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• The guideline covers diagnosis, staging, risk assessment, treatment, disease monitoring and follow-up. • The multidisciplinary expert author group is from different institutions and countries in Europe, Asia and the USA. • Recommendations are based on available scientific data and the authors' collective expert opinion. • ESMO-MCBS and ESCAT scores provide levels of evidence for treatment choices, including targeted therapies. • In clinical practice, all recommendations provided need to be discussed with patients in a shared decision-making approach. [ABSTRACT FROM AUTHOR]

Abstract: The main aim of this multicentre prospective study was to determine the clinical value of SonoVue® administration for the characterisation of focal liver lesions incidentally detected in oncological or cirrhotic patients. Eight hundred and seventy four consecutive patients with 1034 nodules (diameter between 5 and 100mm) not fully characterised by conventional US or previous single-phase CT-scan were imaged using real-time contrast-enhanced scanning after intravenous injection of 2.4ml of SonoVue® Blinded off-site assessment was conducted to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in comparison with gold standard, i.e. triphasic CT-scan or contrast-enhanced MRI or histology. In the differentiation between benign and malignant lesions, CEUS yielded a sensitivity of 79.4% and a specificity of 88.1%. In the subgroup of patients with cirrhosis, the kappa value for off-site diagnosis between CEUS and reference modality was slightly lower compared to the non-cirrhotic group: 0.42 and 0.66 (p =0.0002), respectively. The concordance rate and kappa value of CEUS for benign to malignant differentiation between on-site and blinded review were 90.2% and 0.80%, respectively, compared to 83.4% and 0.66%, respectively, for the reference imaging technique. These results indicate that CEUS using SonoVue® is a competitive and effective diagnostic tool for the characterisation of focal liver lesions compared to other modalities such as CT and MR imaging. [Copyright &y& Elsevier]

Cholangiocarcinoma (CCA) is an adenocarcinoma that arises from the bile duct epithelium and is observed in the entire biliary tree (intrahepatic, hilum, and extrahepatic distal). The staging of this tumor differs depending on location. The role of imaging in the staging of hilar CCA is to assess the extent of ductal involvement by the tumor, hepatic artery, or portal venous involvement, the functional status and volumetric assessment of the underlying liver, and the regional or distant tumor extension. Complete assessment is done by combining magnetic resonance (MR) cholangiography and multidetector computed tomography (CT). Multidetector CT, in particular, is accurate for resectability and the negative predictive value (patients with disease classified as unresectable and in whom unresectability has been confirmed) is quite high: 85-100%. The role of imaging in the staging of intrahepatic CCA is to evaluate resectability based on the tumor itself, vascular involvement, regional and distal extension, and volumetric assessment of the contralateral liver, and to determine the prognostic factors. These factors are mainly: tumor size, the presence of satellite nodules, vascular involvement, and lymph nodes. CT and MR imaging (MRI) are keys and their results are comparable. In distal extrahepatic CCA due to tumor location, staging is focused mainly on the adjacent vessels (portal vein and hepatic artery), the hepatoduodenal ligament, the proximal and distal biliary extent, and pancreatic invasion. CT and MRI are mandatory. [ABSTRACT FROM AUTHOR]

Background: Aim of this retrospective study was to compare induction of left liver hypertrophy after right portal vein ligation (PVL) and right portal vein embolization (PVE) before right hepatectomy for liver metastases.Materials and Methods: Between 1998 and 2005, 18 patients underwent a PVE, whereas 17 patients underwent a PVL during a first stage laparotomy.Results: There was no complication related to PVE or PVL. After a similar interval time (7 +/- 3 vs 8 +/- 3 weeks), the increase of the left liver volume was similar between the two groups (35 +/- 38 vs 38 +/- 26%). After PVE and PVL, right hepatectomy was performed in 12 and 14 patients, respectively. Technical difficulties during the right hepatectomy were similar according to duration of procedure (6.4 +/- 1 vs 6.7 +/- 1 h, p = 0.7) and transfusion rates (33 vs 28%, p = 0.7). Mortality was nil in both groups, and morbidity rates were respectively 58% for the PVE group and 36% for the PVL group (p = 0.6).Conclusion: Right PVL and PVE result in a comparable hypertrophy of the left liver. During the first laparotomy of a two-step liver resection, PVL can be efficiently and safely performed. [ABSTRACT FROM AUTHOR]

Background: Dynamic contrast-enhanced ultrasonography (DCE-US) has been used for evaluation of tumor response to antiangiogenic treatments. The objective of this study was to assess the link between DCE-US data obtained during the first week of treatment and subsequent tumor progression. Patients and methods: Patients treated with antiangiogenic therapies were included in a multicentric prospective study from 2007 to 2010. DCE-US examinations were available at baseline and at day 7. For each examination, a 3 min perfusion curve was recorded just after injection of a contrast agent. Each perfusion curve was modeled with seven parameters. We analyzed the correlation between criteria measured up to day 7 on freedom from progression (FFP). The impact was assessed globally, according to tumor localization and to type of treatment. Results: The median follow-up was 20 months. The mean transit time (MTT) evaluated at day 7 was the only criterion significantly associated with FFP (P = 0.002). The cut-off point maximizing the difference between FFP curves was 12 s. Patients with at least a 12 s MTT had a better FFP. The results according to tumor type were significantly heterogeneous: the impact of MTT on FFP was more marked for breast cancer (P = 0.004) and for colon cancer (P = 0.025) than for other tumor types. Similarly, the differences in FFP according to MTT at day 7 were marked (P = 0.004) in patients receiving bevacizumab. Conclusion: The MTT evaluated with DCE-US at day 7 is significantly correlated to FFP of patients treated with bevacizumab. This criterion might be linked to vascular normalization. [ABSTRACT FROM AUTHOR]

Abstract: Background: Whole-body CT scan is the cornerstone of trauma-related injury assessment. Several lines of evidence indicate that significant number of injuries may remain undetected after the initial hot report of CT. Missed injuries (MI) represent an important issue in trauma patients, for they may increase morbidity, mortality and costs. The aim of this study was to examine incidence and predictors of MI in trauma patients undergoing whole-body CT scan. Methods: 177 CT scan performed upon admission of trauma patients during year 2005 were reviewed by a radiologist blinded to patient''s initial data. MI was defined as injuries not written in the initial report. Patients with and without MI were compared to determine predictors of MI by multivariable analysis. Results: 157 MI were diagnosed in 85 (47%) patients. MI was predominantly encoded AIS 2 (57%) or 3 (29%). Patients with MI had significantly higher SAPSII, higher ISS and were more frequently sedated. Age over 50 years (OR: 4.37, p =0.003) and ISS over 14 (OR: 4.17, p <0.0001) were independent predictors of MI. Median ISS after encoding MI was significantly higher than initial ISS (22 vs. 20 p <0.0001). After adjustment for severity, mortality and length of stay were not different between patients with or without MI. Conclusion: Trauma patients, especially aged and severe, experienced a high rate of missed injuries in the initial hot report which appeared to be predominantly minor and musculoskeletal, advocating a CT scan second reading. [Copyright &y& Elsevier]

Aim: To retrospectively establish the most frequently encountered diagnoses in patients with pancreatic calcifications and to investigate whether the association of certain findings could be helpful for diagnosis. Materials and methods: One hundred and three patients were included in the study. The location and distribution of calcifications; presence, nature, and enhancement pattern of pancreatic lesions; pancreatic atrophy and ductal dilatation were recorded. Differences between patients with chronic pancreatitis and patients with other entities were compared by using Fisher''s exact test. Results: Patients had chronic pancreatitis (n =70), neuroendocrine tumours (n =14), intraductal papillary mucinous neoplasm (n =11), pancreatic adenocarcinoma (n =4), serous cystadenoma (n =4). Four CT findings had a specificity of over 60% for the diagnosis of chronic pancreatitis: parenchymal calcifications, intraductal calcifications, parenchymal atrophy, and cystic lesions. When at least two of these four criteria were used in combination, 54 of 70 (77%) patients with chronic pancreatitis could be identified, but only 17 of 33 (51%) patients with other diseases. When at least three of these four criteria were present, a specificity of 79% for the diagnosis of chronic pancreatitis was achieved. Conclusion: Certain findings are noted more often in chronic pancreatitis than in other pancreatic diseases. The presence of a combination of CT findings can suggest chronic pancreatitis and be helpful in diagnosis. [Copyright &y& Elsevier]

Focal nodular hyperplasia is a benign hypervascular hepatic tumour, frequently detected in asymptomatic patients undergoing imaging studies for unrelated reasons. Magnetic resonance imaging (MRI) generally allows a confident differential diagnosis with other hypervascular liver lesions, either benign or malignant. In addition, due to the recent development of hepatospecific MRI contrast agents, MRI concomitantly enables functional and morphological information to be obtained, thus providing important clues for the detection and characterization of focal nodular hyperplasia lesions. [Copyright &y& Elsevier]

Acute pancreatitis can complicate non-selective transcatheter arterial embolization of hepatocellular carcinoma with an incidence ranging from 1,7% (acute clinical pancreatitis) to 40% (biological pancreatitis). This complication is thought to be related to embolization of extrahepatic arterial collaterals.We report herein a case of acute clinical pancreatitis developing within 24 hours after a second course of selective transcatheter arterial chemo-embolization into the proper hepatic artery. Neither anatomical arterial variation nor particular risk factor for acute pancreatitis could be identified. This complication is unusual after selective arterial embolization. Because it may clinically mimick a postembolization syndrome, dosage of serum pancreatic enzymes should be performed systematically in case of abdominal pain following chemoembolization. [Copyright &y& Elsevier]

Aim: To evaluate the diagnosis and presentation of liver tumours in patients with congenital portosystemic shunts (CPS). Materials and methods: Eight patients were diagnosed in Hôpital Beaujon as having CPS. All patients underwent Doppler ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and histological examination of liver tumours. CPS were classified according to anatomy and the amount of portal flow deviated to the systemic circulation as: total, subtotal, or partial. Liver tumours were diagnosed by needle core biopsy (n = 5) or surgery (n = 3). Clinical follow-up was available in all patients but one (mean follow-up 36 months; range 1–5 years). Results: Six patients had total CPS, one patient had a subtotal CPS, and the last had a partial CPS. All patients presented with multiple liver nodules (range four to >15). The tumours were characterized as focal nodular hyperplasia (FNH; n = 4), FNH with hepatocellular adenoma (n = 2), and regenerative nodular hyperplasia (n = 2). In four of seven patients (57%) that had follow-up, tumours showed enlargement or new lesions appeared. Conclusion: In this series of CPS patients, tumours were all benign, multiple, and of hepatocellular origin, and different tumours were present simultaneously in two patients. Tumour enlargement or new nodules were common during follow-up. [ABSTRACT FROM AUTHOR]

In this article, we present the computed tomographic and magnetic resonance imaging characteristics of the cirrhotic liver. We describe the altered liver morphology in different forms of viral, alcoholic, and autoimmune end-stage liver disease. We present the spectrum of imaging findings in portal hypertension, such as splenomegaly, ascites, and varices. We describe the patchy and lacelike patterns of fibrosis, along with the focal confluent form. The process of hepatocarcinogenesis is detailed, from regenerative to dysplastic nodules to overt hepatocellular carcinoma. Different types of nonneoplastic focal liver lesions occurring in the cirrhotic liver are discussed, including arterially enhancing nodules, hemangiomas, and peribiliary cysts. We show different conditions causing liver morphology changes that can mimic cirrhosis, such as congenital hepatic fibrosis, “pseudocirrhosis” due to breast metastases treated with chemotherapy, Budd-Chiari syndrome, sarcoidosis and carvenous transformation of the portal vein. [Copyright &y& Elsevier]