Liver metastases from unknown primary site: demonstration on MR images

Braga, Larissa; Semelka, Richard C.; Danet, Ioana Maria; Venkataraman, Shambhavi; Woosley, John T.

doi:10.1016/s0730-725x(03)00187-5

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…Peripheral hyperintensity on DWI configuring the “target sign” is likely correlated with the hypervascular peripheral rim in the arterial phase, as both findings correspond to the greater density of viable and vascularized tumor cells in the periphery of the tumor. On the contrary, the most common pattern in SHLM group was rim enhancement in arterial phase with no or minimal central enhancement on delayed images, consistent with previous reports (4). As metastatic tumors develop from cells which do not originate from the liver, they parasitize the surrounding blood vessels, creating the rim appearance of blood supplying the most vascularized outer parts of the tumor (31).…”

Section: Discussionsupporting

confidence: 91%

“…However, a small subset of patients presents with a metastatic disease for which a primary site is undetectable. The inability to detect the primary tumor could be explained by favorable metastatic ability over local tumor growth or spontaneous tumor regression (4,5). Nevertheless, in 30% of these patients the primary site is eventually detected (6).…”

Section: Introductionmentioning

confidence: 99%

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Intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases: is the differential diagnosis using diffusion-weighted MRI possible?

et al. 2017

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Background Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features. Purpose To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases. Material and Methods Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion ( b = 800 s/mm). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs. Results Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs. Conclusion Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases: is the differential diagnosis using diffusion-weighted MRI possible?

et al. 2017

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“…Furthermore, the clinical treatment and practical efficacy of different primary malignancies vary considerably 15–17 . A number of reports point out that there are quite a few hepatic metastatic lesions appearing first; however, clinicians are often unable to determine their primary origin, which makes diagnosis and treatment extremely challenging 1,18–20 . Thus, the identification of the primary tumor is instrumental in therapeutic decision making, and appropriate treatment options for metastatic lesions might lead to a promising result.…”

mentioning

confidence: 99%

Ultrasound Image–Based Radiomics

Qin

Lin

et al. 2020

J of Ultrasound Medicine

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Objectives To develop radiomic models of B‐mode ultrasound (US) signatures for determining the origin of primary tumors in metastatic liver disease. Methods A total of 254 patients with a diagnosis of metastatic liver disease were included in this retrospective study. The patients were divided into 3 groups depending on the origin of the primary tumor: group 1 (digestive tract versus non–digestive tract tumors), group 2 (breast cancer versus non–breast cancer), and group 3 (lung cancer versus other malignancies). The patients in each group were allocated to a training or testing set (a ratio of 8:2). The region of interest of liver metastasis was determined through manual differentiation of the tumors, and radiomic signatures were acquired from B‐mode US images. Optimal features were selected to develop 3 radiomic models using multiple‐dimensionality reduction and classifier screening. The area under the curve (AUC) of the receiver operating characteristic curve was applied to assess each model's performance. Results A total of 5936 features were extracted, and 40, 6, and 14 optimal features were sequentially identified for the development of radiomic models for groups 1, 2, and 3, respectively, with training set AUC values of 0.938, 0.974, and 0.768 and testing set AUC values of 0.767, 0.768, and 0.750. The differences in age, sex, and number of liver metastatic lesions varied greatly between the 4 primary tumors (P < .050). Conclusions B‐mode US radiomic models could be effective supplemental means to identify the origin of hepatic metastatic lesions (ie, unknown primary sites).

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