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Diagnostic Imaging of Liver Diseases

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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 January 2024) | Viewed by 8299

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Dr. Ruxandra Mare

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Guest Editor

1. Department of Internal Medicine II, Division of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
2. Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
Interests: liver diseases; portal hypertension; multiparametric ultrasound; elastography; contrast enhanced ultrasound; fatty liver

Prof. Dr. Ioan Sporea

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Guest Editor

1. Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
2. Advanced Hepatology Research Center of the Medical Science Academy, 300223 Timisoara, Romania
Interests: liver cirrhosis; hepatitis; hepatocellular carcinoma; elastography; gastroenterology; liver diseases; viral hepatitis; ultrasound; hepatology; liver biopsy

Special Issue Information

Dear Colleagues,

It is our pleasure to invite you to contribute to this Special Issue “Diagnostic Imaging of Liver Diseases”

Imaging is critical in the management of liver diseases because it allows for early detection, accurate diagnosis, and monitoring disease progression. A general approach to evaluating a patient with liver disease begins with a simple ultrasound, followed by computer tomography or MRI in inconclusive diagnosis. Liver disease often develops without any signs or symptoms, and it is often detected in the late stages through complications with a significantly poor prognosis.

Over the last decade, we have witnessed an increase in non-invasive ultrasound techniques such as contrast enhanced ultrasound or elastography and advances in imaging that have led to better understanding and diagnosing of liver diseases.

This Special Issue “Diagnostic Imaging of Liver Diseases”, aims to include research that will advance current knowledge in the field of liver diseases. The papers need to explore diagnostic challenges, present new non-invasive elastography techniques or validate existing ones and provide new insights into how imaging can improve health and quality of life in subjects with liver diseases.

In this Special Issue, original research articles, reviews and case presentations are welcome.

We look forward to receiving your contributions.

Dr. Ruxandra Mare
Prof. Dr. Ioan Sporea
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

ultrasonography
elastography
multiparametric ultrasound
contrast-enhanced ultrasound
computer tomography
magnetic resonance imaging
diffuse liver disease
focal liver lesions
liver fibrosis scores

Published Papers (9 papers)

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Research

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12 pages, 1850 KiB

Open AccessArticle

Usefulness of Diffusion-Weighted Imaging in Evaluating Acute Cellular Rejection and Monitoring Treatment Response in Liver Transplant Recipients

by Hsien-Jen Chiang, Yi-Hsuan Chuang, Chun-Wei Li, Chih-Che Lin, Hock-Liew Eng, Chao-Long Chen, Yu-Fan Cheng and Ming-Chung Chou

Diagnostics 2024, 14(8), 807; https://doi.org/10.3390/diagnostics14080807 - 11 Apr 2024

Viewed by 556

Abstract

Acute cellular rejection (ACR) is a significant immune issue among recipients following liver transplantation. Although diffusion-weighted magnetic resonance imaging (DWI) is widely used for diagnosing liver disease, it has not yet been utilized for monitoring ACR in patients after liver transplantation. Therefore, the aim of this study was to evaluate the efficacy of DWI in monitoring treatment response among recipients with ACR. This study enrolled 25 recipients with highly suspected ACR rejection, and all subjects underwent both biochemistry and DWI scans before and after treatment. A pathological biopsy was performed 4 to 24 h after the first MRI examination to confirm ACR and degree of rejection. All patients were followed up and underwent a repeated MRI scan when their liver function returned to the normal range. After data acquisition, the DWI data were post-processed to obtain the apparent diffusion coefficient (ADC) map on a voxel-by-voxel basis. Five regions of interest were identified on the liver parenchyma to measure the mean ADC values from each patient. Finally, the mean ADC values and biochemical markers were statistically compared between ACR and non-ACR groups. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of the ADC and biochemical data in detecting ACR, and correlation analysis was used to understand the relationship between the ADC values, biochemical markers, and the degree of rejection. The histopathologic results revealed that 20 recipients had ACR, including 10 mild, 9 moderate, and 1 severe rejection. The results demonstrated that the ACR patients had significantly lower hepatic ADC values than those in patients without ACR. After treatment, the hepatic ADC values in ACR patients significantly increased to levels similar to those in non-ACR patients with treatment. The ROC analysis showed that the sensitivity and specificity for detecting ACR were 80% and 95%, respectively. Furthermore, the correlation analysis revealed that the mean ADC value and alanine aminotransferase level had strong and moderate negative correlation with the degree of rejection, respectively (r = −0.72 and −0.47). The ADC values were useful for detecting hepatic ACR and monitoring treatment response after immunosuppressive therapy. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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14 pages, 4072 KiB

Open AccessArticle

The Portal Venous Pulsatility Index and Main Portal Vein Diameter as Surrogate Markers for Liver Fibrosis in Nonalcoholic Fatty Liver Disease and Metabolic-Dysfunction-Associated Steatotic Liver Disease

by Jaejun Lee, Seungmyeon Choi, Seong-Hyun Cho, Hyun Yang, Pil-Soo Sung and Si-Hyun Bae

Diagnostics 2024, 14(4), 393; https://doi.org/10.3390/diagnostics14040393 - 11 Feb 2024

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Abstract

(1) Background: Despite numerous noninvasive methods for assessing liver fibrosis, effective ultrasound parameters remain limited. We aimed to identify easily measurable ultrasound parameters capable of predicting liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and metabolic-dysfunction-associated steatotic liver disease (MASLD); (2) Methods: The data of 994 patients diagnosed with NAFLD via ultrasound at the Armed Forces Goyang Hospital were retrospectively collected from June 2022 to July 2023. A liver stiffness measurement (LSM) ≥ 8.2 kPa was classified as significant fibrosis. Liver steatosis with cardiometabolic risk factors was defined as MASLD. Two ultrasound variables, the portal venous pulsatility index (VPI) and main portal vein diameter (MPVD), were measured; (3) Results: Of 994 patients, 68 had significant fibrosis. Significant differences in VPI (0.27 vs. 0.34, p < 0.001) and MPVD (10.16 mm vs. 8.98 mm, p < 0.001) were observed between the fibrotic and non-fibrotic groups. A logistic analysis adjusted for age and body mass index (BMI) revealed that only VPI (OR of 0.955, p = 0.022, VPI on a 0.01 scale) and MPVD (OR of 1.501, p < 0.001) were significantly associated with significant liver fibrosis. In the MASLD cohort (n = 939), VPI and MPVD were associated with significant fibrosis. To achieve better accuracy in predicting liver fibrosis, we established a nomogram that incorporated MPVD and VPI. The established nomogram was validated in the test cohort, yielding an area under the receiver operating characteristic curve of 0.821 for detecting significant liver fibrosis; (4) Conclusions: VPI and MPVD, as possible surrogate markers, are useful in predicting significant fibrosis in patients with NAFLD and MASLD. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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15 pages, 5790 KiB

Open AccessArticle

An Optimized Strategy Based on Conventional Ultrasound for Diagnosing Metabolic Dysfunction-Associated Steatotic Liver Disease

by Xiongcai Feng, Junzhao Ye, Hong Deng, Xin Li, Lishu Xu, Shiting Feng, Zhi Dong, Bing Liao, Zhiyong Dong and Bihui Zhong

Diagnostics 2023, 13(23), 3503; https://doi.org/10.3390/diagnostics13233503 - 22 Nov 2023

Viewed by 834

Abstract

The inherent drawbacks of the conventional B-mode ultrasound for metabolic dysfunction-associated steatotic liver disease (MASLD) are poorly understood. We aimed to investigate the impact factors and optimize the screening performance of ultrasound in MASLD. In a prospective pilot cohort recruited from July 2020 to January 2022, subjects who had undergone magnetic resonance imaging-based proton density fat fraction (MRI-PDFF), ultrasound, and laboratory test-based assessments were included in the deprivation cohort. A validation cohort including 426 patients with liver histologic assessments from five medical centers in South China was also recruited. A total of 1489 Chinese subjects were enrolled in the deprivation cohort, and ultrasound misdiagnosed 62.2% of the non-MASLD patients and failed to detect 6.1% of the MASLD patients. The number of metabolic dysfunction components and the alanine aminotransferase (ALT) level were associated with a missed diagnosis by ultrasound (OR = 0.67, 95% CI 0.55–0.82 p < 0.001; OR = 0.50, 95% CI 0.31–0.79, p = 0.003, respectively). Compared with ultrasound alone, the new strategy based on ultrasound, in combination with measurements of the number of metabolic dysfunction components and ALT and uric acid levels, significantly improved the AUROC both in the research cohort and the validation cohort (0.66 vs. 0.84, 0.83 vs. 0.92, respectively). The number of metabolic dysfunction components and ALT and uric acid levels improved the screening efficacy of ultrasound for MASLD. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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17 pages, 2398 KiB

Open AccessArticle

Diagnostic Performance of an Artificial Intelligence Model Based on Contrast-Enhanced Ultrasound in Patients with Liver Lesions: A Comparative Study with Clinicians

by Marinela-Cristiana Urhuț, Larisa Daniela Săndulescu, Costin Teodor Streba, Mădălin Mămuleanu, Adriana Ciocâlteu, Sergiu Marian Cazacu and Suzana Dănoiu

Diagnostics 2023, 13(21), 3387; https://doi.org/10.3390/diagnostics13213387 - 5 Nov 2023

Cited by 1 | Viewed by 1377

Abstract

Contrast-enhanced ultrasound (CEUS) is widely used in the characterization of liver tumors; however, the evaluation of perfusion patterns using CEUS has a subjective character. This study aims to evaluate the accuracy of an automated method based on CEUS for classifying liver lesions and to compare its performance with that of two experienced clinicians. The system used for automatic classification is based on artificial intelligence (AI) algorithms. For an interpretation close to the clinical setting, both clinicians knew which patients were at high risk for hepatocellular carcinoma (HCC), but only one was aware of all the clinical data. In total, 49 patients with 59 liver tumors were included. For the benign and malignant classification, the AI model outperformed both clinicians in terms of specificity (100% vs. 93.33%); still, the sensitivity was lower (74% vs. 93.18% vs. 90.91%). In the second stage of multiclass diagnosis, the automatic model achieved a diagnostic accuracy of 69.93% for HCC and 89.15% for liver metastases. Readers demonstrated greater diagnostic accuracy for HCC (83.05% and 79.66%) and liver metastases (94.92% and 96.61%) compared to the AI system; however, both were experienced sonographers. The AI model could potentially assist and guide less-experienced clinicians to discriminate malignant from benign liver tumors with high accuracy and specificity. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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19 pages, 5687 KiB

Open AccessArticle

The Clinical Value of Multimodal Ultrasound for the Differential Diagnosis of Hepatocellular Carcinoma from Other Liver Tumors in Relation to Histopathology

by Marinela-Cristiana Urhuț, Larisa Daniela Săndulescu, Adriana Ciocâlteu, Sergiu Marian Cazacu and Suzana Dănoiu

Diagnostics 2023, 13(20), 3288; https://doi.org/10.3390/diagnostics13203288 - 23 Oct 2023

Cited by 1 | Viewed by 1013

Abstract

Recent advances in the field of ultrasonography offer promising tools for the evaluation of liver tumors. We aim to assess the value of multimodal ultrasound in differentiating hepatocellular carcinomas (HCCs) from other liver lesions. We prospectively included 66 patients with 72 liver tumors. The histological analysis was the reference standard for the diagnosis of malignant liver lesions, and partially for benign tumors. All liver lesions were assessed by multiparametric ultrasound: standard ultrasound, contrast-enhanced ultrasound (CEUS), the point shear wave elastography (pSWE) using shear wave measurement (SWM) method and real-time tissue elastography (RTE). To diagnose HCCs, CEUS achieved a sensitivity, specificity, accuracy and positive predictive value (PPV) of 69.05%, 92.86%, 78.57% and 93.55%, respectively. The mean shear-wave velocity (Vs) value in HCCs was 1.59 ± 0.29 m/s, which was lower than non-HCC malignancies (p < 0.05). Using a cut-off value of 1.58 m/s, SWM achieved a sensitivity of 54.76%, and 82.35% specificity, for differentiating HCCs from other malignant lesions. The combination of SWM and CEUS showed higher sensitivity (79.55%) compared with each technique alone, while maintaining a high specificity (89.29%). In RTE, most HCCs (61.53%) had a mosaic pattern with dominant blue areas corresponding to type “c” elasticity. Elasticity type “c” was 70.59% predictive for HCCs. In conclusion, combining B-mode ultrasound, CEUS, pSWE and RTE can provide complementary diagnostic information and potentially decrease the requirements for other imaging modalities. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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14 pages, 1183 KiB

Open AccessArticle

The Prevalence of Liver Fibrosis Stages on More than 23,000 Liver Stiffness Measurements by Vibration-Controlled Transient Elastography: A Single Center Study

by Alin Lazar, Ioan Sporea, Diana Lungeanu, Ruxandra Mare, Raluca Lupusoru, Alina Popescu, Mirela Danila, Alexandra Deleanu, Isabel Dan, Andrada Lascau, Alexandru Popa and Roxana Sirli

Diagnostics 2023, 13(17), 2803; https://doi.org/10.3390/diagnostics13172803 - 30 Aug 2023

Viewed by 736

Abstract

Vibration-controlled transient elastography (VCTE) was the first non-invasive method used for assessing liver fibrosis in patients with chronic liver disease. Over the years, many studies have evaluated its performance. It is now used globally, and, in some countries, it represents the primary step in evaluating liver fibrosis. The aim of this study is to assess the feasibility of VCTE and highlight the prevalence of liver fibrosis stages assessed by VCTE in a large cohort of patients at a single study center. We also aimed to observe the trends in liver stiffness (LS) values over the years according to each type of hepatopathy. A retrospective study was conducted over a period of 13 years (2007–2019) and included patients who presented to our clinic for LS measurements (LSMs), either with known liver diseases or with suspected liver pathology who were undergoing fibrosis screening. The database contained a total of 23,420 measurements. Valid LSMs were obtained in 90.91% (21,291/23,420) of the cases, while 2129 (9.09%) of the measurements were either failed or unreliable. In untreated patients with chronic viral hepatitis, LS values tended to increase during the years, while in patients undergoing antiviral therapy LS values significantly decreased. Our comprehensive study, one of the largest of its kind spanning 13 years, emphasizes the reliability and significance of VCTE in real-world clinical settings. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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14 pages, 1260 KiB

Open AccessReview

Seeing and Sensing the Hepatorenal Syndrome (HRS): The Growing Role of Ultrasound-Based Techniques as Non-Invasive Tools for the Diagnosis of HRS

by Cornelia Tăluță, Horia Ștefănescu and Dana Crișan

Diagnostics 2024, 14(9), 938; https://doi.org/10.3390/diagnostics14090938 - 30 Apr 2024

Viewed by 473

Abstract

More than half of patients hospitalized with liver cirrhosis are dealing with an episode of acute kidney injury; the most severe pattern is hepatorenal syndrome due to its negative prognosis. The main physiopathology mechanisms involve renal vasoconstriction and systemic inflammation. During the last decade, the definition of hepatorenal syndrome changed, but the validated criteria of diagnosis are still based on the serum creatinine level, which is a biomarker with multiple limitations. This is the reason why novel serum and urinary biomarkers have been intensively studied in recent years. Meanwhile, the imaging studies that use shear wave elastography are using renal stiffness as a surrogate for an early diagnosis. In this article, we focus on the physiopathology definition and highlight the novel tools used in the diagnosis of hepatorenal syndrome. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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12 pages, 8004 KiB

Open AccessCase Report

Multimodality Imaging of Primary Hepatic Lymphoma: A Case Report and a Literature Review

by Ryosuke Taiji, Nagaaki Marugami, Aki Marugami, Takahiro Itoh, Sho Shimizu, Ryota Nakano, Yuki Hoda, Hideki Kunichika, Tetsuya Tachiiri, Kiyoyuki Minamiguchi, Satoshi Yamauchi and Toshihiro Tanaka

Diagnostics 2024, 14(3), 306; https://doi.org/10.3390/diagnostics14030306 - 31 Jan 2024

Viewed by 833

Abstract

Primary hepatic lymphoma (PHL) is a rare form of non-Hodgkin lymphoma primarily affecting the liver. We present a case of an 84-year-old man diagnosed with PHL, incidentally detected during abdominal ultrasonography. The ultrasonography showed a hypoechoic nodule. When examined by CEUS, the nodule showed hyperenhancement in the arterial phase and hypoenhancement in the portal and late phases. Conversely, CECT demonstrated hypoenhancement through all the phases. The patient declined a tumor biopsy and opted for follow-up care. Ten months later, the lobular mass had increased from 15 mm to 65 mm, presenting as hypoechogenic and demonstrating the “vessel-penetrating sign” on color Doppler imaging. CEUS revealed reticulated enhancement, indicating intratumoral vessels. The mass displayed hypoattenuation on plain CT, hypointensity in T1-weighted images, and hyperintensity in T2-weighted images and exhibited significant restriction in diffusion-weighted images. Both CECT and contrast-enhanced MRI exhibited hypoenhancement. The patient underwent a partial hepatic segmentectomy, and the mass was pathologically diagnosed as a diffuse large B-cell lymphoma. Subsequent postoperative radiological examinations revealed no other lesions, confirming the diagnosis of PHL. Our report highlights specific ultrasonographic signs of PHL observed from an early stage and presents a review of the relevant literature. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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9 pages, 11132 KiB

Open AccessCase Report

Laparoscopic Extended Left Lateral Sectionectomy for Hepatocellular Carcinoma in a Patient with Right-Sided Ligamentum Teres: A Case Report and Literature Review

by Yuki Adachi, Hiroyuki Takahashi, Tomohiro Yamamoto, Masahiro Hagiwara, Koji Imai and Hideki Yokoo

Diagnostics 2023, 13(15), 2529; https://doi.org/10.3390/diagnostics13152529 - 29 Jul 2023

Viewed by 874

Abstract

Right-sided ligamentum teres (RSLT) is a rare anatomic variant in which the fetal umbilical vein connects to the right portal vein. Patients with RSLT frequently have hepatic vasculature and bile duct anomalies, which increase the risk of complications with hepatectomy. Most patients with RSLT undergo open hepatectomy. Herein, we describe a patient with RSLT and hepatocellular carcinoma who underwent laparoscopic hepatectomy. The patient was a 69-year-old man with hepatocellular carcinoma located in the left liver based on computed tomography (CT) and magnetic resonance imaging. Imaging also demonstrated RSLT. Three-dimensional CT analysis revealed independent right lateral type anomalies of the portal vein and bile duct. A laparoscopic extended left lateral sectionectomy was performed after careful surgical planning. Ultrasonography was used frequently during surgery to avoid damaging the right hepatic vasculature. The left lateral and partial left median sections were removed as planned. The patient’s postoperative recovery was uneventful. Avoiding injury to the right hepatic vasculature is essential when performing left lobectomy, including left lateral sectionectomy, in patients with RSLT. Laparoscopic hepatectomy can be performed safely in patients with RSLT, provided that careful surgical planning is conducted using preoperative three-dimensional CT analysis and intraoperative ultrasonography. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Liver Diseases)

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