Keywords: Liver, Liver

Motivation: Evaluate the performance of the LI-RADS v2018 features and clinical-pathological factors for predicting the prognosis of AFP-negative HCC.

Goal(s): To evaluate the performance of the LI-RADS v2018 features and clinical-pathological factors for predicting the prognosis of AFP-negative HCC.

Approach: A total of 169 AFP-negative HCC patients were enrolled. Risk factors associated with prognosis were identified by Cox regression analysis.

Results: Six risk factors, namely the LI-RADS category, blood products in mass, MVI, tumor size, cirrhosis, and ALBI grade, were associated with recurrence-free survival. The model effectively stratified patients with AFP-negative HCC into high- and low-risk groups with significantly different outcomes (p < 0.05).

Impact: In this study, our prognostic model composed of the LI-RADS category, blood products in mass, MVI, tumor size, cirrhosis, and ALBI grade accurately classified patients into different recurrence risk groups.

Keywords: Liver, Deuterium, Liver, DMI

Motivation: While HCL can be assessed in vivo using ¹H-MRS it may be of interest to determine it with DMI, as this offers the possibility for dynamic studies with incorporation of deuterated substances.

Goal(s): Our goal was to explore the detection limits and estimate HCL based on DMI.

Approach: 10 healthy subjects were measured in a 7T-MR-system with liver adjusted RF surface coil applying a single-voxel ¹H-MRS-GUSTEAU sequence and a ²H-MRSI sequence. HCL was assessed by comparison with the water signal from both measurements. 

Results: The HCL values were underestimated when applying DMI compared to the well-established ¹H-MRS ultra-short echo time GUSTEAU sequence.

Impact: Besides the use of ¹H-MRS, HCL can also be assessed with DMI. Due to the much lower natural abundance of ²H compared to ¹H, the detection limit for ²H-HCL was estimated to be ≥1%.

Keywords: Liver, MR Value, Hepatocellular Carcinoma; immunotargeted therapy; MRI; Quantitative parameters

Motivation: Quantitative MRI maybe helpful for evaluating the immunotargeted therapy efficacy in unresectable HCC.

Goal(s): To investigate the feasibility of quantitative MRI parameters for evaluating the immunotargeted therapy efficacy in unresectable HCC

Approach: Statistics analysis was used to  study the alterations in patients with unresectable HCC at baseline and 2 months, 4 monthsafter immunotherapy

Results: The ADC value of HCC increased,the longest diameter of HCC initially increased and then decreased. The ADC value and ΔT1% of HCC target lesions in partial response group increased significantly. In progressive disease group, the ΔT1% of HCC target lesions decreased significantly, and ADC values showed a downward trend.

Impact: This is the first report to evaluate the immunotargeted therapy in unresectable HCC using quantitative MRI techniques.

Keywords: Liver, Body

Motivation: Streamlining the number of b-values in MRI scans for hepatocellular carcinoma can significantly enhance diagnostic efficiency.

Goal(s): To identify the minimal b-value pairs that correspond with comprehensive diffusion model parameters, potentially simplifying future scanning protocols.

Approach: Employed MRI diffusion parameters across 11 b-values in 35 patients, comparing IVIM, DKI, and CTRW metrics with sADC values derived from varied b-value combinations.

Results: Discovered specific b-value pairs that closely matched the diffusion parameters of comprehensive models, suggesting a possible reduction in required b-values for accurate diagnosis.

Impact: This study could substantially refine MRI protocols, improving tumor characterization and grading while ensuring data quality with fewer b-values.

Keywords: Hepatobiliary, Precision & Accuracy, Differential diagnosis

Motivation: IMCC and SHHM have similarities in imaging manifestations, are prone to confusion, and the treatment methods are different, once misdiagnosed, it seriously affects the patient's treatment and prognosis.

Goal(s): This study aims to explore the differential diagnostic value of amide proton transfer (APT) combined with Gd-BOPTA in IMCC and SHHM.

Approach: Retrospective analysis, normality testing, logistic regression, ROC analysis, and other methods were used for the study.

Results: APT, LLR, and LSIR have significance in the differential diagnosis of IMCC and SHHM. When combined with LLR and LSIR, APT improves the differential efficiency.

Impact: This study helps to more accurately distinguish IMCC from SHHM, thus adopting the correct treatment method, which is of great help to the treatment and prognosis of patients.

Keywords: Liver, Tumor

Motivation: Hepatic hyperintense lesions, has been shown to be difficult for differential diagnosis in clinical. 

Goal(s): Multiple parameters MRI can potentially provide whole insights into hepatic lesion diagnosis. 

Approach: 144 patients based on hepatic hyperintense lesions (HCA and WDHCC) with presurgical MRI to investigate the differential diagnosis. 

Results: Results demonstrated that MRI signal model can provide more effective information for the differential diagnosis of hepatic hyperintense lesions especially for HCA and WDHCC.

Impact: Differentiating Hepatocellular adenomas (HCA) and well-differentiated hepatocellular carcinoma (WDHCC) via MRI signal-based model could offer a more comprehensive diagnostic approach than clinical factors-based model and combined MRI signal plus clinical factors-based model.

Keywords: Liver, Liver

Motivation: Preoperative prediction of tumor recurrence is essential for surveillance and management of patients with hepatocellular carcinoma (HCC).

Goal(s): To explore the diagnostic performance of virtual magnetic resonance elastography (vMRE) derived from preoperative diffusion-weighted images in predicting HCC recurrence after hepatectomy.

Approach: Eighty patients who underwent magnetic resonance imaging with a dedicated diffusion-weighted imaging sequence were retrospectively recruited. The parameters derived from vMRE, together with image features, were used to predict tumor recurrence after hepatectomy.

Results: The μ_diff values of vMRE and corona enhancement are potential biomarkers for the preoperative prediction of recurrence after hepatectomy in patients with HCC.

Impact: Our results revealed that preoperative diffusion–based virtual magnetic resonance elastography could be used for preoperative prediction of HCC recurrence without using additional hardware, which might help in deciding on treatment and formulating management strategies for patients with HCC.

Keywords: Hepatobiliary, Tumor, hepatic inflammatory myofibroblastic tumor

Motivation: Inflammatory myofibroblastic tumors (IMT) of the liver can mimic malignant tumors, yet, they lack definitive radiological characteristics.

Goal(s): To identify gadoxetate acid-enhanced MRI (Gd-EOB-MRI) features distinguishing hepatic inflammatory myofibroblastic tumor (IMT) from colorectal liver metastasis (CLM).

Approach: This retrospective study included 10 IMT (0.7-7.1 cm) and 28 CLM (0.4-5.4 cm) patients who underwent Gd-EOB-MRI. Two reviewers assessed tumor characteristics.

Results: Peripheral hypointense rim on T1WI, and arterial phase and/or portal venous phase, corresponding to the delayed enhanced rim on transitional phase, layered appearance  on T2WI, and obscure hypointensity on hepatobiliary phase were commonly in IMTs, but rare in CLMs.

Impact: The distinctive imaging features on Gd-EOB-DTPA MRI such as early target appearance and delayed enhanced rim and obscure hypointensity on Hepatobiliary phase, are helpful in  differential diagnosis of IMT from colorectal liver metastasis.

Keywords: Pancreas, Hyperpolarized MR (Non-Gas), Pancreatic Cancer, Metabolic Imaging, Early Detection

Motivation: There is an unmet need for early diagnosis of pancreatic cancer due to the asymptomatic nature of the disease.

Goal(s): The goal is to detect the early stages of pancreatic cancer by monitoring the altered metabolism in premalignant pancreatic lesions in vivo with hyperpolarized metabolic imaging.

Approach: This is validated in two mechanistic pathways of cancer progression, (1) pancreatic intraepithelial neoplasia (PanIN), and (2) intraductal papillary mucinous neoplasm (IPMN).

Results: Increased lactate flux is observed with progression of the premalignant lesions in both the pathways. No increase in lactate flux is observed in pancreatitis, a known confounder demonstrating the specificity of this technique.

Impact: This research described has the potential for leading to practice-changing recommendations for non-invasively detecting and monitoring premalignant lesions and incipient pancreatic cancer, to prevent over-diagnosis and over-treatment of cysts that harbor indolent biology. 

Keywords: Liver, Diffusion/other diffusion imaging techniques, diffusion; perfusion; MR imaging

Motivation: HCCs mostly show higher perfusion values compared with the adjacent normal liver tissue. Paradoxically authors reported a decrease IVIM-PF(perfusion fraction) of HCC relative to adjacent liver.

Goal(s): DWI-derived surrogate biomarker DDVD (diffusion-derived vessel density) is a physiological surrogate of the area of micro-vessels per unit tissue area.  This study applied DDVD to assess perfusion of HCC. 

Approach: 72 patients were included. DDVD= (signal intensity at b=0)/ROIarea – (signal intensity at b=2/ROIarea). 

Results: (tumor DDVD)/(liver DDVD) was 2.942 (median), majority of HCC showing a much higher DDVD than liver.

Impact: DDVD overcome the pitfalls associated with IVIM PF.

Keywords: Pancreas, Diffusion/other diffusion imaging techniques, Pancreatic ductal adenocarcinoma; FROC;CTRW;Differentiation

Motivation: This study aims to determine the value of diffusion kurtosis imaging (DKI), intro-voxel incoherent movement (IVIM), continuous-time random walk (CTRW), and fractional order calculus (FROC) in assessing the degree of differentiation of pancreatic cancer.

Goal(s): The objective is to identify the most effective quantitative diffusion metrics for assessing the degree of differentiation in pancreatic cancer.

Approach: Four MRI diffusion models were generated using DXI technology to quantitatively evaluate the degree of differentiation in pancreatic cancer.

Results: Significant differences were observed between the low-grade PDAC group and the high-grade PDAC group in terms of these metrics (K_DKI, α_CTRW, μ_FROC).

Impact: These advanced diffusion models hold potential as noninvasive tools for predicting the degree of differentiation in pancreatic cancer, facilitating personalized management strategies for patients with pancreatic ductal adenocarcinoma (PDAC).

Keywords: Cancer, Cancer

Motivation: Although many methods for generating 4D-MRI have been studied, there are few clinical applications for radiotherapy based on 4D-MRI.

Goal(s): To investigate the clinical potential of multi-parametric 4D-MRI in liver cancer radiotherapy.

Approach: Target contours were delineated on the planning CT with assisted by 3D-MRI and multi-parametric 4D-MRI. Clinical plans were designed based on these contours respectively. Target volume and contours in three different hepatic lobes and target dose were compared and evaluated.

Results: 3D image-guided target delineation may be more likely to underestimate target volume and compromise dose coverage.

Impact: Multi-parametric 4D-MRI can be applied in clinical radiotherapy, which provides more accurate target delineation and dose coverage.

Keywords: Hepatobiliary, Tumor

Motivation: The study seeks to validate an abbreviated MRI protocol for HCC post-treatment surveillance.

Goal(s): To determine whether an abbreviated MRI protocol is as effective as full protocol MRI for HCC surveillance post-MWA.

Approach: A retrospective cohort study comparing abbreviated MRI to full protocol MRI in detecting HCC recurrence after microwave ablation.

Results: The abbreviated MRI achieved an acceptable sensitivity, specificity, and negative predictive value, specificity in detecting local HCC recurrences post-MWA, indicating effective secondary surveillance potential.

Impact: The study demonstrates that abbreviated MRI can effectively monitor HCC post-treatment, offering a less burdensome and cost-effective surveillance method with high accuracy, paving the way for streamlined clinical monitoring protocols.

Keywords: Hepatobiliary, Biliary

Motivation: HCC expressing CK19-positive has a poor prognosis, and accurate preoperative prediction of CK19 is essential for determining the prognosis and treatment options for HCC patients

Goal(s): To explore the prognostic factors of CK19-positive small HCC

Approach: In this study, a nomogram to predict C19-positive small HCC was successfully constructed, and predictive factors for early recurrence in patients with C19-positive small HCCwere clarified.

Results: Rim APHE may help to predict early (2 years) postoperative recurrence in patients with CK19-positive small HCC (≤3 cm).

Impact: In this study, a nomogram to predict CK19-positive small HCC was successfully constructed, and predictive factors for early recurrence in patients with C19-positive small HCC were clarified.

Keywords: Liver, Liver, Hepatocellular Carcinoma, Targeted Therapy, Immunotherapy, Prognostic Prediction ·

Motivation: Biomarkers that predict the efficacy of immunotherapy-based systematic therapy remain an unmet need in HCC. 

Goal(s): To establish an optimized model by integrating magnetic resonance (MR) features and CRAFITY score to predict overall survival (OS) of HCC patients treated with targeted therapy and immunotherapy. 

Approach: The clinical variables and MR features were assessed by univariate and multivariate Cox regression analyses. 

Results: Based on independent risk factors (Gender, intRatumoral fAt, enhancing tumor caPsule, gross growtH type and CRAFITY Score) identified by the multivariate analysis, a novel prognostic tool named GRAPH-CRAFITY Score was developed to predict OS.

Impact: A novel prognostic tool by integrating gender, MR features and laboratory tests was developed to predict OS of HCC patients treated with targeted therapy and immunotherapy, which will help oncologists for decision-making.