Hepatocellular carcinoma(HCC) is the most common primary liver cancer and a major public health problem worldwide. Hepatocarcinogenesis is a complex multistep process at molecular, cellular, and histologic levels with...Hepatocellular carcinoma(HCC) is the most common primary liver cancer and a major public health problem worldwide. Hepatocarcinogenesis is a complex multistep process at molecular, cellular, and histologic levels with key alterations that can be revealed by noninvasive imaging modalities. Therefore, imaging techniques play pivotal roles in the detection, characterization, staging, surveillance, and prognosis evaluation of HCC. Currently, ultrasound is the first-line imaging modality for screening and surveillance purposes. While based on conclusive enhancement patterns comprising arterial phase hyperenhancement and portal venous and/or delayed phase wash-out, contrast enhanced dynamic computed tomography and magnetic resonance imaging(MRI) are the diagnostic tools for HCC without requirements for histopathologic confirmation. Functional MRI techniques, including diffusion-weighted imaging, MRI with hepatobiliary contrast agents, perfusion imaging, and magnetic resonance elastography, show promise in providing further important information regarding tumor biological behaviors. In addition, evaluation of tumor imaging characteristics, including nodule size, margin, number, vascular invasion, and growth patterns, allows preoperative prediction of tumor microvascular invasion and patient prognosis. Therefore, the aim of this article is to review the current state-of-the-art and recent advances in the comprehensive noninvasive imaging evaluation of HCC. We also provide the basic key concepts of HCC development and an overview of the current practice guidelines.展开更多
BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS), supported by the American College of Radiology(ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collectio...BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS), supported by the American College of Radiology(ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma(HCC). Diffusionweighted imaging(DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging(MRI) for HCC.AIM To determine whether the use of DWI can improve the diagnostic efficiency of LIRADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODS In this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity(SE), specificity(SP), accuracy(AC), positive predictive value(PPV), and negative predictive value(NPV) of LI-RADS were calculated.Youden index values were used to compare the diagnostic performance of LIRADS with or without DWI.RESULTS Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS(kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR-4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%,75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.CONCLUSION LI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.展开更多
Hepatocellular carcinoma(HCC)is a primary malignancy of the liver with a high mortality rate.Heterogeneity is the main biological characteristic of HCC,which manifests through the different biological behaviors of eac...Hepatocellular carcinoma(HCC)is a primary malignancy of the liver with a high mortality rate.Heterogeneity is the main biological characteristic of HCC,which manifests through the different biological behaviors of each phenotype and ultimately,affects patient prognosis and treatment efficacy.Various aggressive biological behaviors are considered to be associated with the poor prognosis of HCC patients including poor differentiation,microvascular invasion,intracellular fat accumulation,invasive growth,bile duct invasion or tumor thrombosis,and tumor spread and metastasis,and have been reported as prognostic biomarkers.In addition,HCC results from multifactor synergistic damage,and various factors related to genetics,molecular pathology and immunohistochemistry such asβ-catenin,Ki67,cytokeratin-19,and epithelial cell adhesion molecule have an impact on HCC differentiation and prognosis.This article is an overview of the biological behaviors that lead to poor prognosis of HCC,and the roles of morphological and quantitative noninvasive imaging biomarkers in the evaluation and prediction of these behaviors.Some common biomarkers related to genetics,molecular pathology and immunohistochemistry are also briefly summarized.It is hoped that this review will provide clinicians and radiologists with an update on the development of liver imaging,and provide directions for the combination of radiology,genetics,molecular pathology and histopathology to better predict the prognosis of HCC patients.展开更多
基金Supported by National Natural Science Foundation of China,No.81471658Science and Technology Support Program of Sichuan Province,No.2017SZ0003
文摘Hepatocellular carcinoma(HCC) is the most common primary liver cancer and a major public health problem worldwide. Hepatocarcinogenesis is a complex multistep process at molecular, cellular, and histologic levels with key alterations that can be revealed by noninvasive imaging modalities. Therefore, imaging techniques play pivotal roles in the detection, characterization, staging, surveillance, and prognosis evaluation of HCC. Currently, ultrasound is the first-line imaging modality for screening and surveillance purposes. While based on conclusive enhancement patterns comprising arterial phase hyperenhancement and portal venous and/or delayed phase wash-out, contrast enhanced dynamic computed tomography and magnetic resonance imaging(MRI) are the diagnostic tools for HCC without requirements for histopathologic confirmation. Functional MRI techniques, including diffusion-weighted imaging, MRI with hepatobiliary contrast agents, perfusion imaging, and magnetic resonance elastography, show promise in providing further important information regarding tumor biological behaviors. In addition, evaluation of tumor imaging characteristics, including nodule size, margin, number, vascular invasion, and growth patterns, allows preoperative prediction of tumor microvascular invasion and patient prognosis. Therefore, the aim of this article is to review the current state-of-the-art and recent advances in the comprehensive noninvasive imaging evaluation of HCC. We also provide the basic key concepts of HCC development and an overview of the current practice guidelines.
基金National Natural Science Foundation of China,No.81471658Science and Technology Support Program of Sichuan Province,No.2017SZ0003
文摘BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS), supported by the American College of Radiology(ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma(HCC). Diffusionweighted imaging(DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging(MRI) for HCC.AIM To determine whether the use of DWI can improve the diagnostic efficiency of LIRADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODS In this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity(SE), specificity(SP), accuracy(AC), positive predictive value(PPV), and negative predictive value(NPV) of LI-RADS were calculated.Youden index values were used to compare the diagnostic performance of LIRADS with or without DWI.RESULTS Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS(kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR-4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%,75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.CONCLUSION LI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.
基金This work was supported by grants from the Research Grant of National Nature Science Foundation of China(Grant number 81771797)Science and Technology Support Program of Sichuan Province(Grant number 2017SZ0003)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(Grant number ZYJC18008).
文摘Hepatocellular carcinoma(HCC)is a primary malignancy of the liver with a high mortality rate.Heterogeneity is the main biological characteristic of HCC,which manifests through the different biological behaviors of each phenotype and ultimately,affects patient prognosis and treatment efficacy.Various aggressive biological behaviors are considered to be associated with the poor prognosis of HCC patients including poor differentiation,microvascular invasion,intracellular fat accumulation,invasive growth,bile duct invasion or tumor thrombosis,and tumor spread and metastasis,and have been reported as prognostic biomarkers.In addition,HCC results from multifactor synergistic damage,and various factors related to genetics,molecular pathology and immunohistochemistry such asβ-catenin,Ki67,cytokeratin-19,and epithelial cell adhesion molecule have an impact on HCC differentiation and prognosis.This article is an overview of the biological behaviors that lead to poor prognosis of HCC,and the roles of morphological and quantitative noninvasive imaging biomarkers in the evaluation and prediction of these behaviors.Some common biomarkers related to genetics,molecular pathology and immunohistochemistry are also briefly summarized.It is hoped that this review will provide clinicians and radiologists with an update on the development of liver imaging,and provide directions for the combination of radiology,genetics,molecular pathology and histopathology to better predict the prognosis of HCC patients.