Primary liver cancer is the sixth most common malignancy and the third leading cause of cancer-related death worldwide, and hepatocellular carcinoma (HCC) constitutes the majority of primary liver cancer cases. The Liver Imaging Reporting and Data System (LI-RADS) was introduced to standardize the lexicon, acquisition, interpretation, reporting, and data collection of imaging results in patients at increased risk for HCC. LI-RADS allows effective categorization of focal liver lesions, and has been applied in the full clinical spectrum of HCC from diagnosis, biological behavior characterization, prognosis prediction, to treatment response assessment. This review aimed to summarize the recent applications of CT/MRI LI-RADS in the diagnosis, biological behavior characterization and prognosis prediction of HCC, discuss current challenges and shed light on potential future directions.
Objective To discuss the CT imaging differences between hepatic neuroendocrine neoplasms (NENs) and hepatocellular carcinoma (HCC). Methods The clinical and CT data of 42 patients with hepatic NENs (hepatic NENs group) and 49 patients with HCC (HCC group), who were confirmed by pathology in the West China Hospital of Sichuan University from June 2011 to June 2016, were collected and analyzed retrospectively. This study was based on whether the lesions were larger than 3 cm or not, then CT findings of hepatic NENs patients and HCC patients in different stratification were compared. Results When the lesions were less than 3 cm, the location, contour, and enhancement patterns in the portal vein phase of the tumor had significant differences between the hepatic NENs group and the HCC group (P<0.05), multiple liver lesions, the round shape, and prolonged enhancement in the portal vein phase were more often seen in the hepatic NENs group, but there was no significant on diameter of tumor, boundary of lesion, pseudocapsules, scan density, hypervascularity, enhancement degree in arterial phase, enhancement patterns in arterial phase, daughter foci at liver, retraction, neoplastic artery, arteriovenous invaded, portal vein tumor thrombus, diameter of lymph node, and enhancement degree of lymph node between the 2 groups (P>0.05). And when the lesions were greater than or equal to 3 cm, the location, contour, enhancement patterns in the portal vein phase of the tumor, pseudocapsule, neoplastic artery, and arteriovenous invaded had significant differences between the hepatic NENs group and the HCC group (P<0.05), these CT images were often seen in the hepatic NENs group, such as multiple liver lesions, the lobulated shape, the portal venous phase continuous strengthening, no pseudocapsule, no neoplastic artery, and no arteriovenous invaded, but there was no significant difference on the diameter of tumor, boundary of lesion, scan density, hypervascularity, enhancement degree in arterial phase, enhancement patterns in arterial phase, daughter foci at liver, retraction, portal vein tumor thrombus, diameter of lymph node, and enhancement degree of lymph node between the2 groups (P>0.05). Conclusions No matter whether the lesions’ size are larger than 3 cm or not, the location, contour, and enhancement patterns in the portal vein phase could help for differentiating hepatic NENs from HCC. When the lessions are larger than 3 cm, pseudocapsule, neoplastic artery, and arteriovenous invaded may be useful to differentiate.
This article presented readers with typical enhanced CT and MR images of a patient with epithelioid hemangioendothelioma, and briefly described the pathological mechanisms behind the typical imaging signs, in order to enhance the readers’ understanding and awareness of the typical imaging signs of this rare disease, and thus reduce its underdiagnosis rate and misdiagnosis rate.
Hepatic sinusoidal obstruction syndrome (HSOS) can be easily missed or misdiagnosed as Budd-Chiari syndrome in clinical practice. The authors displayed the imaging pictures of one patient with HSOS and made a brief description of typical imaging features, underlying pathophysiological mechanisms, and differential diagnosis of HSOS, with the hope of improving the understanding of HSOS and reducing the rates of leak diagnosis or misdiagnosis.
Fibropolycystic liver diseases (FLDs) is a rare genetic disorder, including bile duct hamartomas, congenital hepatic fibrosis, polycystic liver disease, Caroli’s disease, and choledochal cysts. Fibropolycystic liver diseases has received little clinical attention and exhibits a variety of imaging manifestations, leading to a high likelihood of missed diagnosis and misdiagnosis. Through this case, we delineate the characteristic imaging manifestations of the disease and its underlying pathological mechanisms. Our objective is to enhance readers' comprehension of the disease and thereby reduce the rate of missed diagnosis and misdiagnosis of the disease.
With the development and popularization of imaging technology, the discovery of gallbladder lesions has become common, among which non-neoplastic lesions (such as gallbladder stones, cholecystitis, gallbladder polyps, gallbladder adenomyosis, etc.) are common but sometimes the imaging manifestations are not specific, and there are many kinds of such diseases, so accurate imaging diagnosis is still quite challenging. Familiarity and understanding of the typical imaging manifestations of these diseases will help to improve the early and accurate diagnosis and help to distinguish them from gallbladder malignant diseases, which is of great significance to the diagnosis, guiding treatment and prognosis of patients.
Lymphoma originating in the liver is rare and few clinical cases had been reported. The imaging manifestations of primary hepatic lymphoma (PHL) were lack of specificity and diverse. The authors displayed the CT and MRI images of one patient with diffuse infiltrating PHL and made a brief description of imaging features, underlying pathophysiological mechanisms, and differential diagnoses of PHL, with the hope of strengthening the understanding of PHL for clinicians and radiologists.
ObjectiveTo investigate the CT presenting rate and features of gastric bare area (GBA, including the area posterior to GBA and the adipose tissue in the gastrophrenic ligament) without pathologic changes.MethodsThirty cases with superior peritoneal ascites, but without pathological involvement of GBA were included into the study to show the normal condition of GBA, including the presenting rate and CT features. We selected some cases with GBA invasion by inflammation or neoplasm to observe their CT features. ResultsAll cases with superior peritoneal ascites showed the GBA against the contrast of ascites with the presenting rate of 100%. The GBA appeared at the level of gastricesophageal conjunction and completely disappeared at the level of hepatoduodenal ligament and Winslow’s foramen. The maximum scope of GBA presented at the level of the sagital part of the left portal vein with mean right to left distance of （4.39±0.08）cm (3.8~5.7 cm) (distance between the left and right layer of the gastrophrenic ligament). In acute pancreatitis, the width of GBA increased, in which local hypodensity area could be seen. In gastric leiomyosarcoma invading GBA, the mass could not separate from the crus of the diaphragm. In lymphoma and metastasis invading GBA, the thickness of GBA increased and the density was heterogeneous, in which lymph nodes presenting as small nodes or fused mass. ConclusionThe results of this study show that it is helpful to use contrast enhanced spiral CT scanning to observe the change of GBA and to diagnose retroperitoneal abnormalities that involving GBA comprehensively and accurately.
【Abstract】Objective To investigate the appropriate reconstruction techniques of multidetectorrow spiral CT angiography (MDCTA) to depict the collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC). Methods MDCTA scanning was performed during the portal venous phase after intravenous contrast materials in 18 HCC patients with CTPV induced by tumor thrombosis. Raw data were reconstructed with thin slice thickness followed by 2D and 3D angiographic reconstruction methods, including maximum intensity projection(MIP), shade surface display （SSD） and volume rendering technique(VRT). Results MDCTA with MIP reconstruction accurately depicted both the tumor thrombus within the portal vein and the collateral vessels of CTPV including the biliary (cystic vein and pericholedochal veinous plexus) and the gastric (left and right gastric veins) branches. However, VRT and SSD methods did poorly in showing the tumor thrombus and the collateral vessels. Conclusion MDCTA with MIP reconstruction is the method of choice to evaluate the collateral vessels of CTPV.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.