State-of-the-art MR imaging in the work-up of primary hepatocellular tumors

Magnetic resonance (MR) imaging is an imaging modality that has evolved rapidly in the past two decades. The development of advanced hardware and new sophisticated pulse sequences have allowed faster imaging, with increased temporal and spatial resolution. This has resulted in the development and implementation of new acquisition techniques that facilitate improved visualisation of neoplastic processes. In addition, faster sequences enable multiphasic dynamic imaging after intravenous administration of contrast material, which results in better tumor characterisation and improved diagnostic confidence by the reading radiologist. The radiol

Liver Biopsy

Liver biopsy is recommended as the gold standard method to determine diagnosis, fibrosis staging, prognosis and therapeutic indications in patients with chronic liver disease. However, liver biopsy is an invasive procedure with a risk of complications which can be serious. This book provides the management of the complications in liver biopsy. Additionally, this book provides also the references for the new technology of liver biopsy including the non-invasive elastography, imaging methods and blood panels which could be the alternatives to liver biopsy. The non-invasive methods, especially the elastography, which is the new procedure in hot topics, which were frequently reported in these years. In this book, the professionals of elastography show the mechanism, availability and how to use this technology in a clinical field of elastography. The comprehension of elastography could be a great help for better dealing and for understanding of liver biopsy

Evaluation of the ECM Structures of Fibrotic Tissues by Using Raman Microspectroscopy

Fibrosis is a pathological process of excessive extracellular matrix (ECM) proteins deposition within tissues undergoing chronic inflammation. Fibrosis is highly related to a wide range of disorders across every organ and can cause negative effects on disease prognosis as well as life expectancy. It can be caused by numerous stimuli including implantation, aging, cancer, repetitive tissue damage, or disorders which are highly relevant to the chronic inflammatory reaction. Implantable medical devices can cause fibrotic capsule formation, which is triggered by the foreign body response (FBR). Fibrotic capsules can physically interfere with medical devices, thereby reducing therapeutic outcomes. The diagnostic evaluation of tissue fibrosis relies on the examination of tissue biopsies by gold-standard histochemical analysis. The definition, location and characteristics of the area of the fibrotic tissue can induce bias between individual pathologists with different clinical experiences, expertise and knowledge. Moreover, the limitations of histological staining involve invasive biopsy procedures and staining artifacts, which may cause errors in diagnostic results. The thesis mainly focused on the establishment of a new fibrotic assessment of implantation-driven FBR in streptozotocin (STZ)-induced diabetic animal model by using Raman microspectroscopy (RMS). ECM compositions as well as pro-inflammatory and regenerative macrophage activation states were investigated. We demonstrated the capability of RMS to discriminate collagen type I (Col I) between diabetic and non-diabetic rodent models via advanced glycation end products (AGEs) which were integrated into collagen fibers in diabetic groups. Furthermore, in combination with multivariate analysis (MVA), we revealed that RMS can be used to discern pathological fibrotic tissues and healthy tissues via the secondary structural differences based on the Raman spectrum of Col I, which can provide a non-biased clinical assessment. In addition to ECM characterization, RMS has the potential for immune cell classification. Raman imaging was applied on tissue sections for immunophenotyping in accordance with the fluorescence-guided generation of M1/M2 macrophages. The classification was attributed to the differences in DNA methylation states in the nuclei between M1/M2 phenotypes. In conclusion, Raman imaging and microspectroscopy offer an advanced diagnostic approach to monitor the FBR and fibrosis investigation in a molecular-sensitive and marker-independent manner

Semiautomated 3D liver segmentation using computed tomography and magnetic resonance imaging

Le foie est un organe vital ayant une capacité de régénération exceptionnelle et un rôle crucial dans le fonctionnement de l’organisme. L’évaluation du volume du foie est un outil important pouvant être utilisé comme marqueur biologique de sévérité de maladies hépatiques. La volumétrie du foie est indiquée avant les hépatectomies majeures, l’embolisation de la veine porte et la transplantation. La méthode la plus répandue sur la base d'examens de tomodensitométrie (TDM) et d'imagerie par résonance magnétique (IRM) consiste à délimiter le contour du foie sur plusieurs coupes consécutives, un processus appelé la «segmentation». Nous présentons la conception et la stratégie de validation pour une méthode de segmentation semi-automatisée développée à notre institution. Notre méthode représente une approche basée sur un modèle utilisant l’interpolation variationnelle de forme ainsi que l’optimisation de maillages de Laplace. La méthode a été conçue afin d’être compatible avec la TDM ainsi que l' IRM. Nous avons évalué la répétabilité, la fiabilité ainsi que l’efficacité de notre méthode semi-automatisée de segmentation avec deux études transversales conçues rétrospectivement. Les résultats de nos études de validation suggèrent que la méthode de segmentation confère une fiabilité et répétabilité comparables à la segmentation manuelle. De plus, cette méthode diminue de façon significative le temps d’interaction, la rendant ainsi adaptée à la pratique clinique courante. D’autres études pourraient incorporer la volumétrie afin de déterminer des marqueurs biologiques de maladie hépatique basés sur le volume tels que la présence de stéatose, de fer, ou encore la mesure de fibrose par unité de volume.The liver is a vital abdominal organ known for its remarkable regenerative capacity and fundamental role in organism viability. Assessment of liver volume is an important tool which physicians use as a biomarker of disease severity. Liver volumetry is clinically indicated prior to major hepatectomy, portal vein embolization and transplantation. The most popular method to determine liver volume from computed tomography (CT) and magnetic resonance imaging (MRI) examinations involves contouring the liver on consecutive imaging slices, a process called “segmentation”. Segmentation can be performed either manually or in an automated fashion. We present the design concept and validation strategy for an innovative semiautomated liver segmentation method developed at our institution. Our method represents a model-based approach using variational shape interpolation and Laplacian mesh optimization techniques. It is independent of training data, requires limited user interactions and is robust to a variety of pathological cases. Further, it was designed for compatibility with both CT and MRI examinations. We evaluated the repeatability, agreement and efficiency of our semiautomated method in two retrospective cross-sectional studies. The results of our validation studies suggest that semiautomated liver segmentation can provide strong agreement and repeatability when compared to manual segmentation. Further, segmentation automation significantly shortens interaction time, thus making it suitable for daily clinical practice. Future studies may incorporate liver volumetry to determine volume-averaged biomarkers of liver disease, such as such as fat, iron or fibrosis measurements per unit volume. Segmental volumetry could also be assessed based on subsegmentation of vascular anatomy

Hepatocellular Carcinoma

This book covers the clinical aspects of hepatocellular carcinoma. This book is a compendium of papers written by experts from different parts of the world to present the most up-to-date knowledge on the clinical aspects of hepatocellular carcinoma. This book is divided into three sections: (I) Diagnosis / Differential Diagnosis; (II) Surgical Treatment; (III) Non-surgical Treatment. There are 19 chapters covering topics from novel diagnostic methods to hepatic lesions mimicking hepatocellular carcinoma, from laparoscopic liver resection to major hepatectomy without allogeneic blood transfusion, from molecular targeted therapy to transarterial radioembolization, and from local ablative therapy to regional therapy. This volume is an important contribution to the clinical management of patients with hepatocellular carcinoma. The intended readers of this book are clinicians who are interested in hepatocellular carcinoma, including hepatologists, liver surgeons, interventional and diagnostic radiologists, pathologists and epidemiologists. General surgeons, general physicians, trainees, hospital administrators, and instruments and drug manufacturers will also find this book useful as a reference

Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) represents one of the most significant global health issues, given its high prevalence and the challenging nature and physiology of the liver and hepatic surgery, in its many forms. This means that the most appropriate management for HCC should incorporate a multidisciplinary approach, combining the expertise from several different specialties. This book showcases the various steps in the development, diagnosis, staging, and management of HCC and provides views and thoughts from true experts in the field. As such, it is a useful resource for any physician or surgeon, whether training or practicing, who is interested in caring for patients with HCC