Articles: liver-neoplasms-diagnosis.
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Management of hepatic malignancy is a challenging clinical problem involving several different medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and locoregional therapies, such as thermal ablation and transarterial embolization. ⋯ The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Comparative Study
Comparison of segmentation-based attenuation correction methods for PET/MRI: evaluation of bone and liver standardized uptake value with oncologic PET/CT data.
For attenuation correction (AC) in PET/MRI systems, segmentation-based methods are most often used. However, the standardized uptake value (SUV) of lesions in the bone and liver, which have higher attenuation coefficients than other organs, can be underestimated, potentially leading to misinterpretation of clinical cases. Errors in SUV estimation are also dependent on the segmentation schemes used in the segmentation-based AC. In this study, this potential bias in SUV estimation using 4 different segmentation-based AC methods was evaluated for the PET/CT data of cancer patients with bone and liver lesions. ⋯ Without bone segmentation, the SUVs of spine lesions were considerably underestimated; however, the bias was acceptable with bone segmentation. In liver lesions, the segmentation-based AC methods yielded a negative bias in SUV; however, inclusion of the bone and fat segments reduced the SUV bias. The results of this study will be useful for understanding organ-dependent bias in SUV between PET/CT and PET/MRI.
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Case Reports
Hypoglycemia-induced convulsive status epilepticus as the initial presentation of primary hepatic carcinoma.
Hypoglycemia is a well-known complication of insulinoma and other non-islet-cell tumors like hepatic tumor. In the emergency unit of neurology department, hypoglycemia is an uncommon cause of convulsive status epilepticus. We report a rare case with hypoglycemia-induced convulsive status epilepticus as the initial presentation of primary hepatic carcinoma. ⋯ He was later found to have hepatoma related hypoglycemia. This case highlights the importance of blood sugar test in unexplained status epilepticus in the emergency room of neurology department. Intravenous glucose infusion rather than anti-epileptic drugs might be safer and more effective in treating status epilepticus caused by hepatoma related hypoglycemia.
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The 45-item Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire assesses health-related quality of life in patients with liver, bile duct, and pancreatic cancers. Although the FACT-Hep was initially derived from patient input, this study's researchers sought to verify adequate coverage of items by soliciting open-ended input from patients with advanced disease. ⋯ The NFHSI-18 assesses symptoms of importance to patients with hepatobiliary and pancreatic cancers and demonstrates promising measurement properties. The scale is a good candidate for brief symptom assessment in clinical trials.
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The objective was to perform ex vivo evaluation of non-Gaussian diffusion kurtosis imaging (DKI) for assessment of hepatocellular carcinoma (HCC), including presence of treatment-related necrosis, using fresh liver explants. ⋯ We observed non-Gaussian diffusion behavior for HCCs ex vivo; this DKI model may have added value in HCC characterization in comparison with a standard monoexponential model of diffusion-weighted imaging.