102 results on '"Lu, David S. K."'
Search Results
2. Safety of percutaneous, image-guided biopsy of hepatocellular carcinoma with and without concurrent ablation
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Tse, Justin R., Terashima, Kevin, Shen, Luyao, McWilliams, Justin P., Lu, David S. K., and Raman, Steven S.
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- 2022
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3. Updated 10-year outcomes of percutaneous radiofrequency ablation as first-line therapy for single hepatocellular carcinoma < 3 cm: emphasis on association of local tumor progression and overall survival
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Lee, Min Woo, Kang, Danbee, Lim, Hyo Keun, Cho, Juhee, Sinn, Dong Hyun, Kang, Tae Wook, Song, Kyoung Doo, Rhim, Hyunchul, Cha, Dong Ik, and Lu, David S. K.
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- 2020
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4. Combination transarterial chemoembolization and microwave ablation vs. microwave ablation monotherapy for hepatocellular carcinomas greater than 3 cm: a comparative study.
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Chiang, Jason, Rajendran, Pradeep S., Frank Hao, Sayre, James, Raman, Steven S., Lu, David S. K., and McWilliams, Justin P.
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CHEMOEMBOLIZATION ,HEPATOCELLULAR carcinoma ,ABLATION techniques ,PROGRESSION-free survival ,OVERALL survival - Abstract
PURPOSE To evaluate the efficacy of combination therapy using transarterial chemoembolization with microwave ablation (MWA) therapy vs. MWA monotherapy for hepatocellular carcinomas (HCCs) >3 cm in size. METHODS This two-arm retrospective observational study included patients with HCCs >3 cm who underwent either combination therapy (29 patients) or MWA monotherapy (35 patients) between 2014 and 2020. The treatment outcomes related to primary treatment efficacy, local tumor progression (LTP), tumor control rate, and overall survival were compared between each cohort. RESULTS The technical success and primary efficacy were 96.56% and 100.00% in the combination therapy cohort, and 91.42% and 100.00% in the MWA cohort, respectively, over a mean follow-up period of 27.6 months. The 1- and 3-year rates of LTP-free survival were 78.57% and 69.56% in the combination therapy cohort, vs. 72.45% and 35.44% in the MWA cohort, respectively (P = 0.001). The overall progression-free survival was longer in the combination therapy cohort compared with the MWA cohort (median: 56.0 vs. 13.0 months; P = 0.017). With the incorporation of additional locoregional therapy, the overall survival rates were not significantly different, with 1- and 3-year overall survival rates of 100.00% and 88.71% in the combination therapy cohort and rates of 90.15% and 82.76% in the MWA cohort, respectively (P = 0.235). CONCLUSION The combination therapy provided significantly longer upfront LTP-free survival in HCCs >3 cm when compared with the MWA treatment alone, albeit with similar local tumor control and overall survival rates when accounting for additional locoregional therapies. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Building a high-resolution T2-weighted MR-based probabilistic model of tumor occurrence in the prostate
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Nagarajan, Mahesh B., Raman, Steven S., Lo, Pechin, Lin, Wei-Chan, Khoshnoodi, Pooria, Sayre, James W., Ramakrishna, Bharath, Ahuja, Preeti, Huang, Jiaoti, Margolis, Daniel J. A., Lu, David S. K., Reiter, Robert E., Goldin, Jonathan G., Brown, Matthew S., and Enzmann, Dieter R.
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- 2018
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6. Does hepatobiliary phase sequence qualitatively outperform unenhanced T1-weighted imaging in assessment of the ablation margin 24 hours after thermal ablation of hepatocellular carcinomas?
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Takeyama, Nobuyuki, Vidhyarkorn, Sirachat, Chung, Dong Jin, Siripongsakun, Surachate, Kim, Hyun J., Lu, David S. K., and Raman, Steven S.
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- 2016
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7. Assessment of Chronological Effects of Irreversible Electroporation on Hilar Bile Ducts in a Porcine Model
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Choi, Jae Woong, Lu, David S. K., Osuagwu, Ferdnand, Raman, Steven, and Lassman, Charles
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- 2014
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8. Surveillance for Hepatocellular Carcinoma Improves Survival in Asian-American Patients with Hepatitis B: Results from a Community-Based Clinic
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Tong, Myron J., Sun, Hai-En, Hsien, Carlos, and Lu, David S. K.
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- 2010
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9. What Can Go Wrong, Will Go Wrong: A Look at Iatrogenia in the Abdomen and Pelvis
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WILLIAMS, PENNY L., RAMAN, STEVEN S., KADELL, BARBARA M., DONG, PAUL R., and LU, DAVID S. K.
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- 2002
10. Percutaneous Radiofrequency Ablation of Small (1–2 cm) Hepatocellular Carcinomas Inconspicuous on B-Mode Ultrasonographic Imaging: Usefulness of Combined Fusion Imaging with MRI and Contrast-Enhanced Ultrasonography.
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Lee, Min Woo, Lim, Hyo Keun, Rhim, Hyunchul, Cha, Dong Ik, Kang, Tae Wook, Song, Kyoung Doo, Min, Ji Hye, Gwak, Geum-Youn, Kim, Seonwoo, and Lu, David S. K.
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- 2018
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11. Prevalence of Incidental Findings on Abdominal Computed Tomography Angiograms on Prospective Renal Donors.
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Tan, Nelly, Charoensak, Aphinya, Ajwichai, Khobkhoon, Gritsch, Hans Albin, Danovitch, Gabriel, Schulam, Peter, Lu, David S. K., Margolis, Daniel J., and Raman, Steven S.
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- 2015
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12. Computed tomography characteristics of hepatic and splenic abscesses associated with melioidosis: A 7-year study.
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Apisarnthanarak, Piyaporn, Thairatananon, Atita, Muangsomboon, Kobkun, Lu, David S. K., Mundy, Linda M., and Apisarnthanarak, Anucha
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CASE studies ,TOMOGRAPHY ,ABSCESS treatment ,HEPATIC manifestations of general diseases ,SPLENIC artery - Abstract
This study aimed to characterise the CT findings associated with hepatic and splenic melioid abscesses. Patients with CT evidence of hepatic and/or splenic abscesses were retrospectively evaluated for clinical evidence of melioidosis over a 7-year period. After blinded review of the CT characteristics of intra-abdominal abscesses (IAA), we conducted a stratified analysis of patients with and without melioid IAA. Among 49 patients with CT evidence of hepatic and/or splenic IAA, the mean age was 50.2 years, 22 (44.9%) were women and eight (16.3%) had laboratory confirmation of melioidosis. For the 113 IAA, 33 were melioid abscesses (15 liver and 18 spleen) and 80 were non-melioid abscesses (69 liver and 11 spleen). Splenic IAA were more common in the melioid group ( P = 0.001) and smaller in diameter than the hepatic IAA ( P < 0.001). Melioid IAA were smaller than non-melioid IAA ( P < 0.001) and the CT necklace sign was the strongest predictor for melioid IAA (odds ratio = 24.6, P = 0.006) with 100% specificity. Other significant predictors for melioidosis were concurrent hepatic and splenic involvement ( P = 0.009), multiple abscesses ( P = 0.015) and residence in an endemic area ( P = 0.047). By multivariate analysis, concurrent hepatic and splenic involvement was the sole predictor of melioidosis (adjusted odds ratio = 11.3, 95% confidence interval = 1.6-77.5, P = 0.014). The CT necklace sign, along with concurrent hepatic and splenic IAA, were highly suggestive of melioidosis in persons from Central Thailand. [ABSTRACT FROM AUTHOR]
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- 2011
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13. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation.
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Lu, David S. K., Yu, Nam C., Raman, Steven S., Lassman, Charles, Tong, Myron J., Britten, Carolyn, Durazo, Francisco, Saab, Sammy, Han, Steven, Finn, Richard, Hiatt, Jonathan R., and Busuttil, Ronald W.
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- 2005
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14. MR-guided percutaneous ethanol ablation of liver tissue in a .2-T open MR system: preliminary study in porcine model.
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Lu, David S. K., Sinha, Shantanu, Lucas, John, Farahani, Keyvan, Lufkin, Robert, Lewin, Klaus, Lu, D S, Sinha, S, Lucas, J, Farahani, K, Lufkin, R, and Lewin, K
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- 1997
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15. Case Report. Early Enhancement of Tumor Thrombus in the Portal Vein on Two-Phase Helical CT.
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Lin, John P. and Lu, David S. K.
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- 1996
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16. Correlation of needle biopsy-acquired histopathologic grade of hepatocellular carcinoma with outcomes after thermal ablation.
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Chiang J, Raman SS, Ramakrishnan A, Keshavarz P, Sayre J, McWilliams JP, Finn RS, Agopian VG, Choi G, and Lu DSK
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Purpose: To correlate pre-ablation needle biopsy-acquired histopathologic grade of LI-RADS 5 HCC to post-ablation local tumor control rate, intrahepatic distant tumor progression-free survival, and overall survival., Materials and Methods: This single-center, retrospective cohort study included adult patients with LI-RADS 5 HCC who received a pre-ablation core needle biopsy within 3 months prior to thermal ablation from January 2015 to December 2022. Histopathologic grade from the needle biopsy was evaluated as predictor of local tumor control rate, intrahepatic distant tumor progression-free survival and overall survival. Kaplan-Meier survival curves were compared using the Gehan-Generalized Wilcoxon test., Results: The study group comprised of 133 patients (mean age, 67 +/- 10 years [SD]; 107 men) with LI-RADS 5 confirmed HCC, stratified into n=18 poorly-differentiated tumors (median follow-up 27.7 months [IQR, 15.5-55.4]) and n=115 well/moderately-differentiated tumors (median follow-up 29.2 months [IQR, 15.4-59.9]). No difference in local tumor control rate was noted between the two cohorts (HR: 1.16 [95% CI: 0.32-4.23]; p=0.898). There was significantly lower intrahepatic distant tumor progression-free survival after thermal ablation in the poorly-differentiated cohort (HR: 2.54 [0.92-7.05]; p<0.001). The overall survival in the poorly-differentiated cohort was also lower, although this did not reach statistical significance (HR: 1.77 [95% CI: 0.60-5.26]; p=0.202)., Conclusion: Patients with needle-biopsy proven poorly-differentiated LI-RADS 5 HCC have significantly lower intrahepatic distant tumor progression-free survival after thermal ablation compared to well/moderately-differentiated HCC., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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17. Characterization of Microwave Generator Energy and Ablation Volumes following Transarterial Embolization in an In Vivo Porcine Liver Model.
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Sparks H, Rink JS, Ramakrishnan A, Sung K, Ni J, Lu DSK, Raman SS, Lee EW, and Chiang J
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- Animals, Female, Swine, Ablation Techniques, Sus scrofa, Magnetic Resonance Imaging, Ultrasonography, Interventional, Embolization, Therapeutic, Microwaves therapeutic use, Liver blood supply, Liver diagnostic imaging, Hepatic Artery diagnostic imaging, Models, Animal
- Abstract
Purpose: To characterize the relationship between ablation zone volume (AZV) and microwave ablation (MWA) energy in an in vivo porcine liver model following arterial embolization., Materials and Methods: With Institutional Animal Care and Use Committee (IACUC) approval, 11 female swine underwent either right (n = 5) or left (n = 6) hepatic artery embolization under fluoroscopic guidance. Subsequently, ultrasound (US)-guided MWA was performed in each liver segment (left lateral, left medial, right medial, and right lateral) at either 30 W (n = 4 lobes), 60 W (n = 4), 65 W (n = 20), 90 W (n = 8), 120 W (n = 4), or 140 W (n = 4) continuously for 5 minutes. Postprocedural volumetric segmentation was performed on standardized multiphase T1 magnetic resonance (MR) imaging sequences., Results: Mean AZVs in embolized lobes (15.8 mL ± SD 10.6) were significantly larger than those in nonembolized lobes (11.2 mL ± SD 6.5, P < .01). MWA energy demonstrated significant positive linear correlation with both embolized (R
2 = 0.66, P < .01) and nonembolized (R2 = 0.64, P < .01) lobes. The slope of the linear models corresponded to a 0.95 mL/kJ (SD ± 0.16) and 0.54 mL/kJ (SD ± 0.09) increase in ablation volume per applied kilojoule of energy (E) in embolized and nonembolized lobes, respectively. In the multivariate model, embolization status significantly modified the relationship between E and AZV as described by the following interaction term: 0.42∗E∗(embolization status) (P = .031)., Conclusions: Linear models demonstrated a near 1.8-fold increase in ratio of AZV per unit E, R(AZV:E), when applied to embolized lobes relative to nonembolized lobes. Absolute AZV differences between embolized and nonembolized lobes were greater at higher-power MWA., (Published by Elsevier Inc.)- Published
- 2024
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18. Technical Feasibility and Safety of Image-Guided Biphasic Monopolar Pulsed Electric Field Ablation of Metastatic and Primary Malignancies.
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Kim DH, Suh RD, Chiang J, Abtin F, Genshaft SJ, Hao F, Lu DSK, and Raman SS
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- Humans, Middle Aged, Aged, Male, Female, Adult, Aged, 80 and over, Retrospective Studies, Treatment Outcome, Young Adult, Time Factors, Neoplasms pathology, Neoplasms diagnostic imaging, Neoplasms therapy, Radiography, Interventional adverse effects, Tumor Burden, Ablation Techniques adverse effects, Feasibility Studies
- Abstract
Purpose: To assess the technical feasibility and safety of image-guided percutaneous biphasic monopolar pulsed electric field (PEF) ablation of primary and metastatic tumors., Materials and Methods: With institutional review board (IRB) approval and Health Insurance Portability and Accountability Act (HIPAA) compliance, this retrospective, single-institution study cohort of 17 patients (mean age, 53.5 years; range, 20-94 years) with overall progressive disease underwent 26 PEF ablation procedures for 30 metastatic (90%) and primary (10%) target lesions in the thorax (n = 20), abdomen (n = 7), and head and neck (n = 3). Concurrent systemic therapy was used in 14 of the 17 patients (82%). Follow-up imaging was scheduled for 1, 3, and 6 months after PEF ablation, and target and off-target lesion sizes were recorded. The overall response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria with imaging immediately before PEF serving as baseline. Adverse events (AEs) were determined by the Society of Interventional Radiology (SIR) classification., Results: PEF ablation procedures were well tolerated and technically feasible for all 17 patients. The mean initial sizes of the target and off-target tumors were 2.6 cm (standard deviation [SD] ± 1.5; range, 0.4-6.9 cm) and 2.2 cm (SD ± 1.1; range, 1.0-5.2 cm), respectively. Overall, 15 of the 30 (50%) target lesions and 12 of the 24 (50%) off-target lesions were unchanged or decreased in size at the patient's last follow-up. Eight patients had overall stable disease (47%) at the last follow-up. Of the 26 AEs, there were 9 mild (35%) and 1 moderate (4%) AE., Conclusions: All PEF procedures were technically feasible with 1 moderate AE and stable disease for 47% of patients with a median follow-up period of 3 months., (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)
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- 2024
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19. Comparison of LIRADS 5 Image Guided Core Biopsy Derived From Formalin Fixed and Frozen Tissue Cores for Radiogenomics and Radioproteomics Analysis in Well, Moderate and Poorly Differentiated Hepatocellular Carcinoma.
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Simonian M, Lu DSK, Whitelegge J, Cohn W, Ahuja P, Hsu W, and Raman SS
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The aim of this pilot study is to evaluate and compare the quality of the genomics and proteomics data obtained from paired Formalin Fixed Paraffin Embedded (FFPE) and frozen (FF) tissue percutaneous core biopsies of Liver Imaging Reporting and Data System 5 (LIRADS 5) hepatocellular carcinoma (HCC) of varying histological grades. The preliminary data identified differentially expressed proteins and genes in poor, moderate and well differentiated HCC biopsies, with a greater efficacy in fresh frozen samples. The data offered valuable insights into the characteristics and suitability of samples for future studies., Competing Interests: Conflicts of Interest The authors declare no conflict of interest.
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- 2024
20. Hepatocellular Adenoma Subtypes Based on 2017 Classification System: Exploratory Study of Gadoxetate Disodium-Enhanced MRI Features With Proposal of a Diagnostic Algorithm.
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Tse JR, Felker ER, Cao JJ, Naini BV, Liang T, Lu DSK, and Raman SS
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- Male, Humans, Female, Young Adult, Adult, Middle Aged, beta Catenin, Retrospective Studies, Contrast Media, Hedgehog Proteins, Magnetic Resonance Imaging methods, Adenoma, Liver Cell diagnostic imaging, Liver Neoplasms diagnostic imaging, Carcinoma, Hepatocellular pathology
- Abstract
BACKGROUND. The classification of hepatocellular adenomas (HCAs) was updated in 2017 on the basis of genetic and molecular analysis. OBJECTIVE. The purpose of this article was to evaluate features on gadoxetate disodium-enhanced MRI of HCA subtypes on the basis of the 2017 classification and to propose a diagnostic algorithm for determining subtype using these features. METHODS. This retrospective study included 56 patients (49 women, seven men; mean age, 37 ± 13 [SD] years) with histologically confirmed HCA evaluated by gadoxetate disodium-enhanced MRI from January 2010 to January 2021. Subtypes were reclassified using 2017 criteria: hepatocyte nuclear factor-1α mutated HCA (HHCA), inflammatory HCA (IHCA), β-catenin exon 3 activated HCA (β-HCA), mixed inflammatory and β-HCA (β-IHCA), sonic hedgehog HCA (shHCA), and unclassified HCA (UHCA). Qualitative MRI features were assessed. Liver-to-lesion contrast enhancement ratios (LLCERs) were measured. Subtypes were compared, and a diagnostic algorithm was proposed. RESULTS. The analysis included 65 HCAs: 16 HHCAs, 31 IHCAs, six β-HCA, four β-IHCA, five shHCA, and three UHCAs. HHCAs showed homogeneous diffuse intralesional steatosis in 94%, whereas all other HCAs showed this finding in 0% ( p < .001). IHCAs showed the "atoll" sign in 58%, whereas all other HCAs showed this finding in 12% ( p < .001). IHCAs showed moderate T2 hyperintensity in 52%, whereas all other HCAs showed this finding in 12% ( p < .001). The β-HCAs and β-IHCAs occurred in men in 63%, whereas all other HCAs occurred in men in 4% ( p < .001). The β-HCAs and β-IHCAs had a mean size of 10.1 ± 6.8 cm, whereas all other HCAs had a mean size of 5.1 ± 2.9 cm ( p = .03). The β-HCAs and β-IHCAs showed fluid components in 60%, whereas all other HCAs showed this finding in 5% ( p < .001). Hepatobiliary phase iso- or hyperintensity was observed in 80% of β-HCAs and β-IHCAs versus 5% of all other HCAs ( p < .001). Hepatobiliary phase LLCER was positive in nine HCAs (eight β-HCAs and β-IHCAs; one IHCA). The shHCA and UHCA did not show distinguishing features. The proposed diagnostic algorithm had accuracy of 98% for HHCAs, 83% for IHCAs, and 95% for β-HCAs or β-IHCAs. CONCLUSION. Findings on gadoxetate disodium-enhanced MRI, including hepatobiliary phase characteristics, were associated with HCA subtypes using the 2017 classification. CLINICAL IMPACT. The algorithm identified common HCA subtypes with high accuracy, including those with β-catenin exon 3 mutations.
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- 2023
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21. Hepatocellular Adenomas: Molecular Basis and Multimodality Imaging Update.
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Tse JR, Felker ER, Naini BV, Shen L, Shen J, Lu DSK, Kamaya A, and Raman SS
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- Humans, beta Catenin, Magnetic Resonance Imaging methods, Adenoma, Adenoma, Liver Cell pathology, Carcinoma, Hepatocellular pathology, Liver Neoplasms pathology
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Hepatocellular adenomas (HCAs) are a family of liver tumors that are associated with variable prognoses. Since the initial description of these tumors, the classification of HCAs has expanded and now includes eight distinct genotypic subtypes based on molecular analysis findings. These genotypic subtypes have unique derangements in their cellular biologic makeup that determine their clinical course and may allow noninvasive identification of certain subtypes. Multiphasic MRI performed with hepatobiliary contrast agents remains the best method to noninvasively detect, characterize, and monitor HCAs. HCAs are generally hypointense during the hepatobiliary phase; the β-catenin-mutated exon 3 subtype and up to a third of inflammatory HCAs are the exception to this characterization. It is important to understand the appearances of HCAs beyond their depictions at MRI, as these tumors are typically identified with other imaging modalities first. The two most feared related complications are bleeding and malignant transformation to hepatocellular carcinoma, although the risk of these complications depends on tumor size, subtype, and clinical factors. Elective surgical resection is recommended for HCAs that are persistently larger than 5 cm, adenomas of any size in men, and all β-catenin-mutated exon 3 HCAs. Thermal ablation and transarterial embolization are potential alternatives to surgical resection. In the acute setting of a ruptured HCA, patients typically undergo transarterial embolization with or without delayed surgical resection. This update on HCAs includes a review of radiologic-pathologic correlations by subtype and imaging modality, related complications, and management recommendations.
© RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.- Published
- 2023
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22. Beyond the AJR : The Emerging Role of Radiofrequency Ablation in the Treatment of Low-Risk Papillary Microcarcinoma of the Thyroid.
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Douek ML and Lu DSK
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- Humans, Carcinoma, Papillary diagnostic imaging, Carcinoma, Papillary surgery, Carcinoma, Papillary pathology, Thyroid Neoplasms diagnostic imaging, Thyroid Neoplasms surgery, Thyroid Neoplasms pathology, Radiofrequency Ablation
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- 2022
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23. Influence of the Location and Zone of Tumor in Prostate Cancer Detection and Localization on 3-T Multiparametric MRI Based on PI-RADS Version 2.
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Wibulpolprasert P, Raman SS, Hsu W, Margolis DJA, Asvadi NH, Khoshnoodi P, Moshksar A, Tan N, Ahuja P, Maehara CK, Sisk A, Sayre J, Lu DSK, and Reiter RE
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- Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Prostatic Neoplasms pathology, Retrospective Studies, Multiparametric Magnetic Resonance Imaging methods, Prostatic Neoplasms diagnostic imaging
- Abstract
OBJECTIVE. The objective of our study was to determine the performance of 3-T multiparametric MRI (mpMRI) for prostate cancer (PCa) detection and localization, stratified by anatomic zone and level, using Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and whole-mount histopathology (WMHP) as reference. MATERIALS AND METHODS. Multiparametric MRI examinations of 415 consecutive men were compared with thin-section WMHP results. A genitourinary radiologist and pathologist collectively determined concordance. Two radiologists assigned PI-RADSv2 scores and sector location to all detected foci by consensus. Tumor detection rates were calculated for clinical and pathologic (tumor location and zone) variables. Both rigid and adjusted sector-matching models were used to account for fixation-related issues. RESULTS. Of 863 PCa foci in 16,185 prostate sectors, the detection of overall and index PCa lesions in the midgland, base, and apex was 54.9% and 83.1%, 42.1% and 64.0% ( p = 0.04, p = 0.02), and 41.9% and 71.4% ( p = 0.001, p = 0.006), respectively. Tumor localization sensitivity was highest in the midgland compared with the base and apex using an adjusted match compared with a rigid match (index lesions, 71.3% vs 43.7%; all lesions, 70.8% vs 36.0%) and was greater in the peripheral zone (PZ) than in the transition zone. Three-Tesla mpMRI had similarly high specificity (range, 93.8-98.3%) for overall and index tumor localization when using both rigid and adjusted sector-matching approaches. CONCLUSION. For 3-T mpMRI, the highest sensitivity (83.1%) for detection of index PCa lesions was in the midgland, with 98.3% specificity. Multiparametric MRI performance for sectoral localization of PCa within the prostate was moderate and was best for index lesions in the PZ using an adjusted model.
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- 2020
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24. Utility of Multiparametric MRI for Predicting Residual Clinically Significant Prostate Cancer After Focal Laser Ablation.
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Felker ER, Raman SS, Lu DSK, Tuttle M, Margolis DJ, ElKhoury FF, Sayre J, and Marks LS
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- Clinical Trials as Topic, Contrast Media, Humans, Image-Guided Biopsy, Male, Middle Aged, Neoplasm Grading, Predictive Value of Tests, Prostate-Specific Antigen blood, Retrospective Studies, Ablation Techniques, Laser Therapy, Multiparametric Magnetic Resonance Imaging, Neoplasm, Residual diagnostic imaging, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms surgery
- Abstract
OBJECTIVE. The purpose of this study was to compare in a multireader manner the diagnostic accuracies of 3-T multiparametric MRI interpretation and serial prostate-specific antigen (PSA) measurement in predicting the presence of residual clinically significant prostate cancer after focal laser ablation. MATERIALS AND METHODS. Eighteen men had undergone focal laser ablation for low- or intermediate-risk prostate cancer as part of two National Cancer Institute-funded phase 1 clinical trials. Multiparametric MRI was performed immediately after and 6 and 12 months after focal laser ablation. Serial PSA measurements after focal laser ablation were recorded, and MRI-ultrasound fusion biopsy was performed 6 and 12 months after ablation and served as the reference standard. Multiparametric MRI was performed at 3 T with pelvic phased-array coils. T2-weighted, DW, and dynamic contrast-enhanced MR images were retrospectively assessed by two blinded radiologists using a 3-point Likert scale (0-2). Inter-reader agreement was assessed with the Cohen kappa statistic. The diagnostic accuracies of multiparametric MRI and PSA measurement were compared. RESULTS. Residual clinically significant prostate cancer was identified in 11 of 18 (61%) men. Logistic regression analysis of serial PSA measurements yielded a correct classification rate of 61.1% ( p > 0.05). Using a multiparametric MRI threshold score of 4 or greater, both radiologists made correct classifications for 16 of 18 men (89%) at 6 months and 15 of 17 men (88%) at 12 months. Interreader agreement was substantial to excellent for T2-weighted imaging, DWI, and dynamic contrast-enhanced MRI and improved uniformly from 6 to 12 months. Logistic regression analysis of the retrospectively reviewed multiparametric MR images yielded AUCs greater than 0.90 for each radiologist 6 and 12 months after focal laser ablation ( p < 0.001). CONCLUSION. Multiparametric MRI 6 and 12 months after focal laser ablation significantly outperformed serial PSA measurements for predicting the presence of residual clinically significant prostate cancer.
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- 2019
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25. Utility of Restriction Spectrum Imaging Among Men Undergoing First-Time Biopsy for Suspected Prostate Cancer.
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Felker ER, Raman SS, Shakeri S, Mirak SA, Bajgiran AM, Kwan L, Khoshnoodi P, ElKhoury FF, Margolis DJA, Karow D, Lu DSK, White N, and Marks LS
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- Aged, Aged, 80 and over, Contrast Media, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, Ultrasonography, Diffusion Magnetic Resonance Imaging methods, Image-Guided Biopsy, Multimodal Imaging, Prostatic Neoplasms pathology
- Abstract
OBJECTIVE. The purpose of this article is to evaluate restriction spectrum imaging (RSI) in men undergoing MRI-ultrasound fusion biopsy for suspected prostate cancer (PCa) and to compare the performance of RSI with that of conventional DWI. MATERIALS AND METHODS. One hundred ninety-eight biopsy-naïve men enrolled in a concurrent prospective clinical trial evaluating MRI-targeted prostate biopsy underwent multiparametric MRI with RSI. Clinical and imaging features were compared between men with and without clinically significant (CS) PCa (MRI-ultrasound fusion biopsy Gleason score ≥ 3 + 4). RSI z score and apparent diffusion coefficient (ADC) were correlated, and their diagnostic performances were compared. RESULTS. CS PCa was detected in 109 of 198 men (55%). Using predefined thresholds of ADC less than or equal to 1000 μm
2 /s and RSI z score greater than or equal to 3, sensitivity and specificity for CS PCa were 86% and 38%, respectively, for ADC and 61% and 70%, respectively, for RSI. In the transition zone ( n = 69), the sensitivity and specificity were 94% and 17%, respectively, for ADC and 59% and 69%, respectively, for RSI. Among lesions with CS PCa, RSI z score and ADC were significantly inversely correlated in the peripheral zone (ρ = -0.4852; p < 0.01) but not the transition zone (ρ = -0.2412; p = 0.17). Overall diagnostic accuracies of RSI and DWI were 0.70 and 0.68, respectively ( p = 0.74). CONCLUSION. RSI and DWI achieved equivalent diagnostic performance for PCa detection in a large population of men undergoing first-time prostate biopsy for suspected PCa, but RSI had superior specificity for transition zone lesions.- Published
- 2019
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26. Detection and Localization of Prostate Cancer at 3-T Multiparametric MRI Using PI-RADS Segmentation.
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Wibulpolprasert P, Raman SS, Hsu W, Margolis DJA, Asvadi NH, Khoshnoodi P, Moshksar A, Tan N, Ahuja P, Maehara CK, Huang J, Sayre J, Lu DSK, and Reiter RE
- Abstract
OBJECTIVE. The purpose of this study is to determine the overall and sector-based performance of 3-T multiparametric MRI for prostate cancer (PCa) detection and localization by using Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) scoring and segmentation compared with whole-mount histopathologic analysis. MATERIALS AND METHODS. Multiparametric 3-T MRI examinations of 415 consecutive men were compared with thin-section whole-mount histopathologic analysis. A genitourinary radiologist and pathologist collectively determined concordance. Two radiologists assigned PI-RADSv2 categories and sectoral location to all detected foci by consensus. Tumor detection rates were calculated for clinical and pathologic (Gleason score) variables. Both rigid and adjusted sector-matching models were used to account for fixation-related issues. RESULTS. The 415 patients had 863 PCa foci (52.7% had a Gleason score ≥ 7, 61.9% were ≥ 1 cm, and 90.4% (375/415) of index lesions were ≥ 1 cm) and 16,185 prostate sectors. Multiparametric MRI enabled greater detection of PCa lesions 1 cm or larger (all lesions vs index lesions, 61.6% vs 81.6%), lesions with Gleason score greater than or equal to 7 (all lesions vs index lesions, 71.4% vs 80.9%), and index lesions with both Gleason score greater than or equal to 7 and size 1 cm or larger (83.3%). Higher sensitivity was obtained for adjusted versus rigid tumor localization for all lesions (56.0% vs 28.5%), index lesions (55.4% vs 34.3%), lesions with Gleason score greater than or equal to 7 (55.7% vs 36.0%), and index lesions 1 cm or larger (56.1% vs 35.0%). Multiparametric 3-T MRI had similarly high specificity (96.0-97.9%) for overall and index tumor localization with adjusted and rigid sector-matching approaches. CONCLUSION. Using 3-T multiparametric MRI and PI-RADSv2, we achieved the highest sensitivity (83.3%) for the detection of lesions 1 cm or larger with Gleason score greater than or equal to 7. Sectoral localization of PCa within the prostate was moderate and was better with an adjusted model than with a rigid model.
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- 2019
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27. Detection of Individual Prostate Cancer Foci via Multiparametric Magnetic Resonance Imaging.
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Johnson DC, Raman SS, Mirak SA, Kwan L, Bajgiran AM, Hsu W, Maehara CK, Ahuja P, Faiena I, Pooli A, Salmasi A, Sisk A, Felker ER, Lu DSK, and Reiter RE
- Subjects
- Aged, False Negative Reactions, Humans, Male, Middle Aged, Neoplasm Grading, Predictive Value of Tests, Retrospective Studies, Tumor Burden, Magnetic Resonance Imaging methods, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms pathology
- Abstract
Background: Multiparametric magnetic resonance imaging (mpMRI) undoubtedly affects the diagnosis and treatment of localized prostate cancer (CaP). However, clinicians need a better understanding of its accuracy and limitations in detecting individual CaP foci to optimize management., Objective: To determine the per-lesion detection rate for CaP foci by mpMRI and identify predictors of tumor detection., Design, Setting, and Participants: We carried out a retrospective analysis of a prospectively managed database correlating lesion-specific results from mpMRI co-registered with whole-mount pathology (WMP) prostatectomy specimens from June 2010 to February 2018. Participants include 588 consecutive patients with biopsy-proven CaP undergoing 3-T mpMRI before radical prostatectomy at a single tertiary institution., Outcome Measurements and Statistical Analysis: We measured mpMRI sensitivity in detecting individual CaP and clinically significant (any Gleason score ≥7) CaP foci and predictors of tumor detection using multivariate analysis., Results and Limitations: The final analysis included 1213 pathologically confirmed tumor foci in 588 patients with primarily intermediate- (75%) or high-risk (12%) CaP. mpMRI detected 45% of all lesions (95% confidence interval [CI] 42-47%), including 65% of clinically significant lesions (95% CI 61-69%) and nearly 80% of high-grade tumors. Some 74% and 31% of missed solitary and multifocal tumors, respectively, were clinically significant. The majority of missed lesions were small (61.1% ≤1cm); 28.3% were between 1 and 2cm, and 10.4% were >2cm. mpMRI missed at least one clinically significant focus in 34% of patients overall, and in 45% of men with multifocal lesions. On multivariate analysis, smaller, low-grade, multifocal, nonindex tumors with lower prostate-specific antigen density were more likely to be missed. Limitations include selection bias in a prostatectomy cohort, lack of specificity data, an imperfect co-registration process, and uncertain clinical significance for undetected lesions., Conclusions: mpMRI detects less than half of all and less than two-thirds of clinically significant CaP foci. The moderate per-lesion sensitivity and significant proportion of men with undetected tumor foci demonstrate the current limitations of mpMRI., Patient Summary: Magnetic resonance imaging of the prostate before surgical removal for prostate cancer finds less than half of all individual prostate cancer tumors. Large, solitary, aggressive tumors are more likely to be visualized on imaging., (Published by Elsevier B.V.)
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- 2019
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28. Liver MR Elastography at 3 T: Agreement Across Pulse Sequences and Effect of Liver R2* on Image Quality.
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Felker ER, Choi KS, Sung K, Wu HH, Raman SS, Bolster BD Jr, Kannengiesser S, Sorge K, and Lu DSK
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Echo-Planar Imaging, Elasticity Imaging Techniques, Liver Cirrhosis diagnostic imaging, Magnetic Resonance Imaging
- Abstract
Objective: The objectives of our study were to compare MR elastography (MRE) based on gradient-recalled echo (GRE) imaging with spin-echo echo-planar imaging (SEEPI) and rapid fractional (RF)-GRE MRE sequences at 3 T in terms of liver stiffness (LS) and image quality and to evaluate the effect of liver R2* on image quality., Materials and Methods: Eighty-one patients underwent 3-T liver MRE with GRE, SE-EPI, and RF-GRE sequences performed in variable order in this study. LS and ROI areas on the LS 95% confidence maps were compared among the three sequences. The relationship between liver R2* and ROI area was investigated., Results: There was no significant difference in mean LS among the three sequences (p = 0.49). Mean ROI area was significantly larger for RF-GRE (18,213 ± 9292 [SD] mm
2 ) than for GRE (13,196 ± 8149 mm2 ) and SE-EPI (12,896 ± 8656 mm2 ) (p < 0.0001). Liver R2* was significantly higher among patients with one or more failed sequences (mean ± SD, 116 ± 76 s-1 ) than for patients with no failed sequences (59 ± 26 s-1 ) (p = 0.001). Technical failure rates were 10% (8/81), 4% (3/81), and 2% (2/81) for GRE, SE-EPI, and RF-GRE, respectively. Among patients with iron overload (R2* ≥ 100 s-1 ), there was a trend toward larger ROI area for SE-EPI (p = 0.09)., Conclusion: SE-EPI-and RF-GRE-based MRE sequences provide equivalent measures of LS compared with GRE-based MRE, and both have lower technical failure rates. The RF-GRE sequence yielded the largest measurable area of LS. Among patients with iron overload, there was a trend toward larger measurable area of LS for the SE-EPI sequence.- Published
- 2018
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29. Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?
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Felker ER, Raman SS, Margolis DJ, Lu DSK, Shaheen N, Natarajan S, Sharma D, Huang J, Dorey F, and Marks LS
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- Aged, Aged, 80 and over, Biopsy, Contrast Media, Humans, Male, Middle Aged, Neoplasm Grading, Prostate-Specific Antigen blood, Retrospective Studies, Risk Assessment, Magnetic Resonance Imaging methods, Prostatic Neoplasms pathology
- Abstract
Objective: The objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score ≥ 3 + 4) in men with Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 3 transition zone (TZ) lesions., Materials and Methods: From 2014 to 2016, 865 men underwent prostate MRI and MRI/ultrasound (US) fusion biopsy (FB). A subset of 90 FB-naïve men with 96 PI-RADSv2 category 3 TZ lesions was identified. Patients were imaged at 3 T using a body coil. Images were assigned a PI-RADSv2 category by an experienced radiologist. Using clinical data and imaging features, we performed univariate and multivariate analyses to identify predictors of clinically significant PCA., Results: The mean patient age was 66 years, and the mean prostate-specific antigen density (PSAD) was 0.13 ng/mL
2 . PCA was detected in 34 of 96 (35%) lesions, 14 of which (15%) harbored clinically significant PCA. In univariate analysis, DWI score, prostate volume, and PSAD were significant predictors (p < 0.05) of clinically significant PCA with a suggested significance for apparent diffusion coefficient (ADC) and prostate-specific antigen value (p < 0.10). On multivariate analysis, PSAD and lesion ADC were the most important covariates. The combination of both PSAD of 0.15 ng/mL2 or greater and an ADC value of less than 1000 mm2 /s yielded an AUC of 0.91 for clinically significant PCA (p < 0.001). If FB had been restricted to these criteria, only 10 of 90 men would have undergone biopsy, resulting in diagnosis of clinically significant PCA in 60% with eight men (9%) misdiagnosed (false-negative)., Conclusion: The yield of FB in men with PI-RADSv2 category 3 TZ lesions for clinically significant PCA is 15% but significantly improves to 60% (AUC > 0.9) among men with PSAD of 0.15 ng/mL2 or greater and lesion ADC value of less than 1000 mm2 /s.- Published
- 2017
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30. Long-term survival after surveillance and treatment in patients with chronic viral hepatitis and hepatocellular carcinoma.
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Tong MJ, Rosinski AA, Huynh CT, Raman SS, and Lu DSK
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Hepatocellular carcinoma (HCC) is the main cause of mortality in patients with chronic viral hepatitis (CVH). We determined the impact of surveillance and treatments on long-term outcomes in patients with CVH who developed HCC. Between 1984 and 2014, 333 patients with HCC and with hepatitis B or hepatitis C virus infection were evaluated. An adjusted lead time bias interval was added to patients with HCC who presented with HCC (no surveillance), and their survival was compared to patients whose HCC was detected by surveillance. After HCC treatments, survival rates within and beyond 3 years of follow-up were compared. In 175 (53%) patients, HCC was detected through surveillance using alpha-fetoprotein and abdominal ultrasound examinations. Compared to 158 (47%) patients with HCC who had no surveillance, more patients with HCC detected by surveillance received surgical and locoregional treatments ( P < 0.0001 to P < 0.001), and their 1-, 3-, and 5-year overall and disease-free survival rates were significantly higher ( P < 0.001 for both). During the first 3 years of follow-up, patients with HCC receiving liver transplantation had similar survival rates as those with liver resection or radiofrequency ablation (RFA); however, due to HCC recurrence, survival in resection and RFA patients became significantly less when followed beyond 3 years ( P = 0.001 to P = 0.04). Factors associated with mortality included tumors beyond University of California at San Francisco criteria (hazard ratio [HR] 2.02; P < 0.0001), Child-Pugh class B and C (HR, 1.58-2.26; P = 0.043 to P = 0.015, respectively), alpha-fetoprotein per log ng/mL increase (HR, 1.30; P < 0.0001), previous antiviral therapy in hepatitis B virus patients (HR, 0.62; P = 0.032), and treatments other than liver transplantation (HR, 2.38-6.45; P < 0.0001 to P < 0.003). Conclusion . Patients with HCC detected by surveillance had prolonged survival. Due to HCC recurrence, survival rates after liver resection and RFA were lower when followed beyond 3 years after treatments. ( Hepatology Communications 2017;1:595-608).
- Published
- 2017
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31. Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation: A 10-year intention-to-treat analysis.
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Lee MW, Raman SS, Asvadi NH, Siripongsakun S, Hicks RM, Chen J, Worakitsitisatorn A, McWilliams J, Tong MJ, Finn RS, Agopian VG, Busuttil RW, and Lu DSK
- Subjects
- Academic Medical Centers, Adult, Aged, Analysis of Variance, California, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Cause of Death, Cohort Studies, End Stage Liver Disease mortality, End Stage Liver Disease pathology, Female, Follow-Up Studies, Humans, Intention to Treat Analysis, Kaplan-Meier Estimate, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Transplantation mortality, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Patient Dropouts, Retrospective Studies, Risk Assessment, Statistics, Nonparametric, Survival Analysis, Time Factors, Treatment Outcome, Waiting Lists, Carcinoma, Hepatocellular surgery, Catheter Ablation methods, End Stage Liver Disease surgery, Hepatectomy methods, Liver Neoplasms surgery, Liver Transplantation methods
- Abstract
In a long-term (10-year) study of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) as bridging therapy in patients listed for orthotopic liver transplantation (LT), we evaluated the impact of RFA on waiting list dropout rate, post-LT tumor recurrence, and long-term intention-to-treat, disease-specific survival (DSS). From March 2004 to October 2014, RFA was performed as the initial stand-alone bridge therapy to LT for 121 patients (men/women ratio, 83:38; mean age, 60.0 years) with 156 de novo HCCs (mean size, 2.4 cm). Follow-up period from initial RFA ranged from 1.3 to 128.0 months (median, 42.9 months). We assessed the overall and tumor-specific waiting list dropout rates, post-LT tumor recurrence, and 10-year post-LT and intention-to-treat survival rates. Dropout from the waiting list due to tumor progression occurred in 7.4% of patients. HCC recurrence after LT occurred in 5.6% of patients. The post-LT overall survival (OS) rate at 5 and 10 years was 75.8% and 42.2%, respectively, and the recurrence-free survival (RFS) rate was 71.1% and 39.6%, respectively. Intention-to-treat OS, RFS, and DSS rates for the entire study population at 5 and 10 years were 63.5% and 41.2%, 60.8% and 37.7%, and 89.5% and 89.5%, respectively., Conclusion: RFA as a first-line stand-alone bridge therapy to LT achieves excellent long-term overall and tumor-specific survivals, with a low dropout rate from tumor progression despite long wait list times and a sustained low tumor recurrence rate upon post-LT follow-up of up to 10 years. (Hepatology 2017;65:1979-1990)., (© 2017 by the American Association for the Study of Liver Diseases.)
- Published
- 2017
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32. In-Bore 3-T MR-guided Transrectal Targeted Prostate Biopsy: Prostate Imaging Reporting and Data System Version 2-based Diagnostic Performance for Detection of Prostate Cancer.
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Tan N, Lin WC, Khoshnoodi P, Asvadi NH, Yoshida J, Margolis DJ, Lu DS, Wu H, Sung KH, Lu DY, Huang J, and Raman SS
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- Adult, Aged, Humans, Image-Guided Biopsy, Male, Middle Aged, Prostate diagnostic imaging, Prostate pathology, ROC Curve, Radiology Information Systems, Reproducibility of Results, Retrospective Studies, Magnetic Resonance Imaging methods, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms pathology
- Abstract
Purpose To determine the diagnostic yield of in-bore 3-T magnetic resonance (MR) imaging-guided prostate biopsy and stratify performance according to Prostate Imaging Reporting and Data System (PI-RADS) versions 1 and 2. Materials and Methods This study was HIPAA compliant and institution review board approved. In-bore 3-T MR-guided prostate biopsy was performed in 134 targets in 106 men who (a) had not previously undergone prostate biopsy, (b) had prior negative biopsy findings with increased prostate-specific antigen (PSA) level, or (c) had a prior history of prostate cancer with increasing PSA level. Clinical, diagnostic 3-T MR imaging was performed with in-bore guided prostate biopsy, and pathology data were collected. The diagnostic yields of MR-guided biopsy per patient and target were analyzed, and differences between biopsy targets with negative and positive findings were determined. Results of logistic regression and areas under the curve were compared between PI-RADS versions 1 and 2. Results Prostate cancer was detected in 63 of 106 patients (59.4%) and in 72 of 134 targets (53.7%) with 3-T MR imaging. Forty-nine of 72 targets (68.0%) had clinically significant cancer (Gleason score ≥ 7). One complication occurred (urosepsis, 0.9%). Patients who had positive target findings had lower apparent diffusion coefficient values (875 × 10
-6 mm2 /sec vs 1111 × 10-6 mm2 /sec, respectively; P < .01), smaller prostate volume (47.2 cm3 vs 75.4 cm3 , respectively; P < .01), higher PSA density (0.16 vs 0.10, respectively; P < .01), and higher proportion of PI-RADS version 2 category 3-5 scores when compared with patients with negative target findings. MR targets with PI-RADS version 2 category 2, 3, 4, and 5 scores had a positive diagnostic yield of three of 23 (13.0%), six of 31 (19.4%), 39 of 50 (78.0%), and 24 of 29 (82.8%) targets, respectively. No differences were detected in areas under the curve for PI-RADS version 2 versus 1. Conclusion In-bore 3-T MR-guided biopsy is safe and effective for prostate cancer diagnosis when stratified according to PI-RADS versions 1 and 2.© RSNA, 2016.- Published
- 2017
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33. Preliminary Outcome of Microwave Ablation of Hepatocellular Carcinoma: Breaking the 3-cm Barrier?
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Thamtorawat S, Hicks RM, Yu J, Siripongsakun S, Lin WC, Raman SS, McWilliams JP, Douek M, Bahrami S, and Lu DS
- Subjects
- Ablation Techniques adverse effects, Ablation Techniques instrumentation, Adult, Aged, Aged, 80 and over, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular pathology, Electronic Health Records, Equipment Design, Female, Humans, Liver Neoplasms diagnostic imaging, Liver Neoplasms pathology, Male, Microwaves adverse effects, Middle Aged, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Ablation Techniques methods, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Microwaves therapeutic use, Tumor Burden
- Abstract
Purpose: To evaluate preliminary outcomes after microwave ablation (MWA) of hepatocellular carcinoma (HCC) up to 5 cm and to determine the influence of tumor size., Materials and Methods: Electronic records were searched for HCC and MWA. Between January 2011 and September 2014, 173 HCCs up to 5 cm were treated by MWA in 129 consecutive patients (89 men, 40 women; mean age, 66.9 y ± 9.5). Tumor characteristics related to local tumor progression and primary and secondary treatment efficacy were evaluated by univariate analysis. Outcomes were compared between tumors ≤ 3 cm and tumors > 3 cm., Results: Technical success, primary efficacy, and secondary efficacy were 96.5%, 99.4%, and 94.2% at a mean follow-up period of 11.8 months ± 9.8 (range, 0.8-40.6 mo). Analysis of tumor characteristics showed no significant risk factor for local tumor progression, including subcapsular location (P = .176), tumor size (P = .402), and perivascular tumor location (P = .323). The 1-year and 2-year secondary or overall treatment efficacy rates for tumors measuring ≤ 3 cm were 91.2% and 82.1% and for tumors 3.1-5 cm were 92.3% and 83.9% (P = .773). The number of sessions to achieve secondary efficacy was higher in the larger tumor group (1.13 vs 1.06, P = .005). There were three major complications in 134 procedures (2.2%)., Conclusions: With use of current-generation MWA devices, percutaneous ablation of HCCs up to 5 cm can be achieved with high efficacy., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)
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- 2016
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34. Qualitative and Quantitative Gadoxetic Acid-enhanced MR Imaging Helps Subtype Hepatocellular Adenomas.
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Tse JR, Naini BV, Lu DS, and Raman SS
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- Adult, Contrast Media, Female, Humans, Male, Middle Aged, Adenoma pathology, Carcinoma, Hepatocellular pathology, Gadolinium DTPA, Liver Neoplasms pathology, Magnetic Resonance Imaging methods
- Abstract
Purpose: To determine which clinical variables and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging features are associated with histologically proved hepatocellular adenoma (HCA) genotypic subtypes., Materials and Methods: In this institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study, clinical information and MR images of 49 histologically proved HCAs from January 2002 to December 2013 (21 patients; mean age, 39 years; age range, 15-59 years) were retrospectively reviewed by two radiologists. Qualitative and quantitative imaging features, including the signal intensity ratio relative to liver in each phase, were studied. HCA tissues were stained with subtype-specific markers and subclassified by a pathologist. Clinical and imaging data were correlated with pathologic findings and compared by using Fisher exact or t test, with a Bonferroni correction for multiple comparisons., Results: Forty-nine HCAs were subclassified into 14 inflammatory, 20 hepatocyte nuclear factor (HNF)-1α-mutated, one β-catenin-activated, and 14 unclassified lesions. Intralesional steatosis was exclusively seen in HNF-1α-mutated lesions. Marked hyperintensity on T2-weighted images was seen in 12 of 14 (86%) inflammatory lesions compared with four of 21 (19%) HNF-1α-mutated, seven of 14 (50%) unclassified, and zero of one (0%) β-catenin-activated lesion. Two large lesions (one β-catenin-activated and one unclassified) transformed into hepatocellular carcinomas and were the only lesions to enhance with marked heterogeneity. In the hepatobiliary phase, all HCA subtypes were hypoenhancing compared with surrounding liver parenchyma, and they reached their nadir signal intensity by 10 minutes after the administration of contrast material before plateauing. HNF-1α-mutated lesions had the lowest lesion signal intensity ratio of 0.47 ± 0.09, compared with 0.73 ± 0.18 for inflammatory lesions (P = .0004), 0.82 for the β-catenin-activated lesion, and 0.73 ± 0.06 for the unclassified lesion (P = .00002)., Conclusion: In this study, all HCA subtypes were hypoenhancing at Gd-EOB-DTPA-enhanced MR imaging in the hepatobiliary phase and reached their nadir signal intensity at 10 minutes. HNF-1α-mutated lesions could be distinguished from other subtypes by having the lowest lesion signal intensity ratio.
- Published
- 2016
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35. Contrast Enhancement Patterns after Irreversible Electroporation: Experimental Study of CT Perfusion Correlated to Histopathology in Normal Porcine Liver.
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Chung DJ, Sung K, Osuagwu FC, Wu HH, Lassman C, and Lu DS
- Subjects
- Ablation Techniques methods, Animals, Male, Models, Animal, Radiography, Interventional, Swine, Ultrasonography, Interventional, Contrast Media, Electroporation methods, Liver diagnostic imaging, Liver surgery, Radiographic Image Enhancement, Tomography, X-Ray Computed
- Abstract
Purpose: To analyze ablated tissue zones after irreversible electroporation (IRE) of porcine liver using computed tomography (CT) perfusion imaging with histopathologic correlation., Materials and Methods: Under ultrasound and CT guidance, 10 IRE ablations were performed percutaneously in three Yorkshire pigs using a single bipolar electrode. CT perfusion imaging was performed in all pigs immediately after ablation and on day 2. Pathologic sections were prepared for correlation with histopathology (hematoxylin-eosin and terminal deoxynucleotidyl transferase dUTP nick end labeling stains, 5-mm-thick slices). The short diameter of different enhancing zones on CT was correlated with the gross specimen., Results: CT perfusion images showed three differently enhancing zones: zone 1, inner nonenhancing zone; zone 2, middle well-defined progressive internal enhancement zone; and zone 3, outer ill-defined arterial enhancement zone with rapid washout. On histopathology, zone 1 showed a strong correlation with a pale zone, and zone 2 correlated with a red zone, together accounting for the extent of cell death. Zone 3 was outside of the ablation zone and contained inflammatory cells. Each enhancing zone had different perfusion parameters., Conclusions: CT perfusion imaging in the acute setting effectively demonstrates histopathologic tissue zones after IRE ablation. Zone 2 is unique to IRE not seen in thermal ablation, characterized by progressive intra-zonal enhancement, and its outer boundary defines the extent of cell death., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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36. Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts.
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Park JK, Al-Tariq QZ, Zaw TM, Raman SS, and Lu DS
- Subjects
- Aged, Carcinoma, Hepatocellular diagnosis, Diagnostic Imaging, Female, Humans, Liver surgery, Liver Neoplasms diagnosis, Liver Transplantation statistics & numerical data, Male, Middle Aged, Postoperative Complications diagnosis, Radiology, Interventional, Retrospective Studies, Treatment Outcome, Carcinoma, Hepatocellular surgery, Catheter Ablation, Liver Neoplasms surgery, Portasystemic Shunt, Transjugular Intrahepatic
- Abstract
Purpose: To assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPSs), in patients with hepatocellular carcinoma (HCC)., Materials and Methods: Retrospective database review of patients with pre-existing TIPS undergoing RF ablation of HCC was conducted over a 159-month period ending in November 2013. TIPS patency pre- and post-RF ablation was assessed by ultrasound, angiography, and/or contrast-enhanced CT or MRI. Patient demographics and immediate post-RF ablation outcomes and complications were also reviewed., Results: 19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients, respectively. Eleven patients (58 %) ultimately underwent liver transplantation. Immediate technical success was seen in all ablation sessions without residual tumor enhancement (100 %). No patients (0 %) suffered liver failure within 1 month of ablation. Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88 %). Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100 %) at immediate post-ablation imaging and in 21/22 (95 %) at last follow-up (1 patient was incidentally noted to have occlusion 31 months later). No immediate complications were observed., Conclusion: Ablation efficacy was similar to the cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation.
- Published
- 2015
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37. The cost of screening esophageal varices: traditional endoscopy versus computed tomography.
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Lotfipour AK, Douek M, Shimoga SV, Sayer JW, Han SB, Jutabha R, and Lu DS
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- Costs and Cost Analysis, Humans, Endoscopy, Gastrointestinal economics, Esophageal and Gastric Varices diagnosis, Esophageal and Gastric Varices economics, Tomography, X-Ray Computed economics
- Abstract
Objective: Under current guidelines, patients diagnosed with cirrhosis are to undergo initial and continued screening endoscopy for esophageal varices throughout the course of disease. Recent literature suggests that computed tomography (CT) of the abdomen is adequately sensitive for detecting grade 3 varices, those in need of immediate intervention. This study presents a cost comparison of traditional endoscopy versus CT of the abdomen., Methods: Using TreeAge Pro software, a budget impact cost model was created for a hypothetical managed care organization covering 1 million lives over a 10-year period. Incidence figures for cirrhosis and the progression of esophageal varices were applied to the patient population. National Medicare reimbursement costs were used to compare screening with traditional endoscopy versus CT. Costs utilizing screening with combined endoscopy and CT were also examined., Results: The results of comparing screening paradigms under a budget impact cost model results in an outcome measure termed "per-member, per-month" (PMPM) cost of implementing a new strategy. Computed tomography was the least expensive modality with an average 10-year cost per screened patient of $1097.30 and PMPM of $0.03. Endoscopy was the most expensive modality with an average 10-year cost per screened patient of $1464.89 and PMPM of $0.04., Conclusion: Computed tomography has been shown to be sensitive in detecting esophageal varices and now less costly to implement in screening. The cost of esophageal rupture in endoscopy and the less costly risk of contrast reaction as well as radiation exposure in CT of the abdomen should be considered when developing a screening paradigm.
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- 2014
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38. Irreversible electroporation: ready for prime time?
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Lu DS, Kee ST, and Lee EW
- Subjects
- Ablation Techniques adverse effects, Animals, Humans, Neoplasms diagnosis, Surgery, Computer-Assisted adverse effects, Treatment Outcome, Ablation Techniques methods, Electroporation, Neoplasms surgery, Surgery, Computer-Assisted methods
- Abstract
Image-guided ablation has evolved rapidly in the past decade into a competitive technique for treating focal solid malignancies. However, as they rely mainly on thermal energy, such as radiofrequency or microwave, many tumors close to sensitive organs, such as ducts, bowel, and nerves, still remain nonablatable owing to the risk of thermal injury. Irreversible electroporation is a novel ablation modality that relies largely on a nonthermal mechanism to induce cell death, and therefore may overcome many of the shortcomings of thermal ablation. Emerging preclinical data as well as early clinical experience is showing promise for this technique in treating a variety of tumors including periportal liver masses, pancreatic cancer, perihilar renal tumors, prostate cancer, and other soft tissue tumors. However, practical limitations remain for irreversible electroporation, and its complete cancer and location-specific safety and efficacy profiles are still largely unknown. We therefore review what is known for this new ablation modality based on preclinical and preliminary clinical data, and discuss its emerging indications as well as technical challenges., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
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39. Doppler US for suspicion of hepatic arterial ischemia in orthotopically transplanted livers: role of central versus intrahepatic waveform analysis.
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Choi EK, Lu DS, Park SH, Hong JC, Raman SS, and Ragavendra N
- Subjects
- Adolescent, Adult, Aged, Algorithms, Female, Humans, Liver blood supply, Liver diagnostic imaging, Male, Middle Aged, ROC Curve, Retrospective Studies, Sensitivity and Specificity, Hepatic Artery diagnostic imaging, Ischemia diagnostic imaging, Liver Transplantation, Ultrasonography, Doppler
- Abstract
Purpose: To compare the diagnostic performance of combinations of parameters derived from main hepatic artery (MHA) and intrahepatic artery (IHA) waveforms at Doppler ultrasonography (US), with the aim of developing a systematic approach to the evaluation of the hepatic arteries in orthotopic liver transplants in patients suspected of having hepatic arterial ischemia., Materials and Methods: This HIPAA-compliant retrospective study was approved by an institutional review board, with waiver of informed consent. From January 1, 2002, to November 1, 2011, 195 transplanted livers in 189 adults (129 men, 60 women; mean age, 53 years; age range, 18-73 years) who underwent Doppler US and follow-up (computed tomographic, magnetic resonance, or conventional) angiographic study within a 2-week interval were included. Diagnostic performance of the standard IHA and MHA criteria (resistive index [RI] < 0.5 and classic parvus tardus waveforms) with and without peak systolic velocity (PSV) thresholds (determined with receiver operating characteristic curve analysis) was assessed. The results of no-flow analysis and the most optimal MHA and IHA criteria were combined to create an algorithm, which was then applied to all liver transplants., Results: The standard criteria (RI < 0.5 and classic parvus tardus) demonstrated greater sensitivity (80% vs 55%, P = .008) when applied to IHA waveforms compared with MHA waveforms. Optimal PSV cutoff values were less than 67 cm/sec and 39 cm/sec for MHA and IHA, respectively. The addition of a PSV threshold resulted in significant decrease in overall accuracy when applied to IHA (87% vs 73%, P < .001) and MHA (82% vs 66%, P = .002) criteria. Application of an algorithm reflecting a combination of the most optimal MHA and IHA criteria and the results of no-flow analysis resulted in 96% sensitivity and 83% specificity., Conclusion: An algorithmic approach involving a tailored evaluation of the geographic distribution of absent flow and the quantitative parameters and waveform morphology of the MHA and IHAs allows for improved diagnostic performance in the detection of hepatic arterial complications in at-risk patients with orthotopic liver transplants., Supplemental Material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120557/-/DC1., (RSNA, 2013)
- Published
- 2013
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40. Irreversible electroporation in porcine liver: acute computed tomography appearance of ablation zone with histopathologic correlation.
- Author
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Lee YJ, Lu DS, Osuagwu F, and Lassman C
- Subjects
- Animals, Contrast Media administration & dosage, Electrodes, Iohexol administration & dosage, Liver pathology, Radiographic Image Interpretation, Computer-Assisted, Software, Swine, Ultrasonography, Interventional, Electroporation methods, Liver diagnostic imaging, Liver surgery, Tomography, X-Ray Computed methods
- Abstract
Objective: The objective of this study was to define acute computed tomography (CT) characteristics of ablation zone created by irreversible electroporation (IRE) in porcine liver, with histopathologic correlation., Methods: Twenty-three IRE ablation zones were created in 4 Yorkshire pig livers percutaneously under image guidance. A prototype generator was used (Ethicon Endo-surgery, Cincinnati, Ohio). Variable spacing of paired electrodes between 1 and 2.0 cm was used. Contrast-enhanced multiphasic CT scans were obtained. Pigs were killed after 5 to 6 hours for gross pathology sectioning with routine and vital histological stains. Computed tomography images were analyzed using 3-dimensional software, and ablation zone size measured on CT was correlated with pathologically determined size., Results: Nineteen of 19 ablation zones created with up to 1.5-cm spacing showed fusion between individual ablation zones generated by each electrode. Ablation zones were isodense precontrast and hypodense to liver postcontrast, with best delineation in the portal phase. Nine of these had nondistorted circumferential margins on both CT and gross pathology suitable for correlation, and among these, size measurements on CT were closely correlated with pathologically determined ablation zone size. Most importantly, on the delayed venous phase, there is internal enhancement within the ablation zone itself, except for small perielectrode zones that remained hypodense. On histopathology, IRE ablation zones showed preserved microvasculature with congestion of sinusoids, except for small perielectrode zones where coagulative changes were suggested., Conclusion: Portal phase contrast-enhanced CT scans correlate well with liver IRE ablation size and shape on histopathology.
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- 2013
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41. Irreversible electroporation in porcine liver: short- and long-term effect on the hepatic veins and adjacent tissue by CT with pathological correlation.
- Author
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Lee YJ, Lu DS, Osuagwu F, and Lassman C
- Subjects
- Animals, Cell Membrane, Disease Models, Animal, Imaging, Three-Dimensional, Liver pathology, Statistics as Topic, Swine, Electroporation methods, Hepatic Veins physiology, Liver blood supply, Tomography, X-Ray Computed methods
- Abstract
Objective: The objective of the study was to determine the short- and long-term effects of irreversible electroporation (IRE) on the hepatic veins and the perivascular tissue through serial computed tomography (CT) with pathological correlation., Materials and Methods: Multiple IRE lesions were created percutaneously by ultrasound guidance in livers of 11 Yorkshire pigs using a prototype IRE generator. Paired electrodes were used. Three pigs were killed at the same day; 2 pigs, at 2 days; 2 pigs, at 2 weeks; 2 pigs, at 4 weeks; and 2 pigs, at 8 weeks. Contrast-enhanced CT was performed in all pigs initially and thereafter at selected intervals. Pathological sections were performed for correlation. Initial CT scans were analyzed for lesions for degree of circumferential contact (< 25%, 26%-50%, 51%-75%, and 76%-100%) to the hepatic veins for analysis of any contour deformity. The hepatic veins were also analyzed for any thrombus and for any narrowing. Those lesions with follow-up scans were also analyzed for changes over time., Results: Twenty-three lesions showed contiguity to the hepatic veins between 3 to 9 mm in size at the initial CT. No contour deformity due to perivascular tissue sparing is detected for any lesion. There was no thrombus detected in any vessel at any time point. Vessel narrowing was seen in 9 of 23 veins on the initial CT, all less than 50% in diameter and all with lesion contact of greater than 25% in circumference, but 2 of 3 veins with follow-up scans showed return-to-normal caliber. No late narrowing of any hepatic vein was seen on the long-term follow-up., Conclusion: Irreversible electroporation creates uniform tissue ablation around the hepatic veins without perivascular tissue sparing. Vessel narrowing may occur acutely but without long-term sequela.
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- 2012
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42. Clear cell renal cell carcinoma: multiphasic multidetector CT imaging features help predict genetic karyotypes.
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Sauk SC, Hsu MS, Margolis DJ, Lu DS, Rao NP, Belldegrun AS, Pantuck AJ, and Raman SS
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Renal Cell pathology, Chromosomes, Human, Pair 5, Chromosomes, Human, Pair 7, Contrast Media, Female, Humans, Iohexol, Karyotype, Kidney Neoplasms pathology, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Trisomy, Carcinoma, Renal Cell diagnostic imaging, Carcinoma, Renal Cell genetics, Kidney Neoplasms diagnostic imaging, Kidney Neoplasms genetics, Multidetector Computed Tomography methods
- Abstract
Purpose: To determine whether imaging characteristics at multiphasic multidetector computed tomography (CT) correlate with common karyotypic abnormalities in patients with clear cell renal cell carcinomas (ccRCCs)., Materials and Methods: Institutional review board approval was obtained, and informed consent was waived for this HIPAA-compliant retrospective study. From January 2000 through September 2007, the prenephrectomy multiphasic (corticomedullary, nephrographic, and excretory phases), multidetector helical CT images of 58 histologically proved and karyotyped ccRCCs were reviewed by two readers with experience in abdominal imaging. Imaging features assessed included degree of attenuation, contour, and presence of calcifications and neovascularity. These features were independently correlated with specific karyotypic abnormalities on the resected specimens. Degree of attenuation data were analyzed with logistic regression for significance (P < .05), and morphologic characteristics were analyzed with odds ratios for assessing their diagnostic power., Results: On unenhanced scans, 7% (two of 28) of ccRCCs with the loss of chromosome 3p were calcified, whereas 37% (11 of 30) of lesions without this anomaly were calcified (odds ratio, 0.13). During the corticomedullary phase, ccRCCs with the loss of chromosome Y enhanced more than those without this anomaly (130.0 vs 102.5 HU, P = .04), and ccRCCs with trisomy 7 enhanced less than those without this anomaly (105.8 vs 139.3 HU, P = .04). During the excretory phase, ccRCCs with trisomy 5 enhanced more than those without this anomaly (115.5 vs 83.4 HU, P = .03)., Conclusion: The genetic makeup of ccRCCs affects their imaging features at multidetector CT examinations. Multidetector CT imaging characteristics may help suggest differences at the cytogenetic level among ccRCCs., (© RSNA, 2011.)
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- 2011
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43. Detection and grading of esophageal varices on liver CT: comparison of standard and thin-section multiplanar reconstructions in diagnostic accuracy.
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Yu NC, Margolis D, Hsu M, Raman SS, and Lu DS
- Subjects
- Adult, Aged, Aged, 80 and over, Esophageal and Gastric Varices pathology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Radiographic Image Interpretation, Computer-Assisted, Sensitivity and Specificity, Esophageal and Gastric Varices diagnostic imaging, Liver Cirrhosis diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Objective: The objective of our study was to evaluate the performance of liver CT in the diagnosis of esophageal varices in patients with cirrhosis and to determine whether thin-section multiplanar reconstructions (MPRs) improve accuracy., Materials and Methods: We identified 109 patients with cirrhosis who underwent endoscopy within 10 weeks after dual-phase liver MDCT supplemented with thin-section axial and coronal portal venous phase reconstructions. Two blinded radiologists independently evaluated each CT examination for the presence and sizes of varices using standard 5-mm axial versus 1- to 3-mm multiplanar images in separate sessions. Sensitivity, specificity, and predictive value calculations and receiver operating characteristic analysis were performed using endoscopy as the reference standard. Interobserver variability and correlation of CT size to variceal grade were assessed., Results: Twenty-six cases of high-risk esophageal varices were identified; all except two were detected on CT by one of the readers on standard 5-mm images. For both readers, sensitivity and negative predictive value (NPV) for the discrimination of high-risk varices using a criterion of 2 mm or greater were nearly the same for the standard 5-mm images versus the 1- to 3-mm multiplanar images (sensitivity and NPV: reader 1, 96% and 98% vs 96% and 99%; reader 2, and 89% and 95% vs 89% and 96%, respectively). Standard 5-mm images yielded a lower specificity for high-risk esophageal varices than the thin-section multiplanar images, and this difference was statistically significant for reader 2. Substantial interobserver agreement was noted for both esophageal varices detection and size measurements., Conclusion: Standard liver CT is sensitive for the detection of high-risk varices and deserves further investigation as a potential cost-effective screening tool for the evaluation of patients with cirrhosis. The addition of 1- to 3-mm MPRs may increase specificity for risk stratification based on size measurements.
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- 2011
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44. CT and MRI improve detection of hepatocellular carcinoma, compared with ultrasound alone, in patients with cirrhosis.
- Author
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Yu NC, Chaudhari V, Raman SS, Lassman C, Tong MJ, Busuttil RW, and Lu DS
- Subjects
- Adolescent, Adult, Aged, Carcinoma, Hepatocellular etiology, Carcinoma, Hepatocellular therapy, False Positive Reactions, Female, Humans, Liver Cirrhosis complications, Liver Neoplasms etiology, Liver Neoplasms therapy, Male, Middle Aged, Retrospective Studies, Sensitivity and Specificity, alpha-Fetoproteins analysis, Carcinoma, Hepatocellular diagnosis, Liver Neoplasms diagnosis, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Ultrasonography
- Abstract
Background & Aims: In patients with cirrhosis, hepatocellular carcinoma (HCC) is detected by ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI); US is recommended for screening and surveillance. We performed a retrospective analysis of the abilities of these cross-sectional imaging modalities to detect HCC., Methods: We analyzed data from 638 consecutive adult patients with cirrhosis who received liver transplants within 6 months of imaging at a tertiary care institution. Imaging reports and serum alpha-fetoprotein levels were compared with results from pathology analysis of explants as the reference standard. Sensitivities of US, CT, and MRI were calculated overall and in defined size categories. False-positive imaging results and patient-based specificities were evaluated., Results: Of the 638 patients, 225 (35%) had HCC, confirmed by pathology analysis of liver explants. In 23 cases, the lesions were infiltrative or extensively multifocal. In the remaining 202 explants (337 numerable, discrete nodules), respective lesion-based sensitivities of US, CT, and MRI were 46%, 65%, and 72% overall and 21%, 40%, and 47% for small (<2 cm) HCC. The sensitivity of US increased with the availability of CT or MRI data (P = .049); sensitivity values were 62% and 85% for lesions 2-4 and ≥ 4 cm, respectively. Patient-based specificities of US, CT, and MRI were 96%, 96%, and 87%, respectively., Conclusions: US, CT, and MRI did not detect small HCC lesions with high levels of sensitivity, although CT and MRI provide substantial improvements over unenhanced US in patients with cirrhosis who received liver transplants., (Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.)
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- 2011
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45. Efficacy of CT angiography for preoperative vascular mapping in adult to adult living related liver transplant donors.
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Apisarnthanarak P, Raman SS, Ghobrial RM, Busuttil RW, Saab S, and Lu DS
- Subjects
- Adult, Female, Hepatic Artery diagnostic imaging, Hepatic Artery surgery, Hepatic Veins diagnostic imaging, Hepatic Veins surgery, Humans, Liver blood supply, Liver diagnostic imaging, Liver surgery, Male, Portography, Preoperative Care methods, Retrospective Studies, Angiography methods, Hepatic Artery anatomy & histology, Hepatic Veins anatomy & histology, Liver Transplantation, Living Donors, Tomography, X-Ray Computed methods
- Abstract
Objective: To assess the utility of CT angiography (CTA) in preoperative mapping of hepatic vascular anatomy in adult-to-adult living related liver transplant (LRLT) donors., Material and Method: Over a 3-year period, 32 potential LRLTdonors underwent CTA with subsequent comparison studies [digital subtraction angiography (DSA) and/or transplantation] were included in this study. Their CTA reports were retrospectively correlated with available DSA and/or operative findings., Results: CTA correctly predicted right lobe arterial and portal venous anatomy in 32/32 (100%) donors. In 27 donors, hepatic venous anatomy on CT was compared with operative findings. The hepatic veins were well opacified in 23/27 (85.2%) donors. Of these, 15/16 (93.8%) significant (> or =5 mm) accessory right hepatic veins and 11/11 (100%) significant segment VIII vein draining to middle hepatic vein were detected., Conclusion: CTA provided an excellent preoperative depiction of hepatic vascular anatomy in LRLT donors.
- Published
- 2011
46. Performance of multidetector computed tomographic angiography in determining surgical resectability of pancreatic head adenocarcinoma.
- Author
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Kaneko OF, Lee DM, Wong J, Kadell BM, Reber HA, Lu DS, and Raman SS
- Subjects
- Adenocarcinoma pathology, Adenocarcinoma surgery, Adult, Aged, Aged, 80 and over, Angiography methods, Contrast Media administration & dosage, Female, Humans, Iohexol administration & dosage, Male, Middle Aged, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Patient Selection, Predictive Value of Tests, Sensitivity and Specificity, Adenocarcinoma diagnostic imaging, Pancreatic Neoplasms diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Objective: To evaluate the performance of multidetector computed tomographic angiography (MDCTA) in assessing the surgical resectability of pancreatic head adenocarcinoma., Methods: With institutional review board approval, radiographic, surgical, and pathological records of 203 consecutive patients with adenocarcinoma of the pancreatic head were analyzed retrospectively. Patients were imaged with MDCT scanners using our institution's CTA pancreatic protocol. Images were compared with surgical outcomes to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCTA in determining resectability., Results: Data were analyzed twice, once with equivocal findings on MDCTA assumed as resectable and again with equivocal cases assumed as unresectable. All equivocal cases were ultimately unresectable; when this was assumed, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were determined to be 100%, 71%, 85%,100% and 89%. Twelve patients deemed resectable by preoperative MDCTA were found to be unresectable on surgical exploration owing to vascular involvement (n = 4), liver metastases (n = 4), and peritoneal involvement (n = 4)., Conclusions: Multidetector CT angiography offers accurate and valuable preoperative assessment of surgical resectability of pancreatic ductal adenocarcinoma. Liver and peritoneal metastases and vascular invasion still remain important pitfalls in preoperative evaluation.
- Published
- 2010
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47. Survival in Asian Americans after treatments for hepatocellular carcinoma: a seven-year experience at UCLA.
- Author
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Tong MJ, Chavalitdhamrong D, Lu DS, Raman SS, Gomes A, Duffy JP, Hong JC, and Busuttil RW
- Subjects
- Aged, Algorithms, Asian, California epidemiology, Carcinoma, Hepatocellular ethnology, Carcinoma, Hepatocellular therapy, Catheter Ablation, Disease-Free Survival, Female, Follow-Up Studies, Humans, Liver Function Tests, Liver Neoplasms ethnology, Liver Neoplasms therapy, Liver Transplantation methods, Male, Middle Aged, Retrospective Studies, Survival Rate, Carcinoma, Hepatocellular mortality, Hepatitis B complications, Hepatitis C complications, Liver Neoplasms mortality
- Abstract
Background/rationale: Hepatocellular carcinoma (HCC) is a common malignancy in Asians and is related to the high incidence of chronic viral hepatitis in this ethnic population. The aims of this study were to examine the tumor characteristics and liver disease status in HCC patients of Asian ancestry and determine their survival after treatments for HCC., Results: Between September 2000 and December 2007, 278 patients, mean age 61.5 years, presented with HCC to the University of California Los Angeles (UCLA) Liver Cancer Center. Hepatitis B (HBV) infection was detected in up to 68% of Chinese, Korean, and Vietnamese patients, whereas 60% of Japanese patients had Hepatitis C (HCV) infection. Compared with HCC patients who presented with symptoms, those detected by surveillance had more tumors within the Milan and University of California, San Francisco (UCSF) criteria and more patients in Child-Turcotte-Pugh class A. On the basis of a predefined UCLA treatment algorithm, 83% of patients received surgical and/or loco-regional therapies. Compared with other treatments, orthotopic liver transplantation (OLT), and radiofrequency ablation had the highest overall patient survival (P<0.0001) and OLT has the highest disease free survival rates (P<0.0001). Independent baseline predictors for: (1) patient survival were HBV [hazard ratio (HR) 0.62, P=0.005], UCSF criteria (HR 0.46, P<0.0001), Child Turcotte Pugh class A (HR 0.57, P=0.005), alphafetoprotein per log10 increase (HR 1.26, P=0.0012), and alkaline phosphatase per log10 increase (HR 2.32, P=0.02); and for (2) disease free survival were UCSF criteria (HR 0.66 P=0.007), aspartate aminotransferase per log10 increase (HR 1.50, P=0.04), and age per year increase (HR=1.02, P=0.04). The 4 Asian subgroups had similar survival rates., Conclusions: HBV and Hepatitis C were associated with over 90% of HCC cases in Asian Americans. HCC detected by surveillance identified more patients eligible for surgical and loco-regional therapies, which improved the overall and disease free survival.
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- 2010
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48. Ten-year experience with nephrogenic systemic fibrosis: case-control analysis of risk factors.
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Bahrami S, Raman SS, Sauk S, Salehmoghaddam S, Villablanca JP, Finn JP, and Lu DS
- Subjects
- Adolescent, Adult, Biopsy, Case-Control Studies, Chi-Square Distribution, Child, Erythropoietin therapeutic use, Female, Humans, Incidence, Male, Middle Aged, Nephrogenic Fibrosing Dermopathy epidemiology, Nephrogenic Fibrosing Dermopathy therapy, Renal Dialysis, Risk Factors, Sex Factors, Contrast Media adverse effects, Gadolinium adverse effects, Immunosuppressive Agents adverse effects, Magnetic Resonance Imaging, Nephrogenic Fibrosing Dermopathy chemically induced
- Abstract
Objectives: To analyze all cases of nephrogenic systemic fibrosis (NSF) at our institution and to compare them with controls., Methods: After the institutional review board approval, 13 biopsy-proven NSF cases were identified. Ten cases had complete records and were compared in a case-control format with 10 age- and sex-matched, dialysis-dependent controls. Analyzed risk factors included single and cumulative gadolinium dose, medication and transplant history, and serum electrolytes at the time of gadolinium exposure., Results: There were 1.9% of dialysis-dependent, gadolinium-exposed patients who developed NSF. There was no difference in gadolinium dose, transplant history, or serum electrolytes. Seven of 10 cases and 3 of 10 controls were treated with erythropoietin (P = 0.13). At the time of NSF diagnosis, 7 of 10 cases were on immunosuppressive therapy. Two of 7 cases developed NSF only after immunosuppressive therapy was initiated. Two of 10 controls were on immunosuppressive therapy (P = 0.06)., Conclusions: All cases of NSF occurred in dialysis-dependent, gadolinium-exposed patients. Associations between immunosuppressive and erythropoietin therapies and NSF need further investigation.
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- 2009
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49. Staging of pancreatic adenocarcinoma by imaging studies.
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Wong JC and Lu DS
- Subjects
- Endosonography, Humans, Magnetic Resonance Imaging, Positron-Emission Tomography, Predictive Value of Tests, Sensitivity and Specificity, Tomography, X-Ray Computed, Ultrasonography, Adenocarcinoma diagnosis, Adenocarcinoma pathology, Pancreas diagnostic imaging, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms pathology, Severity of Illness Index
- Abstract
Imaging studies play a crucial role in the diagnosis and management of patients with pancreatic adenocarcinoma. Computed tomography (CT) is the most widely available and best-validated modality for imaging patients with pancreatic adenocarcinoma. To maximize the diagnostic efficacy of CT, use of a pancreas protocol is mandatory. The sensitivity of CT for diagnosis of pancreatic adenocarcinoma (89%-97%) and its positive predictive value for predicting unresectability (89%-100%) are high. The positive predictive value of CT for predicting resectability (45%-79%) is low because the diagnostic criteria for diagnosing vascular invasion by tumor favors specificity over sensitivity to avoid denying surgery to patients with potentially resectable tumor. Furthermore, the sensitivity of CT for small hepatic and peritoneal metastases is limited. Magnetic resonance imaging has not been shown to perform better than CT for the diagnosis and staging of pancreatic adenocarcinoma, but can be helpful as an adjunct to CT, particularly for evaluation of small hepatic lesions that cannot be fully characterized by CT. Ultrasound is often the first study obtained in patients with obstructive jaundice or unexplained abdominal pain, but its utility for diagnosis and staging of patients with pancreatic adenocarcinoma is limited. Positron emission tomography/CT combines the functional information provided by positron emission tomography with the anatomic information provided by CT and is a promising modality for imaging of patients with pancreatic adenocarcinoma, but its utility has not been established. Endoscopic ultrasound is generally considered superior to CT for the diagnosis and local staging of pancreatic cancer, but is limited by availability and inability to assess for distant metastases.
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- 2008
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50. Pancreatic cystic lesions: discrimination accuracy based on clinical data and high-resolution computed tomographic features.
- Author
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Chaudhari VV, Raman SS, Vuong NL, Zimmerman P, Farrell J, Reber H, Sayre J, and Lu DS
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pancreatic Cyst diagnostic imaging, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms diagnostic imaging, Regression Analysis, Retrospective Studies, Pancreatic Cyst diagnosis, Tomography, X-Ray Computed
- Abstract
Objective: To determine the frequency of typical features of pancreatic cystic lesions on high-resolution computed tomography and the combination of features that best influences discrimination., Methods: Ten computed tomography features of 100 proven pancreatic cystic lesions were retrospectively tabulated by 2 blinded imagers. After final diagnosis was revealed, each lesion was categorized as typical or atypical. Stepwise multivariable logistic regression was used to determine which of 10 imaging and 4 clinical features significantly distinguished between benign and malignant lesions., Results: There were 38 benign cysts and 62 cystic tumors. Serous lesions presented with greater than 6 cysts (83%) and cysts of less than 2 cm (44%). Mucinous lesions presented with cysts of 2 cm or greater (82%) and less than 6 cysts (64%). Pseudocysts, serous, and mucinous lesions presented typically in 77%, 67%, and 64% of cases, respectively. The significant variables in classifying malignant lesions are pancreatitis history, cyst size, symptoms, and calcification pattern (area under the curve, 0.837)., Conclusions: Four specific imaging and clinical features in combination best predict a malignant lesion.
- Published
- 2008
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