Mistakes in imaging hepatic lesions and how to avoid them

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Mistakes in imaging hepatic lesions and how to avoid them

Katja De Paepe

Summary

AI Generated

This article addresses eight common mistakes in the interpretation and acquisition of radiological images of incidental liver lesions, which are increasingly detected with cross-sectional imaging.

Incidental liver lesions encompass a large group of benign and malignant lesions, and combined use of different imaging modalities is often required for accurate diagnosis.
Clinicians and radiologists must be familiar with each imaging modality's strengths and limitations and aware of common pitfalls that can confound correct interpretation.
MRI plays an essential role in the characterisation of liver lesions, and a standard MRI protocol with sequence explanations is provided.
Recommendations for avoiding mistakes are based on clinical experience and literature where possible.
This material is most relevant for clinicians and radiologists involved in liver imaging interpretation.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lim, J. & Singal, A. G. Surveillance and Diagnosis of Hepatocellular Carcinoma. Clin. Liver Dis. 13, 2–5 (2019). [Link]

Singal, A. G., Pillai, A. & Tiro, J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med. 11, e1001624 (2014) [Link]

Tzartzeva, K. et al. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology 154, 1706-1718.e1 (2018). [Link]

Simmons, O. et al. Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis. Aliment. Pharmacol. Ther. 45, 169–177 (2017) [Link]

LI-RADS ® v2017 US Core. [Link]

Vietti Violi, N., Fowler, K. J., Sirlin, C. B. & Taouli, B. Abbreviated Magnetic Resonance Imaging for HCC Surveillance. Clin. Liver Dis. 17, 133–138 (2021). [Link]

Bedogni, G., Nobili, V. & Tiribelli, C. Epidemiology of fatty liver: an update. World J. Gastroenterol. 20, 9050–4 (2014). [Link]

Vilgrain, V. et al. Hepatic steatosis: A major trap in liver imaging. Diagn. Interv. Imaging 94, 713–727 (2013) [Link]

Jang, J. K., Jang, H. J., Kim, J. S. & Kim, T. K. Focal fat deposition in the liver: diagnostic challenges on imaging. Abdom. Radiol. 42, 1667–1678 (2017).

10.

CT/MRI Diagnostic Table [Link]

11.

Zane, K. E., Cloyd, J. M., Mumtaz, K. S., Wadhwa, V. & Makary, M. S. Metastatic disease to the liver: Locoregional therapy strategies and outcomes. World J. Clin. Oncol. 12, 725–745 (2021) [Link]

12.

Galle, P. R. et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma q. Journal of Hepatology 69, (2018) [Link]

13.

Alnammi, M., Wortman, J., Therrien, J. & Afnan, J. MRI features of treated hepatocellular carcinoma following locoregional therapy: a pictorial review. Abdom. Radiol. (New York) 47, 2299–2313 (2022) [Link]

14.

Brink, J. A. & Wagner, B. J. Pathways for the Spread of Disease in the Abdomen and Pelvis. in 57–65 (Springer, Cham, 2018). doi:10.1007/978-3-319-75019-4_6 [Link]

15.

Panagiotopoulou, P. B., Courcoutsakis, N., Tentes, A. & Prassopoulos, P. CT imaging of peritoneal carcinomatosis with surgical correlation: a pictorial review. Insights Imaging 12, 168 (2021). [Link]

16.

Sherif, A. M., Musa, E. R., Kedar, R. & Fu, L. Subcapsular hepatic endometriosis: case report and review of the literature. Radiol. case reports 11, 303–308 (2016). [Link]

17.

Ahlawat, S. et al. Magnetic resonance neurography of peripheral nerve tumors and tumorlike conditions. Neuroimaging Clin N Am. 24, 589–601 (2014). [Link]

18.

Schieda, N. et al. Renal and adrenal masses containing fat at MRI: Proposed nomenclature by the society of abdominal radiology disease-focused panel on renal cell carcinoma. J. Magn. Reson. Imaging 49, 917–926 (2019). [Link]

19.

Caseiro-Alves, F. et al. Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis. Eur. Radiol. 17, 1544–1554 (2007). [Link]

20.

Vilgrain, V. et al. Imaging of Atypical Hemangiomas of the Liver with Pathologic Correlation. RadioGraphics 20, 379–397 (2000). [Link]

21.

Chen, L. et al. Meta-analysis of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the detection of liver metastases. PLoS One 7, e48681 (2012). [Link]

22.

Doo, K. W. et al. ‘Pseudo washout’ sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR. Am. J. Roentgenol. 193, W490-6 (2009). [Link]

23.

Paulatto, L. et al. Colorectal liver metastases: radiopathological correlation. Insights Imaging 11, 99 (2020). [Link]

24.

Elsayes, K. M. et al. Spectrum of pitfalls, pseudolesions, and potential misdiagnoses in cirrhosis. Am. J. Roentgenol. 211, 87–96 (2018). [Link]

Abstract

Incidental liver lesions are increasingly found due to the incremental use of cross-sectional imaging. They encompass a large group of benign and malignant lesions, and the combined use of different imaging modalities is often required to make an accurate diagnosis. It is of utmost importance for clinicians and radiologists to be familiar with each imaging modality's strengths and limitations and be aware of common pitfalls that can confound the correct interpretation of findings. The article will discuss eight common mistakes in the interpretation and acquisition of radiological images. Recommendations on avoiding these mistakes will be based on clinical experience and literature where possible. As MRI plays an essential role in the characterisation of liver lesions, a standard MRI protocol with a brief explanation of the sequences has been added for reference

Topics

Hepatobiliary Radiology & Imaging

Citation

DePaepe K. Mistakes in imaging hepatic lesions and how to avoid them. UEG Education 2022; 22: 37-42.

Published

2022

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Mistakes in endoscopic treatment of Barrett oesophagus neoplasia and how to avoid them

Jacques J. Bergman, Roos E. Pouw, Eva Verheij

Summary

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Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lim, J. & Singal, A. G. Surveillance and Diagnosis of Hepatocellular Carcinoma. Clin. Liver Dis. 13, 2–5 (2019). [Link]

Simmons, O. et al. Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis. Aliment. Pharmacol. Ther. 45, 169–177 (2017) [Link]

LI-RADS ® v2017 US Core. [Link]

Vietti Violi, N., Fowler, K. J., Sirlin, C. B. & Taouli, B. Abbreviated Magnetic Resonance Imaging for HCC Surveillance. Clin. Liver Dis. 17, 133–138 (2021). [Link]

Bedogni, G., Nobili, V. & Tiribelli, C. Epidemiology of fatty liver: an update. World J. Gastroenterol. 20, 9050–4 (2014). [Link]

Vilgrain, V. et al. Hepatic steatosis: A major trap in liver imaging. Diagn. Interv. Imaging 94, 713–727 (2013) [Link]

Jang, J. K., Jang, H. J., Kim, J. S. & Kim, T. K. Focal fat deposition in the liver: diagnostic challenges on imaging. Abdom. Radiol. 42, 1667–1678 (2017).

10.

CT/MRI Diagnostic Table [Link]

11.

Zane, K. E., Cloyd, J. M., Mumtaz, K. S., Wadhwa, V. & Makary, M. S. Metastatic disease to the liver: Locoregional therapy strategies and outcomes. World J. Clin. Oncol. 12, 725–745 (2021) [Link]

12.

Galle, P. R. et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma q. Journal of Hepatology 69, (2018) [Link]

13.

14.

Brink, J. A. & Wagner, B. J. Pathways for the Spread of Disease in the Abdomen and Pelvis. in 57–65 (Springer, Cham, 2018). doi:10.1007/978-3-319-75019-4_6 [Link]

15.

Panagiotopoulou, P. B., Courcoutsakis, N., Tentes, A. & Prassopoulos, P. CT imaging of peritoneal carcinomatosis with surgical correlation: a pictorial review. Insights Imaging 12, 168 (2021). [Link]

16.

Sherif, A. M., Musa, E. R., Kedar, R. & Fu, L. Subcapsular hepatic endometriosis: case report and review of the literature. Radiol. case reports 11, 303–308 (2016). [Link]

17.

Ahlawat, S. et al. Magnetic resonance neurography of peripheral nerve tumors and tumorlike conditions. Neuroimaging Clin N Am. 24, 589–601 (2014). [Link]

18.

19.

Caseiro-Alves, F. et al. Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis. Eur. Radiol. 17, 1544–1554 (2007). [Link]

20.

Vilgrain, V. et al. Imaging of Atypical Hemangiomas of the Liver with Pathologic Correlation. RadioGraphics 20, 379–397 (2000). [Link]

21.

Chen, L. et al. Meta-analysis of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the detection of liver metastases. PLoS One 7, e48681 (2012). [Link]

22.

Doo, K. W. et al. ‘Pseudo washout’ sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR. Am. J. Roentgenol. 193, W490-6 (2009). [Link]

23.

Paulatto, L. et al. Colorectal liver metastases: radiopathological correlation. Insights Imaging 11, 99 (2020). [Link]

24.

Elsayes, K. M. et al. Spectrum of pitfalls, pseudolesions, and potential misdiagnoses in cirrhosis. Am. J. Roentgenol. 211, 87–96 (2018). [Link]

Abstract

Barrett’s oesophagus is a premalignant condition of the distal oesophagus predisposing to oesophageal adenocarcinoma. Given the potential for malignant progression and the poor prognosis of eosophageal adenocarcinoma when diagnosed at a symptomatic stage, patients with known Barrett oesophagus undergo regular endoscopic surveillance to detect neoplastic progression at an early and preferably endoscopically, treatable stage. Endoscopic management of early Barrett oesophagus neoplasia consists of a combination of endoscopic imaging, endoscopic resection and endoscopic ablation. Below we discuss a number of mistakes that are frequently made when managing Barrett oesophagus neoplasia and how to avoid them. Much of this discussion draws on existing guidelines (for background reading, check the ESGE Barrett oesophagus guideline), but in many instances the underlying evidence (even in the guideline) is missing and therefore many of our practically driven recommendations are based on common sense and our experience in this field.

Topics

Oesophagus

Citation

Verheij EPD, Pouw RE and Bergman JJ. Mistakes in endoscopic treatment of Barrett oesophagus neoplasia and how to avoid them. UEG Education 2021; 21: 35–39.

Published

2021

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Affiliations

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Hospital General Universitario de Alicante, Alicante, Spain

Summary

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Published

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Mistakes in coeliac disease diagnosis and how to avoid them

Roberto De Giorgio 1, Giacomo Caio 1, Umberto Volta 1

Affiliations

1 University of Bologna, Italy

Summary

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8

Lim, J. & Singal, A. G. Surveillance and Diagnosis of Hepatocellular Carcinoma. Clin. Liver Dis. 13, 2–5 (2019). [Link]

Simmons, O. et al. Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis. Aliment. Pharmacol. Ther. 45, 169–177 (2017) [Link]

LI-RADS ® v2017 US Core. [Link]

Vietti Violi, N., Fowler, K. J., Sirlin, C. B. & Taouli, B. Abbreviated Magnetic Resonance Imaging for HCC Surveillance. Clin. Liver Dis. 17, 133–138 (2021). [Link]

Bedogni, G., Nobili, V. & Tiribelli, C. Epidemiology of fatty liver: an update. World J. Gastroenterol. 20, 9050–4 (2014). [Link]

Vilgrain, V. et al. Hepatic steatosis: A major trap in liver imaging. Diagn. Interv. Imaging 94, 713–727 (2013) [Link]

Jang, J. K., Jang, H. J., Kim, J. S. & Kim, T. K. Focal fat deposition in the liver: diagnostic challenges on imaging. Abdom. Radiol. 42, 1667–1678 (2017).

10.

CT/MRI Diagnostic Table [Link]

11.

Zane, K. E., Cloyd, J. M., Mumtaz, K. S., Wadhwa, V. & Makary, M. S. Metastatic disease to the liver: Locoregional therapy strategies and outcomes. World J. Clin. Oncol. 12, 725–745 (2021) [Link]

12.

Galle, P. R. et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma q. Journal of Hepatology 69, (2018) [Link]

13.

14.

Brink, J. A. & Wagner, B. J. Pathways for the Spread of Disease in the Abdomen and Pelvis. in 57–65 (Springer, Cham, 2018). doi:10.1007/978-3-319-75019-4_6 [Link]

15.

Panagiotopoulou, P. B., Courcoutsakis, N., Tentes, A. & Prassopoulos, P. CT imaging of peritoneal carcinomatosis with surgical correlation: a pictorial review. Insights Imaging 12, 168 (2021). [Link]

16.

Sherif, A. M., Musa, E. R., Kedar, R. & Fu, L. Subcapsular hepatic endometriosis: case report and review of the literature. Radiol. case reports 11, 303–308 (2016). [Link]

17.

Ahlawat, S. et al. Magnetic resonance neurography of peripheral nerve tumors and tumorlike conditions. Neuroimaging Clin N Am. 24, 589–601 (2014). [Link]

18.

19.

Caseiro-Alves, F. et al. Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis. Eur. Radiol. 17, 1544–1554 (2007). [Link]

20.

Vilgrain, V. et al. Imaging of Atypical Hemangiomas of the Liver with Pathologic Correlation. RadioGraphics 20, 379–397 (2000). [Link]

21.

Chen, L. et al. Meta-analysis of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the detection of liver metastases. PLoS One 7, e48681 (2012). [Link]

22.

Doo, K. W. et al. ‘Pseudo washout’ sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR. Am. J. Roentgenol. 193, W490-6 (2009). [Link]

23.

Paulatto, L. et al. Colorectal liver metastases: radiopathological correlation. Insights Imaging 11, 99 (2020). [Link]

24.

Elsayes, K. M. et al. Spectrum of pitfalls, pseudolesions, and potential misdiagnoses in cirrhosis. Am. J. Roentgenol. 211, 87–96 (2018). [Link]

Abstract

Coeliac disease is an autoimmune disorder triggered by gluten, which activates an immune reaction against the autoantigen tissue transglutaminase (TG2) in genetically predisposed subjects. Genetic susceptibility to coeliac disease has been proven by its close linkage with major histocompatibility complex (MHC) class II human leukocyte antigen (HLA) DQ2 and DQ8 haplotypes. The identification of biomarkers for coeliac disease (e.g. endomysial antibodies [EmA] and antibodies to TG2 [anti-TG2]) has changed the epidemiology of coeliac disease from being a rare to a frequent condition, with an expected prevalence of 1% in the worldwide population. Coeliac disease can be difficult to diagnose because symptoms vary from patient to patient, and the majority of patients who have coeliac disease remain undiagnosed. Small intestinal biopsy remains the gold standard for coeliac disease diagnosis, and a delayed diagnosis in the elderly can be considered a risk factor for complications. Complicated coeliac disease is not so frequent, but for those who have it, the prognosis is very poor, with a low rate of survival after 5 years.

Topics

Small Intestine & Nutrition

Published

2024

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