High-risk esophageal varices in patients treated with locoregional therapy for hepatocellular carcinoma:Assessment with liver computed tomography

AIM： To assess the diagnostic performance of follow- up liver computed tomography （CT） for the detection of high-risk esophageal varices in patients treated with Io- coregional therapy for hepatocellular carcinoma （HCC）. METHODS： We prospectively enrolled 100 patients with cirrhosis who underwent transcatheter arterial chemoembolization, radiofrequency ablation or both procedures for HCCs. All patients underwent upper endoscopy and subsequently liver CT. Three radiolo- gists independently evaluated the presence of high-riskesophageal varices with transverse images alone and with three orthogonal multiplanar reformation （MPR） images, respectively. With endoscopic grading as the reference standard, diagnostic performance was as- sessed by using receiver operating characteristic （ROC） curve analysis. RESULTS： The diagnostic performances （areas under the ROC curve） of three observers with transverse im- ages alone were 0.947 ± 0.031, 0.969 ± 0.024, and 0.916 ＋ 0.038, respectively. The mean sensitivity, spec- ificity, positive predicative value （PPV）, and negative predicative value （NPV） with transverse images alone were 90.1%, 86.39%, 70.9%, and 95.9%, respectively. The diagnostic performances, mean sensitivity, specific- ity, PPV, and NPV with three orthogonal MPR images （0.965 ± 0.025, 0.959 ± 0.027, 0.938 ± 0.033, 91.4%, 89.5%, 76.3%, and 96.6%, respectively） were not su- perior to corresponding values with transverse images alone （P 〉 0.05）, except for the mean specificity （P = 0.039）. CONCLUSION： Our results showed excellent diagnos- tic performance, sensitivity and NPV to detect high-risk esophageal varices on follow-up liver CT after Iocore- gional therapy for HCC,

Differentiation of pyogenic hepatic abscesses from malignant mimickers using multislice-based texture acquired from contrast-enhanced computed tomography

BACKGROUND： Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography（CECT）. The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers.METHODS： This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter（5 filter levels with sigma weighting ranging from 1.0 to 2.5）. We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with oneway ANOVA followed by Tukey honestly significant difference（HSD） test. Diagnostic performance was evaluated using the receiver operating characteristic（ROC） curve analysis.RESULTS： There were significant differences in entropy and uniformity at all sigma weightings（P〈0.001） among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings（P=0.002-0.006）. Tukey HSD testshowed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers（P=0.000-0.004）. Entropy（at a sigma 2.0 weighting） had the largest area under the ROC curve（0.888） in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64.CONCLUSION： Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.