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      Magnetic resonance imaging of the cirrhotic liver: diagnosis of hepatocellular carcinoma and evaluation of response to treatment – Part 2 Translated title: Ressonância magnética do fígado cirrótico: diagnóstico de carcinoma hepatocelular e avaliação da resposta ao tratamento – Parte 2

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          Abstract

          In the second part of this review, we will describe the ancillary imaging features of hepatocellular carcinoma (HCC) that can be seen on standard magnetic resonance imaging (MRI) protocol, and on novel and emerging protocols such as diffusion weighted imaging and utilization of hepatocyte-specific/hepatobiliary contrast agent. We will also describe the morphologic sub-types of HCC, and give a simplified non-invasive diagnostic algorithm for HCC, followed by a brief description of the liver imaging reporting and data system (LI-RADS), and MRI assessment of tumor response following locoregional therapy.

          Resumo

          Na segunda parte desta revisão descreveremos os achados de imagem auxiliares para o diagnóstico de carcinoma hepatocelular (CHC) e que podem ser observados num protocolo de ressonância magnética (RM) padrão e em protocolos emergentes que incluem imagens de difusão e aplicação de contrastes hepatoespecíficos/hepatobiliares. Descreveremos também os subtipos morfológicos de CHC e um algoritmo diagnóstico não invasivo simplificado para o CHC, seguido de uma breve descrição do liver imaging reporting and data system (LI-RADS) e avaliação por RM após terapêutica locorregional.

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          Most cited references61

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          Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma.

          Alejandro Forner, Ramón Vilana, Carmen Ayuso … (2008)
          This study prospectively evaluates the accuracy of contrast-enhanced ultrasound (CEUS) and dynamic magnetic resonance imaging (MRI) for the diagnosis of nodules 20 mm or smaller detected during ultrasound (US) surveillance. We included 89 patients with cirrhosis [median age, 65 years; male 53, hepatitis C virus 68, Child-Pugh A 80] without prior hepatocellular carcinoma (HCC) in whom US detected a small solitary nodule (mean diameter, 14 mm). Hepatic MRI, CEUS, and fine-needle biopsy (gold standard) (FNB) were performed at baseline. Non-HCC cases were followed (median 23 months) by CEUS/3 months and MRI/6 months. FNB was repeated up to 3 times and on detection of change in aspect/size. Intense arterial contrast uptake followed by washout in the delayed/venous phase was registered as conclusive for HCC. 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. These results validate the American Association for the Study of Liver Disease (AASLD) guidelines.
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            Diffusion-weighted MR imaging of the liver.

            Bachir Taouli, Dow-Mu Koh (2010)
            Magnetic resonance (MR) imaging plays an increasingly important role in the evaluation of patients with liver disease because of its high contrast resolution, lack of ionizing radiation, and the possibility of performing functional imaging sequences. With advances in hardware and coil systems, diffusion-weighted (DW) MR imaging can now be applied to liver imaging with improved image quality. DW MR imaging enables qualitative and quantitative assessment of tissue diffusivity (apparent diffusion coefficient) without the use of gadolinium chelates, which makes it a highly attractive technique, particularly in patients with severe renal dysfunction at risk for nephrogenic systemic fibrosis. In this review, acquisition parameters, postprocessing, and quantification methods applied to liver DW MR imaging will be discussed. The current clinical uses of DW MR imaging (liver lesion detection and characterization, compared and combined with conventional sequences) and the emerging applications of DW MR imaging (tumor treatment response and diagnosis of liver fibrosis and cirrhosis) will be reviewed. Also, limitations, mainly image quality and reproducibility of diffusion parameters, and future directions of liver DW MR imaging will be discussed.
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              CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features.

              Jin Young Choi, Jeong Min Lee, Claude Sirlin (2014)
              Computed tomography (CT) and magnetic resonance (MR) imaging play critical roles in the diagnosis and staging of hepatocellular carcinoma (HCC). The second article of this two-part review discusses basic concepts of diagnosis and staging, reviews the diagnostic performance of CT and MR imaging with extracellular contrast agents and of MR imaging with hepatobiliary contrast agents, and examines in depth the major and ancillary imaging features used in the diagnosis and characterization of HCC.
              Article 0 comments Cited 129 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Radiol Bras
                Journal ID (iso-abbrev): Radiol Bras
                Journal ID (publisher-id): rb
                Title: Radiologia Brasileira
                Publisher: Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
                ISSN (Print): 0100-3984
                ISSN (Electronic): 1678-7099
                Publication date (Print and electronic): Mar-Apr 2017
                Publication date (Print): Mar-Apr 2017
                Volume: 50
                Issue: 2
                Pages: 115-125
                Affiliations
                [1 ]Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal
                [2 ]Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
                [3 ]Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
                Author notes
                Mailing address: Richard C. Semelka. University of North Carolina at Chapel Hill – Radiology. 101 Manning Drive, CB 7510 2001 Old Clinic Bldg, Chapel Hill, NC 27599-7510, USA. E-mail: richardsemelka@ 123456gmail.com
                Article
                DOI: 10.1590/0100-3984.2015.0140
                PMC ID: 5397003
                PubMed ID: 28428655
                SO-VID: 5548be47-4c7a-4af2-a5ef-050596d9b114
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 July 2015
                Date accepted : 21 May 2016
                Categories
                Subject: Review Article

                Keywords: magnetic resonance imaging,liver cirrhosis,image enhancement,contrast media
                Data availability:
                Keywords: magnetic resonance imaging, liver cirrhosis, image enhancement, contrast media

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