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Radiomics model based on preoperative gadoxetic acid-enhanced MRI for predicting liver failure

World Journal of Gastroenterology 2020年第11期26卷 1208-1220页

作者： Wang-Shu Zhu Si-Ya Shi Ze-Hong Yang Chao Song Jun Shen Department of Radiology Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhou 510120Guangdong ProvinceChina Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research CenterSun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhou 510120Guangdong ProvinceChina

BACKGROUND Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma(HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently *** To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major *** For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve *** Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure(area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure(area under the curve: 0.894;95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy o

关键词： Liver failure Radiomics gadoxetic acid Magnetic resonance imaging Hepatocellular carcinoma

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Can gadoxetic acid–enhanced magnetic resonance imaging be used to avoid liver biopsy in patients with nonalcoholic fatty liver disease?

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World Journal of Hepatology 2020年第9期12卷 661-671页

作者： Viviane Brandão Amorim Daniella Braz Parente Fernando Fernandes Paiva Jaime Araújo Oliveira Neto Amanda Almeida Miranda Cláudia Cravo Moreira Flávia Ferreira Fernandes Carlos Frederico FerreiraCampos Nathalie Carvalho Leite Renata de Mello Perez Rosana Souza Rodrigues Research Department D’Or Institute for Research and EducationRio de Janeiro 22281Brazil Radiology Department Brazilian National Cancer InstituteRio de Janeiro 20230-130Brazil Radiology Department Fleury Group S.A.Rio de Janeiro 20765-000Brazil Radiology Department Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil São Carlos Institute of Physics University of São PauloSão Carlos 13560-970Brazil Radiology Department Quinta D'Or HospitalRio de Janeiro 20941-150Brazil Radiology Department Centro de Diagnóstico Médico do MaranhãoMaranhão 65074-441Brazil Department of Clinical Medicine Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil Gastroenterology and Hepatology Department Hospital Federal de BonsucessoRio de Janeiro 21041-030Brazil Department of Pathology and Laboratories University of the State of Rio de JaneiroRio de Janeiro 20551-030Brazil Internal Medicine Department Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil Gastroenterology Department Hospital Universitário Pedro ErnestoUniversity of the State of Rio de JaneiroRio de Janeiro 20551-030Brazil

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a major cause of liver disease *** diagnosis of nonalcoholic steatohepatitis(NASH),the most severe form of NAFLD,is crucial and has prognostic and therapeutic ***,currently this diagnosis is based on liver biopsy and has several *** To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging(GA-MRI)in differentiating isolated steatosis from NASH in patients with *** In this prospective study,56 patients with NAFLD(18 with isolated steatosis and 38 with NASH)underwent *** contrast enhancement index(CEI)was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA ***-group differences in mean CEI were examined using Student's t *** area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were *** The mean CEI for all subjects was 1.82±*** mean CEI was significantly lower in patients with NASH than in those with isolated steatosis(P=0.008).Two CEI cut-off points were used:2.00(89%sensitivity)to characterize isolated *** values between 1.66 and 2.00 indicated liver biopsy,and the procedure could be avoided in 40%of patients with *** GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis,and could help to avoid liver biopsy in patients with NAFLD.

关键词： Fatty liver Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis gadoxetic

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Added value of hepatobiliary phase gadoxetic acid-enhanced MRI for diagnosing hepatocellular carcinoma in high-risk patients

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World Journal of Gastroenterology 2013年第45期19卷 8357-8365页

作者： Sith Phongkitkarun Kuruwin Limsamutpetch Penampai Tannaphai Janjira Jatchavala Department of Diagnostic and Therapeutic Radiology Faculty of Medicine Ramathibodi Hospital Mahidol University Ratchatewi Bangkok 10400 Thailand

AIM:To determine the added value of hepatobiliary phase(HBP)gadoxetic acid-enhanced magnetic resonance imaging(MRI)in evaluating hepatic nodules in high-risk ***:The institutional review board approved this retrospective study and waived the requirement for informed *** study included 100 patients at high risk for hepatocellular carcinoma(HCC)and 105hepatic nodules that were larger than 1 cm.A blind review of two MR image sets was performed in a random order:set 1,unenhanced(T1-and T2-weighted)and dynamic images;and set 2,unenhanced,dynamic20-min and HBP *** diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were compared for the two image *** and multivariate analyses were performed on the MR characteristics utilized to diagnose ***:A total of 105 hepatic nodules were identified in 100 ***-nine nodules were confirmed to be *** diameter of the 59 HCCs ranged from1 to 12 cm(mean:1.9 cm).The remaining 46 nodules were benign(28 were of hepatocyte origin,nine were hepatic cysts,seven were hemangiomas,one was chronic inflammation,and one was focal fat infiltration).The diagnostic accuracy significantly increased with the addition of HBP images,from 88.7%in set 1to 95.5%in set 2(P=0.002).In set 1 vs set 2,the sensitivity and NPV increased from 79.7%to 93.2%and from 78.9%to 91.8%,respectively,whereas the specificity and PPV were not significantly *** hypointensity on the HBP images was the most sensitive(93.2%),and typical arterial enhancement followed by washout was the most specific(97.8%).The multivariate analysis revealed that typical arterial enhancement followed by washout,hyperintensity on T2-weighted images,and hypointensity on HBP images were statistically significant MRI findings that could diagnose HCC(Pgadoxetic acidenhanced MRI statistically improved the diagnostic accuracy in HCCs larger than

关键词： Magnetic resonance imaging Liver gadoxetic acid Hepatobiliary phase Hepatocellular carcinoma

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Usefulness of two-point Dixon fat-water separation technique in gadoxetic acid-enhanced liver magnetic resonance imaging

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世界胃肠病学杂志：英文版 2015年第16期21卷 5017-5022页

作者： Ying Ding Sheng-Xiang Rao Cai-Zhong Chen Ren-Chen Li Meng-Su Zeng Department of Radiology Zhongshan Hospital of Fudan UniversityShanghai Institute of Medical Imaging

AIM:To compare differences between volumetric interpolated breath-hold examination(VIBE) using two-point Dixon fat-water separation(Dixon-VIBE) and chemically selective fat saturation(FS-VIBE) with magnetic resonance imaging ***:Forty-nine patients were included, who were scanned with two VIBE sequences(Dixon-VIBE and FS-VIBE) in hepatobiliary phase after gadoxetic acid *** evaluations including sharpness of tumor, sharpness of vessels, strength and homogeneity of fat suppression, and artifacts that were scored using a 4-point *** liver-to-lesion contrast was also calculated and ***:Dixon-VIBE with water reconstruction had significantly higher subjective scores than FS-VIBE in strength and homogeneity of fat suppression(gadoxetic acid administration.

关键词： Dixon-volumetric interpolated breath-holdexamination Fat saturation-volumetric interpolatedbreath-hold examination gadoxetic acid Volumetricinterpolated breath-hold examination Magnetic resonance imaging

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Clinical value of gadoxetic acid-enhanced magnetic resonance imaging in surgery for hepatocellular carcinoma- with a special emphasis on early hepatocellular carcinoma

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World Journal of Hepatology 2015年第30期7卷 2933-2939页

作者： Masanori Matsuda First Department of Surgery Yamanash University School of Medicine

gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI) achieves excellent lesion detection and characterization for both hypervascular hepatocellular carcinoma(HCC) in arterial phase imagingand hypovascular early HCC(small well-differentiated HCC of the vaguely nodular type) in hepatobiliary phase imaging, and has become an indispensable imaging modality in the treatment of HCC. Early HCCs have been detected more frequently since the introduction of EOB-MRI into daily clinical practice. Early HCC is known to progress to conventional hypervascular HCC, and many risk factors have been identified for the hypervascularization of early HCC including the diameter of the tumor, presence of fat, and imaging findings of EOB-MRI. The rate of the development of hypervascular HCC was previously reported to be high in patients with chronic liver disease and early HCC. The presence of early HCC is regarded as a predictor for the recurrence of HCC following hepatic resection. On the other hand, although early HCC itself is currently not regarded as a target lesion for hepatic resection, early HCC at high risk of hypervascularity needs to be treated by local ablation therapy. If concomitant early HCC with progressed HCC is at high risk of hypervascularization and the functional liver reserve of a patient is sufficient, its simultaneous treatment at the time of hepatic resection for progressed HCC is recommended. Further studies on larger numbers of patients are needed before this strategy is adopted.

关键词： hepatocarcinogenesis gadoxetic acidenhancedmagnetic resonance imaging hepatobiliaryphase hypervascularization early hepatocellularcarcinoma organic anion transporting polypeptide gadolinium ethoxybenzyl diethylenetriamine pentaaceticacid-enhanced magnetic resonance imaging hepaticresection

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MR with Gd-EOB-DTPA in assessment of liver nodules in cirrhotic patients

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World Journal of Hepatology 2018年第7期10卷 462-473页

作者： Riccardo Inchingolo Riccardo Faletti Luigi Grazioli Eleonora Tricarico Marco Gatti Anna Pecorelli Davide Ippolito Division of Interventional Radiology Department of Radiology Madonna delle Grazie Hospital Department of Surgical Sciences Radiology Unit University of Turin Department of Radiology University of Brescia "Spedali Civili" Department of Diagnostic Radiology School of Medicine University of Milano-Bicocca

To date the imaging diagnosis of liver lesions is based mainly on the identification of vascular features, which are typical of overt hepatocellular carcinoma(HCC), but the hepatocarcinogenesis is a complex and multistep event during which, a spectrum of nodules develop within the liver parenchyma, including benign small and large regenerative nodule(RN), low-grade dysplastic nodule(LGDN), high-grade dysplastic nodule(HGDN), early HCC, and well differentiated HCC. These nodules may be characterised not only on the basis of their respective different blood supplies, but also on their different hepatocyte function. Recently, in liver imaging the introduction of hepatobiliary magnetic resonance imaging contrast agent offered the clinicians the possibility to obtain, at once, information not only related to the vascular changes of liver nodules but also information on hepatocyte function. For this reasons this new approach becomes the most relevant diagnostic clue for differentiating low-risk nodules(LGDN-RN) from highrisk nodules(HGDN/early HCC or overt HCC) and consequently new diagnostic algorithms for HCC have been proposed. The use of hepatobiliary contrast agents is constantly increasing and gradually changing the standard of diagnosis of HCC. The main purpose of this review is to underline the added value of Gd-EOB-DTPA in early-stage diagnoses of HCC. We also analyse the guidelines for the diagnosis and management of HCC, the key concepts of HCC development, growth and spread and the imaging appearance of precursor nodules that eventually may transform into overt HCC.

关键词： Hepatobiliary contrast materials Cirrhosis gadoxetic acid Magnetic resonance imaging Liver

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Differentiation of hepatocellular carcinoma from its variousmimickers in liver magnetic resonance imaging:What arethe tips when using hepatocyte-specific agents?

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World Journal of Gastroenterology 2016年第1期22卷 284-299页

作者： Yang Shin Park Chang Hee Lee Jeong Woo Kim Sora Shin Cheol Min Park Department of Radiology Korea University Guro HospitalKorea University College of MedicineSeoul 152-703South Korea Korea University College of Medicine Anam-dong 5-gaSeongbuk-GuSeoul 136-701South Korea

Hepatocellular carcinoma is the most common primary hepatic malignant *** widespread use of liver imaging,various cirrhosis-related nodules are frequently detected in patients with chronic liver disease,while diverse hypervascular hepatic lesions are incidentally detected but undiagnosed on dynamic computed tomography and magnetic resonance imaging(MRI).However,use of hepatocyte-specific MR contrast agents with combined perfusion and hepatocyte-selective properties have improved diagnostic performance in detection and characterization of focal liver ***,the enhancement patterns observed during dynamic phases using hepatocyte-specific agents may be different from those observed during MRI using conventional extracellular fluid agents,leading to confusion in ***,we discuss useful tips for the differentiation of hepatocellular carcinoma from similar lesions in patients with and without chronic liver disease using liver MRI with hepatocyte-specific agents.

关键词： Hepatocellular carcinoma gadoxetic acid Magnetic resonance imaging Liver cirrhosis

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