BACKGROUND The clinical management and prognosis differ between benign and malignant solid focal liver lesions(FLLs),as well as among different pathological types of malignant FLLs.Accurate diagnosis of the possible t...BACKGROUND The clinical management and prognosis differ between benign and malignant solid focal liver lesions(FLLs),as well as among different pathological types of malignant FLLs.Accurate diagnosis of the possible types of solid FLLs is important.Our previous study confirmed the value of shear wave elastography(SWE)using maximal elasticity(Emax)as the parameter in the differential diagnosis between benign and malignant FLLs.However,the value of SWE in the differential diagnosis among different pathological types of malignant FLLs has not been proved.AIM To explore the value of two-dimensional SWE(2D-SWE)using Emax in the differential diagnosis of FLLs,especially among different pathological types of malignant FLLs.METHODS All the patients enrolled in this study were diagnosed as benign,malignant or undetermined FLLs by conventional ultrasound.Emax of FLLs and the periphery of FLLs was measured using 2D-SWE and compared between benign and malignant FLLs or among different pathological types of malignant FLLs.RESULTS The study included 32 benign FLLs in 31 patients and 100 malignant FLLs in 96 patients,including 16 cholangiocellular carcinomas(CCCs),72 hepatocellular carcinomas(HCCs)and 12 liver metastases.Thirty-five FLLs were diagnosed as undetermined by conventional ultrasound.There were significant differences between Emax of malignant(2.21±0.57 m/s)and benign(1.59±0.37 m/s)FLLs(P=0.000),and between Emax of the periphery of malignant(1.52±0.39 m/s)and benign(1.36±0.44 m/s)FLLs(P=0.040).Emax of liver metastases(2.73±0.99 m/s)was significantly higher than that of CCCs(2.14±0.34 m/s)and HCCs(2.14±0.46 m/s)(P=0.002).The sensitivity,specificity and accuracy were 71.00%,84.38%and 74.24%respectively,using Emax>1.905 m/s(AUC 0.843)to diagnose as malignant and 23 of 35(65.74%)FLLs with undetermined diagnosis by conventional ultrasound were diagnosed correctly.CONCLUSION Malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas.2D-SWE with Emax was a useful complement to conventional ultrasound for the differential diagnosis of FLLs.展开更多
AIM To assess the value of combined acoustic radiation force impulse(ARFI) imaging, serological indexes and contrast-enhanced ultrasound(CEUS) in distinguishing between benign and malignant liver lesions. METHODS Pati...AIM To assess the value of combined acoustic radiation force impulse(ARFI) imaging, serological indexes and contrast-enhanced ultrasound(CEUS) in distinguishing between benign and malignant liver lesions. METHODS Patients with liver lesions treated at our hospital were included in this study. The lesions were divided into either a malignant tumor group or a benign tumor group according to pathological or radiological findings. ARFI quantitative detection, serological testing and CEUS quantitative detection were performed and compared. A comparative analysis of the measured indexes was performed between these groups. Receiver operating characteristic(ROC) curves were constructed to compare the diagnostic accuracy of ARFI imaging, serological indexes and CEUS, alone or in different combinations, in identifying benign and malignant liver lesions. RESULTS A total of 112 liver lesions in 43 patients were included, of which 78 were malignant and 34 were benign. Shear wave velocity(SWV) value, serum alpha-fetoprotein(AFP) content and enhancement rate were significantly higher in the malignant tumor group than in the benign tumor group(2.39 ± 1.20 m/s vs 1.50 ± 0.49 m/s, 18.02 ± 5.01 ng/m L vs 15.96 ± 4.33 ng/m L, 2.14 ± 0.21 d B/s vs 2.01 ± 0.31 d B/s; P < 0.05). The ROC curve analysis revealed that the areas under the curves(AUCs) of SWV value alone, AFP content alone, enhancement rate alone, SWV value + AFP content, SWV value + enhancement rate, AFP content + enhancement rate and SWV value + AFP content + enhancement rate were 85.1%, 72.1%, 74.5%, 88.3%, 90.4%, 82.0% and 92.3%, respectively. The AUC of SWV value + AFP content + enhancement rate was higher than those of SWV value + AFP content and SWV value + enhancement rate, and significantly higher than those of any single parameter or the combination of any two of parameters.CONCLUSION The combination of SWV, AFP and enhancement rate had better diagnostic performance in distinguishing between benign and malignant liver lesions than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.展开更多
To explore the clinical value of contrast-enhanced ultrasound （CEUS） in differentiating benign and malignant focal liver lesions （FLLs） with SonoVue, CEUS was used to examine 113 patients with focal liver lesions ...To explore the clinical value of contrast-enhanced ultrasound （CEUS） in differentiating benign and malignant focal liver lesions （FLLs） with SonoVue, CEUS was used to examine 113 patients with focal liver lesions （FLLs） in our hospital during July 2005 to December 2006. All the patients underwent contrast-enhanced CT （CECT） or contrast-enhanced MRI （CEMRI）. Except for patients with focal fatty sparings （n=18） and with hemangiomas （n=8）, all the patients were confirmed by operation or ultrasonic-guided liver puncture biopsy. A sulfur hexafluoride gas-based contrast agent was used with a MI of 0.15 to 0.17. Forty-eight cases of malignant FLLs, including 30 hepatocellular carcinomas （HCCs）, 2 cholangiocarcinomas and 16 metastatic tumors, were detected. Seventy-eight cases of benign FLLs, including 33 hemangiomas, 9 focal nodular hyperplasias （FNHs）, 19 focal fatty sparings, 5 abscesses, 7 regenerative nodules and 2 inflammatory pseudo-tumor, were involved. The contrast pattern of benign and malignant FLLs was quite different. CEUS has higher specificity and sensitivity than conventional ultrasound in differentiating benign and malignant FLLs.展开更多
Drug-induced liver injury(DILI)is defined as injury to the liver caused by exposure to a drug or some drugs.The number of cases suffering from DILI has been increased.There are few clinical features specifically assoc...Drug-induced liver injury(DILI)is defined as injury to the liver caused by exposure to a drug or some drugs.The number of cases suffering from DILI has been increased.There are few clinical features specifically associated with DILI.The recognition and diagnosis of DILI is difficult.In this report,we have described a DILI case caused by herbal remedies.展开更多
BACKGROUND Contrast-enhanced ultrasound(CEUS)can be used to diagnose focal liver lesions(FLLs)in children.The America College of Radiology developed the CEUS liver imaging reporting and data system(LI-RADS)for standar...BACKGROUND Contrast-enhanced ultrasound(CEUS)can be used to diagnose focal liver lesions(FLLs)in children.The America College of Radiology developed the CEUS liver imaging reporting and data system(LI-RADS)for standardizing CEUS diagnosis of FLLs in adult patients.Until now,no similar consensus or guidelines have existed for pediatric patients to improve imaging interpretation as adults.AIM To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein(AFP)in differentiating benign and malignant FLLs in pediatric patients.METHODS Between January 2011 and January 2021,patients≤18 years old who underwent CEUS for FLLs were retrospectively evaluated.The following criteria for diagnosing malignancy were proposed:Criterion I considered LR-4,LR-5,or LRM lesions as malignancies;criterion II regarded LR-4,LR-5 or LR-M lesions with simultaneously elevated AFP(≥20 ng/mL)as malignancies;criterion III took LR-4 Lesions with elevated AFP or LR-5 or LR-M lesions as malignancies.The sensitivity,specificity,accuracy and area under the receiver operating characteristic curve(AUC)were calculated to determine the diagnostic value of the aforementioned criteria.RESULTS The study included 63 nodules in 60 patients(mean age,11.0±5.2 years;26 male).There were no statistically significant differences between the specificity,accuracy,or AUC of criterion II and criterion III(95.1%vs 80.5%,84.1%vs 87.3%,and 0.794 vs 0.902;all P>0.017).Notably,criterion III showed a higher diagnostic sensitivity than criterion II(100%vs 63.6%;P<0.017).However,both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III(all P<0.017).For pediatric patients more than 5 years old,the performance of the three criteria was overall similar when patients were subcategorized by age when compared to all patients in aggregate.CONCLUSION CEUS LI-RADS combined with AFP may be a powerful diagnostic tool in pediatric patients.LR-4 with elevated AFP,LR-5 or LR-M lesions is highly suggestive of malignant tumors.展开更多
Computer-aided diagnosis(CAD) has become one of the major research subjects in medical imaging and diagnostic radiology.The basic concept of CAD is to provide computer output as a second opinion to assist radiologists...Computer-aided diagnosis(CAD) has become one of the major research subjects in medical imaging and diagnostic radiology.The basic concept of CAD is to provide computer output as a second opinion to assist radiologists' image interpretations by improving the accuracy and consistency of radiologic diagnosis and also by reducing the image-reading time.To date,research on CAD in ultrasound(US)-based diagnosis has been carried out mostly for breast lesions and has been limited in the fields of gastroenterology and hepatology,with most studies being conducted using B-mode US images.Two CAD schemes with contrast-enhanced US(CEUS) that are used in classifying focal liver lesions(FLLs) as liver metastasis,hemangioma,or three histologically differentiated types of hepatocellular carcinoma(HCC) are introduced in this article:one is based on physicians' subjective pattern classifications(subjective analysis) and the other is a computerized scheme for classification of FLLs(quantitative analysis).Classification accuracies for FLLs for each CAD scheme were 84.8% and 88.5% for metastasis,93.3% and 93.8% for hemangioma,and 98.6% and 86.9% for all HCCs,respectively.In addition,the classification accuracies for histologic differentiation of HCCs were 65.2% and 79.2% for well-differentiated HCCs,41.7% and 50.0% for moderately differentiated HCCs,and 80.0% and 77.8% for poorly differentiated HCCs,respectively.There are a number of issues concerning the clinical application of CAD for CEUS,however,it is likely that CAD for CEUS of the liver will make great progress in the future.展开更多
To the Editor:Peliosis hepatis(PH)is an uncommon benign vascular disorder characterized by widespread blood-filled cysts in the liver.This dis-ease was first described by Wagner in 1861,and because the liver lesions w...To the Editor:Peliosis hepatis(PH)is an uncommon benign vascular disorder characterized by widespread blood-filled cysts in the liver.This dis-ease was first described by Wagner in 1861,and because the liver lesions were generally red or blue-purple,it was first named PH by Schoenlack in 1916[1].The etiology of PH is not completely clear now,which is mainly related to drug factors,immune fac-tors,and infections.The diagnosis of PH is difficult because of the lack of specific clinical manifestations and imaging features.展开更多
BACKGROUND Liver infarction is a rare necrotic lesion due to the dual blood supply consisting of the hepatic artery and portal vein.The absence of specific clinical manifestations and imaging appearances usually leads...BACKGROUND Liver infarction is a rare necrotic lesion due to the dual blood supply consisting of the hepatic artery and portal vein.The absence of specific clinical manifestations and imaging appearances usually leads to misdiagnosis and poor prognosis.Thus,the precise diagnosis of liver infarction always requires imaging studies,serum studies,and possible liver biopsy.CASE SUMMARY We report a case of 31-year-old man who developed a huge liver infarction.Persistent right upper abdominal pain and intermittent fever were the main symptoms in this patient.Computed tomography revealed a huge irregular lesion with a maximum diameter of 12.7 cm in the right lobe of the liver.Threedimensional reconstruction was performed and no significant interruption of the main hepatic vessels was observed.The lesion was initially considered to be a malignant tumor with internal bleeding.Laparoscopic right hepatectomy was performed,and pathology indicated a rare liver infarction.The patient recovered well and was discharged on postoperative day 21.No fever or abnormal liver function were reported in the subsequent 6 mo.CONCLUSION In patients with a huge liver infarction,early surgical intervention may be beneficial.展开更多
BACKGROUND Biliary cystadenoma(BCA)is a rare benign tumor,accounting for only 5%of reported cystic lesions of the liver.Given its potential for malignancy and high rate of recurrence,surgical resection is the preferre...BACKGROUND Biliary cystadenoma(BCA)is a rare benign tumor,accounting for only 5%of reported cystic lesions of the liver.Given its potential for malignancy and high rate of recurrence,surgical resection is the preferred treatment.Therefore,early and accurate preoperative diagnosis is critical to the choice of treatment.We here report the first male case of BCA in our hospital,diagnosed by our team and confirmed by pathological biopsy.This article aims to improve the understanding of this disease and help make a correct diagnosis to better manage it.CASE SUMMARY A 58-year-old man with irregular abdominal discomfort came to our clinic and was found to have a distended abdomen during physical examination.Computed tomography and magnetic resonance imaging both showed a huge cystic mass in the liver.The patient underwent left hepatic lobectomy,cholecystectomy,and liver cyst fenestration,and most of the masses had decreased in size as of the 6-mo follow-up.The pathological diagnosis was consistent with BCA,and no recurrence was detected after the surgery.BCA occurred mainly in middle-aged women.To the best of our knowledge,this patient is the 11th male case of BCA reported in the literature.CONCLUSION The combination of magnetic resonance imaging and magnetic resonance cholangiopancreatography is of great significance for the early accurate diagnosis of the disease and the choice of surgical methods.展开更多
The high prevalence and mortality of lung cancer, together with a poor 5-year survival of only approximately 15%, emphasize the need for prognostic and predictive factors to improve patient treatment. C4.4A, a member ...The high prevalence and mortality of lung cancer, together with a poor 5-year survival of only approximately 15%, emphasize the need for prognostic and predictive factors to improve patient treatment. C4.4A, a member of the Ly6/uP AR family of membrane proteins, qualifies as such a potential informative biomarker in non-small cell lung cancer. Under normal physiological conditions, it is primarily expressed in suprabasal layers of stratified squamous epithelia. Consequently, it is absent from healthy bronchial and alveolar tissue, but nevertheless appears at early stages in the progression to invasivecarcinomas of the lung, i.e., in bronchial hyperplasia/metaplasia and atypical adenomatous hyperplasia. In the stages leading to pulmonary squamous cell carcinoma, expression is sustained in dysplasia, carcinoma in situ and invasive carcinomas, and this pertains to the normal presence of C4.4A in squamous epithelium. In pulmonary adenocarcinomas, a fraction of cases is positive for C4.4A, which is surprising, given the origin of these carcinomas from mucin-producing and not squamous epithelium. Interestingly, this correlates with a highly compromised patient survival and a predominant solid tumor growth pattern. Circumstantial evidence suggests an inverse relationship between C4.4A and the tumor suppressor LKB1. This might provide a link to the prognostic impact of C4.4A in patients with adenocarcinomas of the lung and could potentially be exploited for predicting the efficacy of treatment targeting components of the LKB1 pathway.展开更多
目的探讨超声造影(CEUS)诊断肝脏占位性病变良恶性的效能。方法2020年1月~2023年1月收治的97例肝脏占位性病变患者,接受肝穿刺活检及彩色多普勒超声和CEUS检查,采用Tom Tec Sono Liver CAP软件分析CEUS数据,采用受试者工作曲线(ROC)分...目的探讨超声造影(CEUS)诊断肝脏占位性病变良恶性的效能。方法2020年1月~2023年1月收治的97例肝脏占位性病变患者,接受肝穿刺活检及彩色多普勒超声和CEUS检查,采用Tom Tec Sono Liver CAP软件分析CEUS数据,采用受试者工作曲线(ROC)分析超声诊断肝脏占位性病变良恶性的效能。结果经病理学检查,在97肝脏占位性病变患者中,诊断恶性病变41例(胆管细胞癌5例、转移性肝癌10例、肝细胞癌26例)和良性病变56例(局灶性结节性增生29例和炎性假瘤27例);恶性病变动脉期局部血流量为(63.9±12.1)mL/min,显著大于良性病变【(42.7±8.9)mL/min,P<0.05】,延迟期局部血流量为(17.6±2.4)mL/min,显著小于良性病变【(19.0±2.7)mL/min,P<0.05】;恶性病变始峰时间、达峰时间、上升时间和通过时间分别为(11.5±2.1)s、(34.1±6.9)s、(25.8±4.3)s和(110.5±20.7)s,显著短于良性病变【分别为(14.1±2.3)s、(45.9±6.2)s、(37.6±5.8)s和(149.3±24.1)s,P<0.05】,而灌注指数显著大于良性病变【(141.2±20.0)对(89.7±18.9),P<0.05】;二维超声诊断良恶性肝脏局灶性病变的灵敏度为82.9%,特异度为78.4%,准确度为78.4%,阳性预测值为70.8%,阴性预测值为85.7%,而CEUS诊断良恶性肝脏局灶性病变的灵敏度为80.5%,特异度为82.1%,准确度为81.4%,阳性预测值为76.7%,阴性预测值为85.2%。结论CEUS诊断肝脏占位性病变良恶性具有较高的应用价值,可协助临床决策。展开更多
基金Supported by Natural Science Foundation of Shanghai of China,No.19ZR1441500,No.22ZR1458200Science Research Foundation of Shanghai Municipal Health Commission,No.202140378Key Program of Science and Technology Commission Foundation of Changning,Shanghai,China,No.CNKW2020Z04.
文摘BACKGROUND The clinical management and prognosis differ between benign and malignant solid focal liver lesions(FLLs),as well as among different pathological types of malignant FLLs.Accurate diagnosis of the possible types of solid FLLs is important.Our previous study confirmed the value of shear wave elastography(SWE)using maximal elasticity(Emax)as the parameter in the differential diagnosis between benign and malignant FLLs.However,the value of SWE in the differential diagnosis among different pathological types of malignant FLLs has not been proved.AIM To explore the value of two-dimensional SWE(2D-SWE)using Emax in the differential diagnosis of FLLs,especially among different pathological types of malignant FLLs.METHODS All the patients enrolled in this study were diagnosed as benign,malignant or undetermined FLLs by conventional ultrasound.Emax of FLLs and the periphery of FLLs was measured using 2D-SWE and compared between benign and malignant FLLs or among different pathological types of malignant FLLs.RESULTS The study included 32 benign FLLs in 31 patients and 100 malignant FLLs in 96 patients,including 16 cholangiocellular carcinomas(CCCs),72 hepatocellular carcinomas(HCCs)and 12 liver metastases.Thirty-five FLLs were diagnosed as undetermined by conventional ultrasound.There were significant differences between Emax of malignant(2.21±0.57 m/s)and benign(1.59±0.37 m/s)FLLs(P=0.000),and between Emax of the periphery of malignant(1.52±0.39 m/s)and benign(1.36±0.44 m/s)FLLs(P=0.040).Emax of liver metastases(2.73±0.99 m/s)was significantly higher than that of CCCs(2.14±0.34 m/s)and HCCs(2.14±0.46 m/s)(P=0.002).The sensitivity,specificity and accuracy were 71.00%,84.38%and 74.24%respectively,using Emax>1.905 m/s(AUC 0.843)to diagnose as malignant and 23 of 35(65.74%)FLLs with undetermined diagnosis by conventional ultrasound were diagnosed correctly.CONCLUSION Malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas.2D-SWE with Emax was a useful complement to conventional ultrasound for the differential diagnosis of FLLs.
基金Supported by Yangpu District Health and Family Planning Commission,Yangpu District Science and Technology Commission,No.YP15M18Research Project of Shanghai Municipal Commission of Health and Family Planning,No.201540032
文摘AIM To assess the value of combined acoustic radiation force impulse(ARFI) imaging, serological indexes and contrast-enhanced ultrasound(CEUS) in distinguishing between benign and malignant liver lesions. METHODS Patients with liver lesions treated at our hospital were included in this study. The lesions were divided into either a malignant tumor group or a benign tumor group according to pathological or radiological findings. ARFI quantitative detection, serological testing and CEUS quantitative detection were performed and compared. A comparative analysis of the measured indexes was performed between these groups. Receiver operating characteristic(ROC) curves were constructed to compare the diagnostic accuracy of ARFI imaging, serological indexes and CEUS, alone or in different combinations, in identifying benign and malignant liver lesions. RESULTS A total of 112 liver lesions in 43 patients were included, of which 78 were malignant and 34 were benign. Shear wave velocity(SWV) value, serum alpha-fetoprotein(AFP) content and enhancement rate were significantly higher in the malignant tumor group than in the benign tumor group(2.39 ± 1.20 m/s vs 1.50 ± 0.49 m/s, 18.02 ± 5.01 ng/m L vs 15.96 ± 4.33 ng/m L, 2.14 ± 0.21 d B/s vs 2.01 ± 0.31 d B/s; P < 0.05). The ROC curve analysis revealed that the areas under the curves(AUCs) of SWV value alone, AFP content alone, enhancement rate alone, SWV value + AFP content, SWV value + enhancement rate, AFP content + enhancement rate and SWV value + AFP content + enhancement rate were 85.1%, 72.1%, 74.5%, 88.3%, 90.4%, 82.0% and 92.3%, respectively. The AUC of SWV value + AFP content + enhancement rate was higher than those of SWV value + AFP content and SWV value + enhancement rate, and significantly higher than those of any single parameter or the combination of any two of parameters.CONCLUSION The combination of SWV, AFP and enhancement rate had better diagnostic performance in distinguishing between benign and malignant liver lesions than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.
基金a key program from the Na-tional Natural Sciences Foundation of China (No. 90209009).
文摘To explore the clinical value of contrast-enhanced ultrasound （CEUS） in differentiating benign and malignant focal liver lesions （FLLs） with SonoVue, CEUS was used to examine 113 patients with focal liver lesions （FLLs） in our hospital during July 2005 to December 2006. All the patients underwent contrast-enhanced CT （CECT） or contrast-enhanced MRI （CEMRI）. Except for patients with focal fatty sparings （n=18） and with hemangiomas （n=8）, all the patients were confirmed by operation or ultrasonic-guided liver puncture biopsy. A sulfur hexafluoride gas-based contrast agent was used with a MI of 0.15 to 0.17. Forty-eight cases of malignant FLLs, including 30 hepatocellular carcinomas （HCCs）, 2 cholangiocarcinomas and 16 metastatic tumors, were detected. Seventy-eight cases of benign FLLs, including 33 hemangiomas, 9 focal nodular hyperplasias （FNHs）, 19 focal fatty sparings, 5 abscesses, 7 regenerative nodules and 2 inflammatory pseudo-tumor, were involved. The contrast pattern of benign and malignant FLLs was quite different. CEUS has higher specificity and sensitivity than conventional ultrasound in differentiating benign and malignant FLLs.
文摘Drug-induced liver injury(DILI)is defined as injury to the liver caused by exposure to a drug or some drugs.The number of cases suffering from DILI has been increased.There are few clinical features specifically associated with DILI.The recognition and diagnosis of DILI is difficult.In this report,we have described a DILI case caused by herbal remedies.
基金Supported by the National Natural Science Foundation of China,No.81571697the Science and Technology Department of Sichuan Province,No.2017SZ003 and No.2018FZ0044.
文摘BACKGROUND Contrast-enhanced ultrasound(CEUS)can be used to diagnose focal liver lesions(FLLs)in children.The America College of Radiology developed the CEUS liver imaging reporting and data system(LI-RADS)for standardizing CEUS diagnosis of FLLs in adult patients.Until now,no similar consensus or guidelines have existed for pediatric patients to improve imaging interpretation as adults.AIM To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein(AFP)in differentiating benign and malignant FLLs in pediatric patients.METHODS Between January 2011 and January 2021,patients≤18 years old who underwent CEUS for FLLs were retrospectively evaluated.The following criteria for diagnosing malignancy were proposed:Criterion I considered LR-4,LR-5,or LRM lesions as malignancies;criterion II regarded LR-4,LR-5 or LR-M lesions with simultaneously elevated AFP(≥20 ng/mL)as malignancies;criterion III took LR-4 Lesions with elevated AFP or LR-5 or LR-M lesions as malignancies.The sensitivity,specificity,accuracy and area under the receiver operating characteristic curve(AUC)were calculated to determine the diagnostic value of the aforementioned criteria.RESULTS The study included 63 nodules in 60 patients(mean age,11.0±5.2 years;26 male).There were no statistically significant differences between the specificity,accuracy,or AUC of criterion II and criterion III(95.1%vs 80.5%,84.1%vs 87.3%,and 0.794 vs 0.902;all P>0.017).Notably,criterion III showed a higher diagnostic sensitivity than criterion II(100%vs 63.6%;P<0.017).However,both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III(all P<0.017).For pediatric patients more than 5 years old,the performance of the three criteria was overall similar when patients were subcategorized by age when compared to all patients in aggregate.CONCLUSION CEUS LI-RADS combined with AFP may be a powerful diagnostic tool in pediatric patients.LR-4 with elevated AFP,LR-5 or LR-M lesions is highly suggestive of malignant tumors.
文摘Computer-aided diagnosis(CAD) has become one of the major research subjects in medical imaging and diagnostic radiology.The basic concept of CAD is to provide computer output as a second opinion to assist radiologists' image interpretations by improving the accuracy and consistency of radiologic diagnosis and also by reducing the image-reading time.To date,research on CAD in ultrasound(US)-based diagnosis has been carried out mostly for breast lesions and has been limited in the fields of gastroenterology and hepatology,with most studies being conducted using B-mode US images.Two CAD schemes with contrast-enhanced US(CEUS) that are used in classifying focal liver lesions(FLLs) as liver metastasis,hemangioma,or three histologically differentiated types of hepatocellular carcinoma(HCC) are introduced in this article:one is based on physicians' subjective pattern classifications(subjective analysis) and the other is a computerized scheme for classification of FLLs(quantitative analysis).Classification accuracies for FLLs for each CAD scheme were 84.8% and 88.5% for metastasis,93.3% and 93.8% for hemangioma,and 98.6% and 86.9% for all HCCs,respectively.In addition,the classification accuracies for histologic differentiation of HCCs were 65.2% and 79.2% for well-differentiated HCCs,41.7% and 50.0% for moderately differentiated HCCs,and 80.0% and 77.8% for poorly differentiated HCCs,respectively.There are a number of issues concerning the clinical application of CAD for CEUS,however,it is likely that CAD for CEUS of the liver will make great progress in the future.
文摘To the Editor:Peliosis hepatis(PH)is an uncommon benign vascular disorder characterized by widespread blood-filled cysts in the liver.This dis-ease was first described by Wagner in 1861,and because the liver lesions were generally red or blue-purple,it was first named PH by Schoenlack in 1916[1].The etiology of PH is not completely clear now,which is mainly related to drug factors,immune fac-tors,and infections.The diagnosis of PH is difficult because of the lack of specific clinical manifestations and imaging features.
文摘BACKGROUND Liver infarction is a rare necrotic lesion due to the dual blood supply consisting of the hepatic artery and portal vein.The absence of specific clinical manifestations and imaging appearances usually leads to misdiagnosis and poor prognosis.Thus,the precise diagnosis of liver infarction always requires imaging studies,serum studies,and possible liver biopsy.CASE SUMMARY We report a case of 31-year-old man who developed a huge liver infarction.Persistent right upper abdominal pain and intermittent fever were the main symptoms in this patient.Computed tomography revealed a huge irregular lesion with a maximum diameter of 12.7 cm in the right lobe of the liver.Threedimensional reconstruction was performed and no significant interruption of the main hepatic vessels was observed.The lesion was initially considered to be a malignant tumor with internal bleeding.Laparoscopic right hepatectomy was performed,and pathology indicated a rare liver infarction.The patient recovered well and was discharged on postoperative day 21.No fever or abnormal liver function were reported in the subsequent 6 mo.CONCLUSION In patients with a huge liver infarction,early surgical intervention may be beneficial.
基金Supported by the National Natural Science Foundation of China,Nos.81971592,81971593,and 81771824and the Key Research and Development Projects of Shanxi Province,No.201903D321189.
文摘BACKGROUND Biliary cystadenoma(BCA)is a rare benign tumor,accounting for only 5%of reported cystic lesions of the liver.Given its potential for malignancy and high rate of recurrence,surgical resection is the preferred treatment.Therefore,early and accurate preoperative diagnosis is critical to the choice of treatment.We here report the first male case of BCA in our hospital,diagnosed by our team and confirmed by pathological biopsy.This article aims to improve the understanding of this disease and help make a correct diagnosis to better manage it.CASE SUMMARY A 58-year-old man with irregular abdominal discomfort came to our clinic and was found to have a distended abdomen during physical examination.Computed tomography and magnetic resonance imaging both showed a huge cystic mass in the liver.The patient underwent left hepatic lobectomy,cholecystectomy,and liver cyst fenestration,and most of the masses had decreased in size as of the 6-mo follow-up.The pathological diagnosis was consistent with BCA,and no recurrence was detected after the surgery.BCA occurred mainly in middle-aged women.To the best of our knowledge,this patient is the 11th male case of BCA reported in the literature.CONCLUSION The combination of magnetic resonance imaging and magnetic resonance cholangiopancreatography is of great significance for the early accurate diagnosis of the disease and the choice of surgical methods.
基金Supported by Copenhagen University Hospital(Rigshospitalets Forskningspuljer)The Danish National Research Foundation(Danish-Chinese Centre for Proteases and Cancer)Harboefonden,Torben og Alice Frimodts Fond,Fabrikant Einar Willumsens Mindelegat,Holger Rabitz and hustrus Legat,The Lundbeck Foundation.
文摘The high prevalence and mortality of lung cancer, together with a poor 5-year survival of only approximately 15%, emphasize the need for prognostic and predictive factors to improve patient treatment. C4.4A, a member of the Ly6/uP AR family of membrane proteins, qualifies as such a potential informative biomarker in non-small cell lung cancer. Under normal physiological conditions, it is primarily expressed in suprabasal layers of stratified squamous epithelia. Consequently, it is absent from healthy bronchial and alveolar tissue, but nevertheless appears at early stages in the progression to invasivecarcinomas of the lung, i.e., in bronchial hyperplasia/metaplasia and atypical adenomatous hyperplasia. In the stages leading to pulmonary squamous cell carcinoma, expression is sustained in dysplasia, carcinoma in situ and invasive carcinomas, and this pertains to the normal presence of C4.4A in squamous epithelium. In pulmonary adenocarcinomas, a fraction of cases is positive for C4.4A, which is surprising, given the origin of these carcinomas from mucin-producing and not squamous epithelium. Interestingly, this correlates with a highly compromised patient survival and a predominant solid tumor growth pattern. Circumstantial evidence suggests an inverse relationship between C4.4A and the tumor suppressor LKB1. This might provide a link to the prognostic impact of C4.4A in patients with adenocarcinomas of the lung and could potentially be exploited for predicting the efficacy of treatment targeting components of the LKB1 pathway.
文摘目的探讨超声造影(CEUS)诊断肝脏占位性病变良恶性的效能。方法2020年1月~2023年1月收治的97例肝脏占位性病变患者,接受肝穿刺活检及彩色多普勒超声和CEUS检查,采用Tom Tec Sono Liver CAP软件分析CEUS数据,采用受试者工作曲线(ROC)分析超声诊断肝脏占位性病变良恶性的效能。结果经病理学检查,在97肝脏占位性病变患者中,诊断恶性病变41例(胆管细胞癌5例、转移性肝癌10例、肝细胞癌26例)和良性病变56例(局灶性结节性增生29例和炎性假瘤27例);恶性病变动脉期局部血流量为(63.9±12.1)mL/min,显著大于良性病变【(42.7±8.9)mL/min,P<0.05】,延迟期局部血流量为(17.6±2.4)mL/min,显著小于良性病变【(19.0±2.7)mL/min,P<0.05】;恶性病变始峰时间、达峰时间、上升时间和通过时间分别为(11.5±2.1)s、(34.1±6.9)s、(25.8±4.3)s和(110.5±20.7)s,显著短于良性病变【分别为(14.1±2.3)s、(45.9±6.2)s、(37.6±5.8)s和(149.3±24.1)s,P<0.05】,而灌注指数显著大于良性病变【(141.2±20.0)对(89.7±18.9),P<0.05】;二维超声诊断良恶性肝脏局灶性病变的灵敏度为82.9%,特异度为78.4%,准确度为78.4%,阳性预测值为70.8%,阴性预测值为85.7%,而CEUS诊断良恶性肝脏局灶性病变的灵敏度为80.5%,特异度为82.1%,准确度为81.4%,阳性预测值为76.7%,阴性预测值为85.2%。结论CEUS诊断肝脏占位性病变良恶性具有较高的应用价值,可协助临床决策。
