State of the Art in Artificial Intelligence and Radiomics in Hepatocellular Carcinoma

The most common liver malignancy is hepatocellular carcinoma (HCC), which is also associated with high mortality. Often HCC develops in a chronic liver disease setting, and early diagnosis as well as accurate screening of high-risk patients is crucial for appropriate and effective management of these patients. While imaging characteristics of HCC are well-defined in the diagnostic phase, challenging cases still occur, and current prognostic and predictive models are limited in their accuracy. Radiomics and machine learning (ML) offer new tools to address these issues and may lead to scientific breakthroughs with the potential to impact clinical practice and improve patient outcomes. In this review, we will present an overview of these technologies in the setting of HCC imaging across different modalities and a range of applications. These include lesion segmentation, diagnosis, prognostic modeling and prediction of treatment response. Finally, limitations preventing clinical application of radiomics and ML at the present time are discussed, together with necessary future developments to bring the field forward and outside of a purely academic endeavor

The Role of Radiomics and AI Technologies in the Segmentation, Detection, and Management of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common primary hepatic neoplasm. Thanks to recent advances in computed tomography (CT) and magnetic resonance imaging (MRI), there is potential to improve detection, segmentation, discrimination from HCC mimics, and monitoring of therapeutic response. Radiomics, artificial intelligence (AI), and derived tools have already been applied in other areas of diagnostic imaging with promising results. In this review, we briefly discuss the current clinical applications of radiomics and AI in the detection, segmentation, and management of HCC. Moreover, we investigate their potential to reach a more accurate diagnosis of HCC and to guide proper treatment planning

Relationship between primary liver hepatocellular carcinoma volumes on portal-venous phase CT imaging

The liver is an important organ in the body. It is located under the rib cage on the right side. The liver performs many important functions, it processes food for nutrients that the body requires and also helps in the detoxification of harmful materials. Like any organ in the body, the liver is susceptible to diseases such as liver cancer. Liver cancer is the growth and spread of unhealthy cells of the liver. There are several risk factor for liver cancer, these are: Cirrhosis (scarring of the liver), long term hepatitis B and hepatitis C infection and diabetes patients with long term drinking problem. Hepatocellular Carcinoma is the most common form of liver cancer in adult population which begins in the main type of liver cell (hepatocyte). Because Hepatocellular carcinoma starts from the primary liver cell itself (hepatocytes), as such it is a primary liver cancer. About 30,000 Americans are diagnosed with primary liver cancer yearly, making it an important disease that plaques our society and therefore needs proper diagnosis. In clinical evaluation of primary liver cancer such as HCC, the use of medical imaging technology has been commonplace. Most medical facilities across the country and globally typically use Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) in the diagnosis and treatment follow up of Hepatocellular carcinoma. The medical imaging devices are used to determine the extent and volume of the tumor of the cancerous liver cells. In clinical trials involving the imaging of HCC tumors, the typical protocol used in the CT imaging of HCC involves the use of contrast enhanced dual phase acquisition. This approach is based on the physiology of the blood flow through the liver. Since HCC tumors are hypervascular in nature, it would thus be more apparent in the arterial phase of an acquired CT image. The aforementioned characteristic was tested with a volume paradigm which measure and compare the volume of both the arterial phase and portal venous phase acquired images in the experiment. Overall this study helps in furthering goals to reduce the patient dose from the x-ray tubes during clinical trials. The results of the experiments (n = 19, t = 0.67, p = 0.26), indicates no significant difference between the volume of the HCC tumor images acquired both in the AP and PVP

Invasão microvascular no carcinoma hepatocelular : é possível predizer pelos parâmetros quantitativos da tomografia computadorizada?

To investigate whether quantitative computed tomography (CT) measurements can predict microvascular invasion (MVI) in hepatocellular carcinoma (HCC). This was a retrospective analysis of 200 cases of surgically proven HCCs in 125 consecutive patients evaluated between March 2010 and November 2017. We quantitatively measured regions of interest in lesions and adjacent areas of the liver on unenhanced CT scans, as well as in the arterial, portal venous, and equilibrium phases on contrast-enhanced CT scans. Enhancement profiles were analyzed and compared with histopathological references of MVI. Univariate and multivariate logistic regression analyses were used in order to evaluate CT parameters as potential predictors of MVI. Of the 200 HCCs, 77 (38.5%) showed evidence of MVI on histopathological analysis. There was no statistical difference between HCCs with MVI and those without, in terms of the percentage attenuation ratio in the portal venous phase (114.7 vs. 115.8) and equilibrium phase (126.7 vs. 128.2), as well as in terms of the relative washout ratio, also in the portal venous and equilibrium phases (15.0 vs. 8.2 and 31.4 vs. 26.3, respectively). Quantitative dynamic CT parameters measured in the preoperative period do not appear to correlate with MVI in HCC525287292O objetivo deste estudo foi investigar se parâmetros quantitativos da tomografia computadorizada (TC) podem predizer invasão microvascular (IMV) no carcinoma hepatocelular (CHC). Foram analisados, retrospectivamente, 200 CHCs comprovados de 125 pacientes submetidos consecutivamente a transplante ou ressecção hepática entre março/2010 e novembro/2017. Foram realizadas medidas quantitativas da densidade das lesões e do parênquima hepático adjacente pré-contraste e nas fases arterial, portal e de equilíbrio das TCs. Parâmetros de impregnação foram comparados com a presença de IMV nos laudos anatomopatológicos. Regressões logísticas univariadas e multivariadas foram utilizadas para avaliar os parâmetros da TC como potenciais preditores de IMV. Dos 200 CHCs, 77 (38,5%) tinham IMV no anatomopatológico. Não houve diferença estatística na razão de atenuação entre CHCs com IMV e os sem IMV na fase portal (114,7 para IMV positiva e 115,8 para IMV negativa) ou de equilíbrio (126,7 para IMV positiva e 128,2 para IMV negativa), nem na razão de washout relativa nas fases portal e de equilíbrio (15,0 para IMV positiva e 8,2 para IMV negativa na fase portal, e 31,4 para IMV positiva e 26,3 para IMV negativa na fase de equilíbrio

Artificial Intelligence in the Diagnosis of Hepatocellular Carcinoma: A Systematic Review.

Hepatocellular carcinoma ranks fifth amongst the most common malignancies and is the third most common cause of cancer-related death globally. Artificial Intelligence is a rapidly growing field of interest. Following the PRISMA reporting guidelines, we conducted a systematic review to retrieve articles reporting the application of AI in HCC detection and characterization. A total of 27 articles were included and analyzed with our composite score for the evaluation of the quality of the publications. The contingency table reported a statistically significant constant improvement over the years of the total quality score (p = 0.004). Different AI methods have been adopted in the included articles correlated with 19 articles studying CT (41.30%), 20 studying US (43.47%), and 7 studying MRI (15.21%). No article has discussed the use of artificial intelligence in PET and X-ray technology. Our systematic approach has shown that previous works in HCC detection and characterization have assessed the comparability of conventional interpretation with machine learning using US, CT, and MRI. The distribution of the imaging techniques in our analysis reflects the usefulness and evolution of medical imaging for the diagnosis of HCC. Moreover, our results highlight an imminent need for data sharing in collaborative data repositories to minimize unnecessary repetition and wastage of resources

Updates on the diagnosis and management of hepatocellular carcinoma

Introduction: Globally, the incidence, as well as mortality, related to hepatocellular carcinoma (HCC) is on the rise, owing to relatively few curative options. Underlying cirrhosis is the most common etiology leading to HCC, but risk factors of cirrhosis show great regional variability. Over the years, there has been a steady development in the diagnostic and therapeutic modalities of HCC, including the availability of a wide range of systemic chemotherapeutic agents. We aim to review the recent advancements in the diagnostic and therapeutic strategies for HCC.Methodology: The literature search was done using databases PubMed, Cochrane, and Science Direct, and the latest relevant articles were reviewed.Findings: Screening of HCC is a pivotal step in the early diagnosis of the disease. Current guidelines recommend using ultrasound and alfa fetoprotein but various new biomarkers are under active research that might aid in diagnosing very small tumors, not picked up by the current screening methods. Treatment options are decided based upon the overall performance of the patient and the extent of the disease, as per the Barcelona classification. There are very few options that offer a cure for the disease, ranging from liver resection and transplantation to tumor ablation. Downstaging has proven to have a significant role in the course of the disease. An attempt to control the disease can be made via radiological interventions, such as transarterial chemoembolization, transarterial radioembolization, or radiation therapy. For advanced disease, sorafenib used to be the only option until a couple of years ago. Recently, many other systemic agents have received approval as first-line and second-line therapies for HCC. Genomics is an area of active clinical research as understanding the mutations and genomics involved in the evolution of HCC might lead to a breakthrough therapy

Assessing Doppler-Derived Pressure Gradients and Liver Echogenicity to Predict Liver Disease

Liver disease causes an estimated 36,000 deaths in the United States each year. Currently, to detect liver disease, an invasive biopsy is required. Other, less invasive diagnostic alternatives are needed. The purpose of this study was to assess the efficacy of a modified form of sonographic screening, including portal, hepatic, and splenic venous pressure, hepatic venous waveform analysis, portal vein diameter, and echogenicity of liver parenchyma in predicting liver disease. The study was based on conversion of a velocity measurement to a pressure gradient, allowing a fluid comparison between known catheterization venous pressures and sonographic Doppler-derived pressure gradients. This study was a secondary data analysis of a data set from 546 patients who received abdominal sonograms at a medical facility in the western United States between March 2010 and December 2010. The dependent variable was liver disease and the independent variables were ECHOGRADE, hepatic venous waveform (HVW), splenic vein pressure gradient (SVPG), modified portal vein pressure gradient (MPVPG), and hepatic vein pressure gradient (HVPG). Logistic regression was used to analyze the data. ECHOGRADE, HVW, and MPVPG in males were found to be statistically significant in detecting liver disease, supporting the theoretical framework and thus documenting a novel use of Doppler for the detection of liver disease. The social change significance of these results is to provide clinicians with an alternative, noninvasive method of diagnosing early liver disease before it progresses into chronic liver disease. With earlier detection, severe adverse health outcomes leading to irreversible liver cirrhosis may be avoided

An investigation of the detection and treatment of colorectal liver metastases

In the United Kingdom, colorectal cancer creates a significant health burden, with over 34 000 new cases diagnosed each year and over 16 000 deaths per year. Almost 50% of patients with colorectal cancer will develop liver metastases: up to 25% will have liver metastases at time of initial presentation with the remaining 25% developing liver metastases during the course of their disease. Death from hepatic metastases accounts for a large percentage of colorectal cancer mortalities and if left untreated the prognosis is poor, with median survival from 5 to 21 months with almost none alive at 5 years. Surgical resection offers the only potential curative treatment for colorectal liver metastases with the five year survival rate varying in the literature from 25% to 51%. Hepatic surgery was associated with high morbidity and mortality and it is only since the 1990s that an evidence base has been published showing improved long term outcomes. Radiological imaging plays an essential role in the detection and characterisation of colorectal liver metastases. Accurate staging of the disease allows patient selection for hepatic surgery. Despite recent and significant technological advances in radiological imaging, up to 50% of patients that have undergone curative partial hepatectomy will develop hepatic recurrence in the first two years after surgery. Evidence from growth rate studies has shown that colorectal liver metastases are slow growing and that these recurrences were present at the time of initial staging. Therefore, the problem of occult liver metastases remains. This thesis has assessed the potential clinical role of a new imaging modality in the detection of colorectal liver metastases: contrast enhanced ultrasound (CE-US). Initially a prospective trial using percutaneous CE-US with intravenous administration of an ultrasound contrast agent that has been used primarily in cardiac imaging was performed. The results of this study found that CE-US enhanced late phase vascular imaging. This is an important finding as the persistence of a hypoechoic liver lesion in to the late phase of CE-US imaging is typical of a colorectal liver metastasis and an agent that optimises the late phase would allow improved characterisation of colorectal liver metastases. As a result, CE-US was then compared to percutaneous unenhanced ultrasound and found to have improved sensitivity and accuracy in the detection of colorectal liver metastases (sensitivity 100%, accuracy 90.8% versus 64.4% and 64.4% respectively). Furthermore, the optimal late phase imaging was achieved by the lowest dose of agent (0.4mL) that would allow repeated injections if incorporated into routine clinical practice. These findings support the growing evidence base for percutaneous CE-US and it is likely that CE-US will replace unenhanced ultrasound in routine clinical practice. (Abstract shortened by ProQuest.)