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  • Springer Science and Business Media LLC  (17)
  • 1
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    Prediction of regional lymph node metastasis in intrahepatic cholangiocarcinoma: it’s not all about size
    Springer Science and Business Media LLC ; 2023
    In:  Abdominal Radiology Vol. 48, No. 10 ( 2023-06-24), p. 3063-3071
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    In: Abdominal Radiology, Springer Science and Business Media LLC, Vol. 48, No. 10 ( 2023-06-24), p. 3063-3071
    Abstract: Lymph node metastases (LNM) are frequent in patients with intrahepatic cholangiocarcinoma (iCC) and worsen their prognosis even after surgery. Our aim was to investigate the predictive value of lymph node (LN) short axis, the most common discriminator for identifying LNM in tumor-imaging and to develop a predictive model for regional LNM in iCC taking computed tomography (CT) features of extranodal disease into account. Materials and methods We enrolled 102 patients with pathologically proven iCC who underwent CT prior to hepatic resection and hilar lymph node dissection (LND) from 2005 to 2021. Two blinded radiologists assessed various imaging characteristics and LN diameters, which were analyzed by bivariate and multivariate logistic regression to develop a prediction model for LNM. Results Prevalence of LNM was high (42.4 %) and estimated survival was shorter in LN-positive patients ( p = 0.07). An LN short axis diameter of ≥ 9 mm demonstrated the highest predictive power for LNM. Three additional, statistically significant imaging features, presence of intrahepatic metastasis ( p = 0.003), hilar tumor infiltration ( p = 0.003), and tumor growth along the liver capsule ( p = 0.004), were integrated into a prediction model, which substantially outperformed use of LN axis alone in ROC analysis (AUC 0.856 vs 0.701). Conclusions LN diameter alone proved to be a relevant but unreliable imaging-marker for LNM prediction in iCC. Our proposed prognostic model, which additionally considers intrahepatic metastases and hilar and capsular infiltration, significantly improves discriminatory power. Hilar and capsular involvement might indicate direct tumor extension to lymphatic liver structures.
    Type of Medium: Online Resource
    ISSN: 2366-0058
    URL: Article
    DOI: 10.1007/s00261-023-03991-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2845742-0
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  • 2
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    A radiomics-based model to classify the etiology of liver cirrhosis using gadoxetic acid-enhanced MRI
    Springer Science and Business Media LLC ; 2021
    In:  Scientific Reports Vol. 11, No. 1 ( 2021-05-24)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-05-24)
    Abstract: The implementation of radiomics in radiology is gaining interest due to its wide range of applications. To develop a radiomics-based model for classifying the etiology of liver cirrhosis using gadoxetic acid-enhanced MRI, 248 patients with a known etiology of liver cirrhosis who underwent 306 gadoxetic acid-enhanced MRI examinations were included in the analysis. MRI examinations were classified into 6 groups according to the etiology of liver cirrhosis: alcoholic cirrhosis, viral hepatitis, cholestatic liver disease, nonalcoholic steatohepatitis (NASH), autoimmune hepatitis, and other. MRI examinations were randomized into training and testing subsets. Radiomics features were extracted from regions of interest segmented in the hepatobiliary phase images. The fivefold cross-validated models (2-dimensional—(2D) and 3-dimensional—(3D) based) differentiating cholestatic cirrhosis from noncholestatic etiologies had the best accuracy (87.5%, 85.6%), sensitivity (97.6%, 95.6%), predictive value (0.883, 0.877), and area under curve (AUC) (0.960, 0.910). The AUC was larger in the 2D-model for viral hepatitis, cholestatic cirrhosis, and NASH-associated cirrhosis (P-value of 0.05, 0.05, 0.87, respectively). In alcoholic cirrhosis, the AUC for the 3D model was larger (P = 0.01). The overall intra-class correlation coefficient (ICC) estimates and their 95% confident intervals (CI) for all features combined was 0.68 (CI 0.56–0.87) for 2D and 0.71 (CI 0.61–0.93) for 3D measurements suggesting moderate reliability. Radiomics-based analysis of hepatobiliary phase images of gadoxetic acid-enhanced MRI may be a promising noninvasive method for identifying the etiology of liver cirrhosis with better performance of the 2D- compared with the 3D-generated models.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-021-90257-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2615211-3
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  • 3
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    A surgical strategy for intrahepatic cholangiocarcinoma — the hilar first concept
    Springer Science and Business Media LLC ; 2023
    In:  Langenbeck's Archives of Surgery Vol. 408, No. 1 ( 2023-08-07)
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    In: Langenbeck's Archives of Surgery, Springer Science and Business Media LLC, Vol. 408, No. 1 ( 2023-08-07)
    Abstract: The present study assesses long-term overall survival (OS) and disease-free survival (DFS) after curative resection for intrahepatic cholangiocarcinoma (ICCA) depending on resection margin (RM) status and lymph node (LN) status. Methods Clinical data of all consecutively resected patients with ICCA at a single high-volume center between 2005 and 2018 were collected. Minimum follow-up was 36 months. Perioperative and long-term oncological outcome was assessed. Results One hundred ninety-two cases were included in the analysis. Thirty- and 90-day-mortality was 5.2% ( n  = 10) and 10.9% ( n  = 21). OS was 26 months with 1-, 2-, and 5-year-OS rates of 72%, 53%, and 26%. One-, 2-, and 5-year-DFS rates were 54%, 42%, and 35% (N0 vs. N1: 29 vs. 9 months, p  = 0.116). R1 was not found to be an independent risk factor for reduced survival in the overall cohort ( p  = 0.098). When differentiating according to the LN status, clear resection margins were significantly associated with increased DFS for N0 cases (50 months vs. 9 months, p  = 0.004). For N1 cases, no significant difference in DFS was calculated for R0 compared to R1 cases (9 months vs. 9 months, p  = 0.88). For N0 cases, clear resection margins  〉  10 mm were associated with prolonged OS ( p  = 0.048). Conclusion For N1 cases, there was no significant survival benefit when comparing R0 versus R1, while the complication rate remained high for the extended resection types. In view of merging multimodal treatment, the hilar first concept assesses locoregional LN status for optimal surgical therapy.
    Type of Medium: Online Resource
    ISSN: 1435-2451
    URL: Article
    DOI: 10.1007/s00423-023-03023-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1459390-7
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  • 4
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    Pneumatosis intestinalis and porto-mesenteric venous gas: a multicenter study
    Springer Science and Business Media LLC ; 2021
    In:  BMC Medical Imaging Vol. 21, No. 1 ( 2021-12)
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    In: BMC Medical Imaging, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to refine prognostication to improve decision making in daily clinical routine. Methods A total of 290 patients with confirmed PI were included in the final analysis. The presence of PMVG and mortality (90d follow-up) were evaluated with regard to the influence of possible risk factors. Furthermore, a linear estimation model was devised combining significant parameters to calculate accuracies for predicting death in patients undergoing surgery by means of a defined operation point (ROC-analysis). Results Overall, 90d mortality was 55.2% (160/290). In patients with PI only, mortality was 46.5% (78/168) and increased significantly to 67.2% (82/122) in combination with PMVG (median survival: PI: 58d vs. PI and PMVG: 41d; p   〈  0.001). In the entire patient group, 53.5% (155/290) were treated surgically with a 90d mortality of 58.8% (91/155) in this latter group, while 90d mortality was 51.1% (69/135) in patients treated conservatively. In the patients who survived  〉  90d treated conservatively (24.9% of the entire collective; 72/290) PMVG/PI was defined as “benign”/reversible. PMVG, COPD, sepsis and a low platelet count were found to correlate with a worse prognosis helping to identify patients who might not profit from surgery, in this context our calculation model reaches accuracies of 97% specificity, 20% sensitivity, 90% PPV and 45% NPV. Conclusion Although PI is associated with high morbidity and mortality, „benign causes” are common. However, in concomitant PMVG, mortality rates increase significantly. Our mathematical model could serve as a decision support tool to identify patients who are least likely to benefit from surgery, and to potentially reduce overtreatment in this subset of patients.
    Type of Medium: Online Resource
    ISSN: 1471-2342
    URL: Article
    DOI: 10.1186/s12880-021-00651-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2061975-3
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  • 5
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    T2 mapping of molecular subtypes of WHO grade II/III gliomas
    Springer Science and Business Media LLC ; 2020
    In:  BMC Neurology Vol. 20, No. 1 ( 2020-12)
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    In: BMC Neurology, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: According to the new WHO classification from 2016, molecular profiles have shown to provide reliable information about prognosis and treatment response. The purpose of our study is to evaluate the diagnostic potential of non-invasive quantitative T2 mapping in the detection of IDH1/2 mutation status in grade II-III gliomas. Methods Retrospective evaluation of MR examinations in 30 patients with histopathological proven WHO-grade II ( n  = 9) and III ( n  = 21) astrocytomas (18 IDH-mutated, 12 IDH-wildtype). Consensus annotation by two observers by use of ROI’s in quantitative T2-mapping sequences were performed in all patients. T2 relaxation times were measured pixelwise. Results A significant difference ( p  = 0,0037) between the central region of IDH-mutated tumors (356,83 ± 114,97 ms) and the IDH-wildtype (199,92 ± 53,13 ms) was found. Furthermore, relaxation times between the central region (322,62 ± 127,41 ms) and the peripheral region (211,1 ± 74,16 ms) of WHO grade II and III astrocytomas differed significantly ( p  = 0,0021). The central regions relaxation time of WHO-grade II (227,44 ± 80,09 ms) and III gliomas (322,62 ± 127,41 ms) did not differ significantly (p = 0,2276). The difference between the smallest and the largest T2 value (so called “range”) is significantly larger (p = 0,0017) in IDH-mutated tumors (230,89 ± 121,11 ms) than in the IDH-wildtype (96,33 ± 101,46 ms). Interobserver variability showed no significant differences. Conclusions Quantitative evaluation of T2-mapping relaxation times shows significant differences regarding the IDH-status in WHO grade II and III gliomas adding important information regarding the new 2016 World Health Organization (WHO) Classification of tumors of the central nervous system. This to our knowledge is the first study regarding T2 mapping and the IDH1/2 status shows that the mutational status seems to be more important for the appearance on T2 images than the WHO grade.
    Type of Medium: Online Resource
    ISSN: 1471-2377
    URL: Article
    DOI: 10.1186/s12883-019-1590-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041347-6
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  • 6
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    HBP-enhancing hepatocellular adenomas and how to discriminate them from FNH in Gd-EOB MRI
    Springer Science and Business Media LLC ; 2021
    In:  BMC Medical Imaging Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Medical Imaging, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Recent studies provide evidence that hepatocellular  adenomas  (HCAs) frequently take up gadoxetic acid (Gd-EOB) during the hepatobiliary phase (HBP). The purpose of our study was to investigate how to differentiate between Gd-EOB-enhancing HCAs and focal nodular hyperplasias (FNHs). We therefore retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection). Two readers (experienced abdominal radiologists blinded to clinical data) reviewed the images evaluating morphologic features and subjectively scoring Gd-EOB uptake (25–50%, 50–75% and 75–100%) for each lesion. Quantitative lesion-to-liver enhancement was measured in arterial, portal venous (PV), transitional and HBP. Additionally, multivariate regression analyses were performed. Results Subjective scoring of intralesional Gd-EOB uptake showed the highest discriminatory accuracies (AUC: 0.848 (R#1); 0.920 (R#2)— p   〈  0.001) with significantly higher uptake scores assigned to FNHs (Cut-off: 75%-100%). Typical lobulation and presence of a central scar in FNH achieved an accuracy of 0.750 or higher in at least one reader (lobulation—AUC: 0.809 (R#1); 0.736 (R#2); central scar—AUC: 0.595 (R#1); 0.784 (R#2)). The multivariate regression emphasized the discriminatory power of the Gd-EOB scoring ( p  = 0.001/OR:22.15 (R#1) and p   〈  0.001/OR:99.12 (R#2). The lesion-to-liver ratio differed significantly between FNH and HCA in the PV phase and HBP (PV: 132.9 (FNH) and 110.2 (HCA), p  = 0.048 and HBP: 110.3 (FNH) and 39.2 (HCA), p   〈  0.001)), while the difference was not significant in arterial and transitional contrast phases ( p   〉  0.05). Conclusion Even in HBP-enhancing HCA, characterization of Gd-EOB uptake was found to provide the strongest discriminatory power in differentiating HCA from FNH. Furthermore, a lobulated appearance and a central scar are more frequently seen in FNH than in HCA.
    Type of Medium: Online Resource
    ISSN: 1471-2342
    URL: Article
    DOI: 10.1186/s12880-021-00552-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 7
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    Low bone mineral density is a prognostic factor for elderly patients with HCC undergoing TACE: results from a multicenter study
    Springer Science and Business Media LLC ; 2022
    In:  European Radiology Vol. 33, No. 2 ( 2022-08-20), p. 1031-1039
    Details
    In: European Radiology, Springer Science and Business Media LLC, Vol. 33, No. 2 ( 2022-08-20), p. 1031-1039
    Abstract: Low bone mineral density (BMD) was recently identified as a novel risk factor for patients with hepatocellular carcinoma (HCC). In this multicenter study, we aimed to validate the role of BMD as a prognostic factor for patients with HCC undergoing transarterial chemoembolization (TACE). Methods This retrospective multicenter trial included 908 treatment-naïve patients with HCC who were undergoing TACE as a first-line treatment, at six tertiary care centers, between 2010 and 2020. BMD was assessed by measuring the mean Hounsfield units (HUs) in the midvertebral core of the 11 th thoracic vertebra, on contrast-enhanced computer tomography performed before treatment. We assessed the influence of BMD on median overall survival (OS) and performed multivariate analysis including established estimates for survival. Results The median BMD was 145 HU (IQR, 115–175 HU). Patients with a high BMD (≥ 114 HU) had a median OS of 22.2 months, while patients with a low BMD ( 〈 114 HU) had a lower median OS of only 16.2 months ( p 〈 .001). Besides albumin, bilirubin, tumor number, and tumor diameter, BMD remained an independent prognostic factor in multivariate analysis. Conclusions BMD is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. The integration of BMD into novel scoring systems could potentially improve survival prediction and clinical decision-making. Key Points • Bone mineral density can be easily assessed in routinely acquired pre-interventional computed tomography scans. • Bone mineral density is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. • Thus, bone mineral density is a novel imaging biomarker for prognosis prediction in elderly patients with HCC undergoing TACE.
    Type of Medium: Online Resource
    ISSN: 1432-1084
    URL: Article
    DOI: 10.1007/s00330-022-09069-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1472718-3
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  • 8
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    Correction to: Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?
    Springer Science and Business Media LLC ; 2022
    In:  European Radiology Vol. 32, No. 5 ( 2022-05), p. 3609-3609
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    In: European Radiology, Springer Science and Business Media LLC, Vol. 32, No. 5 ( 2022-05), p. 3609-3609
    Type of Medium: Online Resource
    ISSN: 1432-1084
    URL: Article
    DOI: 10.1007/s00330-021-08386-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 9
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    Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation?
    Springer Science and Business Media LLC ; 2020
    In:  European Radiology Vol. 30, No. 6 ( 2020-06), p. 3497-3506
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    In: European Radiology, Springer Science and Business Media LLC, Vol. 30, No. 6 ( 2020-06), p. 3497-3506
    Abstract: To differentiate subtypes of hepatocellular adenoma (HCA) based on enhancement characteristics in gadoxetic acid (Gd-EOB) magnetic resonance imaging (MRI). Materials and methods Forty-eight patients with 79 histopathologically proven HCAs who underwent Gd-EOB-enhanced MRI were enrolled (standard of reference: surgical resection). Two blinded radiologists performed quantitative measurements (lesion-to-liver enhancement) and evaluated qualitative imaging features. Inter-reader variability was tested. Advanced texture analysis was used to evaluate lesion heterogeneity three-dimensionally . Results Overall, there were 19 (24%) hepatocyte nuclear factor (HNF)-1a-mutated (HHCAs), 37 (47%) inflammatory (IHCAs), 5 (6.5%) b-catenin-activated (bHCA), and 18 (22.5%) unclassified (UHCAs) adenomas. In the hepatobiliary phase (HBP), 49.5% (39/79) of all adenomas were rated as hypointense and 50.5% (40/79) as significantly enhancing (defined as 〉  25% intralesional GD-EOB uptake). 82.5% (33/40) of significantly enhancing adenomas were IHCAs, while only 4% (1/40) were in the HHCA subgroup ( p   〈  0.001). When Gd-EOB uptake behavior was considered in conjunction with established MRI features (binary regression model), the area under the curve (AUC) increased from 0.785 to 0.953 for differentiation of IHCA (atoll sign + hyperintensity), from 0.859 to 0.903 for bHCA (scar + hyperintensity), and from 0.899 to 0.957 for HHCA (steatosis + hypointensity). Three-dimensional region of interest (3D ROI) analysis showed significantly increased voxel heterogeneity for IHCAs ( p  = 0.038). Conclusion Gd-EOB MRI is of added value for subtype differentiation of HCAs and reliably identifies the typical heterogeneous HBP uptake of IHCAs. Diagnostic accuracy can be improved significantly by the combined analysis of established morphologic MR appearances and intralesional Gd-EOB uptake. Key Points • Gd-EOB-enhanced MRI is of added value for subtype differentiation of HCA. • IHCA and HHCA can be identified reliably based on their typical Gd-EOB uptake patterns, and accuracy increases significantly when additionally taking established MR appearances into account. • The small numbers of bHCAs and UHCAs remain the source of diagnostic uncertainty.
    Type of Medium: Online Resource
    ISSN: 0938-7994 , 1432-1084
    URL: Article
    DOI: 10.1007/s00330-020-06726-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 10
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    Liver Venous Deprivation (LVD) Versus Portal Vein Embolization (PVE) Alone Prior to Extended Hepatectomy: A Matched Pair Analysis
    Springer Science and Business Media LLC ; 2022
    In:  CardioVascular and Interventional Radiology Vol. 45, No. 7 ( 2022-07), p. 950-957
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    In: CardioVascular and Interventional Radiology, Springer Science and Business Media LLC, Vol. 45, No. 7 ( 2022-07), p. 950-957
    Abstract: To investigate whether liver venous deprivation (LVD) as simultaneous, portal vein (PVE) and right hepatic vein embolization offers advantages in terms of hypertrophy induction before extended hepatectomy in non-cirrhotic liver. Materials and Methods Between June 2018 and August 2019, 20 patients were recruited for a prospective, non-randomized study to investigate the efficacy of LVD. After screening of 134 patients treated using PVE alone from January 2015 to August 2019, 14 directly matched pairs regarding tumor entity (cholangiocarcinoma, CC and colorectal carcinoma, CRC) and hypertrophy time (defined as time from embolization to follow-up imaging) were identified. In both treatment groups, the same experienced reader ( 〉  5 years experience) performed imaging-based measurement of the volumes of liver segments of the future liver remnant (FLR) prior to embolization and after the standard clinical hypertrophy interval (~ 30 days), before surgery. Percentage growth of segments was calculated and compared. Results After matched follow-up periods (mean of 30.5 days), there were no statistically significant differences in relative hypertrophy of FLRs. Mean ± standard deviation relative hypertrophy rates for LVD/PVE were 59 ± 29.6%/54.1 ± 27.6% ( p  = 0.637) for segments II + III and 48.2 ± 22.2%/44.9 ± 28.9% ( p  = 0.719) for segments II–IV, respectively. Conclusions LVD had no significant advantages over the standard method (PVE alone) in terms of hypertrophy induction of the FLR before extended hepatectomy in this study population.
    Type of Medium: Online Resource
    ISSN: 0174-1551 , 1432-086X
    URL: Article
    DOI: 10.1007/s00270-022-03107-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1458490-6
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