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Investigative Radiology Apr 2024The aim of this study is to describe a comprehensive contrast-enhanced ultrasound (CEUS) imaging protocol and analysis method to implement CEUS LI-RADS (Liver Imaging...
OBJECTIVE
The aim of this study is to describe a comprehensive contrast-enhanced ultrasound (CEUS) imaging protocol and analysis method to implement CEUS LI-RADS (Liver Imaging Reporting and Data System) in a quantifiable manner. The methods that are validated with a prospective single-center study aim to simplify CEUS LI-RADS evaluation, remove observer bias, and potentially improve the sensitivity of CEUS LI-RADS.
MATERIALS AND METHODS
This prospective single-center study enrolled patients with hepatocellular carcinoma (April 2021-June 2022; N = 31; mean age ± SD, 67 ± 6 years; 24 men/7 women). For each patient, at least 2 CEUS loops spanning over 5 minutes were collected for different lesion scan planes using an articulated arm to hold the transducer. Automatic respiratory gating and motion compensation algorithms removed errors due to breathing motion. The long axis of the lesion was measured in the contrast and fundamental images to capture nodule size. Parametric processing of time-intensity curve analysis on linearized data provided quantifiable information of the wash-in and washout dynamics via rise time ( RT ) and degree of washout ( DW ) parameters extracted from the time-intensity curve, respectively. A Welch t test was performed between lesion and parenchyma RT for each lesion to confirm statistically significant differences. P values for bootstrapped 95% confidence intervals of the relative degree of washout ( rDW ), ratio of DW between the lesion and surrounding parenchyma, were computed to quantify lesion washout. Coefficient of variation (COV) of RT , DW , and rDW was calculated for each patient between injections for both the lesion and surrounding parenchyma to gauge reproducibility of these metrics. Spearman rank correlation tests were performed among size, RT , DW , and rDW values to evaluate statistical dependence between the variables.
RESULTS
The mean ± SD lesion diameter was 23 ± 8 mm. The RT for all lesions, capturing arterial phase hyperenhancement, was shorter than that of surrounding liver parenchyma ( P < 0.05). All lesions also demonstrated significant ( P < 0.05) but variable levels of washout at both 2-minute and 5-minute time points, quantified in rDW . The COV of RT for the lesion and surrounding parenchyma were both 11%, and the COV of DW and rDW at 2 and 5 minutes ranged from 22% to 31%. Statistically significant relationships between lesion and parenchyma RT and between lesion RT and lesion DW at the 2- and 5-minute time points were found ( P < 0.05).
CONCLUSIONS
The imaging protocol and analysis method presented provide robust, quantitative metrics that describe the dynamic vascular patterns of LI-RADS 5 lesions classified as hepatocellular carcinomas. The RT of the bolus transit quantifies the arterial phase hyperenhancement, and the DW and rDW parameters quantify the washout from linearized CEUS intensity data. This unique methodology is able to implement the CEUS-LIRADS scheme in a quantifiable manner for the first time and remove its existing issues of currently being qualitative and suffering from subjective evaluations.
Topics: Male; Humans; Female; Carcinoma, Hepatocellular; Liver Neoplasms; Prospective Studies; Reproducibility of Results; Contrast Media; Magnetic Resonance Imaging; Ultrasonography; Retrospective Studies; Sensitivity and Specificity
PubMed: 37725492
DOI: 10.1097/RLI.0000000000001022 -
Surgical Endoscopy Jan 2023Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is...
BACKGROUND
Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The current study aimed to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases.
METHODS
Patients who primarily underwent laparoscopic parenchyma-sparing liver resection (less than 3 consecutive liver segments) for colorectal liver metastases between 1999 and 2019 at Oslo University Hospital were analyzed. In some recent cases, a computer-assisted surgical planning system was used to better visualize and understand the patients' liver anatomy, as well as a tool to further improve the resection strategy. The surgical and oncologic outcomes of patients with large (≥ 50 mm) and small (< 50 mm) tumors were compared. Multivariable Cox-regression analysis was performed to identify risk factors for survival.
RESULTS
In total 587 patients met the inclusion criteria (large tumor group, n = 59; and small tumor group, n = 528). Median tumor size was 60 mm (range, 50-110) in the large tumor group and 21 mm (3-48) in the small tumor group (p < 0.001). Patient age and CEA level were higher in the large tumor group (8.4 μg/L vs. 4.6 μg/L, p < 0.001). Operation time and conversion rate were similar, while median blood loss was higher in the large tumor group (500 ml vs. 200 ml, p < 0.001). Patients in the large tumor group had shorter 5 year overall survival (34% vs 49%, p = 0.027). However, in the multivariable Cox-regression analysis tumor size did not impact survival, unlike parameters such as age, ASA score, CEA level, extrahepatic disease at liver surgery, and positive lymph nodes in the primary tumor.
CONCLUSION
Laparoscopic parenchyma-sparing resections for large colorectal liver metastases provide satisfactory short and long-term outcomes.
Topics: Humans; Hepatectomy; Treatment Outcome; Liver Neoplasms; Laparoscopy; Colorectal Neoplasms; Retrospective Studies
PubMed: 35922606
DOI: 10.1007/s00464-022-09493-3 -
Anatomia, Histologia, Embryologia Jan 2022This study aimed to perform quantitative and qualitative evaluations of the lateral and third ventricles, and brain parenchyma, in healthy dogs of different skull...
This study aimed to perform quantitative and qualitative evaluations of the lateral and third ventricles, and brain parenchyma, in healthy dogs of different skull conformations on CT scans. Forty-five adult client-owned dogs were divided into three groups according to skull conformation: G1 (dolichocephalic)-15 German Shepherds; G2 (mesaticephalic)-15 Rottweilers; G3 (brachycephalic)-15 Boxers. Transverse plane images were used for quantitative and qualitative evaluations of the lateral ventricles and third ventricle, and pre- and post-contrast brain parenchyma. The height of both ventricles and brain was measured at the level of the interthalamic adhesion. Ventricle height, brain height, and ventricle/brain height ratio were statistically higher in G3 compared with G1 and G2 that were similar. The third ventricle was visible but unmeasurable in five dogs from G1 and three from G2. In G3, all dogs had third ventricle visible and measurable in all images. Asymmetric ventricles were seen in five dogs in Group 1 and Group 2, and seven in Group 3. Brain parenchyma had homogenous density in 80% of the dogs in all groups. Contrast enhancement of the rostral midline was visualized in all dogs. In conclusion, brain CT scans of healthy dogs showed that the qualitative data were similar among groups, but lateral ventricle and brain measurements in brachycephalic dogs differed from the dolichocephalic and mesaticephalic dogs.
Topics: Animals; Brain; Dogs; Head; Lateral Ventricles; Skull; Tomography, X-Ray Computed
PubMed: 34854110
DOI: 10.1111/ahe.12767 -
Journal of Healthcare Engineering 2021Segmentation of pulmonary vessels in CT/CTA images can help physicians better determine the patient's condition and treatment. However, due to the complexity of CT...
Segmentation of pulmonary vessels in CT/CTA images can help physicians better determine the patient's condition and treatment. However, due to the complexity of CT images, existing methods have limitations in the segmentation of pulmonary vessels. In this paper, a method based on the separation of pulmonary vessels in CT/CTA images is investigated. The method is divided into two steps: in the first step, the lung parenchyma is extracted using the Unet++ algorithm, which can effectively reduce the oversegmentation rate; in the second step, the pulmonary vessels in the lung parenchyma are extracted using nnUnet. According to the obtained lung parenchyma segmentation results, the "AND" operation is performed on the original image and the lung parenchyma segmentation results, and only the blood vessels within the lung parenchyma are segmented, which reduces the interference of external tissues and improves the segmentation accuracy. The experimental data source used CT/CTA images acquired from the partner hospital. After the experiments were performed on a total of 67 sets of images, the accuracy of CT and CTA images reached 85.1% and 87.7%, respectively. The comparison of whether to segment the lung parenchyma and with other conventional methods was also performed, and the experimental results showed that the algorithm in this paper has high accuracy.
Topics: Algorithms; Humans; Lung; Thorax; Tomography, X-Ray Computed
PubMed: 34777735
DOI: 10.1155/2021/5763177 -
Medicina (Kaunas, Lithuania) Oct 2022Liver resection for malignant tumors should respect oncological margins while ensuring safety and improving the quality of life, therefore tumor staging, underlying... (Review)
Review
Liver resection for malignant tumors should respect oncological margins while ensuring safety and improving the quality of life, therefore tumor staging, underlying liver disease and performance status should all be attentively assessed in the decision process. The concept of parenchyma-sparing liver surgery is nowadays used as an alternative to major hepatectomies to address deeply located lesions with intricate topography by means of complex multiplanar parenchyma-sparing liver resections, preferably under the guidance of intraoperative ultrasound. Regenerative liver surgery evolved as a liver growth induction method to increase resectability by stimulating the hypertrophy of the parenchyma intended to remain after resection (referred to as future liver remnant), achievable by portal vein embolization and liver venous deprivation as interventional approaches, and portal vein ligation and associating liver partition and portal vein ligation for staged hepatectomy as surgical techniques. Interestingly, although both strategies have the same conceptual origin, they eventually became caught in the never-ending parenchyma-sparing liver surgery vs. regenerative liver surgery debate. However, these strategies are both valid and must both be mastered and used to increase resectability. In our opinion, we consider parenchyma-sparing liver surgery along with techniques of complex liver resection and intraoperative ultrasound guidance the preferred strategy to treat liver tumors. In addition, liver volume-manipulating regenerative surgery should be employed when resectability needs to be extended beyond the possibilities of parenchyma-sparing liver surgery.
Topics: Humans; Hepatectomy; Quality of Life; Liver Regeneration; Liver; Portal Vein; Treatment Outcome
PubMed: 36295582
DOI: 10.3390/medicina58101422 -
Radiographics : a Review Publication of... 2022Historically, radiation therapy was not considered in treatment of liver tumors owing to the risk of radiation-induced liver disease. However, development of highly...
Historically, radiation therapy was not considered in treatment of liver tumors owing to the risk of radiation-induced liver disease. However, development of highly conformed radiation treatments such as stereotactic body radiation therapy (SBRT) has increased use of radiation therapy in the liver. SBRT is indicated in treatment of primary and metastatic liver tumors with outcomes comparable to those of other local therapies, especially in treatment of hepatocellular carcinoma. After SBRT, imaging features of the tumor and surrounding background hepatic parenchyma demonstrate a predictable pattern immediately after treatment and during follow-up. The goals of SBRT are to deliver a lethal radiation dose to the targeted liver tumor and to minimize radiation dose to normal liver parenchyma and other adjacent organs. Evaluation of tumor response after SBRT centers on changes in size and enhancement; however, these changes are often delayed secondary to the underlying physiologic effects of radiation. Knowledge of the underlying pathophysiologic mechanisms of SBRT should allow better understanding of the typical imaging features in detection of tumor response and avoid misinterpretation from common pitfalls and atypical imaging findings. Imaging features of radiation-induced change in the surrounding liver parenchyma are characterized by a focal liver reaction that can potentially be mistaken for no response or recurrence of tumor. Knowledge of the pattern and chronology of this phenomenon may allay any uncertainty in assessment of tumor response. Other pitfalls related to fiducial marker placement or combination therapies are important to recognize. The authors review the basic principles of SBRT and illustrate post-SBRT imaging features of treated liver tumors and adjacent liver parenchyma with a focus on avoiding pitfalls in imaging evaluation of response. RSNA, 2022.
Topics: Humans; Radiosurgery; Carcinoma, Hepatocellular; Liver Neoplasms; Diagnostic Imaging; Radiation Injuries
PubMed: 36240077
DOI: 10.1148/rg.220084 -
Respiratory Investigation Nov 2023A patient with sarcoidosis was found to have a massive left pleural effusion. Her chest computed tomography showed small nodules in the lung parenchyma and swelling of...
A patient with sarcoidosis was found to have a massive left pleural effusion. Her chest computed tomography showed small nodules in the lung parenchyma and swelling of the hilar lymph nodes, with normal visceral and parietal pleura. Thoracoscopy showed white nodules on the visceral pleura and normal parietal pleura, which were resected. Epithelioid granulomas were seen in the visceral pleura and lung parenchyma. Surprisingly, in the parietal pleura, abnormal cells that were positive for the leukocyte common antigen, CD20, and CD79a were found, leading to the diagnosis of malignant B-cell lymphoma.
Topics: Female; Humans; Pleura; Pleural Neoplasms; Pleural Effusion; Sarcoidosis; Lymphoma
PubMed: 37708635
DOI: 10.1016/j.resinv.2023.07.010 -
Clinical Radiology Aug 2022To assess the performance of a "triple-low" free-breathing protocol for computed tomography pulmonary angiography (CTPA) evaluated on patients with dyspnoea and...
AIM
To assess the performance of a "triple-low" free-breathing protocol for computed tomography pulmonary angiography (CTPA) evaluated on patients with dyspnoea and suspected pulmonary embolism and discuss its application in routine clinical practice for the study of the pulmonary parenchyma and vasculature.
MATERIAL AND METHODS
This study was conducted on a selected group of dyspnoeic patients referred for CTPA. The protocol was designed using fast free-breathing acquisition and a small, fixed volume (35 ml) of contrast agent in order to achieve a low-exposure dose. For each examination, radiodensity of the pulmonary trunk and ascending aorta, and the dose-length product (DLP) were recorded. A qualitative analysis was performed of pulmonary arterial enhancement and the pulmonary parenchyma.
RESULTS
This study included 134 patients. Contrast enhancement of the pulmonary arteries (409 ± 159 HU) was systematically >250 HU. The duration of acquisition ranged from 0.9 to 1.3 seconds for free-breathing imaging. The mean DLP was in the range of low-dose chest CT acquisitions (145 ± 73 mGy·cm). The analysis was deemed optimal in 90% (120/134) of cases for the pulmonary parenchyma. Sixty-nine per cent (92/134) of cases demonstrated homogeneous enhancement of the pulmonary arteries to the subsegmental level. Only 6% (8/134) of examinations were considered uninterpretable.
CONCLUSION
The present "triple-low" CTPA protocol allows convenient analysis of the pulmonary parenchyma and arteries without hindrance by respiratory motion artefacts in dyspnoeic patients.
Topics: Humans; Angiography; Contrast Media; Dyspnea; Pulmonary Artery; Pulmonary Embolism; Tomography, X-Ray Computed
PubMed: 35688771
DOI: 10.1016/j.crad.2022.05.007 -
World Journal of Surgical Oncology Mar 2023To evaluate perioperative safety and outcome of parenchyma-preserving pancreatectomy and risk factors of metastasis and recurrence for patients with solid...
BACKGROUND/OBJECTIVES
To evaluate perioperative safety and outcome of parenchyma-preserving pancreatectomy and risk factors of metastasis and recurrence for patients with solid pseudopapillary neoplasm (SPN).
METHODS
Demographic data, operative and pathological parameter, follow-up data of patients with SPN undergoing their first operation were collected in our single center from May 2016 to October 2021 and compared between regular pancreatectomy group and parenchyma-preserving surgery group. Risk factors for metastasis and recurrence were investigated.
RESULTS
A total of 194 patients were included, 154 of whom were female and the average age of all patients was 33 years old. Most patients were asymptomatic, with the most common complaint being abdominal pain or discomfort. Of them, 62 patients underwent parenchyma-preserving pancreatectomy including middle segment pancreatectomy and enucleation, and 132 patients underwent regular pancreatectomy including pancreaticoduodenectomy, distal pancreatectomy and total pancreatectomy. Patients in the parenchyma-preserving surgery group had a shorter duration of operation, less intraoperative bleeding, and decreased risk of combined organ removal and blood transfusion, with no statistical significance yet. The two groups exhibited a similar incidence of postoperative complications including grade B and C pancreatic fistula, delayed gastric emptying, postoperative pancreatic hemorrhage, and other complications, as well as radiological intervention, relaparotomy and the length of postoperative hospital stay. There were no perioperative deaths. All the patients, except 18 of those who discontinued follow-up, were alive with a median follow-up time of 31 months. Three patients in the regular pancreatectomy group were observed to have liver metastasis, and no metastasis was observed in the parenchyma-preserving surgery group. Significant risk factors for tumor metastasis and recurrence were tumor size, angioinvasion, and nerve infiltration.
CONCLUSIONS
Parenchyma-preserving surgery did not significantly increase the frequency of perioperative complications or recurrence and might be preferable if comprehensive conditions allow.
Topics: Humans; Female; Adult; Male; Pancreatic Neoplasms; Prognosis; Pancreatectomy; Pancreaticoduodenectomy; Postoperative Hemorrhage; Retrospective Studies; Pancreas; Treatment Outcome
PubMed: 37004027
DOI: 10.1186/s12957-023-03003-y -
Seminars in Cancer Biology Feb 2020The macro-metastasis/organ parenchyma interface (MMPI) was previously considered an inert anatomical border which sharply separates the affected organ parenchyma from... (Review)
Review
The macro-metastasis/organ parenchyma interface (MMPI) was previously considered an inert anatomical border which sharply separates the affected organ parenchyma from the macro-metastatic tissue. Recently, infiltrative growth of macro-metastases from various primary tumors was described in the brain, liver and lung, with significant impact on survival. Strikingly, the MMPI patterns differed between entities, so that at least nine different patterns were described. The MMPI patterns could be further classified into three major groups: displacing, epithelial and diffuse infiltrating. Additionally, macro-metastases are a source of further tumor cell dissemination in the affected organ; and these intra-organ metastatic dissemination tracks starting from the MMPI also vary depending on the anatomical structures of the colonized organ and influence disease outcome. In spite of their relevance, MMPIs and organ-specific dissemination tracks are still largely overlooked by many clinicians, pathologists and/or researchers. In this review, we aim to address this important issue and enhance our current understanding of the different MMPI patterns and dissemination tracks in the brain, liver and lung.
Topics: Humans; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Neoplasms; Organ Specificity
PubMed: 31647982
DOI: 10.1016/j.semcancer.2019.10.012