FEASIBILITY STUDY OF AN ULTRASOUND CONTRAST AGENT(LEVOVIST) IN COLOR DOPPLER IMAGING OF LIVER NEOPLASMS

The purpose of this study was to determine the efficacy of using an ultrasound contrast agent(levovist)to enhance the color Doppler imaging of liver neoplasms.Thirty patients with hepatic tumors were enrolled in this study.After intravenous administration of levovist,the color Doppler signals of normal hepatic vessels were enhanced.In various hepatic tumors,the different patterns of tumor vascularity were observed,which had not been demonstrated in conventional non contrast color Doppler imaging.In 11 of 16 patients with hepatocarcinoma,additional color Doppler signals were observed in the central part of the tumors.On the contrary,3 patients with metastatic liver lesions the enhanced color Doppler signals appear only at the peripheral of tumors.A typical rim like color enhancement was seen in 2 of the 3 cases.In six patients with hepatic hemangiomas contrast enhanced color Doppler imaging demonstrated the blood vessels at the margin of the neoplasms.Contrast enhanced color Doppler imaging improves the visualization of the hepatic neoplasm vascularity.This technique holds great promise for detecting small liver tumors and differentiating hepatic neoplasms.

Current update on imaging for pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms(panNEN)are a heterogeneous group of tumors with differing pathological,genetic,and clinical features.Based on clinical findings,they may be categorized into functioning and nonfunctioning tumors.Adoption of the 2017 World Health Organization classification system,particularly its differentiation between grade 3,well-differentiated pancreatic neuroendocrine tumors(panNET)and grade 3,poorly-differentiated pancreatic neuroendocrine carcinomas(panNEC)has emphasized the role imaging plays in characterizing these lesions.Endoscopic ultrasound can help obtain biopsy specimen and assess tumor margins and local spread.Enhancement patterns on computed tomography(CT)and magnetic resonance imaging(MRI)may be used to classify panNEN.Contrast enhanced MRI and diffusion-weighted imaging have been reported to be useful for characterization of panNEN and quantifying metastatic burden.Current and emerging radiotracers have broadened the utility of functional imaging in evaluating panNEN.Fluorine-18 fluorodeoxyglucose positron emission tomography(PET)/CT and somatostatin receptor imaging such as Gallium-681,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid–octreotate PET/CT may be useful for improved identification of panNEN in comparison to anatomic modalities.These new techniques can also play a direct role in optimizing the selection of treatment for individuals and predicting tumor response based on somatostatin receptor expression.In addition,emerging methods of radiomics such as texture analysis may be a potential tool for staging and outcome prediction in panNEN,however further investigation is required before clinical implementation.

Diffusion weighted imaging in the liver

Diffusion weighted magnetic resonance imaging (DWI) is an imaging technique which provides tissue contrast by the measurement of diffusion properties of water molecules within tissues. Diffusion is expressed in an apparent diffusion coefficient (ADC), which reflects the diffusion properties unique to each type of tissue. DWI has been originally used in neuroradiology. More recently, DWI has increasingly been used in addition to conventional unenhanced and enhanced magnetic resonance imaging (MRI) in other parts of the body. The reason for this delay was a number of technical problems inherent to the technique, making DWI very sensitive to artifacts, which had to be overcome. With assessment of ADC values, DWI proved to be helpful in characterization of focal liver lesions. However, DWI should always be used in conjunction to conventional MRI since there is considerable overlap between ADC values of benign and malignant lesions. DWI is useful in the detection of hepatocellular carcinoma in the cirrhotic liver and detection of liver metastases in oncological patients. In addition, DWI is a promising tool in the prediction of tumor responsiveness to chemotherapy and the follow-up of oncological patients after treatment, as DWI may be capable of detecting recurrent disease earlier than conventional imaging.This review focuses on the most common applications of DWI in the liver.

Quantification of angiogenesis by CT perfusion imaging in liver tumor of rabbit

BACKGROUND:Tumor angiogenesis is essential for primary and metastatic tumor growth.Computed tomography perfusion(CTP)is a new imaging method,made possible by the recent development of fast CT scanners and improved data analysis techniques,which allows measurement of the physiologic and hemodynamic properties of tissue vasculature.This study aimed to evaluate CTP in the quantification of angiogenesis and to assess the relationship between tissue perfusion parameters and microvascular density(MVD)and vascular endothelial growth factor(VEGF),attempting to detect the physiologic properties of angiogenesis.METHODS:Sixteen rabbits with VX2 liver tumors underwent multi-slice CT perfusion(MSCTP)on day 14 after tumor inoculation.CTP parameters included hepatic blood flow(HBF),hepatic blood volume(HBV),mean transit time(MTT),permeability of capillary vessel surface(PS),hepatic artery index(HAI),hepatic artery perfusion(HAP),and hepatic portal perfusion(HPP).The border of the tumor was stained with CD34 and VEGF immunohistochemical stains,and MVD was measured by anti-CD34.Then,CTP parameters were determined whether they were correlated with MVD and VEGF using Pearson’s correlation coefficient.RESULTS:The positive expression of MVD was different in the center and border of the tumor(P【0.01).There was a positive correlation between MVD and VEGF in the border(P【0.05).As more VEGF was expressed,the number of microvessels increased.Correlation analyses were also made between the perfusion parameters and MVD and VEGF in the border of the tumor.HBF,PS,HAI,and HAP values were positively correlated with MVD and VEGF(P【0.05),HPP was negatively correlated with MVD and VEGF(P【0.01),and HBV and MTT values were not correlated with MVD and VEGF(P】0.05).CONCLUSIONS:Significant correlations were found between perfusion parameters and MVD and VEGF.Therefore,MSCTP can be used to evaluate tumor angiogenesis in vivo.

Magnetic resonance imaging of the liver:New imaging strategies for evaluating focal liver lesions

The early detection of focal liver lesions,particularly those which are malignant,is of utmost importance.The resection of liver metastases of some malignancies(including colorectal cancer)has been shown to improve the survival of patients.Exact knowledge of the number,size,and regional distribution of liver metastases is essential to determine their resectability.Almost all focal liver lesions larger than 10 mm are demonstrated with current imaging techniques but the detection of smaller focal liver lesions is still relatively poor.One of the advantages of magnetic resonance imaging(MRI)of the liver is better soft tissue contrast(compared to other radiologic modalities),which allows better detection and characterization of the focal liver lesions in question.Developments in MRI hardware and software and the availability of novel MRI contrast agents have further improved the diagnostic yield of MRI in lesion detection and characterization.Although the primary modalities for liver imaging are ultrasound and computed tomography,recent studies have suggested that MRI is the most sensitive method for detecting small liver metastatic lesions,and MRI is now considered the pre-operative standard method for diagnosis.Two recent developments in MRI sequences for the upper abdomen comprise unenhanced diffusion-weighted imaging(DWI),and keyhole-based dynamic contrast-enhanced(DCE)MRI(4D THRIVE).DWI allows improved detection(b=10 s/mm2)of small(<10 mm)focal liver lesions in particular,and is useful as a road map sequence.Also,using higher b-values,the calculation of the apparent diffusion coefficient value,true diffusion coefficient,D,and the perfusion fraction,f,has been used for the characterization of focal liver lesions.DCE 4D THRIVE enables MRI of the liver with high temporal and spatial resolution and full liver coverage.4D THRIVE improves evaluation of focal liver lesions,providing multiple arterial and venous phases,and allows the calculation of perfusion parameters using pharmacokinetic models.4D THRIVE has potential benefits in terms of detection,characterization and staging of focal liver lesions and in monitoring therapy.

Benign focal liver lesions:The role of magnetic resonance imaging

Liver lesions are common findings in radiologists’daily routine.They are a complex category of pathology that range from solitary benign lesions to primary liver cancer and liver metastases.Benign focal liver lesions can arise from different liver cell types:Epithelial(hepatocytes and biliary cells)and nonepithelial(mesenchymal cells).Liver magnetic resonance imaging(MRI)is a fundamental radiological method in these patients as it allows with its multiparametric approach optimal non-invasive tissue characterization.Furthermore,advanced liver MRI techniques such as diffusion-weighted imaging and hepatobiliary contrast agents have improved the detection of focal liver lesions and can be highly effective in differentiating pseudotumor from tumors,as well as benign from malignant lesions,and can also be used for differential diagnosis.Although histological examination can be useful in making a definitive diagnosis,MRI is an important modality in the diagnosis of liver lesions with a significant impact on patient care.This aim of this review is to provide a comprehensive overview of benign liver lesions on MRI.

Prognostication and response assessment in liver and pancreatic tumors:The new imaging

Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations.Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography(PET)CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging,therefore these techniques could be used also for posttreatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart frommolecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations,prognostic stratification and post-treatment monitoring.

Hepatobiliary phases in magnetic resonance imaging using liverspecific contrast for focal lesions in clinical practice

BACKGROUND Challenging lesions,difficult to diagnose through non-invasive methods,constitute an important emotional burden for each patient regarding a still uncertain diagnosis(malignant x benign).In addition,from a therapeutic and prognostic point of view,delay in a definitive diagnosis can lead to worse outcomes.One of the main innovative trends currently is the use of molecular and functional methods to diagnosis.Numerous liver-specific contrast agents havebeen developed and studied in recent years to improve the performance of liver magnetic resonance imaging(MRI).More recently,one of the contrast agents introduced in clinical practice is gadoxetic acid(gadoxetate disodium).AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions(FLL)in clinical practice.METHODS Overall,302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL.Two radiologists independently reviewed the MRI exams using four stages,and categorized them on a 6-point scale,from 0(lesion not detected)to 5(definitely malignant).The stages were:stage 1-images without contrast,stage 2-addition of dynamic phases after contrast(analogous to usual extracellular contrasts),stage 3-addition of hepatobiliary phase after 10 min(HBP 10’),stage 4-hepatobiliary phase after 20 min(HBP 20’)in addition to stage 2.RESULTS The interobserver agreement was high(weighted Kappa coefficient:0.81-1)at all stages in the characterization of benign and malignant FLL.The diagnostic weighted accuracy(Az)was 0.80 in stage 1 and was increased to 0.90 in stage 2.Addition of the hepatobiliary phase increased Az to 0.98 in stage 3,which was also 0.98 in stage 4.CONCLUSION The hepatobiliary sequences improve diagnostic accuracy.With growing potential in the era of precision medicine,the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.

Magnetic resonance imaging of portal vein invasion in hepatocellular carcinoma:A corroboration of 25 cases

AIMS Pre-operatively to assess tumor thrombus as- sociated with hepatocellular carcinoma in the portal vein. METHEDS Twenty-five patients diagnosed as hav- ing thrombus due to hepatocellular carcinoma were corroborated. MR imaging was perfomed with a 1.0T superconducting magnetic system. Both T1 and T2 weighed images and FLASH sequences were obtained in transverse plane. Additional FLASH images were ob- tained in coronal plane. RESULTS Thrombus in portal vein had a signal in- tensity similar to that of the main tumors. Intrinsic por- tal vein thrombus was in 16 patients. Six cases showed occlusive thrombus. Diffusely narrow portal branches were found in 3 patients. Portal venous thrombus showed an area of signal intensity which was replacing the normal flow void in the portal vein and showed a stumpy portal vein,irregular stenosis of portal vein and the formation of vascular net. CONCLUSION MRI was more sensitive and specific and a noninvasive method in detection of portal tumor thrombus used jointly with spin ech (SE) and gradient echo (GRE) techniques.

Contrast-enhanced multiple-phase imaging features in hepatic epithelioid hemangioendothelioma

AIM： To investigate and review the contrast-enhanced multiple-phase computed tomography （CEMP CT） and magnetic resonance imaging （MRI） findings in patients with pathologically confirmed hepatic epithelioid hemangioendothelioma （HEHE）. METHODS： Findings from imaging examinations in 8 patients （5 women and 3 men） with pathologically confirmed HEHE were retrospectively reviewed （CT images obtained from 7 patients and MR images obtained from 6 patients）. The age of presentation varied from 27 years to 60 years （average age 39.8 years）. RESULTS： There were two types of HEHE： multifocal type （n = 7） and diffuse type （n = 1）. Tn the multifocal-type cases, there were 74 lesions on CT and 28 lesions on MRI with 7 lesions found with diffusion weighted imaging; 18 （24.3%） of 74 lesions on plain CT and 26 （92.9%） of 28 lesions on pre-contrast MRI showed the target sign. On CEMP CT, 28 （37.8%） of 74 lesions appeared with the target sign and a progressive-enhancement rim and 9 （12.2%） of 74 lesions displayed progressive enhancement, maintaining a state of persistent enhancement. On CEMP MRI, 27 （96.4%） of 28 lesions appeared with the target sign with a progressive-enhancement rim and 28 （100%） of 28 lesions displayed progressive-enhancement, maintaining a state of persistent enhancement. In the diffuse-type cases, an enlarged liver was observed with a large nodule appearing with persistent enhancement on CEMP CT and MRI. CONCLUSION： The most important imaging features of HEHE are the target sign and/or progressive en- hancement with persistent enhancement on CEMP CT and MRI. MRI is advantageous over CT in displaying these imaging features.

Imaging of bone metastasis: An update

Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bone and describes the available imaging methods to diagnose bone metastasis and monitor response to treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques whichfuse morphological and functional data are the most sensitive and specific, and positron emission tomography(PET)/computed tomography and PET/magnetic resonance imaging will almost certainly continue to evolve and become increasingly important in this regard.

Efficacy of texture analysis of pre-operative magnetic resonance imaging in predicting microvascular invasion in hepatocellular carcinoma

BACKGROUND Presence of microvascular invasion(MVI)indicates poorer prognosis postcurative resection of hepatocellular carcinoma(HCC),with an increased chance of tumour recurrence.By present standards,MVI can only be diagnosed postoperatively on histopathology.Texture analysis potentially allows identification of patients who are considered‘high risk’through analysis of pre-operative magnetic resonance imaging(MRI)studies.This will allow for better patient selection,improved individualised therapy(such as extended surgical margins or adjuvant therapy)and pre-operative prognostication.AIM This study aims to evaluate the accuracy of texture analysis on pre-operative MRI in predicting MVI in HCC.METHODS Retrospective review of patients with new cases of HCC who underwent hepatectomy between 2007 and 2015 was performed.Exclusion criteria:No preoperative MRI,significant movement artefacts,loss-to-follow-up,ruptured HCCs,previous hepatectomy and adjuvant therapy.Fifty patients were divided into MVI(n=15)and non-MVI(n=35)groups based on tumour histology.Selected images of the tumour on post-contrast-enhanced T1-weighted MRI were analysed.Both qualitative(performed by radiologists)and quantitative data(performed by software)were obtained.Radiomics texture parameters were extracted based on the largest cross-sectional area of each tumor and analysed using MaZda software.Five separate methods were performed.Methods 1,2 and 3 exclusively made use of features derived from arterial,portovenous and equilibrium phases respectively.Methods 4 and 5 made use of the comparatively significant features to attain optimal performance.RESULTS Method 5 achieved the highest accuracy of 87.8%with sensitivity of 73%and specificity of 94%.CONCLUSION Texture analysis of tumours on pre-operative MRI can predict presence of MVI in HCC with accuracies of up to 87.8%and can potentially impact clinical management.

Mucinous cystic neoplasm of the liver: A case report

BACKGROUND Mucinous cystic neoplasm of the liver(MCN-L)is a cyst-forming epithelial neoplasm.The most distinguishing feature is the ovarian-type subepithelial stroma on pathological examination.CASE SUMMARY An abdominal ultrasound incidentally revealed a liver tumor in a 32-year-old woman.Physical and laboratory examination results did not reveal any abnormalities.Enhanced abdominal computed tomography(CT)revealed a cystic space measuring 7.2 cm×5.4 cm in the liver.Subsequent CT showed an increase in tumor size.Thus,we performed surgical resection of the tumor and gallbladder.Postoperative histopathological examination confirmed the diagnosis of MCN-L.At the 6-mo of follow-up,no recurrence was observed on ultrasound or CT.CONCLUSION Since preoperative diagnosis of MCN-L is difficult,active surgery is recommended and helpful for the diagnosis and treatment of MCN-L.

The Value of In-Phase and Opposed-Phase T1-Weighted Breath-Hold FLASH Sequences for Hepatic Imaging

The value of the combined in-phase (IP) and opposed-phase (OP) T1-weighted (T1-W) breath-hold FLASH sequences for hepatic imaging, especially for fat content, was evaluated. Non- contrast-enhanced IP and OP T1-W GRE breath-hold images were obtained in 76 patients refereed for abdominal MRI at 1. 5T. 76 patients were divided into three groups for analysis: (1) liver with- out mass (n=8); (2) liver with hepatoma (n=34); (3) liver with haemangioma or cyst (n=34). Liver/spleen and liver/lesion signal-to-noise (SNR) and contrast-to-noise ratio (CNR) were assessed for lesion detection. Images between IP and OP sequences were compared quantitatively. The results showed that there was not statistically significant difference in liver/spleen and liver/lesion SNR be- tween IP and OP sequences. In the patients with fatty infiltration, the OP sequences yielded substan- tially lower values for liver/spleen and liver/lesion SNR than those of the IP sequences. Further- more, OP imaging showed fatty infiltration in 14 cases and demonstrated hyperintense peritumor rim in 4 cases. In 14 cases of fatty infiltration, many lesions were identified using IP images. The use of IP and OP GRE sequences provides complementary diagnostic information for hepatic lesions and fat content. Focal hepatic lesions may be obscured in the setting of fatty infiltration if only OP sequences are employed. A complete assessment of the liver with MR should include both IP and OP imaging.

Diagnostic value of the fluoroscopic triggering 3D LAVA technique for primary liver cancer

BACKGROUND: Primary liver cancer (PLC) is one of the common malignant tumors. Liver acquisition with acceleration volume acquisition (LAVA), which allows simultaneous dynamic enhancement of the hepatic parenchyma and vasculature imaging, is of great help in the diagnosis of PLC. This study aimed to evaluate application of the fluoroscopic triggering 3D LAVA technique in the imaging of PLC and liver vasculature. METHODS: The clinical data and imaging findings of 38 adults with PLC (22 men and 16 women; average age 52 years), pathologically confirmed by surgical resection or biopsy, were collected and analyzed. All magnetic resonance images were obtained with a 1.5-T system (General Electrics Medical Systems) with an eight-element body array coil and application of the fluoroscopic triggering 3D LAVA technique. Overall image quality was assessed on a 5-point scale by two experienced radiologists. All the nodules and blood vessel were recorded and compared. The diagnostic accuracy and feasibility of LAVA were evaluated. RESULTS: Thirty-eight patients gave high quality images of 72 nodules in the liver for diagnosis. The accuracy of LAVA was 97.2% (70/72), and the coincidence rate between the extent of tumor judged by dynamic enhancement and pathological examination was 87.5% (63/72). Displayed by the maximum intensity projection reconstruction, nearly all cases gave satisfactory images of branches III and IV of the hepatic artery. Furthermore, small early-stage enhancing hepatic lesions and the parallel portal vein were also well displayed. CONCLUSIONS: Sequence of LAVA provides good multi-phase dynamic enhancement scanning of hepatic lesions. Combined with conventional scanning technology, LAVA effectively and safely displays focal hepatic lesions and the relationship between tumor and normal tissues, especially blood vessels. (Hepatobiliary Pancreat Dis Int 2010; 9: 159-163)

Perivascular epithelioid cell tumor of the liver:A report of two cases and review of the literature

Perivascular epithelioid cell tumor (PEComa) is a rare tumor which arises from mesenchymal tissues. It is predominant in the uterus,but very rare in the liver. To the best of our knowledge,less than 5 cases of PEComa of the liver have been reported. Herein we present two pathologically proven cases of PEComa of the liver,retrospectively analyze their clinical and imaging features,and review the literature.

CT assessment of liver hemodynamics in patients with hepatocellular carcinoma after argon-helium cryoablation

BACKGROUND:Assessment of tumor response after argonhelium cryoablation is critical in guiding future therapy for unresectable hepatocellular carcinoma.This study aimed to evaluate liver hemodynamics in hepatocellular carcinoma after argon-helium cryoablation with computed tomography perfusion.METHODS:The control group comprised 40 volunteers without liver disease.The experimental group was composed of 15 patients with hepatocellular carcinoma treated with argon-helium cryoablation.Computed tomography perfusion parameters were measured:hepatic blood flow,hepatic blood volume,mean transit time,permeability of capillary vessel surface,hepatic arterial fraction,hepatic arterial perfusion,and hepatic portal perfusion.RESULTS:After treatment,in the tumor foci,permeability of capillary vessel surface was higher,and hepatic blood flow,hepatic blood volume,hepatic arterial fraction,and hepatic arterial perfusion values were lower(P【0.05).In the liver parenchyma surrounding the tumor,hepatic arterial perfusion was significantly lower(P【0.05);however,there was no significant difference in hepatic blood flow,hepatic blood volume,mean transit time,permeability of capillary vessel surface,hepatic arterial fraction,or hepatic portal perfusion(P】0.05).CONCLUSION:Computed tomography perfusion can evaluate tumor response after argon-helium cryoablation.

Detection and differentiation of early hepatocellular carcinoma from cirrhosis using CT perfusion in a rat liver model

BACKGROUND： Functional imaging such as CT perfusion can detect morphological and hemodynamic changes in he- patocellular carcinoma （HCC）. Pre-carcinoma and early HCC nodules are difficult to differentiate by observing only their hemodynamics changes. The present study aimed to investi- gate hemodynamic parameters and evaluate their differential diagnostic cut-off between pre-carcinoma and early HCC nodules using CT perfusion and receiver operating characteristic （ROC） curves. METHODS： Male Wistar rats were randomly divided into control （n=20） and experimental （n=70） groups. Diethylnitrosamine （DEN） was used to induce pre-carcinoma and early HCC nodules in the experimental group. Perfusion scanning was carried out on all survival rats discontinuously from 8 to 16 weeks. Hepatic portal perfusion （HPP）, hepatic arterial fraction （HAF）, hepatic arterial perfusion （HAP）, hepatic blood volume （HBV）, hepatic blood flow （HBF）, mean transit time （MTT） and permeability of capillary vessel surface （PS） data were provided by mathematical deconvolution model. The perfusion parameters were compared among the three groups of rats （control, pre-carcinoma and early HCC groups） using the Kruskal-Wallis test and analyzed with ROC curves. Histological examination of the liver tissues with hematoxylin and eosin staining was performed after CT scan.RESULTS： For HPP, HAF, HBV, HBF and MTT, there were significant differences among the three groups （P〈0.05）. HAF had the highest areas under the ROC curves： 0.80 （control vs pre-carcinoma groups） and 0.95 （control vs early HCC groups） with corresponding optimal cut-offs of 0.37 and 0.42, respectively. The areas under the ROC curves for HPP was 0.79 （control vs pre-carcinoma groups） and 0.92 （control vs early HCC groups） with corresponding optimal cut-offs of 136.60 mL/min/100 mg and 108.47 mL/min/100 mg, respectively. CONCLUSIONS： CT perfusion combined with ROC curve analysis is a new diagnosis model for distinguishing between pre-carcinoma and early HCC nodules. HAF and HPP are the ideal reference indices.

Application of radionuclide imaging to hepatic impact injury in rabbits

Objective: To investigate the role and clinical value of radionuclide imaging in hepatic impact injuries in rabbits. Methods: Rabbits were experimentally impacted on the liver with BIM IV bio impact machine. Liver imaging was performed with 99m Tc labeled sodium phytate. Liver blood pool imaging was performed with 99m Tc stannous pyrophosphate labeled red blood cells. The results of radionuclide imaging were compared with the anatomic results. Results: There was significant difference between the images of the injured liver and the control. Radio diminution and defect were shown in the injured liver areas. Various sorts of abnormal radioactivity distribution were observed with hepatic blood pool imaging. The results of the liver imaging and liver blood pool imaging were accorded with the results of the anatomic findings. Conclusions: Radionuclide imaging may well display the changes of hepatocellular structures and functions after injury, which is valuable in locating the concrete injured position and differentiating the injured degrees of liver.

Perioperative liver and spleen elastography in patients without chronic liver disease

AIM To investigate changes in hepatic and splenic stiffness in patients without chronic liver disease during liver resection for hepatic tumors.METHODS Patients scheduled for liver resection for hepatic tumors were considered for enrollment. Tissue stiffness measurements on liver and spleen were conducted before and two days after liver resection using point shear-wave elastography. Histological analysis of the resected liver specimen was conducted in all patients and patients with marked liver fibrosis were excluded from further study analysis. Patients were divided into groups depending on size of resection and whether they had received preoperative chemotherapy or not. The relation between tissue stiffness and postoperative biochemistry was investigated. RESULTS Results are presented as median(interquartile range). 35 patients were included. The liver stiffness increased in patients undergoing a major resection from 1.41(1.24-1.63) m/s to 2.20(1.72-2.44) m/s(P = 0.001). No change in liver stiffness in patients undergoing a minor resection was found [1.31(1.15-1.52) m/s vs 1.37(1.12-1.77) m/s, P = 0.438]. A major resection resulted in a 16%(7%-33%) increase in spleen stiffness, more(P = 0.047) than after a minor resection [2(-1-13) %]. Patients who underwent preoperative chemotherapy(n = 20) did not differ from others in preoperative right liver lobe [1.31(1.16-1.50) vs 1.38(1.12-1.56) m/s, P = 0.569] or spleen [2.79(2.33-3.11) vs 2.71(2.37-2.86) m/s, P = 0.515] stiffness. Remnant liver stiffness on the second postoperative day did not show strong correlations with maximum postoperative increase in bilirubin(R^2 = 0.154, Pearson's r = 0.392, P = 0.032) and international normalized ratio(R^2 = 0.285, Pearson's r = 0.534, P = 0.003). CONCLUSION Liver and spleen stiffness increase after a major liver resection for hepatic tumors in patients without chronic liver disease.