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Keywords: Liver, Liver

A modified version of LI-RADS was devised for abbreviated MRI (AMRI) with second shot arterial phase (SSAP) by referring to CEUS LI-RADS. The modified LI-RADS scores using AMRI with SSAP showed a high concordance rate with the conventional LI-RADS score using full-protocol MRI.  The recall rate significantly decreased when the HCC surveillance and diagnosis strategy was changed from strategy 1 (AMRI without SSAP; surveillance then recall test) to strategy 2 (AMRI with SSAP; simultaneous surveillance and diagnosis).

Yue Zhao¹, Xiuhong Guan¹, Yongzhou Xu², Xinqing Jiang¹, and Ruimeng Yang^1
1Department of Radiology, Guangzhou First People’s Hospital, Guangzhou, China, ²Philips Healthcare, Guangzhou, China

Keywords: Liver, Liver, Hepatocellular carcinoma; T1 mapping.

Cytokeratin 19 (CK19) is well acknowledged as a progenitor cell marker and tumor stem cell marker that plays an important role in promoting the malignant property of HCC. If the preoperative CK19 expression status in HCC can be accurately predicted noninvasively, it may provide important information for clinical decision-making. T1 mapping is useful for preoperative prediction of CK19 expression and early recurrence of HCC. The clinical-quantitative model combining alpha-fetoprotein and quantitative features showed good performance and robustness in predicting CK19 expression. T1 relaxation time on hepatobiliary phase was an independent predictor of CK19 expression and recurrence-free survival.

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Lei Lei Gao¹ and Yuan-Cheng Wang^1
1Zhongda Hospital Southeast University, Nanjing, China

Keywords: Liver, Cancer, Deep learning

We proposed a Two-stage Progressive Attention (TPA) framework by simulating the radiologists’ decision process for hepatocellular carcinoma segmentation. The study included  400 HCC patients as an internal set and 109 patients as an external test set. To obtain sensitive and specific results, our model is divided into two stages, respectively introducing attention mechanism and residual network.

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Keywords: Liver, Liver, Free-breathing MRI, hepatobiliary imaging, 3D cones with golden-angle ordering

Conventional cartesian T1 weighted 3D spoiled gradient recalled echo imaging with respiratory navigation (3D-SPGR-NAV) can help mitigate motion artifacts in post contrast liver imaging but suffer from respiratory rate dependence. 3D cones trajectories with golden angle ordering (T1g) allow continuous sampling during free-breathing liver imaging. We compared the diagnostic performance of an accelerated T1g (T1gER) versus 3D-SPGR-NAV in liver lesion detection. Two readers reviewed imaging from 35 patients containing 127 hepatic lesions. T1gER was non-inferior to 3D-SPGR-NAV for <5 mm and >=10 mm lesions. 3D-SPGR-NAV was superior for lesions 5-9 mm, possibly due to susceptibility artifact on the T1gER images. 

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Keywords: Liver, Cancer

The macrotrabecular-massive (MTM) subtype of hepatocellular carcinoma (HCC) is aggressive and associated with an unfavorable prognosis. This study aimed to characterize MTM-HCC features based on contrast‑enhanced MRI and to evaluate the prognosis of imaging characteristics combined with pathology for predicting early recurrence and overall survival after surgery. This retrospective study included 123 and 59 patients with HCC that underwent preoperative contrast‑enhanced MRI and surgery, respectively. The multivariate analysis and multiple Cox regression analysis identified that corona enhancement combined with MVI risk was significantly associated with poor outcomes after surgery.

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SERGE DIDENKO VASYLECHKO¹, LINA LU¹, CEMRE ARIYUREK¹, ONUR AFACAN¹, and SILA KURUGOL^1
1RADIOLOGY, BOSTON CHILDREN'S HOSPITAL, HARVARD MEDICAL SCHOOL, BOSTON, MA, United States

Keywords: Liver, Motion Correction

Voxel misalignment due to unavoidable respiratory motion and bulk motion introduce large errors in DW-MRI quantitative parameter fitting. Apparent diffusion coefficient (ADC) is an effective tool for characterization of malignant tumors.  In this study we evaluate the use of a motion correction method for DW-MRI imaging based on 3D slice level motion tracking using a rigid slice to volume registration and Kalman filtering. We show improvement in robustness of parameter estimation and reduction of blurring in b-value images for assessment of pediatric hepatoblastoma lesions. 

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Hong Wei¹, Hanyu Jiang¹, Yidi Chen¹, Tianying Zheng¹, Ting Yang¹, Xiaolan Zhang², Chao Zheng², and Bin Song^1
1West China Hospital, Sichuan University, Chengdu, China, ²Shukun (Beijing) Technology Co., Ltd, Beijing, China

Keywords: Liver, Cancer, Carcinoma, hepatocellular; Barcelona Clinic Liver Cancer; Overall survival; Tumor burden

In the present study of 297 patients, we evaluated the role of three-dimensional (3D) quantitative tumor burden analysis using fully automatic segmentation at magnetic resonance imaging in the subcategorization of the Barcelona Clinic Liver Cancer (BCLC) stage A hepatocellular carcinoma (HCC) after curative resection. Our results demonstrated that 3D quantitative total tumor burden (TTB) and serum a-fetoprotein were independent predictors of overall survival and could be used to subcategorize the BCLC stage A HCC. Additionally, the higher TTB (>18.5%) was correlated to more aggressive tumor behaviors (i.e., microvascular invasion and poor tumor differentiation). 

Fei Xing¹, Yi shi Wang², and Xian ce Zhao^3
1the Third Affiliated Nantong Hospital of Nantong University, Nantong, China, ²Philips Healthcare, Beijing, China, ³Philips Healthcare, Shanghai, China

Keywords: Liver, Cancer, HCC

This study assessed the imaging outcomes of Liver Imaging Reporting and Data System (LI-RADS) v2018 category 2, 3, and 4 observations in prospective hepatocellular carcinoma (HCC) surveillance cohort. LI-RADS observations demonstrate increasing risk of progression to HCC with increasing category. About two-fifths of LR-4  progressed to a malignant category. LR-3 observations with APHE or threshold/subthreshold growth upgraded to LR-5 were significantly higher. Most LR-2 observations that remain stable in category for at least two years.

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Keywords: Pancreas, Cancer, magnetic resonance imaging; radiomics;

Radiomics features were extracted from multiparametric MRI including conventional MRI (T2WI, T1WI, arterial phase, portal venous phase images) and apparent diffusion coefficient (ADC). The radiomics score was built based on the least absolute shrinkage and selection operator regression model.  Three models, including clinicopathological and radiographic characteristics (CPR) model, multiparametric MRI radiomics model and conventional MRI radiomics model, were built to predict recurrence-free survival (RFS) and overall survival (OS) in patients with resectable pancreatic ductal adenocarcinoma (PDAC). Multiparametric MRI radiomics model showed improved diagnostic performance in survival prediction than conventional MRI radiomics model and CPR model.

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Katsuhiro Sano¹, Shohei Fujita^1,2, Gastao Cruz^3,4, Carlos Velasco³, Hideo Kawasaki¹, Yuki Fukumura⁵, Akiyoshi Suzuki¹, Yuichi Morita¹, Koji Kamagata¹, Issei Fukunaga¹, Masami Yoneyama⁶, Ryohei Kuwatsuru¹, Akio Saiura⁷, Kenichi Ikejima⁸, Rene Botnar³, Claudia Prieto³, and Shigeki Aoki^1
1Department of Radiology, Juntendo University, Tokyo, Japan, ²Department of Radiology, The University of Tokyo, Tokyo, Japan, ³Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom, ⁴Department of Radiology, University of Michigan, Ann Arbor, MI, United States, ⁵Department of Human Pathology, Juntendo University, Tokyo, Japan, ⁶MR Clinical Science, Philips Japan, Tokyo, Japan, ⁷Department of Hepatobiliary-Pancreatic Surgery, Juntendo University, Tokyo, Japan, ⁸Department of Gastroenterology, Juntendo University, Tokyo, Japan

Keywords: Liver, MR Fingerprinting

Objective and contrast-free methods for differentiating benign focal liver lesions from malignant lesions (e.g., hepatocellular carcinomas and metastases) are desired. Herein, we evaluated the diagnostic capability of liver magnetic resonance fingerprinting (MRF) in patients with focal liver lesions. Liver MRF provided repeatable T1, T2, T2*, and fat-fraction values for various focal liver lesions. The liver MRF T1 and T2 relaxation times showed high agreement with separate conventional quantitative mapping measurements. Measurements of liver MRF and a combination of MRF relaxation times provided good differentiation of focal liver lesions (AUC of 0.87 for differentiating common benign lesions from common malignant lesions).

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Ryuji Shimada^1,2, Keitaro Sofue², Yuichiro Somiya¹, Shintaro Horii¹, Yushi Tujita², Yoshiko Ueno², Tetsuya Wakayama³, Akiko Kusaka¹, and Takamichi Murakami^1,2
1Center of Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan, ²Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan, ³GE Healthcare, Hino, Japan

Keywords: Pancreas, Cancer

We investigated the utility of breath-hold (BH) fat-suppressed single-shot T2-weighted MRI with deep learning image reconstruction (DLIR) in 42 patients with pancreatic cancer. Three fat-suppressed T2-weighted sequences of 1) single-shot fast-spin echo (SSFSE) of 6mm thickness with 1BH, 2) SSFSE of 3mm thickness with 2BH and 3) FSE of 6mm thickness with 3BH were compared. SSFSE sequences improved signal-to-noise ratio on anatomical organs, pancreas-to-lesion contrast, and image quality in terms of motion artifacts, image sharpness, and anatomical clarity in comparison with conventional FSE. The T2-weighted SSFSE with DLIR can be a useful sequence for the evaluation of pancreatic cancer.

Yongjian Zhu¹, Bing Feng¹, Wei Cai¹, Shuang Wang¹, Lizhi Xie², Xiaohong Ma¹, and Xinming Zhao^1
1Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ²GE healthcare, China, Beijing, China

Keywords: Liver, Tumor, Pathology, Microvascular invasion

The peri-tumoral region (PTR) of liver is the main-site of microvascular invasion (MVI) taken place, and contains perfusion information which could reflected the hemodynamic change during MVI. This study investigated the value of quantitative dynamic contrast-enhanced MRI (DCE-MRI) to evaluate the MVI status of hepatocellular carcinoma (HCC) in both intra-tumoral region (ITR) and PTR. The result showed quantitative DCE-MRI perfusion parameters could predict the MVI status in both ITR and PTR. Combining parameters from ITR and PTR could improve the prediction performance. Our study suggest quantitative DCE-MRI perfusion parameters could be employed as an efficient approach to predicting MVI status.

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Keywords: Cancer, Biliary

This study evaluated the diagnostic accuracy of image features for differentiating benign from malignant gallbladder wall thickening disease with non-contrast MRI and constructed the optimal diagnostic indicator. 23 patients with wall thickening type gallbladder carcinoma and 61 patients with benign wall thickening disease were included. Six image indicators (the layered pattern on T2WI and DWI images, T2WI signal intensity, papillary growth, ADC value, and ratio of the ADC value of the lesion to that of liver parenchyma) were shown to have high diagnostic accuracy. The layered pattern on DWI combined with papillary growth was demonstrated as the optimal indicator.

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Hooman Salavati^1,2,3, Wim Ceelen^1,3, Charlotte Debbaut^2,3, Clarisse Lecluyse⁴, and Pim Pullens^4,5,6
1Department of Human Structure and Repair, Ghent University, Ghent, Belgium, ²IBiTech – Biommeda, Ghent University, Ghent, Belgium, ³Cancer Research Institute Ghent (CRIG), Ghent, Belgium, ⁴Department of Radiology, Ghent University Hospital (UZGent), Ghent, Belgium, ⁵Ghent Institute of Functional and Metabolic Imaging (GIFMI), Ghent, Belgium, ⁶IBiTech – Medisip, Ghent University, Ghent, Belgium

Keywords: In Silico, Simulations, Biomechanics

The abnormal interstitial fluid flow (IFF) in solid tumors characterized by the elevated interstitial fluid pressure (IFP) is one of the major barriers for treating solid tumors. Here, we implemented DCE-MRI and IVIM DW-MRI in a clinical study to upgrade the existing basic mathematical framework of IFF to a patient-specific model. The results were compared with the basic model, which showed a noticeable difference regarding the prediction of the heterogeneity of IFF.