Surgical Resection of a Malignant Liver Lesion: What the Surgeon Wants the Radiologist to Know

Shin, David S.; Ingraham, Christopher R.; Dighe, Manjiri; Wang, Carolyn; Vaidya, Sandeep; Moshiri, Mariam; Lall, Chandana; Park, James O.; Bhargava, Puneet

doi:10.2214/ajr.13.11701

Cited by 19 publications

(17 citation statements)

References 39 publications

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“…In case of intraductal mass, a hypoattenuation with irregular margins can be observed on pre-contrast imaging, showing increasing contrast enhancement in portal venous- and delayed-phase images [13]. Imaging-based preoperative differentiation of growth pattern of eCC into nodular, sclerosing, and papillary remains challenging and does not seem to be of primary importance concerning the surgical strategy [19]. …”

Section: Computed Tomographymentioning

confidence: 99%

Imaging of Cholangiocarcinoma

Olthof¹,

Othman²,

Clasen³

et al. 2016

Visc Med

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Cholangiocarcinoma (CC) is the second most common primary hepatobiliary tumour, and it is increasing in incidence. Imaging characteristics, behaviour, and therapeutic strategies in CC differ significantly, depending on the morphology and location of the tumour. In cross-sectional imaging, CCs can be classified according to the growth pattern (mass-forming, periductal infiltrating, intraductal) and the location (intrahepatic, perihilar, extrahepatic/distal). The prognosis of CC is unfavourable and surgical resection is the only curative treatment option; thus, early diagnosis (also in recurrent disease) and accurate staging including the evaluation of lymph node involvement and vascular infiltration is crucial. However, the diagnostic evaluation of CC is challenging due to the heterogeneous nature of the tumour. Diagnostic modalities used in the imaging of CC include transabdominal ultrasound, endosonography, computed tomography, magnetic resonance imaging with cholangiopancreatography, and hybrid imaging such as positron emission tomography/computed tomography. In this review, the potential of cross-sectional imaging modalities in primary staging, treatment monitoring, and detection of recurrent disease will be discussed.

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Section: Computed Tomographymentioning

confidence: 99%

Imaging of Cholangiocarcinoma

Olthof¹,

Othman²,

Clasen³

et al. 2016

Visc Med

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“…Because hepatic metastases are a common cause of mortality, there is a significant survival benefit from surgical metastasectomy, particularly for colon cancer metastases [3, 4]. However, many hepatic metastases (and primary tumors) are either too large or too numerous to be removed surgically [5]. In addition, many patients have multiple medical comorbidities that render surgical resection contraindicated [6].…”

mentioning

confidence: 99%

Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes

Glazer

Tatlı

Shyn

et al. 2017

American Journal of Roentgenology

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OBJECTIVE The purpose of this article is to report our intermediate to long-term outcomes with image-guided percutaneous hepatic tumor cryoablation and to evaluate its technical success, technique efficacy, local tumor progression, and adverse event rate. MATERIALS AND METHODS Between 1998 and 2014, 299 hepatic tumors (243 metastases and 56 primary tumors; mean diameter, 2.5 cm; median diameter, 2.2 cm; range, 0.3–7.8 cm) in 186 patients (95 women; mean age, 60.9 years; range, 29–88 years) underwent cryoablation during 236 procedures using CT (n = 126), MRI (n = 100), or PET/CT (n = 10) guidance. Technical success, technique efficacy at 3 months, local tumor progression (mean follow-up, 2.5 years; range, 2 months to 14.6 years), and adverse event rates were calculated. RESULTS The technical success rate was 94.6% (279/295). The technique efficacy rate was 89.5% (231/258) and was greater for tumors smaller than 4 cm (93.4%; 213/228) than for larger tumors (60.0%; 18/30) (p < 0.0001). Local tumor progression occurred in 23.3% (60/258) of tumors and was significantly more common after the treatment of tumors 4 cm or larger (63.3%; 19/30) compared with smaller tumors (18.0%; 41/228) (p < 0.0001). Adverse events followed 33.8% (80/236) of procedures and were grade 3–5 in 10.6% (25/236) of cases. Grade 3 or greater adverse events more commonly followed the treatment of larger tumors (19.5%; 8/41) compared with smaller tumors (8.7%; 17/195) (p = 0.04). CONCLUSION Image-guided percutaneous cryoablation of hepatic tumors is efficacious; however, tumors smaller than 4 cm are more likely to be treated successfully and without an adverse event.

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“…Both modalities can provide accurate and reproducible measurements with the various post-processing software packages available today (Fig. 8) [40]. While the FLR is a reliable predictor of postsurgical hepatic dysfunction, an absolute FLR volume is not exact in isolation given that larger patients require a larger amount of parenchyma compared to smaller patients.…”

Section: Critical Imaging Findings To Reportmentioning

confidence: 99%

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know

et al. 2015

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Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.

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Surgical Resection of a Malignant Liver Lesion: What the Surgeon Wants the Radiologist to Know

Abstract: Diagnostic and interventional radiology plays an important role in the assessment and treatment of malignant hepatic lesions. Radiologists should be familiar with how surgeons select, work up, and treat candidates for liver resection to provide the most clinically valuable service.

Cited by 19 publications

References 39 publications

Imaging of Cholangiocarcinoma

Imaging of Cholangiocarcinoma

Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know

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