Aged, 80 and over Carcinoma, Hepatocellular / diagnostic imaging* It is strongly associated with cirrhosis, from both alcohol and viral etiologies. surrounding liver 17, decreased intensity in the surrounding liver, enhancement is usually arterial ("hypervascularity"), rapid "washout", becoming hypointense to the remainder of the liver (96% specific) 3, this is because the supply to hepatocellular carcinoma is predominantly from the hepatic artery rather than the portal vein, an imaging classification system (LI-RADS) has been developed to stratify lesions, similar to assessment with extracellular gadolinium, but evaluation of the hepatobiliary phase requires care, arterial hyperenhancement with washout assessed on the portal venous phase, washout on transitional phase (3 minutes delayed) is less reliable (see: Eovist and LI-RADS), T2: variable,typically moderately hyperintense, C+ post-SPIO (iron oxide): increases sensitivity in diagnosing small hepatocellular carcinomas, DWI: intratumoral high signal;increases sensitivity and specificity, threads and streaks pattern: sign of tumor thrombus in the portal vein. Correspondence to For the other histogram parameters, there were no statistically significant differences between the two groups. Infiltrative hepatocellular carcinoma: comparison of MRI sequences for lesion conspicuity. Triphasic CT, alpha fetoprotein and biopsy were the essential methods for diagnosis. Zhao, F., Pang, G., Li, X. et al. 23. Transplantation 99(6), 123642. Liver Transpl. The triple-phase liver CT protocol is a useful examination in the assessment of focal liver lesions, hypervascular liver metastases and endocrine tumors. AJR Am. The mean interval between the CT imaging and surgery or biopsy was 5.5days (range 119days) for patients with IMCCs, and 7days (range 143days) for patients with HCCs. https://doi.org/10.1053/j.gastro.2009.06.003 (2009). Gut 59(5), 638644 (2010). Characterization of hepatocellular carcinomas with triphasic CT and Among all included patients, 33 cases were MVI negative and 48 cases were MVI positive. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. Development, growth, and spread: Key pathologic and imaging aspects. A flow diagram of inclusion and exclusion criteria is shown in Fig. Extrahepatic metastases of hepatocellular carcinoma. 23(4), 779787. Approximately 1020% of HCCs may exhibit hypoenhancement in the arterial phase owing to the insufficient development of tumor neovascularity and the retention of dual blood supply17; thus, mimicking IMCC10. Sci Rep 13, 8629 (2023). 82, e101e106 (2013). Available from: http://www.ncbi.nlm.nih.gov/books/NBK1515/. In the past, many scholars have done a lot of research on preoperative prediction of MVI and achieved good results, especially in terms of clinicoradiological features and radiomics. The perfusion parameters for IMCCs and HCCs are shown in Table 2. Thank you for visiting nature.com. Provided by the Springer Nature SharedIt content-sharing initiative. Differentiation Between Hepatocellular Carcinoma and Dysplastic Nodules. Purpose To develop and evaluate a triple arterial phase CT liver protocol with a similar radiation dose to that of standard single arterial phase CT in study subjects suspected of having hepatocellular carcinoma (HCC). Heterogeneity analysis of triphasic CT scan perfusion : Medicine Imaging. Variable appearance depending on the individual lesion, size, and echogenicity of background liver. Waiver for informed consent was approved by the Ethics Committee of The Second Hospital of Shandong University. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Therefore, the MannWhitney U test was performed for data analysis. In the future, we will continue our investigations to improve its diagnostic abilities. The red lines in Figures (B) and (C) depict the abdominal aorta and portal vein, respectively. Estimating the world cancer burden: Globocan 2000. The optimal parameters for differentiation were also determined. Materials and Methods Imaging. The difference between Zhaos findings and our research results may be due to the fact that their perfusion evaluation of the lesion was jointly affected by hepatic artery, portal vein and hepatic vein, while we calculated each perfusion separately. You are using a browser version with limited support for CSS. Bains S, Behr S, Corvera C et al (2012) SUVmax values in FDG-PET/CT scans of patients with HCC: a possible new prognostic factor. (B) and (D) are corresponding perfusion images (AEF). AEF, which reflects the HAP, could also be used to predict MVI26. Methods: The study was conducted in Department of Radiology of Aga Khan University Hospital and Sind Institute of Urology and Transplantation, Karachi from Feb 2006 to Feb 2007. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 55, 858865 (2011). Am. MATERIALS AND METHODS. Reference article, Radiopaedia.org (Accessed on 05 Jul 2023) https://doi.org/10.53347/rID-94730, see full revision history and disclosures, iodinated contrast-induced thyrotoxicosis, saline flush during contrast administration, CT NCAP (neck, chest, abdomen and pelvis), CT angiography of the cerebral arteries (protocol), CT angiography of the circle of Willis (protocol), cardiac CT (prospective high-pitch acquisition), CT transcatheter aortic valve implantation planning (protocol), CT colonography reporting and data system, CT kidneys, ureters and bladder (protocol), CT angiography of the splanchnic vessels (protocol), level of the diaphragmatic hiatus or first lumbar vertebra at the aorta, 15-30 seconds post bolus trigger (35-45 s after injection), 60-75 seconds post-injection (independent of arterial timing), an understanding of how each phase should appear is important, portal vein enhanced, no hepatic vein enhancement, hepatocellular carcinoma may only show enhancement in the late arterial phase so this is very important, portal veins, hepatic veins (via antegrade flow)enhanced, portal and hepatic veins slightly enhanced by a lot less than on the portal venous phase, slice thickness less than or equal to 5 mm, if the patient has received an injection of drug-eluting beads such as. 21. (A) and (C) are portal phase images of MVI negative and positive patients. The 75th percentile of HAP had the highest sensitivity of 88.9%, while the 25th and 50th percentile of HAP had the highest specificity of 73.5%. HPB (Oxford). Tomogr. Risk factors for cholangiocarcinoma. The remarkable ability of the liver to regenerate means that up to two-thirds of the liver can be resected 19. Parente DB, Perez RM, Eiras-Araujo A et-al. Sniderman King L, Trahms C, Scott CR. With an improved sample size, further analyses of the relationship between perfusion parameters and MVI grades will be guaranteed in future studies. J. Radiol. Summary of clinical characteristics is shown in Table 1. Google Scholar. 20, 32539. Wen, T. et al. Radiographics. Assist. PubMedGoogle Scholar. 49, 975983 (2019). Hepatic perfusion parameters in chronic liver disease: Dynamic CT measurements correlated with disease severity. All of the methods were performed in accordance with the 1975 declaration of Helsinki and corresponding guidelines. Terminology For some departments and/or radiologists, a triple-phase may instead be used to refer to an initial non-contrast phase followed by a late arterial and portal venous phases. https://doi.org/10.1038/s41598-021-02667-4, DOI: https://doi.org/10.1038/s41598-021-02667-4. The KolmogorovSmirnov test was first used for normally-distributed perfusion parameters and histogram parameters. Article Hyperattenuation in PVP images was found to be associated with well-differentiated HCCs and portal vein inva-sion was more frequent in tumors larger than 10cm. We consider that the IMCC is peripherally rich in tumor cells with abundant fibrotic stroma and necrosis in the center, which may account for the enhancement patterns and relative hypo-vascularity28. Hepatocellular carcinoma receives most of its blood supply from branches of the hepatic artery, accounting for its characteristic enhancement pattern: early arterial enhancement with early "washout." Robbins & Cotran Pathologic Basis of Disease. The aim of the current study was to explore the value of tumor attenuation and quantitative analysis of perfusion parameters obtained from traditional tri-phasic CT scans in grading hepatocellular carcinoma (HCC).Totally 39 patients (42 lesion samples) with pathologically confirmed HCC who underwent tri-phasic CT scans were enrolled. The mean value of the AEF, and the 75th percentiles of AEF and rAEF showed the highest sensitivity of 94.4%. Imaging is important for establishing a diagnosis of HCC. 2005;7 (1): 35-41. https://doi.org/10.1038/s41572-020-00240-3, https://doi.org/10.3760/cma.j.issn.1007-3418.2017.12.002, https://doi.org/10.1016/j.ejso.2016.05.032, https://doi.org/10.1245/s10434-012-2513-1, https://doi.org/10.1053/j.gastro.2009.06.003, https://doi.org/10.1097/TP.0000000000000489, https://doi.org/10.1097/SLA.0000000000003268, https://doi.org/10.1016/j.jhep.2017.04.024, https://doi.org/10.1007/s11605-019-04134-y, https://doi.org/10.1007/s00330-018-5935-8, https://doi.org/10.1016/j.jhep.2019.02.023, https://doi.org/10.1186/s40644-019-0207-7, https://doi.org/10.1016/0140-6736(91)92455-b, https://doi.org/10.1097/00004728-199505000-00016, https://doi.org/10.1016/j.jamcollsurg.2007.03.002, https://doi.org/10.1007/s10278-014-9725-9, https://doi.org/10.1097/CM9.0000000000001446, https://doi.org/10.1097/RCT.0b013e318256b1e2, https://doi.org/10.1007/s00330-011-2307-z, https://doi.org/10.1371/journal.pone.0197488, https://doi.org/10.2214/ajr.176.3.1760667, https://doi.org/10.1148/radiology.188.2.8327686, https://doi.org/10.1007/s00432-016-2286-1, http://creativecommons.org/licenses/by/4.0/. Willatt JM, Hussain HK, Adusumilli S et-al. Ippolito, D., Capraro, C., Casiraghi, A., Cestari, C. & Sironi, S. Quantitative assessment of tumour associated neovascularisation in patients with liver cirrhosis and hepatocellular carcinoma: Role of dynamic-CT perfusion imaging. PVP images showed hyperperfusion from the peripheral to the central part of the tumor. J. Surg. Rev. The patient is hooked up to an IV, but the first scan is usually done before IV contrast injection. In the HCC group, 44 patients (44/54; 81.5%) had HBV or HCV infection and 10 patients (10/54; 18.5%) had alcoholic liver cirrhosis. All athours reviewed the manuscript. PubMedGoogle Scholar. Provided by the Springer Nature SharedIt content-sharing initiative. Lancet 379, 12451255 (2012). Zou et al.36 reported that analyses of the volumetric ADC histogram provided additional value to dynamic enhanced MRIs in differentiating IMCCs from HCCs. 8 (5): 449-59. Get what matters in cancer research, free to your inbox weekly. ISSN 2045-2322 (online). Hepatology 42, 12081236 (2005). Flow chart of inclusion and exclusion criteria for the subject enrollment in the study. However, the 5-year tumor recurrence and metastasis rate after liver resection is as high as 40 to 70%, which seriously affect patients prognosis3,4. 1. Primers 7(1), 6. https://doi.org/10.1038/s41572-020-00240-3 (2021). The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Lee et al.27 illuminated that perfusion parameters arise from traditional triphasic CT scans using the dual maximum slope model and there were no significant differences compared with routine PCT in liver and HCCs. J. Hepatol. Lippincott Williams & Wilkins. L.Z. Progressive abdominal enlargement of patient known to have HCV. Diagn. Asayama et al.37 also performed histogram analyses of ADC values to differentiate IMCCs from poorly differentiated HCCs. In order to compensate for the decrease in PVP, arterial liver perfusion will increase, which eventually leads to an increase in HPI33,34. performed statistical expertise. All of the parameters mentioned above were significantly higher for HCCs than for IMCCs, which may indicate a relatively high hypervascularity in HCCs compared to IMCCs, and may also be indicative of the different pathological components of the tumor. There are innumerable small size nodules, most of them enhance avidly in arterial phase with rapid washout in portovenous and delayed phases. Detailed patients information can be found in Table 1. Purpose Radical treatments of HCC include liver resection, liver transplantation and ablation, as the first-choice treatments for patients with early-stage HCC2. 22(4), 80311. Second, the patient sample size was adequate but relatively small, and of single center origin. Lippincott Williams & Wilkins. Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update. Measurements were performed by two independent radiologists (F.Z and H.Z with 6 and 15years of experience in abdominal imaging, respectively). ; Literature research: G.P., S.Y. Bridgewater, J. et al. Article J. Hepatol. Tomogr. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. J. MagnReson. Cancer Imaging 19(1), 21. https://doi.org/10.1186/s40644-019-0207-7 (2019). The need to obtain informed consent from patients for our study was waived by the Ethics Committee of the Second Hospital of Shandong University. Update review of the acute porphyrias. The presence of cancer cell nests in blood vessels, whether in arteries, hepatic veins, or portal veins, theoretically leads to changes in blood flow perfusion within the lesion. Bialecki ES, Di Bisceglie AM. https://doi.org/10.1002/lt.22368 (2011). This result may be attributed to the small sample size. 2006 Jul 24 [Updated 2014 Jul 17]. Mayr, N. A. et al. The data of the perfusion parameters and histogram parameters were non-normally distributed. Shindoh, J. et al. Hepatology 54, 173184 (2011). Cuenod CA, de Bazelaire C, et al. 2006;186(6):1571-9. 6. Internet Explorer). Histological differentiation grade and microvascular invasion of hepatocellular carcinoma predicted by dynamic contrast-enhanced MRI. Xu, X. et al. Thank you for visiting nature.com. Totally 39 patients (42 lesion samples) with pathologically confirmed HCC who underwent tri-phasic CT scans were enrolled. The inclusion criteria were as follows: patients that (a) underwent traditional triphasic CT scans with adequate image quality and without artefacts; (b) had no history of prior treatment of hepatic tumor; and (c) had histologically confirmed IMCCs or HCCs according to the 2010 World Health Organization classification20 within 6months of the CT scans. CT triple-phase liver (protocol) | Radiology Reference Article Hepatic arterioportal shunts: dynamic CT and MR features. Imaging. 2008;190 (4): 1018-27. The value of AEF in MVI negative patient was significantly higher than in MVI positive patient. Scientific Reports (Sci Rep) Radiol. In the IMCC group, five patients (5/36; 14%) had HBV or HCV infection and four patients (4/36; 11%) had alcoholic liver cirrhosis. Ros, P. R. et al. J. J. Hepatol. Radiomics, a relatively new discipline, has also been used by some scholars to predict MVI for HCC18,19,20. Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans. Thus, the purpose of this study was to explore whether different perfusion parameters and corresponding histogram parameters could provide additional value to triphasic CT scans in differentiating IMCCs from HCCs. Effect of dual vascular input functions on CT perfusion parameter values and reproducibility in liver tumors and normal liver. 138 (1): 52-64. Iodinated contrast agent (Omnipaque 370mg iodine/mL, GE) followed by a 30mL saline chaser was injected into an antecubital vein at a rate of 3.54.0mL/s with power injector 1.5mL/kg. MATERIALS AND METHODS. The 10th, 25th, 50th, and 75th percentiles of HAP were significantly higher in HCCs than in IMCCs (P<0.05). 1. Finally, 36 patients diagnosed with IMCCs (mean age, 58.9years; male:female=20:16) and 54 patients diagnosed with HCCs (mean age, 57.3years; male:female=36:18) were included. The accuracy of these techniques depends on the size of the tumors, complications of cirrhosis, and the experience of the radiologist13,14. Evaluation of the American Joint Committee on Cancer (AJCC) 8th edition staging system for hepatocellular carcinoma in 1008 patients with curative resection. Accurate differentiation between HCC and IMCC is challenging, but vital because their prognoses and treatments differ substantially. PubMed Central Radiol. Unable to process the form. 12 of the MVI negative patients had alpha fetoprotein (AFP) levels higher than 20 ng/mL, while 28 of the MVI positive patients had AFP levels higher than 20 ng/mL. 1. Fibrolamellar hepatocellular carcinomais a distinct variant of hepatocellular carcinoma not associated with cirrhosis and has different demographics and risk factors. The value of rPVP(Min) and rAEF(Min) in MVI negative group were significantly higher than those in positive group, while for rHPI (Max) and rAEF(Max), the value of MVI positive group was significantly higher than that of negative group (Table 4). Guarantor of integrity of the entire study: F.Z., G.P. Differentiating liver lesions on non-contrast studies is difficult due to the homogeneity of the liver tissue on CT however this exam helps solve that problem. Value of perfusion parameters and histogram analysis of trip - LWW 27. Dis. To obtain It has been proved that tumor blood perfusion parameters can be calculated by linear combination of enhancement curves of aorta and portal vein25. 14. The differential performances, including the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity were assessed. Hepatocellular carcinoma. were responsible for data collection and analysis. 143(2), 293303. The perfusion parameters of hepatic arterial supply perfusion (HAP), portal vein blood supply perfusion (PVP), and arterial enhancement fraction (AEF) were measured using CT hemodynamic kinetics software on the basis of the model-free maximum method. Get what matters in cancer research, free to your inbox weekly. ; Manuscript preparation: G.P. Tumor size ranged from 2 to 11 cm with median 5.5cm (Table 3). ; Experimental studies/data analysis: G.P. ; Data acquisition: F.Z., G.P., S.Y. Role of PET CT in comparison to triphasic CT in early follow-up of J. MagnReson. To our knowledge, no previous study has illustrated the perfusion parameters or histogram parameters originated from triphasic CT enhancement scans to distinguish HCC from IMCC. North Am. Hepatocellular carcinoma is typically diagnosed in late middle-aged or elderly adults (average 65 years) and is more common in males (75% of cases)7. Radiographics. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. PubMed Fifth, to make the results more rigorous and convicing, there needs some subgroup analysis. Scan delay for the arterial phase, portal venous phase and delayed phase was 3035s, 6070s, 180s. The Digital Imaging and Communications in Medicine (DICOM) files of dynamic enhanced CT data were processed with CT hemodynamic kinetics software (CT Kinetics, GE Healthcare). The LI-RADSimaging classification system is also used to stratify lesions in an at-risk liver. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. We do acknowledge that our research has limitations. Lastly, we did not classify HCCs by histological grades which would affect the accuracy of the results, and we did not compare the performance between our study and other radiological and/or clinical diagnostic algorithms. Otherwise, presentation may include: portal hypertension from the invasion of the portal vein. If a tumor is resectable, then 5-year survival is ~45% (range 37-56%) 23. Among all parameters, the mean value of AEF, the 75th percentiles of AEF and rAEF, and the 25th percentile of HFtumor exhibited the highest sensitivities of 94.4%, while the 50th percentile of rAEF had the highest specificity of 82.4%. https://doi.org/10.3760/cma.j.issn.1007-3418.2017.12.002. 273(3), 564571. The blood perfusion parameters were derived from triple-phase CT scans. 49(4), 975983 (2019). Thus, a history of chronic hepatitis B or C infection promoted the development of HCC. Approach Considerations The diagnosis of hepatocellular carcinoma (HCC) can often be. This study is to investigate quantitative measures and heterogeneity of perfusion parameters in the differential diagnosis of hepatocellular carcinoma (HCC) and hemangioma.In total, 32 HCC and 44 hemangioma (types 1, 2, and 3) cases were included in this retrospective study. Med. Miles, K. A., Hayball, M. P. & Dixon, A. K. Functional images of hepatic perfusion obtained with dynamic CT. Radiology 188(2), 40511. Our study showed that the maximum values ofHPI and rHPI of HCC with MVI were significantly higher than those without MVI, which is consistent with previous research results by other groups. For patients with non-solitary lesions, the largest lesion was selected as the target lesion.The ROIs included the lesion and its size-matched normal liver parenchyma, the abdominal aorta (at the level of the celiac artery), and the portal vein (near the bifurcation). Regarding the sensitivity and specificity of the statistically significant variables in differentiating between HCCs and IMCCs, the mean AEF value, and the 75th percentiles of the AEF and the rAEF exhibited the highest sensitivity of 94.4%. Tyson, G. L. & El-Serag, H. B. Ann. CT computed tomography, HCC hepatocellular carcinoma, MVI microvascular invasion. First, our study was a retrospective study, and some potential selection bias cannot be ruled out when selecting cases. Abdullah, S. S. et al. To help characterize the vascularity of hypervascular liver lesions. Become a Gold Supporter and see no third-party ads. Palmer, W. C. & Patel, T. Are common factors involved in the pathogenesis of primary liver cancers? For example, hepatitis virus-negative and cirrhosis-negative, hepatitis virus-negative and cirrhosis-positive, and so on. Transverse computed tomography (CT) images of a dog with hepatocellular carcinoma. Radiol. All Statistical analyses were performed using SPSS version 19.0 (SPSS statistics; IBM). The area delineated by the yellow line in Figure (A) is the lesion, while the red line represents the surrounding normal liver parenchyma. Lim, J. H. Cholangiocarcinoma: Morphologic classification according to growth pattern and imaging findings. 33, 771779 (2013). 3 and 4, and Table 4, of the mean value of AEF and all corresponding percentiles of the histogram analysis, the 10th percentile of the AEF had the highest value of 0.769. 2014;69 (1): 1-10. Bruix, J. Quantitative analysis of CT images derived from triphasic CT scans were evaluated to generate liver perfusion and histogram parameters. Roayaie, S. et al. Nevertheless, the reproducibility of radiomics is poor, though it is more objective. alpha-fetoprotein (AFP)levels are elevated in 50-75% of cases 2. https://doi.org/10.1016/0140-6736(91)92455-b (1991). What is the triphasic CT scan technique? - Quora However, hepatitis B and C virus infections were also risk factors for IMCC25,26, but our study showed no significant association between infection and IMCC. ROI setting was shown. Feng, L. H. et al. 14 with median 5.4 (Table 2). https://doi.org/10.3748/wjg.v22.i42.9279 (2016). A two-tailed P<0.05 indicated statistical significance. Robbins and Cotran pathologic basis of disease. Radiol. 67(3), 526534. 2005;7 (1): 26-34. Tyrosinemia Type I. Pixel analysis of MR perfusion imaging in predicting radiation therapy outcome in cervical cancer. The incidence of hepatocellular carcinoma is rising, largely attributable to a rise in hepatitis C infection 2. More and more studies have shown that liver cancer with microvascular invasion requires a larger resection range and a wider ablation margin, and should be more cautiously used as a candidate for liver transplantation. 41(5), 978989 (2016). If there was a disagreement between observers, an agreement was achieved through discussion. Liver cancers differ in their type of vascularization18 and in principle, HCC is hyper-vascular and initially vascularized by the hepatic artery. For the mean value and corresponding percentiles of AEF and rAEF, the 10th percentile of AEF and rAEF had the highest AUC value of 0.788, with the cutoff value of 0.034 and 0.952, respectively. World J. Gastroenterol. Perfusion parameters of triphasic computed tomography hold preoperative prediction value for microvascular invasion in hepatocellular carcinoma, https://doi.org/10.1038/s41598-023-35913-y. Lee, T. Y. et al. Hai Zhong. Post-TACE assessment of hepatocellular carcinoma, Post-TARE assessment of hepatocellular carcinoma. The evaluation of hepatocellular carcinoma with biphasic - PubMed Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. believed that there was no significant difference in perfusion related diffusion parameters in hepatocellular carcinoma with or without MVI32. Forner, A., Llovet, J. M. & Bruix, J. Hepatocellular carcinoma. Iguchi, T. et al. On the contrary, the minimum values related to AEF, including AEF, AEF and rAEF, were significantly higher in MVI negative group than those in positive group. Perfusion computed tomography (PCT) can be used to quantitatively measure liver perfusion parameters and therefore be applied for liver perfusion evaluation. Triple-Phase MDCT of Hepatocellular Carcinoma | AJR (PDF) Biphasic & triphasic computed tomography (CT) scan in focal Fifty-one patients with newly diagnosed hepatocellular carcinoma underwent standardized triple-phase CT using a multidetector scanner. J. Magn. Prediction of microvascular invasion in hepatocellular carcinoma: Preoperative Gd-EOB-DTPA-dynamic enhanced MRI and histopathological correlation. Other parameters had no statistical significance between the two groups (P>0.05). A., Morgan, R. & Mcglynn, K. A. Kim KW, Kim MJ, Lee SS et-al. Objective: To evaluate the role of biphasic contrast-enhanced helical CT including Hepatic Arterial Phase (HAP) imaging with Portal Venous Phase (PVP) imaging, in the detection and characterization of hepatocellular carcinomas. The relationship of . Seattle (WA): University of Washington, Seattle; 1993-2016. Radiology 272(3), 635654 (2014). Impact of PIVKA-II in diagnosis of hepatocellular carcinoma HPI+AEF refers to the combination of HPI(Max) and rAEF(Min). 17. Eur Radiol . Radiomics improved on this front, but still has its own limitations. At the time the article was last revised Ashesh Ishwarlal Ranchod had ; Statistical analysis: X.L. and G.P. Bosman, F. T., Carneiro, F., Hruban, R. H. & Theise, N. D. WHO Classification of Tumours of the Digestive System (World Health Organization, 2010).

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