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      Diagnostic accuracy of magnetic resonance, computed tomography and contrast enhanced ultrasound in radiological multimodality assessment of peribiliary liver metastases

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          Abstract

          Purpose

          We compared diagnostic performance of Magnetic Resonance (MR), Computed Tomography (CT) and Ultrasound (US) with (CEUS) and without contrast medium to identify peribiliary metastasis.

          Methods

          We identified 35 subjects with histological proven peribiliary metastases who underwent CEUS, CT and MR study. Four radiologists evaluated the presence of peribiliary lesions, using a 4-point confidence scale. Echogenicity, density and T1-Weigthed (T1-W), T2-W and Diffusion Weighted Imaging (DWI) signal intensity as well as the enhancement pattern during contrast studies on CEUS, CT and MR so as hepatobiliary-phase on MRI was assessed.

          Results

          All lesions were detected by MR. CT detected 8 lesions, while US/CEUS detected one lesion. According to the site of the lesion, respect to the bile duct and hepatic parenchyma: 19 (54.3%) were periductal, 15 (42.8%) were intra-periductal and 1 (2.8%) was periductal-intrahepatic. According to the confidence scale MRI had the best diagnostic performance to assess the lesion. CT obtained lower diagnostic performance. There was no significant difference in MR signal intensity and contrast enhancement among all metastases (p>0.05). There was no significant difference in CT density and contrast enhancement among all metastases (p>0.05).

          Conclusions

          MRI is the method of choice for biliary tract tumors but it does not allow a correct differential diagnosis among different histological types of metastasis. The presence of biliary tree dilatation without hepatic lesions on CT and US/CEUS study may be an indirect sign of peribiliary metastases and for this reason the patient should be evaluated by MRI.

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          Most cited references30

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          Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver.

          H Bismuth, M Corlette (1975)
          It is important to expand the indications for resection of tumors of the hilas, generally requiring associated hepatectomy, after careful search for metastases and biopsy of any suspicious areas makes this reasonable. One can justify such a procedure, representing a major stress and a considerable mortality rate, only if one is sure that all the tumor will be removed. If resection cannot be carried out, a unilateral intrahepatic cholangioenteric anastomosis with preference for the round ligament technique is an excellent procedure when properly applied. If a contraindication to a left sided anastomosis exists, particularly invasion of the left sided confluences, the anastomosis is made on the right to the duct of segment V. Study of the cholangiogram with attenion to the primary and secondary confluences directs a decision to perform a double anastomosis the ducts are not dilated or a poor quality anastomosis is all that can be achieved on one side and when secondary confluents are involved on both sides. The results of a variety of techniques emphasize the importance of the cholangiogram in choosing the location of an anastomosis and the role of invasion of primary and secondary conversions in choosing the technique. Many of thse patients are young and, even if no resection is possible, amy survive several years. A renewed sense of well being and prolongation of life are achievable goals even if the tumor cannot be removed. There is every reason to offer the maximum to these patients so that, if they muse eventually die, it will be from the tumor itself and not from its biliary complications.
          Article 0 comments Cited 66 times – based on 0 reviews     Review now
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            ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents

            E Neri, M. A. Bali, A. Ba-Ssalamah … (2015)
            Objectives To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents. Methods The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach’s statistics were used to rate levels of agreement and internal reliability of the consensus. Results Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases. Conclusions The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases. Key points • Liver-specific contrast agents are recommended in MRI of the liver. • The hepatobiliary phase improves the detection and characterization of hepatocellular lesions. • Liver-specific contrast agents can improve the detection of HCC.
            Article 0 comments Cited 48 times – based on 0 reviews     Review now
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              Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis

              J. Kleijnen, M. Westwood, M. Joore … (2013)
              Article 0 comments Cited 43 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Gianfranco D. Alpini: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 20 June 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 6
                Electronic Location Identifier: e0179951
                Affiliations
                [1 ]Division of Radiology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Naples, Italy
                [2 ]Division of Abdominal Oncology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Naples, Italy
                [3 ]Division of Hepatobiliary Surgical Oncology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Naples, Italy
                [4 ]Division of Diagnostic Pathology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Naples, Italy
                [5 ]Departement of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
                [6 ]Division of Anesthesia, Endoscopy and Cardiology, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale”, Naples, Italy
                Texas A&M University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: VG FI.

                • Data curation: VG RF OC AV RP GB FT FG FI AP MC.

                • Formal analysis: VG RF.

                • Investigation: VG OC AV RP GB FT FG FI AP.

                • Methodology: VG RF OC AV RP GB FT FG FI AP.

                • Resources: GB AV FI AP.

                • Supervision: VG.

                • Validation: VG RF FI.

                • Visualization: VG RF FI.

                • Writing – original draft: VG RF FG FI.

                • Writing – review & editing: VG RF FG FI.

                Author information
                http://orcid.org/0000-0002-0469-9969
                Article
                Publisher ID: PONE-D-17-14108
                DOI: 10.1371/journal.pone.0179951
                PMC ID: 5478136
                PubMed ID: 28632786
                SO-VID: 734525e5-dbb9-4b4f-8725-60e0e0981536
                Copyright © © 2017 Granata et al
                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 author and source are credited.

                History
                Date received : 11 April 2017
                Date accepted : 7 June 2017
                Page count
                Figures: 4, Tables: 4, Pages: 14
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Medicine and Health Sciences
                Subject: Radiology and Imaging
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Signs and Symptoms
                Subject: Lesions
                Subject: Medicine and Health Sciences
                Subject: Pathology and Laboratory Medicine
                Subject: Signs and Symptoms
                Subject: Lesions
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Brain Mapping
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Medicine and Health Sciences
                Subject: Radiology and Imaging
                Subject: Diagnostic Radiology
                Subject: Magnetic Resonance Imaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Neuroimaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Neuroimaging
                Subject: Brain Morphometry
                Subject: Diffusion Weighted Imaging
                Subject: Research and Analysis Methods
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                Subject: Biology and Life Sciences
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                Subject: Diagnostic Medicine
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                Subject: Tomography
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                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Diagnostic Radiology
                Subject: Tomography
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                Subject: Medicine and Health Sciences
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                Subject: People and Places
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                Subject: Metastasis
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                Subject: Oncology
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                Subject: Carcinomas
                Subject: Adenocarcinomas
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