Research

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13 pages, 2122 KiB

Open AccessArticle

Liver-Specific Contrast-Enhanced Magnetic Resonance Cholangio-Pancreatography (Ce-MRCP) in Non-Invasive Diagnosis of Iatrogenic Biliary Leakage

by Renato Argirò, Bruno Sensi, Leandro Siragusa, Luigi Bellini, Luigi Edoardo Conte, Camilla Riccetti, Giovanna Del Vecchio Blanco, Edoardo Troncone, Roberto Floris, Mike Salavracos, Giuseppe Tisone and Alessandro Anselmo

Diagnostics 2023, 13(10), 1681; https://doi.org/10.3390/diagnostics13101681 - 09 May 2023

Cited by 2 | Viewed by 1301

Abstract

Current non-invasive diagnostic modalities of iatrogenic bile leak (BL) are not particularly sensitive and often fail to localise the BL origin. Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) are considered the gold standard, yet are invasive studies with potential complications. Ce-MRCP [...] Read more.

Current non-invasive diagnostic modalities of iatrogenic bile leak (BL) are not particularly sensitive and often fail to localise the BL origin. Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) are considered the gold standard, yet are invasive studies with potential complications. Ce-MRCP has been not comprehensively studied in this setting but may prove particularly helpful given its non-invasive nature and the anatomical dynamic detail. This paper reports a monocentric retrospective study of BL patients referred between January 2018 and November 2022 submitted to Ce-MRCP followed by PTC. The primary outcome was the accuracy of Ce-MRCP in detecting and localising BL compared to PTC and ERCP. Blood tests, coexisting cholangitis features and time for leak resolution were also investigated. Thirty-nine patients were included. Liver-specific contrast-enhanced MRCP detected BL in 69% of cases. The BL localisation was 100% accurate. Total bilirubin above 4 mg/dL was significantly associated with false negative results of Ce-MRCP. Ce-MRCP is highly accurate in detecting and localising BL, but sensitivity is significantly reduced by a high bilirubin level. Ce-MRCP may be very useful in early BL diagnosis and in accurate pre-treatment planning, but can only be reliably used in selected patients with TB < 4 mg/dL. Non-surgical techniques, both radiological and endoscopic, are proven to be effective in terms of leak resolution. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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11 pages, 2965 KiB

Open AccessArticle

Precision Mapping of Intrahepatic Biliary Anatomy and Its Anatomical Variants Having a Normal Liver Using 2D and 3D MRCP

by Jehan A. Mazroua, Yassir Edrees Almalki, Mohamed Alaa, Sharifa Khalid Alduraibi, Mervat Aboualkheir, Asim S. Aldhilan, Ziyad A. Almushayti, Sameh Abdelaziz Aly and Mohammad Abd Alkhalik Basha

Diagnostics 2023, 13(4), 726; https://doi.org/10.3390/diagnostics13040726 - 14 Feb 2023

Cited by 1 | Viewed by 1364

Abstract

Despite significant advances in hepatobiliary surgery, biliary injury and leakage remain typical postoperative complications. Thus, a precise depiction of the intrahepatic biliary anatomy and anatomical variant is crucial in preoperative evaluation. This study aimed to evaluate the precision of 2D and 3D magnetic [...] Read more.

Despite significant advances in hepatobiliary surgery, biliary injury and leakage remain typical postoperative complications. Thus, a precise depiction of the intrahepatic biliary anatomy and anatomical variant is crucial in preoperative evaluation. This study aimed to evaluate the precision of 2D and 3D magnetic resonance cholangiopancreatography (MRCP) in exact mapping of intrahepatic biliary anatomy and its variants anatomically in subjects with normal liver using intraoperative cholangiography (IOC) as a reference standard. Thirty-five subjects with normal liver activity were imaged via IOC and 3D MRCP. The findings were compared and statistically analyzed. Type I was observed in 23 subjects using IOC and 22 using MRCP. Type II was evident in 4 subjects via IOC and 6 via MRCP. Type III was observed equally by both modalities (4 subjects). Both modalities observed type IV in 3 subjects. The unclassified type was observed in a single subject via IOC and was missed in 3D MRCP. Accurate detection by MRCP of intrahepatic biliary anatomy and its anatomical variants was made in 33 subjects out of 35, with an accuracy of 94.3% and a sensitivity of 100%. In the remaining two subjects, MRCP results provided a false-positive pattern of trifurcation. MRCP competently maps the standard biliary anatomy. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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10 pages, 3205 KiB

Open AccessArticle

Comparison of Conventional Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnostic Accuracy of Staging in Patients with Intrahepatic Cholangiocarcinoma

by Eiko Nishioka, Masakatsu Tsurusaki, Ryohei Kozuki, Sung-Woon Im, Atsushi Kono, Kazuhiro Kitajima, Takamichi Murakami and Kazunari Ishii

Diagnostics 2022, 12(11), 2889; https://doi.org/10.3390/diagnostics12112889 - 21 Nov 2022

Cited by 4 | Viewed by 1267

Abstract

We aimed to examine the accuracy of tumor staging of intrahepatic cholangiocarcinoma (ICC) by using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT). From January 2001 to December 2021, 202 patients underwent PET-CT, CT, and MRI for the initial staging of ICC in two [...] Read more.

We aimed to examine the accuracy of tumor staging of intrahepatic cholangiocarcinoma (ICC) by using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT). From January 2001 to December 2021, 202 patients underwent PET-CT, CT, and MRI for the initial staging of ICC in two institutions. Among them, 102 patients had undergone surgical treatment. Ninety patients who had a histopathological diagnosis of ICC were retrospectively reviewed. The sensitivity and specificity of 18F-FDG PET-CT, CT, and magnetic resonance imaging (MRI) in detecting tumors, satellite focus, vascular invasion, and lymph node metastases were analyzed. Ninety patients with histologically diagnosed ICC were included. PET-CT demonstrated no statistically significant advantage over CT and MR in the diagnosis of multiple tumors and macrovascular invasion, and bile duct invasion. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT in lymph node metastases were 84%, 86%, 91%, 84%, and 86%, respectively. PET-CT revealed a significantly higher accuracy compared to CT or MRI (86%, 67%, and 76%, p < 0.01, respectively) in the diagnosis of regional lymph node metastases. The accuracy of tumor staging by PET-CT was higher than that by CT/MRI (PET-CT vs. CT vs. MRI: 68/90 vs. 47/90 vs. 51/90, p < 0.05). 18F-FDG PET-CT had sensitivity and specificity values for diagnosing satellite focus and vascular and bile duct invasion similar to those of CT or MRI; however, PET-CT showed higher accuracy in diagnosing regional lymph node metastases. 18F-FDG PET-CT exhibited higher tumor staging accuracy than that of CT/MRI. Thus, 18FDG PET-CT may support tumor staging in ICC. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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11 pages, 1418 KiB

Open AccessArticle

Left Anterior Sectorectomy: An Alternative to Left Hepatectomy for Tumors Invading the Distal Part of the Left Portal Vein

by Mattia Garancini, Mauro Alessandro Scotti, Luca Gianotti, Cristina Ciulli, Francesca Carissimi, Fabio Uggeri, Luca Degrate, Marco Braga and Fabrizio Romano

Diagnostics 2022, 12(2), 545; https://doi.org/10.3390/diagnostics12020545 - 21 Feb 2022

Viewed by 2027

Abstract

Background: Liver tumors invading the distal part of the umbilical portion of the left portal vein usually require left hepatectomy. The recent introduction of the concept of left anterior sector, an independent anatomo-functional unit including the anterior portion of the left liver and [...] Read more.

Background: Liver tumors invading the distal part of the umbilical portion of the left portal vein usually require left hepatectomy. The recent introduction of the concept of left anterior sector, an independent anatomo-functional unit including the anterior portion of the left liver and supplied by the distal part of the umbilical portion of the left portal vein, could represent the rational for an alternative surgical approach. The aim of this study was to introduce the novel surgical procedure of ultrasound-guided left anterior sectorectomy. Methods: Among 92 consecutive patients who underwent hepatectomy, 3 patients with tumor invading the distal part of the umbilical portion of the left portal (two with colorectal liver metastases and one with neuroendocrine tumor liver metastases) underwent left anterior sectorectomy alone or in association with liver multiple metastasectomies. Results: Mean operation time was 393 min; post-operative morbidity and mortality were not observed. After a mean FU of 23 months (range 19–28), no local recurrence occurred. Conclusions: In presence of tumors invading the distal part of the umbilical portion of the left portal, left anterior sectorectomy could be considered as an anatomic radical surgical option that is safe but more conservative than a left hepatectomy. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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13 pages, 1468 KiB

Open AccessArticle

From LI-RADS Classification to HCC Pathology: A Retrospective Single-Institution Analysis of Clinico-Pathological Features Affecting Oncological Outcomes after Curative Surgery

by Leonardo Centonze, Riccardo De Carlis, Ivan Vella, Luca Carbonaro, Niccolò Incarbone, Livia Palmieri, Cristiano Sgrazzutti, Alberto Ficarelli, Maria Grazia Valsecchi, Umberto Dello Iacono, Andrea Lauterio, Davide Bernasconi, Angelo Vanzulli and Luciano De Carlis

Diagnostics 2022, 12(1), 160; https://doi.org/10.3390/diagnostics12010160 - 10 Jan 2022

Cited by 21 | Viewed by 2859

Abstract

Background: The latest Liver Imaging Reporting and Data System (LI-RADS) classification by the American College of Radiology has been recently endorsed in the American Association for the Study of Liver Disease (AASLD) guidelines for Hepatocellular carcinoma (HCC) management. Although the LI-RADS protocol [...] Read more.

Background: The latest Liver Imaging Reporting and Data System (LI-RADS) classification by the American College of Radiology has been recently endorsed in the American Association for the Study of Liver Disease (AASLD) guidelines for Hepatocellular carcinoma (HCC) management. Although the LI-RADS protocol has been developed as a diagnostic algorithm, there is some evidence concerning a possible correlation between different LI-RADS classes and specific pathological features of HCC. We aimed to investigate such radiological/pathological correlation and the possible prognostic implication of LI-RADS on a retrospective cohort of HCC patients undergoing surgical resection. Methods: We performed a retrospective analysis of the pathological characteristics of resected HCC, exploring their distribution among different LI-RADS classes and analyzing the risk factors for recurrence-free, overall and cancer-specific survival Results: LI-RADS-5 (LR-5) nodules showed a higher prevalence of microvascular invasion (MVI), satellitosis and capsule infiltration, as well as higher median values of alpha-fetoprotein (αFP) compared to LI-RADS-3/4 (LR-3/4) nodules. MVI, αFP, satellitosis and margin-positive (R1) resection resulted as independent risk factors for recurrence-free survival, while LI-RADS class did not exert any significant impact. Focusing on overall survival, we identified patient age, Eastern Cooperative Oncology Group performance status (ECOG-PS), Model for End Stage Liver Disease (MELD) score, αFP, MVI, satellitosis and R1 resection as independent risk factors for survival, without any impact of LI-RADS classification. Last, MELD score, log10αFP, satellitosis and R1 resection resulted as independent risk factors for cancer-specific survival, while LI-RADS class did not exert any significant impact. Conclusions: Our results suggest an association of LR-5 class with unfavorable pathological characteristics of resected HCC; tumor histology and underlying patient characteristics such as age, ECOG-PS and liver disease severity exert a significant impact on postoperative oncological outcomes. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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11 pages, 1654 KiB

Open AccessArticle

Measuring HCC Tumor Size in MRI—The Sequence Matters!

by Marco Armbruster, Markus Guba, Joachim Andrassy, Markus Rentsch, Vincent Schwarze, Johannes Rübenthaler, Thomas Knösel, Jens Ricke and Harald Kramer

Diagnostics 2021, 11(11), 2002; https://doi.org/10.3390/diagnostics11112002 - 28 Oct 2021

Cited by 3 | Viewed by 1320

Abstract

Background: The aim of this paper was to assess and compare the accuracy of common magnetic resonance imaging (MRI) pulse sequences in measuring the lesion sizes of hepatocellular carcinomas (HCCs) with respect to the Milan criteria and histopathology as a standard of reference. [...] Read more.

Background: The aim of this paper was to assess and compare the accuracy of common magnetic resonance imaging (MRI) pulse sequences in measuring the lesion sizes of hepatocellular carcinomas (HCCs) with respect to the Milan criteria and histopathology as a standard of reference. Methods: We included 45 patients with known HCC who underwent contrast-enhanced MRI of the liver prior to liver transplantation or tumor resection. Tumor size was assessed pathologically for all patients. The MRI protocol contained axial T2-weighted images as well as T1-weighted imaging sequences before and after application of Gd-EOB-DTPA. Tumor diameters, the sharpness of lesions, and the presence of artifacts were evaluated visually on all available MRI sequences. MRI measurements and pathologically assessed tumor dimensions were correlated using Pearson’s correlation coefficient and Bland–Altman plots. The rate of misclassifications following Milan criteria was assessed. Results: The mean absolute error (in cm) of MRI size measurements in comparison to pathology was the smallest for the hepatobiliary phase T1-weighted acquisition (0.71 ± 0.70 cm, r = 0.96) and largest for the T2w turbo-spin-echo (TSE) sequence (0.85 ± 0.78 cm, r = 0.94). The misclassification rate regarding tumor size under the Milan criteria was lowest for the T2w half-Fourier acquisition single-shot turbo spin-echo sequence and the hepatobiliary phase T1w acquisition (each 8.6%). The highest rate of misclassification occurred in the portal venous phase T1w acquisition and T2w TSE sequence (each 14.3%). Conclusions: The hepatobiliary phase T1-weighted acquisition seems to be most accurate among commonly used MRI sequences for measuring HCC tumor size, resulting in low rates of misclassification with respect to the Milan criteria. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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21 pages, 5208 KiB

Open AccessArticle

Symmetric Reconstruction of Functional Liver Segments and Cross-Individual Correspondence of Hepatectomy

by Doan Cong Le, Jirapa Chansangrat, Nattawut Keeratibharat and Paramate Horkaew

Diagnostics 2021, 11(5), 852; https://doi.org/10.3390/diagnostics11050852 - 10 May 2021

Cited by 3 | Viewed by 4233

Abstract

Accurate localization and analyses of functional liver segments are crucial in devising various surgical procedures, including hepatectomy. To this end, they require the extraction of a liver from computed tomography, and then the identification of resection correspondence between individuals. The first part is [...] Read more.

Accurate localization and analyses of functional liver segments are crucial in devising various surgical procedures, including hepatectomy. To this end, they require the extraction of a liver from computed tomography, and then the identification of resection correspondence between individuals. The first part is usually impeded by inherent deficiencies, as present in medical images, and vast anatomical variations across subjects. While the model-based approach is found viable to tackle both issues, it is often undermined by an inadequate number of labeled samples, to capture all plausible variations. To address segmentation problems by balancing between accuracy, resource consumption, and data availability, this paper presents an efficient method for liver segmentation based on a graph-cut algorithm. One of its main novelties is the incorporation of a feature preserving a metric for boundary separation. Intuitive anatomical constraints are imposed to ensure valid extraction. The second part involves the symmetric conformal parameterization of the extracted liver surface onto a genus-0 domain. Provided with a few landmarks specified on two livers, we demonstrated that, by using a modified Beltrami differential, not only could they be non-rigidly registered, but also the hepatectomy on one liver could be envisioned on another. The merits of the proposed scheme were elucidated by both visual and numerical assessments on a standard MICCAI SLIVER07 dataset. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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Review

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11 pages, 4731 KiB

Open AccessReview

The Applications of 3D Imaging and Indocyanine Green Dye Fluorescence in Laparoscopic Liver Surgery

by Giammauro Berardi, Marco Colasanti, Roberto Luca Meniconi, Stefano Ferretti, Nicola Guglielmo, Germano Mariano, Mirco Burocchi, Alessandra Campanelli, Andrea Scotti, Alessandra Pecoraro, Marco Angrisani, Paolo Ferrari, Andrea Minervini, Camilla Gasparoli, Go Wakabayashi and Giuseppe Maria Ettorre

Diagnostics 2021, 11(12), 2169; https://doi.org/10.3390/diagnostics11122169 - 23 Nov 2021

Cited by 16 | Viewed by 2616

Abstract

Laparoscopic liver resections have gained widespread popularity among hepatobiliary surgeons and is nowadays performed for both standard and more complex hepatectomies. Given the increased technical challenges, preoperative planning and intraoperative guidance is pivotal in laparoscopic surgery to safely carry out complex and oncologically [...] Read more.

Laparoscopic liver resections have gained widespread popularity among hepatobiliary surgeons and is nowadays performed for both standard and more complex hepatectomies. Given the increased technical challenges, preoperative planning and intraoperative guidance is pivotal in laparoscopic surgery to safely carry out complex and oncologically safe hepatectomies. Modern tools can help both preoperatively and intraoperatively and allow surgeons to perform more precise hepatectomies. Preoperative 3D reconstructions and printing as well as augmented reality can increase the knowledge of the specific anatomy of the case and therefore plan the surgery accordingly and tailor the procedure on the patient. Furthermore, the indocyanine green retention dye is an increasingly used tool that can nowadays improve the precision during laparoscopic hepatectomies, especially when considering anatomical resection. The use of preoperative modern imaging and intraoperative indocyanine green dye are key to successfully perform complex hepatectomies such as laparoscopic parenchymal sparing liver resections. In this narrative review, we discuss the aspects of preoperative and intraoperative tools that are nowadays increasingly used in experienced hepatobiliary centers. Full article

(This article belongs to the Special Issue The Role of Imaging in Liver Surgery)

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