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Autoimmune pancreatitis in the context of IgG4-related disease:Review of imaging findings

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World Journal of Gastroenterology 2014年第41期20卷 15177-15189页

作者： Leslie K Lee Dushyant V Sahani division of abdominal Imaging and Intervention Department of RadiologyMassachusetts General HospitalHarvard Medical School

Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the “capsule” and “penetrating duct” signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.

关键词： Autoimmune pancreatitis IgG4-related disease Pancreatic cancer Imaging Computed tomography Magnetic resonance Positron emission tomography Review

Hepatocellular Carcinoma:Diagnosis, Treatment Algorithms, and Imaging Appearance after Transarterial Chemoembolization

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Journal of Clinical and Translational Hepatology 2018年第2期6卷 175-188页

作者： Patrick Vande Lune Ahmed K.Abdel Aal Sergio Klimkowski Jessica G.Zarzour Andrew J.Gunn University of Alabama at Birmingham School of Medicine BirminghamALUSA division of Vascular and Interventional radiology Department of RadiologyUniversity of Alabama at BirminghamBirminghamALUSA Department of radiology University of Alabama at BirminghamBirminghamALUSA division of abdominal Imaging Department of RadiologyUniversity of Alabama at BirminghamBirminghamALUSA

Hepatocellular carcinoma(HCC)is a common cause of cancer-related death,with incidence increasing ***,the overall prognosis for patients with HCC is poor and many patients present with advanced stages of disease that preclude curative *** and interventional radiologists play a key role in the management of patients with *** radiologists can use contrast-enhanced computed tomography(CT),magnetic resonance imaging,and ultrasound to diagnose and stage HCC,without the need for pathologic confirmation,by following established *** staged,the interventional radiologist can treat the appropriate patients with percutaneous ablation,transarterial chemoem-bolization,or ***-up imaging after these liver-directed therapies for HCC can be characterized according to various radiologic response criteria;although,enhancement-based criteria,such as European Association for the Study of the Liver and modified Response Evaluation Criter in Solid Tumors,are more reflective of treatment effect in *** imaging technologies like volumetric analysis,dual-energy CT,cone beam CT and perfusion CT may provide additional benefits for patients with HCC.

关键词： Interventional radiology Interventional oncology Hepatocellular carcinoma Response criteria Transarterial chemoembolization Diagnostic radiology

Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

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World Journal of Gastroenterology 2017年第10期23卷 1735-1746页

作者： Murad Feroz Bandali Anirudh Mirakhur Edward Wolfgang Lee Mollie Clarke Ferris David James Sadler Robin Ritchie Gray Jason Kam Wong Department of radiology Foothills Medical Centre University of Calgary division of Interventional radiology Department of Radiology UCLA Medical Center

Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

关键词： Portal hypertension Diagnostic imaging Portosystemic collaterals Image-guided therapy

Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes

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World Journal of Hepatology 2017年第12期9卷 603-612页

作者： Michael C Hsu Charles N Weber S William Stavropoulos Timothy W Clark Scott O Trerotola Richard D Shlansky Goldberg Michael C Soulen Gregory J Nadolski Department of radiology Division of Interventional RadiologyMount Sinai Hospital Department of radiology Division of Interventional RadiologyHospital of the University of Pennsylvania

AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated *** Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging( 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive *** Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(

关键词： Variceal hemorrhage Portal hypertension Transjugular intrahepatic portosystemic shunts Ascites Sub-maximal dilation Underdilated Passive expansion Hepatic encephalopathy

Current status of imaging in nonalcoholic fatty liver disease

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World Journal of Hepatology 2018年第8期10卷 530-542页

作者： Qian Li Manish Dhyani Joseph R Grajo Claude Sirlin Anthony E Samir Department of radiology Massachusetts General Hospital Harvard Medical School Department of radiology Lahey Hospital and Medical Center Department of radiology Division of Abdominal Imaging University of Florida College of Medicine Altman Clinical Translational Research Institute University of CaliforniaSan Diego

Non-alcoholic fatty liver disease(NAFLD) is the most common diffuse liver disease, with a worldwide prevalence of 20% to 46%. NAFLD can be subdivided into simple steatosis and nonalcoholic steatohepatitis. Most cases of simple steatosis are non-progressive, whereas nonalcoholic steatohepatitis may result in chronic liver injury and progressive fibrosis in a significant minority. Effective risk stratification and management of NAFLD requires evaluation of hepatic parenchymal fat, fibrosis, and inflammation. Liver biopsy remains the current gold standard; however, non-invasive imaging methods are rapidly evolving and may replace biopsy in some circumstances. These methods include well-established techniques, such as conventional ultrasonography, computed tomography, and magnetic resonance imaging and newer imaging technologies, such as ultrasound elastography, quantitative ultrasound techniques, magnetic resonance elastography, and magnetic resonancebased fat quantitation techniques. The aim of this article is to review the current status of imaging methods for NAFLD risk stratification and management, including their diagnostic accuracy, limitations, and practical applicability.

关键词： Simple steatosis Non-alcoholic fatty liver disease Ultrasonography Computed tomography Nonalcoholic steatohepatitis Elastography Magnetic resonance

Predictive value of multi-detector computed tomography for accurate diagnosis of serous cystadenoma:Radiologic-pathologic correlation

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World Journal of Gastroenterology 2009年第22期15卷 2739-2747页

作者： Anjuli A Shah Nisha I Sainani Avinash Kambadakone Ramesh Zarine K Shah Vikram Deshpande Peter F Hahn Dushyant V Sahani Department of radiology Division of Abdominal Imaging and Interventional RadiologyWhite Bldg.270Massachusetts General Hospital Department of Pathology Massachusetts General Hospital

AIM： To identify multi-detector computed tomography （MDCT） features most predictive of serous cystadenomas （SCAs）, correlating with histopathology, and to study the impact of cyst size and MDCT technique on reader performance. METHODS： The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs. Accuracy in lesion characterization and reader confidence were correlated with lesion size （≤3 cm or 〉≥3 cm） and scanning protocols （dedicated vs routine）. RESULTS： 28/164 cysts （mean size, 39 mm; range, 8-92 mm） were diagnosed as SCA on pathology. The MDCT features predictive of diagnosis of SCA were microcystic appearance （22/28, 78.6%）, surface Iobulations （25/28, 89.3%） and central scar （9/28, 32.4%）. Stepwise logistic regression analysis showed that only microcystic appearance was significant for CT diagnosis of SCA （P = 0.0001）. The sensitivity, specificity and PPV of central scar and of combined microcystic appearance and Iobulations were 32.4%/100%/100% and 68%/100%/100%, respectively. The reader confidence was higher for lesions 〉 3 cm （P = 0.02） and for MDCT scans performed using thin collimation （1.25-2.5 mm） compared to routine 5 mm collimation exams （P 〉 0.05）. CONCLUSION： Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs. Microcystic morphology is the most significant CT feature in diagnosis of SCA. A combination of microcystic appearance and surface Iobulations offers accuracy comparable to central scar with higher sensitivity.

关键词： Pancreas Serous cystadenoma Multidetector computed tomography Central scar Lobulations Microcystic

Radiological response and inflammation scores predict tumour recurrence in patients treated with transarterial chemoembolization before liver transplantation

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World Journal of Gastroenterology 2017年第20期23卷 3690-3701页

作者： Daniele Nicolini Andrea Agostini Roberto Montalti Federico Mocchegiani Cinzia Mincarelli Alessandra Mandolesi Nicola L Robertson Roberto Candelari Andrea Giovagnoni Marco Vivarelli division of Hepatobiliary and Transplant Surgery Department of Experimental and Clinical MedicinePolytechnic University of Marche division of General and Pediatric radiology Department of Radiological SciencesPolytechnic University of Marche division of Interventional radiology Department of Radiological SciencesPolytechnic University of Marche division of Pathology Department of PathologyPolytechnic University of Marche division of radiology Department of RadiologyMemorial Sloan Kettering Cancer Center

To investigate the prognostic value of the radiological response after transarterial chemoembolization (TACE) and inflammatory markers in patients affected by hepatocellular carcinoma (HCC) awaiting liver transplantation (LT).METHODSWe retrospectively evaluated the preoperative predictors of HCC recurrence in 70 patients treated with conventional (n = 16) or doxorubicin-eluting bead TACE (n = 54) before LT. The patient and tumour characteristics, including the static and dynamic alpha-fetoprotein, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR) measurements, were recorded. Treatment response was classified according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and the European Association for the Study of the Liver (EASL) criteria as complete response (CR), partial response (PR), stable disease or progressive disease. After examination of the explanted livers, histological necrosis was classified as complete (100% of the cumulative tumour area), partial (50%-99%) or minimal (< 50%) and was correlated with the preoperative radiological *** to the pre-TACE radiological evaluation, 22/70 (31.4%) and 12/70 (17.1%) patients were beyond Milan and University of San Francisco (UCSF) criteria, respectively. After TACE procedures, the objective response (CR + PR) rates were 71.4% and 70.0% according to mRECIST and EASL criteria, respectively. The agreement between the two guidelines in defining the radiological response was rated as very good both for the overall and target lesion response (weighted k-value: 0.98 and 0.93, respectively). Complete and partial histological necrosis were achieved in 14/70 (20.0%) and 28/70 (40.0%) patients, respectively. Using histopathology as the reference standard, mRECIST criteria correctly classified necrosis in 72.9% (51/70) of patients and EASL criteria in 68.6% (48/70) of cases. The mRECIST non-response to TACE [Exp(b) = 9.2, p = 0.012], exceeding UCSF criteria before

关键词： Liver transplantation Recurrence-free survival Hepatocellular carcinoma Radiological response Locoregional therapies Inflammatory markers Selection criteria

Evidence-based medical oncology and interventional radiology paradigms for liver-dominant colorectal cancer metastases

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World Journal of Gastroenterology 2016年第11期22卷 3127-3149页

作者： Alan Alper Sag Fatih Selcukbiricik Nil Molinas Mandel division of Interventional radiology Department of RadiologyKoc University School of Medicine division of Medical Oncology Department of Internal MedicineKoc University School of Medicine

Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is(limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.

关键词： Colonic neoplasms Rectal neoplasms Neoplasm metastasis Antineoplastic agents FOLFOX protocol Irinotecan 5-flurouracil and leucovorin protocol Radiofrequency ablation Microwave ablation Chemoembolization Therapeutic Immunotherapy

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma:A systematic review

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2203-2215页

作者： Renato Patrone Francesco Izzo Raffaele Palaia Vincenza Granata Guglielmo Nasti Alessandro Ottaiano Gilda Pasta Andrea Belli University of Naples Federico II Naples 80100Italy Department of abdominal Oncology Division of Hepatobiliary Surgical OncologyIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy division of radiology Istituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy SSD-Innovative Therapies for abdominal Metastases Clinical and Experimental Abdominal OncologyIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy division of Anesthesia Pain medicine and Supportive CareIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy

BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal *** surgical resection represents the only potentially curative *** the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases,its use for ICC is not commonly *** fact,to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed,as well as an associated lymph node *** To review and summarize the current evidences on the minimally invasive resection of *** A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January2021 in 4 databases(PubMed,Scopus,Google Scholar,and Cochrane databases).All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were *** evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa *** After a systematic search 9 studies fulfilled the inclusion *** the all 3012 included patients,2450 were operated by an open approach and 562 by a minimally invasive(laparoscopic)*** characteristics,tumor characteristics,surgical outcomes and oncological outcomes were collected and analyzed,highlighting values with a statistical significant difference between patients treated with open or laparoscopic *** hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery,on the contrary,in the open group there was a higher number of lymphadenectomies and a higher percentage of major *** Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in select

关键词： Cholangiocarcinoma Minimally invasive Laparoscopic Liver resection Hepatectomy Biliary neoplasm