Magnetic Resonance Imaging of Nonhepatocellular Malignancies in Chronic Liver Disease

Cannella, Roberto; Cunha, Guilherme Moura; Catania, Roberta; Chupetlovska, Kalina; Borhani, Amir A.; Fowler, Kathryn J.; Furlan, Alessandro

doi:10.1016/j.mric.2021.05.009

Cited by 4 publications

(6 citation statements)

References 54 publications

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“…It classically manifests as a large lesion with irregular lobulated margins, rim APHE, progressive centripetal enhancement, and peripheral washout on PVP and DP [ 29 , 30 ]. This enhancement pattern reflects the histology of the tumor, with viable tumor cells usually located at the periphery, with a central portion composed of a desmoplastic and hypovascularized tumor stroma with fibrosis and coagulative necrosis [ 31 – 33 ]. Other common imaging findings include capsular retraction, dilatation and thickening of the intrahepatic bile ducts around the tumor, vascular encasement by the tumor (but intravascular tumor invasion is rare), satellite nodules, intrahepatic metastases, and obliteration of the portal vein [ 33 , 34 ].…”

Section: Malignantmentioning

confidence: 99%

“…Other common imaging findings include capsular retraction, dilatation and thickening of the intrahepatic bile ducts around the tumor, vascular encasement by the tumor (but intravascular tumor invasion is rare), satellite nodules, intrahepatic metastases, and obliteration of the portal vein [ 33 , 34 ]. On MRI, iCCA shows low-to-moderate SI on T2-WI and low SI on T1-WI [ 31 – 33 ]. iCCA may show the “necrosis imaging sign” as a persistent, nonenhancing defect with either high SI or low SI on the T2-WI.…”

Section: Malignantmentioning

confidence: 99%

“…iCCA may show the “necrosis imaging sign” as a persistent, nonenhancing defect with either high SI or low SI on the T2-WI. DWI demonstrates a target appearance on high b -value images (a central darker area due to fibrosis with peripheral hyperintense area) associated with peripheral hypointensity and central hyperintensity on the ADC map [ 31 – 34 ]. This “targetoid appearance” is also seen on the HBP of Gd-EOB-MRI, which indicates peripheral rim hypointensity and central cloud-like hyperintensity due to retained contrast material in the fibrotic stroma (“EOB-cloud enhancement”) (Fig.…”

Section: Malignantmentioning

confidence: 99%

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Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI

Matteini,

Cannella,

Garzelli

et al. 2024

Insights Imaging

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Rim arterial phase hyperenhancement is an imaging feature commonly encountered on contrast-enhanced CT and MRI in focal liver lesions. Rim arterial phase hyperenhancement is a subtype of arterial phase hyperenhancement mainly present at the periphery of lesions on the arterial phase. It is caused by a relative arterialization of the periphery compared with the center of the lesion and needs to be differentiated from other patterns of peripheral enhancement, including the peripheral discontinuous nodular enhancement and the corona enhancement. Rim arterial phase hyperenhancement may be a typical or an atypical imaging presentation of many benign and malignant focal liver lesions, challenging the radiologists during imaging interpretation. Benign focal liver lesions that may show rim arterial phase hyperenhancement may have a vascular, infectious, or inflammatory origin. Malignant focal liver lesions displaying rim arterial phase hyperenhancement may have a vascular, hepatocellular, biliary, lymphoid, or secondary origin. The differences in imaging characteristics on contrast-enhanced CT may be subtle, and a multiparametric approach on MRI may be helpful to narrow the list of differentials. This article aims to review the broad spectrum of focal liver lesions that may show rim arterial phase hyperenhancement, using an approach based on the benign and malignant nature of lesions and their histologic origin. Critical relevance statement Rim arterial phase hyperenhancement may be an imaging feature encountered in benign and malignant focal liver lesions and the diagnostic algorithm approach provided in this educational review may guide toward the final diagnosis. Key Points Several focal liver lesions may demonstrate rim arterial phase hyperenhancement. Rim arterial phase hyperenhancement may occur in vascular, inflammatory, and neoplastic lesions. Rim arterial phase hyperenhancement may challenge radiologists during image interpretation. Graphical Abstract

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Section: Malignantmentioning

confidence: 99%

Section: Malignantmentioning

confidence: 99%

Section: Malignantmentioning

confidence: 99%

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Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI

Matteini,

Cannella,

Garzelli

et al. 2024

Insights Imaging

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“…Metastases with peripheral arterial phase hyperenhancement are characterized by a targetoid appearance on post-contrast phases, showing rim hyperenhancement on arterial phase with washout on portal-venous or delayed phases, reflecting the increased cellularity at the lesion’s periphery, in comparison with the central hypo-perfused area[ 37 , 45 ].…”

Section: Conventional Mri Features Of Liver Metastasesmentioning

confidence: 99%

Liver metastases: The role of magnetic resonance imaging

Maino,

Vernuccio,

Cannella

et al. 2023

World J Gastroenterol

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The liver is one of the organs most commonly involved in metastatic disease, especially due to its unique vascularization. It’s well known that liver metastases represent the most common hepatic malignant tumors. From a practical point of view, it’s of utmost importance to evaluate the presence of liver metastases when staging oncologic patients, to select the best treatment possible, and finally to predict the overall prognosis. In the past few years, imaging techniques have gained a central role in identifying liver metastases, thanks to ultrasonography, contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). All these techniques, especially CT and MRI, can be considered the non-invasive reference standard techniques for the assessment of liver involvement by metastases. On the other hand, the liver can be affected by different focal lesions, sometimes benign, and sometimes malignant. On these bases, radiologists should face the differential diagnosis between benign and secondary lesions to correctly allocate patients to the best management. Considering the above-mentioned principles, it’s extremely important to underline and refresh the broad spectrum of liver metastases features that can occur in everyday clinical practice. This review aims to summarize the most common imaging features of liver metastases, with a special focus on typical and atypical appearance, by using MRI.

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“…Existing studies all report that KLCA-NCC and APASL guidelines are more sensitive for the diagnosis of HCC in patients examined with gadoxetate disodium MRI, while EASL and LI-RADS guidelines are more specific. Differences among guidelines are probably due to the inclusion of HBP hypointensity as a major feature for the diagnosis of HCC in KLCA-NCC and APASL criteria, resulting in false positive diagnoses of HCC in patients with dysplastic nodules, small intrahepatic cholangiocarcinoma, or combined hepatocellular-cholangiocarcinoma, which may have nonrim APHE and HBP hypointensity [33]. Although LI-RADS observations categorized as LR-3 (intermediate probability of malignancy) or LR-4 (probably HCC) are not considered to be HCC lesions for the assessment of LT eligibility, they have a 31-38% and 64-74% probability of being HCC, respectively [34,35].…”

Section: The Performance Of Ct and Mri For The Diagnosis Of Hcc Befor...mentioning

confidence: 99%

Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation

Dioguardi Burgio,

Garzelli,

Cannella

et al. 2023

Life

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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 Liver Imaging Reporting and Data System (LI-RADS) criteria, the evaluation of the response to locoregional therapy, as well as the non-invasive prediction of HCC aggressiveness and its impact on the outcome of LT. We will also briefly discuss the role of nuclear medicine in the pre-LT evaluation and the emerging role of artificial intelligence models in patients with HCC.

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Magnetic Resonance Imaging of Nonhepatocellular Malignancies in Chronic Liver Disease

Cited by 4 publications

References 54 publications

Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI

Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI

Liver metastases: The role of magnetic resonance imaging

Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation

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