What’s new in Liver Imaging – January 2021

1 year ago



Enhancement patterns of small hepatocellular carcinoma (≤ 30 mm) on contrast-enhanced ultrasound: Correlation with clinicopathologic characteristics.

Fan PL, Ding H, Mao F, et al.

Eur J Radiol. Elsevier Ireland Ltd; 2020;132.

Available from: http://www.ejradiology.com/article/S0720048X20305301/fulltext

Keywords: CEUS, HCC

Clinical question: What are the clinical implications of various enhancement patterns that can be seen on CEUS in small HCCs that measure less than or equal to 3 cm?

What was done: Small HCC CEUS enhancement patterns were correlated with clinicopathologic characteristics.

How was it done: Retrospective evaluation of 372 pathologically-confirmed small HCCs that underwent CEUS before pathology. Clinicopathologic characteristics that were included in the analysis were serum AFP, PIVKA-II, whether HCC was primary or recurrent, number of tumors, tumor differentiation, tumor size, background liver parenchyma characteristics, and microvascular invasion.

Findings and results: HCCs that were moderately- or poorly-differentiated had 96% likelihood to show arterial phase hyperenhancement, while well-differentiated HCC had 59% likelihood. Portal venous/late washout was seen in 79% of HCCs, and had high correlation with tumor size, odds ratio of 2.34, with larger HCCs (2-3 cm) having a higher proportion of washout than those < 2 cm.

Conclusion: HCC was more commonly an underlying etiology for LR-TIV than non-HCC contingent upon the reference standard, geographic differences, and study design.

Implications: Any malignancy can cause tumor-in-vein, though HCC is the most commonly reported etiology. The reference standard used for diagnosis may affect the percentage of HCC and non-HCC in LR-TIV. Study design was found to be a significant factor causing report heterogeneity.


US-triggered Microbubble Destruction for Augmenting Hepatocellular Carcinoma Response to Transarterial Radioembolization: A Randomized Pilot Clinical Trial.

Eisenbrey JR, Forsberg F, Wessner CE, et al.

Radiology. RSNA; 2020;202321.

Available from: http://pubs.rsna.org/doi/10.1148/radiol.2020202321

Keywords: CEUS, TARE, UTMD

Clinical question: What is the safety and efficacy of combined ultrasound-triggered microbubble destruction (UTMD) and transarterial radioembolization (TARE) for treatment of HCC?

What was done: Prospective pilot clinical trial of 28 participants randomized to undergo either TARE, TARE followed by UTMD 1-4 hours later, and TARE followed by UTMD 1-2 weeks later.

How was it done: Treatment efficacy was evaluated by mRECIST criteria, comparative analysis was done with Mann-Whitney U test, differences in prevalence of tumor response were evaluated by Fisher’s exact test, and differences in overall survival curves were evaluated by log-rank Mantel-Cox test.

Findings and results: No significant changes in temperature, heart rate, or blood pressure were found before and after UTMD in the study participants. When evaluated 1 month after TARE, no changes in LFTs were seen across the treatment arms. Treatment efficacy showed higher prevalence of tumor response in participants who underwent both UTMD and TARE (93%) versus TARE alone (50%).

Conclusion/Implications: UTMD and TARE was shown to not only be safe and feasible, but also shown to have improved HCC treatment response.




MRI Ancillary Features for LI-RADS Category 3 and 4 Observations: Improved Categorization to Indicate the Risk of Hepatic Malignancy.

Kim Y-Y, Choi J-Y, Kim SU, et al.

Am J Roentgenol. ARRS; 2020;215(6):1354–1362.

Available from: https://www.ajronline.org/doi/10.2214/AJR.20.22802

Keywords: MRI, LI-RADS, ancillary features

Clinical question: Can LI-RADS ancillary features help stratify malignancy risk between categories 3 and 4?

What was done: Hepatic observations that were previously characterized as LR3 or LR4 were re-evaluated using only the major features followed by the ancillary features, and then analyzed for cumulative incidence curves of malignancy.

How was it done: Retrospective study of 106 hepatic observations. MRI features were compared using generalized estimating equations. Cumulative incidence curves for malignancy were compared using long-rank tests with resampling extension.

Findings and results: Cumulative incidence of malignancy did not differ between LR3 and LR4 observations when only taking major features into account. However, after application of ancillary features, the cumulative incidence of malignancy was significantly higher in observations characterized as LR4 than in those as LR3.

Conclusions/Implications: The use of ancillary features is essential to correctly categorizing hepatic observations into LR3 and LR4. The use of major features alone is not enough




Usefulness of 18 F-FDG PET/CT and Multiphase CT in the Differential Diagnosis of Hepatocellular Carcinoma and Combined Hepatocellular Carcinoma-Cholangiocarcinoma.

Park JC, Park JG, Jung G-S, et al.

J Korean Soc Radiol. 2020;81(6):1424.

Available from: https://jksronline.org/DOIx.php?id=10.3348/jksr.2019.0154

Keywords: HCC, cholangiocarcinoma, PET, CT, diagnostic value

Clinical question: Can PET/CT differentiate between combined HCC-cholangiocarcinoma (cHCC-CCA) and HCC?

What was done: Compared positive rate on PET/CT for HCC versus cHCC-CCA.

How was it done: Retrospective study of 93 patients with pathologically-confirmed HCC or cHCC-CCA who underwent CT and PET/CT. CT was done with contrast enhancement and dynamic enhancement curves were built. All cases were stratified by type of enhancement pattern for immediately surrounding liver parenchyma, among type I (early arterial enhancement and delayed washout), type II (early arterial enhancement without delayed washout), or type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement).

Findings and results: The cHCC-CCAs had a higher PET/CT positive rate of 89% than HCC of 61%, overall. This difference was amplified within the subset of cases with a type II enhancement pattern, in which 21% of HCCs versus 80% of cHCC-CCAs were PET positive.

Conclusions/Implications: PET/CT can be useful in differentiating between cHCC-CCA and HCC, especially if a type II enhancement pattern is observed.


Diagnostic Performance of LI-RADS Version 2018, LI-RADS Version 2017, and OPTN Criteria for Hepatocellular Carcinoma.

Kierans AS, Song C, Gavlin A, et al.

Am J Roentgenol. ARRS; 2020;215(5):1085–1092.

Available from: https://www.ajronline.org/doi/10.2214/AJR.20.22772

Keywords: LI-RADS, MRI, CT, HCC, OPTN, diagnostic value

Clinical question: How do the diagnostic performances for HCC (on MRI) of LIRADS v2018, LIRADS v2017, and the Organ Procurement and Transplantation Network (OPTN) criteria compare?

What was done: Hepatic observations consistent with HCC by histopathology or follow-up imaging were assigned categories based on LIRADS v2017, LIRADS v2018, and OPTN.

How was it done: Retrospective analysis of these 159 HCC observations was independently done by three different abdominal radiologists.

Findings and results: LIRADS v2018 category 5 and TIV had higher sensitivity for HCC than OPTN class 5 (64% v. 54%) while maintaining specificity (97%). Similarly, LIRADS v2018 category 5 and TIV had higher sensitivity than OPTN class 5 (64% v. 55%) while maintaining specificity (97%).

Conclusions/Implications: LIRADS v2018 had higher sensitivity for HCC than LIRADS v2017 and OPTN without sacrificing specificity.


Edited by Guest Editor Dr. Carla Harmath, MD

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