Hepatocelluar carcinoma presenting as a biliary duct tumor thrombus is a relatively rare entity, with poor prognosis. The primary clinical manifestation of this disease is obstructive jaundice, which can often be misdiagnosed. A 59-year-old female patient was admitted with sudden onset of abdominal pain. Laboratory tests suggested obstructive jaundice, and enhanced magnetic resonance imaging of the upper abdomen did not show obvious biliary dilatation. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography suggested an occupying lesion in the upper bile duct. SpyGlass and biopsy finally confirmed hepatocellular carcinoma with right hepatic duct tumor thrombus hemorrhage. The SpyGlass Direct Visualization System, as an advanced biliary cholangioscopy device, showed the advantages of single-person operation as well as easy access to and visualization of the lesion.
Female ; Humans ; Middle Aged ; Carcinoma, Hepatocellular/diagnostic imaging* ; Jaundice, Obstructive/etiology* ; Liver Neoplasms/diagnostic imaging* ; Hepatic Duct, Common/pathology* ; Thrombosis/complications* ; Hemorrhage/complications*

Objective To investigate the value of gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in detecting different stages of liver fibrosis in rats.Methods Rat models of liver fibrosis were induced by carbon tetrachloride intraperitoneal injection for 4 - 12 weeks (n=45). The control group was applied with 0.9% saline (n=15). The MRI protocol contained both dynamic contrast-enhanced sequence (60 continuous scans within 3 minutes,including three pre-contrast measurements) and multiple hepatobiliary-phase acquisitions (every 5 minutes after contrast injection,60 minutes in total). METAVIR score was used to grade liver fibrosis:normal (F0),mild fibrosis (F1 - F2),and advanced fibrosis (F3 - F4). Liver perfusion parameters [transfer constant (K ),extravascular extracellular volume fraction (V),initial area under curve (iAUC),maximum relative enhancement (RE),and time of maximum RE (T)] as well as hepatobiliary-phase parameters [RE at different time point,the decrease of RE (RE=RE - RE),and elimination half-life of RE (T)] were measured and compared with ANOVA analysis and Spearman rank correlation.Results Thirty-one rats completed MRI exams and were then divided into normal (n=10),mild fibrosis (n=10),and advanced fibrosis (n=11) groups. K ,V and iAUC decreased as liver fibrosis progressed (r=-0.631,P=0.002;r=-0.503,P=0.017;r=-0.446,P=0.037). K and V showed significant differences among three groups(F=7.011,P=0.005;F=4.656,P=0.023). K and V were significantly lower in advanced fibrosis group than in normal group (P=0.001,P=0.009). There were statistical significant differences of T,T and RE among groups(F=6.633,P=0.005;F=5.493,P=0.010;F=5.343,P=0.014). Compared to normal and mild fibrosis groups,advanced fibrosis group had significantly longer T and T (P=0.005,P=0.004;P=0.008,P=0.008)and significantly lower RE(P=0.007,P=0.012).Conclusion Perfusion and multi-hepatobiliary-phase parameters such as K ,V,T, T and RE obtained from Gd-EOB-DTPA-enhanced MRI,may be valuable for detecting and staging liver fibrosis.
Animals ; Contrast Media ; chemistry ; Gadolinium DTPA ; chemistry ; Liver ; diagnostic imaging ; pathology ; Liver Cirrhosis ; diagnostic imaging ; Magnetic Resonance Imaging ; Rats

Objective To compare measurements of dual-energy CT iodine map parameters and liver perfusion CT parameters in patients with focal liver lesions using a third-generation dual-source CT scanner. Methods Between November 2015 and August 2016,33 patients with non-cystic focal lesions of liver were enrolled in this study. CT examinations were performed with a third-generation dual-source CT. The study CT protocol included a perfusion CT and dual-energy arterial and portal venous scans,with a time interval of 15 minutes. Iodine attenuation was measured at five region of interests including areas of high,medium,and low density within the lesion,as well as right and left liver parenchyma from the iodine map,while arterial liver perfusion (ALP),portal venous liver perfusion (PVP),and hepatic perfusion index (HPI) at the same location were measured from perfusion CT. The Pearson product-moment correlation coefficient was used to evaluate the relationship between iodine attenuation and perfusion parameters. Results The iodine attenuation at arterial phase showed significant intra-individual correlation with ALP (r=0.812,95% CI=0.728-0.885,P<0.001)and PVP (r=-0.209,95% CI=-0.323--0.073,P=0.007),but not significantly correlated with HPI (r=0.058,95% CI=0.046-0.498,P=0.461). The iodine attenuation at portal venous phase showed significant correlation with PVP (r=0.214,95% CI=0.072-0.361,P=0.005) but not with HPI(r=0.036,95% CI=-0.002-0.242,P=0.649). The mean effective dose of arterial phase and portal venous phase of dual-energy CT together [(3.53±1.17)mSv] was significantly lower than that of the perfusion CT [(14.53±0.45)mSv](t=25.212,P<0.001). Conclusion Iodine attenuation from arterial phase of dual energy CT demonstrates significant correlation with ALP and PVP,and iodine attenuation from portal venous phase demonstrates significant correlation with PVP.
Contrast Media ; Humans ; Iodine ; Liver ; diagnostic imaging ; pathology ; Perfusion ; Portal Vein ; Tomography, X-Ray Computed ; methods

Primary squamous cell carcinoma (SCC) of the liver is very rare, and few cases have been reported in Korea. Primary SCC of the liver is known to be associated with hepatic cysts and intrahepatic stones. A 71-year-old male was admitted to our hospital, and a abdominal computed tomography scan revealed a 10 × 6 cm mass in the liver. Analysis of a biopsy sample suggested SCC, and so our team performed a thorough workup to find the primary lesion, which was revealed hepatoma as a pure primary SCC of the liver with multiple distant metastases. The patient was treated with one cycle of radiotherapy, transferred to another hospital for hospice care, and then died 1 month after discharge.
Abdomen/diagnostic imaging ; Aged ; Carcinoma, Squamous Cell/*diagnosis/pathology/radiotherapy ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Liver Neoplasms/*diagnosis/pathology/radiotherapy ; Male ; Palliative Care ; Positron-Emission Tomography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: To assess the usefulness of magnetization-tagged magnetic resonance imaging (MRI) in quantifying cardiac-induced liver motion and deformation in order to predict liver fibrosis. METHODS: This retrospective study included 85 patients who underwent liver MRI including magnetization-tagged sequences from April 2010 to August 2010. Tagged images were acquired in three coronal and three sagittal planes encompassing both the liver and heart. A Gabor filter bank was used to measure the maximum value of displacement (MaxDisp) and the maximum and minimum values of principal strains (MaxP1 and MinP2, respectively). Patients were divided into three groups (no fibrosis, mild-to-moderate fibrosis, and significant fibrosis) based on their aspartate-aminotransferase-to-platelet ratio index (APRI) score. Group comparisons were made using ANOVA tests. RESULTS: The patients were divided into three groups according to APRI scores: no fibrosis (≤0.5; n=41), moderate fibrosis (0.5-1.5; n=23), and significant fibrosis (>1.5; n=21). The values of MaxDisp were 2.9±0.9 (mean±SD), 2.3±0.7, and 2.1±0.6 in the no fibrosis, moderate fibrosis, and significant fibrosis groups, respectively (P<0.001); the corresponding values of MaxP1 were 0.05±0.2, 0.04±0.02, and 0.03±0.01, respectively (P=0.002), while those of MinP2 were -0.07±0.02, -0.05±0.02, and -0.04±0.01, respectively (P<0.001). CONCLUSIONS: Tagged MRI to quantify cardiac-induced liver motion can be easily incorporated in routine liver MRI and may represent a helpful complementary tool in the diagnosis of early liver fibrosis.
Aged ; Aspartate Aminotransferases/analysis ; Blood Platelets/cytology ; Humans ; Liver Cirrhosis/*diagnostic imaging/metabolism/pathology ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index

Many guidelines for hepatocellular carcinoma (HCC) have been published and updated globally. In contrast to other cancers, there is a range of treatment options for HCC involving several multidisciplinary care of the patient. Consequently, enormous heterogeneity in management trends has been observed. To support standard care for HCC, we systematically appraised 8 current guidelines for HCC around the world, including 3 guidelines from Asia, 2 from Europe, and 3 from the United States according to the selection criteria of credibility influence and multi-faceted. After a systematic appraisal, we found that these guidelines have both similarities and dissimilarities in terms of surveillance and treatment allocation recommendations due to regional differences in disease and other variables (diagnosis, staging systems) secondary to the lack of a solid, high level of evidence. In contrast to other tumors, the geographic differences in tumor biology (i.e., areas of increased hepatitis B prevalence) and available resources (organ availability for transplantation, medical technology, accessibility to treatment, health systems, and health resources) make it impractical to have an internationally universal guideline for all patients with HCC. Although Barcelona-Clinic Liver Cancer (BCLC) has long been dominant system for treatment-guiding staging of HCC, many Asia-pacific experts do not fully agree with its principle. The concepts of BCLC, for surgical resection or other locoregional therapy, are considered too conservative. Asian guidelines represent consensus about surgical resection and TACE indication for more advanced tumor.
Algorithms ; Carcinoma, Hepatocellular/diagnostic imaging/pathology/*therapy ; Chemoembolization, Therapeutic ; Guidelines as Topic ; Humans ; Liver Neoplasms/diagnosis/pathology/*therapy ; Liver Transplantation ; Neoplasm Staging ; alpha-Fetoproteins/analysis

BACKGROUND/AIMS: The diagnosis and treatment plan for hepatocellular carcinoma (HCC) can be made from radiologic imaging. However, lesion detection may vary depending on the imaging modality. This study aims to evaluate the sensitivities of hepatic multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) in the detection of HCC and the consequent management impact on potential liver transplant patients. METHODS: One hundred and sixteen HCC lesions were analyzed in 41 patients who received an orthotopic liver transplant (OLT). All of the patients underwent pretransplantation hepatic DSA, MDCT, and/or MRI. The imaging results were independently reviewed retrospectively in a blinded fashion by two interventional and two abdominal radiologists. The liver explant pathology was used as the gold standard for assessing each imaging modality. RESULTS: The sensitivity for overall HCC detection was higher for cross-sectional imaging using MRI (51.5%, 95% confidence interval [CI]=36.2-58.4%) and MDCT (49.8%, 95% CI=43.7-55.9%) than for DSA (41.7%, 95% CI=36.2-47.3%) (P=0.05). The difference in false-positive rate was not statistically significant between MRI (22%), MDCT (29%), and DSA (29%) (P=0.67). The sensitivity was significantly higher for detecting right lobe lesions than left lobe lesions for all modalities (MRI: 56.1% vs. 43.1%, MDCT: 55.0% vs. 42.0%, and DSA: 46.9% vs. 33.9%; all P<0.01). The sensitivities of the three imaging modalities were also higher for lesions ≥2 cm vs. <2 cm (MRI: 73.4% vs. 32.7%, MDCT: 66.9% vs. 33.8%, and DSA: 62.2% vs. 24.1%; all P<0.01). The interobserver correlation was rated as very good to excellent. CONCLUSIONS: The sensitivity for detecting HCC is higher for MRI and MDCT than for DSA, and so cross-sectional imaging modalities should be used to evaluate OLT candidacy.
Adult ; Aged ; Angiography, Digital Subtraction ; Carcinoma, Hepatocellular/*diagnostic imaging/pathology/therapy ; Female ; Humans ; Liver Neoplasms/*diagnostic imaging/pathology/therapy ; Liver Transplantation ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Aged ; Bile Duct Diseases ; complications ; diagnostic imaging ; pathology ; Bile Duct Neoplasms ; diagnosis ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Jaundice, Obstructive ; etiology ; Klatskin Tumor ; diagnosis ; Liver Neoplasms ; complications ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Thrombosis ; complications ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

The prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to be 25-30% of the population, and is the most common cause of elevated liver enzymes in Korea. NAFLD is a "hot potato" for pharmaceutical companies. Many clinical trials are underway to develop a first-in-class drug to treat NAFLD. However, there are several challenging issues regarding the diagnosis of NAFLD. Currently, liver biopsy is the gold standard method for the diagnosis of NAFLD and steatohepatitis. Ideally, globally recognized standards for histological diagnosis and methods to optimize observer agreement on biopsy interpretation should be developed. Liver biopsy is the best method rather than a perfect one. Recently, multi-parametric magnetic resonance imagery can estimate the amount of intrahepatic fat successfully and is widely used in clinical trials. But no diagnostic method can discriminate between steatohepatitis and simple steatosis. The other unresolved issue in regard to NAFLD is the absence of satisfactory treatment options. Vitamin E and obeticholic acid have shown protective effects in randomized controlled trials, but this drug has not been approved for use in Korea. This study will provide a description of diagnostic methods and treatments that are currently recommended for NAFLD.
Biomarkers/analysis ; Chenodeoxycholic Acid/analogs & derivatives/therapeutic use ; Clinical Trials as Topic ; Fatty Liver/diagnosis ; Fibrosis ; Humans ; Liver/diagnostic imaging/pathology ; Magnetic Resonance Imaging ; Non-alcoholic Fatty Liver Disease/*diagnosis/drug therapy ; Tomography, X-Ray Computed ; Ultrasonography ; Vitamin E/therapeutic use

There has been ongoing debate that the Milan criteria may be too strict that a significant number of patients who could benefit from liver transplantation (LT) might have been excluded. Based on this idea, various studies have been conducted to further expand the Milan criteria and give more HCC patients a chance of cure. In deceased donor LT (DDLT) setting, expansion of the criteria is relatively tempered because the results of LT for HCC should be comparable to those of patients with non-malignant indications. On the other hand, in living donor LT (LDLT) situation, liver grafts are not public resources. The acceptable target outcomes for LDLT might be much lower than those for DDLT. Patients with biologically favorable tumors might have excellent survivals after LT despite morphological advanced HCCs. Therefore, the significance and utility of biological tumor parameters for selecting suitable LT candidates have been increased to predict HCC recurrence after LT. Although there is no consensus regarding the use of prognostic biomarkers in LT selection criteria for HCC, the combination of conventional morphological parameters and new promising biomarkers could help us refine and expand the LT criteria for HCC in the near future.
Biomarkers, Tumor/analysis ; Carcinoma, Hepatocellular/diagnostic imaging/pathology/*therapy ; Humans ; Liver Neoplasms/diagnostic imaging/pathology/*therapy ; Liver Transplantation ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Patient Selection ; Positron-Emission Tomography