R L Baron

University of Chicago, Chicago, IL, United States

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Publications (60)276.76 Total impact

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    ABSTRACT: The objective of this study was to assess the long-term natural history of focal confluent fibrosis in cirrhotic liver with CT. Two radiologists retrospectively reviewed in consensus 118 liver CT examinations in 26 patients (19 men, seven women; age range, 32-68 years; mean age, 50 years) performed over approximately 6 years. Helical CT scans were obtained before and 30-35 and 65-70 seconds after injection of 125-150 mL of contrast medium at a rate of 4-5 mL/s. Proof of cirrhosis was based on liver transplantation (n = 6), biopsy (n = 9), or imaging findings (n = 11). The number, location, and attenuation of fibrotic lesions and presence of trapped vessels were evaluated. Variation of hepatic retraction associated with the development of focal confluent fibrosis lesions was assessed using the ellipsoid volume formula and an arbitrary retraction index. Each radiologist identified 41 focal confluent fibrosis lesions. All lesions were identified by both radiologists. Twelve patients (46%) had a single lesion, 13 (50%) had two lesions, and one (4%) had three lesions. Thirty-four (83%) of 41 lesions were located in segment IV, VII, or VIII. Thirty-two lesions (78%) were hypoattenuating on unenhanced images, 25 lesions (61%) were hypoattenuating on hepatic arterial phase images, and 20 lesions (49%) were isoattenuating on portal venous phase images. Seven lesions (17%) were or became hyperattenuating at follow-up on portal venous phase images. Trapped vessels were found in six lesions (15%). The retraction index showed a significant increase over time (r = 0.423, p < or = 0.0001). The degree of capsule retraction associated with focal confluent fibrosis evolves with time and relates to the natural evolution of cirrhosis.
    American Journal of Roentgenology 06/2009; 192(5):1341-7. · 2.90 Impact Factor
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    ABSTRACT: Benign hepatic vascular neoplasms and vascular pseudolesions are commonly encountered in magnetic resonance (MR) imaging. Most of these benign lesions demonstrate not only arterial-phase hyperintensity, but also persistent enhancement on venous and delayed imaging, unlike most malignant hepatic masses. These features, along with other MR findings and morphological characteristics, may allow for more confident diagnosis and distinction from hepatic malignancy. The objective of our study was to illustrate the MR imaging findings of hepatic lesions that demonstrate both early arterial and sustained enhancement on hepatic venous and delayed phase.
    Journal of Computer Assisted Tomography 01/2007; 31(1):116-24. · 1.58 Impact Factor
  • Richard L Baron, Giuseppe Brancatelli
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    ABSTRACT: The ability of x-ray computed tomography (CT) to detect and characterize liver lesions has been one of the most studied issues in radiology during the past 20 years. Technological advances, combined with increased knowledge about the pathophysiological characteristics of these tumors, have dramatically increased the ability to detect and characterize large hepatocellular carcinomas (HCCs). Nonetheless, detection and characterization of early and small HCC lesions remains a difficult task. We review the imaging appearances of HCC on CT and discuss the sensitivity and specificity of computed tomographic imaging in screening patients with cirrhosis for HCC.
    Gastroenterology 12/2004; 127(5 Suppl 1):S133-43. · 12.82 Impact Factor
  • Vibhu Kapoor, Richard L Baron, Mark S Peterson
    American Journal of Roentgenology 03/2004; 182(2):451-8. · 2.90 Impact Factor
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    ABSTRACT: The purpose of our study was to determine the specificity of helical CT for depiction of hepatocellular carcinoma in a population of patients with cirrhosis. Single-detector helical CT screening was undertaken in 1329 patients with cirrhosis who were referred for transplantation. The patients underwent one or more helical CT examinations over 30 months and were followed up for an additional 19 months or until transplantation. We predominantly used unenhanced and biphasic contrast-enhanced techniques with infusions of 2.5-5.0 mL/sec. Four hundred thirty patients underwent transplantation within this period. Liver specimens were sectioned at 1-cm intervals, with direct comparison of imaging and pathologic findings and histologic confirmations of all lesions. Prospective preoperative helical CT reports were used for the primary data analysis. A retrospective unblinded review was undertaken to determine characteristics of false-positive lesions diagnosed as hepatocellular carcinoma. Thirty-five patients (8%) had false-positive diagnoses for hepatocellular carcinoma based on helical CT. Twenty of these patients (5%) showed hypoattenuating lesions seen during one of the three helical CT examination phases. Fifteen patients (3%) had hyperattenuating lesions seen during the arterial phase. Among the 15 hyperattenuating lesions, CT revealed the causes to be transient benign hepatic enhancement (n = 3), hemangiomas (n = 2), fibrosis (n = 2), peliosis (n = 1), volume averaging (n = 1), low-grade dysplastic nodule (n = 1), or undetermined (n = 5). Of the 20 hypoattenuating lesions, the causes were shown to be fibrosis (n = 8), focal fat (n = 4), infarcted regenerative nodules (n = 2), regenerative nodules (n = 1), fluid trapped at the dome of the liver (n = 1), hemangioma (n = 1), or undetermined (n = 3). Follow-up helical CT in 13 (72%) of 18 patients allowed a change in the diagnosis of hepatocellular carcinoma to a finding of no cancer present. Helical CT screening for hepatocellular carcinoma in patients with cirrhosis has a substantial false-positive detection rate. Although most of lesions were hypoattenuating, a few hyperenhancing arterial phase lesions were proven not to be hepatocellular carcinoma. An awareness of imaging characteristics and follow-up imaging can help radiologists avoid a mistaken diagnosis in many patients.
    American Journal of Roentgenology 05/2003; 180(4):1007-14. · 2.90 Impact Factor
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    ABSTRACT: An understanding of underlying biliary pathology and the corresponding subtle changes reflected at imaging can greatly improve imaging accuracy in evaluating the biliary tract. The optimal demonstration of biliary tract imaging findings requires attention to specific imaging and contrast techniques, regardless of the modality used.
    Radiologic Clinics of North America 01/2003; 40(6):1325-54. · 1.95 Impact Factor
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    ABSTRACT: OBJECTIVE: The purpose of our study was to assess the usefulness of mangafodipir trisodium-enhanced MR cholangiography for evaluating intrahepatic biliary anatomy of adult living liver donors and to correlate the results with intraoperative cholangiography. CONCLUSION: Mangafodipir trisodium-enhanced MR cholangiography accurately shows the biliary anatomy in the livers of donors. Noninvasive preoperative evaluation of the biliary anatomy in donor candidates is important for the detection of common anatomic variants that may require alternative graft-harvesting surgery.
    American Journal of Roentgenology 12/2002; 179(5):1281-6. · 2.90 Impact Factor
  • R L Baron, M S Peterson
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    ABSTRACT: The inherent distortion of the appearance of liver parenchyma by the underlying pathologic changes of cirrhosis can obscure and simulate malignancy at imaging. That hepatocellular carcinoma is the most common abdominal malignancy worldwide and occurs most often in patients with chronic liver disease and cirrhosis compounds this problem. Magnetic resonance (MR) imaging and, to a lesser extent, computed tomography (CT) can depict the underlying nodular and fibrotic changes in patients with cirrhosis, particularly when siderotic nodular regeneration is present. Application of state-of-the-art helical CT and MR imaging techniques has improved the ability to detect hepatocellular carcinoma in this population, but, even with these advances, fewer than 50% of small tumors are detected with either of these techniques in a screening population. Dynamic hepatic arterial-phase contrast material-enhanced imaging is essential with both CT and MR imaging to achieve even these levels of success. Benign lesions that simulate tumor tissue are encountered in many patients with cirrhosis and include focal fibrosis, infarcted regenerative nodules, arteriovenous shunts, hemangiomas, pseudoaneurysms, and focal transient hepatic enhancement. An awareness of the imaging characteristics of these lesions can help one avoid a mistaken diagnosis of hepatocellular carcinoma in many cases.
    Radiographics 11/2001; 21 Spec No:S117-32. · 2.79 Impact Factor
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    ABSTRACT: To compare the appearance of small hepatic hemangiomas at nonenhanced and contrast material-enhanced helical computed tomography (CT) with that of small (<3-cm) hypervascular malignant liver tumors and to evaluate the accuracy of multiphase helical CT for differentiating small hemangiomas from small hypervascular malignant tumors. Radiologists reviewed multiphase helical CT liver images in 86 patients with 37 hemangiomas and 49 malignant liver tumors. They evaluated lesion type and degree of enhancement for change from arterial to portal venous phase. They rated their confidence in the discrimination of hemangiomas from malignant tumors. At arterial phase CT, enhancement similar to aortic enhancement was observed in 19%-32% of hemangiomas and 0%-2% of malignant tumors; globular enhancement, in 62%-68% and 4%-12%, respectively. At portal venous phase CT, enhancement similar to blood pool enhancement was observed in 43%-54% of hemangiomas and 4%-14% of malignant tumors; globular enhancement, in 46%-49% and 0%-2%, respectively. For all readers and all phases of enhancement, the area under the receiver operating characteristic curves was 0.81-0.87, indicating that inherent accuracy of CT is high and that there was no significant difference (P >.28) in overall accuracy. Readers diagnosed hemangiomas with 47%-53% mean sensitivity with all enhancement phases and diagnosed malignant lesions with 95% mean specificity. Small hemangiomas frequently show atypical appearances at CT. Two-phase helical CT does not improve sensitivity but does improve specificity for differentiating hemangiomas from hypervascular malignant tumors.
    Radiology 06/2001; 219(3):699-706. · 6.34 Impact Factor
  • M S Peterson, R L Baron
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    ABSTRACT: Substantial recent technologic improvements in CT scanning, US scanning, and MR imaging, together with advances in the understanding of the optimal application of contrast administration techniques, have facilitated advances in radiologic imaging detection for HCC diagnosis. Despite a large number of earlier publications reporting a high sensitivity for imaging detection of HCC, more recent screening studies of large cirrhotic populations confirm that only 37% to 45% of HCC tumor nodules are detected by CT scanning, US scanning, or MR imaging. Future investigation will include efforts to improve the detection of small tumors and to characterize with greater specificity the spectrum of nodular changes that occur with cirrhosis. Although several small series have attempted to characterize cirrhotic nodules by evaluating the relative arterial or portal blood supply, these preliminary results require substantiation with larger series. Continued technologic advances such as multidetector helical CT scanning and new US and MR contrast agents under investigation may improve the imaging characterization of cirrhotic nodules.
    Clinics in Liver Disease 03/2001; 5(1):123-44. · 2.82 Impact Factor
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    ABSTRACT: To determine the prevalence of clinically unsuspected hepatocellular carcinoma (HCC) with advanced cirrhosis and assess the sensitivity of helical computed tomographic (CT) surveillance for tumor detection in these patients. Prospective direct correlation of CT findings with explanted liver specimen findings was performed in 430 transplant recipients with cirrhosis. The prevalence of clinically unsuspected HCC according to liver disease cause was evaluated. Serum alpha-fetoprotein (AFP) values in patients with and those without tumor were recorded. Prospective and retrospective CT tumor detection was evaluated with respect to CT technique and time from CT to transplantation. HCC was found in 59 (14%) of 430 transplant recipients without suspicion of tumor before referral for transplantation. HCC was most prevalent with hepatitis B (27%) and hepatitis C (22%). Serum AFP values were not sensitive for detection of most small tumors. With triphasic helical CT, the prospective and retrospective rates of identifying patients with tumor were 59% and 68%, respectively; the prospective and retrospective tumor nodule detection rates were 37% and 44%, respectively. Tumor detection rates were highest with CT performed within 67 days before transplantation. Clinically unsuspected HCC is most prevalent with cirrhosis secondary to hepatitis B or C, and, when evaluated at CT, is best detected with triphasic contrast material-enhanced helical imaging performed within 67 days before transplantation.
    Radiology 01/2001; 217(3):743-9. · 6.34 Impact Factor
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    ABSTRACT: The purpose of this study was to use hepatic arterial phase helical CT to assess tumor vascularity and predict the likelihood of response to transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Helical CT findings for 57 patients with hepatocellular carcinoma were classified into one of three patterns of vascularity on the basis of the degree of tumor or liver enhancement during the hepatic arterial phase. Cases in which hypervascular lesions predominated were classified as a type 1 pattern. Cases in which hypovascular lesions predominated were classified as a type 2 pattern. Patients were classified as responders or nonresponders on the basis of the changes of tumor size revealed on CT after three transcatheter arterial chemoembolization treatments. We classified the 57 patients as 37 responders (65%) and 20 nonresponders (35%). A statistically significant correlation between the type 1 hypervascular pattern and response to transcatheter arterial chemoembolization was seen; conversely, the type 2 hypovascular pattern correlated with nonresponse to transcatheter arterial chemoembolization (chi-square = 7.85, p = 0.02). Patients classified as responders lived significantly longer than those classified as nonresponders with 12-, 24-, and 36-month survival rates of 90%, 67%, and 36%, respectively, for responders and 70%, 17%, and 10%, respectively, for nonresponders. We found that patients who responded to transcatheter arterial chemoembolization had prolonged survival (p < 0.01). Response correlated closely with tumor vascularity as shown on hepatic arterial phase helical CT.
    American Journal of Roentgenology 12/2000; 175(6):1665-72. · 2.90 Impact Factor
  • T Kim, R L Baron, M A Nalesnik
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    ABSTRACT: OBJECTIVE. The purpose of this article is to present the imaging findings and correlative pathologic findings of infarcted regenerative nodules in the cirrhotic liver. CONCLUSION. Infarcted regenerative nodules exhibit a spectrum of imaging appearances in the cirrhotic liver and can resemble hypovascular hepatocellular carcinoma or other neoplasms on CT and MR imaging. Although uncommon, this abnormality must be included in the differential diagnosis of focal liver lesions in patients with cirrhosis, particularly in patients with a history of substantial gastrointestinal bleeding. Serial imaging may help differentiate these lesions from malignant tumors.
    American Journal of Roentgenology 11/2000; 175(4):1121-5. · 2.90 Impact Factor
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    ABSTRACT: To determine the relative frequency, incidence, and locations of metastases of hepatocellular carcinoma (HCC), correlate extrahepatic metastatic disease with intrahepatic tumor staging, and determine the computed tomographic (CT) manifestations of HCC metastases. CT findings in 403 consecutive patients with HCC at our institution since 1992 were reviewed retrospectively. One hundred forty-eight patients with extrahepatic metastatic HCC were identified, and the locations, sizes, and attenuation and enhancement characteristics of the lesions were recorded. A majority (128 [86%] of 148) of patients with extrahepatic HCC foci had either intrahepatic stage IVA tumor (112 [76%] patients) or an intrahepatic stage III tumor (16 [11%] patients) at the occurrence of metastases. The most frequent site of the first detectable metastasis was the lung (58 [39%] patients). Tabulation of all extrahepatic metastatic sites showed the most common to be the lung in 81 (55%) patients, the abdominal lymph nodes in 60 (41%) patients, and the bone in 41 (28%) patients. The lung, abdominal lymph nodes, and bone are the most common sites of extrahepatic metastatic HCC. Most extrahepatic HCC occurs in patients with advanced intrahepatic tumor stage (stage IVA). Incidental extrahepatic lesions at CT in patients with stage I or II intrahepatic HCC are unlikely to represent metastatic HCC.
    Radiology 10/2000; 216(3):698-703. · 6.34 Impact Factor
  • M S Peterson, R L Baron, S C Rankin
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    ABSTRACT: OBJECTIVE: The objective of our study was to identify multiphasic contrast-enhanced helical CT findings of angiosarcoma of the liver to determine whether this tumor could be confused with hemangioma of the liver. CONCLUSION: Angiosarcoma of the liver is a multifocal tumor with a variety of findings on multiphasic contrast-enhanced helical CT. None of the findings would usually be confused with the typical findings of hepatic hemangioma.
    American Journal of Roentgenology 08/2000; 175(1):165-70. · 2.90 Impact Factor
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    ABSTRACT: To compare the effectiveness of biphasic computed tomography (CT) and magnetic resonance (MR) imaging in the detection of pancreatic islet cell tumors. Retrospective quantitative, qualitative, and receiver operating characteristic analyses of biphasic CT and MR imaging were performed in 19 patients with 26 histopathologically proved islet cell tumors. Delayed arterial dominant-phase (AP) and portal venous-phase (PVP) biphasic CT was performed after the administration of contrast material. MR imaging included T1-weighted spin-echo (SE) and T2-weighted SE or fast SE imaging, fat-saturated T1-weighted SE imaging, dynamic contrast material-enhanced T1-weighted gradient-echo imaging, and delayed enhanced T1-weighted SE imaging with or without fat saturation. PVP CT and delayed enhanced T1-weighted MR imaging had the highest A(z) values (0.98 and 0.97, respectively; P <.05). Delayed enhanced T1-weighted MR imaging had the highest relative sensitivity (14-15 [74%-79%] of 19 lesions), followed by PVP CT (18-19 [69%-73%] of 26 lesions), AP CT (17-19 [65%-73%] of 26 lesions), fat-saturated T1-weighted MR imaging (eight to 10 [57%-71%] of 14 lesions), T2-weighted (16-17 [62%-65%] of 26 lesions), T1-weighted (15-18 [58%-69%] of 26 lesions) MR imaging, and dynamic MR imaging (nine [56%] of 16 lesions). Biphasic (especially PVP) CT and MR imaging have similar effectiveness in the detection of islet cell tumors if fat-saturated T1-weighted and delayed enhanced T1-weighted MR imaging are included.
    Radiology 08/2000; 216(1):163-71. · 6.34 Impact Factor
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    ABSTRACT: Cirrhosis, through the process of necrosis, fibrosis, regeneration, and malignant transformation, creates multiple focal benign and malignant hepatic masses. The detection and appearance of these masses varies with the severity of the cirrhotic process and the imaging technique used. Although some overlap exists in the imaging appearance of the benign and malignant masses, in most instances recognition of a few characteristic features will yield the correct diagnosis.
    American Journal of Roentgenology 12/1999; 173(5):1185-92. · 2.90 Impact Factor
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    American Journal of Roentgenology 11/1999; 173(4):1031-6. · 2.90 Impact Factor
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    ABSTRACT: To determine if there is a significant difference in the hepatic morphology depicted on computed tomographic (CT) scans in patients with end-stage cirrhosis caused by primary sclerosing cholangitis versus that in patients with end-stage cirrhosis caused by other factors. The frequency of five morphologic findings of the liver parenchyma and two intrahepatic biliary findings identified on CT scans in 36 patients with end-stage cirrhosis caused by primary sclerosing cholangitis were compared with the frequency of the same findings in 472 patients with end-stage cirrhosis caused by other factors. The morphologic findings were lobulation of the liver contour, atrophy of the lateral or posterior hepatic segments, hypertrophy of the caudate lobe, and pseudotumor of the caudate lobe. Lobulation, atrophy, and hypertrophy were subclassified as mild-moderate or severe. The biliary findings were ductal dilatation and calculi. Each of the 11 findings occurred more frequently (P < .05) in patients with primary sclerosing cholangitis than in the other 472 patients. Six findings occurred more frequently (P < .05) in patients with primary sclerosing cholangitis than in patients with cirrhosis caused by any other single agent. There is a significant difference in the hepatic morphology observed in patients with primary sclerosing cholangitis-induced end-stage cirrhosis versus that in patients with end-stage cirrhosis of other causes.
    Radiology 05/1999; 211(2):357-62. · 6.34 Impact Factor
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    ABSTRACT: The aim of the study was to define the clinical characteristics and outcome of patients found to have an undetected hepatocellular carcinoma (HCC) at liver transplantation. Patients who underwent liver transplantation and were found to have a hepatoma with a prior workup showing normal alpha-fetoprotein levels and no corresponding lesion on radiological evaluation were defined as having an undetected HCC. Detailed information was collected, and the last abdominal computed tomographic (CT) scan before transplantation was performed was retrospectively reviewed. Thirty-nine patients had a tumor that met the criteria for an undetected hepatoma. The most common causes for pretransplantation liver disease were hepatitis C virus (HCV) (49%) and alcohol use (28%). Tumor size was 2 cm or less in 85% of the patients, vascular invasion was detected in 31% of the patients, and tumor, node, metastasis (TNM) classification was stage I or II in 77% of the patients. Review of the last CT scan before transplantation showed that the lesion was evident in retrospect in only 15% of the patients. Thirty-two patients (82%) remained alive at the time of the study with a mean follow-up of 30 months. Metastatic HCC was detected in 1 patient 7 months after transplantation. There were no other tumor recurrences. Survival analysis showed no significant differences when tumor size, stage, presence of vascular invasion, or causes of pretransplantation liver disease were compared. Undetected HCCs represent a significant percentage of total hepatomas in patients undergoing liver transplantation. Most patients have small, early-stage tumors, but tumors greater than 2 cm or of advanced stage are also frequently found in this population. Overall and tumor-free survival appear to be favorable.
    Liver transplantation and surgery: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 12/1998; 4(6):477-82.

Publication Stats

2k Citations
276.76 Total Impact Points

Institutions

  • 2003–2004
    • University of Chicago
      • Department of Radiology
      Chicago, IL, United States
  • 1994–2001
    • University of Pittsburgh
      • Department of Radiology
      Pittsburgh, PA, United States
  • 1996
    • University of Texas Health Science Center at San Antonio
      • Department of Radiology
      San Antonio, TX, United States