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To prospectively assess the frequency of severe abdominal pain during and after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) using the visual analog scale (VAS), and to identify predictive factors.Ninety-eight TACE performed in 80 patients (mean 65 ± 12 years old, 60 men) were consecutively and prospectively included. Abdominal pain was considered severe if the VAS ≥ 30/100 after treatment administration, or if opioid analgesic (grades 2-3) intake was required during hospitalization. Patient and tumor characteristics as well as technical factors associated with severe pain were identified by binary logistic regression.The criterion for severe pain was met in 41/98 (42%) of procedures (peri-procedural pain 30/98 [31%] and opioid consumption during hospitalization 24/98 [25%]). Multivariate analysis identified age (odds ratio [OR] = 0.943 (95% confidence interval 0.895-0.994), p = 0.029), cirrhosis (OR = 0.284 (0.083-0.971), p = 0.045), and alcoholic liver disease (OR = 0.081 (0.010-0.659), p = 0.019) as negative predictive factors of severe abdominal pain. Severe abdominal pain occurred in or after 1/13 (8%), 8/34 (24%), 22/41 (54%), and 10/10 (100%) TACE sessions when none, one, two, and three of the protective factors were absent, respectively (p 0.001). The area under the ROC curve of the combination of factors for the prediction of severe abdominal pain was 0.779 (CI 0.687-0.871).Severe abdominal pain was frequent during and after TACE revealing a clinically relevant and underestimated problem. A predictive model based on three readily available clinical variables suggests that young patients without alcoholic liver disease or cirrhosis could benefit from reinforced analgesia.• Severe abdominal pain occurs in 43% of TACE for HCC. • Younger age, absence of cirrhosis, and absence of alcoholic liver disease were identified as independent predictive factors of severe abdominal pain. • A simple combination of the three abovementioned features helped predict the occurrence of severe abdominal pain.

Purpose The purpose of this study was to compare the diagnostic accuracy and inter-reader agreement of unenhanced computed tomography (CT) to those of contrast-enhanced CT for triage of patients older than 75 years admitted to emergency department (ED) with acute abdominal pain (AAP). Patients and methods Two hundred and eight consecutive patients presenting with AAP to the ED who underwent CT with unenhanced and contrast-enhanced images were retrospectively included. There were 90 men and 118 women with a mean age of 85.4 ± 4.9 (SD) (range: 75–101.4 years). Three readers reviewed unenhanced CT images first, and then unenhanced and contrast-enhanced CT images as a single set. Diagnostic accuracy was compared to the standard of reference defined as the final diagnosis obtained after complete clinico-biological and radiological evaluation. Correctness of the working diagnosis proposed by the ED physician was evaluated. Intra- and inter-reader agreements were calculated using the kappa test and interclass correlation. Subgroup analyses were performed for patients requiring only conservative management and for those requiring intervention. Results Diagnostic accuracy ranged from 64% (95% CI: 62–66%) to 68% (95% CI: 66–70%) for unenhanced CT, and from 68% (95% CI: 66–70%) to 71% (95% CI: 69–73%) for both unenhanced and contrast-enhanced CT. Contrast-enhanced CT did not significantly improve the diagnostic accuracy (P = 0.973–0.979). CT corrected the working diagnosis proposed by the ED physician in 59.1% (range: 58.1–60.0%) and 61.2% (range: 57.6–65.5%) of patients before and after contrast injection (P > 0.05). Intra-observer agreement was moderate to substantial (k = 0.513–0.711). Inter-reader agreement was substantial for unenhanced (kappa = 0.745–0.789) and combined unenhanced and contrast-enhanced CT (kappa = 0.745–0.799). Results were similar in subgroup analyses. Conclusion Unenhanced CT alone is accurate and associated with high degrees of inter-reader agreement for clinical triage of patients older than 75 years with AAP in the emergency setting.

Resume L’objectif de l’imagerie est la detection precoce de l’adenocarcinome pancreatique, afin de permettre une chirurgie curative. L’identification de lesions dysplasiques avant la transformation en grade eleve est encore preferable. Deux formes sont desormais connues : les neoplasies intra-epitheliales pancreatiques (pancreatic intraepithelial neoplasia [PanIN]) et les tumeurs intracanalaires papillaires et mucineuses du pancreas (TIPMP). Afin de detecter ces lesions a l’imagerie, nous devons connaitre leur aspect. Un programme de depistage peut ensuite etre utilise pour les mettre en evidence. Ce programme ne peut materiellement pas etre applique a la population globale. Aussi, l’identification des patients presentant un risque accru d’adenocarcinome du pancreas constitue la premiere etape de ce depistage.

Background & Aims Post-procedural pain is frequent after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), and is only partially prevented by treatment selectivity. Our aim was to determine the risk factors of severe pain after selective TACE for HCC. Methods From January 2012 to June 2014, all treatment-naive patients undergoing a first selective TACE were included. Risk factors for severe pain, that is, the need for opioid analgesics (grade II–III), were identified by uni- and multivariate analysis. Internal validation of a logistic regression model for prediction of opioid intake was done with bootstrapping. Results We analysed 335 tumours (mean 47 ± 37 mm) in 159 patients (131 men), mean 63.4 years old (20–92). Twenty-seven patients (17%) requested opioids. In univariate analysis, opioid intake was associated with young age (P=.021), doxorubicin dose received (P=.031), large HCC (P=.038), absence of chronic liver disease (P

Image-guided thermal ablation is a well-established locoregional technique for the treatment of hepatocellular carcinoma (HCC). HCC surveillance programs have led to an increase in the number of patients diagnosed at an early stage of the disease who are eligible for thermal ablation. Tumor response is assessed on imaging and requires extensive follow-up; thus, radiologists play a key role in defining the technical success and efficacy of treatment as well as identifying progressive disease. Although they are rare, complications, such as secondary infections, must also be identified. Several contrast-enhanced imaging techniques can be used at different postprocedural timepoints but magnetic resonance imaging (MRI) and computed tomography (CT), which allow both liver-centered and whole-body imaging are the cornerstones of follow-up. This review describes the imaging features of HCC following thermal ablation. After describing the basic technical elements of follow-up imaging, imaging findings are divided into three groups: normal and expected features (the good), abnormal features, uncontrolled disease, and complications (the bad), and atypical or rare presentations (the ugly). J. Magn. Reson. Imaging 2016;44:1070-1090.

Liver cysts and abcesses. Liver cysts are common lesions and present in around 5% of the population. Their diagnosis is based on clinical presentation and imaging, mostly ultrasound and computed-tomography- scan. Magnetic resonance imaging and contrast-enhanced ultrasound are useful in order to characterize complex or atypical cystic lesions. The simple hepatic cyst is the most common lesion; it is always benign and is usually asymptomatic. It does justify neither monitoring nor treatment. The other cystic lesions of the liver are of infectious origin: the hydatid disease, caused by Echinococcus and frequent in endemic areas, and hepatic abscesses that include pyogenic and amebic abscesses. Other rare cystic lesions include mucinous cystic lesions, which have vascularized solid components and are potentially malignant, and cystic metastases. Overall, less than 5% of cystic liver lesions are malignant.Kystes et abcès hépatiques. Les lésions kystiques hépatiques sont fréquentes, observées dans environ 5 % de la population générale. Leur diagnostic repose sur la présentation clinique et leur caractérisation est principalement faite par échographie et tomodensitométrie injectée. Pour identifier les lésions kystiques hépatiques complexes ou atypiques, l’imagerie par résonance magnétique et plus récemment l’échographie de contraste peuvent être utiles. Le kyste biliaire, toujours bénin, est de loin la lésion la plus fréquente. Généralement asymptomatique, il ne nécessite pas de traitement ni de surveillance. Les autres lésions kystiques hépatiques sont représentées par les étiologies infectieuses : le kyste hydatique, d’origine parasitaire, assez fréquent surtout dans les régions d’endémie, et les abcès hépatiques, regroupant les abcès à pyogènes et les abcès amibiens. Très rarement, il s’agit de tumeurs kystiques mucineuses ayant des parois et des végétations vascularisées et pouvant dégénérer, ou de métastases kystiques. Au total, moins de 5 % des lésions kystiques hépatiques sont des tumeurs malignes.

Liver diseases have been known to induce changes in systemic hemodynamics and to modify the liver-heart-lung balance. Severe or chronic liver disease may result in several heart or pulmonary complications independently of any other existing cardiac or lung disease. The main liver diseases causing

Changes in the expression of hepatocyte membrane transporters in advanced fibrosis decrease the hepatic transport function of organic anions. The aim of our study was to assess if these changes can be evaluated with pharmacokinetic analysis of the hepatobiliary transport of the MR contrast agent gadoxetate. Dynamic gadoxetate-enhanced MRI was performed in 17 rats with advanced fibrosis and 8 normal rats. After deconvolution, hepatocyte three-compartmental analysis was performed to calculate the hepatocyte influx, biliary efflux and sinusoidal backflux rates. The expression of Oatp1a1, Mrp2 and Mrp3 organic anion membrane transporters was assessed with reverse transcription polymerase chain reaction. In the rats with advanced fibrosis, the influx and efflux rates of gadoxetate decreased and the backflux rate increased significantly (p = 0.003, 0.041 and 0.010, respectively). Significant correlations were found between influx and Oatp1a1 expression (r = 0.78, p

The liver is rarely involved in female genital diseases or pregnancy. Peripheral hepatic and perihepatic lesions are mainly due to the progression of genital malignancies, usually ovarian cancer. It should be distinguished from other malignant and non-malignant lesions. In all clinical situations, liver involvement is a sign of distant extension or dissemination of female genital diseases. Therefore, accurate detection and characterization of hepatic and perihepatic involvement on imaging is of clinical importance and often changes patient management.

Resume L’imagerie de perfusion hepatique est une modalite d’etude quantitative et fonctionnelle. La difficulte, dans le cas du foie, vient de son double apport vasculaire, des artefacts lies aux mouvements respiratoires et aux capillaires sinusoides fenetres laissant diffuser le traceur. On peut etudier la perfusion hepatique en echographie, scanner ou IRM et chaque technique presente limites et specificites. Les grandes indications en hepatologie sont l’oncologie (detection, caracterisation et reponse tumorale) et l’exploration non invasive des maladies hepatiques chroniques. Des efforts de standardisation sont necessaires concernant les modalites d’acquisition et la modelisation pour permettre une diffusion des resultats et une utilisation plus large.

Liver perfusion imaging is a quantitative functional investigation. Liver perfusion imaging is complicated because of the liver's dual vascular supply, artefacts due to respiratory movements and the fenestrated sinusoidal capillaries which allow the contrast medium to diffuse out. Liver perfusion can be examined by ultrasound, CT or MRI: each technique has its limitations and specific features. The major indications in hepatology are oncology (detection, characterization and tumor response) and non-invasive investigation of patients with chronic liver disease. Work is needed to standardize acquisition and modeling methods to allow wider use of results and more widespread use of the technique.

Background Visual semi-quantitative assessment of liver tumour burden for neuroendocrine tumour liver metastases is often used in patient management and outcome. However, published data on the reproducibility of these evaluations are lacking. Objective The aim of this study was to evaluate the interobserver and intraobserver agreement of a visual semi-quantitative assessment of liver tumour burden using CT scan. Methods Fifty consecutive patients (24 men and 26 women, mean aged 54 years) were retrospectively reviewed by four readers (two senior radiologists, one junior radiologist and one gastroenterologist) who assessed the liver tumour burden based on a visual semi-quantitative method with four classes (0–10, 11–25, 26–50 and ≥50%). Interobserver and intraobserver agreement were assessed by weighted kappa coefficient and percentage of agreement. The intraclass correlation was calculated. Results Agreement among the four observers for the evaluation of liver tumour burden was substantial, ranging from 0.62 to 0.73 (P P Conclusion Reproducibility of the visual semi-quantitative evaluation of liver tumour burden is good and is independent of the level of experience of the readers. We therefore suggest that clinical studies in patients with neuroendocrine liver metastases use this method to categorise liver tumour burden.

Early detection of pancreatic adenocarcinoma is the goal of imaging, enabling curative surgery. The identification of high-grade dysplastic precursor lesions is even more beneficial. Two forms are now better known: pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). To detect these lesions with imaging, we need to know the patterns associated with them. A screening program could then be used to pinpoint them. This program could not be applied to the entire population. Identifying patients with an increased risk of pancreas adenocarcinoma is the first step of such screening.

Despite various sophisticated imaging techniques, there are numerous pitfalls in liver imaging. This review for residents discusses the major traps in image interpretation and gives some diagnostic clues to confidently interpret computed tomographic or magnetic resonance imaging studies.

Cone beam computed tomography (CBCT) is an imaging modality that provides computed tomographic images using a rotational C-arm equipped with a flat panel detector as part of the Angiography suite. The aim of this technique is to provide additional information to conventional 2D imaging to improve the performance of interventional liver oncology procedures (intraarterial treatments such as chemoembolization or selective internal radiation therapy, and percutaneous tumor ablation). CBCT provides accurate tumor detection and targeting, periprocedural guidance, and post-procedural evaluation of treatment success. This technique can be performed during intraarterial or intravenous contrast agent administration with various acquisition protocols to highlight liver tumors, liver vessels, or the liver parenchyma. The purpose of this review is to present an extensive overview of published data on CBCT in interventional oncology of the liver, for both percutaneous ablation and intraarterial procedures.

International audience; To compare the value of enhancement and pharmacokinetic parameters measured at dynamic gadoxetate-enhanced magnetic resonance (MR) imaging in determining hepatic organic anion transporter expression in control rats and rats with advanced liver fibrosis.Institutional animal review board approval was received before the study began. Advanced liver fibrosis was created in rats by means of carbon tetrachloride injections over an 8-week period. In 17 rats with liver fibrosis and eight control rats, dynamic gadoxetate-enhanced MR images of the liver were obtained during 1 hour after injection of 0.025 mmol gadoxetate per kilogram of body weight. Enhancement parameters (maximum enhancement [Emax], time to peak [Tmax], and elimination half-life) were measured on enhancement-versus-time curves, and pharmacokinetic parameters (hepatic extraction fraction [HEF] and mean residence time [MRT]) were obtained by means of deconvolution analysis of the concentration-versus-time curves in the liver and the portal vein. The parameters were correlated at simple and multiple regression analysis with the expression of the hepatic anion uptake transporter organic anion-transporting polypeptide 1A1 (Oatp1a1), the hepatobiliary transporter multidrug resistance–associated protein 2 (Mrp2), and the backflux transporter Mrp4, as determined with reverse transcription polymerase chain reaction.In rats with advanced liver fibrosis, the Emax, Tmax, HEF, and MRT decreased significantly relative to those in control rats, whereas the elimination half-life increased significantly. The enhancement and pharmacokinetic parameters correlated significantly with the expression of the transporters at simple regression analysis. At multiple regression analysis, HEF was the only parameter that was significantly associated with the expression of Oatp1a1 and Mrp2 (P < .001, r = 0.74 and P < .001, r = 0.70, respectively).The pharmacokinetic parameter HEF at dynamic gadoxetate-enhanced MR imaging is independently correlated with hepatic organic anion transporter expression.

Our objective was to determine the diagnostic accuracy of a free-breathing diffusion-weighted single-shot echo-planar magnetic resonance imaging (FBDW-SSEPI) technique with parallel imaging and high diffusion factor value (b = 1000 s/mm2) in the detection of primary rectal adenocarcinomas. Thirty-one patients (14M and 17F; mean age 67 years) with histopathologically proven primary rectal adenocarcinomas and 31 patients without rectal malignancies (14M and 17F; mean age 63.6 years) were examined with FBDW-SSEPI (repetition time (TR/echo time (TE) 3900/91 ms, gradient strength 45 mT/m, acquisition time 2 min) at 1.5 T using generalized autocalibrating partially parallel acquisitions (GRAPPA, acceleration factor 2) and a b value of 1000 s/mm2. Apparent diffusion coefficients (ADCs) of rectal adenocarcinomas and normal rectal wall were measured. FBDW-SSEPI images were evaluated for tumour detection by 2 readers. Sensitivity, specificity, accuracy and Youden score for rectal adenocarcinoma detection were calculated with their 95% confidence intervals (CI) for ADC value measurement and visual image analysis. Rectal adenocarcinomas had significantly lower ADCs (mean 1.036 x 10(-3)+/- 0.107 x 10(-3) mm2/s; median 1.015 x 10(-3) mm2/s; range (0.827-1.239) x 10(-3) mm2/s) compared with the rectal wall of control subjects (mean 1.387 x 10(-3)+/- 0.106 x 10(-3) mm2/s; median 1.385 x 10(-3) mm2/s; range (1.176-1.612) x 10(-3) mm2/s) (p < 0.0001). Using a threshold value < or = 1.240 x 10(-3) mm2/s, all rectal adenocarcinomas were correctly categorized and 100% sensitivity (31/31; 95% CI 95-100%), 94% specificity (31/33; 95% CI 88-100%), 97% accuracy (60/62; 95% CI 92-100%) and Youden index 0.94 were obtained for the diagnosis of rectal adenocarcinoma. FBDW-SSEPI image analysis allowed depiction of all rectal adenocarcinomas but resulted in 2 false-positive findings, yielding 100% sensitivity (31/31; 95% CI 95-100%), 94% specificity (31/33; 95% CI 88-100%), 97% accuracy (60/62; 95% CI 92-100%) and Youden index 0.94 for the diagnosis of primary rectal adenocarcinoma. We can conclude that FBDW-SSEPI using parallel imaging and high b value may be helpful in the detection of primary rectal adenocarcinomas.