Impact of variations in fatty liver on sonographic detection of focal hepatic lesions originally identified by CT

Size Wu,Rong Tu,Ruixia Nan,Guangqing Liu,Xiaojing Cui,Xian Liang 대한초음파의학회 2016 ULTRASONOGRAPHY Vol.35 No.1

Purpose: The aim of this study was to investigate the influence of variations in fatty liver on the ultrasonographic detection of focal liver lesions. Methods: A total of 229 patients with varying degrees of fatty liver and focal liver lesions and 200 patients with focal liver lesions but no fatty liver were randomly selected for inclusion in groups I and II, respectively. Findings of focal liver lesions identified on computed tomography were taken as the reference, and findings on ultrasonography were compared with them. Results: The number of focal liver lesions in groups I and II were 501 and 413, respectively. The ultrasonographic detection rates of focal liver lesions in groups I and II were 86.8% (435/501) and 94.2% (389/413), respectively. Comparison of the detection of the focal lesions between patients with and without fatty liver or different grades of fatty liver were as follows: mild fatty liver (162/177) vs. liver without fat infiltration (389/413) (P=0.277); mild fatty liver (162/177) vs. moderate fatty liver (190/212) (P=0.604); mild fatty liver (162/177) vs. severe fatty liver (83/112) (P<0.001); moderate fatty liver (190/212) vs. liver without fat infiltration (389/413) (P=0.051); moderate fatty liver (190/212) vs. severe fatty liver (83/112) (P<0.001); severe fatty liver (83/112) vs. liver without fat infiltration (389/413) (P<0.001); and fatty liver (435/501) vs. liver without fat infiltration (389/413) (P<0.001). Conclusion: Mild and moderate fatty liver are not significantly associated with the visualization of the lesion, while severe fatty liver usually impairs the detection of focal lesions in the liver. If a patient with severe fatty liver is suspected to have a liver tumor, ultrasonography should only be chosen cautiously in case of a missed diagnosis.

건강검진에서 간 혈관종의 초음파 pattern 분류에 따른 정확도 연구

김민정(Kim Min-Jeong),김연민(KIm Yun-Min),이현복(Lee Hyun-Bok) 대한초음파의료영상학회 2012 대한초음파의료영상학회지 Vol.3 No.1

목적 : 간 혈관종은 간에 발생하는 양성 종양의 일종으로서 임상적으로 의의가 큰 증상은 아니나, 간의 다른 병변과 구별이 어려울 수도 있으므로, 정확한 감별이 필요하다. 간 혈관종에 대한 전형적인 초음파 소견은 비교적 널리 알려져 있으나, 지방간이 있는 경우, 비전형적인 초음파 검사 소견이 흔하게 관찰되어 감별에 어려움을 보이고 있다. 본 연구에서는 혈관종의 특성을 좀 더 이해하고 초음파에서 관찰되는 에코 패턴을 분류하여 진단에 있어 임상적 의미를 알아보고자 한다. 특히, 지방간 유무에 따른 간 혈관종의 초음파 소견을 분류 및 분석하고, 혈관종의 크기 및 에코 변화의 상관관계에 대해 연구해보았다. 대상 및 방법 : 2010년 1월에서 12월까지 삼성서울병원 건강의학센터에서 복부초음파 검사를 처음 시행하여 간 혈관종이 의심되는 459명 중 CT검사를 통해 확진을 받은 79명을 대상으로 하였으며, 간질환, 간염치료 및 보균자는 echotexture의 변화를 야기하므로 대상군에서 제외하였다. 간 혈관종 크기에 따라 총 3개의 군으로 구분하였고, 기저 간 상태는 정상과 지방간으로 분류하였다. 혈관종의 초음파 소견은 내부에코와 가장자리에코의 조합 형태에 따라 총 4개의 군으로 분류하였다. 또한 CT 검사를 통한 확진 후 초음파 검사의 정확성을 판단하기 위하여 확진 결과를 3개의 군으로 분류하였다. 결과 : 대상자 79명 중 105개의 병소를 보였으며, 초음파 소견 크기별로 분석한 결과, 지름이 15mm 이하인 것이 55예(52.4%)이었고, 16mm~30mm 이하는 42예(40%), 30mm보다 큰 것은 8예(7.6%)이었다. 기저 간 상태에 따라 분류한 결과, 정상간 81예(77.1%), 지방간 Ⅰ기가 9예(8.6%), 지방간 Ⅱ기가 6예(5.7%), 지방간 Ⅲ기가 7예(6.7%), 지방간 Ⅳ기가 2예(1.9%)였다. 정상간 81예 중 고에코 56예(53.3%), 혼합에코 11예(10.5%), 저에코 5예(4.8%), 고에코 테두리를 가진 9예(8.6%)가 관찰되었다. 지방간 Ⅰ, Ⅱ, Ⅲ, Ⅳ기의 24예 중 고에코 9예(37.5%), 혼합에코 0예(0.0%), 저에코 14예(58.3%), 고에코 테두리를 가진 1예(4.2%)가 관찰되었다. 초음파 소견을 통하여 간혈관종으로 의심되던 105개 병소에 대하여 CT 검사를 시행한 결과, 확진된 간혈관종이 85예(81.0%), 간혈관종이 아닌 다른 질환으로 확진된 병변이 10예(9.5%), 질환을 확진하지 못한 병변이 10예(9.5%)였다. 결론 : 병소의 크기가 클수록 비전형적인 초음파 소견이 증가하다는 기존의 보고대로, 실제로도 15mm 미만의 혈관종에서 균질한 고에코의 종괴가 높게 나타났으며, 이에 대해 높은 정확도를 보였다. 지방간에서의 혈관종은 저에코의 종괴로 발견되는 경우가 많다는 주장이 있었으나, 본 연구에서는 고에코 및 저에코에서도 균등하게 관찰 할 수 있었다. 또한 동일한 기저 간 상태에서도 서로 다른 에코 양상을 보이는 경우가 있었으며, 이는 종괴 내부의 변화에 따라 초음파 소견이 달라질 수 있다는 것을 추정할 수 있었다. Objective : Hepatic hemangioma is a kind of benign tumor appeared in liver. To make a diagnosis of hepatic hemangioma is very important because it is difficult to distinguish hepatic hemangioma between other liver disease. Typical sonographic findings for hepatic hemangioma are well known but in case of fatty liver complication, accurate diagnosis is difficult because of non-typical sonographic findings. In this study, authors performed a retrospective analysis by classifications of echo patterns in sonographic findings by size and fatty liver presence. Eventually, authors studied relationship between selected factors and echo patterns and clinical meaning of diagnosis. Method : The study was performed for 79 people confirmed among 459 people who were suspected of hepatic hemangioma by abdominal sonography in Samsung Medical Center in 2010. People who had liver disease and hepatitis were excluded since these diseases could cause changes of echo textures. 3 groups were classified by size and normal and fatty acid group were classified by liver condition at baseline. Sonographic findings were classified to 4 groups by combination of internal echo and marginal echo. To analyse accuracy of sonography, confirmation results by CT were classified to 3 groups. Results : 105 cases of 79 people were suspected of hepatic hemangioma by sonographic findings. The number of cases for diameter x≤15mm, 16mm<x≤30mm and x>30mm by classification of size were 55 cases(52.4%), 42 cases(40%) and 8 cases(7.6%), respectively. The number of cases for normal, fatty liver I phase, II phase, III phase and IV phase by classification of liver condition were 81 cases(77.1%), 9 cases(8.6%), 6 cases(5.7%), 7 cases(6.7%) and 2 cases(1.9%), respectively. Among normal 81 cases, the number of cases for hyper, mixed, hypo, rim were 56 cases(69.1%), 11 cases(13.6%), 5 cases(6.2%), 9 cases(11.1%), respectively. Among fatty liver 24 cases, the number of cases for hyper, mixed, hypo, rim were 9 cases(37.5%), 0 cases(0.0%), 14 cases(58.3%), 1 cases(4.2%), respectively. By CT results of 105 cases, the number of cases for confirmations of hepatic hemangioma, confirmations of other liver disease and non-confirmation of any disease were 85 cases(81.0%), 10 cases(9.5%), 10 cases(9.5%), respectively. Conclusion : Like established reports that non-typical sonographic findings were increased when the size is large, authors could find hyper-echo masses were mainly observed in case of hepatic hemangioma with size ≤15mm and the CT results for these cases were quite accurate. Even many established reports demonstrate hypo-echo masses were observed in case of hepatic hemangioma with fatty liver, authors could find hyper-echo and hypo-echo masses were observed equally. Of course, in consideration of relative ratio, authors could find many hypo-echo in fatty liver than normal. Furthermore, authors found different echo patterns in same liver condition. Authors could presume sonographic findings could be changeable by mass internal changes.

간암 한약제제 임상시험 가이드라인 개발을 위한 한약제제 무작위배정 대조군 임상시험 고찰

한가진,김동훈,박은주,성신,김성수,임정태 대한한방내과학회 2019 大韓韓方內科學會誌 Vol.40 No.1

Objective: This study aimed to ascertain what should be considered in the “Guideline for Clinical Trials with Herbal Medicinal Products for Liver Cancer,” by analyzing existing guidelines and clinical trials. Methods: Committee for the development of a guideline, consisting of 6 Korean medicine doctors, reviewed guidelines and clinical trials on using herbal medicine for treating liver cancer. The trials were analyzed in terms of inclusion and exclusion of participants, intervention, comparators, outcomes, and trial design. We then compared the results of our analysis with the guidelines to identify issues we must to consider when following the “Guideline for Clinical Trials with Herbal Medicinal Products for Liver Cancer.” Several guidelines for antitumor agents and clinical trials on herbal medicine were obtained from the Ministry of Food and Drug Safety homepage, etc. The search terms were as follows: “liver neoplasms”; “herbal medicine”; “medicine, Korean traditional”; and “medicine, Chinese Traditional.”. Results: Ten articles were obtained from pubmed and Embase. There was no guideline for clinical trials on using herbal medicine for treating liver cancer. All the participants in the reviewed articles had primary liver cancer, and the type of intervention varied (e.g., decoction, patches, and capsules. The comparators included placebos and conventional treatments such as chemotherapy. The outcome assessment methods were tumor response, quality of life, survival, and liver function tests. Adverse events occuring during the trial were also evaluated. Conclusion: Findings were derived by reviewing existing guidelines and comparing them with clinical trials on liver cancer and herbal medicinal products. These results will be utilized in the development of the “Guideline for Clinical Trials with Herbal Medicinal Products for Liver Cancer.”

A Case of Metastatic Melanoma in the Liver Mimicking Hepatocellular Carcinoma

( Jae-kyoung So ),( Ji-yun Hong ),( Min-woo Chung ),( Sung-bum Cho ) 대한간암학회 2021 대한간암학회지 Vol.21 No.1

The liver is one of the most common sites of metastasis. Although most metastatic liver cancers are hypovascular, some hypervascular metastases, such as those from melanoma, need to be differentiated from hepatocellular carcinoma (HCC) because they may show similar radiologic findings due to their hypervascularity. We encountered a case of multinodular liver masses with hyperenhancement during the arterial phase and washout during the portal venous and delayed phases, which were consistent with imaging hallmarks of HCC. The patient had a history of malignant melanoma and had undergone curative resection 11 years earlier. We performed a liver biopsy for pathologic confirmation, which revealed a metastatic melanoma of the liver. Metastatic liver cancer should be considered if a patient without chronic liver disease has a history of other primary malignancies, and caution should be exercised with hypervascular cancers that may mimic HCC. (J Liver Cancer 2021;21:92-96)

Detection of liver metastases in cancer patients with geographic fatty infiltration of the liver: the added value of contrast-enhanced sonography

Tommaso Vincenzo Bartolotta,Adele Taibbi,Dario Picone,Andrea Anastasi,Massimo Midiri,Roberto Lagalla 대한초음파의학회 2017 ULTRASONOGRAPHY Vol.36 No.2

Purpose: The aim of this study is to assess the role of contrast-enhanced ultrasonography (CEUS) in the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale ultrasonography (US). Methods: Thirty-seven consecutive cancer patients (24 women and 13 men; age, 33 to 80 years; mean, 58.1 years) with geographic liver fatty deposition, but without any detectable focal liver lesion on greyscale US, underwent sulphur hexafluoride-enhanced US. Two readers reported by consensus the presence, size, and location of any detected lesion. All patients underwent magnetic resonance imaging (MRI) as a confirmatory study. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy were calculated. Results: Seven focal liver lesions (size, 4 to 10 mm; mean, 6.1 mm) were detected in 4/37 patients (10.8%): four metastases (size, 5 to 10 mm; mean, 6.7 mm) were detected both by CEUS and MRI, with one hemangioma and two cysts (size range, 4 to 6 mm; mean, 5.3 mm) detected by MRI only. In 1/37 patients (2.7%), CEUS misdiagnosed geographic fatty change as three metastases. In 32/37 patients (86.5%), no lesions were detected. Sensitivity, specificity, PPV, NPV, and accuracy of CEUS were 100% (95% confidence Interval [CI], 1.000 to 1.000), 97.1% (95% CI, 0.914 to 1.027), 75%, 100%, and 97.3%, respectively. No statistically significant differences were found between CEUS and MRI in the detection of focal liver lesions (P=0.480), whereas both of them performed better than baseline US (P<0.001). Conclusion: CEUS improves the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale US.

Gut Microbiota Alteration Influences Colorectal Cancer Metastasis to the Liver by Remodeling the Liver Immune Microenvironment

Yuan Na,Li Xiaoyan,Wang Meng,Zhang Zhilin,Qiao Lu,Gao Yamei,Xu Xinjian,Zhi Jie,Li Yang,Li Zhongxin,Jia Yitao 거트앤리버 소화기연관학회협의회 2022 Gut and Liver Vol.16 No.4

Background/Aims:This study aimed to explore the effect of gut microbiota-regulated Kupffer cells (KCs) on colorectal cancer (CRC) liver metastasis. Methods: A series of in vivo and in vitro researches were showed to demonstrate the gut microbiota and its possible mechanism in CRC liver metastasis. Results: Fewer liver metastases were identified in the ampicillin-streptomycin-colistin and colistin groups. Increased proportions of Parabacteroides goldsteinii, Bacteroides vulgatus, Bacteroides thetaiotaomicron, and Bacteroides uniformis were observed in the colistin group. The significant expansion of KCs was identified in the ampicillin-streptomycin-colistin and colistin groups. B. vulgatus levels were positively correlated with KC levels. More liver metastases were observed in the vancomycin group. An increased abundance of Parabacteroides distasonis and Proteus mirabilis and an obvious reduction of KCs were noted in the vancomycin group. P. mirabilis levels were negatively related to KC levels. The number of liver metastatic nodules was increased in the P. mirabilis group and decreased in the B. vulgatus group. The number of KCs decreased in the P. mirabilis group and increased in the B. vulgatus group. In vitro, as P. mirabilis or B. vulgatus doses increased, there was an opposite effect on KC proliferation in dose- and time-dependent manners. P. mirabilis induced CT26 cell migration by controlling KC proliferation, whereas B. vulgatus prevented this migration. Conclusions: An increased abundance of P. mirabilis and decreased amount of B. vulgatus play key roles in CRC liver metastasis, which might be related to KC reductions in the liver.

간암에서 Ferumoxides와 Gadolinium의 이중 조영 자기공명 영상

최상희 대한영상의학회 2004 대한영상의학회지 Vol.50 No.6

Purpose: To evaluate the effects of Ferumoxides on Gadolinium (Gd) enhanced dynamic liver magnetic resonance imaging (MRI) in cirrhotic patients and also for the diagnosis of hepatocellular carcinoma (HCC). Materials and Methods: 29 patients with liver cirrhosis were examined at 1.5T. 12 patients had HCC. The imaging protocol included GE T1 in and opposed phases, and a breath-hold TSE T2 before and 30-60 min following 0.05 ml/kg Ferumoxides. Four dynamic in-phase GE series were also acquired after an injection of 20 ml of Gd at 2 ml/sec. SNR and CNR were calculated for liver lesion relative to the muscle and background liver respectively. Statistical analysis was performed using the paired t-test. Results: The SNR of the liver decreased by 8.6±1.20 (p<0.001) after Ferumoxides injection. At the peak of the Gd effect, the liver increased by 6.09±1.15 relative to the post Ferumoxides, but it was not significantly different from the pre-Ferumoxides study (p<0.01). Although there was no significant change in post Ferumoxides SNR of HCC, CNR of HCC relative to the liver increased by 7.54±1.61 (p<0.05). After the Gd injection, CNR of HCC increased by 15.6±3.87 (p<0.05). Conclusion: The administration of Ferumoxides made HCC CNR increase, and it canceled the effect of Gd enhancement of the cirrhotic liver. The combination of Ferumoxides and Gd makes HCC CNR increase. 목적: 만성 간 질환과 간암이 발생한 환자에서 Gadolinium(Gd) 조영증강 동적 자기공명영상에 서 Ferumoxides의 효과를 알아 보고자 한다. 대상과 방법: 29명의 간 경화 환자를 대상으로 하였다. 12명은 간암이 발생한 환자 였다. 몸무 게 당 0.05 ml의 Ferumoxides 주사 전과 주사 후 30-60분에 gradient echo(GE) T1 in phase 와 opposed -phase, breath-hold turbo spin echo(TSE) T2을 얻었고 20 ml의 Gd을 초당 2 ml의 속도로 주사 후에 4 dynamic in-phase GE series를 얻었다. 간과 간암에 대한 signal to noise ratio(SNR)과 contrast to noise ratio(CNR)을 구하고 paired t-test 를 이용하여 통 계적 분석을 하였다. 결과: Ferumoxides 주사 후 간의 SNR은 8.6±1.20 감소하였다(p<0.001). Gd 주사후 간은 Ferumoxides 주사 후와 비교해 6.09±1.15 증가 하여 Ferumoxides 주사 전과 의미있는 차이 는 없었다(p<0.01). Ferumoxides 주사 후에 간암의 SNR은 의미 있게 변하지 않았으나 배경 간에 대한 간암의 CNR은 7.54±1.61 증가 되었다(p<0.05). Gd은 간암의 CNR을 15.6±3.87 로 더욱 증가 시켰다(p<0.05). 결론: 간암은 Gd으로 조영 증강되고 Ferumoxides는 배경 간의 Gd 조영 증강 효과를 없애기 때문에 Ferumoxides와 Gd의 조합은 간암의 CNR을 높인다.

포스터 전시 : 간경변증에서 잔존 간기능을 나타내는 지표: 아포지단백 A-1

이승룡,이호경,권혁진,문병식,이승옥,김대곤 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3(S)

Background/Aims: Apolipoprotein A-I(Apo A-I) is synthesized mainly by hepatocytes. It is decreased in alcoholic patients with liver fibrosis and cirrhosis. The mechanisms of serum apo A-I decrease in liver cirrhosis are unknown, but it has been shown that serum apo A-I measurement alone or in correlation with other biological data such as prothrombin time and r-glutamyl transferase, albumin and total bilirubin can serve as a marker of liver cirrhosis in alcoholic patients. The goal of this study was to to describe the changes of apo A-I according to the different stages of the liver cirrhosis, to correlate the changes to serum liver tests and to estimate its diagnosis, prognotic valuse and functional reserve of injuried liver. Mathods: We examed the value of apo A-I in 201 patients of liver cirrhosis and 138 patients of hepatocellular carcinoma in Korea. Results: The results showed that apo A-I concentration is highly related to the degree of liver injury, reaching a minimum in patients with severe cirrhosis. And apo A-I is correlated with biological marker of liver function such as albumin, prothrombin time, total bilirubin, α- macroglobulin. Apo A-I had an independent and discriminative value for the diagnosis of cirrhosis. This result was also observed not only in patients of alcoholic liver cirrhosis but also in patients of hepatocellular carcinoma due to hepatitis B. Conclusions: Our results suggest that serum Apo A-I is index for functional reserve in the irreversible liver disease such as cirrhosis of liver and hepatocellular carcinoma.

Gadolinium-ethoxybenzyl-DTPA : 흰쥐에 실험적으로 유발한 원발성 간암의 자기공 명영상에서의 유용성

김명진 대한영상의학회 1996 대한영상의학회지 Vol.35 No.1

Purpose : To determine the efficacy of Gd-ethoxybenzyl-DTPA(Gd-EOB-DTPA) in MR imaging of primary hepatic tumors in rats. Materials and Methods : Primary hepatic tumors had been induced on 12 male Sprague-Dawley rats byoral administration of an experimental diet containing 3'-methyl-4'-dimethylaminobenzene for 12 weeks. T1-weighted spin echo images were obtained with 1.5 T system before and after injection of 25 $\mu$mol/kg ofGd-EOB-DTPA. The detection rate of tumors in each image was compared to that in resected specimens. Signal intensity of the liver and the largest tumor were measured in each rat on pre- and postcontrast images. Signal to noise ratio(SNR) of the liver and liver-to-tumor contrast to noise ratio(CNR) were calculated. Results : One hundred and twenty-five liver tumors were identified on gross examination. Fifty one lesions(41%) on precontrast images, and 80(64%) on postcontrast images were demonstrated (p<0.01). Of the 33 tumors larger than 5mm, 28lesions(85%) were demonstrated on precontrast image, and 31(94%) on postcontrast image (p>0.05). Of the 92 lesions smaller than 5mm in diameter, 23(25%) were seen on precontrast image and 49 the (53%) on postcontrast image(p<0.01). After contrast enhancement, the signal intensity of both liver and tumor increased(p〈0.05), though background noise also increased (p>0.05). Consequently, SNR increased significantly in the liver from 10.89 $\pm$1.96(mean standard error) to 15.59 $\pm$ 2.34(p<0.05), but not in tumors(from 8.21 $\pm$ 3.71 to 8.85 $\pm$ 5.42). Liver-to-tumor CNR increased from 5.55 $\pm$ 0.94 to 13.25 $\pm$ 2.50 (p〈0.01). Conclusion : The use of Gd-EOB-DTPA can increase the detection rate of primary hepatic tumors in rats, especially of small lesions.

Primary pleomorphic liver liposarcoma: A case series and literature review

Chuah Jun Sen,Siaw Jia Yng,Soon Koon Choon,Fatin Izni Zamri 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.3

Primary hepatic liposarcoma is an extremely rare mesenchymal tumor that accounts for only 0.1% to 2% of primary malignant liver tumors. Due to its rarity, there is a lack of knowledge about its clinical course, management, and prognosis. Only 15 cases of primary liposarcoma of the liver have been reported since 1973. Among these 15 cases, only two involved primary liver liposarcoma with a pleomorphic subtype. Here we report the third and fourth cases of primary pleomorphic liver liposarcoma. A 57-year-old female presented with abdominal discomfort and progressive abdominal distension for two weeks. Computed tomography (CT) of her abdomen revealed a large well-defined solid nodule mass with an area of necrosis and hemorrhage occupying segment IV-B of the liver. Wide local excision was performed. She had an uneventful recovery and remained well at six months post-treatment. A 65-year-old male presented with an abdominal mass for two-month. CT demonstrated a mass in the left lobe of the liver with mixed soft tissues and fat attenuation. He underwent wide local excision. He was discharged on day three postoperatively. Histological analysis for both cases revealed liposarcoma of the liver with a pleomorphic subtype.