https://doi.org/10.1148/radiol.2262011593 (2003). T2-weighted images may be acquired with a single-shot fast spin-echo technique in the coronal and axial plane without fat saturation, and in the axial plane with fat saturation using a spectral adiabatic inversion recovery (SPAIR) technique (21, 22). Other future directions include automated MRI systems that will improve reproducible optimized technique across different imaging centers. This limitation prompted several groups to evaluate different strategies to improve diagnostic accuracy. The site is secure. A real time bolus-triggered method has been described with breath-hold instructions initiated as the contrast bolus reaches the celiac trunk (trigger point), and imaging initiated at an 810 s delay from the trigger point (19). Gd-EOB-DTPA demonstrates 50% uptake (through an active transport mechanism) and excretion by the normal liver into the bile ducts. Precontrast (b), arterial (c), and delayed phase (d) T1-weighted 3D GRE images show arterial enhancement in multiple tumors in both lobes of the liver with subsequent washout. Hepatocellular carcinomas constitute approximately 5% of all cancers partly due to the high endemic rates of hepatitis B infection 1. Progress of MRI Radiomics in Hepatocellular Carcinoma CAS Arterial enhancement of tumor is also a marker for viability and can be used to track tumor response to localized chemo-ablative therapies. Substantial interobserver agreement was observed during the delayed phase regarding non-peripheral washout (0.646 [95% CI: 0.0111] for gadoteric acid and 0.617 [95% CI: 0.1331] for gadoxetic acid) and enhancing capsule (0.0.642 [95% CI: 0.2471.0] for gadoteric acid and 0.649 [95% CI: 0.3410.957] for gadoxetic acid), as well as for detection of arterial phase hyperenhancement during the late arterial phase of gadoteric acid-enhanced MRI (0.623 [95% CI: 0.161]). Between July 2014 and April 2018, we enrolled adult patients with established diagnosis of HCC who were scheduled to undergo preoperative MRI examination prior to liver resection. Epidemiology The demographics of patients with liver metastases will mirror that of the underlying primaries. Reason. In addition, prophylactic bland embolization of the gastroduodenal artery and other extrahepatic vessels is essential prior to Y-90 microspheres administration to prevent reflux of the radioactive microspheres into the gastric vascular supply, which may cause intractable radiation ulcers (45). https://doi.org/10.1007/s00330-018-5559-z (2019). Dynamic postcontrast imaging with a standard extracellular GBCA will show arterial enhancement within tumor thrombus and intermediate level signal on venous phase. Neri, E. et al. Results of quantitative analysis are summarized in Table 1. CT and MR Imaging Diagnosis and Staging of Hepatocellular Carcinoma The mean longest diameter of the HCC lesions measured in the hepatobiliary phase (HBP) was 42mm (range 17124mm). The pattern of HCC growth is highly characteristic. A breath-hold (end inspiration) dual-echo spoiled GRE sequence is also performed for qualitative evaluation of tissue fat and iron and to best define features that may be important when evaluating a subset of focal liver lesions in the setting of CLD. Similarly, Chen et al. Complementary to conventional MRI, a lesion on DWI is suspicious for HCC when it shows sustained, elevated signal relative to the surrounding liver parenchyma with increasing b factors (b=50, 400, and 800 s/mm2) and a nearly equivalent or lower apparent diffusion coefficient compared with the background parenchyma on the ADC map (24, 25). 8, 46. Sampling error in biopsy (Fig. The percutaneous treatment methods may be divided into arterial delivery of a tumor cytotoxic agent (transarterial chemoembolization and/or yttrium-90 [Y-90] microspheres) versus direct tissue infarction through the use of microwave energy, radiofrequency heating, or cryoablation. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. This prospective intra-individual comparative study was performed in accordance with the Declaration of Helsinki and approved by the local ethics committee of Federal Institute for Drugs and Medical Devices. 3D, three-dimensional; MRI, magnetic resonance imaging. However, despite ECA-enhanced MRI displayed a lower incidence of artifacts and a higher lesion conspicuity during the LAP, the overall image quality during the LAP did not demonstrate statistically significant differences between the two contrast agents. https://doi.org/10.1088/0031-9155/44/12/403 (1999). Most I-HCCs are highly conspicuous on T2-weighted images showing high signal relative to the adjacent liver. Approximately 10%15% of HCC may retain contrast on delayed hepatobiliary phase images, thereby appearing isointense or hyperintense to background hepatic parenchyma, enhancement features that are similar to benign regenerative or dysplastic nodules (7, 23). Z., Elsayes, K. M., Chernyak, V., Tang, A. Cancer Res. Statistical analysis was performed using R version 3.5.1 (The R Foundation for Statistical Computing). Although large head-to-head comparative studies are still lacking, numerous studies comparing the diagnostic performance of ECA and HSCA have shown a higher sensitivity of HSCA-enhanced MRI, particularly in small HCC10,11,12. Regenerative nodules may undergo low to high grade dysplastic change, forming dysplastic nodules, which are found in 15%25% of cirrhotic livers. During the PVP, an enhancing capsule (Fig. It is strongly associated with cirrhosis, from both alcohol and viral etiologies. Hepatocellular carcinoma (HCC) , also called hepatoma, is the most common primary malignancy of the liver. Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV. Min, J. H. et al. US is used for HCC surveillance in CLD at many centers, primarily due to ease of access, lack of ionizing radiation, and relative lower initial per study cost compared with CT and MRI. This retrospective study included patients with HCC treated with surgical resection between January 2008 and February 2018 and who underwent preoperative multiphase contrast material-enhanced MRI. In patients with diagnosis based on noninvasive diagnostic criteria, histology obtained after resection or before ablation served as reference standard. The LI-RADS has been developed as a tool for the standardized interpretation of liver imaging findings in patients who are at risk for HCC16. Contrast-to-noise ratio (CNR) was significantly higher with gadoteric acid-enhanced MRI compared to gadoxetic acid-enhanced MRI (median of 72.7; IQR: 50.8165 vs median of 49.4; IQR: 18.1154.4; P=0.005). Hepatic lesions are categorized from LR1 to LR5 depending on imaging features to suggest whether the findings are definitely benign (LR1) or definitely malignant, i.e., HCC (LR5). Sano, K. et al. Becker-Weidman DJ, Kalb B, Sharma P, et al. Patients were excluded if they were or have been suspected to be pregnant or breastfeeding; were scheduled for liver transplantation; had a previous systemic or locoregional therapy for the HCC or had contraindications to MR imaging or impaired renal function (glomerular filtration rate (GFR)<30mL/min). arrowheads). All tests were two-sided, and the level of significance was set to 0.05. Dilated vasculature in the arterial phase of dynamic CT and lower relative enhancement ratio in the hepatobiliary phase of gadoxetic acid-enhanced MRI were associated with P53-mutated hepatocellular carcinoma. PubMed Central Using longitudinal short-interval time-course imaging for staging in a patient with an indeterminate nodule is therefore now believed to be more accurate and safer than biopsies (41, 43). Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. 44, 4142. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. (8) evaluated 100 patients that developed HCC while receiving surveillance US and who had prior negative US examinations with the appropriate time interval between scans; up to 30% of these patients presented with tumor stage outside of surgical treatment options such as transplantation or surgical resection. The excellent long-term results of transplantation for the treatment of HCC are highly dependent on accurate pretransplant staging of the disease because patients that underwent transplantation from outside the established criteria have shown significantly worse outcomes (4, 40). Third, the use of a predefined delay of 15s after contrast agent injection during the two MRI also represents a limitation as HSCA is disadvantaged by its smaller volume. MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Mori K, Yoshioka H, Takahashi N, et al. Reason. 41, 10091022. To ensure patients are detected with treatable disease, surveillance screening is advocated using imaging in place of biopsy. MRI can be used to monitor treatment response. Preliminary data from our institution suggests that the degree of T2 signal abnormality in HCC may correlate with the biologic behavior and risk of post-transplant tumor recurrence (34). The authors declared no conflicts of interest. https://doi.org/10.3978/j.issn.2218-676X.2014.07.01 (2014). In comparison with traditional chemoembolization, drug-eluting microspheres have the advantage of sustained release of the chemotherapeutic agent over a long period of time. However, reports indicate highly variable sensitivity for the detection of HCC with US, ranging from 33% to 96% (5). Scientific Reports Earlier studies have also demonstrated that treated tumors normally will develop an enhancing halo of liver tissue adjacent to the outer margins of the tumor. When a focus of HCC develops within a dysplastic nodule, a mildly elevated signal may be observed on T2-weighted images, representing the focus of HCC within the low density dysplastic nodule, and has been described as a nodule in nodule appearance. Hepatocellular carcinoma treated with radio frequency ablation: an early evaluation with magnetic resonance imaging. Non-peripheral washout on the PVP was observed in 82.6% of the nodules on gadoteric acid-enhanced MRI and in 73.9% of the nodules on gadoxetic acid-enhanced MRI (P=0.479). Liver Imaging-Reporting and Data System (LI-RADS), Includes nodule-like hepatic arterial phase hyperenhancement. reporting a higher rate of HCC displaying APHE on ECA-enhanced MRI compared to HSCA-enhanced MRI (96.8% vs 87.4%)18. Histopathological diagnosis (i.e., liver biopsy) was reserved for patients in whom definite diagnosis of the etiology of liver cirrhosis was not confirmed by the above-mentioned methods. Multiphase Liver MRI for Identifying the Macrotrabecular-Massive In distinction to the solitary focal and multifocal subtypes, I-HCC may be nearly inconspicuous on postcontrast imaging, making I-HCC potentially a challenging diagnosis. The use of multidetector CT for the detection of HCC requires an optimized triple-phase technique that includes image acquisition during multiple phases of contrast enhancement to evaluate for the distinctive findings of arterial enhancement and delayed washout characteristics of HCC (9). Hepatic metastases | Radiology Reference Article | Radiopaedia.org Cite this article. Overall image quality of the different phases was assessed based on the definitions proposed by LI-RADS v201817. An increased three- to six-months interval imaging frequency has been suggested (20). During the portal venous phase (PVP) and delayed phase (DP), gadoteric acid-enhanced MRI showed a significantly higher overall image quality (P=0.041 and 0.008, respectively). Some studies have suggested a lower sensitivity for dysplastic nodules, small HCC, and infiltrative-HCC compared with MRI (Fig. A further point of discussion in the comparative evaluation between both contrast agents is image quality. MRI of hepatocellular carcinoma: an update of current practices The challenges of novel contrast agents for the imaging diagnosis of hepatocellular carcinoma. PDF Personalised management of patients with hepatocellular carcinoma: a AASLD and the Journal of the National Cancer Institute (AASLD-JNCI) have modified the Response Evaluation Criteria in Solid Tumors (mRECIST) to incorporate enhancement features on MRI as an indicator of treatment response, in combination with size measurements (3, 7, 52). 1) compared to that of gadoxetic acid (19.8; IQR: 7.335.6 vs. 9.3; IQR: 6.5 to 21; P=0.006). During the late arterial phase (LAP), CNR was significantly lower with ECA (P=0.005), while SNR did not differ significantly (P=0.39). arrowheads) compared with the in-phase images (f, Relationship between diffusion-weighted magnetic resonance imaging and histological tumor grading of hepatocellular carcinoma. Lancet 391, 13011314. Note the tumor demonstrated elevated signal on precontrast images, suggesting coagulative necrosis following treatment (d, sharing sensitive information, make sure youre on a federal The ability to use CT and MR imaging with extracellular agents to identify and differentiate cirrhotic nodules, low-grade dysplastic nodules, high-grade dysplastic nodules, and early hepatocellular. Noninvasive imaging-based machine learning algorithm to - Nature Quant Imaging Med . However, tumor screening protocols in high risk patients can lead to an earlier detection of treatable disease. Pretreatment imaging is crucial for procedural planning specifically to identify the extent of tumor and to assess the distribution of adjacent structures relative to the tumor, such as the hepatic or portal veins (which may decrease treatment efficacy by acting as a heat sink) and bile ducts or bowel (to avoid unwanted injury from heating effects). The chances of success with repeat biopsy is relatively low when the deficiency is limited by characteristics of the lesions, such as areas of necrosis in large nodules or well differentiated cellular areas in small sized HCC, and increases the risk of bleeding and tumor seeding (42). arrow) with an enhancing capsule. Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Preferred examination Cross-sectional imaging with computed tomography (CT) scanning and magnetic resonance imaging (MRI) is most commonly used to detect hepatocellular carcinoma (HCC). Article The results were interpreted as slight agreement for values of 0.010.20, fair agreement for 0.210.40, moderate agreement for 0.410.60, substantial agreement for 0.610.80, and excellent agreement for 0.810.9931. Role of spectral presaturation attenuated inversion-recovery fat-suppressed T2-weighted MR imaging in active inflammatory bowel disease. Radiology 261, 834844. Intratumoral lipid is a relatively common characteristic observed with HCC histologically, and may be identified in a subset of cases on dual echo, T1-weighted GRE images, with loss of signal on the opposed-phase images compared with the in-phase images. Kalva SP, Thabet A, Wicky S. Recent advances in transarterial therapy of primary and secondary liver malignancies. Briefly, the LAP was defined by a strong enhancement of the hepatic artery and its branches, substantial enhancement of the portal vein, slight parenchymal enhancement, and absence of hepatic venous enhancement. Through this period, the nodule may develop the specific imaging features of HCC, which will obviate the need for a biopsy and provide the confirmatory diagnosis needed for pretransplant staging. Magn. Dual echo T1-weighted GRE images show loss of signal on the out-of-phase image (e, ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. During the late arterial phase (LAP), there was no significant difference regarding the signal-to-noise ratio (SNR) between gadoxetic acid-enhanced MRI (median of 298.7; IQR: 183.3482.9) and gadoteric acid-enhanced MRI (median of 264.1; IQR: 220.3380.4; P=0.393). Major transplant organizations, including the UNOS and the European Society for Organ Transplantation (ESOT) no longer require histological confirmation of HCC prior to liver transplantation if a tumor shows characteristic features of HCC on imaging, either CT or MRI. Electronic address, e. e. e. & European Association for the Study. Abstract Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and remains a global health challenge. Multiple therapeutic strategies are available for the treatment of HCC, including medical therapy, percutaneous tumor ablation, transarterial embolic therapy, surgical resection, and liver transplantation. Major imaging features in LI-RADS v2018 (APHE, nonperipheral washout, enhancing capsule, size, and threshold growth) are used to categorize observations as LI-RADS 3 (intermediate probability of malignancy), LI-RADS 4 (probably HCC), and LI-RADS 5 (definite HCC)17. Following direct ablative techniques, the necrotic tumor cavity becomes hyperintense relative to the pretherapy tumor signal and to the surrounding parenchyma on T1-weighted images. HCC invades and grows within the lumen, often distending the vein. Screening for HCC has resulted in significant improvements in the one-year cause-specific survival rates for new patients (1), and this is directly attributed to improved survival through the detection of early stage tumor. Detection and characterization of focal liver lesions: A Japanese phase III, multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease. https://doi.org/10.1002/jmri.20288 (2005). MRI differentiation of nodules in chronic liver disease. Several parameters such as coil geometry, phase-encoding direction, and acceleration factor can influence the noise distribution in parallel imaging. American College of Radiology. Figures(1a,2a) demonstrates the stronger APHE during the arterial Phase (1a) and enhancing capsule in the portal venous phase (2a) after administration of the extracellular contrast agent gadoteric acid than with the hepatocyte-specific contrast agent gadoxetic acid (1b,2b). As a library, NLM provides access to scientific literature. MRI radiomics features predict immuno-oncological characteristics of MR imaging of hepatocellular carcinoma: prospective - Nature We recorded each patients weight and administered gadobenate dimeglumine (MultiHance, Bracco Diagnostics, Princeton, New Jersey, USA) at a dose of 0.05 mmol/kg and an injection rate of 2 mL/s, followed by a 30-mL saline flush (also at 2 mL/s) using a dual-chamber power injector, with the objective of minimizing gadolinium dose while preserving R1 effects of a standard agent dose (16).

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