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Diffusion weighted magnetic resonance imaging of liver: Principles, clinical applications and recent updates

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World Journal of Hepatology 2017年第26期9卷 1081-1091页

作者： Anuradha Shenoy-Bhangle Vinit Baliyan Hamed Kordbacheh Alexander R Guimaraes Avinash Kambadakone Beth Israel Deaconess Medical Center Harvard Medical School Abdominal Imaging and Interventional Radiology Massachusetts General Hospital Oregon Health and Science University

Diffusion-weighted imaging(DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.

关键词： liver imaging Diffusion weighted imaging Magnetic resonance imaging Focal liver lesion Diffuse liver disease Response assessment

Role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of focal hepatic lesions

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World Journal of Gastroenterology 2009年第46期15卷 5805-5812页

作者： Naoto Koike Akihiro Cho Katsuhiro Nasu Kazuhiko Seto Shigeyuki Nagaya Yuji Ohshima Nobuhiro Ohkohchi Department of Surgery Seirei Sakura Citizen Hospital Department of Surgery Chiba Cancer Center Department of Radiology Institute of Clinical MedicineUniversity of Tsukuba Department of Radiology Seirei Sakura Citizen Hospital Department of Radiology Seirei Mikatabara Hospital Department of Surgery Institute of Clinical MedicineUniversity of Tsukuba

AIM： To evaluate the utility of diffusion-weighted imaging （DWl） in screening and differential diagnosis of benign and malignant focal hepatic lesions. METHODS： Magnetic resonance imaging （MRI） examinations were performed using the Signa Excite Xl Twin Speed 1.5T system （GE Healthcare, Milwaukee, Wl, USA）. Seventy patients who had undergone MRI of the liver [29 hepatocellular carcinomas （HCC）, four cholangiocarcinomas, 34 metastatic liver cancers, 10 hemangiomas, and eight cysts] between April 2004 and August 2008 were retrospectively evaluated. Visualization of lesions, relative contrast ratio （RCR）, and apparent diffusion coefficient （ADC） were compared between benign and malignant lesions on DWl. Su- perparamagnetic iron oxide （SPIO） was administered to 59 patients, and RCR was compared pre- and ***： DWI showed higher contrast between malignant lesions （especially in multiple small metastatic cancers） and surrounding liver parenchyma than did contrast-enhanced computed tomography. ADCs （mean±SD × 10^-3 mm2/s） were significantly lower （P 〈 0.05） in malignant lesions （HCC： 1.31 ± 0.28 and liver metastasis： 1.11 ± 0.22） and were significantly higher in benign lesions （hemangioma： 1.84 ± 0.37 and cyst： 2.61 ± 0.45） than in the surrounding hepatic tissues. RCR between malignant lesions and surrounding he- patic tissues significantly improved after SPIO administration, but RCRs in benign lesions were not ***： DWI is a simple and sensitive method for screening focal hepatic lesions and is useful for differential diagnosis.

关键词： Hepatic tumor liver imaging Magneticresonance imaging Diffusion-weighted imaging Apparent diffusion coefficient

Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2015年第1期14卷 63-68页

作者： Mahmoud Abdelwahab Ali Jung-Fang Chuang Chee-Chien Yong Chih-Chi Wang Chi-Ying Lin Chao-Long Chen Division of General Surgery Department of SurgeryKaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Department of Surgery PingT ung Christian Hospital

BACKGROUND： In order to preserve functional liver parenchyma, extended central hepatectomy （segments 4, 5, 7 and 8 resection） was proposed for the management of centrally located hepatocellular carcinoma invading the right and middle hepatic veins, reconstructing segment 6 outflow in the absence of the thick inferior right hepatic vein. The present study was to describe our surgical techniques of extended central ***： Between 2008 and 2012, 5 patients with centrally located hepatocellular carcinoma invading or in the vicinity of the right and middle hepatic veins underwent extended central hepatectomy. The thick inferior right hepatic vein was preserved during dissection. Gore-Tex graft was used for segment 6 outflow reconstruction in the absence of the thick inferior right hepatic ***： The mean future remnant liver volume for segments 2 and 3 was 28% versus 45% on segment 6 preservation. The mean tumor diameter was 7.4 cm. The thick inferior right hepatic vein was found in 1 patient. Outflow reconstruction from segment 6 was performed in 4 patients. Postoperative complications included bile leakage （1 patient）, pleural effusion （2） and liver failure （1）. The rate of graft patency was 75%. There was no perioperative ***： Extended central hepatectomy is a safe alternative for extended hepatic resection in selected patients attempting to preserve the functional liver parenchyma.

关键词： hepatectomy hepatic vein thrombosis hepatocellular carcinoma liver cirrhosis liver imaging

Application of computer-assisted three-dimensional quantitative assessment and a surgical planning tool for living donor liver transplantation

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Chinese Medical Journal 2013年第7期126卷 1288-1291页

作者： WEI Lin ZHU Zhi-jun LU Yi JIANG Wen-tao GAO Wei ZENG Zhi-gui SHEN Zhong-yang Department of Hepatobiliary Surgery First Affiliated Hospital of Medical College Xi'an Jiaotong University Xi'an Shaanxi 710061 China Department of' Transplantation Tianjin First Central Hospital Tianjin 300192 China

Background Precise evaluation of the live donor＇s liver is the most important factor for the donor＇s safety and the recipient＇s prognosis in living donor liver transplantation （LDLT）. Our study assessed the clinical value of computer-assisted three-dimensional quantitative assessment and a surgical planning tool for donor evaluation in LDLT. Methods Computer-assisted three-dimensional （3D） quantitative assessment was used to prospectively provide quantitative assessment of the graft volume for 123 consecutive donors of LDLT and its accuracy and efficiency were compared with that of the standard manual-traced method. A case of reduced monosegmental LDLT was also assessed and a surgical planning tool displayed the precise surgical plan to avoid large-for-size syndrome. Results There was no statistically significant difference between the detected graft volumes with computer-assisted 3D quantitative assessment and manual-traced approaches （（856.76±162.18） cm3 vs. （870.64±172.54） cm3, P=0.796）. Estimated volumes by either method had good correlation with the actual graft weight （r-manual-traced method： 0.921, r-3D quantitative assessment method： 0.896, both P 〈0.001）. However, the computer-assisted 3D quantitative assessment approach was significantly more efficient taking half the time of the manual-traced method （（16.91±1.375） minutes vs. （39.27±2.102） minutes, P 〈0.01） to estimate graft volume. We performed the reduced monosegmental LDLT, a pediatric case, with the surgical planning tool （188 g graft in the operation, which was estimated at 208 cm3 pre-operation）. The recipient recovered without large-for-size syndrome. Conclusions Computer-assisted 3D quantitative assessment provided precise evaluation of the graft volume. It also assisted surgeons with a better understanding of the hepatic 3D anatomy and was useful for the individual surgical planning tool.

关键词： living donor liver transplantation liver imaging computed tomography anatomy, safety

Impact of intra-operative cholangiography and parenchymal resection to donor liver function in living donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2014年第3期13卷 259-263页

作者： Feng Gao Xiao Xu Yang-Bo Zhu Qiang Wei Bin Zhou Xiao-Yong Shen Qi Ling Hai-Yang Xie Jian Wu Wei-Lin Wang Shu-Sen Zheng Division of Hepatobiliary and Pancreatic Surgery Department of Surgery Zhejiang University School of Medicine Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases Zhejiang University School of Medicine Department of General Surgery The Second Hospital of Ningbo City Department of Radiology Zhejiang University School of Medicine Key Lab of Combined Multi-Organ Transplantation Ministry of Public HealthFirst Affiliated Hospital Zhejiang University School of Medicine

BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall ***: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also ***: The ALT and AST values were significantly increased after IOC(P0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the ***: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.

关键词： living donor liver transplantation intra-operative liver imaging liver function hepatectomy

Trapped vessel of abdominal pain with hepatomegaly: A case report

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World Journal of Hepatology 2018年第11期10卷 887-891页

作者： Sirisha Grandhe Joy A Lee Ankur Chandra Christopher Marsh Catherine T Frenette Department of Gastroenterology and Hepato-logy University of California Davis Medical Center Department of Internal Medicine Scripps Green Hospital Department of Vascular Surgery Scripps Green Hospital Scripps Center for Organ Transplant Scripps Green Hospital

Abdominal pain with elevated transaminases from inferior vena cava(IVC) obstruction is a relatively common reason for referral and further workup by a hepatologist. The differential for the cause of IVC obstruction is extensive, and the most common etiologies include clotting disorders or recent trauma. In some situations the common etiologies have been ruled out, and the underlying process for the patient's symptoms is still not explained. We present one unique case of abdominal pain and hepatomegaly secondary to IVC constriction from extrinsic compression of the diaphragm. Based on this patient's presentation, we urge that physicians be cognizant of the IVC diameter and consider extrinsic compression as a contributor to the patient's symptoms. If IVC compression from the diaphragm is confirmed, early referral to vascular surgery is strongly advised for further surgical intervention.

关键词： liver imaging Abdominal pain Hepatic circulation Ischemia/reperfusion