scholarly journals Is There a Place for Elastography in the Diagnosis of Hepatocellular Carcinoma?

2021 ◽  
Vol 10 (8) ◽  
pp. 1710
Author(s):  
Ana-Maria Ghiuchici ◽  
Ioan Sporea ◽  
Mirela Dănilă ◽  
Roxana Șirli ◽  
Tudor Moga ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Shear Wave Elastography ◽  
Abdominal Ultrasound ◽  
Liver Parenchyma ◽  
Final Diagnosis ◽  
Focal Liver Lesions ◽  
Additional Information ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced

Background and Aims: Elastography can provide information regarding tissue stiffness (TS). This study aimed to analyze the elastographic features of hepatocellular carcinoma (HCC) and the factors that influence intratumoral elastographic variability in patients with liver cirrhosis. Methods: This prospective study included 115 patients with liver cirrhosis and hepatocellular carcinoma evaluated between June 2016–November 2019. A total of 88 HCC nodules visualized in conventional abdominal ultrasound (US) met the inclusion criteria and underwent elastographic evaluation. Elastographic measurements (EM) were performed in HCC and liver parenchyma using VTQ (Virtual Touch Quantification), a point shear wave elastography (pSWE) technique. In all patients, we performed contrast-enhanced ultrasound (CEUS), and the final diagnosis of HCC was established by contrast-enhanced-CT or contrast-enhanced-MRI. Results: The mean VTQ values in HCCs were 2.16 ± 0.75 m/s. TS was significantly lower in HCCs than in the surrounding liver parenchyma 2.16 ± 0.75 m/s vs. 2.78 ± 0.92 (p < 0.001). We did not find significant differences between the first five and the last five EM, and the intra-observer reproducibility was excellent ICC: 0.902 (95% CI: 0.87–0.950). However, the tumor size, heterogeneity, and depth correlated with higher intralesional stiffness variability (p < 0.001). Conclusions: VTQ brings additional information for HCC characterization. Intra-observer reproducibility for both HCC and liver parenchyma was excellent. Knowing the stiffness of HCC’s might endorse an algorithm-based approach towards focal liver lesions (FLLs) in liver cirrhosis.

scholarly journals Role of Contrast-Enhanced Ultrasonography in Hepatocellular Carcinoma by Using LI-RADS and Ancillary Features: A Single Tertiary Centre Experience

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2232
Author(s):  
Adriana Ciocalteu ◽  
Sevastita Iordache ◽  
Sergiu Marian Cazacu ◽  
Cristiana Marinela Urhut ◽  
Sarmis Marian Sandulescu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Yield ◽  
High Specificity ◽  
Final Diagnosis ◽  
Focal Liver Lesions ◽  
Liver Imaging ◽  
Tertiary Centre ◽  
Contrast Enhanced ◽  
Contrast Enhanced Ultrasonography ◽  
Ancillary Features

Clinical utility of ancillary features (AFs) in contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®) is yet to be established. In this study, we assessed the diagnostic yield of CEUS LI-RADS and AFs in hepatocellular carcinoma (HCC). We retrospectively included patients with risk factors for HCC and newly diagnosed focal liver lesions (FLL). All lesions have been categorized according to the CEUS LI-RADS v2017 by an experienced sonographer blinded to clinical data and to the final diagnosis. From a total of 143 patients with 191 FLL, AFs favoring HCC were observed in 19.8% cases as hypoechoic rim and in 16.7% cases as nodule-in nodule architecture. From the total of 141 HCC cases, 83.6% were correctly classified: 57.4%- LR-5 and 26.2%- LR-4. In 9.21% cases, CEUS indicated LR-M; 2.12% cases- LR-3. The LR-5 category was 96.2% predictive (PPV) of HCC. LR-5 had 60.4% sensitivity and 93.6% specificity. PPV for primitive malignancy (LR-4 + LR-5) was 95.7%, with 88% sensitivity, 89.3% specificity and 88.4% accuracy for HCC. LR-4 category had 94.8% PPV and 26.2% sensitivity. CEUS LR4 + LR5 had 81,8% sensitivity for HCCs over 2 cm and 78.57% sensitivity for smaller HCCs. CEUS LR-5 remains an excellent diagnostic tool for HCC, despite the size of the lesion. The use of AFs might improve the overarching goal of LR-5 + LR-4 diagnosis of high specificity for HCC and exclusion of non-HCC malignancy.

scholarly journals Capabilities of contrast-enhanced ultrasound in the diagnosis of liver cirrhosis

2019 ◽  
Vol 3 (29) ◽  
pp. 26-30 ◽  
Author(s):  
A. V. Borsukov ◽  
A. O. Buyeverov ◽  
A. V. Tikhankova
Keyword(s):  
Liver Cirrhosis ◽  
Viral Hepatitis ◽  
Shear Wave ◽  
Ultrasound Examination ◽  
Reference Method ◽  
Shear Wave Elastography ◽  
Liver Parenchyma ◽  
Chronic Viral Hepatitis ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

The pilot results of the contrast — enhanced ultrasound (CEUS) application in the liver parenchyma assessment are presented in this article. 65 people aged 37 to 69 years were examined, 41 of them (63 %) with chronic viral hepatitis and 24 people (37 %) with established diagnosis of liver cirrhosis as the outcome of viral hepatitis. All patients underwent multiparametric ultrasound examination: ultrasound of the liver in B — mode, color Doppler’s mapping of liver vessels, 2D — Shear Wave Elastography (2DSWE) and CEUS. Liver biopsy and D — Shear Wave Elastography (2DSWE) were used as the reference method.

Evaluation of 2D- Shear Wave Elastography for Characterisation of Focal Liver Lesions

2017 ◽  
Vol 26 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Ludmila Gerber ◽  
Daniel Fitting ◽  
Kajana Srikantharajah ◽  
Nina Weiler ◽  
Georgia Kyriakidou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Shear Wave ◽  
Focal Nodular Hyperplasia ◽  
Shear Wave Elastography ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Nodular Hyperplasia ◽  
Glutamyl Transferase

Background & Aim: This is a prospective study for evaluation of 2D-shear wave elastography (2D-SWE) for characterisation and differentiation of benign und malignant focal liver lesions (FLLs).Methods: The patients referred to our ultrasound unit were prospectively included. B-mode ultrasound and 2D-SWE (Aixplorer® France) were performed for one FLL in each patient. Liver histology and/or contrast-enhanced imaging were used as a reference method.Results: 140 patients with FLL were included. SWE acquisitions failed in 24% of them. Therefore, 106 patients with FLL could be analysed, 42/106 with benign and 64/106 with malignant FLLs. The median stiffness for benign FLLs was 16.4 (2.1-71.9) kPa: 16.55 kPa for 18 focal nodular hyperplasia (FNH), 16.35 kPa for 18 hemangioma, 9.8 kPa for 3 focal fatty sparings (FFS), 8.9 kPa for 1 adenoma, 20 kPa for one regenerative node and 29 kPa for one cholangiofibroma, and for the malignant FLLs 36 (4.1-142.9) kPa: 44.8 kPa for 16 hepatocellular carcinoma (HCC), 70.7 kPa for 7 cholangiocarcinoma (CCC) and 29.5 kPa for the 41 metastasis (p<0.001). Malignant FLLs were significantly stiffer than benign FLLs (p<0.0001). Cholangiocarcinomas were the stiffest malignant FFLs with significantly higher values as compared to HCCs and metastases (p=0.033 and p=0.0079, respectively). No significant difference in stiffness could be observed between the different benign FLL entities. No significant difference was observed whether 2D-SWE included the whole FLL, the periphery or only the hardest area of the FLL.Conclusions: 2D-SWE provides further characterising information for interpretation of FLLs and may be useful at least in differentiation of CCCs and HCCs.Abbreviations: ALT: alanine aminotransaminase; AST: aspartate aminotransaminase; AUROC: area under the ROC; ARFI: acoustic radiation force impulse; CCC: cholangiocarcinoma; CECT: contrast-enhanced CT; CEMRI: contrast-enhanced MRI; CEUS: contrast-enhanced ultrasound; FFS: focal fatty sparing; FLL: focal liver lesion; FNH: focal nodular hyperplasia; GGT: gamma-glutamyl-transferase; HCC: hepatocellular carcinoma; NASH: nonalcoholic steatohepatitis; pSWE: point shear wave elastography; ROC: receiver-operating-characteristic; ROI: region of interest; 2D-SWE: 2D-shear wave elastography; TE: transient elastography.

scholarly journals Liver fibrosis staging by deep learning: a visual-based explanation of diagnostic decisions of the model

2021 ◽  
Author(s):  
Yunchao Yin ◽  
Derya Yakar ◽  
Rudi A. J. O. Dierckx ◽  
Kim B. Mouridsen ◽  
Thomas C. Kwee ◽  
...  
Keyword(s):  
Deep Learning ◽  
Liver Fibrosis ◽  
Liver Parenchyma ◽  
Ct Images ◽  
Fibrosis Stage ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Liver Surface ◽  
Fibrosis Staging

Abstract Objectives Deep learning has been proven to be able to stage liver fibrosis based on contrast-enhanced CT images. However, until now, the algorithm is used as a black box and lacks transparency. This study aimed to provide a visual-based explanation of the diagnostic decisions made by deep learning. Methods The liver fibrosis staging network (LFS network) was developed at contrast-enhanced CT images in the portal venous phase in 252 patients with histologically proven liver fibrosis stage. To give a visual explanation of the diagnostic decisions made by the LFS network, Gradient-weighted Class Activation Mapping (Grad-cam) was used to produce location maps indicating where the LFS network focuses on when predicting liver fibrosis stage. Results The LFS network had areas under the receiver operating characteristic curve of 0.92, 0.89, and 0.88 for staging significant fibrosis (F2–F4), advanced fibrosis (F3–F4), and cirrhosis (F4), respectively, on the test set. The location maps indicated that the LFS network had more focus on the liver surface in patients without liver fibrosis (F0), while it focused more on the parenchyma of the liver and spleen in case of cirrhosis (F4). Conclusions Deep learning methods are able to exploit CT-based information from the liver surface, liver parenchyma, and extrahepatic information to predict liver fibrosis stage. Therefore, we suggest using the entire upper abdomen on CT images when developing deep learning–based liver fibrosis staging algorithms. Key Points • Deep learning algorithms can stage liver fibrosis using contrast-enhanced CT images, but the algorithm is still used as a black box and lacks transparency. • Location maps produced by Gradient-weighted Class Activation Mapping can indicate the focus of the liver fibrosis staging network. • Deep learning methods use CT-based information from the liver surface, liver parenchyma, and extrahepatic information to predict liver fibrosis stage.

scholarly journals Delayed response to proton beam treatment of hepatocellular carcinoma

2020 ◽  
Vol 6 (1) ◽  
pp. 20180125
Author(s):  
Chee-Wai Cheng ◽  
Mitchell Machtay ◽  
Jennifer Dorth ◽  
Olga Sergeeva ◽  
Hangsheng Xia ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Ct Scan ◽  
Proton Beam ◽  
Arterial Phase ◽  
Delayed Response ◽  
Data Set ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Imaging Response

Hepatocellular carcinoma (HCC) has become one of the leading causes of cancer death worldwide. There has been anecdotal report regarding the effectiveness of proton beam treatment for HCC. In this pre-clinical investigation, the woodchuck model of viral hepatitis infection-induced HCC was used for proton beam treatment experiment. The radiopaque fiducial markers that are biodegradable were injected around the tumor under ultrasound guidance to facilitate positioning in sequential treatments. An α cradle mode was used to ensure reproducibility of animal positioning on the treatment couch. A CT scan was performed first for contouring by a radiation oncologist. The CT data set with contours was then exported for dose planning. Three fractionations, each 750 CcGyE, were applied every other day with a Mevion S250 passive scattering proton therapy system. Multiphase contrast-enhanced CT scans were performed after the treatment and at later times for follow-ups. 3 weeks post-treatment, shrinking of the HCC nodule was detected and constituted to a partial response (30% reduction along the long axis). By week nine after treatment, the nodule disappeared during the arterial phase of multiphase contrast-enhanced CT scan. Pathological evaluation corroborated with this imaging response. A delayed, but complete imaging response to proton beam treatment applied to HCC was achieved with this unique and clinically relevant animal model of HCC.

scholarly journals Metabolic Alterations Associated with Early-Stage Hepatocellular Carcinoma and Their Correlation with Aging and Enzymatic Activity in Patients with Viral Hepatitis-Induced Liver Cirrhosis: A Preliminary Study

2020 ◽  
Vol 9 (3) ◽  
pp. 765
Author(s):  
Chung-Man Moon ◽  
Sang Soo Shin ◽  
Suk Hee Heo ◽  
Yong Yeon Jeong
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Lactate Dehydrogenase ◽  
Enzymatic Activity ◽  
Viral Hepatitis ◽  
Potential Risk ◽  
Early Stage ◽  
Liver Parenchyma ◽  
Cirrhotic Liver ◽  
1H Mrs

Liver cirrhosis (LC) can develop hepatocellular carcinoma (HCC). However, noninvasive early diagnosis of HCCs in the cirrhotic liver is still challenging. We aimed to quantify the hepatic metabolites in normal control (NC), cirrhotic liver without HCC, cirrhotic liver with HCC (CLH), and early-stage HCC groups using proton magnetic resonance spectroscopy (1H-MRS) with a long echo-time (TE) and to assess the potential association between the levels of hepatic metabolites in these four groups and aging and enzymatic activity. Thirty NCs, 30 viral hepatitis-induced LC patients without HCC, and 30 viral hepatitis-induced LC patients with HCC were included in this study. 1H-MRS measurements were performed on a localized voxel of the normal liver parenchyma (n = 30) from NCs, cirrhotic liver parenchyma (n = 30) from LC patients without HCC, and each of the cirrhotic liver parenchyma (n = 30) and HCC (n = 30) from the same patients in the CLH group. Generalized estimating equations were used to evaluate potential risk factors for changes in metabolite levels. Potential associations between metabolite levels and age and serum enzymatic activities were assessed by correlation analysis. The levels of lactate+triglyceride (Lac+TG) and choline (Cho) in HCC were significantly higher compared to those in LC and CLH. A potential risk factor for changes in the Lac+TG and Cho levels was age, specifically 60–80 years of age. In particular, the Lac+TG level was associated with a high odds ratio of HCC in males aged 60–80 years. The Lac+TG and Cho concentrations were positively correlated with lactate dehydrogenase and alkaline phosphatase activities, respectively. Our findings suggested that 1H-MRS measurement with a long TE was useful in quantifying hepatic Lac+TG and Cho levels, where higher Lac+TG and Cho levels were most likely associated with HCC-related metabolism in the viral hepatitis-induced cirrhotic liver. Further, the level of Lac+TG in HCC was highly correlated with older age and lactate dehydrogenase activity.

scholarly journals Hepatocellular Carcinoma Is the Most Frequent Final Diagnosis of Focal Liver Lesions Identified in a Cross-Sectional Evaluation of Patients with Chronic Liver Disease in Saudi Arabia

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Adnan Agha ◽  
Manuele Furnari ◽  
Rafaat Morched Chakik ◽  
Mamdouh M. Abdulhadi Ali ◽  
Dib Alsaudi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Odds Ratio ◽  
Final Diagnosis ◽  
Liver Lesion ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Benign Lesions ◽  
Cross Sectional

Background. Hepatocellular carcinoma (HCC) is a frequent diagnosis in patients with chronic liver disease (CLD) and a newly identified liver lesion, although benign diseases may also be responsible for this finding. Objective. To evaluate the characteristics of focal liver lesions in a population of patients with CLD not under surveillance for HCC in the Middle East. Methods. We performed a cross-sectional study evaluating 77 patients with CLD and a focal liver lesion identified during ultrasonography. Patients’ characteristics were analyzed on the basis of the final diagnosis (HCC versus benign lesions). Results. The most frequent diagnosis was HCC (64.9%). These patients were older (median age 64 versus 55 years, P=0.003) and cirrhotics (80.0% versus 51.9%, P=0.018), with multinodular lesions (58.0% versus 29.6%, P=0.031) and portal vein thrombosis (24.0% versus 0%, P=0.001) compared to patients with benign lesions. Prevalence of elevated alpha-fetoprotein (>10 ng/mL) was similar in both groups (80.0% versus 88.9%, P=0.198). Cirrhosis (odds ratio: 3.283) and multinodularity (odds ratio: 2.898) were independently associated with HCC. Conclusions. HCC is the most common diagnosis in Middle-Eastern patients with CLD and a liver lesion identified outside HCC surveillance programs, especially in cirrhotic patients. In these patients, elevated alpha-fetoprotein does not differentiate HCC from benign lesions.

Sign in / Sign up

Export Citation Format

Share Document