Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma

Abstract Background Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide, and if left untreated, one of the most lethal. Ablative therapies including radiofrequency ablation (RFA) play increasingly important role for patients with liver tumors who are not surgical candidates. Monitoring treatment response following ablation is crucial in oncologic imaging. Dynamic contrast-enhanced MRI can assess changes in tumor vascularity and perfusion while subtraction imaging is useful in differentiating residual tumor from post-ablation parenchymal changes. The aim of this study is to compare the role of subtraction MRI and conventional dynamic MRI in assessing treatment response following RFA in patients with HCC. Results The study included 48 patients with 62 HCC lesions who underwent RFA from May to October 2020, followed by MRI evaluation with 1-month interval. Two readers with experience in hepatic imaging interpreted the dynamic and subtraction dynamic MRI. The hepatic focal lesions were classified into “well-ablated” and “residual” groups according to MRI findings, and the agreement between the two readers was evaluated. Using dynamic MRI, the first reader reported 38 well-ablated lesions, and the second reader agreed in 34 of them (89.5%). Residual disease was reported by the first reader in 22 lesions and the second reader disagreed in 10 of them (45.5%) where complete ablation was reported. Thirty-eight out 44 well-ablated lesions (86.4%) showed high signal intensity on non-enhanced T1 images, and 28 lesion (63.6%) showed intermediate T2 signal. All the mis-matched readings occurred in lesions with a high signal intensity in pre-contrast T1 images. Moderate agreement between the two readers was found with Kappa value of 0.467. Significant additive value of subtraction technique to dynamic MRI was detected with a P value of 0.009. No major complications recorded except for a single case of major portal vein branch occlusion. Conclusion MRI is a powerful imaging tool in assessing tumor viability and complications after RFA in patients with HCC. Dynamic MRI study is the gold standard in detecting recurrent lesions while subtraction technique is crucial in differentiating between arterial enhancement due to residual disease and normal hyperintense T1 signal of the ablation zone.

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Paradoxical high signal intensity of hepatocellular carcinoma in the hepatobiliary phase of Gd-EOB-DTPA enhanced MRI: initial experience

Magnetic Resonance Imaging ◽

10.1016/j.mri.2010.07.019 ◽

2011 ◽

Vol 29 (1) ◽

pp. 83-90 ◽

Cited By ~ 35

Author(s):

Seun Ah Lee ◽

Chang Hee Lee ◽

Woon Yong Jung ◽

Jongmee Lee ◽

Jae Woong Choi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Signal Intensity ◽

High Signal Intensity ◽

High Signal ◽

Hepatobiliary Phase ◽

Initial Experience ◽

Enhanced Mri

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High-signal-intensity MR Image in the Hepatobiliary Phase Predicts Long-term Survival in Patients With Hepatocellular Carcinoma

Anticancer Research ◽

10.21873/anticanres.13583 ◽

2019 ◽

Vol 39 (8) ◽

pp. 4219-4225

Author(s):

SHUN-ICHI ARIIZUMI ◽

DAISUKE BAN ◽

YUTA ABE ◽

TAKAFUMI KUMAMOTO ◽

SATOSHI KOIZUMI ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Signal Intensity ◽

High Signal Intensity ◽

High Signal ◽

Hepatobiliary Phase ◽

Mr Image ◽

Term Survival ◽

Long Term Survival

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A Case of Hepatic Angiomyolipoma Which Was Misdiagnosed as Hepatocellular Carcinoma in a Hepatitis B Carrier

Case Reports in Hepatology ◽

10.1155/2012/606108 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

Jin Yeon Hwang ◽

Sung Wook Lee ◽

Yang Hyun Baek ◽

Jong Han Kim ◽

Ha Yeon Kim ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis B ◽

Signal Intensity ◽

Hepatic Tumor ◽

High Signal Intensity ◽

Arterial Phase ◽

High Signal ◽

Hepatic Angiomyolipoma ◽

Phase Images ◽

Hepatitis B Carrier

We report a rare case of resected hepatic AML, which was misdiagnosed as hepatocellular carcinoma in a chronic hepatitis B carrier. A 45-year-old woman who was a carrier of hepatitis B virus infection presented with a hepatic tumor. Her serum alpha-fetoprotein level was normal. Ultrasonography revealed a round and well-circumscribed echogenic hepatic tumor measuring 2.5 cm in the segment VI. On contrast-enhanced computed tomography, a hypervascular tumor was observed in the arterial phase and washing-out of the contrast medium in the portal phase and delayed phase. On MR T1-weighted in-phase images, the mass showed low signal intensity, and on out-of-phase images, the mass showed signal drop and dark signal intensity. On MR T2-weighted images, the mass showed high signal intensity. The mass demonstrated high signal intensity on arterial phase after contrast injection, suggestive of hepatocellular carcinoma. The patient underwent hepatic wedge resection and histopathological diagnosis was a hepatic angiomyolipoma.

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The joint involvement in adult onset Still's disease is characterised by a peculiar magnetic resonance imaging and a specific transcriptomic profile

Scientific Reports ◽

10.1038/s41598-021-91613-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Piero Ruscitti ◽

Antonio Barile ◽

Onorina Berardicurti ◽

Sonia Iafrate ◽

Paola Di Benedetto ◽

...

Keyword(s):

Signal Intensity ◽

Clinical Characteristics ◽

High Signal Intensity ◽

Adult Onset Still’S Disease ◽

Joint Involvement ◽

High Signal ◽

Bone Erosions ◽

Transcriptomic Profile ◽

Synovial Tissues ◽

Bone Oedema

AbstractAdult onset Still's disease (AOSD) is a rare systemic autoinflammatory disease, characterised by fever, arthritis, and skin rash, and joint involvement is one of its clinical manifestations. The aims of this work were to assess joint involvement, to describe main patterns of involvement, and associated clinical characteristics. In this work, we aimed at assessing the joint involvement in AOSD by using MRI, to describe main patterns and associated clinical characteristics. In addition, we aimed at assessing the global transcriptomic profile of synovial tissues in AOSD to elucidate possible pathogenic pathways involved. We also evaluated the global transcriptomic profile of synovial tissues to elucidate possible pathogenic pathways involved in the disease. Thus, AOSD patients, who underwent to MRI exam on joints, were assessed to describe patterns of joint involvement and associated clinical characteristics. Some synovial tissues were collected for RNA-sequencing purposes. The most common MRI finding was the presence of synovitis on 60.5%, mainly in peripheral affected joints, with low to intermediate signal intensity on T1-weighted images and intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. Bone oedema and MRI-bone erosions were reported on 34.9% and 25.6% MRI exams, respectively. Patients with MRI-bone erosions showed a higher prevalence of splenomegaly, a more frequent chronic disease course, lower levels of erythrocyte sedimentation rate, and ferritin. In AOSD synovial tissues, a hyper-expression of interleukin (IL)-1, IL-6, and TNF pathways was shown together with ferritin genes. In conclusion, in AOSD patients, the most common MRI-finding was the presence of synovitis, characterised by intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. MRI-bone erosions and bone oedema were also observed. In AOSD synovial tissues, IL-1, IL-6, and TNF pathways together with ferritin genes resulted to be hyper-expressed.

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