Hypovascular hepatic nodules at gadoxetic acid-enhanced MRI: whole-lesion hepatobiliary phase histogram metrics for prediction of progression to arterial-enhancing hepatocellular carcinoma

Purpose

To explore whole-lesion histogram analysis of the hepatobiliary phase (HBP) defect in indeterminate hypovascular liver lesions for predicting progression to arterial-enhancing hepatocellular carcinoma (HCC).

Methods

Twenty patients undergoing gadoxetic acid-enhanced MRI for HCC screening with 12° and 25° flip angle (FA) HBP acquisitions demonstrating an indeterminate lesion showing HBP hypointensity but no arterial enhancement were included. Volumes-of-interest were placed on HBP defects, from which histogram metrics were obtained. Associations between these metrics and progression to arterial-enhancing HCC on follow-up imaging were investigated. Lesions were also assessed for the presence of a signal abnormality on conventional sequences.

Results

40% of lesions progressed to arterial-enhancing HCC; 60% were stable at ≥6 months follow-up. Neither T2-hyperintensity increased diffusion signal nor portal/equilibrium phase washout was different between progressing and nonprogressing lesions (p = 1.0). Among direct signal intensity-based measures (overall mean; mean of bottom 10th, 10–25th, and 25–50th percentiles), area-under-the-curve (AUC) for prediction of progression to arterial-enhancing HCC was consistently higher at 25° (range 0.619–0.657) than at 12° (range 0.512–0.548). However, at both FAs, the four measures with highest AUC were measures related to lesion texture and heterogeneity [standard deviation (SD), coefficient of variation (CV), skewness, and entropy], having AUC of 0.655–0.750 at 12° and 0.686–0.800 at 25. The metric with highest AUC at 12° was SD (AUC = 0.750) and at 25° was CV (AUC = 0.800).

Conclusion

Whole-lesion histogram HBP measures of indeterminate hypovascular liver lesions may help predict progression to arterial-enhancing HCC by reflecting greater lesion heterogeneity, particularly at higher FA. Larger studies are therefore warranted.

     

普美显肝胆期甜甜圈结节MRI表现及其与结节信号胆汁淤积的关系

目的  分析肝硬化患者普美显肝胆期（HBP）甜甜圈结节的MRI影像表现及HBP结节信号与胆汁淤积关系。方法  回顾性分析2019年1月1日~2021年7月31日在本院行MR普美显检查的551例肝硬化患者的影像和临床资料。对存在HBP甜甜圈结节的60例患者进行分析,分析HBP甜甜圈结节在不同原因肝硬化出现频率,结节在MR平扫、扩散加权成像（DWI）及增强各序列信号特点及随访情况。分析HBP结节信号与胆汁淤积等的关系,60例HBP甜甜圈结节患者中31例肝背景伴发肝癌、部分行手术治疗,为避免该因素对结果干扰故被排除,另外3例因资料不全被排除;最终纳入112例患者,其中HBP甜甜圈结节患者26例,高信号结节患者27例,等信号结节患者59例;分析HBP甜甜圈结节、高信号结节与等信号结节患者组胆汁淤积标志物（总胆红素、直接胆红素、间接胆红素、碱性磷酸酶、谷氨酰转移酶、总胆汁酸）差异。结果  551例肝硬化患者中HBP甜甜圈结节患者占10.9%（60/551）,不同原因肝硬化甜甜圈结节出现频率的差异有统计学意义（P=0.032）。60例患者共计688个甜甜圈结节,单发占18.3%,多发占81.7%,病灶径线5~32 mm;Fs-T2WI序列上77%结节呈等信号,22.5%结节为稍高信号,0.4%结节呈低信号。同反相位T1WI上89.1%结节为等信号,7%呈稍高信号,3.9%呈低信号。DWI序列上4.5%结节DWI呈稍高信号,但无弥散受限;余95.5%结节DWI呈等信号。所有结节动脉期均无强化,48.5%结节自门脉期开始强化,42.8%自延迟期开始强化,8.7%结节多期无强化。25例患者随访无恶性转化。HBP甜甜圈结节、单纯高信号结节及等信号结节组年龄、性别、直接胆红素、间接胆红素、碱性磷酸酶及肝功能分级组间差异无统计学意义（P > 0.05）。总胆红素、谷氨酰转移酶及总胆汁酸组间差异存在统计学意义（P < 0.05）,多重比较显示甜甜圈组与等信号组总胆红素、甜甜圈结节与高信号结节组谷氨酰转移酶差异有统计学意义（P < 0.05）。结论  HBP甜甜圈结节并不少见,具有无动脉期强化、门脉供血且无弥散受限的特征性影像表现,随访结节没有恶变;HBP甜甜圈结节、高信号结节形成与胆汁淤积无关。     

A case of focal nodular hyperplasia with a new characteristic finding on contrast-enhanced ultrasonography using Levovist

We used contrast-enhanced ultrasound with Levovist, a microbubble contrast agent, to diagnose a case of hepatic focal nodular hyperplasia (FNH). A new characteristic finding of heartbeat-synchronized centrifugal enhancement was discovered. We call this enhancement pattern the “sonographic fireworks sign.” It is expected to be useful for diagnosing FNH, especially when the lesions are small and it is difficult to depict a spoke-wheel pattern.     

NOTCH3 as a modulator of vascular disease: a target in elastin deficiency and arterial pathologies

During blood vessel disease, vascular smooth muscle cell (VSMC) expansion and interaction with the matrix trigger changes in gene expression and phenotype. In this issue of the JCI, Dave et al. discover a signaling network that drives VSMC expansion and vascular obstruction caused by elastin insufficiency. Using a combination of gene-targeted mice, tissues and cells from patients with Williams-Beuren syndrome, and targeting of elastin in human VSMCs, the authors identified VSMC-derived NOTCH3 signaling as a critical mediator of aortic hypermuscularization and loss of vascular patency. NOTCH3-specific therapies or therapies that target downstream molecular pathways may provide opportunities to minimize VSMC growth and treat cardiovascular disease with minimal side effects.     

A study on the inconsistency of arterial phase hypervascularity detection between contrast-enhanced ultrasound using sonazoid and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid magnetic resonance imaging of hepatocellular carcinoma lesions

Journal of Medical Ultrasonics - By analyzing possible factors contributing to imaging misevaluation of arterial phase (AP) vascularity, we aimed to provide a more proper way to detect AP...     

Evaluation of transcatheter arterial embolization therapy on hepatocellular carcinomas using contrast-enhanced harmonic power Doppler sonography: comparison with CT,power Doppler sonography,and dynamic MRI

Purpose The aim of this study was to assess and compare the sensitivity of power Doppler sonography, contrast-enhanced sonography, plain computed tomography (CT), and dynamic magnetic resonance imaging (MRI) for detecting hepatocellular carcinoma (HCC) nodules incompletely treated with transcatheter arterial embolization (TAE). Methods A total of 63 unresectable HCC nodules were examined in this study. The HCCs were treated with TAE. All patients underwent plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI 1 week after TAE. The sensitivity of each modality to incompletely treated HCC nodules was compared. Detection of the residual viable HCC on angiography or tumor biopsy was regarded as the gold standard for the diagnosis of incomplete treatment. Results Twenty-four nodules (38%) were diagnosed as incompletely treated. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these incompletely treated nodules were 42% (10/24), 46% (11/24), 88% (21/24), and 79% (19/24), respectively. Eighty percent (19 nodules) of the 24 incompletely treated nodules were located within a depth of less than 8 cm. The sensitivities of plain CT, power Doppler sonography, contrast-enhanced harmonic power Doppler sonography, and dynamic MRI to these superficial incompletely treated nodules were 37% (7/19), 53% (10/19), 100% (19/19), and 74% (14/19), respectively. In contrast, the sensitivities of each modality to deeply located nodules were 60% (3/5), 20% (1/5), 40% (2/5), and 100% (5/5), respectively. Conclusion Plain CT and power Doppler sonography had a low sensitivity to HCC nodules incompletely treated with TAE. Except for those that were deeply located, contrast-enhanced harmonic sonography showed the highest sensitivity in detecting incompletely treated HCC nodules.     

Development and clinical application of an immunoassay using intact Helicobacter pylori attached to a solid phase as an antigen.

OBJECTIVE: At present, H. pylori homogenates, extracts and recombinant proteins are used as antigens in immunoassays, but significant false positive and negative results are obtained. We attempted to develop an ELISA system using immobilized whole intact H. pylori cells as a solid phase antigen (WIC-ELISA) which specifically recognizes surface antigens. METHODS: Intact H. pylori cells were immobilized on ELISA plates by centrifugation (150 g for 10 min). HRP-labeled antihuman IgG was used as the second antibody. H. pylori-infections were investigated with WIC-ELISA and a conventional method in which H. pylori-extracts were used as antigen in 117 patients. RESULTS: WIC-ELISA showed better characteristics than conventional ELISA in regards to sensitivity (98.9 vs. 90.4%), specificity (95.7 vs. 95.7%), positive predictive value (98.9 vs. 98.8%), negative predictive value (95.7 vs. 71.0%) and accuracy (98.3 vs. 91.5%). CONCLUSIONS: WIC-ELISA is useful for quantification of antibodies against H. pylori surface antigens and as a clinical screening test.