Focal liver lesions: detection, characterization, ablation

Riccardo Lencioni, Dania Cioni, Carlo Bartolozzi, A.L. Baert9783540263548, 9783540644644, 3540644644

Few fields of medicine have witnessed such impressive progress as the diagnosis and treatment of liver tumors. Advances in imaging technology, the development of novel contrast agents, and the introduction of optimized scanning protocols have greatly facilitated the non-invasive detection and characterization of focal liver lesions. Furthermore, image-guided techniques for percutaneous tumor ablation have become an accepted alternative treatment for patients with inoperable liver cancer. This book provides a comprehensive and up-to-date overview of the role of diagnostic and interventional radiology in respect of liver tumors. The volume moves from background sections on methodology and segmental liver anatomy to the main sections on the diagnosis of benign and malignant liver lesions. An integrated approach, focused on the correlation of ultrasound, CT, and MR imaging findings, is presented. Finally, a full section describes the principles, methods, and results of percutaneous tumor ablation techniques.

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Table of contents :
Cover……Page 1
Foreword……Page 6
Preface……Page 8
Contents……Page 10
Technique and Methodology in Liver Imaging……Page 14
Introduction……Page 16
Technology……Page 18
Microbubble Contrast Agents……Page 20
Focal Lesions……Page 22
Conclusions……Page 28
Introduction……Page 30
Technique……Page 31
Data Review Post-Processing……Page 42
Conclusions……Page 43
References……Page 44
Methodology……Page 46
Contrast Agents……Page 53
References……Page 60
Liver Anatomy……Page 64
Descriptive Anatomy of the Liver……Page 66
The Functional or Vascular Anatomy……Page 67
The Correlation Between the Radiological Anatomy and the Functional Anatomy……Page 70
The Correlation Between the Functional Anatomy and the Surgical Anatomy……Page 72
Beyond the Ideal View……Page 73
References……Page 74
Anatomical Landmarks and Nomenclature……Page 76
Imaging Landmarks: CT and MR Imaging……Page 77
Imaging Landmarks: Ultrasound……Page 78
Normal Variants……Page 82
Future Prospects……Page 83
References……Page 84
Benign Liver Lesions……Page 86
Introduction……Page 88
Pathological Features……Page 90
References……Page 95
Developmental Lesions……Page 98
Infl ammatory Lesions……Page 105
Neoplasms……Page 108
Miscellaneous lesions……Page 112
References……Page 113
Sonography……Page 114
Computed Tomography……Page 115
Magnetic Resonance……Page 117
Percutaneous Biopsy……Page 120
Atypical Patterns……Page 121
Association with Other Lesions……Page 125
Complications……Page 127
References……Page 128
Histopathological Findings……Page 132
Diagnostic Imaging……Page 135
Diff erential Diagnosis……Page 146
References……Page 148
Introduction……Page 150
Imaging Features……Page 151
Liver Adenomatosis……Page 157
Diff erential Diagnosis……Page 159
References……Page 160
Introduction……Page 162
Pitfalls……Page 164
Vascular Abnormalities and Variants……Page 165
Focal Fatty Infi ltration and Focal Fatty Sparing……Page 173
References……Page 178
Primary Malignancies in Cirrhotic Liver……Page 180
The Pathological Classifi cation……Page 182
Early Detected Tumors……Page 183
Diagnosis……Page 184
Staging……Page 185
Natural History of the Tumor……Page 186
Conclusions……Page 187
References……Page 188
Ultrasound……Page 190
Computed Tomography……Page 196
Magnetic Resonance Imaging……Page 202
Angiography and Angiographically Assisted Techniques……Page 207
Diagnostic Workup……Page 208
Staging Workup……Page 209
References……Page 211
Primary Malignancies in Non-Cirrhotic Liver……Page 214
Hepatocellular Tumors……Page 216
Cholangiocellular Tumors……Page 217
Mesenchymal Tumors……Page 218
References……Page 219
Hepatocellular Carcinoma……Page 222
Fibrolamellar Hepatocellular Carcinoma……Page 225
Diff erential Diagnosis……Page 229
References……Page 230
Introduction……Page 232
Pathology……Page 233
Imaging Findings……Page 234
Treatment……Page 247
References……Page 250
Introduction……Page 252
Cystadenocarcinoma……Page 253
Angiosarcoma……Page 255
Epithelioid Hemangioendothelioma……Page 259
Other Sarcomas……Page 261
Lymphoma……Page 265
References……Page 269
Hepatic Metastases……Page 272
Introduction……Page 274
Examination Technique……Page 275
Appearances of Liver Metastases……Page 279
Differential Diagnosis on Contrast Enhanced Ultrasound……Page 283
Detection of Hepatic Metastases with Ultrasound……Page 284
References……Page 286
Introduction……Page 288
Contrast Enhancement……Page 289
Imaging Features at CT/MR……Page 295
Pitfalls in Liver Imaging……Page 298
Assessment of Small Liver Lesions……Page 299
Value of CT and MR……Page 302
Assessment of Surgical Candidates……Page 303
References……Page 304
Introduction……Page 308
Imaging Studies……Page 309
Strategies for Staging and Follow-Up……Page 312
Conclusion……Page 316
References……Page 317
Image-Guided Tumor Ablation……Page 318
Radiofrequency: How it Works……Page 320
The Bio-heat Equation: How to Increase Tumor Destruction……Page 323
Technical Clues for Clinical Application……Page 324
References……Page 327
Image Guidance……Page 330
T1 Thermometry……Page 333
Parenchymal Changes at MR……Page 334
New Developments……Page 337
Recognising Recurrence……Page 338
References……Page 340
General Eligibility Criteria……Page 342
Percutaneous Ethanol Injection……Page 343
Radiofrequency Ablation……Page 344
Other Methods of Percutaneous Ablation……Page 347
References……Page 348
Cryotherapy……Page 350
Radiofrequency Ablation……Page 351
Laser Ablation……Page 357
Conclusion……Page 358
References……Page 359
Introduction……Page 362
Technique of Laser-Induced Thermometry……Page 363
Clinical Data……Page 366
Discussion……Page 369
References……Page 372
Introduction……Page 376
Biology of Colorectal and Other Liver Metastases……Page 377
Treatment of Resectable Isolated Liver Metastases……Page 378
Treatment of Nonresectable Isolated Liver Metastases……Page 385
Stage Adapted Individualized Treatment Concept……Page 388
Stage Dependent Treatment Strategies……Page 393
References……Page 394
Introduction……Page 400
Complications……Page 401
References……Page 404
Subject Index……Page 406
List of Contributors……Page 412