RESUMEN
We investigated the diagnostic accuracy of 2 magnetic resonance imaging (MRI) sequences of T2 weighted image (T2WI) half-Fourier acquired single turbo spin-echo (HASTE) and BLADE, for hepatocellular carcinoma (HCC) detection. From November 2010 to August 2018, patients diagnosed with HCC and regularly followed up, and who underwent MRI with 2 kinds of T2WI, were included in this study. The diagnosis of HCC was established based on histopathological findings or LI-RADS 4 and 5 by image. The sensitivities and positive predictive value for the detection of HCC by T2WI HASTE and BLADE were compared for each sequence. Quantitative assessment with lesion contrast-to-noise ratio and visual rating scoring of image quality, based on factors such as artifact, margin of organs, and vessel sharpness of the 2 sequences, were compared. No significant differences in lesion detection were observed based on paired comparison of all lesions and lesions larger than 1 cm across both sequences. The sensitivity was higher in larger than 1cm group in all sequences. The HASTE sequence had less motion artifact, but the BLADE images had advantage in edge sharpness of organs and vessels. The HASTE without fat-saturation seems to have better overall image quality. The lesions contrast-to-noise ratio of the 2 image modalities were not significantly different. Compared with T2 BLADE, T2 HASTE may be a more effective protocol for detecting HCC larger than 1 cm without loss of sensitivity. The accuracy of data from 2 T2WI protocols could be applied to streamline MRI protocols of HCC screening and surveillance.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , ArtefactosRESUMEN
BACKGROUND: Hepatectomy is one potential treatment for intrahepatic cholangiocarcinoma (IHCC). Recurrent rate is high after curative resection and most recurrences occur within residual liver parenchyma. The aim of this study was to elucidate the impact of different treatment modalities on recurrent diseases in patients with IHCC after primary liver resection. METHODS: Between February 1999 and December 2015, we retrospectively identified patients who received curative resection for IHCC. Patients who experienced recurrences were included. Locoregional therapies included re-hepatectomy, radiofrequent ablation, and transhepatic arterial chemoembolization. These patients were categorized into three groups: intrahepatic recurrence without locoregional therapies (group A), intrahepatic recurrence with locoregional therapies (group B) and extrahepatic metastases (group C). RESULTS: Forty-three patients were included and there were 12, 15, and 16 patients in groups A, B, and C, respectively. The median disease-free survival times were 8.3, 9.1, and 8.7 months in groups A, B, and C (p = 0.099). The median after-recurrence overall survival times (period between recurrence and death/censor) were 6.4, 34.0, and 8.3 months in groups A, B, and C (p = 0.001). Locoregional therapies showed favorable benefit in multivariant analysis (hazard ratio: 0.274, confidence interval: 0.083-0.908, p = 0.010). CONCLUSION: Locoregional therapies offered favorable benefits for patients with recurrent intrahepatic cholangiocarcinoma.
RESUMEN
This study evaluated multi-detector computed tomography (MDCT) scans performed on potential living donors for adult-to-adult liver transplantation (LDLT), with the aim of identifying significant findings that could be used to exclude potential transplantation donors. We retrospectively reviewed the medical records of 151 consecutive potential adult donors for LDLT from May 2007 to January 2015. Liver parenchyma steatosis, focal hepatic mass or intraabdominal malignancy, vascular variations, and donor liver volume were evaluated via MDCT. Grounds for excluding potential donors were also recorded and analyzed. Of the 151 potential donors, nine (6.0%) had moderate to severe fatty liver, 37 (24.5%) had hepatic arterial variants, 22 (14.6%) had significant portal venous variants, and more than half were found to have right accessory inferior hepatic vein. No intraabdominal malignancies were found. Eighty-eight potential donors were rejected, with the most common cause being insufficient recipient volume or remnant donor volume (47.7%), moderate to severe parenchymal steatosis (10.2%), and recipient expiration prior to transplantation (8.0%). An additional 16 potential donors were excluded by the surgical team due to the complexity of their portal venous variations. The rate of exclusion by pre-transplant imaging evaluation with MDCT was 33.8%. MDCT can provide accurate quantification of donor liver volume and steatosis severity along with precise demonstration of vascular variants, which are crucial for the preoperative evaluation of LDLT. However, MDCT may be ineffective for evaluating the biliary system without hepatobiliary-excreted contrast agent and has the disadvantage of ionizing radiation.