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MRI versus 64-row MDCT for diagnosis of hepatocellular carcinoma

World Journal of Gastroenterology 2009年第48期15卷 6044-6051页

作者： Michael Bernhard Pitton Roman Kloeckner Sascha Herber Gerd Otto Karl Friedrich Kreitner Christoph Dueber department of Diagnostic and Interventional Radiology Johannes Gutenberg-University department of Transplantation and hepatobili-opancreatic Surgery University of Mainz

AIM： To compare the diagnostic capability of multidetector computed tomography （MDCT） and magnetic resonance imaging （MRI） for the detection of hepatocellular carcinoma （HCC） tumour nodules and their effect on patient management. METHODS： A total of 28 patients （25 male, 3 female, mean age 67 ± 10.8 years） with biopsy-proven HCC were investigated with 64-row MDCT （slice 3 mm native, arterial and portal-venous phase, 120 mL Iomeprol, 4 mL/s, delay by bolus trigger） and MRI （Tlfs fl2d TE/ TR 2.72/129 ms, T2tse TE/TR 102/4000 ms, 5-phase dynamic contrast-enhanced Tlfs fl3d TE/TR 1.56/4.6, Gadolinium-DTPA, slice 4 mm）. Consensus reading of both modalities was used as reference. Tumour nodules were analyzed with respect to number, size, and location. RESULTS： In total, 162 tumour nodules were detected by consensus reading. MRI detected significantly more tumour nodules （159 vs 123, P 〈 0.001） compared to MDCT, with the best sensitivity for early arterial phase MRI. False-negative CT findings included nodules ≤ 5 mm （n = 5）, ≤ 10 mm （n = 17）, ≤ 15 mm （n= 12）,≤20mm（n=4）,andlnodule〉*** missed 2 nodules ≤ 10 mm and 1 nodule ≤ 15 mm. On MRI, nodule diameters were greater than on CT （29.2 ≤25.1 mm, range 5-140 mm vs 24.1 ± 22.7 mm, range 4-129 mm, P 〈 0.005）. In 2 patients, MDCT showed only unilobar tumour spread, whereas MRI revealed additional nodules in the contralateral lobe. Detection of these nodules could have changed the therapeutic strategy. CONCLUSION： Contrast-enhanced MRI is superior to 64-row MDCT for the detection of HCC nodules. Patients should be allocated to interventional or operative treatment according to a dedicated MRI-protocol.

关键词： American Association for the Study of Liver Diseases European Association for the Study of the Liver Hepatocellular carcinoma Multidetector computed tomography Magnetic resonance imaging

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Surgicopathological classification of hepatic space-occupying lesions:A single-center experience with literature review

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World Journal of Gastroenterology 2011年第19期17卷 2372-2378页

作者： Wen-Ming Cong Hui Dong Lu Tan Xu-Xu Sun Meng-Chao Wu department of Pathology Eastern Hepatobiliary Surgery Hospital Second Military Medical University Shanghai 200438 China department of Surgery Eastern Hepatobili- ary Surgery Hospital Second Military Medical University 225 Changhai Road Shanghai 200438 China

Accompanying rapid developments in hepatic surgery,the number of surgeries and identifications of histological types of primary hepatic space-occupying lesions (PHSOLs) have increased *** has led to many changes in the surgicopathological spectrum of PHSOLs,and has contributed to a theoretical basis for modern hepatic surgery and oncological *** 1982 and 2009 at the Eastern hepatobiliary Surgery Hospital (EHBH) in Shanghai,31 901 patients underwent surgery and were diagnosed as having a *** this paper,we present an analysis of the PHSOL cases at the EHBH for this time period,along with results from a systematic literature *** describe a surgicopathological spectrum comprising more than 100 types of PHSOLs that can be stratified into three types:tumor-like,benign,and *** also stratified the PHSOLs into six subtypes derived from hepatocytes;cholangiocytes;vascular,lymphoid and hemopoietic tissues;muscular,fibrous and adipose tissues;neural and neuroendocrine tissues;and miscellaneous *** present study provides a new classification system that can be used as a current reference for clinicians and pathologists to make correct diagnoses and differential diagnoses among various PHSOLs.

关键词： Liver tumors Tumor-like lesions Pathology Immunohistochemistry Classification

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Preoperative serum liver enzyme markers for predicting early recurrence after curative resection of hepatocellular carcinoma

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hepatobiliary & Pancreatic Diseases International 2015年第2期14卷 178-185页

作者： Zhong-Xia Wang Chun-Ping Jiang Yin Cao Guang Zhang Wei-Bo Chen Yi-Tao Ding department of hepatobiliary Surgery the Affiliated Drum Tower Hospital of Nanjing University Medical School department of hepatobili-ary Surgery Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University department of hepatobiliary Surgery Nanjing Drum Tower Hospital Clinical Medical College of Nanjing Medical University

BACKGROUND：Early recurrence of hepatocellular carcinoma（HCC）is associated with worse prognosis after liver resection This study aimed to investigate the prognostic value of com mon liver enzyme markers in HCC early recurrence after cu rative hepatectomy and to establish a simple predictive model for HCC early ***： A total of 200 patients who had undergone curative resection for HCC were retrospectively analyzed. The patients were divided into early recurrence （within 2 years） and non-early recurrence groups. Demographical characteristics, preopera- tive liver function parameters, surgical factors and tumor related factors of the patients were assessed by univariate analysis to identify potential significant predictors for early recurrence after resection of HCC. Parameters with statisti- cal significance were entered into a Cox proportional hazard model to find independent risk factors. Receiver operating characteristic analysis was done to determine optimal cut-off values and the number of combined factors in multi-factor predictive model. RESULTS： Of 13 potential risk factors for early recurrence identified by univariate analysis, high lactate dehydrogenase （LDH〉206 U/L, HR=1.711, P=0.006）, high aspartate aminotransferase （AST）/alanine aminotransferase （ALT） ratio （AST/ ALT〉0.96, HR=1.769, P=0.006）, elevated alpha-fetoprotein （AFP〉8.6 ng/mL, HR=2.079, P=0.007）, small resection margin （〈1 cm, HR=2.354, P〈0.001） and advanced TNM stage （TNM III-IV, HR=2.164, P〈0.001） were independent risk factors for early recurrence of HCC shown by multivariate analysis. Patients with three or more concurrent independent risk factors had significantly higher risk for early recurrence than those with low risk factors. The sensitivity and specificity of this predictive model are 53.6% and 80.7%, respectively （area under curve=0.741, 95% CI 0.674-0.800, P〈0.0001）. CONCLUSIONS： Preoperative common fiver enzyme markers, LDH and AST/ALT ratio, were independently associated

关键词： hepatocellular carcinoma liver enzyme recurrence resection hepatectomy

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