Hepatic incidentaloma: the rule of tens

ObjectivesHepatic incidentalomas (HI) are asymptomatic lesions detected incidentally during investigations for other pathologies. This prospective series outlines the management and outcomes of 121 HI managed over 7 years.MethodsData were recorded prospectively on 121 patients referred between 2003 and 2010 for assessment of HI out of 1081 patients referred for a hepatic resection. Patients were reviewed in multidisciplinary meetings and investigated with tumour markers and radiological investigations. HI were classified as hypo‐ or hypervascular depending on arterial phase CT scan findings. Univariate and multivariate analysis was performed to define predictive factors for malignancy.ResultsForty HI were hypovascular, 35 were benign (18 cysts, 12 focal fatty sparing, 1 fetal lobulation and 4 solitary necrotic nodules) and 5 cholangiocarcinomas (all resected)]. Eighty‐one HI were hypervascular, 72 were benign [40 focal nodular hyperplasia (FNH), 8 adenoma and 24 hemangiomas) and 9 cancers (5 HCC, 4 metastases: 7 resected). Male gender [relative risk (RR) 2.70, confidence interval (CI) 1.69–3.51], age >45 years (RR 3.15, CI 2.71–3.89), tumour diameter >4 cm (RR 3.35, CI 3.13–4.01) and late (8 min) enhancement on magnetic resonace imaging (MRI) (RR 4.15, CI 3.01–4.79) were predictive of malignancy.ConclusionsHI constitute 10% of practice volume. 10% of hyper and hypovascular incidental lesions are malignant. Most can be treated aggressively after diagnosis.     

Assessment of clinical and magnetic resonance imaging features of de novo hypervascular hepatocellular carcinoma using gadoxetic acid‐enhanced magnetic resonance imaging

Aim

To clarify the clinical and magnetic resonance imaging (MRI) features of de novo hypervascular hepatocellular carcinoma (HCC) using serial gadoxetic acid‐enhanced MRI.

Methods

The institutional review board approved this retrospective study. After review of 1007 MRI examinations in 240 patients with chronic liver disease, 17 newly developed hypervascular HCCs in 16 patients detected by follow‐up from initial MRI examination without hepatocellular nodules were evaluated. The clinical and MRI findings such as previous treatment history for HCC, period to hypervascular HCC onset, presence or absence of hypovascular hypointense nodules on hepatobiliary phase before hypervascularization, and intralesional fat component were recorded or evaluated. Statistical evaluations included Fisher's exact test, χ²‐test, and Mann–Whitney U‐test.

Results

In 17 HCCs, 12 (71%) were de novo hypervascular HCC without showing hypovascular hypointense nodule on hepatobiliary phase before hypervascularization (de novo group) and 5 (29%) were hypervascularized HCC developed during multistep hepatocarcinogenesis (multistep group). The incidence of previous treatment history for HCC in the de novo group (91%) was significantly higher than that in the multistep group (20%) (P = 0.013). The duration to hypervascular HCC onset from initial examination was shorter in the de novo group (mean, 291 days) than in the multistep group (mean, 509 days) (P = 0.035). The incidence of fat‐containing lesion in the de novo group (0%) was lower than that in the multistep group (40%) (P = 0.074).

Conclusion

De novo hypervascular HCC is characterized by rapid growth, patients with previous treatment history for HCC, and lack of intralesional fat, compared to hypervascular HCC with multistep progression.

     

Hepatic angiomyolipoma: an international multicenter analysis on diagnosis,management and outcome

BackgroundHepatic angiomyolipoma (HAML) may easily be misdiagnosed as a malignancy. The study aim was to assess diagnostic dilemmas, clinical management and outcome of this rare tumor.MethodsThis retrospective international multicenter study included all patients with pathologically proven HAML diagnosed between 1997 and 2017. Data on patient characteristics, diagnostic work-up, management and follow-up were analyzed.ResultsThirty-eight patients were included, 32 female. Median age was 56yrs (i.q.r. 43–64) and median HAML-diameter was 57.5 mm (i.q.r. 38.5–95.3). Thirty patients had undergone CT and 27/38 MRI of the liver, diagnostic biopsy was performed in 19/38. Initial diagnosis was incorrect in 15/38 patients, of which 13 were thought to have malignancy. In 84% biopsy resulted in a correct preoperative diagnosis. Twenty-nine patients were managed with surgical resection, 4/38 with surveillance and 3/38 with liver transplantation. Recurrence after resection occurred in two cases. No HAML related deaths or progression to malignancy were documented.ConclusionHAML diagnosis proved problematic even in hepatobiliary expertise centers. Biopsy is indicated and may provide valuable additional information when HAML diagnosis is considered on cross-sectional imaging, especially when surgical resection imposes a risk of complications. Conservative management with regular imaging follow-up might be justified when biopsy confirms (classic type) HAML.     

Post-transplantation hepatocellular carcinoma recurrence: Patterns and relation between vascularity and differentiation degree

AIM: To evaluate the relationship between hepatocellular carcinoma(HCC) vascularity and grade; to describe patterns and vascular/histopathological variations of post-transplantation recurrence.METHODS: This retrospective study included 165 patients(143 men, 22 women; median age 56.8 years, range 28-70.4 years) transplanted for HCC who had a follow-up period longer than 2 mo. Pre-transplantation dynamic computed tomography or magnetic resonance examinations were retrospectively reviewed, classifying HCC imaging enhancement pattern into hypervascular and hypovascular based on presence of wash-in during arterial phase. All pathologic reports of the explanted livers were reviewed, collecting data about HCC differentiation degree. The association between imaging vascular pattern and pathological grade was estimated using the Fisher exact test. All follow-up clinical and imaging data were reviewed for evidence of recurrence. Recurrence rate was calculated and imaging features of recurrent tumor were collected, classifying early and late recurrences based on timing(< or ≥ 2 years after transplantation) and intrahepatic, extrahepatic and both intrahepatic and extrahepatic recurrences based onlocation. All intrahepatic recurrences were classified as hypervascular or hypovascular and the differentiation degree was collected where available. The presence of variations in imaging enhancement pattern and pathological grade between the primary tumor and the intrahepatic recurrence was evaluated and the association between imaging and histopatholgical variations was estimated by using the χ2 test. RESULTS: Of the 163 patients with imaging evidence of viable tumor, 156(95.7%) had hypervascular and 7(4.3%) hypovascular HCC. Among the 125 patients with evidence of viable tumor in the explanted liver, 19(15.2%) had grade 1, 56(44.8%) grade 2, 40(32%) grade 3 and 4(3.2%) grade 4 HCC, while the differentiation degree was not assessable for 6 patients(4.8%). A significant association was found between imaging vascularity and pathological grade(P = 0.035). Post-transplantation recurrence rate was 14.55%(24/165). All recurrences occurred in patients who had a hypervascular primary tumor. Three patients(12.5%) experienced late recurrence; the location of the first recurrence was extrahepatic in 14 patients(58.3%), intrahepatic in 7 patients(29.2%) and both intrahepatic and extrahepatic in 3 patients(12.5%). Two patients had a variation in imaging characteristics between the primary HCC(hypervascular) and the intrahepatic recurrent HCC(hypovascular), while 1 patient had a variation of histopathological characteristics(from moderate to poor differentiation), however no association was found between imaging and histopathological variations.CONCLUSION: A correlation was found between HCC grade and vascularity; some degree of variability may exist between the primary and the recurrence imaging/histopathological characteristics, apparently not correlated.     

Clinicopathological assessment of steatohepatitic hepatocellular carcinoma

AimTo compare the clinicopathological features of typical steatohepatitic HCC (SH-HCC) with other HCCs.MethodsSubjects were 486 patients with untreated HCC who underwent hepatectomy at our hospital from January 2015 to December 2020. We compared patient backgrounds, preoperative laboratory data, imaging findings (ultrasonography, computed tomography [CT], and magnetic resonance imaging [MRI]), and postoperative pathological findings (tumor and background of liver). The Liver Imaging Reporting And Data System (LI-RADS) was used to examine CT and MRI findings.ResultsTypical SH-HCCs were significantly different from other HCCs with respect to age, hepatitis B virus (HBV) infection, and nonalcoholic steatohepatitis (NASH). Diabetes and hyperlipidemia were also significantly more common. Regarding histopathology, tumor size and background steatosis were significantly different between groups. Although ultrasonography, CT, and MRI could each alone diagnose SH-HCCs with a diameter < 20 mm in ≥ 50% of patients, the combined use of these tests improved diagnostic accuracy. By LI-RADS, 87% of SH-HCC cases were classified as LR-5, which are considered to be malignant tumors.ConclusionsIt seems possible to diagnose SH-HCC by combining ultrasonography, CT, and MRI.     

Assessment of Gd-EOB-DTPA-enhanced MRI for HCC and dysplastic nodules and comparison of detection sensitivity versus MDCT

Background

We aimed to evaluate gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the detection of hepatocellular carcinomas (HCCs) and dysplastic nodules (DNs) compared with dynamic multi-detector row computed tomography (MDCT), and to discriminate between HCCs and DNs.

Methods

Eighty-six nodules diagnosed as HCC or DNs were retrospectively investigated. Gd-EOB-DTPA-enhanced MRI and dynamic MDCT were compared with respect to their diagnostic ability for hypervascular HCCs and detection sensitivity for hypovascular tumors. The ability of hepatobiliary images of Gd-EOB-DTPA-enhanced MRI to discriminate between these nodules was assessed. We also calculated the EOB enhancement ratio of the tumors.

Results

For hypervascular HCCs, the diagnostic ability of Gd-EOB-DTPA-enhanced MRI was significantly higher than that of MDCT for tumors less than 2?cm (p?=?0.048). There was no difference in the detection of hypervascular HCCs between hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI (43/45: 96%) and dynamic MDCT (40/45: 89%), whereas the detection sensitivity of hypovascular tumors by Gd-EOB-DTPA-enhanced MRI was significantly higher than that by dynamic MDCT (39/41: 95% vs. 25/41: 61%, p?=?0.001). EOB enhancement ratios were decreased in parallel with the degree of differentiation in DNs and HCCs, although there was no difference between DNs and hypovascular well-differentiated HCCs.

Conclusion

The diagnostic ability of Gd-EOB-DTPA-enhanced MRI for hypervascular HCCs less than 2?cm was significantly higher than that of MDCT. For hypovascular tumors, the detection sensitivity of hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI was significantly higher than that of dynamic Gd-EOB-DTPA-enhanced MRI and dynamic MDCT. It was difficult to distinguish between DNs and hypovascular well-differentiated HCCs based on the EOB enhancement ratio.     

LI-RADS 4 or 5 categorization may not be clinically relevant for decision-making processes: A prospective cohort study

Introduction and objectivesThe liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center.Materials and methodsProspective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1).ResultsOf 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18–90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59–98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64–87) had confirmed HCC, 17% with microvascular invasion.ConclusionsLI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.     

Hepatic Angiomyolipoma Mimicking Hepatocellular Carcinoma: Magnetic Resonance Imaging and Clinical Pathological Characteristics in 9 Cases

Hepatic angiomyolipoma (HAML) is a rare mesenchymal tumor of the liver with marked histological diversity. The present study was to review the magnetic resonance imaging (MRI) and clinical pathological features of HAML resembling hepatocellular carcinoma (HCC).Nine patients who underwent surgical resection and had pathological diagnosis of HAML were retrospectively analyzed.All of 9 patients (5 males and 4 females) had a solitary hepatic mass with a median size of 4 cm (from 1.4 cm to 15.3 cm). Seven cases were identified as incidental liver tumors during health screening and 2 patients were diagnosed for hepatic mass when visited hospitals with unspecific abdominal discomfort. Before resection, 6 cases were diagnosed as HCC on MRI. MRI on chemical shift imagings showed a large amount of lipids in 5 cases. The enhancement pattern of MRI was classified into 2 types: in 2 cases, lesions with small or no vessels that demonstrated prolonged enhancement (1 mixed subtype and 1 myomatous subtype) and in 7 cases, lesions with abundant central vessels that show rapid washout (3 mixed subtypes and 4 myomatous subtypes) in the portal venous/delayed phase. All patients underwent resection of hepatic tumor and no recurrence was observed during follow-up (range: 2–24 months) of median 10 months. By immunohistochemistry, the tumor cells demonstrated positive immunostaining for human melanoma black-45, smooth muscle actin, and CD34.In conclusion, all of 9 patients with HAML presented with none or nonspecific clinical manifestations. The diagnosis of HAML relies on disease and immunohistochemistry, but not MRI due to its resemblance to HCC.     

原发性肝癌的MRI增强表现临床分析

目的分析肝胆期表现为乏血管低信号结节有可能转变为富血管原发性肝癌（PLC）的MRI增强影像表现。方法 135例乙型肝炎合并肝硬化患者的肝胆期增强MRI中,发现214个乏血管低信号结节灶。分析每一个结节的大小,在肝胆期的低信号程度（分为4度）,有无脂肪成分,在T1加权、T2加权及弥散成像序列的信号强度。将这些变量进行多变量单变量回归分析,来确认再生结节转变为PLC最有价值的影像特征。结果在135例214个结节的MRI随访系列图像上,139个结节（65.0%）无PLC形成的迹象（稳定组,平均随访522天）,转变组75个结节（35.0%）则最终转变为富血管高信号PLC结节。单变量回归分析显示与PLC形成明显相关的为在MRI增强肝胆期结节灶的低信号程度（P=0.001）,T2加权高信号（P=0.001）与弥散成像高信号（P=0.0001）。多变量回归分析显示首次MRI弥散成像结节高信号为PLC形成最有价值的影像特征（危害比7.44;95%CI 4.28,12.94）。结论肝硬化患者MRI增强肝胆期结节灶信号最低而在弥散成像序列表现为高信号,强烈提示富血管PLC已经形成。     

Des-γ-carboxyl prothrombin is associated with tumor angiogenesis in hepatocellular carcinoma

Background and Aim: Hepatocellular carcinoma (HCC) is a hypervascular tumor, and angiogenesis plays an important role in its development. Previously, we demonstrated that des‐γ‐carboxyl prothrombin (DCP) promotes both cell proliferation and migration of human umbilical vein endothelial cells (HUVECs) by inducing the autophosphorylation of kinase insert domain receptor (KDR). In the present study, DCP‐associated tumor angiogenesis was assessed by comparing hypovascular and common hypervascular HCC. Methods: The solitary HCCs of 827 patients were classified into two groups according to the tumor density at the arterial phase of a dynamic computed tomography scan; the initial clinical data of patients with the hyper‐ and hypovascular types were compared. The HCC tissues from 95 tumors were analyzed by immunohistochemical staining for DCP and phosphorylated KDR, and intratumoral microvessel density (MVD) was analyzed to evaluate microvessel angiogenesis. Results: The serum DCP levels (320 ± 3532 mAU/mL) and tumor size (18.4 ± 9.0 mm) of patients with hypervascular HCC were significantly greater than those with hypovascular HCC (38.7 ± 80 mAU/mL and 14.6 ± 5.2 mm, P < 0.001). Immunohistochemical analysis revealed that the expressions of DCP and phospho‐KDR were significantly greater in hypervascular HCC (71.4% and 31.0%, respectively) than in hypovascular HCC (7.6% and 5.7%, respectively). Intratumoral MVD was significantly correlated with DCP (r = 0.48, P < 0.0001). Conclusions: des‐γ‐carboxyl prothrombin production is associated with tumor angiogenesis in HCC.     

Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis

Contrast-enhanced ultrasound(CEUS)using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis.CEUS can be used as a problem-solving method for indeterminate nodules on computed tomography(CT)or magnetic resonance imaging(MRI)or as an initial diagnostic test for small newly detected liver nodules.CEUS has unique advantages over CT and MRI including no renal excretion of contrast,real-time imaging capability,and purely intravascular contrast.Hepatocellular carcinoma(HCC)is characterized by arterial-phase hypervascularity and later washout(negative enhancement).Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial phase and isoechoic in the late phase.However,there are occasional HCC lesions with atypical enhancement including hypovascular HCC and hypervascular HCC without washout.Cholangiocarcinomas are infrequently detected during HCC surveillance and mostly show rimlike or diffuse hypervascularity followed by rapid washout.Hemangiomas are often found at HCC surveillance and are easily diagnosed by CEUS.CEUS can be effectively used in the diagnostic work-up of small nodules detected at HCC surveillance.CEUS is also useful to differentiate malignant and benign venous thrombosis and to guide and monitor the local ablation therapy for HCC.     

Lymphoepithelioma-like cholangiocarcinoma:A mimic of hepatocellular carcinoma on imaging features

Primary lymphoepithelioma-like carcinoma in the liver is extremely rare. A few cases of lymphoepithelioma-like cholangiocarcinoma have been reported, but few radiologic features were described. We reviewed 23 cases of lymphoepithelioma-like cholangiocarcinoma reported between 1996 and 2014 and describe a rare case of a 35-year-old woman in our hospital who was diagnosed with lymphoepithelioma-like cholangiocarcinoma of the liver and was a hepatitis B carrier. The tumor(1.6 cm) in our patient appeared to be hypoechoic in sonographic images and hypodense in computed tomography(CT) images. In addition, it was homogeneous hypointense in T1-weighted magnetic resonance(MR) images(MRI) and hyperintense in T2-weighted MRI. Dynamic gadolinium-enhanced MRI showed typical image pattern of hepatocellular carcinoma(HCC). The patient underwent a laparoscopic left hepatic lobectomy, and the resected tumor consisted of well-differentiated glandular cells with extensive lymphocytic infiltration that were immunoreactive to CK(AE1/AE3), CD3, and CD20. In addition, the tumor was positive for Epstein-Barr virus-encoded RNA in situ hybridization. Finally, lymphoepithelioma-like cholangiocarcinoma was diagnosed. In previous studies, the incidence is highest among middle-aged people. Most tumors appeared to be hypodense with either hypovascular or hypervascular patterns in CT images. This case report is the first study to address sonography, CT, and MRI observations and delineate pathologic correlations. We suggest that the imaging pattern of lymphoepithelioma-like cholangiocarcinoma, either the typical cholangiocarcinoma pattern or a mimic of HCC, should be considered in the differential lists for HCC.     

Noninvasive quantitative measurement of tissue blood flow in hepatocellular carcinoma using xenon-enhanced computed tomography

The aim of this study was to quantitatively measure tissue blood flow (TBF) in hepatocellular carcinoma (HCC) by a noninvasive method using xenon (Xe) inhalation/CT scans and to correlate the measured TBF with histological features. TBF was measured in HCC with xenon-enhanced CT (xenon/CT) in 20 patients. In 15 patients with HCC diagnosed as hypervascular tumors by conventional CT, TBF of the tumors was significantly higher than that of noncancerous liver tissue (151.1 ± 20 vs 42.6 ± 20 ml/min/100 g). Histologically, these tumors were diagnosed as moderately-to-poorly differentiated HCC. In contrast, in five patients with hypovascular HCC, TBF of HCC was almost comparable to that of the noncancerous regions (45.3 ± 6 vs 48.3 ± 6 ml/min/100 g). All these tumors were well-differentiated HCC. In conclusions, the measured values of TBF correlate with the clinicopathologic features of liver tumors and nontumorous liver tissue in patients with HCC.     

Systematic Training of Liver Imaging Reporting and Data System Magnetic Resonance Imaging v2018 can Improve the Diagnosis of Hepatocellular Carcinoma for Different Radiologists

Background and AimsLiver imaging reporting and data system (LI-RADS) provides standardized lexicon and categorization for diagnosing hepatocellular carcinoma (HCC). However, there is limited knowledge about the effect of LI-RADS training. We prospectively explored whether the systematic training of LI-RADS v2018 on magnetic resonance imaging (MRI) can effectively improve the diagnostic performances of different radiologists for HCC.MethodsA total of 20 visiting radiologists and the multiparametric MRI of 70 hepatic observations in 61 patients with high risk of HCC were included in this study. The LI-RADS v2018 training procedure included three times of thematic lectures (each lasting for 2.5 h) given by a professor specialized in imaging diagnosis of liver, with an interval of a month. After each seminar, the radiologists had a month to adopt the algorithm into their daily work. The diagnostic performances and interobserver agreements of these radiologists adopting the algorithm for HCC diagnosis before and after training were compared.ResultsA total of 20 radiologists (male/female, 12/8; with an average age of 36.75±4.99 years) were enrolled. After training, the interobserver agreements for the LI-RADS category for all radiologists (p=0.005) were increased. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of all radiologists for HCC diagnosis before and after training were 43% vs. 54%, 86% vs. 88%, 74% vs. 81%, 62% vs. 67%, and 65% vs. 71%, respectively. The diagnostic performances of all radiologists (p<0.001) showed improvement after training.ConclusionsThe systematic training of LI-RADS can effectively improve the diagnostic performances of radiologists with different experiences for HCC.     

Epithelioid angiomyolipoma of the liver： Cross-sectional imaging findings of 10 immunohistochemically-verified cases

AIM： To retrospectively evaluate the computed tomography （CT）/magnetic resonance imaging （MRI） imaging features of epithelioid angiomyolipoma of the liver （Epi-HAML）, with pathology as a reference. METHODS： The CT/MRI findings （number, diameter, lobar location, and appearance of lesions） in a series of 10 patients with 12 pathologically proven epithelioid angiomyolipomas of the liver were retrospectively analyzed. The imaging features, including attenuation/ signal intensity characteristics, presence of fat, hypervascular, outer rim, and vessels within lesion, were evaluated and compared with that of non-Epi- HAML in 11 patients （13 lesions）. The Fisher exact test was used to compare difference in probability of imaging features between the two types. RESULTS： For 21 patients, CT images of 15 patients and MR images of six patients were available. No patient underwent two examinations. For the 15 patients with a CT scan, all HAML lesions in the two groups （10 Epi-HAML and seven non-Epi-HAML） manifested as hypoattenuation. For the six patients with MRI, all lesions （two Epi-HAML and six non-Epi- HAML） were hypointense on TlWI （fat suppression） and hyperintense on T2WI. There were 10 non-Epi-HAML, but only two Epi-HAML lesions showed the presence of fat, which significantly different between the two types （P = 0.005）. On the dynamic contrast enhancement （DCE） imaging, eight Epi-HAML, and 13 non-Epi lesions manifested as hypervascular. Punctate or curved vessels were displayed in 10 Epi-HAML as well as in nine non- Epi lesions and outer rim enhancement could be found with eight Epi-HAML as well as six non-Epi lesions. CONCLUSION： Little or no presence of adipose tissue was found to be an imaging feature of Epi- HAML, compared with the non-Epi type. In addition, hypervascularity with opacification of central punctiform or filiform vessels on DCE would be a characteristic enhancement pattern for Epi-HAML.     

Prognostic impact of tumor vascularity on CT in resectable intrahepatic cholangiocarcinoma

BackgroundWe investigated the vascularity of intrahepatic cholangiocarcinoma (ICC) on computed tomography (CT) images and its association with ICC recurrence after surgery and prognosis after recurrence.MethodsIn this retrospective study, the data of patients who underwent resection with curative intent for ICC between March 2001 and July 2017 were reviewed. Clinicopathologic factors including tumor vascularity (hypovascular, rim-enhancement, and hypervascular) on CT that could affect recurrence-free survival (RFS) were assessed. The association between the vascularity of recurrent ICC and survival after recurrence was also analyzed.ResultsOverall, 147 patients were enrolled and followed up for a median of 36.1 months of which, 101 (68.7%) experienced ICC recurrence. Hypervascularity of ICC showed better RFS than other vascularities [rim-enhanced image hazard ratio (HR), 3.893; 95% confidence interval (CI), 1.700–8.915, p = 0.001; hypovascular image HR, 6.241; 95% CI, 2.670–14.586, p < 0.001]. The hypervascular recurrent ICC was also significantly associated with better survival after recurrence (log-rank test, p < 0.001).ConclusionHypervascular ICC was associated with a longer RFS and better prognosis after recurrence. The vascularity of ICC on CT may be a noninvasive, accessible, and useful prognostic index, and should be considered while planning treatment.     

肝血管平滑肌脂肪瘤43例临床分析

目的 研究肝血管平滑肌脂肪瘤(HAML)临床、影像学、病理及免疫组织化学生表现,旨在提高其诊治水平.方法 回顾性分析2009年6月-2011年6月第二军医大学东方肝胆外科医院43例经手术病理证实HAML病例的临床、影像学、病理和免疫组织化学资料.结果 本组HAML患者,女性多见,大部分无HBV感染背景,肿瘤标志物[甲胎蛋白(AFP)、癌胚抗原(CEA)、CA-199]阴性,临床症状无特异性;影像学表现多样,术前诊断为HAML的8例,误诊为肝细胞癌17例,误诊为局灶性结节样增生(FNH)的2例,误诊为肝腺瘤2例,误诊为血管瘤2例,诊断不明确的12例;明确诊断依赖于术后病理及免疫组织化学结果,HMB45阳性率97.6％,SMA阳性率88.1％,CD34阳性率70.7％.结论 HAML术前容易误诊,误诊为肝细胞癌多见,结合临床与影像学检查,可能提高其术前诊断率;该肿瘤术后预后良好.     

Detection and characterization of hepatocellular carcinoma in rats with liver cirrhosis:diagnostic value of combined use of MR positive and negative contrast agents

BACKGROUND:Gadolinium-enhanced multi-phase dynamic imaging has improved the accuracy of the diagnosis of hypervascular hepatocellular carcinoma (HCC),but using gadolinium-enhanced dynamic imaging alone is problematic in evaluating hypovascular HCC.This work aimed at evaluating the combined use of superparamagnetic iron oxide(SPIO)-enhanced and gadolinium set in distinguishing HCCs from regenerative nodules(RNs)in a rat model induced by diethylnitrosamine(DEN). METHODS:DEN-induced HCC model rats(n=40)and con...     

Clinical value of gadoxetic acid-enhanced magnetic resonance imaging in surgery for hepatocellular carcinoma - with a special emphasis on early hepatocellular carcinoma

Gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellular carcinoma (HCC) in arterial phase imaging and hypovascular early HCC (small well-differentiated HCC of the vaguely nodular type) in hepatobiliary phase imaging, and has become an indispensable imaging modality in the treatment of HCC. Early HCCs have been detected more frequently since the introduction of EOB-MRI into daily clinical practice. Early HCC is known to progress to conventional hypervascular HCC, and many risk factors have been identified for the hypervascularization of early HCC including the diameter of the tumor, presence of fat, and imaging findings of EOB-MRI. The rate of the development of hypervascular HCC was previously reported to be high in patients with chronic liver disease and early HCC. The presence of early HCC is regarded as a predictor for the recurrence of HCC following hepatic resection. On the other hand, although early HCC itself is currently not regarded as a target lesion for hepatic resection, early HCC at high risk of hypervascularity needs to be treated by local ablation therapy. If concomitant early HCC with progressed HCC is at high risk of hypervascularization and the functional liver reserve of a patient is sufficient, its simultaneous treatment at the time of hepatic resection for progressed HCC is recommended. Further studies on larger numbers of patients are needed before this strategy is adopted.     

肝转移癌超声造影增强模式表现分析

目的 研究肝转移癌患者肝内病灶超声造影(CEUS)增强模式。方法 2016年1月～2019年1月我院诊治的肝转移癌患者76例,经手术或病灶活检病理学检查诊断,行CEUS和CT增强扫描检查,根据病灶在CT扫描肝动脉期表现为低密度灶者称为乏血供病灶,表现为高密度或等密度灶者为富血供病灶。结果 本组肝转移癌的原发灶包括结肠癌50例(65.8%)、乳腺癌7例(9.2%)、肺癌5例(6.6%)、胃癌5例(6.6%)、胰腺癌4例(5.3%)、胰腺神经内分泌肿瘤3例(3.9%)、卵巢癌2例(2.6%);乏血供组肝转移癌来自结肠癌、肺癌、胃癌、胰腺癌和卵巢癌,富血供组肝转移癌来自胰腺神经内分泌肿瘤和乳腺癌;CEUS动脉期成像表现为高增强、局部高增强、同步等增强和不均匀低增强。乏血供组108个病灶动脉期呈高增强、局部高增强、同步等增强和不均匀低增强发生率分别为52.8%、35.2%、3.7%和8.3%,与富血供组24个病灶的87.5%、12.5%、0.0%和0.0%比,差异显著(P<0.05);乏血供组病灶门脉期呈低增强和等增强发生率为分别为99.1%和0.9%,延迟期呈低增强和等增强发生率分别为99.1%和0.9%,与富血供组比,差异显著(分别为70.8%、29.2%、79.2%和20.8%,P<0.05);乏血供组病灶增强时间和病灶达峰时间分别为(17.6±3.8)s和(23.0±4.8)s,显著长于富血供组【分别为(15.2±2.9)s和(19.8±5.9)s,P<0.05],而病灶增强廓清时间为(41.1±23.4)s,显著短于富血供组。结论 肝转移癌以乏血供病灶为主,常见的CEUS动脉期增强模式为短暂均匀强化后快速廓清,找到原发病灶有助于对肝内病灶的定性。