Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation

Dioguardi Burgio, Marco; Garzelli, Lorenzo; Cannella, Roberto; Ronot, Maxime; Vilgrain, Valérie

doi:10.3390/life13122267

Life

2023

DOI: 10.3390/life13122267

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Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation

Marco Dioguardi Burgio,

Lorenzo Garzelli,

Roberto Cannella

et al.

Abstract: Liver transplantation (LT) is the recommended curative-intent treatment for patients with early or intermediate-stage hepatocellular carcinoma (HCC) who are ineligible for resection. Imaging plays a central role in staging and for selecting the best LT candidates. This review will discuss recent developments in pre-LT imaging assessment, in particular LT eligibility criteria on imaging, the technical requirements and the diagnostic performance of imaging for the pre-LT diagnosis of HCC including the recent Liv… Show more

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2024

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Cited by 3 publications

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The prediction value of lipiodol retention pattern on post-TACE CT scan for local progression of HCC after complete response

Grace,

Mahmoud,

Abdel-Latif

et al. 2024

Egypt J Radiol Nucl Med

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Background Hepatocellular carcinoma (HCC) is classified as the sixth commonest cancer over the world and the fourth common in Egypt, representing the third leading cause of cancer-related mortality. Trans-arterial chemoembolization (TACE) is considered as one of the most effective treatment option for intermediate stage HCC. Lesions showing complete response (CR) after TACE can be classified according to their lipiodol retention pattern into complete (C-Lip, covering the entire tumor volume) or incomplete (I-Lip). The purpose of this study was to assess the prediction value of post-TACE lipiodol retention pattern on the local disease progression after complete response and thus to decide which patient should be carefully observed and considered to be incompletely treated. Results The study included 45 HCC lesions treated with TACE and showed complete response in the first follow-up CT performed 4–6 weeks after the procedure; 23 cases showed incomplete lipiodol retention pattern and 22 with complete lipiodol retention pattern which was carefully assessed on non-contrast CT images done 4 to 6 weeks after treatment. Follow-up CT was then performed every 3 months for at least 12 months or until local progression occurred. On the follow-up CT studies, 20 out of the 45 lesions showed persistent complete response (i.e., no local progression), while 25 of them showed local progression. Among the 25 cases with disease progression upon correlation with their lipiodol retention pattern, it was found that local progression occurred in 31.8% of tumors showed CR with complete lipiodol retention, as opposed to 78.2% of tumors showed CR with incomplete lipiodol retention with significant statistical difference and p value 0.010. Conclusions Lipiodol retention pattern of HCC after TACE can predict the potential tumor local outcome. Lesions with incomplete lipiodol retention are at a higher risk of local tumor progression and therefore should probably observed and can be retreated; on the other hand, tumors with complete lipiodol retention have a much lower risk of local disease tumor progression.

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The prediction value of lipiodol retention pattern on post-TACE CT scan for local progression of HCC after complete response

Grace,

Mahmoud,

Abdel-Latif

et al. 2024

Egypt J Radiol Nucl Med

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Challenges in Liver Transplantation for Hepatocellular Carcinoma: A Review of Current Controversies

Mauro,

Sanduzzi-Zamparelli,

Jutras

et al. 2024

Cancers

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Liver transplantation (LT) remains one of the most effective treatments for hepatocellular carcinoma (HCC) and significantly enhances patient survival. However, the application of LT for HCC faces challenges owing to advancements in cancer-specific treatment modalities and the increased burden of patients’ comorbidities. This narrative review explores current controversies and advancements in LT for HCC. Key areas of focus include the management of comorbidities and patient education by advanced practice nurses, impacts of frailty on waitlists and post-LT outcomes, selection criteria for LT in the era of new downstaging tools, role of radiology in patient selection, and implications of potential immunotherapy use both before and after LT. Additionally, the importance of immunosuppression management with strategies aimed at minimizing rejection while considering the risk of HCC recurrence and the role of surveillance for HCC recurrence is highlighted. This review also underscores the importance of a multidisciplinary approach for optimizing outcomes in patients with HCC undergoing LT.

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Contrast-Enhanced Intraoperative Ultrasound Shows Excellent Performance in Improving Intraoperative Decision-Making

Kupke,

Dropco,

Götz

et al. 2024

Life

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Background: The aim of this study was to evaluate the performance and the impact of contrast-enhanced intraoperative ultrasound (CE-IOUS) on intraoperative decision-making, as there is still no standardized protocol for its use. Therefore, we retrospectively analyzed multiple CE-IOUS performed in hepato-pancreatic-biliary surgery with respect to pre- and postoperative imaging and histopathological findings. Methods: Data of 50 patients who underwent hepato-pancreatic-biliary surgery between 03/2022 and 03/2024 were retrospectively collected. CE-IOUS was performed with a linear 6–9 MHz multifrequency probe connected to a high-resolution device. The ultrasound contrast agent used was a stabilized aqueous suspension of sulphur hexafluoride microbubbles. Results: In total, all 50 lesions indicated for surgery were correctly identified. In 30 cases, CE-IOUS was used to localize the primary lesion and to define the resection margins. In the remaining 20 cases, CE-IOUS identified an additional lesion. Fifteen of these findings were identified as malignant. In eight of these cases, the additional malignant lesion was subsequently resected. In the remaining seven cases, CE-IOUS again revealed an inoperable situation. In summary, CE-IOUS diagnostics resulted in a high correct classification rate of 95.7%, with positive and negative predictive values of 95.2% and 100.0%, respectively. Conclusions: CE-IOUS shows excellent performance in describing intraoperative findings in hepato-pancreatic-biliary surgery, leading to a substantial impact on intraoperative decision-making.

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Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation

Cited by 3 publications

References 95 publications

The prediction value of lipiodol retention pattern on post-TACE CT scan for local progression of HCC after complete response

The prediction value of lipiodol retention pattern on post-TACE CT scan for local progression of HCC after complete response

Challenges in Liver Transplantation for Hepatocellular Carcinoma: A Review of Current Controversies

Contrast-Enhanced Intraoperative Ultrasound Shows Excellent Performance in Improving Intraoperative Decision-Making

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