Outcomes of follow-up CT for small (5-10-mm) arterial enhancing nodules in the liver and risk factors for developing hepatocellular carcinoma in a surveillance population
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea. European Radiology
(Impact Factor: 4.01).
10/2010; 20(10):2397-404. DOI: 10.1007/s00330-010-1810-y
To evaluate the outcomes of small (5-10 mm), arterially enhancing nodules (SAENs) shown exclusively at the hepatic arterial phase of CT in a hepatocellular carcinoma (HCC) surveillance population and to determine risk factors for developing HCC.
The study population included 112 patients (male:female = 100:12; aged 36-92 years) with 175 SAENs who were at risk of HCC. We evaluated serial changes during follow-up (1.4-41.8 months, mean 35.7 months) and analysed the initial CT findings of SAENs and the accompanying lesions to elucidate the risk factors for HCC development.
Of 175 SAENs, 101(57.7%) disappeared and 34(19.4%) persisted. Forty SAENs (22.9%) became HCC in 33 patients (29.5%). Presence of HCC treatment history (p = 0.005, risk ratio = 7.429), a larger size of SAEN (p = 0.003, risk ratio = 1.630), presence of coexistent HCC (p = 0.021, risk ratio = 3.777) and absence of coexistent typical arterioportal shunts (p = 0.003, risk ratio = 4.459) turned out to be independently significant risk factors for future development of HCC.
SAENs were frequently seen in an HCC surveillance population and have a 22.9% probability of becoming HCC on a per-lesion basis. Risk increased particularly when the lesion was associated with a previous or concurrent HCC, a large size or found without a coexistent typical arterioportal shunt.
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ABSTRACT: The purpose of our study was to determine the value of adding delayed phase imaging to dual-phase helical CT for the detection of hepatocellular carcinoma.
One hundred thirteen patients with 131 hepatocellular carcinomas underwent triple-phase helical CT. The diagnosis was established by pathologic examination after surgical resection in all patients. For triple-phase helical CT, hepatic arterial, portal venous, and delayed phase scanning began 30, 60, and 180 sec, respectively, after the injection of 120 mL of iodinated contrast material. Dual-phase helical CT excluding delayed phase and triple-phase helical CT images were reviewed independently by three radiologists on a segment-by-segment basis. Diagnostic accuracy was assessed using receiver operating characteristic analysis in 330 resected segments. Sensitivities and specificities were calculated. The value of the delayed phase images in the characterization of hepatocellular carcinoma was also assessed.
The diagnostic accuracy of triple-phase helical CT including delayed phase (area under the curve [A(z)], 0.973) was significantly higher than that of dual-phase helical CT (A(z), 0.954). The mean sensitivity of triple-phase CT (89%) was also significantly higher than that of dual-phase CT (86%). The mean specificities of triple-phase CT (99%) and dual-phase CT (99%) were equal. Delayed phase images were helpful in the characterization of hepatocellular carcinoma in 14% of patients.
The addition of delayed phase imaging to dual-phase helical CT is valuable for the detection and characterization of hepatocellular carcinoma.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: Recently, Gadoxetic acid (Gd-EOB-DTPA; Primovist®; Bayer Schering Pharma), a tissue-specific contrast material, has been used for clinical MR imaging. This agent is a biphasic hepatobiliary contrast agent because it behaves as both an extracellular and a hepatocyte-specifi c agent as it undergoes both renal and biliary excretion. Up to 50% of the injected dose is taken up into normal hepatocytes due to the presence of the lipophilic ethoxybenzyl group in its chemical structure. As such, dynamic imaging can be performed using this agent for the evaluation of hemodynamic perfusion or status and for hepatobiliary phase imaging (10 to 20 minutes after injection) for the evaluation of functional status. Compared to extracellular contrast materials, Gadoxetic acid-enhanced magnetic resonance imaging (MRI) provides comparable arterial enhancement and prominent venous washout of hepatocellular carcinoma (HCC) during dynamic imaging. Additional hepatobiliary phase images are useful for the detection of small lesions that are not readily visible during dynamic imaging. Current evidence and experience suggest that Gadoxetic acid-enhanced MRI will improve the accuracy of HCC imaging diagnosis by allowing better characterization of hypovascular lesions and better differentiation of small arterial enhancing lesions as well as by providing improved preoperative staging accuracy. Therefore, with the aid of Gadoxetic acid-enhanced MRI, very early HCC will be more commonly diagnosed, with patient treatment occurring in earlier stages of the disease.
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ABSTRACT: Abnormalities of the portal venous system are a heterogeneous group of conditions that can cause substantial morbidity and mortality and may lead to complications during surgery or percutaneous interventions involving the portal venous system. High-resolution computed tomography, ultrasonography, and magnetic resonance imaging permit a comprehensive, noninvasive evaluation of the portal venous system, enabling the detection of both structural and functional abnormalities. However, an understanding of the embryologic development of the normal portal venous anatomy and anatomic variants is essential to accurately interpret the imaging findings. Knowledge of the characteristic appearances of abnormalities of the portal venous system allows a more confident diagnosis, permitting timely treatment and more informed guidance of surgical procedures and percutaneous interventions, which may lead to an improved outcome.
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