Imaging of Dysplastic Nodules and Small Hepatocellular Carcinomas: Experience with Explanted Livers

Krinsky, Glenn A.

doi:10.1159/000078472

Cited by 33 publications

(20 citation statements)

References 34 publications

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“…Small synchronous lesions may have been missed in patients in whom histological confirmation was obtained by biopsy or surgical resection, and the absolute sensitivity of the technique may have been overestimated to some degree [41]. Although whole-explant correlation should be considered as the ideal approach for assessment of cirrhotic nodules, the long delay between the MRI and transplantation make validation of such correlative studies difficult [41]. In order to minimise potential bias in the patients who were surgically treated or in whom correlation was obtained by biopsy, careful followup was ensured to evaluate potential progression in other than the studied cirrhotic lesions.…”

Section: Discussionmentioning

confidence: 99%

Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma

et al. 2009

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The purpose of this study was to evaluate the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating HCC from benign cirrhotic lesions compared with conventional dynamic contrast-enhanced MRI. Fifty-five patients with cirrhosis underwent conventional and DW-MRI at 1.5 Tesla. Signal intensity ratios (SI(ratio)) of solid liver lesions to adjacent hepatic parenchyma were measured for b0, b100, b600 and b1000, and the apparent diffusion coefficients (ADC) were calculated. In 27 patients, imaging results were compared to histopathology, and in 28 patients, to imaging follow-up. Based on predetermined thresholds, sensitivity and specificity of DW-MRI and conventional MRI were compared. SI(ratio) was significantly different between malignant and benign lesions at all b-values (P < 0.0001). No significant difference in ADC was seen (P = 0.47). For detection of malignant lesions, DW-MRI with b600-SI(ratio) yielded a sensitivity of 95.2% compared to 80.6% for conventional MRI (P = 0.023) and a specificity of 82.7% compared to 65.4% (P = 0.064). The improved accuracy was most beneficial for differentiating malignant lesions smaller than 2 cm. DW-MRI with b600-SI(ratio) improved the detection of small HCC and the differentiation of pseudotumoral lesions compared with conventional MRI.

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Section: Discussionmentioning

confidence: 99%

Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma

et al. 2009

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“…The following possible explanations for those difficulties were perfectly detailed by Taouli and Krinsky [16,17] .…”

Section: Difficulties In Analyzing Performances Of Radiologic Modalitmentioning

confidence: 92%

Diagnostic Accuracy of Multi-/Single-Detector Row CT and Contrast-Enhanced MRI in the Detection of Hepatocellular Carcinomas Meeting the Milan Criteria before Liver Transplantation

Kim¹,

Choi²,

Lee³

et al. 2008

Intervirology

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Liver transplantation has been considered to be the only causal treatment for liver cirrhosis patients with hepatocellular carcinoma (HCC) due to its theoretical advantage of eliminating both the tumor and liver disease. However, because of the shortage of donor organs, it is strongly recommended that liver transplantations should be performed on cirrhotic patients with HCCs only when the patients meet the predetermined criteria in terms of number and extent of HCCs. Imaging is thus decisive in the patient inclusion or exclusion from transplantation lists. The imaging techniques used are CT, MRI and ultrasonography. The latter has been proven to be ineffective for HCC surveillance in transplant recipients because of its heavy operator dependence and unreliable detection of small and intermediately sized HCCs. The purpose of this article, then, is to systematically review the diagnostic performances of single-/multidetector row CT, dynamic gadolinium-enhanced MRI, superparamagnetic iron oxide (SPIO)-enhanced MRI and double-contrast MRI using both gadolinium and SPIO for the detection of HCCs with special emphasis on liver transplantation.

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“…[3][4][5] The majority of these lesions are hypovascular upon dynamic CT or angiography. 6 Therefore, the enhancement pattern of these lesions upon dynamic CT is notably different from that of overt HCC. [6][7][8][9][10][11][12] The intensity of early HCC on T 1 -and T 2 -weighted MR images is also different from that of overt HCC.…”

Section: Introductionmentioning

confidence: 98%

Multistep human hepatocarcinogenesis: correlation of imaging with pathology

2009

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Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The majority of HCCs develop in cirrhotic livers, and the early detection and characterization of this entity is very important. Pathologically, human HCC develops in a multistep fashion in the following sequence: from low-grade dysplastic nodule (LGDN), to high-grade dysplastic nodule (HGDN), early HCC, well-differentiated HCC, nodule-in-nodule HCC, and, finally, to moderately differentiated HCC. Differentiation between early HCC and DN is the most important issue in the clinical setting. CT during hepatic angiography (CTHA) and CT during arterial portography (CTAP) are the most sensitive tools in the differentiation of premalignant/borderline lesions (LGDN and HGDN) and early HCC. Recent progress in imaging modality, especially Sonazoidenhanced US and Gd-EOB-DTPA MRI, is starting to play a very important role in the imaging of multistep hepatocarcinogenesis, resulting in changing the therapeutic strategy of these nodular lesions associated with liver cirrhosis.

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Imaging of Dysplastic Nodules and Small Hepatocellular Carcinomas: Experience with Explanted Livers

Cited by 33 publications

References 34 publications

Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma

Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma

Diagnostic Accuracy of Multi-/Single-Detector Row CT and Contrast-Enhanced MRI in the Detection of Hepatocellular Carcinomas Meeting the Milan Criteria before Liver Transplantation

Multistep human hepatocarcinogenesis: correlation of imaging with pathology

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