| 1. Kaltenbach TE, Engler P, Kratzer W, et al. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Abdom Radiol. 41(1):25-32, 2016 Jan. |
Observational-Dx |
45,319 patients |
To determine the sonographic prevalence of benign focal liver lesions on the basis of a population of hospital patients. |
At least one of the lesions to be investigated was diagnosed in 15.1% (n = 6839) of the patients of the total population. The most commonly recorded lesion, with a total prevalence of 6.3% (n = 2839), was focal fatty sparing, followed by hepatic cysts with 5.8% (n = 2631). The prevalence of hepatic hemangioma was 3.3% (n = 1640), while that of FNH was 0.2% (n = 81) and that of hepatic adenoma was 0.04% (n = 19). An association between the occurrence of benign focal liver lesions and age was observed. |
4 |
| 2. Taimr P, Jongerius VL, Pek CJ, et al. Liver Contrast-Enhanced Ultrasound Improves Detection of Liver Metastases in Patients with Pancreatic or Periampullary Cancer. Ultrasound in Medicine & Biology. 41(12):3063-9, 2015 Dec. |
Observational-Dx |
89 Patients |
To provide a diagnostic performance evaluation of contrast-enhanced ultrasonography (CEUS) in detecting liver metastases in patients with suspected of pancreatic or periampullary cancer. |
Eighty-nine patients with suspected pancreatic or periampullary cancer were included in this prospective study with retrospective analysis. Patients underwent an abdominal CT and CEUS. Fifteen patients had liver metastases. The CT sensitivity was 73.3% (11/15), the specificity 93.2% (69/74), the positive predictive value (PPV) 68.8% (11/16) and the negative predictive value (NPV) 94.6% (69/73). Based on CEUS, the sensitivity was 80% (12/15), specificity 98.6% (73/74), PPV 92.3% (12/13) and NPV 96.1% (73/76). |
4 |
| 3. Expert Panel on Gastrointestinal Imaging:, Horowitz JM, Kamel IR, et al. ACR Appropriateness Criteria Chronic Liver Disease. J. Am. Coll. Radiol.. 14(11S):S391-S405, 2017 Nov. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic liver disease. |
No results stated in abstract. |
4 |
| 4. Gore RM, Pickhardt PJ, Mortele KJ, et al. Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee. J. Am. Coll. Radiol.. 14(11):1429-1437, 2017 Nov. |
Review/Other-Dx |
N/A |
To improve the quality of care by providing guidance on how to manage incidentally detected liver lesions. |
No results stated in the abstract. |
4 |
| 5. Hope TA, Petkovska I, Saranathan M, Hargreaves BA, Vasanawala SS. Combined parenchymal and vascular imaging: High spatiotemporal resolution arterial evaluation of hepatocellular carcinoma. Journal of Magnetic Resonance Imaging. 43(4):859-65, 2016 Apr. |
Review/Other-Dx |
38 studies in cirrhotic patients |
To assess the ability of high-resolution arterial phase imaging of hepatocellular carcinoma (HCC) to provide combined vascular characterization and parenchymal evaluation. |
The high spatiotemporal multiphasic acquisition allowed imaging of both the angiographic and late arterial phase in 30 of 38 studies with good image quality. Maximal lesion enhancement compared to precontrast occurred more frequently during the late arterial phase compared to maximal lesion-to-adjacent, which occurred more frequently during the early arterial phase (P?<?0.001). Common and proper hepatic arteries were visualized adequately in 100%, right hepatic artery in 94-97%, left hepatic artery in 94%, and segmental vessel in 83% of cases. Arterial variants were detected with sensitivity of 87-100% and specificity of 100%. |
4 |
| 6. American College of Radiology: Liver Imaging Reporting and Data System. http://nrdr.acr.org/lirads/ 2014. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 7. D'Onofrio M, Crosara S, De Robertis R, Canestrini S, Mucelli RP. Contrast-Enhanced Ultrasound of Focal Liver Lesions. [Review]. AJR Am J Roentgenol. 205(1):W56-66, 2015 Jul. |
Review/Other-Dx |
N/A |
To discuss the use of contrast-enhanced ultra-sound (CEUS) in focal liver lesions. |
No results stated in abstract. |
4 |
| 8. Mojtahedi A, Thamake S, Tworowska I, Ranganathan D, Delpassand ES. The value of (68)Ga-DOTATATE PET/CT in diagnosis and management of neuroendocrine tumors compared to current FDA approved imaging modalities: a review of literature. [Review]. Am J Nucl Med Mol Imaging. 4(5):426-34, 2014. |
Review/Other-Dx |
N/A |
To systematically review all published data on the role of (68)Ga-DOTATATE in diagnostic and management of patients with neuroendocrine cancer and compare it to current FDA approved imaging modalities, including Octreoscan, MIBG scintigraphy and MRI. |
68Ga-DOTATATE PET/CT provides incremental diagnostic information compared to Octreoscan, MIBG scintigraphy and conventional imaging. 68Ga-DOTATATE also has been proved to have significant impact in management of patients with neuroendocrine tumors. Additional benefit of 68Ga-DOTATATE PET/CT include patient convenience with short time acquisition and lower radiation exposure signifying the important role of 68Ga-DOTATATE/CT in clinical practice of neuroendocrine and other somatostatin-avid malignancies. |
4 |
| 9. Moriyasu F, Itoh K. Efficacy of perflubutane microbubble-enhanced ultrasound in the characterization and detection of focal liver lesions: phase 3 multicenter clinical trial. AJR Am J Roentgenol. 2009; 193(1):86-95. |
Observational-Dx |
196 patients |
To assess the efficacy and safety of CEUS performed with perflubutane microbubbles in comparison with unenhanced US and dynamic CT in the characterization of FLLs during the vascular phase of imaging and in the detection of lesions during the Kupffer phase. |
Among the 190 patients included in the characterization analysis, the accuracy of CEUS (88.9%) was significantly greater than that of unenhanced US (68.4%) and dynamic CT (80.5%) (P<0.001 and P=0.008). Among the 191 patients in the detection analysis, the efficacy of CEUS in detection of lesions was significantly higher than that of unenhanced US and dynamic CT (P<0.001 and P=0.008), predominantly because more metastatic lesions were detected (both P<0.001). In particular, CEUS was superior to dynamic CT in the detection of metastatic lesions measuring =1 cm. The incidence of adverse events was 49.2% and that of adverse drug reactions was 10.4%. All adverse drug reactions were mild. |
2 |
| 10. Chung YE, Kim MJ, Kim YE, Park MS, Choi JY, Kim KW. Characterization of incidental liver lesions: comparison of multidetector CT versus Gd-EOB-DTPA-enhanced MR imaging.[Erratum appears in PLoS One. 2013;8(10). doi:10.1371/annotation/a03efa25-49f8-4616-a256-074a3d60ceaf]. PLoS ONE. 8(6):e66141, 2013. |
Review/Other-Dx |
80 patients |
To compare the accuracy of contrast-enhanced multidetector CT (MDCT) and Gd-EOB-DTPA-enhanced MRI for characterization of incidental liver masses |
The proportion of confident interpretations for the differentiation of benign and malignant lesions was significantly higher with EOB-MRI(94.5%-97.6%) than with MDCT (74.0%-92.9%). In terms of specific diagnosis, sensitivity and accuracy were significantly higher with EOB-MRI than with MDCT for the diagnosis of focal nodular hyperplasia (FNH) and focal eosinophilic infiltration. The diagnoses of the remaining diseases were comparable between EOB-MRI and MDCT. |
4 |
| 11. Margolis NE, Shaver CM, Rosenkrantz AB. Indeterminate liver and renal lesions: comparison of computed tomography and magnetic resonance imaging in providing a definitive diagnosis and impact on recommendations for additional imaging. J Comput Assist Tomogr. 37(6):882-6, 2013 Nov-Dec. |
Observational-Dx |
143 renal lesions |
To compare computed tomography (CT) and magnetic resonance imaging (MRI) in terms of likelihood of providing a definitive diagnosis (DD) and a recommendation for additional imaging (RAI), when performed to evaluate indeterminate liver and renal lesions detected on ultrasound as well as in terms of impact on imaging costs. |
A total of 143 renal lesions were included, of which 77 and 66 underwent CT and MRI, respectively. Magnetic resonance imaging was significantly more likely than CT to provide DD (95.5% vs 77.9%; P = 0.003) and significantly less likely to provide RAI (1.5% vs 10.4%; P = 0.038). A total of 221 liver lesions were included, of which 76 and 145 underwent CT and MRI, respectively. Magnetic resonance imaging was significantly more likely than CT to provide DD (95.2% vs 71.1%; P < 0.001) and significantly less likely to provide RAI (0% vs 10.5%; P < 0.001). Across the entire study cohort, there were 13 instances of MRI recommended after an indeterminate CT and 1 case of CT recommended after an indeterminate MRI. A DD was provided in 8 of 9 instances in which MRI was performed after an indeterminate CT. However, anticipated imaging costs were higher when directly obtaining MRI for all indeterminate lesions, compared with initially obtaining multiphase CT, for both kidney ($64,739 vs $49,759) and liver ($64,739 vs. $56,975) lesions, respectively. |
4 |
| 12. Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO. Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol 2008; 43(7):504-511. |
Observational-Dx |
176 patients 59 FNH; 3 blinded readers |
Prospective, multicenter study to evaluate the value of MRI of the liver with the hepatocellular-specific contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid in comparison to precontrast MRI and spiral CT in the specific diagnosis of FNH and to describe morphologic features and enhancement pattern of FNH. |
Enhancement in the hepatocyte-phase after 10 and 20 minutes was observed in 88% and 90% of lesions, respectively. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI is superior to pre-contrast MRI alone or spiral CT in the characterization of FNH. |
1 |
| 13. Seitz K, Strobel D, Bernatik T, et al. Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions - prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the Ultrasound Dreilandertreffen 2008, Davos. Ultraschall Med. 2009; 30(4):383-389. |
Observational-Dx |
1,349 patients |
To evaluate the diagnostic value of CEUS for the characterization of FLLs in a prospective multi-center study in clinical practice. |
The subcollective of 267 patients was divided in two subgroups. In 109 of these patients (subgroup A) there was no histological verification, diagnoses based on clear spiral CT-findings in 79 cases of hemangioma or FNH, as well as in 20 cases with a clear clinical diagnosis. 6 cases (5.5%) remained unclear. In this subgroup the assessment of tumor differentiation was concordant with CEUS in 90 cases, discordant in 19 cases and the assessment of tumor specification was concordant in 82 and discordant in 27 cases. In 158 patients (subgroup B) a histological finding was also present, only in 4 cases no definitive tumor diagnosis was achieved. In this subgroup assessment of tumor differentiation with CEUS and spiral CT was concordant in 124 cases and discordant in 30 cases (CEUS/spiral CT: sensitivity 94.0%/ 90.7%, specificity 83.0%/81.5%, PPV 91.6%/91.5%, NPV 87.5%/80.0%, accuracy 90.3%/87.8%). Tumor specification matched in 103cases and was different in 51 cases (CEUS/spiral CT: sensitivity 95.3%/90.6%, specificity 83.7%/81.6%, PPV 92.7%/91.4%, NPV 89.1%/80.0%, accuracy 91.6%/87.7%). A statistically significant difference could not be established. The analysis of particular tumor specification showed a statistically nonsignificant slight advantage in tumor differentiation for CEUS in the case of hemangioma, FNH, HCC and metastases. |
3 |
| 14. Trillaud H, Bruel JM, Valette PJ, et al. Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI. World J Gastroenterol. 2009; 15(30):3748-3756. |
Experimental-Dx |
127 patients |
Phase IIIb, controlled, multicenter, multinational study to determine whether the sonographic characterization of FLLs can be improved using SonoVue-enhancement; and to compare this method with CT and MRI. |
Compared to CT and/or dynamic MRI, SonoVue-enhanced sonography was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available (n=30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specificity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). Sensitivity and specificity of CEUS for the identification of FNH and hemangiomas was 100% and 87%, accuracy 94.5%. SonoVue-enhanced sonography is the most sensitive, most specific and thus most accurate imaging modality for the characterization of FLLs. |
3 |
| 15. Holzapfel K, Eiber MJ, Fingerle AA, Bruegel M, Rummeny EJ, Gaa J. Detection, classification, and characterization of focal liver lesions: Value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods. Abdom Imaging. 2012; 37(1):74-82. |
Observational-Dx |
36 patients |
To evaluate DWI MRI, gadoxetic acid-enhanced MRI and the combination of both methods in the detection, classification, and characterization of FLL. |
There was no significant difference between the three image sets in the detection of FLL with regards to A(z). However, when only lesions with a diameter of 10 mm or less were analyzed, the A(z) values of set C were significantly higher than those of sets A and B for both readers. For classifying and characterizing FLL both set B and C were significantly superior to set A. |
2 |
| 16. Purysko AS, Remer EM, Coppa CP, Obuchowski NA, Schneider E, Veniero JC. Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. AJR Am J Roentgenol. 2012; 198(1):115-123. |
Observational-Dx |
12 patients with hepatocellular adenoma and 35 patients with FNH |
To evaluate the performance of gadoxetate disodium-enhanced MRI in the characterization of FNH and hepatocellular adenoma and to assess potential advantages of hepatocyte phase imaging in identifying features that distinguish FNH from hepatocellular adenoma. |
The readers' average receiver operating characteristic area was significantly higher after disclosure of hepatocyte phase images (P=0.024). FNHs were correctly diagnosed in 74.3%-97.1% of cases before and 97.1%-100% of cases after the disclosure of hepatocyte phase images; hepatocellular adenoma was correctly diagnosed in 83%-100% and 91.7%-100% of cases (P>0.05). The presence of a central scar in FNH and fat on hepatocellular adenoma were the only morphologic features that were statistically significantly different (P<0.05). FNH had greater average contrast-enhanced signal intensity and enhancement ratio in all phases (P<0.001). A hepatocyte phase enhancement ratio of less than 0.7 was 100% specific and 91.6% sensitive for hepatocellular adenoma, with accuracy of 97.1% for these data. |
3 |
| 17. Agarwal S, Fuentes-Orrego JM, Arnason T, et al. Inflammatory hepatocellular adenomas can mimic focal nodular hyperplasia on gadoxetic acid-enhanced MRI. AJR Am J Roentgenol. 203(4):W408-14, 2014 Oct. |
Observational-Dx |
10 possible cases of inflammatory hepatocellular adenoma (HCA) |
To investigate whether gadoxetic acid-enhanced MRI can distinguish inflammatory HCA from focal nodular hyperplasia (FNH). |
A total of 10 possible cases of inflammatory HCA were identified in the pathology database. On the basis of glutamine synthetase staining performed for this study, three cases were rediagnosed as FNH and thus were excluded from the study. Therefore, a total of seven patients with inflammatory HCA were identified. On gadoxetic acid-enhanced MRI, four of these patients had classic features of FNH (group A, FNH mimics), and three had imaging features suggestive of HCA (group B, typical inflammatory HCA). Imaging features that were considered diagnostic of FNH included isointense or minimal T2 hyperintensity, arterial enhancement, and diffuse hyperintensity on hepatobiliary phase. Three of the four patients with FNH mimics had slides available for pathologic rereview, and the diagnosis of inflammatory HCA was supported by glutamine synthetase immunohistochemistry findings. The pathology reports of the remaining four cases were rereviewed and were also found to have features consistent with inflammatory HCA. |
3 |
| 18. Fang L, Zhu Z, Huang B, et al. A comparative study of contrast enhanced ultrasound and contrast enhanced magnetic resonance imaging for the detection and characterization of hepatic hemangiomas. Biosci. trends. 9(2):104-10, 2015 Apr. |
Review/Other-Dx |
66 Patients |
To compare contrast enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance imaging (CEMRI) for the detection and characterization of hepatic hemangiomas. |
CEUS diagnosed 78 lesions of hemangioma against 80 by CEMRI. There were no statistical significant differences in the diagnostic value between CEUS and CEMRI in terms of sensitivity (88.0% vs. 92.8%), specificity (99.0% vs. 99.4%), accuracy (97.3% vs. 98.4%), positive predictive value (93.6% vs. 96.3%), and negative predictive value (98.0% vs. 98.8%) (p > 0.05, all). In the arterial phase, the main enhancement pattern on both CEUS and CEMRI was peripheral nodular enhancement (73 vs. 76), but lesions with diffuse enhancement on CEUS outnumbered those on CEMRI (3 vs. 1) and lesions with circular enhancement on CEMRI outnumbered those on CEUS (3 vs. 2). In the portal venous phase and delayed phase, the main enhancement pattern was hyperechoic change on CEUS and hyperintense on CEMRI (66 vs. 65), some lesions presented isoechoic change (12 vs. 15). |
4 |
| 19. Miller FH, Hammond N, Siddiqi AJ, et al. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging. 2010; 32(1):138-147. |
Observational-Dx |
542 lesions in 382 patients |
To evaluate ADC values for characterization of a variety of FLLs and specifically for differentiation of solid benign lesions (FNH and adenomas) from solid malignant neoplasms (metastases and HCC) in a large case series. |
There was high interobserver agreement in ADC measurements for all lesion types. The mean ADCs for cysts was 3.40 (x10 (-3) mm(2)/second), hemangiomas 2.26, FNH 1.79, adenomas 1.49, abscesses 1.97, HCC 1.53, and metastases 1.50. The mean ADC for benign lesions was 2.50 and for malignant lesions was 1.52. Cysts were easily distinguished from other lesions. There was, however, overlap between solid benign and malignant lesions. |
2 |
| 20. Bai YF, Liu JM, Zhang XM, Jiang CZ, Xu X, Zheng SS. Percutaneous liver biopsy: retrospective study of primary and secondary hepatic lymphoma in twenty-one patients. Hepatobiliary Pancreat Dis Int. 16(1):58-64, 2017 Feb. |
Observational-Dx |
21 cases |
To explore the prevalence of HL in ultrasound guided liver biopsies for hepatic mass or mass-like lesions, to investigate HL associated clinicopathological features, raise the awareness of early recognition and proper diagnosis of this entity, and to assess specimen adequacy in needle core biopsy. |
HL was diagnosed in 0.94% of 2242 liver biopsy cases with ambiguous clinical presentation, laboratory tests and image studies. There were two cases of PHL (0.09%), and nineteen cases of SHL (0.85%). Histopathologically, diffuse large B-cell lymphoma was the most common type, followed by B-cell lymphoma not otherwise specified, T-cell lymphoma, Hodgkin's lymphoma, and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma. Additionally, three lymphocytic infiltration patterns were documented microscopically. The nodular infiltration was the most common type. |
4 |
| 21. Eso Y, Takai A, Takeda H, et al. Sonazoid-enhanced ultrasonography guidance improves the quality of pathological diagnosis in the biopsy of focal hepatic lesions. Eur J Gastroenterol Hepatol. 28(12):1462-1467, 2016 Dec. |
Observational-Dx |
121 focal hepatic lesions in 108 patients |
To evaluate the utility of Sonazoid-enhanced ultrasonography (SEUS) in guiding percutaneous biopsy of focal hepatic lesions by comparing the results of histopathological diagnosis between B-mode US and SEUS guidance. |
Among 121 lesions, 56 lesions were subjected to biopsy with B-mode US guidance whereas 65 were subjected to SEUS guidance. The technical success rate was significantly higher under SEUS guidance than under B-mode US guidance (92.3 vs. 76.8%, respectively, P<0.05). When biopsies were performed to diagnose or rule out malignancy in indeterminate lesions, the technical success rate was also significantly higher under SEUS guidance than under B-mode US guidance (100 vs. 73.9%, respectively, P<0.05). SEUS guidance resulted in a significantly higher rate of successful single-puncture attempts compared with B-mode US guidance (55.4 vs. 35.7%, respectively, P<0.05). |
4 |
| 22. Sparchez Z, Radu P, Kacso G, Sparchez M, Zaharia T, Al Hajjar N. Prospective comparison between real time contrast enhanced and conventional ultrasound guidance in percutaneous biopsies of liver tumors. Med. ultrasonography. 17(4):456-63, 2015 Dec. |
Observational-Dx |
171 patients |
To evaluate the feasibility and performance of CEUS as a guiding method in performing liver biopsy (PLB). |
Real time CEUS-PLB was technically successful in 84 of the 86 procedures (97.6% technical success rate). The rate of successful single puncture attempt in CEUS-PLB (43.02%) was higher than in the US-PLB group (23.4%) (p<0.05). The sensitivity of LB was significantly higher in the CEUS-PLB group than in the conventional US-LB group for all lesions (96.5% vs. 81.48%, p<0.05), for lesions on liver cirrhosis (95.2% vs. 75%, p<0.05), for large (> 6 cm) (97.8% vs. 82%, p<0.05), and for poorly visible lesions (100 vs. 66.6%, p=0.029). The patients with inconclusive pathological results after conventional guided LB were then biopsied with CEUS guidance. In all cases the final diagnosis could be established. One major complication occurred in each group (p>0.05). |
3 |
| 23. Tacher V, Le Deley MC, Hollebecque A, et al. Factors associated with success of image-guided tumour biopsies: Results from a prospective molecular triage study (MOSCATO-01). Eur J Cancer. 59:79-89, 2016 May. |
Observational-Dx |
460 patients |
To identify factors associated with high tumour cellularity. |
Among 460 patients enrolled between November, 2011 and March, 2014, 334 patients (73%) had an image-guided needle biopsy of the primary tumour (N = 38) or a metastatic lesion (N = 296). Biopsies were performed on liver (N = 127), lung (N = 72), lymph nodes (N = 71), bone (N = 11), or another tumour site (N = 53). Eighteen patients (5%) experienced a complication: pneumothorax in 10 patients treated medically, and haemorrhage in 8, requiring embolisation in 3 cases. Median tumour cellularity was 50% (interquartile range, 30-70%). The molecular analysis was successful in 291/334 cases (87%). On-going chemotherapy, tumour origin (primary versus metastatic), lesion size, tumour growth rate, presence of necrosis on imaging, standardised uptake value, and needle size were not statistically associated with cellularity. Compared to liver or lung biopsies, cellularity was significantly lower in bone and higher in other sites (P < 0.0001). Cellularity significantly increased with the number of collected samples (P < 0.0001) and was higher in contrast-enhanced ultrasound-guided biopsies (P < 0.02). In paired samples, cellularity in central samples was lower than in peripheral samples in 85, equal in 68 and higher in 89 of the cases. |
3 |
| 24. Partovi S, Lu Z, Kessner R, et al. Contrast enhanced ultrasound guided biopsies of liver lesions not visualized on standard B-mode ultrasound-preliminary experience. J. gastrointest. oncol.. 8(6):1056-1064, 2017 Dec. |
Observational-Dx |
26 patients |
To assess the technical success of contrast enhanced ultrasound (CEUS) guided biopsies of liver lesions poorly visualized on B-mode ultrasound. |
CEUS guided liver biopsy was successful in 23 out of 26 patients (88.5%). The average procedure time was 30.7+/-12.3 minutes and the average lesion size was 2.2+/-1.7 cm. The majority of lesions (80.8%) were hypoenhancing on the delayed phase of CEUS. The mean number of samples taken from each lesion per procedure was 3.2 (+/-1.7). |
3 |
| 25. Park HJ, Lee MW, Lee MH, et al. Fusion imaging-guided percutaneous biopsy of focal hepatic lesions with poor conspicuity on conventional sonography. J Ultrasound Med. 32(9):1557-64, 2013 Sep. |
Observational-Dx |
22 patients |
To evaluate the effectiveness of real-time fusion imaging (sonography combined with computed tomography or magnetic resonance imaging) for percutaneous sonographically guided biopsy of focal hepatic lesions with poor sonographic conspicuity. |
A total of 22 patients were enrolled in the study. On fusion imaging, lesion conspicuity was increased in 63.6% of focal hepatic lesions (14 of 22). Moreover, 66.7% of lesions (6 of 9) that were invisible on B-mode sonography became visible on fusion imaging. The true-positive detection rate was significantly different between B-mode sonography and fusion imaging (9 of 22 versus 19 of 22; P = .0044). Percutaneous biopsy was performed for all lesions, including 3 target lesions that were invisible even on fusion imaging. The technical success rate was 95.5% (21 of 22). |
3 |
| 26. Sainani NI, Schlett CL, Hahn PF, Gervais DA, Mueller PR, Arellano RS. Computed tomography-guided percutaneous biopsy of isoattenuating focal liver lesions. Abdominal Imaging. 39(3):633-44, 2014 Jun. |
Observational-Dx |
133 patients |
To evaluate the efficacy of CT-guided percutaneous biopsy of isoattenuating liver lesions using anatomic landmarks (ALs) to guide needle placement and added value of intravenous (IV) contrast. |
Between January 2000 and December 2011, CT-guided percutaneous biopsy of 133 isoattenuating focal liver lesions was performed in 133 patients. The AL group included 54 patients (M:F = 29:25) with 54 lesions (size range 7-90 mm, mean 32.1 +/- 18.1) and AL+IV group included 79 patients (M:F = 44:35) with 79 lesions (size range 7-100 mm, mean 25.6 +/- 15.0). AL group included 23 (43%) benign and 31 (57%) malignant lesions; AL+IV group included 31 (39%) benign and 48 (61%) malignant lesions. Sensitivity and accuracy for CT-guided biopsy of focal isoattenuating liver lesions were, overall 94% and 96%, AL group 97% and 98% and AL+IV group 92% and 94%, with no statistical significant difference between the AL and AL+IV groups (P = 0.88-1.00). |
3 |
| 27. Sandrasegaran K, Thayalan N, Thavanesan R, et al. Risk factors for bleeding after liver biopsy. Abdom Radiol. 41(4):643-9, 2016 04. |
Observational-Dx |
847 patients. |
To determine factors that increase the risk of bleeding after liver biopsy. |
Of 847 patients queried by retrospective database search, 296 had adequate records for the period of 2 weeks prior to biopsy to 4 weeks after biopsy. The remaining patients had liver biopsy as outpatients and probably did not have bleeding complications but no electronic records were found to confirm this. 25 (8.4%) of 296 patients had post-biopsy bleeding, with incidences of 11.7% and 4.9% in groups 1 and 2 (p = 0.04). On logistic regression analysis, the only significant predictor of bleeding was the "Risk Score" (p = 0.01, odds ratio 4.6). There was substantial overlap in INR, and platelet count in bleeders vs. non-bleeders. Pre-biopsy fresh frozen plasma or platelet concentrate infusions did not reduce the risk of bleeding. |
4 |
| 28. Kang TW, Lee MW, Choi D, et al. Safety of Percutaneous Biopsy for Hepatic Angiosarcoma: Results of a Multicenter Korean Survey. J Vasc Interv Radiol. 27(6):846-51, 2016 Jun. |
Review/Other-Dx |
33 patients |
To evaluate the incidence of severe bleeding and mortality associated with percutaneous biopsy for hepatic angiosarcoma in a multicenter retrospective cohort. |
There was a mean of 2.8 needle passes per patient during the procedure (range, 1-6). The overall incidence of severe bleeding events (SIR grade C/D) was 9.1% (3 of 33). Two patients were managed with blood transfusion, and one patient underwent embolization for bleeding control. No other major complications were encountered. There were no cases of mortality associated with the biopsy. |
4 |
| 29. Wang WP, Wu Y, Luo Y, et al. Clinical value of contrast-enhanced ultrasonography in the characterization of focal liver lesions: a prospective multicenter trial. Hepatobiliary Pancreat Dis Int. 2009; 8(4):370-376. |
Observational-Dx |
148 patients with 164 FLLs |
To assess the efficacy of CEUS in the characterization of FLLs in comparison with final diagnosis based on gold standard assessment. |
When compared to the gold standard, the number of indeterminate diagnoses was reduced from 56.7% (93/164) as assessed by fundamental imaging to 6.1% (10/164) after SonoVue enhanced US examination. Sensitivity and specificity improved from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively (P<0.01). Diagnostic accuracy of CEUS was 88% in contrast to 41% of baseline US. |
3 |
| 30. Sporea I, Martie A, Bota S, Sirli R, Popescu A, Danila M. Characterization of focal liver lesions using contrast enhanced ultrasound as a first line method: a large monocentric experience. J. Gastrointestinal Liver Diseases. 23(1):57-63, 2014 Mar. |
Review/Other-Dx |
1100 patients |
To present a large monocentric experience in the characterization of focal liver lesions (FLLs) using Contrast Enhanced Ultrasound (CEUS). |
From the 1329 FLLs, CEUS was conclusive for a specific pathology in 1102 cases (82.9%). For the differentiation of benign/malignant lesions, CEUS reached a conclusive diagnosis in 1196 (90%) cases. The percentage of conclusive CEUS examinations was significantly higher in patients without chronic liver disease as compared with those with chronic hepatopathies: 87.3% vs. 74.4% (p<0.0001). |
4 |
| 31. Sporea I, Badea R, Martie A, et al. Contrast enhanced ultrasound for the characterization of focal liver lesions. Med Ultrason. 2011; 13(1):38-44. |
Observational-Dx |
729 cases |
To present the practice of two experienced centers concerning the use of CEUS in the characterization of FLLs. |
From the 729 cases with FLL, 389 (53.4%) were patients without known and 340 (46.6%) with known chronic liver disease. CEUS was conclusive for the diagnosis in 597/729 cases (82%) and allowed the positive diagnosis of benign vs malignant lesion in 662/729 (90.8%) FLL. For each center independently (Center A vs Center B) the situation was as follows: conclusive for the diagnosis 390/506 (77.1%) vs 207/223 (92.8%) (P<0.0001), conclusive for the differentiation benign/malignant 449/506 (88.7%) vs 213/223 (95.5%) (P=0.0032). |
3 |
| 32. Sporea I, Sirli R, Martie A, Popescu A, Danila M. How useful is contrast enhanced ultrasonography for the characterization of focal liver lesions? J Gastrointestin Liver Dis. 2010; 19(4):393-398. |
Review/Other-Dx |
379 cases |
To present a single center experience concerning the use of CEUS in the characterization of FLL and to find when one can avoid using other expensive imaging modalities such as contrast enhanced CT or MRI. |
From the 379 cases with FLL, 198 (52.2%) were patients without known liver disease and 181 (47.8%) with known chronic liver disease (156 had cirrhosis, 25 chronic hepatitis); in 296/379 cases (78.1%) CEUS was conclusive. CEUS allowed the positive diagnosis of benign vs malignant lesion in 261/294 (88.8%) de novo FLLs (CEUS performed for the first time), while in 33 (11.2%) cases it was inconclusive and could not differentiate between benign or malignant lesions. The CEUS results included 129 (49.4%) benign lesions and 132 (50.6%) malignant. |
4 |
| 33. Corvino A, Catalano O, Setola SV, Sandomenico F, Corvino F, Petrillo A. Contrast-enhanced ultrasound in the characterization of complex cystic focal liver lesions. Ultrasound Med Biol. 41(5):1301-10, 2015 May. |
Review/Other-Dx |
36 Patients |
To investigate the value of contrast-enhanced US (CEUS) in the differential diagnosis of complex cystic focal liver lesions (FLLs). |
We evaluated 36 consecutive patients with 61 FLLs (1-6/patient, mean = 2). The diameter of the lesions ranged from 1.1 to 7.9 cm (mean = 3.9 cm). Sixteen patients had an extrahepatic malignancy. There were 42 malignant lesions and 19 benign lesions. No lesion had a certain diagnosis at conventional US, whereas 16 FLLs were classified as probable (benign or malignant) and 45 as uncertain. CEUS correctly categorized 95% of the malignant cases. CEUS was not able to differentiate the biliary cystadenoma from its malignant counterpart and misdiagnosed two abscesses. Complete non-enhancement throughout three phases or sustained enhancement in the portal/late phase was exhibited in most benign complex cystic FLLs, except for 1 (of the 3) cystadenomas and in 2 (of the 4) abscesses. On the other hand, all malignant lesions presented a contrast washout with a hypo-enhancing appearance. |
4 |
| 34. Sirli R, Sporea I, Popescu A, et al. Contrast enhanced ultrasound for the diagnosis of liver hemangiomas in clinical practice. Med Ultrason. 2011; 13(2):95-101. |
Review/Other-Dx |
413 cases |
To evaluate the usefulness of CEUS in the assessment of liver hemangiomas. |
During September 2009 - October 2010, 413 CEUS examinations were performed in our department for the evaluation of de novo FLL. Out of the 413 cases, based on standard US, 43 were suspected hemangiomas, 125 were uncharacteristic lesions and 245 were suspected for other types of lesions (metastases, FNHs, HCCs etc.). Out of the 413 de novo FLL, 64 cases (15.5%) were diagnosed as hemangiomas by CEUS (typical CEUS pattern). MRI diagnosed 7 additional hemangiomas in inconclusive CEUS cases, so 90.1% (64/71) of the hemangiomas were diagnosed by CEUS alone. Out of the 125 uncharacteristic lesions on standard US, 29 cases were diagnosed after CEUS as hemangiomas. Thus, CEUS diagnosed additional 40.8% (29/71) hemangiomas as compared to standard US, without the need of more expensive imaging methods. |
4 |
| 35. Seitz K, Bernatik T, Strobel D, et al. Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI--a prospective comparison in 269 patients. Ultraschall Med. 2010; 31(5):492-499. |
Observational-Dx |
1,349 patients |
A prospective multicenter study to assess the diagnostic role of CEUS in the diagnosis of newly discovered FLLs in clinical practice. |
In the subcollective (n=262), the tumor differentiation (malignant or benign) of CEUS and MRI was concordant in 225 cases (85.9%), and the assessment of tumor entity in 204 cases (77.9%). In subgroup A (n=180), concordant results for tumor differentiation were obtained in 169 (93.2%) and for tumor entity in 160 (88.9%) cases. Liver hemangiomas (n=122) and FNH (n=43) were most frequent. Subgroup B (n=82) comprised mainly malignant liver lesions (n=55), with only a few of hemangiomas (n=8) or FNH (n=5). Tumor differentiation was concordant in 56 (68.3%) and tumor entity in 44 cases (53.7%). There were no statistically proven differences between CEUS and MRI. |
3 |
| 36. Sirli R, Sporea I, Sandulescu DL, et al. Contrast enhanced ultrasound for the diagnosis of liver hemangiomas - results of a Romanian multicentre study. Med. ultrasonography. 17(4):444-50, 2015 Dec. |
Review/Other-Dx |
1153 CEUS examinations |
To evaluate the performance of CEUS for the diagnosis of liver hemangiomas in a large cohort of patients. |
During February 2011 - May 2015, 1153 CEUS examinations were performed for the evaluation of de novo FLL. Out of the 1153 de novo FLL, 238 cases were diagnosed as hemangiomas by CEUS (typical enhancing pattern). Contrast CT/MRI and biopsy diagnosed additional 24 hemangiomas. From the 238 cases diagnosed as hemangiomas by CEUS, in 11 the final diagnosis was different. Considering contrast CT/MRI and biopsy as reference methods, CEUS had 90.4% sensitivity, 98.8% specificity, 95.4% positive predictive value, 97.4% negative predictive value, resulting in 96.9% diagnostic accuracy for the diagnosis of hemangiomas. |
4 |
| 37. Celli N, Gaiani S, Piscaglia F, et al. Characterization of liver lesions by real-time contrast-enhanced ultrasonography. Eur J Gastroenterol Hepatol. 2007; 19(1):3-14. |
Observational-Dx |
Group 1: 125 noncirrhotic patients, 171 lesions: Group 2: 67 cirrhotic patients, 75 lesions |
To examine the role of real-time CEUS in the characterization of liver lesions. |
In noncirrhotic patients, the hypoechoic pattern in portal and sinusoidal phase (rapid washout) or the markedly hypoechoic or anechoic pattern in sinusoidal phase (marked late washout) showed a sensitivity, specificity and accuracy of 96.8%, 100% and 98.2% for the diagnosis of malignancy. In cirrhotic patients, early arterial enhancement showed a sensitivity of 93.9% for diagnosis of malignancy and specificity of 55.5%. Real-time CEUS provides sensitive and specific criteria for characterization of liver lesions. |
2 |
| 38. Phongkitkarun S, Srianujata T, Jatchavala J. Supplement value of magnetic resonance imaging in small hepatic lesion (< or = 20 mm) detected on routine computed tomography. J Med Assoc Thai. 2009; 92(5):677-686. |
Observational-Dx |
64 patients with 81 lesions |
Retrospective blinded study to determine the supplemental MRI value in characterization of small hepatic lesions (=20 mm) undetermined by routine CT scan. |
MRI interpreted 55 lesions as benign, 17 lesions as malignant, and 9 as indeterminate lesions. If the indeterminate lesions were assumed as benign lesions, sensitivity, specificity, PPV, and NPV, are 68.4%, 93.6%, 76.5%, and 90.6%, respectively. MRI can supplement CT scan in characterization of small hepatic lesion. |
2 |
| 39. Quaia E, De Paoli L, Angileri R, Cabibbo B, Cova MA. Indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography: assessment of the additional diagnostic value of contrast-enhanced ultrasound in the non-cirrhotic liver. Eur J Radiol. 83(3):456-62, 2014 Mar. |
Observational-Dx |
46 patients |
To assess the additional diagnostic value of contrast-enhanced ultrasound (CEUS) in the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography (CT). |
Final diagnoses included 29 hemangiomas, 3 focal nodular hyperplasias, 1 hepatocellular adenoma, and 22 metastases. The additional review of CEUS after CT images improved significantly (P<.05) the diagnostic accuracy (before vs after CEUS review=49% [20/55] vs 89% [49/55]--reader 1 and 43% [24/55] vs 92% [51/55]--reader 2) and confidence (Az, 95% Confidence Intervals before vs after CEUS review=.773 [.652-.895] vs .997 [.987-1]--reader 1 and .831 [.724-.938] vs .998 [.992-1]--reader 2). |
3 |
| 40. Jolepalem P, Rydberg JN, Wong CO. Improvement of hepatic lesion characterization by 18F-FDG PET/CT with the use of the lesion to background liver activity ratio. Clin Nucl Med. 38(11):869-73, 2013 Nov. |
Observational-Dx |
76 patients |
To develop a reproducible method to improve (18)F-FDG PET/CT's diagnostic accuracy when characterizing hepatic lesions. |
A SUV(TLR) greater than 2.0 strongly correlated with metastasis, while less than 2.0 strongly correlated with benign activity. Based on the original interpreter's visual analysis (PET(VA)), (18)F-FDG PET/CT had an accuracy of 74.6% with a high sensitivity (95.5%), but limited specificity (33.3%). Using the SUV(TLR) cutoff value of 2.0 to objectively re-stratify these cases, there was improvement in accuracy to 97.8%, sensitivity to 100%, and specificity to 93.3%. These values were statistically significant by chi-square analysis, with P = 0.0001 for both PET(VA) and SUV(TLR). The 58 MRI lesions and 107 diagnostic CT lesions that were reviewed had accuracies of 70.7% (P = 0.008) and 73.8% (P = 0.0001), respectively. |
4 |
| 41. van Kessel CS, van Leeuwen MS, van den Bosch MA, et al. Accuracy of multislice liver CT and MRI for preoperative assessment of colorectal liver metastases after neoadjuvant chemotherapy. Dig Surg. 2011; 28(1):36-43. |
Observational-Dx |
79 lesions in 15 patients |
To determine the best imaging modality for preoperative detection, characterization and measurement of colorectal liver metastases after neoadjuvant chemotherapy. |
Lesion detection rate was similar for multislice-CT and MRI (76% and 80%, respectively, P=0.648). Lesion characterization was significantly superior (P=0.021) at MRI (89%, kappa 0.747, P=0.001) compared to multislice-CT (77%, kappa 0.235, P=0.005). Interobserver variability for diameter measurement was not significant at MRI (P=0.909 [95% confidence interval; -1.245 to 1.395]), but significant at multislice-CT (P=0.028 [95% confidence interval; -3.349 to -2.007]). Differences in diameter measurement were independent of observer (P=0.131), and no statistical effect from imaging modality on diameter measurement was observed (P=0.095). |
3 |
| 42. D'Souza M M, Sharma R, Mondal A, et al. Prospective evaluation of CECT and 18F-FDG-PET/CT in detection of hepatic metastases. Nucl Med Commun. 2009; 30(2):117-125. |
Observational-Dx |
45 patients |
To evaluate the performance FDG-PET/CT and contrast-enhanced CT in the detection and characterization of hepatic metastases. |
The sensitivity and specificity of contrast-enhanced CT in the detection of hepatic metastases was 87.9% and 16.7%, respectively, whereas that of PET/CT was 97% and 75%, respectively. This study showed the superiority of PET/CT over contrast-enhanced CT in the detection of hepatic metastases, irrespective of the primary site. This was especially owing to the latter's inability to reliably distinguish small (<15 mm) lesions as benign or malignant. |
2 |
| 43. Sadigh G, Nandwana SB, Moreno C, et al. Assessment of Added Value of Noncontrast to Contrast-Enhanced Abdominal Computed Tomography Scan for Characterization of Hypervascular Liver Metastases. Curr Probl Diagn Radiol. 45(6):373-379, 2016 Nov - Dec. |
Review/Other-Dx |
81 patients |
To assess the added value of nonenhanced computed tomography (NECT) to contrast-enhanced CT (CECT) of the abdomen for characterization of hypervascular liver metastases and incidental findings |
A total of 81 patients were included (mean age = 55 years; 52% male; 64% with liver lesions; 27% and 11% with incidental renal and adrenal lesions, respectively). Percentage area under the curve and 95% CI of CECT vs combination with NECT for characterization of liver metastases was 98(94-100) vs 99(96-100) for reviewer 1 (P = 0.35), 93(86-100) vs 94(87-100) for reviewer 2 (P = 0.23), and 96(90-100) vs 99(97-100) for reviewer 3 (P = 0.32). Mean difference in area under the curve and 95% CI between 2 protocols for characterization of liver, renal, and adrenal lesions were -0.007(-0.05 to 0.04) (P = 0.63), -0.09(-0.25 to 0.07) (P = 0.22), and -0.01(-0.05 to 0.02) (P = 0.27), respectively. After addition of NECT, confidence level for lesion characterization increased 4%-15% for liver metastases, 18%-59% and 33%-67% for renal and adrenal lesions, respectively. |
4 |
| 44. Sadigh G, Applegate KE, Baumgarten DA. Comparative accuracy of intravenous contrast-enhanced CT versus noncontrast CT plus intravenous contrast-enhanced CT in the detection and characterization of patients with hypervascular liver metastases: a critically appraised topic. [Review]. Academic Radiology. 21(1):113-25, 2014 Jan. |
Review/Other-Dx |
81 patients |
To evaluate whether addition of nonenhanced computed tomography (NECT) to intravenous contrast-enhanced (CE) abdominal CT improves detection or characterization of hypervascular liver masses. Patients were referred for initial staging or follow-up with known breast, melanoma, neuroendocrine, or thyroid cancer. |
One thousand one hundred studies were reviewed; only 11 studies matched the PICO of our study and were appraised. Most of the appraised articles were published in the 1990s using older technology and contrast delivery. The retrieved diagnostic performance for characterization of liver metastases showed sensitivity/specificity of 97%/76% for NECT, 97%/75% for arterial CT, and 98%/76% for portal venous phase CT in patients with breast cancer; sensitivity of 96% (arterial and portal CT) versus 100% (NECT, arterial and portal CT) in patients with melanoma; and sensitivity of 43% (portal CT) versus 17% (NECT) in patients with neuroendocrine tumor. No primary study was found for performance of different CT protocols in patients with thyroid cancer. Available evidence showed radiologists reported more conspicuous liver masses on CECT compared to NECT in patients with breast or neuroendocrine cancer. |
4 |
| 45. Sundin A, Vullierme MP, Kaltsas G, Plockinger U. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: radiological examinations. Neuroendocrinology. 2009;90(2):167-183. |
Review/Other-Dx |
N/A |
To describe the various applications of current radiological modalities. |
No abstract available. |
4 |
| 46. Kwekkeboom DJ, Krenning EP, Scheidhauer K, et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: somatostatin receptor imaging with (111)In-pentetreotide. [46 refs]. Neuroendocrinology. 90(2):184-9, 2009. |
Review/Other-Dx |
N/A |
To assist nuclear medicine practitioners in performing, interpreting, and reporting the results of somatostatin receptor scitntigraphy with (111)In-pentetreotide. |
No results stated in the abstract. |
4 |
| 47. Haimerl M, Wachtler M, Platzek I, et al. Added value of Gd-EOB-DTPA-enhanced Hepatobiliary phase MR imaging in evaluation of focal solid hepatic lesions. BMC med. imaging. 13:41, 2013 Dec 01. |
Observational-Dx |
84 patients |
To determine the added value of hepatobiliary phase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid hepatic lesions. |
Diagnostic accuracy was significantly improved by the addition of Gd-EOB-DTPA-enhanced dynamic images: Az in set 1 was 0.708 and 0.833 in set 2 (P = 0.0002). The addition of hepatobiliary phase images increased the Az value to 0.941 in set 3 (set 3 vs set 2, P < 0.0001; set 3 vs set 1, P < 0.0001). The index of diagnostic performance was lowest in set 1 (45%), improved in set 2 (71%), and highest in set 3 (94%). |
4 |
| 48. Huf S, Platz Batista da Silva N, Wiesinger I, et al. Analysis of Liver Tumors Using Preoperative and Intraoperative Contrast-Enhanced Ultrasound (CEUS/IOCEUS) by Radiologists in Comparison to Magnetic Resonance Imaging and Histopathology. ROFO Fortschr Geb Rontgenstr Nuklearmed. 189(5):431-440, 2017 May. |
Observational-Dx |
70 Patients |
To evaluate the diagnostic significance of preoperatively and intraoperatively performed contrast-enhanced ultrasound (CEUS/IOCEUS) in the diagnosis of liver tumors in comparison to magnetic resonance imaging (MRI) and histopathology. |
In 70 analyzed patient cases, 64 malignant liver lesions could be detected. 6 patients had benign liver lesions. Among the 64 malignant lesions, there were 28 metastases, 24 hepatocellular carcinomas (HCC), 9 cholangiocellular carcinomas (CCC) and 3 gallbladder carcinomas. 2 of the 6 benign liver lesions were hemangiomas, 2 were adenomas, 1 was an FNH and 1 was a complicated cyst. There was no significant difference when determining the lesion's malignancy/ benignity (p?=?1.000). Furthermore, there was no statistical significance between preoperative CEUS and MRI regarding the general differential diagnosis of a tumor (p?=?0.210) and the differential diagnosis classification between HCCs (p?=?0.453) and metastases (p?=?0.250). There was no statistical significance in tumor size (10?mm - 151?mm; mean 49?mm SD +/- 31?mm) and location (tumor size p?=?0.579; allocation to liver lobes p?=?0.132; segment diagnosis p?=?0.121) between preoperatively performed CEUS and MRI. The combination of preoperative MRI and CEUS for lesion detection showed significant differences compared to CEUS or MRI only (p?<?0.001 for CEUS; p?=?0.004 for MRI). IOCEUS offered the substantial advantage of locating additional liver lesions (p?=?0.004 compared to preoperative MRI, p?=?0.002 compared to preoperative CEUS). In 10/37 cases (27?%) IOCEUS could locate further liver lesions which had not been identified during CEUS and/or MRI preoperatively, so that operative therapy was adapted accordingly and resection was extended if necessary. |
3 |
| 49. Chung WS, Kim MJ, Chung YE, et al. Comparison of gadoxetic acid-enhanced dynamic imaging and diffusion-weighted imaging for the preoperative evaluation of colorectal liver metastases. J Magn Reson Imaging. 2011; 34(2):345-353. |
Observational-Dx |
47 patients |
To retrospectively compare the diagnostic accuracy for the detection of colorectal liver metastases between gadoxetic acid-enhanced MRI and DWI on 3.0 T system, and then to determine whether a combination of the two techniques may improve the diagnostic performance. |
A total of 78 confirmed colorectal liver metastases in 42/47 patients was found. Each reader noted higher diagnostic accuracy of combined set of gadoxetic acid-enhanced MRI and DWI than DWI set and gadoxetic acid-enhanced set, without statistical significance. Regardless of the size of colorectal liver metastasis, each reader detected significantly more metastases on combined set than on DWI set, and PPV was significantly higher with DWI set than with gadoxetic acid-enhanced set or with combined set for one reader. |
2 |
| 50. Testa ML, Chojniak R, Sene LS, et al. Is DWI/ADC a useful tool in the characterization of focal hepatic lesions suspected of malignancy?. PLoS ONE. 9(7):e101944, 2014. |
Review/Other-Dx |
67 Patients |
To evaluate the ability of apparent diffusion coefficient (ADC) values to differentiate metastatic liver lesions from all benign or only solid benign liver lesions. |
The average ADC value for cysts was 2.4×10(-3) mm2/sec (CI: 2.1-2.6), for solid benign lesions was 1.4×10(-3) mm2/sec (CI: 1.1-1.7) and for metastases was 1.0×10(-3) mm2/sec (CI: 0.8-1.3). There was a difference between the ADC values of metastases and benign solid lesions (p<0.0001). With the ADC value of 1.5×10(-3) mm2/sec as a cut off it is possible to distinguish metastatic from benign liver lesions, including cysts, with an accuracy of 78%. But to distinguish metastatic from benign solid liver lesions the best ADC cut off value was 1.2×10(-3) mm2/sec and the accuracy drops to 71%. |
4 |
| 51. Elsayes KM, Ellis JH, Elkhouly T, et al. Diagnostic yield of percutaneous image-guided tissue biopsy of focal hepatic lesions in cancer patients: ten percent are not metastases from the primary malignancy. Cancer. 117(17):4041-8, 2011 Sep 01. |
Observational-Dx |
580 patients |
To evaluate the diagnostic yield of percutaneous image-guided tissue biopsy of hepatic lesions identified on computed tomography (CT) performed for staging a primary malignancy and to determine how often the biopsy result was unexpectedly negative, benign, or secondary to a second unknown malignancy. |
Liver biopsies were performed in 580 patients (288 men and 292 women; age, 25-92 years; mean age, 61 years). The most common primary malignancies were pancreatic (n = 96), breast (n = 85), melanoma (n = 57), esophageal (n = 51), lung (n = 47), colorectal (n = 37), and urothelial tumors (n = 26). Biopsy results were positive for malignancy in 528 (91%) cases. Among the positive biopsies, 29 (5%) cases had pathology results different from the primary tumor. Of the 52 biopsies negative for malignancy, 20 yielded a specific benign diagnosis, and 32 were nondiagnostic. |
3 |
| 52. Szpakowski JL, Drasin TE, Lyon LL. Rate of seeding with biopsies and ablations of hepatocellular carcinoma: A retrospective cohort study. Hepatol. commun.. 1(9):841-851, 2017 11. |
Observational-Dx |
1,015 patients. |
To determine the rate of seeding when biopsies and ablations were performed in a large community setting in the United States. |
Six cases of seeding were identified. The rate of wall seeding was 2/795 patients (0.13%; 95% confidence interval [CI], 0.00%-0.60%) if only biopsies were done versus 4/220 (1.82%; 95% CI, 0.05%-3.58%) if ablations were performed (P = 0.01). The rate was 0/72 (0.00%; 95% CI, 0.00%-0.04%) with ablations alone and 4/148 (2.70%; 95% CI, 0.74%-6.78%) if both procedures were done (P = 0.31). Of those with 1 year follow-up (n = 441), the rate of seeding was 2/269 (0.74%; 95% CI, 0.00%-1.77%) if biopsies alone were done and 4/172 (2.33%; 95% CI, 0.07%-4.58%) if ablations were done. In none of the cases was the seeding a proximate cause of death. |
3 |
| 53. Ahn DW, Shim JH, Yoon JH, et al. Treatment and clinical outcome of needle-track seeding from hepatocellular carcinoma. Korean J Hepatol. 17(2):106-12, 2011 Jun. |
Observational-Tx |
5,092 patients |
To determine the appropriate treatment for needle-track seeding and its clinical outcome. |
Seven (0.14%) of 5,092 patients who experienced needle-track seeding (2 after PEI, 4 after FNAB, and 1 after PTBD) during the study period and 1 other patient who experienced needle-track seeding recently were recruited for this study. Two of the eight patients underwent mass excision and the other six patients underwent en-bloc wide excision for the needle-track seeding. Tumors recurred in the needle-tracks in both patients who underwent mass excision but not in the six patients who underwent en-bloc wide excision. Mortality occurred in three patients who experienced the recurrence and progression of intrahepatic HCC. |
2 |
| 54. Chen QW, Cheng CS, Chen H, et al. Effectiveness and complications of ultrasound guided fine needle aspiration for primary liver cancer in a Chinese population with serum alpha-fetoprotein levels <=200 ng/ml--a study based on 4,312 patients. PLoS ONE. 9(8):e101536, 2014. |
Observational-Dx |
1,929 cases |
To elucidate the effectiveness and complications of fine needle aspiration in a Chinese population with primary liver cancer and AFP levels </=200 ng/ml. |
Of the 1,929 cases with AFP </=200 mg/ml, 1,756 underwent FNA. Of these, 1,590 cases were determined malignant and the remaining 166 were determined benign. Further, 1,478 malignant cases were diagnosed by FNA alone, and of these, 1,138 were diagnosed as PLC. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the diagnoses were 92.96%, 100%, 100%, 59.71%, and 93.62% respectively. There was no significant difference in the sensitivity, specificity, PPV and NPV between the subgroups with tumor size<2 cm and >/=2 cm. Major complications included implantation metastasis and hemorrhage. |
4 |
| 55. Chernyak V, Santillan CS, Papadatos D, Sirlin CB. LI-RADS R algorithm: CT and MRI. [Review]. Abdominal Radiology. 43(1):111-126, 2018 01. |
Review/Other-Dx |
N/A |
To discuss the steps necessary for application of the LI-RADS algorithm and provide examples illustrating each step. |
No results stated in abstract. |
4 |
| 56. Mita K, Kim SR, Kudo M, et al. Diagnostic sensitivity of imaging modalities for hepatocellular carcinoma smaller than 2 cm. World J Gastroenterol. 16(33):4187-92, 2010 Sep 07. |
Observational-Dx |
29 patients |
To compare the imaging results with histology and to evaluate the diagnostic sensitivity of imaging modalities for hepatocellular carcinoma (HCC) smaller than 2 cm. |
Overall, the sensitivity of diagnosing HCC smaller than 2 cm was 52.9% (18/34) (95% CI: 35.1-70.2) by CECT; 67.6% (23/34) (95% CI: 49.5-82.6) by Sonazoid CEUS; 76.5% (26/34) (95% CI: 58.8-89.3) by Gd-EOB-DTPA MRI; and 88.2% (30/34) (95% CI: 72.5-96.7) by CT arterioportal angiography. The diagnostic sensitivity of detecting moderately-differentiated HCC by CECT, Sonazoid CEUS, Gd-EOB-DTPA MRI and CT arterioportal angiography was 62.5% (15/24) (95% CI: 40.6-81.2), 79.2% (19/24) (95% CI: 57.8-92.9), 75.0% (18/24) (95% CI: 53.3-90.2) and 95.8% (23/24) (95% CI: 78.9-99.9), respectively. A significant difference (P < 0.05) was observed between CECT and CT arterioportal angiography in all nodules. There was no difference between Sonazoid CEUS, Gd-EOB-DTPA MRI, and CT arterioportal angiography. The combined sensitivity of Sonazoid CEUS and Gd-EOB-DTPA MRI was 94.1% (32/34). |
3 |
| 57. Ichikawa T, Saito K, Yoshioka N, et al. Detection and characterization of focal liver lesions: a Japanese phase III, multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease. Invest Radiol. 2010; 45(3):133-141. |
Experimental-Dx |
178 patients |
To prospectively evaluate the safety and efficacy of combined unenhanced and gadoxetic acid disodium-enhanced MRI compared with unenhanced MRI and triphasic contrast-enhanced spiral CT for the detection and characterization of FLLs. |
Overall, 9.6% of patients who received Gd- gadoxetic acid disodium reported 21 drug-related adverse events. A total of 151 patients were included in the efficacy analysis. Combined MRI showed statistically higher sensitivity in lesion detection (67.5%-79.5%) than unenhanced MRI (46.5%-59.1%; P<0.05 for all). Combined MRI also showed higher sensitivity in lesion detection than CT (61.1%-73.0%), with the results being statistically significant (P<0.05) for on-site readers and 2 of 3 blinded readers. Higher sensitivity in lesion detection with combined MRI compared with CT was also clearly demonstrated in the following subgroups: lesions with a diameter =20 mm (lesions =10 mm: 38.0%-55.4% vs 26.1%-47.3%, respectively; lesions 10-20 mm: 71.1%-87.3% vs 65.7%-78.4%, respectively); in cirrhotic patients (64.5%-75.4% vs 54.5%-70.3%, respectively); and in patients with HCC (66.6%-78.6% vs 59.1%-71.6%, respectively). Combined MRI demonstrated a higher proportion of correctly characterized lesions (50.5%-72.1%) than unenhanced MRI (30.2%-50.0%; P<0.05 for all), whereas there were no significant differences compared with CT (49.0%-68.1%), except for one blinded reader (P<0.05). |
2 |
| 58. Iannaccone R, Laghi A, Catalano C, et al. Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis. Radiology. 2005;234(2):460-467. |
Observational-Dx |
195 patients. Note: Quadruple-phase CT performed. |
To determine, by using multi-detector row helical computed tomography (CT), the added value of obtaining unenhanced and delayed phase scans in addition to biphasic (hepatic arterial and portal venous phases) scans in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. |
Mean sensitivity and positive predictive values, respectively, for HCC detection were 88.8% (666 of 750 readings) and 97.8% (666 of 681 readings) for the combined hepatic arterial and portal venous phases, 89.2% (669 of 750 readings) and 97.8% (669 of 684 readings) for hepatic arterial and portal venous phases with the unenhanced phase, 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for hepatic arterial and portal venous phases with the delayed phase, and 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for all four phases combined. The reading sessions in which delayed phase images were available for interpretation showed significantly (P < .05) superior sensitivity and A(z) values. |
2 |
| 59. Jang HJ, Kim TK, Khalili K, et al. Characterization of 1-to 2-cm liver nodules detected on hcc surveillance ultrasound according to the criteria of the American Association for the Study of Liver Disease: is quadriphasic CT necessary?. AJR Am J Roentgenol. 201(2):314-21, 2013 Aug. |
Observational-Dx |
96 patients |
To identify the essential number of phases from multiphasic CT for 1- to 2-cm hepatocellular carcinoma (HCC) on surveillance ultrasound and to compare the results with the American Association for the Study of Liver Disease (AASLD) standard (arterial phase hypervascularity and portal venous phase [PVP] or delayed phase hypovascularity). |
Only arterial phase hypervascularity and delayed phase hypovascularity were significantly associated with HCC both on univariate (odds ratio, arterial phase 7.51 [95% CI, 2.79-20.20]; delayed phase, 2.80 [1.14-6.90]) and multivariate analyses (arterial phase, 11.30 [4.30-29.68]; delayed phase, 4.39 [1.20-16.13]). The combination of arterial phase and delayed phase yielded the highest specificity (99%) and sensitivity (57%). There was no significant difference between AASLD standard (sensitivity, 57%; specificity, 98%) versus biphasic (arterial phase hypervascularity and delayed phase hypovascularity: sensitivity, 57%; p = 1 and specificity, 99%; p = 0.32), triphasic (arterial phase hypervascularity and unenhanced or PVP hypovascularity: sensitivity, 53%; p = 0.325 and specificity, 97%; p = 0.32), or quadriphasic combination (arterial phase hypervascularity and unenhanced, PVP or delayed phase hypovascularity: sensitivity, 57%; specificity, 97%), whereas the sensitivity of biphasic arterial phase and PVP was significantly lower (39% vs 57%, p = 0.022). |
3 |
| 60. Kornberg A, Freesmeyer M, Barthel E, et al. 18F-FDG-uptake of hepatocellular carcinoma on PET predicts microvascular tumor invasion in liver transplant patients.[Erratum appears in Am J Transplant. 2009 May;9(5):1255. Note: Settmacher, U [added]]. Am J Transplant. 9(3):592-600, 2009 Mar. |
Observational-Dx |
42 patients. |
To determine the prognostic value of preoperative (18)F-FDG-PET in liver transplant candidates with HCC, with special focus on its power for predicting aggressive tumor biology, such as MVI and posttransplant tumor recurrence. |
Forty-two patients underwent LT for HCC after PET evaluation. Sixteen patients had an increased 18F-FDG tumor uptake on preoperative PET scans (PET+), while 26 recipients revealed negative PET findings (PET-) pre-LT. PET- recipients demonstrated a significantlybetter 3-year recurrence-free survival (93%) than PET + patients (35%, p<0.001). HCC recurrence ratewas 50% in the PET + group, and 3.8% in the PET—population (p < 0.001). PET + status was identified as independent predictor ofMVI [hazard ratio: 13.4]. Patientswith advanced PET negative tumors and patients with HCC meeting the Milan criteria had a comparable 3-yearrecurrence- free survival (80% vs. 94%, p = 0.6). |
4 |
| 61. Becker-Weidman DJ, Kalb B, Sharma P, et al. Hepatocellular carcinoma lesion characterization: single-institution clinical performance review of multiphase gadolinium-enhanced MR imaging--comparison to prior same-center results after MR systems improvements. Radiology. 2011; 261(3):824-833. |
Observational-Dx |
101 patients |
To measure diagnostic performance in the detection of HCC by using the most recent technology and multiphase gadolinium-enhanced MRI and to compare with earlier results at the same institution. |
35 (34.7%) of 101 patients had HCC at explant analysis. Patient-based analysis of all lesions showed a sensitivity and specificity of 97.1% (34/35) and 100% (66/66), respectively. For lesions =2 cm, MRI had a sensitivity and specificity of 100% (23/23) and 100% (78/78), respectively. For lesions <2 cm, MRI had a sensitivity and specificity of 82.6% (19/23) and 100% (78/78), respectively. Lesion-based sensitivity for all tumors was 91.4% (53/58) in the current study, compared with 77.8% in 2007 (P=.07). For lesions <2 cm, the sensitivity was 87.5% (28/32) in the current study, compared with 55.6% previously (P=.02). |
3 |
| 62. Di Martino M, Anzidei M, Zaccagna F, et al. Qualitative analysis of small (<=2 cm) regenerative nodules, dysplastic nodules and well-differentiated HCCs with gadoxetic acid MRI. BMC med. imaging. 16(1):62, 2016 Nov 11. |
Observational-Dx |
73 Patients |
To evaluate the role of gadoxetic-acid MRI in the differentiation of small (=2 cm) well-differentiated hepatocellular carcinomas from regenerative and dysplastic nodules. |
Good agreement was reported between the two readers (? 0.70). Both readers reported a significantly improved sensitivity (57.7 and 66.2 vs 74.6 and 83.1) and diagnostic accuracy (0.717 and 0.778 vs 0.843 and 0.901) with the adjunction of the hepatobiliary phase 57.7 vs 74.6 and 66.2 vs 83.1 (p?=?0.04). |
2 |
| 63. Kwon S, Kim YK, Park HJ, Jeong WK, Lee WJ, Choi D. Is gadoxetic acid-enhanced MRI limited in tumor characterization for patients with chronic liver disease?. Magn Reson Imaging. 32(10):1214-22, 2014 Dec. |
Observational-Dx |
183 liver tumors |
To investigate the preoperative diagnostic performance of gadoxetic acid-enhanced MRI protocol including diffusion-weighted imaging (DWI) with emphasis on tumor characterization developed in high risk HCC patients |
Sensitivities for detecting all 183 liver tumors were 98.4%, 97.8%, and 96.2% for each observer, respectively, with a 97.5% for pooled data. Among 183 hepatic tumors, 91.3% (n=167), 87.4% (n=160), and 86.9% (n=159) were correctly characterized according to their reference standard by each observer, respectively. In 13 cholangiocarcinomas, one to three were misinterpreted as HCC, and the remaining tumors were correctly characterized by each observer. The accuracies (Az) of MRI for HCC diagnosis were 0.952 for observer 1, 0.906 for observer 2, and 0.910 for observer 3, with 0.922 for pooled data. There was good inter-observer agreement. |
3 |
| 64. Chou CT, Chen YL, Wu HK, Chen RC. Characterization of hyperintense nodules on precontrast T1-weighted MRI: utility of gadoxetic acid-enhanced hepatocyte-phase imaging. J Magn Reson Imaging. 2011; 33(3):625-632. |
Observational-Dx |
19 patients |
To evaluate the utility of gadoxetic acid-enhanced hepatocyte-phase MRI in characterization of T1-weighted hyperintense nodules within cirrhotic liver. |
Evaluation of the nodules with standard of reference revealed 15 DNs, 7 well-differentiated HCCs, and 12 moderately differentiated HCCs. The mean size of DNs was smaller than that of HCCs (P<0.001). Using the HCC criteria (T2W or arterial enhancement followed with portal venous washout), 11/19 HCC were correctly characterized. Using solely hypointensity (compared to the surrounding liver parenchyma) during the hepatocyte phase as the criterion, 18/19 HCC were correctly characterized. There were 7 additional HCCs diagnosed with hepatocyte-phase imaging (P=0.02). |
2 |
| 65. Chou CT, Chen YL, Su WW, Wu HK, Chen RC. Characterization of cirrhotic nodules with gadoxetic acid-enhanced magnetic resonance imaging: the efficacy of hepatocyte-phase imaging. J Magn Reson Imaging. 2010; 32(4):895-902. |
Observational-Dx |
66 nodules of 38 patients |
To evaluate the efficacy of hepatocyte-phase imaging in characterization of focal hepatic lesions in cirrhotic liver using gadoxetic acid-enhanced MRI. |
The mean enhancement ratios of moderately differentiated HCCs were significantly increased in arterial phase followed by a subsequent decreased in hepatocyte phases. The mean enhancement ratios of well-differentiated HCC were increased in dynamic study and followed by a plateau in the hepatocyte phase. The mean enhancement ratios of DNs were increased in dynamic study and hepatocyte phase. The mean liver-to-lesion contrasts of moderately differentiated HCCs were increased in arterial phase and hepatocyte-phase imaging (P<0.05). Well-differentiated HCC were only increased in hepatocyte-phase imaging (P<0.05). DNs showed no significant difference in any phase (P>0.05). There were 7 additional HCCs that were detected in hepatocyte-phase imaging using imaging Set B compared to Set A. The diagnostic performance of Set B was significantly higher than that of Set A (P=0.016). |
2 |
| 66. Orlacchio A, Chegai F, Fabiano S, et al. Role of MRI with hepatospecific contrast agent in the identification and characterization of focal liver lesions: pathological correlation in explanted livers. Radiologia Medica. 121(7):588-96, 2016 Jul. |
Observational-Dx |
17 patients |
To assess the diagnostic performance of magnetic resonance imaging (MRI) with gadoxetic acid in the identification of hepatocellular carcinoma (HCC) nodules by comparison with histological findings. |
At the histopathological examination, 46 nodules were identified, on average 2.7 nodules for each patient. Of these, 37 were hepatocellular carcinomas, 3 were characterized by histologically unrecognizable complete necrosis, and 6 showed high-grade dysplasia. MRI with hepatospecific contrast medium showed inter-observer average values of sensitivity, specificity, and diagnostic accuracy of 94.6, 90, and 93.6 %, respectively. In one case, a nodule was not identified by MRI with gadoxetic acid, even in the hepatospecific phase (false negative (FN)). This result could be implicated to the long time interval between the analysis and the explant (88 days). In another case, there was an overdiagnosis of a HCC with a typical nodular pattern (false positive (FP)), but which most likely should have been attributed to a previous echinococcus cyst. MRI analysis, in combination with the study of the hepatobiliary phase, also showed a greater sensitivity, the same specificity, and a greater diagnostic accuracy compared to MRI evaluated only in the dynamic phases (with an average percentage between the two operators, respectively, of 75.7, 90, and 78 %). |
3 |
| 67. Bashir MR, Gupta RT, Davenport MS, et al. Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis?. J Magn Reson Imaging. 37(2):398-406, 2013 Feb. |
Review/Other-Dx |
100 MRI examinations |
To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd-EOB-DTPA, in a North American population. |
Lesion detection was slightly improved for all lesion types with the inclusion of the HBP, and was substantially higher for small HCCs (96.0% versus 85.3%). Mean confidence scores for the diagnosis of HCC increased for HCCs overall and each size category (P < 0.001). Diagnostic performance improved with the addition of the HBP (aggregate AROC 87.7% versus 80.0%, P < 0.01), and sensitivity for characterization improved (90.9% versus 78.3%, P < 0.01) while specificity was unchanged. |
4 |
| 68. Khouri Chalouhi C, Vernuccio F, Rini F, et al. Hepatobiliary phase in cirrhotic patients with different Model for End-stage Liver Disease score: comparison of the performance of gadoxetic acid to gadobenate dimeglumine. Eur Radiol. 29(6):3090-3099, 2019 Jun. |
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4 |
| 69. Torrisi C, Picone D, Cabibbo G, Matranga D, Midiri M, Brancatelli G. Gadoxetic acid-enhanced MRI of transient hepatic enhancement differences: Another cause of hypointense observation on hepatobiliary phase. Eur J Radiol. 107:39-45, 2018 Oct. |
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4 |
| 70. Yang D, Zhang J, Han D, Jin E, Yang Z. The role of apparent diffusion coefficient values in characterization of solid focal liver lesions: a prospective and comparative clinical study. Sci China Life Sci. 60(1):16-22, 2017 Jan. |
Observational-Dx |
142 Patients |
To evaluate and compare the diagnostic accuracy (DA) of apparent diffusion coefficient (ADC) values with that of lesion-to-liver ADC ratios in the characterization of solid focal liver lesions (FLLs). |
The mean ADC values and ADC ratios of benign solid FLLs were significantly higher than those of malignant lesions (P<0.01). The difference between the area under the receiver operating characteristic curve of the ADC values (0.699) and ADC ratios (0.752) was not significant. |
3 |
| 71. Shin SK, Kim YS, Choi SJ, et al. Characterization of small (<=3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis: A STARD-compliant article. Medicine. 96(29):e7278, 2017 Jul. |
Observational-Dx |
43 Patients |
To assess the usefulness of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI including diffusion-weighted imaging (DWI) for differentiation between atypical small hepatocellular carcinomas (HCCs) and dysplastic nodules showing low signal intensity (SI) in the hepatobiliary phase, and to evaluate the MRI findings in determining the histological grade of atypical HCCs in patients with cirrhosis. |
Atypical HCC was defined as not showing arterial hyperenhancement and delayed washout on dynamic MRI.High SI on both T2WI and DWI (sensitivity 80.0%, specificity 100%, positive predictive value 100%, negative predictive value 78.3%) was the most specific feature to differentiate atypical HCCs from dysplastic nodules. High SI on both T2WI and DWI (100% vs 61.5%, P?=?.039) or low SI on pre-enhanced T1WI (83.3% vs 30.8%, P?=?.021) was more frequent observed in Edmonson grade II-III HCCs compared with those in grade I HCCs. |
4 |
| 72. Takahashi M, Maruyama H, Shimada T, et al. Characterization of hepatic lesions (<= 30 mm) with liver-specific contrast agents: a comparison between ultrasound and magnetic resonance imaging. European Journal of Radiology. 82(1):75-84, 2013 Jan. |
Observational-Dx |
56 patients |
To compare the diagnostic abilities to differentiate w-HCC from RN using contrast-enhanced ultrasound and magnetic resonance imaging (MRI) both with liver specific contrast agents. |
Sensitivity, specificity and accuracy of hepatic-arterial phase hyper-enhancement for w-HCC were 59.3%, 100% and 67.2% by ultrasound and 46.3%, 100% and 56.7% by MRI without significant difference. Meanwhile, those of liver-specific-phase hypo-enhancement for w-HCC were 44.4%, 100% and 55.2% by ultrasound and 87.0% (p<0.0001), 46.2% (p=0.0052) and 79.1% (p=0.0032) by MRI. Diagnostic accuracies for w-HCC by area under the receiver operating characteristic curves were higher in the hepatic-arterial phase in ultrasound (0.8316) than MRI (0.6659, p=0.0101) and similar in the liver-specific phase in ultrasound (0.7225) and MRI (0.7347, p=0.8814). |
4 |
| 73. Xu PJ, Yan FH, Wang JH, Shan Y, Ji Y, Chen CZ. Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr. 2010; 34(4):506-512. |
Observational-Dx |
54 patients |
To evaluate the diagnostic value of DWI MRI for the characterization of HCC and DN in cirrhotic liver, compared with contrast material-enhanced MRI. |
In the qualitative analysis, among 40 HCCs, 39 (97.5%) had slightly high or strongly high signal intensity on DWI, and 1 (2.5%) had low signal intensity; only 4 (21.5%) of 19 DNs had slightly high signal intensity, and 15 (78.95%) had iso-signal intensity or low signal intensity. The mean (standard deviation) ADC and ADC ratio for HCCs (1.28 x 10 [0.25] mm/s and 0.88 [0.15], respectively) were significantly lower (P<0.01 and P<0.001, respectively) than those for DNs (1.53 x 10 [0.33] mm/s and 1.00 [0.08], respectively). The area, A(z), under the receiver operating characteristic curve for the signal intensity feature, the ADC ratio, and the ADCs based on the diagnosis of HCC vs DN were 0.88, 0.81, and 0.68, respectively. When the slightly high signal intensity of lesion with a cutoff ADC ratio <0.92 was applied as a criterion, the A(z), the sensitivity, the specificity, and the accuracy of DWI for the diagnosis of HCC vs DN were 0.81, 67.50%, 94.74%, and 76.27%, respectively. The corresponding A(z), sensitivity, specificity, and accuracy of contrast enhanced-MRI were 0.70, 82.50%, 57.89%, and 74.58%, respectively. Combined DWI plus contrast enhanced-MRI had 0.91 A(z), 97.50% sensitivity, and 93.22% accuracy, which increased significantly compared with those of contrast enhanced-MRI alone. |
3 |
| 74. Santillan C, Chernyak V, Sirlin C. LI-RADS categories: concepts, definitions, and criteria. [Review]. Abdominal Radiology. 43(1):101-110, 2018 01. |
Review/Other-Dx |
N/A |
To provide a standardized way to both assess and communicate the likelihood of benignity or malignancy of observations seen in patients at risk for development of hepatocellular carcinoma (HCC). |
No results stated in abstract. |
4 |
| 75. Silva MA, Hegab B, Hyde C, Guo B, Buckels JA, Mirza DF. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. [Review] [50 refs]. Gut. 57(11):1592-6, 2008 Nov. |
Review/Other-Dx |
N/A |
To determine the incidence of needle tract tumour seeding following biopsy of a HCC. |
Eight studies identified by systematic review on biopsy of HCC were included in a meta-analysis. The pooled estimate of a patient with seeding per 100 patients with HCC was 0.027 (95% confidence interval (CI) 0.018 to 0.040). There was no difference whether a fixed or random effects model was used. Q was 4.802 with 7 degrees of freedom, p = 0.684; thus the observed heterogeneity was compatible with variation by chance alone. The pooled estimate of a patient with seeding per 100 patients per year was 0.009 (95% CI 0.006 to 0.013), p = 0.686. |
4 |
| 76. Wu W, Chen M, Yan K, et al. Evaluation of contrast-enhanced ultrasound for diagnosis of dysplastic nodules with a focus of hepatocellular carcinoma in liver cirrhosis patients. Chin. J. Cancer Res.. 27(1):83-9, 2015 Feb. |
Observational-Dx |
193 patients |
To compare the enhancement features of dysplastic nodules with a focus of hepatocellular carcinoma (DN-HCC) versus HCC and regenerative nodules (RN) in cirrhotic patients. |
There were 86 HCC lesions, 102 RN lesions, and 27 DN-HCC lesions diagnosed by biopsy. Of 86 HCC lesions, 87.2% (75/86) showed complete enhancement during the arterial phase, and 12.8% (11/86) had inhomogeneous enhancement, with no enhancement in the central area during the arterial phase; 100% (86/86) exhibited washout during the late phase. Of 102 RN lesions, 95.1% (97/102) had delayed or simultaneous enhancement during the arterial phase, and 4.9% (5/102) displayed slight enhancement during the arterial phase; 26.5% (27/102) exhibited washout and 73.5% (75/102) exhibited no washout during the late phase. In 27 DN-HCC lesions, only part of the lesions enhanced during the arterial phase and washed out during the late phase; the other areas had delayed or simultaneous enhancement during the arterial phase, and 29.6% (8/27) exhibited slight washout in the late phase. In 86 HCCs, the pathological feature was HCC in the enhanced area of 75 lesions, hepatocellular fatty degeneration in the slightly enhanced area of 7 lesions, and hepatocellular necrosis in the unenhanced area and HCC in the enhanced area of 4 lesions. In 102 RNs, the pathological diagnosis was hepatocyte proliferation with or without fatty degeneration. In 27 DN-HCCs, the pathological feature was HCC in the enhanced area and hepatocyte regeneration in the unenhanced area. |
4 |
| 77. Jang HJ, Kim TK, Wilson SR. Small nodules (1-2 cm) in liver cirrhosis: characterization with contrast-enhanced ultrasound. Eur J Radiol. 2009; 72(3):418-424. |
Observational-Dx |
59 patients |
To determine the diagnostic efficacy of arterial phase CEUS for characterizing small hepatic nodules (1-2 cm) in patients with high-risk for HCC. |
At of the time of CEUS, the 59 nodules were diagnosed as HCC in 26 and benign lesions in 33, including 20 regenerative nodules/DN, 11 hemangiomas, and 2 focal fat sparing. All 26 nodules with arterial phase hypervascularity without hemangioma-like features were HCC. However, CEUS misdiagnosed HCC as regenerative nodules/DN in 4 cases with arterial iso- (n=3) or hypovascularity (n=1). CEUS correctly diagnosed all 11 hemangiomas. The sensitivity, specificity, and accuracy of CEUS for diagnosing HCC were 86.7%, 100%, and 93.2%. |
3 |
| 78. Wildner D, Bernatik T, Greis C, Seitz K, Neurath MF, Strobel D. CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients - early or late washout matters: a subanalysis of the DEGUM multicenter trial. Ultraschall Med. 36(2):132-9, 2015 Apr. |
Review/Other-Dx |
1349 patients |
To compare tumor vascularization and contrast enhancement in contrast-enhanced ultrasound (CEUS) for the characterization of hepatocellular carcinoma (HCC) and intrahepatic cholangiocellular carcinoma (ICC). |
An underlying liver cirrhosis was found in 214/278 patients with HCC (76.9?%) and 7/42 patients with ICC (16.7?%). In CEUS, HCC showed a global arterial hyperenhancement compared to ICC (HCC: tumor center: 60.3?%; tumor periphery: 75?%; ICC: tumor center: 16.7?%; tumor periphery: 40.5?%). ICC showed an initial contrast enhancement primarily at the tumor periphery (ICC: 85.7?% vs. HCC: 61?%) followed by an early portal-venous contrast washout in the tumor center (ICC: 85.8?% vs. HCC: 49.8?%) and tumor periphery (ICC: 66.7?% vs. HCC: 32.6?%). HCC showed a delayed contrast washout (late phase hypoenhancement: HCC: 75?% vs. ICC: 92.9?%). |
4 |
| 79. Wildner D, Pfeifer L, Goertz RS, et al. Dynamic contrast-enhanced ultrasound (DCE-US) for the characterization of hepatocellular carcinoma and cholangiocellular carcinoma. Ultraschall Med. 35(6):522-7, 2014 Dec. |
Review/Other-Dx |
43 patients |
To compare the different perfusion kinetics of hepatocellular carcinoma and cholangiocellular carcinoma using dynamic contrast-enhanced ultrasound (DCE-US). |
43 patients with proven HCC (n?=?23 HCC; cirrhosis n?=?16) and ICC (n?=?20 ICC; Cirrhosis n?=?6) were examined. No statistical difference of the arterial DCEUS parameters was found between HCC and ICC. Contrast enhancement of the portal venous and late phases showed significantly lower values in the ICC group indicating early wash-out of the contrast agent: mTTl (p?=?0.0209): HCC 118.4 s (SD±?88.4); ICC 64.8 s (SD±?49.7). FT (p?=?0.0433): HCC 42.5 s (SD±?27.7); ICC 27.7 s (SD±?16.2). The percental loss of intensity at a definite time point after PE was significantly higher in ICC than in HCC lesions. |
4 |
| 80. Kamaya A, Maturen KE, Tye GA, Liu YI, Parti NN, Desser TS. Hypervascular liver lesions. [Review] [140 refs]. Semin Ultrasound CT MR. 30(5):387-407, 2009 Oct. |
Review/Other-Dx |
N/A |
To review types of hypervascular liver lesions. |
No results stated in abstract. |
4 |
| 81. Jang HJ, Lim HK, Lee WJ, Lee SJ, Yun JY, Choi D. Small hypoattenuating lesions in the liver on single-phase helical CT in preoperative patients with gastric and colorectal cancer: prevalence, significance, and differentiating features. J Comput Assist Tomogr. 26(5):718-24, 2002 Sep-Oct. |
Review/Other-Dx |
1133 patients |
To determine the prevalence and significance of small low attenuating hepatic lesions (SLAHs) seen on helical CT in preoperative patients with gastric and colorectal cancers and to find differentiating features of benign from malignant SLAH. |
Among 881 SLAHs in 268 patients, 693 (78.3%) in 248 patients (92.5%) were benign, and 188 (21.2%) in 30 patients (11.2%) were metastases; 10 patients (3.7%) had both. Among SLAHs in patients who had SLAHs only, 14 lesions (1.6%) in 6 patients (2.2%) were metastases. Benign SLAHs were smaller (6.4 +/- 3.1 mm; P < 0.001) and more frequently had discrete margin (P < 0.001) and markedly low attenuation (P < 0.001) than metastases (9.3 +/- 2.7 mm). Target-enhancement was far more frequent in metastases (64.4%) than benign SLAHs (1.2%; P < 0.001). Excellent interobserver agreement (kappa > 0.60) was found for all parameters in SLAHs larger than 5 mm. |
4 |
| 82. Schwartz LH, Gandras EJ, Colangelo SM, Ercolani MC, Panicek DM. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology. 1999; 210(1):71-74. |
Review/Other-Dx |
378 patients |
Retrospective follow-up CT study of patients with known malignancy to assess the frequency that 1 cm or smaller hepatic lesions were metastasis. |
Small hepatic lesions demonstrated interval growth in 11.6% patients (6+ months follow-up) and were considered metastatic. In 80.2% of patients there was no interval growth (mean follow-up 25.6 months; range, 6-56 months). These were presumed benign. 8.2% of patients had <6 months follow-up and were considered indeterminate. |
4 |
| 83. Elnahal SM, Shinagare AB, Szymonifka J, Hong TS, Enzinger PC, Mamon HJ. Prevalence and significance of subcentimeter hepatic lesions in patients with localized pancreatic adenocarcinoma. Pract Radiat Oncol. 2(4):e89-e94, 2012 Oct-Dec. |
Review/Other-Dx |
101 patients |
To determine the prevalence and significance of incidental, subcentimeter hepatic lesions in patients with a new diagnosis of pancreatic cancer. |
A total of 31 patients (30.7%) had subcentimeter hepatic lesions on staging scans. Of these patients, 21 (20.7% of total, 67.7% of patients with lesions) had eventual metastases to the liver. Finally, of this group, 5 patients (5.0% of total, 16.1% of patients with lesions) eventually had a metastatic focus at the specific site of the original lesion. Liver lesions predicted the occurrence of metastatic disease to the liver compared with patients without lesions (67.7% with lesions vs 44.4% without, P = .034). The presence of subcentimeter liver lesions at diagnosis was significantly associated with reduced overall survival (hazard ratio 1.65; 95% confidence interval 1.03-2.64, P = .036). |
4 |
| 84. Holzapfel K, Bruegel M, Eiber M, et al. Characterization of small (</=10 mm) focal liver lesions: value of respiratory-triggered echo-planar diffusion-weighted MR imaging. Eur J Radiol. 2010;76(1):89-95. |
Observational-Dx |
185 FLL in 77 patients |
To evaluate respiratory-triggered DWI MRI in the characterization of small (=10 mm) FLL. |
Accuracy for characterizing FLL was 93.0% for reader 1 and 91.9% for reader 2. Interobserver agreement was excellent between both readers (kappa=0.88). Sensitivity and specificity for diagnosing malignancy were 90.8% and 89.9% using a threshold ADC of 1.41x10(-3) mm(2)/s. |
2 |
| 85. Khalil HI, Patterson SA, Panicek DM. Hepatic lesions deemed too small to characterize at CT: prevalence and importance in women with breast cancer. Radiology. 235(3):872-8, 2005 Jun. |
Review/Other-Dx |
7692 women |
To retrospectively evaluate the prevalence and clinical importance of hepatic lesions considered too small to characterize (TSTC) at initial computed tomography (CT) in women with breast cancer. |
Of 7692 women, 1012 (13.2%) underwent contrast-enhanced CT including liver assessment. The mean age of the 1012 women was 54.6 years (range, 20.7-89.1 years). The median time from diagnosis of breast cancer to initial CT examination was 14.1 weeks (range, -3.7 to 296 weeks). The presence of at least one hepatic lesion deemed TSTC was reported in 277 of 941 women (29.4%) in whom no definite hepatic metastasis was reported. Subsequent imaging examinations were performed in 191 of the 277 women (69.0%) (median time from initial CT to last follow-up imaging examination, 54 weeks; range, 0.3-302 weeks). Those examinations revealed the lesions were unchanged in 175 (91.6%) women, no longer visible in eight (4.2%), and larger in six (3.1%). In two women (1.0%), change could not be determined. The enlarging hepatic lesions deemed TSTC represented metastatic breast cancer (three patients), metastatic pancreatic cancer (one patient), or cysts (one patient); in one patient, the etiology was not known. Results of best- and worst-case analyses showed that the lesions were benign in 96.9% (95% CI: 93%, 99%) and 92.7% (95% CI: 88%, 96%) of women, respectively. |
4 |
| 86. Holalkere NS, Sahani DV, Blake MA, Halpern EF, Hahn PF, Mueller PR. Characterization of small liver lesions: Added role of MR after MDCT. J Comput Assist Tomogr. 2006; 30(4):591-596. |
Observational-Dx |
59 patients |
A retrospective study to evaluate the added role of MRI in characterizing subcentimeter FLLs detected on MDCT. |
Sensitivity, specificity, PPV, and NPV in differentiation of benign from malignant lesions on MDCT were 81.2%, 77.3%, 60.5%, 90.6 % and on MRI were 83.3%, 97.5%, 92.1%, and 94.4 %, respectively. Liver MRI has significantly higher accuracy for characterization of subcentimeter FLLs discovered on MDCT. |
3 |
| 87. Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology. 2010;257(3):674-684. |
Meta-analysis |
39 studies; 3,391 patients |
To obtain diagnostic performance values of computed tomography (CT), magnetic resonance (MR) imaging, fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET), and FDG PET/CT in the detection of colorectal liver metastases in patients who have not previously undergone therapy. |
Thirty-nine articles (3391 patients) were included. Variation existed in study design characteristics, patient descriptions, imaging features, and reference tests. The sensitivity estimates of CT, MR imaging, and FDG PET on a per-lesion basis were 74.4%, 80.3%, and 81.4%, respectively. On a per-patient basis, the sensitivities of CT, MR imaging, and FDG PET were 83.6%, 88.2%, and 94.1%, respectively. The per-patient sensitivity of CT was lower than that of FDG PET (P = .025). Specificity estimates were comparable. For lesions smaller than 10 mm, the sensitivity estimates for MR imaging were higher than those for CT. No differences were seen for lesions measuring at least 10 mm. The sensitivity of MR imaging increased significantly after January 2004. The use of liver-specific contrast material and multisection CT scanners did not provide improved results. Data about FDG PET/CT were too limited for comparisons with other modalities. |
M |
| 88. Laghi F, Catalano O, Maresca M, Sandomenico F, Siani A. Indeterminate, subcentimetric focal liver lesions in cancer patients: additional role of contrast-enhanced ultrasound. Ultraschall Med. 2010; 31(3):283-288. |
Review/Other-Dx |
132 patients |
To evaluate whether the use of CEUS could improve the characterization of indeterminate subcentimetric FLLs seen with MDCT in cancer patients. |
Among the 132 patients with MDCT evidence of indeterminate, subcentimetric FLLs (206 lesions), US proved the cystic nature of 138 lesions in 87 patients. In 45 cases US failed to recognize any abnormality or cystic image and these subjects underwent CEUS. The CEUS results were confirmed by further assessment or follow-up for 43/45 patients (3 cysts, 8 hemangiomas, 47 metastases, 2 areas of focal steatosis, 2 eosinophilic necroses, 1 granuloma, 1 abscess, 1 fistula). CEUS failed to detect 3 lesions (1 metastasis and 2 benign lesions). In 8 cases CEUS recognized additional liver metastases. |
4 |
| 89. Chernyak V, Fowler KJ, Kamaya A, et al. Liver Imaging Reporting and Data System (LI-RADS) Version 2018: Imaging of Hepatocellular Carcinoma in At-Risk Patients. [Review]. Radiology. 289(3):816-830, 2018 12. |
Review/Other-Dx |
N/A |
The Liver Imaging Reporting and Data System (LI-RADS) is composed of four individual algorithms intended to standardize the lexicon, as well as reporting and care, in patients with or at risk for hepatocellular carcinoma in the context of surveillance with US; diagnosis with CT, MRI, or contrast material-enhanced US; and assessment of treatment response with CT or MRI. |
No results stated in abstract. |
4 |
| 90. Golfieri R, Marini E, Bazzocchi A, et al. Small (<or=3 cm) hepatocellular carcinoma in cirrhosis: the role of double contrast agents in MR imaging vs. multidetector-row CT. |
Observational-Dx |
63 patients |
To prospectively compare gadoliniumenhanced magnetic resonance imaging (dynamic MRI), superparamagnetic iron oxide (SPIO) (ferucarbotran) MRI and multidetector-row computed tomography (MDCT) and the combination of dynamic MRI plus MDCT vs. dynamic MRI plus SPIO-MRI (double-contrast MRI: DC-MRI) for the detection of small (<or=3 cm) hepatocellular carcinomas (HCCs). |
One hundred and twenty-three nodules were detected: 87 were confirmed HCCs in 54 patients. The accuracy of SPIO-MRI and dynamic MRI were similar, both being superior to MDCT. Dynamic MRI demonstrated the highest sensitivity (83.9%; p<0.001). especially for lesions <1 cm (90.6%) - coupled with a lower specificity (36.1%) than SPIO-MRI, particularly in subcentimeter lesions (28.6%). SPIO-MRI demonstrated the highest sensitivity for nodules >1 cm and the highest specificity (83.3%) superior to dynamic MRI (p<0.0001). In the per-lesion analysis, SPIO-MRI demonstrated a positive predictive value higher than dynamic MRI (p=0.0059) and than both the combinations dynamic MRI/MDCT and DC-MRI (p=0.0021 and p=0.0087, respectively). DC-MRI showed the highest sensitivity (97.7%) and accuracy (78.9%), detecting hypovascular and atypical HCCs >1 cm. Furthermore its per-patient negative predictive value was the highest (100%), and significantly higher than all the other methods. |
4 |
| 91. Bottcher J, Hansch A, Pfeil A, et al. Detection and classification of different liver lesions: comparison of Gd-EOB-DTPA-enhanced MRI versus multiphasic spiral CT in a clinical single centre investigation. Eur J Radiol. 82(11):1860-9, 2013 Nov. |
Observational-Dx |
29 patients |
To compare the diagnostic efficacy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) vs. multidetector computed tomography (MDCT) for the detection and classification of focal liver lesions, differentiated also for lesion entity and size; a separate analysis of pre- and postcontrast images as well as T2-weighted MRI sequences of focal and exclusively solid lesions was integrated. |
Among 130 lesions, 68 were classified as malignant and 62 as benign by SOR. The detection of malignant and benign lesions differed significantly between combined and postcontrast MRI vs. MDCT; overall detection rate was 91.5% for combined MRI and 80.4% for combined MDCT (p<0.05). Considering all four readers together, combined MDCT achieved sensitivity of 66.2%, specificity of 79.0%, and diagnostic accuracy of 72.3%; combined MRI reached superior diagnostic efficacy: sensitivity 86.8%, specificity 94.4%, accuracy 90.4% (p<0.05). Differentiated for lesion size, in particular lesions <20mm revealed diagnostic benefit by MRI. Postcontrast MRI also achieved higher overall sensitivity, specificity, and accuracy compared to postcontrast MDCT for focal and exclusively solid liver lesions (p<0.05). |
2 |
| 92. Forner A, Vilana R, Ayuso C, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology. 2008;47(1):97-104. |
Experimental-Dx |
89 patients
Note: CEUS was performed. T1 and T2 weighted MRI as well as contrast enhance MRI performed. |
To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) and MRI for the diagnosis of solitary nodules of 20 mm or smaller detected during surveillance in patients with cirrhosis |
Final diagnoses were: HCC (n = 60), cholangiocarcinoma (n = 1), and benign lesions (regenerative/dysplastic nodule, hemangioma, focal nodular hyperplasia) (n = 28). Sex, cirrhosis cause, liver function, and alpha-fetoprotein (AFP) levels were similar between HCC and non-HCC groups. HCC patients were older and their nodules significantly larger (P < 0.0001). First biopsy was positive in 42 of 60 HCC patients. Sensitivity, specificity, and positive and negative predictive values of conclusive profile were 61.7%, 96.6%, 97.4%, and 54.9%, for MRI, 51.7%, 93.1%, 93.9%, and 50.9%, for CEUS. Values for coincidental conclusive findings in both techniques were 33.3%, 100%, 100%, and 42%. Thus, diagnosis of HCC 20 mm or smaller can be established without a positive biopsy if both CEUS and MRI are conclusive. However, sensitivity of these noninvasive criteria is 33% and, as occurs with biopsy, absence of a conclusive pattern does not rule out malignancy. |
2 |
| 93. Kojiro M.. Pathological diagnosis at early stage: reaching international consensus. Oncology. 78 Suppl 1:31-5, 2010 Jul. |
Review/Other-Dx |
N/A |
To improve the consistency of pathological diagnosis of early HCC |
No results stated in abstract. |
4 |
| 94. Zheng SG, Xu HX, Liu LN, et al. Parametric imaging with contrast-enhanced ultrasound: usefulness for characterization of dynamic effects of microvascularization for hepatocellular carcinoma and focal nodular hyperplasia.[Erratum appears in Clin Hemorheol Microcirc. 2014;58(4):559]. Clin Hemorheol Microcirc. 55(3):375-89, 2013. |
Review/Other-Dx |
30 HCCs and 30 FNHs |
To evaluate whether parametric imaging with contrast-enhanced ultrasound (CEUS) is equal to experienced radiologists after review of CEUS in differentiating hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH). |
On parametric imaging, the rise time, time to peak and mean transit time for HCC and FNH were 16.7±11.1 s vs. 21.9±9.0 s (P=0.052), 29.9±14.1 s vs. 33.2±11.1 s (P=0.322), 115.0±90.9 s vs. 271.5±147.6 s (P<0.001), respectively. The ROC analysis showed that, for the differentiation between HCC and FNH, the cut-off point for mTT was 107.93 s with the Az value of 0.817 (95% CI: 0.703-0.931), and the Az value was 0.834 (95%CI: 0.728-0.941) for two experienced readers (P=0.417 compared with mTT). The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were 96.7%, 66.7%, 81.7%, 74.4%, and 95.2%, respectively, for parametric imaging, and 86.7%, 76.7%, 81.7%, 78.8%, and 85.2%, respectively, for two experienced readers (all P>0.05 compared with parametric imaging). |
4 |
| 95. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
