Shahid M. Hussain

Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase i-ii study

The feasibility, toxicity and tumor response of stereotactic body radiation therapy (SBRT) for treatment of primary and metastastic liver tumors was investigated. From October 2002 until June 2006, 25 patients not suitable for other local treatments were entered in the study. In total 45 lesions were treated, 34 metastases and 11 hepatocellular carcinoma (HCC). Median follow-up was 12.9 months (range 0.5–31). Median lesion size was 3.2 cm (range 0.5–7.2) and median volume 22.2 cm3 (range 1.1–322). Patients with metastases, HCC without cirrhosis, and HCC < 4 cm with cirrhosis were mostly treated with 3×12.5 Gy. Patients with HCC ≥4cm and cirrhosis received 5×5 Gy or 3×10 Gy. The prescription isodose was 65%. Acute toxicity was scored following the Common Toxicity Criteria and late toxicity with the SOMA/LENT classification. Local failures were observed in two HCC and two metastases. Local control rates at 1 and 2 years for the whole group were 94% and 82%. Acute toxicity grade ≥3 was seen in four patients; one HCC patient with Child B developed a liver failure together with an infection and died (grade 5), two metastases patients presented elevation of gamma glutamyl transferase (grade 3) and another asthenia (grade 3). Late toxicity was observed in one metastases patient who developed a portal hypertension syndrome with melena (grade 3). SBRT was feasible, with acceptable toxicity and encouraging local control. Optimal dose-fractionation schemes for HCC with cirrhosis have to be found. Extreme caution should be used for patients with Child B because of a high toxicity risk.

MR imaging of hepatocellular carcinoma

In this article, MR imaging features of hepatocellular carcinoma (HCC) are described. To better understand the MR imaging features of HCC, recent progress regarding its etiology, treatment, carcinogenesis, histology, and gross pathology will be described. Currently, T2-weighted fast spin-echo with fat saturation, and multiphasic dynamic gadolinium-enhanced two-dimensional and three-dimensional T1-weighted gradient echo imaging provides excellent results for detection and characterization of HCC.

Hepatocellular adenoma : findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis

The purpose of this paper is to describe the most recent concepts and pertinent findings of hepatocellular adenomas, including clinical presentation, gross pathology and histology, pathogenesis and transformation into hepatocellular carcinoma (HCC), and imaging findings at ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.

MR imaging of hepatocellular carcinoma: Relationship between lesion size and imaging findings, including signal intensity and dynamic enhancement patterns

To assess the relationship between lesion size and MR imaging findings of pathologically‐proven hepatocellular carcinoma (HCC).

A review and update of treatment options and controversies in the management of hepatocellular carcinoma

Objective:To review the current management, outline recent advances and address controversies in the management of hepatocellular carcinoma (HCC). Summary of Background data:The treatment of HCC is multidisciplinary involving hepatologists, surgeons, medical oncologists, radiation oncologists, radiologists, interventional radiologists, and other disciplines. Each of these disciplines brings its unique perspective and differing opinions that add to controversies in the management of HCC. Methods:A focused literature review was performed to identify recent studies on the management of HCC and thereby summarize relevant information on the various therapeutic modalities and controversies involved in the treatment of HCC. Results:The main treatment algorithms continue to rely on hepatic resection or transplantation with controversies involving patients harboring early stage disease and borderline hepatic function. The other treatment strategies include locoregional therapies, radiation, and systemic therapy used alone or in combination with other treatment modalities. Recent advances in locoregional therapies, radiation, and systemic therapies have provided better therapeutic options with curative intent potential for some locoregional therapies. Further refinements in combination therapies such as algorithms consisting of locoregional therapies and systemic or radiation therapies are likely to add additional options and improve survival. Conclusions:The management of HCC has witnessed significant strides with advances in existing options and introduction of several new treatment modalities of various combinations. Further refinements in these treatment options combined with enrollment in clinical trials are essential to improve the management and outcomes of patients with HCC.

Cirrhosis and Lesion Characterization at MR Imaging

Magnetic resonance (MR) imaging has emerged as an important imaging modality for the assessment of cirrhosis and its complications. Faster sequences now allow high-quality liver imaging with high intrinsic soft-tissue contrast. Automated contrast detection methods in combination with faster sequences allow reproducible capture of the arterial phase, which is essential for the detection and characterization of hepatocellular carcinoma. The lack of ionizing radiation permits routine use of gadolinium-enhanced three-dimensional (3D) fat-suppressed multiphasic imaging with high temporal and spatial resolution. In addition, MR imaging allows simultaneous evaluation of the background liver parenchyma and the liver lesions with the combined use of sequences that include T2-weighted sequences, T1-weighted sequences (including chemical shift imaging), echoplanar diffusion-weighted sequences, dynamic gadolinium-enhanced 3D multiphasic imaging, and liver-specific delayed phase sequences (if contrast agents with hepatobiliary excretion are used). The combination of findings from different sequences often helps pinpoint the nature of the liver abnormalities.

Abdominal magnetic resonance imaging at 3.0 T: Problem or a promise for the future?

Abstract: The development of transmit-receive body coils and local and phased-array radiofrequency receive coils for 3.0-T magnetic resonance imaging (MRI) systems, and their recent approval in Europe and North America has promoted a move toward higher field, whole-body MRI. With approximately double the signal-noise ratio of a 1.5-T system, 3.0-T MR systems can substantially improve image quality and image acquisition speed; 3.0 T can potentially deliver √2 improvement in resolution in the same acquisition time of a comparable study at 1.5 T or one-half slice thickness with identical coverage or 4-fold speedup in scanning time for identical resolution settings. Parallel imaging, multiple coil elements, specific absorption rate, and altered MR physical properties at 3.0 T (T1 relaxation times, susceptibility, T2*) are important issues during optimization of sequences at high field. Possible future applications in the abdomen include high-resolution, contrast-enhanced imaging of the liver and pancreas; MR angiography; and MR spectroscopy. In this article, we will present our initial experience with optimization of sequences for abdominal MRI at 3.0 T and will include a short description of parallel imaging because of its importance for imaging at 3.0 T, general remarks comparing some of the physical properties of 1.5 T and 3.0 T, and some of the challenges during sequence optimization for the abdomen at 3.0 T with examples of abdominal MRI at 3.0 T with 4- and 8-channel coils.

Focal nodular hyperplasia: lesion characteristics on state-of-the-art MRI including dynamic gadolinium-enhanced and superparamagnetic iron-oxide-uptake sequences in a prospective study.

To image a cohort of patients with pathology‐proven focal nodular hyperplasia (FNH) to assess which characteristics of state‐of‐the‐art magnetic resonance imaging (MRI) of the liver are the most useful for improving the detection and characterization of FNH.

Stepwise carcinogenesis of hepatocellular carcinoma in the cirrhotic liver: demonstration on serial MR imaging.

To demonstrate imaging findings of stepwise carcinogenesis of hepatocellular carcinoma (HCC) in cirrhosis at serial state‐of‐the‐art MR imaging exams.

Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study

OBJECTIVE The purpose of this study was to determine the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis during pregnancy in a multiinstitutional study. STUDY DESIGN In this multicenter retrospective study, the cases of pregnant women who underwent MRI evaluation of abdominal or pelvic pain and who had clinical suspicion of acute appendicitis between June 1, 2009, and July 31, 2014, were reviewed. All MRI examinations with positive findings for acute appendicitis were confirmed with surgical pathologic information. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated. Receiver operating characteristic curves were generated, and area under the curve analysis was performed for each participating institution. RESULTS Of the cases that were evaluated, 9.3% (66/709) had MRI findings of acute appendicitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive values were 96.8%, 99.2%, 99.0%, 92.4%, and 99.7%, respectively. There was no statistically significant difference between centers that were included in the study (pair-wise probability values ranged from 0.12-0.99). CONCLUSION MRI is useful and reproducible in the diagnosis of suspected acute appendicitis during pregnancy.