Search

Objective Hepatic artery infusion chemotherapy (HAIC) is an effective therapy for unresectable malignant neoplasms of the liver. Percutaneous port-catheter implantation for HAIC is technically safe and provides a viable alternative to traditional methods of hepatic artery access, enabling variable chemotherapy regimens. This article reviews the principle of HAIC, techniques of percutaneous port-catheter implantation, and its application and advances in liver malignancy [ABSTRACT FROM AUTHOR]

Introduction: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary neoplasm of the liver after hepatocellular carcinoma (HCC). Although an underlying cause is not usually found, liver flukes, cirrhosis, primary sclerosing cholangitis, and viral hepatitis have been found to increase the risk in recent years. In this study, we aimed to present our experience on ICC and compare the outcomes of patients with a concomitant liver pathology and with incidentally detected ICC. Patients and Methods: Thirty-three patients who underwent surgical resection for ICC were included in the study. Patients were divided into two groups, group one (with concomitant liver disease, n = 13) and group two (incidentally detected ICC, n = 18). Demographics, perioperative findings, pathological properties, recurrence rates, and survival rates were retrospectively analyzed and compared between the groups. Results: The mean age of patients was 59.77 ± 9.81 years, of whom sixteen (51.6%) were males. Thirteen patients (41.9%) had concomitant liver disease, the most common being chronic hepatitis B infection. Eighteen patients (58.1%) had incidentally detected ICC. There were no significant differences between the groups except for follow-up time and recurrence rate. The recurrence rate was significantly higher in the incidentally detected ICC group (61.1% versus 7.7%, p = 0.003). Follow-up time was significantly higher in patients with concomitant liver disease (42 versus 17.5 months, p = 0.007). The mortality rate was higher in the incidentally detected ICC group (55.6 to 23.1%, p = 0.071) but the difference did not reach statistical significance. Conclusion: Surgical resection in ICC patients with underlying liver disease is associated with better prognosis than in incidentally detected ICC patients. Incidental ICC may be a different tumor with different biology, hence the high recurrence rates. [ABSTRACT FROM AUTHOR]

Objectives: To determine if dynamic CT can differentiate local progression from radioactive seed-induced peritumoral reaction (RSIPR) after brachytherapy with iodine-125 radioactive seeds (BIRS) for advanced hepatic malignancies.Methods: Enhanced CT images of seed-implanted lesions between 2006 and 2018 were retrospectively evaluated. Hounsfield units of peritumoral parenchyma were measured and assessed quantitatively. The classification, conversion, consequences, and serological indicators during follow-up were recorded and quantified. Statistical differences were analyzed using a Pearson χ2 test.Results: RSIPR was observed in 201 of 290 (69.3%) lesions (161 patients; median age, 55 years; range, 26-79 years), while local progression occurred in 53 lesions. The low density of local progression was much lower than that of RSIPR (p < 0.001), and the former did not exhibit iso-/high density in the portal or equilibrium phase. Ring-like enhancement in progressive lesions was also quite different from RSIPR. Local progression rate was lower for lesions with RSIPR than for those without RSIPR (14.9% vs 25.8%; p = 0.03), and their doses were different (397.2 Gy vs 120.3 Gy, p < 0.001).Conclusions: Radioactive seed-induced peritumoral reaction has characteristic manifestations on CT images, which is associated with a higher dose of lesions and lower local progression rate. Notably, the enhancement pattern of local progression was distinct from RSIPR and was clearly distinguishable on dynamic-enhanced CT.Key Points: • Radioactive seed-induced peritumoral reaction after brachytherapy with 125I seeds for liver malignancies has characteristic manifestations on CT images, which is associated with a higher dose of lesions (397.2 Gy vs 120.3 Gy, p < 0.001), as a focal radiation injury. • Lesions with RSIPR were less likely to develop local progression, while those without RSIPR had a higher rate of local progression (14.9% vs 25.8%; p = 0.03). • The enhancement pattern of local progression after brachytherapy was distinct from radioactive seed-induced peritumoral reaction and was clearly distinguishable on dynamic-enhanced CT. [ABSTRACT FROM AUTHOR]

Zhaonan Li,* Dechao Jiao,* Chaoyan Wang, Jing Li, Zaoqu Liu, Wenguang Zhang, Xinwei Han Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xinwei HanInstitute of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou City, Henan Province, 450000, People’s Republic of ChinaTel +861359258-3911Fax +86-371-66278082Email 13592583911@163.comBackground: To evaluate the technical success and clinical safety of magnetic resonance (MR)-guided microwave ablation (MWA) of small hepatic metastases.Materials and Methods: Institutional review board approval and informed patient consent were obtained. A retrospective analysis of the patient data revealed 50 patients with small hepatic metastases (34 men, 16 women) who underwent MWA under MR guidance and monitoring. After the procedure, the intervention-related complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) and Society of Interventional Radiology (SIR) classification system. Furthermore, the overall survival (OS) and local tumor-free survival (LTP) of the patients were analyzed.Results: The patients who underwent MR-guided MWA achieved technical success. The mean energy, ablation duration per tumor, and procedure duration were 55.3 ±  9.4 kJ, 11.7 ±  5.6 min and 89.5 ±  30.9 min, respectively. Most adverse events and complications were CTCAE grade 1 or 2 or SIR classification grade A or B. The 1-, 2-, and 3-year local tumor progression (LTP) rates were 65.9%, 31.5% and 18.5%, respectively, with a mean LTP of 19.216 months (95% CI: 16.208, 22.224); and the 1-, 2- and 3-year overall survival (OS) rates were 81.8%, 60.8% and 44.7%, respectively, with a mean OS of 26.378 months (95% CI: 23.485, 29.270). Multivariate Cox’s regression analysis further illustrated that tumor location (challenging locations vs ordinary locations) and the anesthesia (general anesthesia VS local anesthesia) were important factors affecting LTP and OS.Conclusion: MR-guided MWA can successfully treat small hepatic metastases with potentially favorable safety and technical efficacy.Keywords: microwave ablation, magnetic resonance imaging, liver tumors, tumor ablation, hepatic malignancies

Purpose: To assess the influence of low skeletal muscle mass (LSMM) on post-operative complications in patients with hepatic malignancies grade (Clavien Dindo ≥ 3) undergoing resection. Methods: MEDLINE, Cochrane, and SCOPUS databases were screened for associations between sarcopenia and major post-operative complications (≥ grade 3 according to Clavien-Dindo classification) after resection of different malignant liver tumors. RevMan 5.3 software was used to perform the meta-analysis. The methodological quality of the included studies was assessed according to the QUIPS instrument. Results: The analysis included 17 studies comprising 3157 patients. Subgroup analyses were performed for cholangiocarcinoma (CCC), colorectal cancer (CRC) liver metastases, and hepatocellular carcinoma (HCC). LSMM as identified on CT was present in 1260 patients (39.9%). Analysis of the overall sample showed that LSMM was associated with higher post-operative complications grade Clavien Dindo ≥ 3 (OR 1.56, 95% CI 1.25–1.95, p < 0.001). In the subgroup analysis, LSMM was associated with post-operative complications in CRC metastases (OR 1.60, 95% CI 1.11–2.32, p = 0.01). In HCC and CCC sub-analyses, LSMM was not associated with post-operative complications in simple regression analysis. Conclusion: LSMM is associated with major post-operative complications in patients undergoing surgery for hepatic metastases and it does not influence major post-operative complications in patients with HCC and CCC. [ABSTRACT FROM AUTHOR]

Purpose Hepatic recurrence of liver malignancies is a leading problem in patients after liver resection with curative intention. Thermoablation is a promising treatment approach for patients after hepatic resection, especially in liver-limited conditions. This study aimed to investigate safety, survival, and local tumor control rates of MRI-guided percutaneous thermoablation of recurrent hepatic malignancies following hepatic resection. Material and methods Data from patients with primary or secondary hepatic malignancies treated between 2004 and 2018 with MRI-guided percutaneous thermoablation of hepatic recurrence after prior hepatic resection were retrospectively analyzed. Disease-free survival and overall survival rates were calculated using the Kaplan-Meier method. Results A total of 57 patients with hepatic recurrence (mean tumor size = 18.9 ± 9.1 mm) of colorectal cancer liver metastases (n = 27), hepatocellular carcinoma (n = 17), intrahepatic recurrence of cholangiocellular carcinoma (n = 9), or other primary malignant tumor entities (n = 4) were treated once or several times with MR-guided percutaneous radiofrequency (n = 52) or microwave ablation (n = 5) (range: 1–4 times). Disease progression occurred due to local recurrence at the ablation site in nine patients (15.8%), non-local hepatic recurrence in 33 patients (57.9%), and distant malignancy in 18 patients (31.6%). The median overall survival for the total cohort was 40 months and 49 months for the colorectal cancer group, with a 5-year overall survival rate of 40.7 and 42.5%, respectively. The median disease-free survival was 10 months for both the total cohort and the colorectal cancer group with a 5-year disease-free survival rate of 15.1 and 14.8%, respectively. The mean follow-up time was 39.6 ± 35.7 months. Conclusion MR-guided thermoablation is an effective and safe approach in the treatment of hepatic recurrences in liver-limited conditions and can achieve long-term survival.

Purpose To investigate technical success, technique efficacy, safety and outcome of MR-guided microwave ablation (MWA) in hepatic malignancies. Material and methods In this prospective IRB-approved study, patients scheduled for percutaneous treatment of hepatic malignancies underwent MR-guided MWA in a closed-bore 1.5 T MR system. Technical success was assessed on post-procedural MR control imaging. Technique efficacy was evaluated 4 weeks after the procedure on multi-parametric MRI. Assessment of safety followed the Society of Interventional Radiology grading system. Kaplan–Meier survival estimates were calculated to evaluate overall survival (OS), time to local tumor progression (TLTP), and time to non-target progression (TNTP). Results Between 2015 and 2019, 47 patients (60.5 ± 12.2 years; 39 male) underwent 50 procedures for 58 hepatic tumors (21 hepatocellular carcinomas; 37 metastases). Mean target tumor size was 16 ± 7mm (range: 6–39 mm). Technical success and technique efficacy were 100% and 98%, respectively. Lesions were treated using 2.6 applicator positions (range: 1–6). Mean energy, ablation duration per tumor, and procedure duration were 43.2 ± 23.5 kJ, 26.7 ± 13.1 min and 211.2 ± 68.7 min, respectively. 10 minor (20%) and 3 major (6%) complications were observed. Median post-interventional hospital admission was 1 day (range: 1–19 days). Median OS was 41.6 (IQR: 26.4–) months. Local recurrence occurred after 4 procedures (8%) with TLTP ranging between 3.1 and 41.9 months. Non-target recurrence was observed in 64% of patients after a median TNTP of 13.8 (IQR 2.3–) months. Conclusion MR-guided MWA allows for safe and successful treatment of hepatic malignancies with a high technique efficacy however with relatively long procedure durations.

Purpose: Hepatic recurrence of liver malignancies is a leading problem in patients after liver resection with curative intention. Thermoablation is a promising treatment approach for patients after hepatic resection, especially in liver-limited conditions. This study aimed to investigate safety, survival, and local tumor control rates of MRI-guided percutaneous thermoablation of recurrent hepatic malignancies following hepatic resection. Material and methods: Data from patients with primary or secondary hepatic malignancies treated between 2004 and 2018 with MRI-guided percutaneous thermoablation of hepatic recurrence after prior hepatic resection were retrospectively analyzed. Disease-free survival and overall survival rates were calculated using the Kaplan-Meier method. Results: A total of 57 patients with hepatic recurrence (mean tumor size = 18.9 ± 9.1 mm) of colorectal cancer liver metastases (n = 27), hepatocellular carcinoma (n = 17), intrahepatic recurrence of cholangiocellular carcinoma (n = 9), or other primary malignant tumor entities (n = 4) were treated once or several times with MR-guided percutaneous radiofrequency (n = 52) or microwave ablation (n = 5) (range: 1–4 times). Disease progression occurred due to local recurrence at the ablation site in nine patients (15.8%), non-local hepatic recurrence in 33 patients (57.9%), and distant malignancy in 18 patients (31.6%). The median overall survival for the total cohort was 40 months and 49 months for the colorectal cancer group, with a 5-year overall survival rate of 40.7 and 42.5%, respectively. The median disease-free survival was 10 months for both the total cohort and the colorectal cancer group with a 5-year disease-free survival rate of 15.1 and 14.8%, respectively. The mean follow-up time was 39.6 ± 35.7 months. Conclusion: MR-guided thermoablation is an effective and safe approach in the treatment of hepatic recurrences in liver-limited conditions and can achieve long-term survival. [ABSTRACT FROM AUTHOR]

Open-ended coaxial probes can be used as tissue characterization devices. However, the technique suffers from a high error rate. To improve this technology, there is a need to decrease the measurement error which is reported to be more than 30% for an in vivo measurement setting. This work investigates the machine learning (ML) algorithms’ ability to decrease the measurement error of open-ended coaxial probe techniques to enable tissue characterization devices. To explore the potential of this technique as a tissue characterization device, performances of multiclass ML algorithms on collected in vivo rat hepatic tissue and phantom dielectric property data were evaluated. Phantoms were used for investigating the potential of proliferating the data set due to difficulty of in vivo data collection from tissues. The dielectric property measurements were collected from 16 rats with hepatic anomalies, 8 rats with healthy hepatic tissues, and in house phantoms. Three ML algorithms, k-nearest neighbors (kNN), logistic regression (LR), and random forests (RF) were used to classify the collected data. The best performance for the classification of hepatic tissues was obtained with 76% accuracy using the LR algorithm. The LR algorithm performed classification with over 98% accuracy within the phantom data and the model generalized to in vivo dielectric property data with 48% accuracy. These findings indicate first, linear models, such as logistic regression, perform better on dielectric property data sets. Second, ML models fitted to the data collected from phantom materials can partly generalize to in vivo dielectric property data due to the discrepancy between dielectric property variability. [ABSTRACT FROM AUTHOR]

To investigate technical success, technique efficacy, safety and outcome of MR-guided microwave ablation (MWA) in hepatic malignancies. In this prospective IRB-approved study, patients scheduled for percutaneous treatment of hepatic malignancies underwent MR-guided MWA in a closed-bore 1.5 T MR system. Technical success was assessed on post-procedural MR control imaging. Technique efficacy was evaluated 4 weeks after the procedure on multi-parametric MRI. Assessment of safety followed the Society of Interventional Radiology grading system. Kaplan–Meier survival estimates were calculated to evaluate overall survival (OS), time to local tumor progression (TLTP), and time to non-target progression (TNTP). Between 2015 and 2019, 47 patients (60.5 ± 12.2 years; 39 male) underwent 50 procedures for 58 hepatic tumors (21 hepatocellular carcinomas; 37 metastases). Mean target tumor size was 16 ± 7mm (range: 6–39 mm). Technical success and technique efficacy were 100% and 98%, respectively. Lesions were treated using 2.6 applicator positions (range: 1–6). Mean energy, ablation duration per tumor, and procedure duration were 43.2 ± 23.5 kJ, 26.7 ± 13.1 min and 211.2 ± 68.7 min, respectively. 10 minor (20%) and 3 major (6%) complications were observed. Median post-interventional hospital admission was 1 day (range: 1–19 days). Median OS was 41.6 (IQR: 26.4–) months. Local recurrence occurred after 4 procedures (8%) with TLTP ranging between 3.1 and 41.9 months. Non-target recurrence was observed in 64% of patients after a median TNTP of 13.8 (IQR 2.3–) months. MR-guided MWA allows for safe and successful treatment of hepatic malignancies with a high technique efficacy however with relatively long procedure durations. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) comprise the two most common primary liver malignancies. Curative treatment options often include hepatectomy or liver transplantation; however, many patients present with advanced disease that is not amenable to surgical management. In turn, many patients are treated with systemic or targeted therapy. The tumor microenvironment (TME) is a complex network of immune cells and somatic cells, which can foster an environment for disease development and progression, as well as susceptibility and resistance to systemic therapeutic agents. In particular, the TME is comprised of both immune and non-immune cells. Immune cells such as T lymphocytes, natural killer (NK) cells, macrophages, and neutrophils reside in the TME and can affect tumorigenesis, disease progression, as well as response to therapy. Given the importance of the immune system, there are many emerging approaches for cancer immunotherapy. We herein provide a review the latest data on immunotherapy for primary HCC and BTC relative to the TME., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Open-ended coaxial probes can be used as tissue characterization devices. However, the technique suffers from a high error rate. To improve this technology, there is a need to decrease the measurement error which is reported to be more than 30% for an in vivo measurement setting. This work investigates the machine learning (ML) algorithms’ ability to decrease the measurement error of open-ended coaxial probe techniques to enable tissue characterization devices. To explore the potential of this technique as a tissue characterization device, performances of multiclass ML algorithms on collected in vivo rat hepatic tissue and phantom dielectric property data were evaluated. Phantoms were used for investigating the potential of proliferating the data set due to difficulty of in vivo data collection from tissues. The dielectric property measurements were collected from 16 rats with hepatic anomalies, 8 rats with healthy hepatic tissues, and in house phantoms. Three ML algorithms, k-nearest neighbors (kNN), logistic regression (LR), and random forests (RF) were used to classify the collected data. The best performance for the classification of hepatic tissues was obtained with 76% accuracy using the LR algorithm. The LR algorithm performed classification with over 98% accuracy within the phantom data and the model generalized to in vivo dielectric property data with 48% accuracy. These findings indicate first, linear models, such as logistic regression, perform better on dielectric property data sets. Second, ML models fitted to the data collected from phantom materials can partly generalize to in vivo dielectric property data due to the discrepancy between dielectric property variability.

Background: The value of ultra-low-activity 2-[ 18 F]-fluoro-2-deoxy-D-glucose ( 18 F-FDG) positron emission tomography (PET) imaging in patients with hepatic malignancies remains unclear., Methods: A cross-sectional study was conducted from April 2019 to May 2021 in Zhongshan Hospital, Fudan University. A total of 49 patients with hepatic malignancies, including hepatocellular carcinoma (HCC) (n=13) or intrahepatic cholangiocarcinoma (ICC) (n=36), underwent 60-min dynamic PET imaging, with 15 undergoing full-activity 18 F-FDG and 34 undergoing ultra-low-activity 18 F-FDG. The kinetic metrics ( K 1 - k ) of tumors were calculated and compared between the activity groups. Another 54 patients (27 each group) with hepatic malignancies, including HCC (n=9), ICC (n=34), and metastases (n=11), underwent static imaging. Image qualities were compared between the groups in terms of 5-point Likert scores (with a score ≥3 fulfilling the clinical requirement), the mean standardized uptake value (SUV 3, and Ki ) of tumors were calculated and compared between the activity groups. Another 54 patients (27 each group) with hepatic malignancies, including HCC (n=9), ICC (n=34), and metastases (n=11), underwent static imaging. Image qualities were compared between the groups in terms of 5-point Likert scores (with a score ≥3 fulfilling the clinical requirement), the mean standardized uptake value (SUV mean ), the standard deviation of standardized uptake value (SUV SD ), and the signal-to-noise ratio (SNR) of the liver; the SUV mean of blood pool and muscle; and the tumor-to-liver ratio (TLR), tumor-to-blood ratio (TBR), and tumor-to-muscle ratio (TMR) of lesions. Intergroup comparisons were performed using Chi-squared test for categorical variables and the Student's t -test or the Mann-Whitney test for continuous variables depending on the normality of variables., Results: There was a nonsignificant difference in the kinetic metrics ( K 1 - k 3 and Ki ) of tumors between the activity groups. In static imaging, 1-min full-activity (F 1 ) and 8-min ultra-low-activity (L 8 ) images obtained image-quality scores >3 and were thus selected for intergroup comparisons. Nonsignificant differences in SUV mean of liver, blood pool, and muscle were identified between F 1 and L 8 images (P=0.641, P=0.542, and P=0.073, respectively) although the liver SNR was slightly higher in F 1 (13.10 vs . 11.31; P=0.003). Lesion detectability was 98.5% and 100% for F 1 and L 8 images, respectively, but there were no significant differences in TLR, TBR, or TMR between the groups., Conclusions: The results of this single-center study indicate that the performance of ultra-low-activity PET imaging is comparable to that of full-activity imaging in patients with hepatic malignancies., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-719/coif). The authors have no conflicts of interest to declare., (2023 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background/purpose The purpose of this study was to determine factors associated with patient and graft survival following orthotopic liver transplantation (OLT) in children and adolescents with primary hepatic malignancies. Methods The United Network for Organ Sharing (UNOS) database was queried for all patients < 18 years old who received an OLT with a primary malignant liver tumor between 1987 and 2012 ( n = 544). Five-year patient and graft survival were determined using Kaplan–Meier methodology, and independent predictors of survival were determined using multivariate Cox proportional hazards model. Results The majority of patients were diagnosed with hepatoblastoma (HB) ( n = 376, 70%) with 84 (15%) hepatocellular carcinoma (HCC) and 84 (15%) other. HCC patients were older, more often hospitalized at the time of transplant, and more likely to receive a cadaveric organ compared to HB patients. Five-year patient and graft survival for the entire cohort was 73% and 74%, respectively, with the majority of deaths owing to malignancy. On multivariate analysis, independent predictors of 5-year patient and graft survival included diagnosis, transplant era, and medical condition at transplant. Conclusions In recent years, there has been significant improvement in posttransplant patient and graft survival for children and adolescents with primary hepatic malignancies. However, patients with HCC continue to have worse outcomes than those with other cancer types. Type of study Case series with no comparison group. Level of evidence IV. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic accuracy of the individual sequences of a clinical routine liver MRI protocol for the detection of local tumour progression after radiofrequency (RF) ablation of hepatic malignancies.Material and Methods: A cohort of 93 patients treated for 140 primary and secondary hepatic malignancies with RF ablation was assembled for this retrospective study. The cohort contained 31 cases of local tumour progression, which occurred 8.3±6.2months (range: 4.0-28.2 months) after treatment. All patients underwent clinical routine follow-up MRI at 1.5T including following sequences: unenhanced T1-weighted fast low angle shot (FLASH-2D), T2-weighted turbo-spin-echo sequence, contrast-enhanced (CE) T1-weighted volume-interpolated breath-hold examination (VIBE), diffusion-weighted imaging (DWI). Follow-up was 32.7±22.5months (range: 4.0-138.3 months). Two readers independently evaluated the individual sequences separately for signs of local tumour progression. Diagnostic confidence was rated on a 4-point scale. Inter-reader agreement was assessed with Coheńs kappa. Long-term follow-up and histological specimen served as standard of reference.Results: Both readers reached the highest sensitivity for detection of local tumour progression with unenhanced T1-FLASH 2D (88.2% and 94.1%, respectively) and the highest specificity with CE T1-VIBE (96.2% and 97.2%, respectively). Highest inter-reader agreement was reached with T1-FLASH-2D (kappa=0.83). Typical pitfalls for false-positive diagnoses were focal cholestasis and vasculature adjacent to the ablation zone. Diagnostic confidence was highest with CE T1-VIBE for reader 1 and DWI for reader 2.Conclusion: Unenhanced T1-FLASH-2D is an essential sequence for follow-up imaging after tumour ablation with a high sensitivity for detection of local progression and a high inter-reader agreement. [ABSTRACT FROM AUTHOR]

Abstract Imaging appearance of cyst-like changes is most frequently described in primary neuroendocrine lesions, especially pancreatic NETs. The imaging finding of a pseudocystic lesion of the liver puts in differential diagnosis many pathologies such as infectious diseases, simple biliary cysts up to biliary cystadenomas and eventually to primary or metastatic malignancies. Primary or metastatic hepatic malignancies with pseudocystic aspects are rare, and a pseudocystic aspect is reported only after neo-adjuvant treatment. Liver metastasis of untreated neuroendocrine tumors are usually solid and, to our knowledge, only two cases of neuroendocrine cystic hepatic metastases of ileal atypical carcinoids have been reported so far. We present a case of a 67 years old man with synchronous finding of an untreated hepatic pseudocystic lesion and an ileal mass histologically diagnosed as a well differentiated (G1) neuroendocrine tumor. [ABSTRACT FROM AUTHOR]

Background: Computed tomographic arterial portography (CTAP) has been an invaluable tool in detecting hepatic tumors for staging patients with hepatic malignancies. This technique is more sensitive than conventional computed tomography (CT) and allows for accurate surgical planning. One of the major drawbacks of CTAP has been the high false-positive rate. Delayed imaging after CTAP helps identify perfusion artifacts, increasing specificity. Using pathologic analysis of the resected specimen as the gold standard, the current study compares the sensitivity and specificity of standard CTAP to those that include a delayed-phase (210 to 240 minutes) imaging. Results: In 60 patients subjected to both phases of imaging and surgical resection of their hepatic colorectal metastases, 139 tumors were found at pathology. One hundred seventy lesions were identified on standard CTAP, with 55 being false-positive. Using delayed imaging, 155 lesions were noted, with 40 being false-positive. Thus, the sensitivity of CTAP remained high with the delayed imaging (83% vs 82% in standard CTAP), whereas the accuracy increased to 74% from 68% (p 5 .01). The positive predictive values were similarly increased (74% vs 68%). Conclusion: Delayed imaging can be easily performed during the observation period after CTAP. Although there is increased radiation exposure, the delayed images increase the specificity of CTAP significantly. We therefore feel that such delayed imaging should be included in the standard evaluation of the patient with hepatic tumors undergoing CTAP. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the usefulness of Sonazoid-enhanced ultrasonography (US) in the diagnosis of hepatic malignancies in comparison with contrast-enhanced CT findings. Methods: A total of 74 patients with 113 hepatic tumors having or highly suspected of having malignancies were enrolled. These hepatic nodules were diagnosed by typical findings of imaging such as contrast-enhanced CT, dynamic MRI or Sonazoid-enhanced US, tumor markers and histological examinations after surgical resection or biopsy. Results: 108 nodules were diagnosed as malignant tumors (hepatocellular carcinoma: n = 90; metastasis: n = 16; intrahepatic cholangiocarcinoma: n = 2) and the remaining five tumors were diagnosed as benign tumors (dysplastic nodules: n = 5). Sonazoid-enhanced US correctly depicted the presence or absence of tumors in 74 patients, with a sensitivity of 95.4%, an accuracy of 94.7%, and a positive predictive rate of 99%. Contrast-enhanced CT depicted the malignancies with a sensitivity of 85.2%, an accuracy of 82.3%, and a positive predictive rate of 95.8%. There were significant differences between Sonazoid-enhanced US and contrast-enhanced CT for sensitivity and accuracy (both p < 0.05). Conclusion: Sonazoid-enhanced US has a higher sensitivity and accuracy for the diagnosis of hepatic malignancies than contrast-enhanced CT. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the safety and feasibility of a real-time integrated system with computed tomography (CT) and sonographic images for radiofrequency (RF) ablation of hepatic malignancies poorly defined on B-mode sonography, and to clarify the suitable phase of CT images for using this virtual sonography. Methods: Between September 2004 and December 2004, 12 patients with 16 hepatocellular carcinomas and two metastatic lesions arising from colorectal adenocarcinoma (n = 1) and rectal carcinoid (n = 1) were treated. The maximum diameter of nodules ranged from 1.0 to 2.5 cm (mean ± SD; 1.5 ± 0.6 cm) on CT images. Results: Complete tumor necrosis was achieved in a single session in 19 lesions (90%), while a second session was required for the remaining two lesions (10%). Portal phase multi-planar reconstruction images were displayed under a suitable position corresponding to the ultrasound images in 9 patients (HCC = 7, metastasis = 2), and arterial phase multi-planar reconstruction images were displayed in the 3 remaining patients with hepatocellular carcinoma. Conclusion: Percutaneous RF ablation guidance using virtual sonography is an effective treatment for patients with hepatic malignancies. The portal phase of CT images may be the most suitable to indicate the 3-dimensional relationship between the liver vasculature and tumors on virtual sonography. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The management of hepatic malignancies, primary or metastatic, is an increasingly common problem in clinical practice. Unfortunately, most patients present with unresectable disease for which there is no universally accepted standard therapy. Radiotherapy is gaining importance in the management of these tumors and in this article we will review the advancements made in this field recently. Increased understanding of the relationship between radiation dose and volume and the risk of radiation-induced liver disease (RILD) has allowed delivery of high-dose focal liver radiation with encouraging results. A recent US phase II trial suggests a radiation dose-dependent improvement in survival when compared to historical controls. Others have reported favorable experience with moderate-dose external-beam radiotherapy, stereotactic hypofractionated radiotherapy, and radiopharmaceuticals. [Copyright &y& Elsevier]

Surgical resection is often the first-line treatment option for primary and select metastatic hepatic malignancies. A minority of patients with hepatocellular carcinoma undergo potentially curative resection. Similarly, patients with liver-only metastasis are candidates for resection less than 15% of the time because of bilobar disease in which resection would sacrifice too great a volume of hepatic parenchyma, tumor proximity to major vascular or biliary structures thus preventing adequate margins, or unfavorable tumor biology. Ablative techniques directed at tumor elimination while minimizing injury to the surrounding functional hepatic parenchyma may be offered to select patients with unresectable cancers. Radiofrequency ablation, percutaneous ethanol injection, transarterial chemoembolization, cryoablation, microwave coagulation, and laser-induced interstitial thermotherapy all offer potential local tumor control and occasionally achieve long-term disease-free survival. This review focuses on the indications, anticipated benefits, and limitations of these ablative techniques. [Copyright &y& Elsevier]

AbstractTo prospectively evaluate the efficacy and safety of Selective Internal Radiation (SIR) Spheres (Sirtex Medical, Sydney, NSW, Australia) in patients with unresectable primary or secondary hepatic malignancies.We report our experience of SIR sphere therapy at three Australian centres. Patients with previously untreated colorectal cancer (CRC) received concurrent 5FU, other patients with CRC received 5-FU at investigator discretion and all other patients received SIR spheres alone.Forty-six patients were enrolled between January 2002 and June 2003. The majority (32 patients) had metastatic colorectal cancer and five patients had hepatocellular carcinoma. The median age of patients was 64 years (range 46–78 years). Forty-three patients were evaluable for response. There were 12 partial responses, of which 10 were in patients with CRC. The median duration of response for all patients was 8.6 months (range 2–21 months). Overall treatment related toxicity was acceptable. Significant late toxicity included four cases of severe gastric ulceration, despite standard work-up and treatment by experienced interventional radiologists.In this series of patients, treatment with SIR-spheres has demonstrated modest activity, mostly observed in patients with CRC. Toxicity was substantial in a small number of patients. (Intern Med J 2005; 35: 222–227) [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA) is increasingly used for the local destruction of unresectable hepatic malignancies. There is little information on its optimal approach or potential complications. Methods: Since late 1997, we have undertaken 91 RFA procedures to ablate 231 unresectable primary or metastatic liver tumors in 84 patients. RFA was performed via celiotomy (n=39), laparoscopy (n=27), or a percutaneous approach (n=25). Patients were followed with spiral computed tomographic (CT) scans at 1 to 2 weeks postprocedure and then every 3 months for 2 years. Results: Intraoperative ultrasound (IOUS) detected intrahepatic disease not evident on the preoperative scans of 25 of 66 patients (38%) undergoing RFA via celiotomy or laparoscopy. In 38 of 84 patients (45%), RFA was combined with resection or cryosurgical ablation (CSA), or both. RFA was used to treat an average of 2.8 lesions per patient, and the median size of treated lesions was 2 cm (range, 0.3–9 cm). The average hospital stay was 3.6 days overall (1.8 days for percutaneous and laparoscopic cases). Ten patients underwent a second RFA procedure (sequential ablations) and, in one case, a third RFA procedure for large (one patient), progressive (seven patients), and/or recurrent (three patients) lesions. Seven (8%) patients had complications: one skin burn; one postoperative hemorrhage; two simple hepatic abscesses; one hepatic abscess associated with diaphragmatic heat necrosis following sequential percutaneous ablations of a large lesion; one postoperative myocardial infarction; and one liver failure. There were three deaths, one (1%) of which was directly related to the RFA procedure. Three of the complications, including one RFA-related death, occurred after percutaneous RFA. At a median follow-up of 9 months (range, 1–27 months), 15 patients (18%) had recurrences at an RFA site, and 36 patients (43%) remained clinically free of disease. Conclusions: Celiotomy or laparoscopic approaches are preferred for RFA because they allow IOUS, which may demonstrate occult hepatic disease. Operative RFA also allows concomitant resection, CSA, or placement of a hepatic artery infusion pump, and isolation of the liver from adjacent organs. Percutaneous RFA should be reserved for patients at high risk for anesthesia, those with recurrent or progressive lesions, and those with smaller lesions sufficiently isolated from adjacent organs. Complications may be minimized when these approaches are applied selectively. [ABSTRACT FROM AUTHOR]

The incidence of implantable arterial post-related bloodstream infections (IAP-RBSI) among patients with unresectable hepatic malignancies is not well defined. We reviewed the 9-year incidence of implantable arterial post-related bloodstream infections in patients with hepatic malignancies, at a tertiary care center in Japan. The incidence was 1.9 infections per 10,000 catheter-days. [Copyright &y& Elsevier]

Background/purpose: The purpose of this study was to determine factors associated with patient and graft survival following orthotopic liver transplantation (OLT) in children and adolescents with primary hepatic malignancies., Methods: The United Network for Organ Sharing (UNOS) database was queried for all patients <18years old who received an OLT with a primary malignant liver tumor between 1987 and 2012 (n=544). Five-year patient and graft survival were determined using Kaplan-Meier methodology, and independent predictors of survival were determined using multivariate Cox proportional hazards model., Results: The majority of patients were diagnosed with hepatoblastoma (HB) (n=376, 70%) with 84 (15%) hepatocellular carcinoma (HCC) and 84 (15%) other. HCC patients were older, more often hospitalized at the time of transplant, and more likely to receive a cadaveric organ compared to HB patients. Five-year patient and graft survival for the entire cohort was 73% and 74%, respectively, with the majority of deaths owing to malignancy. On multivariate analysis, independent predictors of 5-year patient and graft survival included diagnosis, transplant era, and medical condition at transplant., Conclusions: In recent years, there has been significant improvement in posttransplant patient and graft survival for children and adolescents with primary hepatic malignancies. However, patients with HCC continue to have worse outcomes than those with other cancer types., Type of Study: Case series with no comparison group., Level of Evidence: IV., (Published by Elsevier Inc.)