Diagnostic performance of ultrasonography-guided core-needle biopsy according to MRI LI-RADS diagnostic categories

Purpose@#According to the American Association for the Study of Liver Diseases (AASLD) guidelines, biopsy is a diagnostic option for focal hepatic lesions depending on the Liver Imaging Reporting and Data System (LI-RADS) category. We evaluated the diagnostic performance of ultrasonography-guided core-needle biopsy (CNB) according to LI-RADS categories. @*Methods@#A total of 145 High-risk patients for hepatocellular carcinoma (HCC) who underwent magnetic resonance imaging (MRI) followed by CNB for a focal hepatic lesion preoperatively were retrospectively enrolled. Focal hepatic lesions on MRI were evaluated according to LI-RADS version 2018. Pathologic results were categorized into HCC, non-HCC malignancies, and benignity. The categorization was defined as correct when the CNB pathology and surgical pathology reports were identical. Nondiagnostic results were defined as inadequate CNB pathology findings for a specific diagnosis. The proportion of correct categorizations was calculated for each LI-RADS category, excluding nondiagnostic results. @*Results@#After excluding 16 nondiagnostic results, 131 lesions were analyzed (45 LR-5, 24 LR-4, 4 LR-3, and 58 LR-M). All LR-5 lesions were HCC, and CNB correctly categorized 97.8% (44/45) of LR-5 lesions. CNB correctly categorized all 24 LR-4 lesions, 16.7% (4/24) of which were non-HCC malignancies. All LR-M lesions were malignant, and 62.1% (36/58) were non-HCC malignancies. CNB correctly categorized 93.1% (54/58) of LR-M lesions, and 12.5% (3/24) of lesions with CNB results of HCC were confirmed as non-HCC malignancies. @*Conclusion@#In agreement with AASLD guidelines, CNB could be helpful for LR-4 lesions, but is unnecessary for LR-5 lesions. In LR-M lesions, CNB results of HCC did not exclude non-HCC malignancy.

US LI-RADS visualization score: diagnostic outcome of ultrasound-guided focal hepatic lesion biopsy in patients at risk for hepatocellular carcinoma

Purpose@#This study investigated the diagnostic outcome of ultrasound (US)-guided focal hepatic lesion biopsy in patients at risk for hepatocellular carcinoma (HCC) and evaluated the US visualization score as a risk factor for non-diagnostic results. @*Methods@#We retrospectively evaluated 208 focal hepatic lesions in 208 patients who underwent US-guided biopsy in 2016. Using the US Liver Imaging Reporting and Data System version 2017, each exam was assigned a US visualization score (A, B, or C). Final diagnoses were made using pathology reports, and biopsy results were categorized as diagnostic or non-diagnostic. Univariable and multivariable analyses were performed to determine risk factors for non-diagnostic results, including US visualization score and other clinical covariates. @*Results@#Of the 208 lesions, 85.1% were diagnostic and 14.9% were non-diagnostic. The rates of non-diagnostic results were 8.9%, 25.5%, and 57.1% for scores of A, B, and C, respectively. In the univariable analysis, scores of B or C were associated with a significantly higher rate of nondiagnostic results than scores of A (58.1% vs. 24.9%, P<0.001). In the multivariable analysis, US visualization score of B or C (adjusted odds ratio [aOR], 2.7; P=0.027), high-risk needle pathway usage (aOR, 5.7; P=0.001), and lesion size ≤2.0 cm (aOR, 2.7; P=0.024) were independent risk factors for non-diagnostic results. @*Conclusion@#US-guided biopsy had a high diagnostic yield for focal hepatic lesions in patients at risk for HCC. US visualization score of B or C, lesion size ≤2.0 cm, and high-risk needle pathway usage were independent risk factors for non-diagnostic results.

Percutaneous Radiofrequency Ablation for Metachronous Hepatic Metastases after Curative Resection of Pancreatic Adenocarcinoma

OBJECTIVE: To retrospectively evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma who had previously received curative surgery.MATERIALS AND METHODS: Between 2002 and 2017, percutaneous RFA was performed on 94 metachronous hepatic metastases (median diameter, 1.5 cm) arising from pancreatic cancer in 60 patients (mean age, 60.5 years). Patients were included if they had fewer than five metastases, a maximum tumor diameter of ≤ 5 cm, and disease confined to the liver or stable extrahepatic disease. For comparisons during the same period, we included 66 patients who received chemotherapy only and met the same eligibility criteria described.RESULTS: Technical success was achieved in all hepatic metastasis without any procedure-related mortality. During follow-up, local tumor progression of treated lesions was observed in 38.3% of the tumors. Overall median survival and 3-year survival rates were 12 months and 0%, respectively from initial RFA, and 14.7 months and 2.1%, respectively from the first diagnosis of liver metastasis. Multivariate analysis showed that a large tumor diameter of > 1.5 cm, a late TNM stage (≥ IIB) before curative surgery, a time from surgery to recurrence of < 1 year, and the presence of extrahepatic metastasis, were all prognostic of reduced overall survival after RFA. Median overall (12 months vs. 9.1 months, p = 0.094) and progression-free survival (5 months vs. 3.3 months, p = 0.068) were higher in the RFA group than in the chemotherapy group with borderline statistical difference.CONCLUSION: RFA is safe and may offer successful local tumor control in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma. Patients with a small diameter tumor, early TNM stage before curative surgery, late hepatic recurrence, and liver-only metastasis benefit most from RFA treatment. RFA provided better survival outcomes than chemotherapy for this specific group with borderline statistical difference.

The Korean guideline for gastric cancer screening

Despite improvements in treatment modalities, gastric cancer is the second cause of mortality among Korean men and third among females in Korea. Korea implemented a gastric cancer screening program for the general population in 1999. However, the effectiveness and harms of gastric cancer screening using gastric endoscopy and upper gastrointestinal (UGI) series have not been fully evaluated. In an effort to evaluate the screening program, the Korean multidisciplinary expert committee for developing a gastric cancer screening guideline systematically reviewed the evidence regarding the benefits and harms of gastric cancer screening, and developed an evidence-based clinical guideline. There is 'low' level evidence that gastric cancer screening using gastric endoscopy or UGI series can reduce gastric cancer mortality for asymptomatic adults aged between 40 to 74 years. The benefits of gastric cancer screening using gastric endoscopy are substantially higher than its harms, while the benefits of screening with UGI series are moderately higher. We recommend that asymptomatic adults from 40 to 75 years of age undergo biannual gastric cancer screening using gastric endoscopy (recommendation B). Gastric cancer screening using UGI series in asymptomatic adults aged between 40 to 74 years may be recommended based on clinicians' judgment regarding the patient's risk and the patient's preference (recommendation C). There is insufficient evidence to assess the benefits and harms of gastric cancer screening for adults aged between 75 to 84 years (recommendation I). We recommend against gastric cancer screening for adults older than 85 years (recommendation D).

Recent advances in the imaging of hepatocellular carcinoma

The role of imaging is crucial for the surveillance, diagnosis, staging and treatment monitoring of hepatocellular carcinoma (HCC). Over the past few years, considerable technical advances were made in imaging of HCCs. New imaging technology, however, has introduced new challenges in our clinical practice. In this article, the current status of clinical imaging techniques for HCC is addressed. The diagnostic performance of imaging techniques in the context of recent clinical guidelines is also presented.

Surveillance method and imaging characteristics of recurrent biliary cancer after surgical resection

This is a review of the diagnostic imaging techniques and findings of recurrent biliary cancer after surgical resection of the extrahepatic bile duct and gallbladder. Radiological examination plays an important role in diagnosing postoperative recurrence of biliary cancers. Early detection and diagnosis of recurrent cancer is critical in obtaining proper treatment and improves the prognosis. In the surveillance of recurrent biliary cancer, several diagnostic imaging modalities are currently used. Usually CT is the most common method for surveillance of postoperative patients, but MRI and PET/CT scans are also widely used. Recurrent biliary cancer can manifest as local recurrence, liver metastasis, lymph node metastasis, and peritoneal metastasis. Imaging findings of a locally recurrent tumor or metastatic lymph node enlargement overlaps with benign postoperative changes, thus radiologists commonly overlook subtle CT findings or misinterpret them as benign postoperative changes. There are several reports that FDG-PET scan is more effective in the diagnosis of recurrent biliary tract cancer than CT. Multidisciplinary diagnostic approaches using CT, MRI, and FDG-PET as well as clinical information seem to be essential for the precise diagnosis of recurrent tumors.

Gene expression of MC3T3-E1 osteoblastic cells on titanium and zirconia surface

PURPOSE: This study was performed to define attachment and growth behavior of osteoblast-like cells and evaluate the gene expression on zirconia compared to titanium. MATERIALS AND METHODS: MC3T3-E1 cells were cultured on (1) titanium and (2) zirconia discs. The tetrazolium-based colorimetric assay (MTT test) was used for examining the attachment of cells. Cellular morphology was examined by scanning electron microscopy (SEM) and alkaline phosphatase (ALP) activity was measured to evaluate the cell differentiation rate. Mann-Whitney test was used to assess the significance level of the differences between the experimental groups. cDNA microarray was used for comparing the 20215 gene expressions on titanium and zirconia. RESULTS: From the MTT assay, there was no significant difference between titanium and zirconia (P>.05). From the SEM image, after 4 hours of culture, cells on both discs were triangular or elongated in shape with formation of filopodia. After 24 hours of culture, cells on both discs were more flattened and well spread compared to 4 hours of culture. From the ALP activity assay, the optical density of E1 cells on titanium was slightly higher than that of E1 cells on zirconia but there was no significant difference (P>.05). Most of the genes related to cell adhesion showed similar expression level between titanium and zirconia. CONCLUSION: Zirconia showed comparable biological responses of osteoblast-like cells to titanium for a short time during cell culture period. Most of the genes related to cell adhesion and signal showed similar expression level between titanium and zirconia.

Trace of Electrodes on Follow-up Liver Ultrasonography After Percutaneous Ultrasound-Guided Radiofrequency Ablation: "Tram-Track Sign"

PURPOSE: The purpose of this study is to report on the trace of the electrode used for a radiofrequency ablation (RFA) for a hepatic tumor on US images and to determine its frequency, factors affecting it, and its usefulness. MATERIALS AND METHODS: Twenty three patients had 44 RFA zones in the liver. Two parallel echogenic lines in the RFA zone were regarded as the trace of electrode and classified into four groups according to length. Parametric variables, including diameter of the tumor, location of the RFA zone, type of RFA electrode, length of the exposed tip, and the interval between the RFA procedure and follow-up US examination, were correlated with grades. RESULTS: Mean diameter of tumors was 2 cm and 28 of 44 RFA zones were located in the right hepatic lobe. Forty single and four cluster electrodes were used. Exposed tips measured 2 cm (n = 8), 2.5 cm (n = 4), and 3 cm (n = 32) in length. Two parallel echogenic lines more than 1 cm in length were detected in 23 of 44 RFA zones (52%). The grade of the trace showed negative correlation with the interval (p = 0.014). CONCLUSION: According to the results of our study, the frequency of traces of the electrodes (two parallel echogenic lines more than 1 cm in length, named the "tram-track sign") was 52%, and these fade over time. This sign could be useful as a landmark for accurate targeting in cases of local tumor progression.

Hepatic angiomyolipoma with minimal fat, mimicking hepatocellular carcinoma

No abstract available.

Sclerosing hemangioma in the liver / 대한간학회지

No abstract available.

Hepatic amyloidosis / 대한간학회지

No abstract available.

Posttransplantation lymphoproliferative disorder involving liver after renal transplantation / 대한간학회지

No abstract available.

Biliary hamartoma presented as a single mass / 대한간학회지

No abstract available.

Hepatic adrenal rest tumor mimicking hepatocellular carcinoma / 대한간학회지

No abstract available.

Hepatic eosinophilic abscess presenting as a single nodular mass / 대한간학회지

No abstract available.

Hepatic tuberculosis presenting as a large liver mass / 대한간학회지

No abstract available.

Hepatic Hemangiomas with Peritumoral Sparing of Fatty Infiltration in Hepatic Steatosis: Findings on Contrast-enhanced MR Imaging and on Sonography

PURPOSE: We wanted to determine the frequency of peritumoral sparing of fatty infiltration (PTSF) around hepatic hemangioma in hepatic steatosis and to evaluate the finding of these tumors on dynamic contrast-enhanced MR imaging and on sonography. MATERIALS AND METHODS: This study included 76 hemangiomas in 67 patients suffering with hepatic steatosis. A diagnosis of hemangioma was based on the histologic findings, hemangioma SPECT or a compatible enhancement pattern on the dynamic contrast-enhanced MR study. For chemical shifting, PTSF was defined when there wasn't any decrease in signal intensity of the liver parenchyma on the opposed-phase images as compared with the in-phase images, and this intensity appeared as a hyperintense area around the tumor. We evaluated the frequency of PTSF and we analyzed if the presence of PTSF was related to the tumor size, the rapidity of enhancement or an associated arterioportal shunt. Among those, sonographic images were available in 55 hemangiomas. We also evaluated the sonographic appearances of hemangiomas with PTSF. RESULTS: Of the 76 hemangiomas, PTSF was noted on the MR chemical-shift images in 57 hemangiomas (75%). There was no significant relationship between tumor size and the presence of PTSF (p=.578). However, this finding was more frequently found in high-flow hemangiomas than in the slow-flow ones (p=.0038) and it was also related to the presence of associated arterioportal shunt (p=.0158). Sonographically, hemangiomas with PTSF were commonly surrounded by a peritumoral low-echoic area (28/41, 68%); these tumors more frequently showed a thin high-echoic rim on sonography than did the tumors without this finding (p=.0055). CONCLUSION: PTSF is commonly seen in hemangiomas in hepatic steatosis patients. Hepatic hemangiomas with PTSF tend to show rapid enhancement on dynamic MR imaging and this is accompanied by arterioportal shunt. They tend to be seen as an iso- or low-echoic mass with a thin high-echoic rim on sonography, and the mass is commonly surrounded by a peritumoral low-echoic area.

Imaging Findings of Abdominal Extraosseous Plasma Cell Neoplasm

PURPOSE: To evaluate the imaging findings of abdominal extraosseous plasma cell neoplasm. MATERIALS AND METHODS: From April 2000 to January 2005, eight patients (four men, four women; mean age, 50.6 years) with pathologically proved, extraosseous plasma cell neoplasm involving the abdominal organs were included in this study. The diagnoses were based on consensus agreement between two radiologists who retrospectively reviewed CT, ultrasonography, and enteroclysis findings. We evaluated the findings by focusing on the location, size, margin, and enhancement pattern of the lesion, and lymphadenopathy on each image. RESULTS: There were multiple myeloma in four patients and extramedullary plasmacytoma in the remaining four. Involved abdominal organs were the liver (n = 4), spleen (n = 4), lymph node (n = 3), stomach (n = 1), small bowel (n = 1), and colon (n = 1). The hepatic involvement of plasma cell neoplasm presented as a homogeneous, well-defined, solitary mass (n = 1), multiple nodules (n = 1), and hepatomegaly (n = 2). Its involvement of the spleen and lymph node appeared as splenomegaly and lymphadenopathy, respectively. Its involvement of the gastrointestinal tract including the stomach, small bowel, and colon, presented as a homogeneous, diffuse wall thickening or mass in the gastrointestinal tract. CONCLUSION: Abdominal extraosseous plasma cell neoplasm involves occasionally the liver, spleen, and lymph node, and rarely the gastrointestinal tract. When we encounter a well-defined, homogeneous lesion of the abdominal organs in patients diagnosed or suspected as having plasma cell neoplasm, we should consider its involvement of the abdominal organs.

Quality Control of Medical Imaging

Medical imaging is the one of the most important diagnostic tools of modern medical science and quality control of the medical imaging is already systemized in the advanced countries. However, in Korea, quality control of medical imaging has not been properly performed until now and low quality examinations have been done without any regulation. The Korean Radiological Society, as society of supervision of medical imaging, has emphasized the importance of quality control and in 2003, the law for the quality control of medical imaging was made. In conformity of the law, the regulation of the quality control of medical imaging will commence, but this is just the beginning and there are still many tasks left for settling down and expanding the range of the quality control of the medical imaging. We reviewed the history of the quality control of medical imaging in Korea and explained the particulars of mammography, fluoroscopy, computed tomography and magnetic resonance imaging. We also looked into future prospect and tasks of the quality control of medical imaging.

An Experimental Study on the Intraarterial cis-platinum Chemotherapeutic Response of Musculoskeletal Tumor Using MR Imaging and Digital Subtraction Angiography

PURPOSE: To determine MRI features of tumor response in the early phase of preoperative chemotherapy in malignant tumors after intraarterial chemotherapy of VX-2 tumor in the rabbit thigh. MATERIALS AND METHODS: VX-2 tumors were induced in the thighs of eleven New Zealand white rabbits and intraarterial infusion of Cis-Platinum (3mg/kg) was performed in six. Pre- and post-contrast enhanced MR images and angiographies were obtained prior to and two weeks after chemotherapy. Five rabbits with VX-2 tumors were imaged at these same interval. Difference in MRI changes between the two groups were analysed and MRI findings were compared with angiographic and histologic findings. RESULTS: All VX-2 tumors showed rapid extensive necrosis, the most prominent MRI change in the chemotherapeutic group was decreased thickness of the enhancing rim which in the control group had increased (p = 0.083 and p = 0.374, respectively). The enhancing rim reflected the peripheral capsule with surrounding edema, inflammatory change, and tumors which were histologically viable. On angiography, it coincided with tumor staining. Change in tumor size was not significantly different between the two groups. In the chemotherapeutic group, a marginal necrotic band was the most prominent histologic feature. CONCLUSION: In the VX-2 tumor, chemotherapeutic response is seen on MRI as decreased thickness of the rim, and this reflects the tumor capsule and viable tumors. MRI can provide guidance in planning the treatment of malignant soft tissue tumors.