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Advances and Novelties in Hepatobiliary and Pancreatic Imaging

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 July 2022) | Viewed by 26034

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Dr. Robbert J. de Haas

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Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Interests: abdominal radiology; special emphasis on hepato-pancreato-biliary diseases and transplantations; radiological imaging modalities (ultrasound, CT, MRI, PET-scans)
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Special Issue Information

Dear Colleagues,

Hepato-pancreato-biliary (HPB) imaging is a rapidly evolving subdivision of abdominal radiology, and HPB radiologists and nuclear medicine physicians are faced with challenging pathologies every day. HPB imaging includes all types of imaging modalities, including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography (PET). All these modern techniques contribute to detection and characterization of HPB diseases. Besides, artificial intelligence techniques play an increasing role in detection and characterization of HPB diseases, as well as in predicting patient outcomes. Furthermore, an important part of HPB imaging concerns providing anatomical information for preoperative planning. As a result, HPB radiologists and nuclear medicine physicians work closely together with surgeons, gastroenterologists, and oncologists. Because management of HPB pathologies has become more complex (e.g. increasing numbers of living-related liver transplantations are being performed, and liver surgery has been extended to more complex procedures), clinicians are expecting more advanced and sophisticated imaging techniques to answer their increasingly complex questions. Therefore, improvements of existing imaging modalities and development of novel imaging techniques are needed.

This Special Issue aims at providing the latest information regarding important developments in the field of HPB imaging, by gathering contributions concerning all aspects of HPB imaging. This concerns improvements in conventional imaging techniques focused both on focal and diffuse HPB pathologies, as well as the rapidly progressing artificial intelligence techniques which have become increasingly important in HPB imaging. In addition, contributions may also be focused on liver transplantation imaging.

Dr. Robbert J. de Haas
Guest Editor

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Keywords

Ultrasound
Computed tomography
Magnetic resonance imaging
Positron emission tomography
Artificial intelligence
Deep learning
Radiomics
Focal liver lesions
Diffuse liver disease
Liver transplantation
Biliary diseases
Pancreatitis
Pancreatic lesions
Surgery
Gastroenterology
Oncology

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Published Papers (10 papers)

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17 pages, 4932 KiB

Open AccessArticle

Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement after Pancreatic Surgery: Technical and Clinical Outcome in 133 Consecutive Patients during a 14-Year Period

by Christoph G. Trumm, Danilo Hackner, Katharina Badmann, Alexander Crispin, Robert Forbrig, Yigit Ozpeynirci, David Kuppinger, Vera Pedersen, Thomas Liebig and Robert Stahl

Diagnostics 2022, 12(9), 2243; https://doi.org/10.3390/diagnostics12092243 - 16 Sep 2022

Cited by 3 | Viewed by 1459

Abstract

(1) Purpose: To retrospectively assess the technical and clinical outcome of patients with symptomatic postoperative fluid collections after pancreatic surgery, treated with CT-guided drainage (CTD). (2) Methods: 133 eligible patients between 2004 and 2017 were included. We defined technical success as the sufficient drainage of the fluid collection(s) and the absence of peri-interventional complications (minor or major according to SIR criteria). Per definition, clinical success was characterized by normalization of specific blood parameters within 30 days after the intervention or a decrease by at least 50% without requiring additional surgical revision. C-reactive protein (CRP), Leukocytes, Interleukin-6, and Dose length product (DLP) for parts of the intervention were determined. (3) Results: 97.0% of 167 interventions were technically successful. Clinical success was achieved in 87.5% of CRP, in 78.4% of Leukocytes, and in 87.5% of Interleukin-6 assessments. The median of successful decrease was 6 days for CRP, 5 days for Leukocytes, and 2 days for Interleukin-6. No surgical revision was necessary in 93.2%. DLP was significantly lower in the second half of the observation period (total DLP: median 621.5 mGy*cm between 2011–2017 vs. median 944.5 mGy*cm between 2004–2010). (4) Conclusions: Technical success rate of CTD was very high and the clinical success rate was fair to good. Given an elderly and multimorbid patient cohort, CTD can have a temporizing effect in the postoperative period after pancreatic surgery. Reducing the radiation dose over time might reflect developments in CT technology and increased experience of interventional radiologists. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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12 pages, 4920 KiB

Open AccessArticle

Combining Hepatic and Splenic CT Radiomic Features Improves Radiomic Analysis Performance for Liver Fibrosis Staging

by Yunchao Yin, Derya Yakar, Rudi A. J. O. Dierckx, Kim B. Mouridsen, Thomas C. Kwee and Robbert J. de Haas

Diagnostics 2022, 12(2), 550; https://doi.org/10.3390/diagnostics12020550 - 21 Feb 2022

Cited by 12 | Viewed by 2535

Abstract

Background: The exact focus of computed tomography (CT)-based artificial intelligence techniques when staging liver fibrosis is still not exactly known. This study aimed to determine both the added value of splenic information to hepatic information, and the correlation between important radiomic features and information exploited by deep learning models for liver fibrosis staging by CT-based radiomics. Methods: The study design is retrospective. Radiomic features were extracted from both liver and spleen on portal venous phase CT images of 252 consecutive patients with histologically proven liver fibrosis stages between 2006 and 2018. The radiomics analyses for liver fibrosis staging were done by hepatic and hepatic–splenic features, respectively. The most predictive radiomic features were automatically selected by machine learning models. Results: When using splenic–hepatic features in the CT-based radiomics analysis, the average accuracy rates for significant fibrosis, advanced fibrosis, and cirrhosis were 88%, 82%, and 86%, and area under the receiver operating characteristic curves (AUCs) were 0.92, 0.81, and 0.85. The AUC of hepatic–splenic-based radiomics analysis with the ensemble classifier was 7% larger than that of hepatic-based analysis (p < 0.05). The most important features selected by machine learning models included both hepatic and splenic features, and they were consistent with the location maps indicating the focus of deep learning when predicting liver fibrosis stage. Conclusions: Adding CT-based splenic radiomic features to hepatic radiomic features increases radiomics analysis performance for liver fibrosis staging. The most important features of the radiomics analysis were consistent with the information exploited by deep learning. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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11 pages, 1953 KiB

Open AccessArticle

Noninvasive Diagnosis of Hepatocellular Carcinoma on Sonazoid-Enhanced US: Value of the Kupffer Phase

by Hiroshi Takahashi, Katsutoshi Sugimoto, Naohisa Kamiyama, Kentaro Sakamaki, Tatsuya Kakegawa, Takuya Wada, Yusuke Tomita, Masakazu Abe, Yu Yoshimasu, Hirohito Takeuchi and Takao Itoi

Diagnostics 2022, 12(1), 141; https://doi.org/10.3390/diagnostics12010141 - 7 Jan 2022

Cited by 18 | Viewed by 2140

Abstract

The aim of this study was to compare the diagnostic performance of Contrast-Enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) version 2017, which includes portal- and late-phase washout as a major imaging feature, with that of modified CEUS LI-RADS, which includes Kupffer-phase findings as a major imaging feature. Participants at risk of hepatocellular carcinoma (HCC) with treatment-naïve hepatic lesions (≥1 cm) were recruited and underwent Sonazoid-enhanced US. Arterial phase hyperenhancement (APHE), washout time, and echogenicity in the Kupffer phase were evaluated using both criteria. The diagnostic performance of both criteria was analyzed using the McNemar test. The evaluation was performed on 102 participants with 102 lesions (HCCs (n = 52), non-HCC malignancies (n = 36), and benign (n = 14)). Among 52 HCCs, non-rim APHE was observed in 92.3% (48 of 52). By 5 min, 73.1% (38 of 52) of HCCs showed mild washout, while by 10 min or in the Kupffer phase, 90.4% (47 of 52) of HCCs showed hypoenhancement. The sensitivity (67.3%; 35 of 52; 95% CI: 52.9%, 79.7%) of modified CEUS LI-RADS criteria was higher than that of CEUS LI-RADS criteria (51.9%; 27 of 52; 95% CI: 37.6%, 66.0%) (p = 0.0047). In conclusion, non-rim APHE with hypoenhancement in the Kupffer phase on Sonazoid-enhanced US is a feasible criterion for diagnosing HCC. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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12 pages, 12000 KiB

Open AccessArticle

A Novel Endoscopic Ultrasonography Imaging Technique for Depicting Microcirculation in Pancreatobiliary Lesions without the Need for Contrast-Enhancement: A Prospective Exploratory Study

by Yasunobu Yamashita, Takanori Yoshikawa, Hirofumi Yamazaki, Yuki Kawaji, Takashi Tamura, Keiichi Hatamaru, Masahiro Itonaga, Reiko Ashida, Yoshiyuki Ida, Takao Maekita, Mikitaka Iguchi and Masayuki Kitano

Diagnostics 2021, 11(11), 2018; https://doi.org/10.3390/diagnostics11112018 - 30 Oct 2021

Cited by 14 | Viewed by 2616

Abstract

Detective flow imaging endoscopic ultrasonography (DFI-EUS) provides a new method to image and detect fine vessels and low-velocity blood flow without using ultrasound contrast agents. The aim of this study was to evaluate the utility of DFI-EUS for pancreatobiliary lesions and lymph nodes. Between January 2019 and January 2020, 53 patients who underwent DFI-EUS, e-FLOW EUS, and contrast-enhanced EUS were enrolled. The ability of DFI-EUS and e-FLOW EUS to detect vessels was compared with that of contrast-enhanced EUS. This article describes the DFI technique along with our first experience of its use for vascular assessment of pancreatobiliary lesions. Vessels were imaged in 34 pancreatic solid lesions, eight intraductal papillary mucinous neoplasms (IPMNs), seven gall bladder lesions, and four swollen lymph nodes. DFI-EUS (91%) was significantly superior to e-FLOW EUS (53%) with respect to detection of vessels (p < 0.001) and for discrimination of mural nodules from mucous clots in IPMN and gallbladder lesions from sludge (p = 0.046). Thus, DFI-EUS has the potential to become an essential tool for diagnosis and vascular assessment of various diseases. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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19 pages, 14276 KiB

Open AccessArticle

Single-Breath-Hold MRI-SPACE Cholangiopancreatography with Compressed Sensing versus Conventional Respiratory-Triggered MRI-SPACE Cholangiopancreatography at 3Tesla: Comparison of Image Quality and Diagnostic Confidence

by Olivier Chevallier, Hélène Escande, Khalid Ambarki, Elisabeth Weiland, Bernd Kuehn, Kévin Guillen, Sylvain Manfredi, Sophie Gehin, Julie Blanc and Romaric Loffroy

Diagnostics 2021, 11(10), 1886; https://doi.org/10.3390/diagnostics11101886 - 13 Oct 2021

Cited by 2 | Viewed by 3668

Abstract

To compare two magnetic resonance cholangiopancreatography (MRCP) sequences at 3 Tesla (3T): the conventional 3D Respiratory-Triggered SPACE sequence (RT-MRCP) and a prototype 3D Compressed-Sensing Breath-Hold SPACE sequence (CS-BH-MRCP), in terms of qualitative and quantitative image quality and radiologist’s diagnostic confidence for detecting common bile duct (CBD) lithiasis, biliary anastomosis stenosis in liver-transplant recipients, and communication of pancreatic cyst with the main pancreatic duct (MPD). Sixty-eight patients with suspicion of choledocholithiasis or biliary anastomosis stenosis after liver transplant, or branch-duct intraductal papillary mucinous neoplasm of the pancreas (BD-IPMN), were included. The relative CBD to peri-biliary tissues (PBT) contrast ratio (CR) was assessed. Overall image quality, presence of artefacts, background noise suppression and the visualization of 12 separated segments of the pancreatic and bile ducts were evaluated by two observers working independently on a five-point scale. Diagnostic confidence was scored on a 1–3 scale. The CS-BH-MRCP presented significantly better CRs (p < 0.0001), image quality (p = 0.004), background noise suppression (p = 0.011), fewer artefacts (p = 0.004) and better visualization of pancreatic and bile ducts segments with the exception of the proximal CBD (p = 0.054), cystic duct confluence (p = 0.459), the four secondary intrahepatic bile ducts, and central part of the MPD (p = 0.885) for which no significant differences were found. Overall, diagnostic confidence was significantly better with the CS-BH-MRCP sequence for both readers (p = 0.038 and p = 0.038, respectively). This study shows that the CS-BH-MRCP sequence presents overall better image quality and bile and pancreatic ducts visualization compared to the conventional RT-MRCP sequence at 3T. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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12 pages, 7998 KiB

Open AccessArticle

Feasibility of TSPO-Specific Positron Emission Tomography Radiotracer for Evaluating Paracetamol-Induced Liver Injury

by Daehee Kim, Byung Seok Moon, Sun Mi Park, Sang Ju Lee, Seo Young Kang, Sanghui Park, Seung Jun Oh, Bom Sahn Kim and Hai-Jeon Yoon

Diagnostics 2021, 11(9), 1661; https://doi.org/10.3390/diagnostics11091661 - 10 Sep 2021

Cited by 5 | Viewed by 2132

Abstract

Macrophages are activated during the early phase of paracetamol-induced liver injury (PLI). [¹⁸F]GE180 is a radiolabeled ligand that recognizes the macrophage translocator protein (TSPO). In this study, we evaluated the feasibility of a TSPO-specific radiotracer in a rat model of PLI. A rat model of liver injury was induced by intraperitoneal administration of paracetamol. [¹⁸F]GE180 positron emission tomography (PET) images were obtained after 24 h. The maximal and mean standardized uptake values (SUV_max and SUV_av) of the liver and serum biomarker levels were examined. The TSPO expression level was examined using real-time polymerase chain reaction and Western blot analysis. [¹⁸F]GE180 hepatic uptake in the PLI group was significantly higher than that in the control group (SUV_max p = 0.001; SUV_av p = 0.005). Both mRNA and protein TSPO expression levels were higher in the PLI group. The mRNA expression level of TSPO was significantly correlated with [¹⁸F]GE180 hepatic uptake in both groups (SUV_max p = 0.019; SUV_av p = 0.007). [¹⁸F]GE180 hepatic uptake in the PLI group showed a significant positive correlation with ALT₂₄ and ALT₄₈ (ALT₂₄ p = 0.016; ALT₄₈p = 0.002). [¹⁸F]GE180 enabled visualization of PLI through TSPO overexpression. Our results support the potential utility of hepatic uptake by TSPO-PET as a non-invasive imaging biomarker for the early phase of PLI. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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14 pages, 2519 KiB

Open AccessArticle

Metabolic Alterations in Pancreatic Cancer Detected by In Vivo ¹H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome

by Chih-Kai Chang, Tiffany Ting-Fang Shih, Yu-Wen Tien, Ming-Chu Chang, Yu-Ting Chang, Shih-Hung Yang, Mei-Fang Cheng and Bang-Bin Chen

Diagnostics 2021, 11(9), 1541; https://doi.org/10.3390/diagnostics11091541 - 25 Aug 2021

Cited by 7 | Viewed by 2000

Abstract

Objective: To compare the metabolites of in vivo 1H- MRS in pancreatic cancer with normal pancreas, and correlate these metabolites with Positron Emission Tomography (PET) metabolic activity, clinical stages, and survival outcomes. Methods: The prospective study included 58 patients (mean age 62.7 ± 12.1 years, range 34–81 years; 36 men, 22 women) with pathological proof of pancreatic adenocarcinoma, and all of them received 18F-fluorodeoxyglucose (FDG) PET/MRI before treatment. The single-voxel MRS with a point-resolved selective spectroscopy sequence was used to measure metabolites (creatine, Glx (glutamine and glutamate), N-acetylaspartate (NAA), and lipid) of pancreatic cancer and adjacent normal parenchyma, respectively. FDG-PET parameters included SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Non-parametric tests were used to evaluate the differences of MRS metabolites between pancreatic cancer and those in normal pancreas, and their correlation with PET parameters and clinical stages. The correlation with progression-free survival (PFS) and overall survival (OS) was measured using the Kaplan–Meier and Cox proportional hazard models. Results: When compared with normal pancreas, the Glx, NAA, and lipid levels were significantly decreased in pancreatic cancer (all p < 0.05). Creatine, Glx, and lipid levels were all inversely correlated with both MTV (rho = −0.405~−0.454) and TLG (rho = −0.331~−0.441). For correlation with clinical stages, lower lipid levels were found in patients with T4 (vs. <T4, p = 0.038) and lower creatine levels were found in N1 (vs. N0, p = 0.019). Regarding survival outcomes, high TNM stage, low creatine, low Glx, and low lipid levels were associated with both poor PFS and OS (all p < 0.05). Additionally, creatine remained an independent factor for PFS and OS after adjusting for age, sex, tumor size, stages, and other metabolites levels. Conclusions: Decreased MRS metabolites in pancreatic cancer were associated with poor survival outcome, and may be used as prognostic image biomarkers for these patients. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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11 pages, 1015 KiB

Open AccessArticle

Correlation of Native Liver Parenchyma T1 and T2 Relaxation Times and Liver Synthetic Function Tests: A Pilot Study

by Ute Lina Fahlenkamp, Jan Kunkel, Katharina Ziegeler, Konrad Neumann, Lisa Christine Adams, Günther Engel, Sarah Maria Böker and Marcus Richard Makowski

Diagnostics 2021, 11(6), 1125; https://doi.org/10.3390/diagnostics11061125 - 20 Jun 2021

Cited by 2 | Viewed by 2511

Abstract

MR relaxometry increasingly contributes to liver imaging. Studies on native relaxation times mainly describe relation to the presence of fibrosis. The hypothesis was that relaxation times are also influenced by other inherent factors, including changes in liver synthesis function. With the approval of the local ethics committee and written informed consent, data from 94 patients referred for liver MR imaging, of which 20 patients had cirrhosis, were included. Additionally to standard sequences, both native T1 and T2 parametric maps and T1 maps in the hepatobiliary phase of gadoxetate disodium were acquired. Associations with laboratory variables were assessed. Altogether, there was a negative correlation between albumin and all acquired relaxation times in cirrhotic patients. In non-cirrhotic patients, only T1 values exhibited a negative correlation with albumin. In all patients, bilirubin correlated significantly with post-contrast T1 relaxation times, whereas native relaxation times correlated only in cirrhotic patients. Evaluating patients with pathological INR values, post-contrast relaxation times were significantly higher, whereas native relaxation times did not correlate. In conclusion, apart from confirming the value of hepatobiliary phase T1 mapping, our results show a correlation of native T1 with serum albumin even in non-cirrhotic liver parenchyma, suggesting a direct influence of liver’s synthesis capacity on T1 relaxation times. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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11 pages, 387 KiB

Open AccessSystematic Review

FAPI PET versus FDG PET, CT or MRI for Staging Pancreatic-, Gastric- and Cholangiocarcinoma: Systematic Review and Head-to-Head Comparisons of Diagnostic Performances

by Sophie E. M. Veldhuijzen van Zanten, Kay J. Pieterman, Bas P. L. Wijnhoven, Ilanah J. Pruis, Bas Groot Koerkamp, Lydi M. J. W. van Driel, Frederik A. Verburg and Maarten G. J. Thomeer

Diagnostics 2022, 12(8), 1958; https://doi.org/10.3390/diagnostics12081958 - 12 Aug 2022

Cited by 19 | Viewed by 3396

Abstract

Introduction: There is a pressing demand for the development of cancer-specific diagnostic imaging tools, particularly for staging of pancreatic-, gastric- or cholangiocarcinoma, as current diagnostic imaging techniques, including CT, MRI and PET using FDG, are not fully adequate. The novel PET-tracer “FAPI” has the potential to visualize even small tumour deposits employing the tumour-specific expression of fibroblast-activating protein (FAP) in malignant cells. Methods: We performed a systematic review to select studies investigating the use of FAPI PET for staging pancreatic-, gastric- and cholangiocarcinoma (PROSPERO CRD42022329512). Patient-wise and lesion-wise comparisons were performed for primary tumour (T), lymph nodes (N), organ metastases (M) and peritoneal carcinomatosis (PC). Maximum standardized uptake values (SUVmax) and tumour-to-background ratios (TBR) were compared between PET using FAPI versus FDG (if reported). Results: Ten articles met the inclusion criteria. In all studies, FAPI PET showed superiority over FDG-PET/CT/MRI for the detection of T, N, M and PC, both in the patient-wise and in lesion-wise comparisons (when performed). Additionally, higher SUVmax and TBRmax values were reported for use of FAPI compared to FDG. Conclusions: The positive results of this review warrant prospective clinical studies to investigate the accuracy and clinical value of FAPI PET for diagnosing and staging patients with pancreatic-, gastric- and cholangiocarcinoma. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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4 pages, 18404 KiB

Open AccessInteresting Images

Dynamic PET/CT with the Hepatobiliary Tracer [68Ga]Ga-Tmos-DAZA for Characterization of a Hepatic Tumor

by Martin Freesmeyer, Julia Greiser, Thomas Winkens, Falk Gühne, Christian Kühnel, Falk Rauchfuß, Hans-Michael Tautenhahn and Robert Drescher

Diagnostics 2021, 11(4), 660; https://doi.org/10.3390/diagnostics11040660 - 6 Apr 2021

Cited by 2 | Viewed by 2000

Abstract

Established imaging modalities for the characterization of liver tumors are computed tomography (CT), magnetical resonance (MR) imaging, sonography, and hepatobiliary scintigraphy. In some cases, their results may be inconclusive or certain examinations not possible due to contraindications. Positron emission tomography (PET)/CT has the capability of dynamic imaging with high temporal resolution. With radiolabeled tri-alkoxysalicyl-1,4-diazepan-6-amine (TAoS-DAZA) tracers, imaging of liver perfusion and hepatobiliary function is possible in a single examination. In the presented case, the PET/CT was performed in a patient with suspected hepatocellular carcinoma and atypical CT findings. PET imaging characteristics were consistent with a hepatocellular carcinoma (HCC). PET with DAZA ligands may be a supplemental method for liver tumor characterization in difficult cases. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging)

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