Hepatic tumor diagnosis by analysing dense transport fields in contrast-enhanced ultrasound

International audienceDynamic contrast agent enhanced ultrasound (DCEUS) is considered as a safe, noninvasive, accurate, and economic tool for analysing blood perfusion of various organs [1]. Gas-filled mi-crobubble contrast agents are used as intravascular flow tracers. In this study, a new methodology is proposed to quantify the divergence (i.e sources, sinks), curl (i.e sheering) and amplitude in the apparent microbubble transports during the bolus arrival. The efficiency of proposed methodology is evaluated in-vivo, for the classification of focal nodular hyperplasia (FNH) and inflammatory hepatic adenomas (I-HCA)

Hepatic tumor diagnosis by analysing dense transport fields in contrast-enhanced ultrasound

International audienceDynamic contrast agent enhanced ultrasound (DCEUS) is considered as a safe, noninvasive, accurate, and economic tool for analysing blood perfusion of various organs [1]. Gas-filled mi-crobubble contrast agents are used as intravascular flow tracers. In this study, a new methodology is proposed to quantify the divergence (i.e sources, sinks), curl (i.e sheering) and amplitude in the apparent microbubble transports during the bolus arrival. The efficiency of proposed methodology is evaluated in-vivo, for the classification of focal nodular hyperplasia (FNH) and inflammatory hepatic adenomas (I-HCA)

ASS1 Overexpression:A Hallmark of Sonic Hedgehog Hepatocellular Adenomas; Recommendations for Clinical Practice

Until recently, 10% of hepatocellular adenomas (HCAs) remained unclassified (UHCA). Among the UHCAs, the sonic hedgehog HCA (shHCA) was defined by focal deletions that fuse the promoter of Inhibin beta E chain with GLI1. Prostaglandin D2 synthase was proposed as immunomarker. In parallel, our previous work using proteomic analysis showed that most UHCAs constitute a homogeneous subtype associated with overexpression of argininosuccinate synthase (ASS1). To clarify the use of ASS1 in the HCA classification and avoid misinterpretations of the immunohistochemical staining, the aims of this work were to study (1) the link between shHCA and ASS1 overexpression and (2) the clinical relevance of ASS1 overexpression for diagnosis. Molecular, proteomic, and immunohistochemical analyses were performed in UHCA cases of the Bordeaux series. The clinico-pathological features, including ASS1 immunohistochemical labeling, were analyzed on a large international series of 67 cases. ASS1 overexpression and the shHCA subgroup were superimposed in 15 cases studied by molecular analysis, establishing ASS1 overexpression as a hallmark of shHCA. Moreover, the ASS1 immunomarker was better than prostaglandin D2 synthase and only found positive in 7 of 22 shHCAs. Of the 67 UHCA cases, 58 (85.3%) overexpressed ASS1, four cases were ASS1 negative, and in five cases ASS1 was noncontributory. Proteomic analysis performed in the case of doubtful interpretation of ASS1 overexpression, especially on biopsies, can be a support to interpret such cases. ASS1 overexpression is a specific hallmark of shHCA known to be at high risk of bleeding. Therefore, ASS1 is an additional tool for HCA classification and clinical diagnosis

Hyperplasie nodulaire focale (corrélation radio-histologique, une série retrospective depuis 2007 au CHU de Bordeaux)

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Liver contrast-enhanced sonography: Computer-assisted differentiation between focal nodular hyperplasia and inflammatory hepatocellular adenoma by reference to microbubble transport patterns

International audienc

Hepatic tumor diagnosis by analysing dense transport fields in contrast-enhanced ultrasound

Dynamic contrast agent enhanced ultrasound (DCEUS) is considered as a safe, noninvasive, accurate, and economic tool for analysing blood perfusion of various organs [1]. Gas-filled mi-crobubble contrast agents are used as intravascular flow tracers. In this study, a new methodology is proposed to quantify the divergence (i.e sources, sinks), curl (i.e sheering) and amplitude in the apparent microbubble transports during the bolus arrival. The efficiency of proposed methodology is evaluated in-vivo, for the classification of focal nodular hyperplasia (FNH) and inflammatory hepatic adenomas (I-HCA)

Magnetic resonance texture parameters are associated with ablation efficiency in MR-guided high-intensity focussed ultrasound treatment of uterine fibroids

OBJECTIVES: The objective of this study is to assess the association between texture parameter analysis derived from T2-weighted images and efficiency of magnetic resonance-guided focussed ultrasound (MRgFUS) ablation for the treatment of uterine fibroids. MATERIALS AND METHODS: Fifty-five women treated by MRgFUS were included in this retrospective analysis. Texture parameters were calculated using three 2D regions of interest placed on three consecutive slices on the same sagittal 3D T2-weighted images obtained at the beginning of MRgFUS ablation. Using uni- and multi-variate linear regression, texture parameters, fibroids/muscular T2W ratio (T2Wr), Funaki type, and fibroid depth were correlated with ablation efficiency, defined as the ratio of non-perfused volume (NPV) on post-treatment contrast-enhanced MRI by total volume of treatment-cell sizes used. Inter-rater reproducibility for texture analysis was assessed using variation coefficients. RESULTS: The mean total treatment cell volume was 49.5 (±30) ml, corresponding to a mean NPV of 57.2 (±57) ml (28%). The mean ablation efficiency was 1.14 (±0.7), with a range of 0.03-3.6. In addition to fibroid/muscular T2Wr, seven of the 14 texture parameters were significantly correlated with ablation efficiency: mean signal intensity (p = .047); Skewness (p = .03); Kurtosis (p = .015); mean uniformity (p = .052); mean sum of square (p = .045); mean sum entropy (p = .021) and mean entropy (p = .051). In multivariate linear regression, fibroid/muscular T2Wr and sum of entropy were associated with ablation efficiency. The inter-rater coefficient of variation for sum entropy was 2.6%. CONCLUSIONS: Uterine fibroid texture parameters provide complementary information to T2Wr, and are associated with MRgFUS efficiency. Key points Mean sum entropy is negatively correlated with MRgFUS efficiency (ρ = -0.307, p = .021). Fibroids/muscular T2-weighted ratio and entropy are associated with MRgFUS efficiency. Texture parameters are better predictors of MRgFUS efficiency than Funaki type. Fibroid MR texture analysis can improve patient selection for MRgFUS

Acoustic Radiation Force Impulse (ARFI) and Transient Elastography (TE) for evaluation of liver fibrosis in HIV-HCV co-infected patients.

International audienceBACKGROUND: Transient elastography (TE) is widely used for non-invasive assessment of liver fibrosis in HIV-HCV co-infected patients. TE, however, cannot determine liver morphology. Acoustic radiation force impulse (ARFI) imaging is a novel procedure enabling assessment of liver fibrosis during a conventional ultrasonographic examination. This study evaluated the correlation between liver fibrosis measurements by TE and ARFI. METHODS: Each of 46 HIV-HCV patients underwent both ARFI and TE within 6 months. Patients were evaluated by the "equivalent METAVIR" scoring system, using previously established cut-off values. Agreements between the ARFI and TE scores were estimated by Kappa coefficients, with Kappa values ≥0.40, ≥0.60, and ≥0.80 defined as moderate, good and very good agreement, respectively. RESULTS: ARFI and TE yielded "Equivalent Metavir" fibrosis scores of F1 in 26 and 31 patients, respectively; F2 in nine and seven, respectively; F3 in three and two, respectively; and F4 in eight and six, respectively. The two methods showed very good agreement in predicting overall stages [Kappa = 0.82] and for F ≥3 [Kappa = 0.80] and moderate agreement in predicting significant fibrosis F ≥2 [Kappa = 0.50]. Morphologic ultrasound analysis concomitant to ARFI detected two hepatocarcinomas. CONCLUSIONS: ARFI showed promising results in the non-invasive assessment of liver fibrosis in HIV-HCV patients, with liver fibrosis staging similar to that of TE. Moreover, ARFI can assess morphology and fibrosis during the same session

Three-Dimensional Measurement Of hepatocellular carcinoma Ablation Zones And Margins For Predicting Local Tumor Progression

International audiencePurpose: To propose a postprocessing technique that measures tumor surface with insufficient ablative margins (r 5 mm) on magnetic resonance (MR) imaging to predict local tumor progression (LTP) following radiofrequency (RF) ablation.Materials and Methods: A diagnostic method is proposed based on measurement of tumor surface with a margin r 5 mm on MR imaging. The postprocessing technique includes fully automatic registration of pre-and post–RF ablation MR imaging, a semiautomatic segmentation of pre–RF ablation tumor and post–RF ablation volume, and a subsequent calculation of the three-dimensional exposed tumor surface area. The ability to use this surface margin r 5 mm to predict local recurrence at 2 years was then tested on 16 patients with cirrhosis who were treated by RF ablation with a margin r 5 mm in 2012: eight with LTP matched according to tumor size and number and α-fetoprotein level versus eight without local recurrence. Results: The error of estimated tumor surface with a margin r 5 mm was less than 12%.Results of a log-rank test showed that patients with a tumor surface area 4 425 mm 2 had a 2-year LTP rate of 77.5%, compared with 25% for patients with a tumor surface area r 425 mm 2 (P ¼ .018).Conclusions: This proof-of-concept study proposes an accurate and reliable postprocessing technique to estimate tumor surface with insufficient ablative margins, and underscores the potential usefulness of tumor surface with a margin r 5 mm to stratify patients with HCC treated by RF ablation according to their risk of LTP