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Query: UMLS:C0345904 (liver cancer)
 15,188 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The choice of management for the patient with HCC hinges on precise localization and staging of the disease process. All the major imaging modalities are employed to achieve this end. US is frequently the initial means of detection of the lesion. Since percutaneous needling may lead to tumour dissemination, the temptation to proceed to imaging-guided biopsy should be resisted until a full evaluation has been completed and it is clear that neither curative surgery nor transplantation is a therapeutic option. CT scanning is considered to be superior to ultrasound both in detection and staging of the disease. A variety of modifications to the technique, including CT arterio-portography and lipiodol-CT, is used to obtain optimum results. The role of MRI has not yet been established but initial results suggest that this may be the optimum means of scanning the patient following percutaneous or intra-arterial therapy. Angiography is generally performed prior to resection and may be combined with the delivery of chemotherapeutic and embolic agents pre-operatively or as a definitive palliative procedure. Imaging-guided percutaneous alcohol is also a useful palliative measure where the lesion is small. In the majority of cases, resection is not feasible. In a selected few liver transplantation is an option. Imaging requirements of the potential liver transplant candidate depend on the nature of the underlying liver problem. A general assessment including a chest X-ray and US with Doppler imaging of the hepatic vascular structures is sufficient in the majority. In children with complex structural anomalies and in patients with bile duct disease or tumours, the full range of investigations is required. US, cholangiography CT and angiography may all be required in the diagnosis and management of post-transplant complications.
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PMID:Imaging: focus on hepatocellular carcinoma and liver transplantation. 890 5

To demonstrate the usefulness of iron colloid-enhanced MR images in differentiating hepatocellular carcinoma (HCC) from hyperplastic nodules (HN), microautoradiographs of chemically induced rat liver tumours were prepared 4 h after intravenous injection of chondroitin sulphate iron colloid (CSIC) labelled with 59Fe by the dipping technique. 20 Wistar rats were allocated into three groups: (1) a normal group, 10; (2) an HN group, 5; and (3) a liver cancer (LC) group, 5. In the I.C group, a diet containing 0.06% 3'-methydiaminobenzine tetrahydro-chloride (DAB) was administered for 3 months. In the HN group, a diet containing 0.025% acetylaminofluorene (AAF) was administered for 4 months. Non-labelled CSIC was intravenously injected into five rats in the normal group, and pseudomicroautoradiographs were prepared using the same technique (normal cold group). 50 sites for examination were randomly selected for each of the normal liver tissue, HN, well-differentiated HCC (HCC-W), and moderately to poorly-differentiated HCC (HCC-MP). The number of Kupffer cell-like macrophages and the photosensitized area ratio (PAR) per field of view were calculated. There was no significant difference in either the number of Kupffer cell-like macrophages or the PAR between HN and normal liver tissue. Although there was no significant difference in the number of these cells between groups HN and HCC-W, the PAR in group HCC-W was significantly lower than that in group HN (p = 0.045). In HCC-MP, both their number (p = 0.003) and the PAR (p = 1.18 x 10(-9)) were significantly lower than in group HCC-W. However, the PAR in HCC-MP was significantly higher than those in the normal cold group (p = 0.019). Iron colloid-enhanced MRI is useful for differentiating HCC from HN, and for diagnosing the degree of HCC differentiation.
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PMID:Usefulness of iron colloid-enhanced MRI in differentiating experimental hepatocellular carcinoma from hyperplastic nodules in rats: analysis by microautoradiography. 913 70

We conducted a retrospective study on the relation of the preoperative imaging patterns to the prognosis of patients with small HCC after hepatectomy. Forty patients with small HCC less than 2 cm in diameter without vascular invasion were enrolled in this study. There were no significant differences in the signal intensity of T1WI on MRI, and angiographic findings such as neo-vascularity or tumor stain. Ultrasonographical images of the internal of tumor were classified into two groups. Six cases with homogeneous pattern were significantly worse in cumulative survival rate than 28 cases with heterogeneous pattern (p = 0.0012). The same results were obtained with respect to limitation of cases treated by relative curative operation (p = 0.0041). It was concluded that histopathological grading and malignant potential of small HCC could be evaluated by classification of the pattern of internal ultrasonographical images, and complete locoregional therapy, and that intense course observation for cases with ultrasonographical homogeneous pattern would be important.
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PMID:[Prognosis and preoperative imaging of patients with small hepatocellular carcinoma]. 938 17

We report the experience of our general hospital in selecting the patients for orthotopic liver transplantation (OLT). Fifty-one patients with cirrhosis were examined and 20 of them submitted to OLT from August, 1992, to November, 1995. For liver studies, the 20 transplant recipients were examined with US and plain and dynamic CT; 15/20 were submitted to CTAP, 10/20 to Lipiodol CT and 17/20 to angiography. The accuracy of these techniques in HCC detection was assessed by correlation with resected whole livers. The accuracy of duplex Doppler and color flow Doppler for portal and/or mesenteric vein thrombosis was evaluated by correlation with resected livers, CT and angiographic findings. Pathologic examinations diagnosed HCC in 5/20 transplant recipients: 2 lesions (1.5 cm and 2 cm; 2 cm and 3.5 cm) were found in 2 resected specimens (total hepatectomy) and 1 lesion was found in 3 cases (2.5 cm, 1.5 cm, 1 cm). The sensitivity of US, plain and dynamic CT in identifying HCC patients was 20%; US and CT specificity rates were 100% and 87%, respectively. CTAP sensitivity was 75% and the sensitivity of Lipiodol CT and angiography was 100%. Therefore, in our series, US was poorly sensitive in the detection of liver cancers, which may depend on the small number of patients, lesion size (< or = 3.5 cm) and the radiologists ignoring clinical and laboratory data on purpose. Nevertheless, the patients with a single HCC not exceeding 5 cm phi or with no more than 3 tumors, none of them exceeding 3 cm phi, are generally considered eligible for transplantation: therefore, our patients chosen for OLT on the basis of US and CT findings were actually eligible for transplantation in spite of US and CT false negative results. At US, the portal vein had an average caliber of 13.5 +/- 2.5 mm in 21/51 patients; the average caliber of the common hepatic artery was 6 +/- 1.5 mm in 49/51 patients; average spleen length was 174 +/- 38 mm. US showed ascites in 28/51 cases. In conclusion, considering also the long stand-by list for OLT, the first selection of transplant candidates could be performed with US and color flow Doppler, plain and dynamic CT. The patients who are ruled out as candidates for OLT on the basis of the findings of these imaging techniques and of clinical and laboratory findings are submitted to no further examination and referred to the transplantation unit. Otherwise, if conventional and color flow Doppler US and conventional CT are not enough to exclude a patient from OLT, the subject is submitted to more invasive (angiography, CTAP, Lipiodol CT) or less widespread (spiral CT, MRI) techniques.
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PMID:[Diagnostic imaging in the selection of candidates to orthotopic transplantation of the liver. Experience at a hospital lacking a transplantation department]. 941 19

Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using the spectrally selected enhanced fast gradient recall sequence (spec IR-efgre3d) was performed in five patients with HCC. Ten HCC nodules were confirmed by CTA, CTAP and Lipiodol CT, and all of them were detected with dynamic MRI. MIP images reconstructed from 3D gadolinium-enhanced dynamic MR studies clearly showed the main portal vein and its branches in all cases. Portal vein thrombosis was also demonstrated with the MIP images.
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PMID:[Three-dimensional gadolinium-enhanced dynamic MRI of whole liver using spectrally selected enhanced fast gradient recall sequence]. 955 53

We report a case of combined chronic subdural and acute epidural hematoma caused by metastatic hepatocellular cancer of the dura mater. A 44-year-old woman, who had been under treatment for hepatic cancer for one year, presented with right hemiparesis. MRI revealed a chronic subdural hematoma on the left fronto-parietal region with subgaleal and epidural metastasis. The patient was found comatose 7 days later. A huge epidural hematoma in the left parietal region was disclosed with CT scan. She died of hepatic failure despite the evacuation of the hematoma. This is the first reported case with a combined subdural and epidural hematoma secondary to metastatic brain tumor of the dura mater.
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PMID:[Combined chronic subdural and acute epidural hematoma secondary to metastatic hepatocellular cancer: case report]. 1034 47

The incidence of metastatic brain tumors is increasing because of the recent progress in the detection and management of primary cancer. However, metastatic skull tumors from cancers associated with giant subcutaneous mass lesions are rare. We present four patients with metastatic skull tumors: two from hepatic cancer, one from lung cancer, and one from mamma cancer. In these patients, plain skull X-ray and bone CT showed osteolytic lesions. Angiograms revealed a tumor stain fed by abnormal vessels from the external carotid artery. MRI demonstrated masses with marked homogeneous enhancement with the "dural tail sign" in the dura adjacent to the tumors in three skull tumors from hepatic and mamma cancers, and a mass with slightly enhancement without the "dural tail sign" in a skull tumor from lung cancer. At surgery, hemorrhagic well-demarcated tumors were totally removed. The histological diagnosis was skull metastases from cancers in all cases. In cases with the "dural tail sign" on MRI, no tumor cells were seen in the inner layer of the dura and the dura adjacent to the tumors. It is possible that the "dural tail" is due to increased vascular permeability of the dural vessels. The recurrence of these skull tumors was not observed during the follow-up period. Surgical treatment for the metastatic skull tumors from cancers may be indicated to prevent deteriorating neurological symptoms affecting the quality of life.
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PMID:[Metastatic skull tumors from cancers associated with subcutaneous mass lesions]. 1036 72

In this review the usefulness of percutaneous radiofrequency interstitial thermal ablation of liver cancer has been evaluated. The technique has been recently improved by using modified needle electrodes (eg, expandable needle, cooled needle) that allow the ablation of tumors of less than 3.5 cm in diameter in only one session. Tumor necrosis has been shown by imaging techniques such as dynamic or spiral CT, MRI, selective hepatic angiography, ultrasonography-guided fine needle biopsy, and pathologic studies. Both in hepatocellular carcinoma and liver metastases, a complete necrosis has been obtained in more than 80% of the cases. The complication rate has been low without any mortality. In a series of hepatocellular carcinoma followed for a mean time of 23 months, median survival time has been 44 months, whereas recurrence rate was similar to that observed after surgery or ethanol injection. In two small series of metastases, the percentage of disease-free survivors at 1 year ranged from 11 to 66%. In conclusion, radiofrequency interstitial thermal ablation is a safe and effective technique for ablation of liver tumor; however, its precise role in the treatment of liver metastases needs to be defined.
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PMID:Technology for Radiofrequency Thermal Ablation of Liver Tumors. 1040 Nov 46

Modern therapeutic strategies can improve survival of patients with pancreatic or liver malignancies. A prerequisite is thorough radiologic assessment of these patients. A variety of radiologic techniques are available, such as ultrasound, contrast-enhanced CT, CTAP, contrast-enhanced MRI, and endoscopic ultrasound. In this review the advantages and weaknesses of the different techniques are presented in the staging of patients with HCC, cholangiocarcinoma, suspected liver metastases, and pancreatic carcinoma. In an era of economic restraints, funds are not flowing freely anymore for radiologic studies. We have to consider not doing so many different examinations for each patient. We have to decide in the future which diagnostic test we want to perform for detection and staging of a particular disease. For liver and pancreatic malignancies it is likely to be MRI that will take this role.
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PMID:[Radiologic staging of liver and pancreatic malignancies]. 1047 85

MR-guided LITT (laser-induced thermotherapy) is currently being evaluated for its effectiveness in clinical oncology. MR-guided LITT is defined as a minimally invasive technology based on the effects of the applied Nd-YAG laser on tumorous tissue. Due to specific characteristics of the laser-induced coagulative effect, online monitoring via MR thermometry is possible and extremely precise. In a period of 6 years 335 patients suffering from malignant soft tissue tumors were prospectively treated via MR-guided LITT. We evaluated the local tumor control rate, the rate of complications and the survival data from the clinical and MRI follow-up. Our results prove that MR-guided LITT results in a extremely low rate of side effects and an effective tumor control rate higher than 95%, depending on the size of the lesion. It is concluded that this therapeutic concept is of clinical value for patients with primary and secondary liver cancer, malignant lymph node involvement, abdominal recurrent tumors and tumors of the head and neck.
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PMID:[Interventional MR-guided laser induced thermotherapy in oncologic indications. Status and prospects]. 1052 34


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