLINE]
Is liver lesion characterisation by simplified IVIM DWI also feasible at 3.0 T?
Eur Radiol. 2019 Nov;29(11):5889-5900
Authors: Mürtz P, Pieper CC, Reick M, Sprinkart AM, Schild HH, Willinek WA, Kukuk GM
OBJECTIVE: To evaluate simplified intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for liver lesion characterisation at 3.0 T and to compare it with 1.5 T.
METHODS: 3.0-T DWI data from a respiratory-gated MRI sequence with b = 0, 50, 250, and 800 s/mm2 were analysed in 116 lesions (78 patients) and 27 healthy livers. Apparent diffusion coefficient ADC = ADC(0,800) and IVIM-based parameters D1' = ADC(50,800), D2' = ADC(250,800), f1' = f(0,50,800), f2' = f(0,250,800), D*' = D*(0,50,250,800), ADClow = ADC(0,50), and ADCdiff = ADClow-D2' were calculated voxel-wise and analysed on per-patient basis. Results were compared with those of 173 lesions (110 patients) and 40 healthy livers at 1.5 T.
RESULTS: Focal nodular hyperplasias were best discriminated from all other lesions by f1' and haemangiomas by D1' with an area under the curve (AUC) of 0.993 and 1.000, respectively. For discrimination between malignant and benign lesions, ADC was best suited (AUC of 0.968). The combination of D1' and f1' correctly identified more lesions as malignant or benign than the ADC (99.1% vs 88.8%). Discriminatory power for differentiating malignant from benign lesions tended to be higher at 3.0 T than at 1.5 T.
CONCLUSION: Simplified IVIM is suitable for lesion characterisation at 3.0 T with a trend of superior diagnostic accuracy for discriminating malignant from benign lesions compared with 1.5 T.
KEY POINTS: • Simplified IVIM is also suitable for liver lesion characterisation at 3.0 T. • Excellent accuracy was reached for discriminating malignant from benign lesions. • The acquisition of only three b-values (0, 50, 800 s/mm 2 ) is required.
PMID: 30963269 [PubMed - indexed for MEDLINE]
Predicting liver failure after extended right hepatectomy following right portal vein embolization with gadoxetic acid-enhanced MRI.
Eur Radiol. 2019 Nov;29(11):5861-5872
Authors: Theilig D, Steffen I, Malinowski M, Stockmann M, Seehofer D, Pratschke J, Hamm B, Denecke T, Geisel D
OBJECTIVES: Predicting post-hepatectomy liver failure (PHLF) after extended right hepatectomy following portal vein embolization (PVE) from serial gadoxetic acid-enhanced magnetic resonance imaging (MRI).
METHODS: Thirty-six patients who underwent hepatectomy following PVE were evaluated prospectively with gadoxetic acid-enhanced MRI examinations at predefined intervals during the course of their treatment, i.e., before and 14 days and 28 days after PVE as well as 10 days after hepatectomy. Relative enhancement (RE) and volume of the left and right liver lobes were determined. The study population was divided into two groups with respect to signs of PHLF. Differences between the two groups were assessed using the Mann-Whitney U test, and predictive parameters for group membership were investigated using ROC and logistic regression analysis.
RESULTS: RE of the left lobe prior to PVE versus 14 days after PVE was significantly lower in patients with PHLF than in those without PHLF (Mann-Whitney U test p < 0.001) and proved to be the best predictor of PHLF in ROC analysis with an AUC of 0.854 (p < 0.001) and a cutoff value of - 0.044 with 75.0% sensitivity and 92.6% specificity. Consistent with this result, logistic linear regression analysis adjusted for age identified the same parameter to be a significant predictor of PHLF (p = 0.040).
CONCLUSIONS: Gadoxetic acid-enhanced MRI performed as an imaging-based liver function test before and after PVE can help to predict PHLF. The risk of PHLF can be predicted as early as 14 days after PVE.
KEY POINTS: • To predict the likelihood of post-hepatectomy liver failure, it is important to estimate not only future liver remnant volume prior to extended liver resection but also future liver remnant function. • Future liver remnant function can be predicted by performing gadoxetic acid-enhanced MRI as an imaging-based liver function test before and after portal vein embolization. • A reduction of relative enhancement of the liver in gadoxetic acid-enhanced MRI after portal vein embolization of 0.044 predicts post-hepatectomy liver failure with 75.0% sensitivity and 92.6% specificity.
PMID: 30899977 [PubMed - indexed for MEDLINE]
Lesion detection performance of an abbreviated gadoxetic acid-enhanced MRI protocol for colorectal liver metastasis surveillance.
Eur Radiol. 2019 Nov;29(11):5852-5860
Authors: Canellas R, Patel MJ, Agarwal S, Sahani DV
OBJECTIVE: To assess the lesion detection performance of an abbreviated MRI (AMRI-M) protocol consisting of ultrafast SE T2W, DWI, and T1W-HBP at 20 min for colorectal liver metastasis (CRLM) surveillance.
METHODS: In this Institutional Review Board (IRB)-approved retrospective study, gadoxetic acid-enhanced MRI scans of 57 patients (43 with pathologically proven CRLMs) were assessed. Two readers independently evaluated two sets of images per patient and commented on the number, location, and size of liver lesions. Set 1 included ultrafast spin-echo (SE) T2-weighted (T2W) + T1-weighted (T1W) hepatobiliary phase (HBP) at 20 min sequences + diffusion-weighted imaging (DWI), and set 2 consisted of the standard MRI protocol. A maximum of 10 lesions per patient were recorded. Cohen's kappa analysis, sensitivity, areas under the curve (AUCs), and the MRI cost analysis of the AMRI-M protocol were assessed.
RESULTS: Between 198 and 209 lesions were assessed with each set of images. The inter-observer agreement for the abbreviated protocol was reported excellent (κ = 0.91). The sensitivity and AUCs for the lesion characterization of AMRI-M protocol were very high (over 90%) for both readers. No statistically significant differences in sensitivity (assessed by mixed-effects logistic regression) and AUCs for lesion characterization (by ROC regression) were found between both protocols. The AMRI-M acquisition time was estimated to be less than 10 min, which translated into 59% cost of standard MRI.
CONCLUSION: Our proposed AMRI-M protocol (ultrafast SE T2W, DWI, and T1W-HBP at 20 min) is fast, low-cost alternative to the standard MRI protocol and has a high lesion detection performance.
KEY POINTS: • Gadoxetic acid-enhanced protocol has increased the accuracy, sensitivity, and specificity of MRI for detecting colorectal liver metastases. • Our proposed abbreviated MRI protocol is fast, low-cost alternative compared with the standard MRI protocol and has a high lesion detection performance. • Adoption of our protocol may translate to substantial savings for patients and payers.
PMID: 30888485 [PubMed - indexed for MEDLINE]
Radial MP2RAGE sequence for rapid 3D T1 mapping of mouse abdomen: application to hepatic metastases.
Eur Radiol. 2019 Nov;29(11):5844-5851
Authors: Faller TL, Trotier AJ, Miraux S, Ribot EJ
OBJECTIVES: The T1 longitudinal recovery time is regarded as a biomarker of cancer treatment efficiency. In this scope, the Magnetization Prepared 2 RApid Gradient Echo (MP2RAGE) sequence relevantly complies with fast 3D T1 mapping. Nevertheless, with its Cartesian encoding scheme, it is very sensitive to respiratory motion. Consequently, a radial encoding scheme was implemented for the detection and T1 measurement of hepatic metastases in mice at 7T.
METHODS: A 3D radial encoding scheme was developed using a golden angle distribution for the k-space trajectories. As in that case, each projection contributes to the image contrast, the signal equations had to be modified. Phantoms containing increasing gadoteridol concentrations were used to determine the accuracy of the sequence in vitro. Healthy mice were repetitively scanned to assess the reproducibility of the T1 values. The growth of hepatic metastases was monitored. Undersampling robustness was also evaluated.
RESULTS: The accuracy of the T1 values obtained with the radial MP2RAGE sequence was > 90% compared to the Inversion-Recovery sequence. The motion robustness of this new sequence also enabled repeatable T1 measurements on abdominal organs. Hepatic metastases of less than 1-mm diameter were easily detected and T1 heterogeneities within the metastasis and between the metastases within the same animal were measured. With a twofold acceleration factor using undersampling, high-quality 3D T1 abdominal maps were achieved in 9 min.
CONCLUSIONS: The radial MP2RAGE sequence could be used for fast 3D T1 mapping, to detect and characterize metastases in regions subjected to respiratory motion.
KEY POINTS: • The Cartesian encoding of the MP2RAGE sequence was modified to a radial encoding. The modified sequence enabled accurate T 1 measurements on phantoms and on abdominal organs of mice. • Hepatic metastases were easily detected due to high contrast. Heterogeneity in T 1 was measured within the metastases and between each metastasis within the same animal. • As implementation of this sequence does not require specific hardware, we expect that it could be readily available for clinical practice in humans.
PMID: 30888483 [PubMed - indexed for MEDLINE]