RESUMO
OBJECTIVE: To determine common imaging findings of hepatic epithelioid hemangioendothelioma on magnetic resonance images. MATERIALS AND METHODS: A search was made of three institutional databases between January 2000 and August 2012. Seven patients (mean age, 47 years; range, 21-66 years; 6 women) with pathology-confirmed diagnosis of hepatic epithelioid hemangioendothelioma who had undergone magnetic resonance imaging were identified. None of the patients had received any treatment for hepatic epithelioid hemangioendothelioma at the time of the initial magnetic resonance imaging examination. RESULTS: Hepatic epithelioid hemangioendothelioma tumors appeared as focal masses in 7/7 patients, greater than 5 in number, with a coalescing lesion in 1/5, and peripheral localization in 6/7. Capsular retraction was present in 4/7, and was associated with peripherally located lesions. Early ring enhancement was appreciated in the majority of lesions in 7/7 patients. Centripetal progressive enhancement was shown in 5/7 patients on venous phase that exhibited a distinctive thick inner border of low signal on venous phase images, and a central core of delayed enhancement. Small lesions did not show this. CONCLUSION: The combination of multifocal round-configuration lesions that are predominantly peripheral and exhibit early peripheral ring enhancement and late appearance of an inner thick border of low signal and central core of high signal may represent an important feature for hepatic epithelioid hemangioendothelioma.
OBJETIVO: Determinar os achados comuns de hemangioendotelioma epitelioide hepático em imagens de ressonância magnética. MATERIAIS E MÉTODOS: Uma pesquisa foi feita em três bases de dados institucionais entre janeiro de 2000 e agosto de 2012. Sete pacientes (média de idade, 47 anos; variação, 21-66 anos; 6 mulheres) com diagnóstico confirmado por exame patológico de hemangioendotelioma epitelioide hepático submetidos a ressonância magnética foram identificados. Nenhum dos pacientes havia recebido tratamento para hemangioendotelioma epitelioide hepático antes do exame inicial por ressonância magnética. RESULTADOS: Tumores de hemangioendothelioma epitelioide hepático apareceram como massas focais, maiores que 5 em número, em 7/7 pacientes, com uma lesão coalescente em 1/5 e localização periférica em 6/7 pacientes. Retração capsular esteve presente em 4/7 pacientes e foi associada com lesões perifericamente localizadas. Realce precoce em anel foi visto na maioria das lesões, em 7/7 pacientes. Realce progressivo centrípeto foi demonstrado em 5/7 pacientes na fase venosa, que exibia uma borda interna espessa distinta de baixo sinal nas imagens de fase venosa e um núcleo central de realce tardio. As lesões pequenas não mostraram isso. CONCLUSÃO: A combinação de lesões de configuração arredondada multifocais que são predominantemente periféricas e exibem realce precoce em anel periférico e aparecimento tardio de uma borda espessa interna de baixo sinal e um núcleo central de alto sinal pode representar uma característica importante para hemangioendotelioma epitelioide hepático.
RESUMO
Abstract Objective: To determine common imaging findings of hepatic epithelioid hemangioendothelioma on magnetic resonance images. Materials and Methods: A search was made of three institutional databases between January 2000 and August 2012. Seven patients (mean age, 47 years; range, 21-66 years; 6 women) with pathology-confirmed diagnosis of hepatic epithelioid hemangioendothelioma who had undergone magnetic resonance imaging were identified. None of the patients had received any treatment for hepatic epithelioid hemangioendothelioma at the time of the initial magnetic resonance imaging examination. Results: Hepatic epithelioid hemangioendothelioma tumors appeared as focal masses in 7/7 patients, greater than 5 in number, with a coalescing lesion in 1/5, and peripheral localization in 6/7. Capsular retraction was present in 4/7, and was associated with peripherally located lesions. Early ring enhancement was appreciated in the majority of lesions in 7/7 patients. Centripetal progressive enhancement was shown in 5/7 patients on venous phase that exhibited a distinctive thick inner border of low signal on venous phase images, and a central core of delayed enhancement. Small lesions did not show this. Conclusion: The combination of multifocal round-configuration lesions that are predominantly peripheral and exhibit early peripheral ring enhancement and late appearance of an inner thick border of low signal and central core of high signal may represent an important feature for hepatic epithelioid hemangioendothelioma.
Resumo Objetivo: Determinar os achados comuns de hemangioendotelioma epitelioide hepático em imagens de ressonância magnética. Materiais e Métodos: Uma pesquisa foi feita em três bases de dados institucionais entre janeiro de 2000 e agosto de 2012. Sete pacientes (média de idade, 47 anos; variação, 21-66 anos; 6 mulheres) com diagnóstico confirmado por exame patológico de hemangioendotelioma epitelioide hepático submetidos a ressonância magnética foram identificados. Nenhum dos pacientes havia recebido tratamento para hemangioendotelioma epitelioide hepático antes do exame inicial por ressonância magnética. Resultados: Tumores de hemangioendothelioma epitelioide hepático apareceram como massas focais, maiores que 5 em número, em 7/7 pacientes, com uma lesão coalescente em 1/5 e localização periférica em 6/7 pacientes. Retração capsular esteve presente em 4/7 pacientes e foi associada com lesões perifericamente localizadas. Realce precoce em anel foi visto na maioria das lesões, em 7/7 pacientes. Realce progressivo centrípeto foi demonstrado em 5/7 pacientes na fase venosa, que exibia uma borda interna espessa distinta de baixo sinal nas imagens de fase venosa e um núcleo central de realce tardio. As lesões pequenas não mostraram isso. Conclusão: A combinação de lesões de configuração arredondada multifocais que são predominantemente periféricas e exibem realce precoce em anel periférico e aparecimento tardio de uma borda espessa interna de baixo sinal e um núcleo central de alto sinal pode representar uma característica importante para hemangioendotelioma epitelioide hepático.
RESUMO
BACKGROUND AND AIMS: We conducted an individual participant data (IPD) pooled analysis on the diagnostic accuracy of magnetic resonance elastography (MRE) to detect fibrosis stage in liver transplant recipients. MATERIAL AND METHODS: Through a systematic literature search, we identified studies on diagnostic performance of MRE for staging liver fibrosis, using liver biopsy as gold standard. We contacted study authors for published and unpublished IPD on age, sex, body mass index, liver stiffness, fibrosis stage, degree of inflammation and interval between MRE and biopsy; from these we limited analysis to patients who had undergone liver transplantation. Through pooled analysis using nonparametric two-stage receiver-operating curve (ROC) regression models, we calculated the cluster-adjusted AUROC, sensitivity and specificity of MRE for any (≥ stage 1), significant (≥ stage 2) and advanced fibrosis (≥ stage 3) and cirrhosis (stage 4). RESULTS: We included 6 cohorts (4 published and 2 unpublished series) reporting on 141 liver transplant recipients (mean age, 57 years; 75.2% male; mean BMI, 27.1 kg/m2). Fibrosis stage distribution stage 0, 1, 2, 3, or 4, was 37.6%, 23.4%, 24.8%, 12% and 2.2%, respectively. Mean AUROC values (and 95% confidence intervals) for diagnosis of any (≥ stage 1), significant (≥ stage 2), or advanced fibrosis (≥ stage 3) and cirrhosis were 0.73 (0.66-0.81), 0.69 (0.62-0.74), 0.83 (0.61-0.88) and 0.96 (0.93-0.98), respectively. Similar diagnostic performance was observed in stratified analysis based on sex, obesity and inflammation grade. CONCLUSIONS: In conclusion, MRE has high diagnostic accuracy for detection of advanced fibrosis and cirrhosis in liver transplant recipients, independent of BMI and degree of inflammation.