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Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0

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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 October 2023) | Viewed by 19901

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Special Issue Editor

Dr. Robbert J. de Haas

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Guest Editor

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)
Special Issues, Collections and Topics in MDPI journals

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 the detection and characterization of HPB diseases. Moreover, artificial intelligence techniques play an increasing role in the 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 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 the 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 that 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

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

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

Published Papers (9 papers)

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Research

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12 pages, 1473 KiB

Open AccessCommunication

Can Plasma Volume Determination in Cirrhosis Be Replaced by an Algorithm Using Body Weight and Hematocrit?

by Martine Prütz Nørskov, Thormod Mønsted, Nina Kimer, Morten Damgaard and Søren Møller

Diagnostics 2024, 14(8), 835; https://doi.org/10.3390/diagnostics14080835 - 17 Apr 2024

Viewed by 342

Abstract

Background: Patients with cirrhosis often develop hyperdynamic circulation with increased cardiac output, heart rate, and redistribution of the circulating volume with expanded plasma volume (PV). PV determination is part of the evaluation of patients with cirrhosis, but gold-standard methods are invasive, expensive, and time-consuming. Therefore, other estimations of PV would be preferable, and the aim of this study was therefore to study if PV, as assessed by a simplified algorithm based on hematocrit and weight, can replace the gold-standard method. Methods: We included 328 patients with cirrhosis who had their PV assessed by the indicator dilution technique as the gold-standard method (PV_I-125). Actual PV was estimated as PV_a = (1 − hematocrit)·(a + (b·body weight)). Ideal PV was estimated as PV_i = c · body weight, where a, b, and c are constants. Results: PV_I-125, PV_a, and PV_i were 3.99 ± 1.01, 3.09 ± 0.54, and 3.01 ± 0.65 (Mean ± SD), respectively. Although PV_I-125 correlated significantly with PV_a (r = 0.72, p < 0.001), a Bland–Altman plot revealed wide limits of confidence. Conclusions: The use of simplified algorithms does not sufficiently estimate PV and cannot replace the indicator dilution technique. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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11 pages, 4317 KiB

Open AccessArticle

Liver PET Reloaded: Automated Synthesis of [⁶⁸Ga]Ga-BP-IDA for Positron Imaging of the Hepatobiliary Function and First Clinical Experience

by Anke Werner, Martin Freesmeyer, Christian Kühnel, Robert Drescher and Julia Greiser

Diagnostics 2023, 13(6), 1144; https://doi.org/10.3390/diagnostics13061144 - 16 Mar 2023

Cited by 2 | Viewed by 1399

Abstract

Hepatobiliary scintigraphy is a well-established nuclear imaging method for evaluating liver function and displaying the biliary system, but the spatial and temporal resolution is limited, and, there is still no established PET equivalent. Adapted from the work of Schuhmacher et al. in 1983, the production of a ⁶⁸Gallium-labeled substitute, tetrabromophthalein ([⁶⁸Ga]Ga-BP-IDA), was undertaken according to current Good Manufacturing Practice (GMP) standards and proved feasible and reproducible. PET/CT with the radiotracer was performed in two complex patients with hepatocellular carcinoma in preparation for transarterial radioembolization. Due to its high spatial and temporal resolution, localization of areas with impaired liver function and visualization of the biliary system were possible. We could demonstrate that this ⁶⁸Gallium-labeled, IDA-based PET tracer is feasible and could advance hepatic and biliary function PET imaging. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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9 pages, 2554 KiB

Open AccessArticle

Can Imaging Using Radiomics and Fat Fraction Analysis Detect Early Tissue Changes on Historical CT Scans in the Regions of the Pancreas Gland That Subsequently Develop Adenocarcinoma?

by Ronald Lee Korn, Andre Burkett, Jeff Geschwind, Dominic Zygadlo, Taylor Brodie, Derek Cridebring, Daniel D. Von Hoff and Michael J. Demeure

Diagnostics 2023, 13(5), 941; https://doi.org/10.3390/diagnostics13050941 - 01 Mar 2023

Cited by 1 | Viewed by 9948

Abstract

Despite a growing number of effective therapeutic options for patients with pancreatic adenocarcinoma, the prognosis remains dismal mostly due to the late-stage presentation and spread of the cancer to other organs. Because a genomic analysis of pancreas tissue revealed that it may take years, if not decades, for pancreatic cancer to develop, we performed radiomics and fat fraction analysis on contrast-enhanced CT (CECT) scans of patients with historical scans showing no evidence of cancer but who subsequently went on to develop pancreas cancer years later, in an attempt to identify specific imaging features of the normal pancreas that may portend the subsequent development of the cancer. In this IRB-exempt, retrospective, single institution study, CECT chest, abdomen, and pelvis (CAP) scans of 22 patients who had evaluable historical imaging data were analyzed. The images from the “healthy” pancreas were obtained between 3.8 and 13.9 years before the diagnosis of pancreas cancer was established. Afterwards, the images were used to divide and draw seven regions of interest (ROIs) around the pancreas (uncinate, head, neck-genu, body (proximal, middle, and distal) and tail). Radiomic analysis on these pancreatic ROIs consisted of first order quantitative texture analysis features such as kurtosis, skewness, and fat quantification. Of all the variables tested, fat fraction in the pancreas tail (p = 0.029) and asymmetry of the histogram frequency curve (skewness) of pancreas tissue (p = 0.038) were identified as the most important imaging signatures for subsequent cancer development. Changes in the texture of the pancreas as measured on the CECT of patients who developed pancreas cancer years later could be identified, confirming the utility of radiomics-based imaging as a potential predictor of oncologic outcomes. Such findings may be potentially useful in the future to screen patients for pancreatic cancer, thereby helping detect pancreas cancer at an early stage and improving survival. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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12 pages, 1761 KiB

Open AccessArticle

Evaluation of Perfusion Change According to Pancreatic Cancer and Pancreatic Duct Dilatation Using Free-Breathing Golden-Angle Radial Sparse Parallel (GRASP) Magnetic Resonance Imaging

by Moonhyung Choi, Seungbae Yoon, Youngjoon Lee and Dongyeob Han

Diagnostics 2023, 13(4), 731; https://doi.org/10.3390/diagnostics13040731 - 15 Feb 2023

Viewed by 1386

Abstract

Purpose: To evaluate perfusion changes in the pancreas with pancreatic cancer and pancreatic duct dilatation using dynamic contrast-enhanced MRI (DCE-MRI). Method: We evaluate the pancreas DCE-MRI of 75 patients. The qualitative analysis includes pancreas edge sharpness, motion artifacts, streak artifacts, noise, and overall image quality. The quantitative analysis includes measuring the pancreatic duct diameter and drawing six regions of interest (ROIs) in the three areas of the pancreas (head, body, and tail) and three vessels (aorta, celiac axis, and superior mesenteric artery) to measure the peak-enhancement time, delay time, and peak concentration. We evaluate the differences in three quantitative parameters among the ROIs and between patients with and without pancreatic cancer. The correlations between pancreatic duct diameter and delay time are also analyzed. Results: The pancreas DCE-MRI demonstrates good image quality, and respiratory motion artifacts show the highest score. The peak-enhancement time does not differ among the three vessels or among the three pancreas areas. The peak-enhancement time and concentrations in the pancreas body and tail and the delay time in the three pancreas areas are significantly longer (p < 0.05) in patients with pancreatic cancer than in those without pancreatic cancer. The delay time was significantly correlated with the pancreatic duct diameters in the head (p < 0.02) and body (p < 0.001). Conclusion: DCE-MRI can display the perfusion change in the pancreas with pancreatic cancer. A perfusion parameter in the pancreas is correlated with the pancreatic duct diameter reflecting a morphological change in the pancreas. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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Other

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12 pages, 762 KiB

Open AccessProtocol

Protocol for a Multi-Center Confirmatory Trial to Evaluate the Differential Diagnostic Performance of Contrast-Enhanced Ultrasonography Using Perflubutane in Patients with a Pancreatic Mass: A Multicenter Prospective Study

by Yasunobu Yamashita, Toshio Shimokawa, Reiko Ashida, Yoshiki Hirooka, Takuji Iwashita, Hironari Kato, Toshifumi Kin, Atsushi Masamune, Haruo Miwa, Eizaburo Ohno, Hideyuki Shiomi, Atsushi Sofuni, Mamoru Takenaka and Masayuki Kitano

Diagnostics 2024, 14(2), 130; https://doi.org/10.3390/diagnostics14020130 - 06 Jan 2024

Viewed by 751

Abstract

For pancreatic masses, an evaluation of their vascularity using contrast-enhanced ultrasonography can help improve their characterization. This study was designed to evaluate the utility and safety of contrast-enhanced transabdominal ultrasonography (CE-TUS) and endoscopic ultrasonography (CE-EUS) in the diagnosis of pancreatic masses including solid or cystic masses. This multi-center comparative open-label superiority study is designed to compare Plain (P)-TUS/EUS alone with P-TUS/P-EUS plus CE-TUS/CE-EUS. Three hundred and one patients with a total of 232 solid pancreatic masses and 69 cystic masses were prospectively enrolled. The primary endpoints are to compare the diagnostic accuracy between P-TUS/P-EUS alone and P-TUS/P-EUS plus CE-TUS/CE-EUS for both the TUS and EUS of solid pancreatic masses, and to compare the diagnostic accuracy between P-EUS alone and P-EUS plus CE-EUS in cystic pancreatic masses. The secondary endpoints are to compare the diagnostic sensitivity and specificity of P-TUS/P-EUS alone and P-TUS/P-EUS plus CE-TUS/CE-EUS for pancreatic solid/cystic masses, and the accuracy of P-TUS alone and P-TUS plus CE-TUS for pancreatic cystic masses. Other secondary endpoints included comparing the diagnostic sensitivity, specificity, and accuracy of CE-TUS, CE-EUS and CE-computed tomography (CT) for solid/cystic pancreatic masses. The safety, degree of effective enhancement, and diagnostic confidence obtained with CE-TUS/CE-EUS will also be assessed. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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5 pages, 2870 KiB

Open AccessInteresting Images

Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report

by Eun Ju Yoon, Jin Woong Kim, Jun Hyung Hong, Sang Gook Song, Hyun Chul Kim, Young Hoe Hur and Hyung Joong Kim

Diagnostics 2023, 13(21), 3322; https://doi.org/10.3390/diagnostics13213322 - 26 Oct 2023

Viewed by 945

Abstract

We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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7 pages, 1532 KiB

Open AccessCase Report

Subcapsular Biloma following Endoscopic Retrograde Cholangiopancreatography and Endoscopic Biliary Sphincterotomy: A Case Report with a Mini Review of Literature

by Natalia Valeria Pentara, Aristidis Ioannidis, Georgios Tzikos, Leonidas Kougias, Eleni Karlafti, Angeliki Chorti, Despoina Tsalkatidou, Antonios Michalopoulos and Daniel Paramythiotis

Diagnostics 2023, 13(5), 831; https://doi.org/10.3390/diagnostics13050831 - 22 Feb 2023

Viewed by 1784

Abstract

A biloma is a loculated, extrahepatic, intra-abdominal bile collection. It is an unusual condition with an incidence of 0.3–2% and is usually a result of choledocholithiasis, iatrogenic injury or abdominal trauma causing disruption to the biliary tree. Rarely, it will occur spontaneously, resulting in spontaneous bile leak. We herein present a rare case of biloma as a complication of endoscopic retrograde cholangiopancreatography (ERCP). A 54-year-old patient experienced right upper quadrant discomfort, following ERCP, endoscopic biliary sphincterotomy and stenting for choledocholithiasis. Initial abdominal ultrasound and computed tomography revealed an intrahepatic collection. Percutaneous aspiration under ultrasound guidance of yellow-green fluid confirmed the diagnosis, indicated infection and contributed to effective management. Most likely, a distal branch of the biliary tree was injured during the insertion of the guidewire through the common bile duct. Magnetic resonance image/magnetic resonance cholangiopancreatography contributed in the diagnosis of two seperate bilomas. Even though post ERCP biloma is an unusual complication, differential diagnosis of patients with right upper quadrant discomfort following an iatrogenic or traumatic event should always include biliary tree disruption. A combination of radiological imaging for diagnosis and minimal invasive technique to manage a biloma can prove to be successful. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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10 pages, 2714 KiB

Open AccessBrief Report

The Value of Deep Learning in Gallbladder Lesion Characterization

by Yunchao Yin, Derya Yakar, Jules J. G. Slangen, Frederik J. H. Hoogwater, Thomas C. Kwee and Robbert J. de Haas

Diagnostics 2023, 13(4), 704; https://doi.org/10.3390/diagnostics13040704 - 13 Feb 2023

Cited by 4 | Viewed by 1325

Abstract

Background: The similarity of gallbladder cancer and benign gallbladder lesions brings challenges to diagnosing gallbladder cancer (GBC). This study investigated whether a convolutional neural network (CNN) could adequately differentiate GBC from benign gallbladder diseases, and whether information from adjacent liver parenchyma could improve its performance. Methods: Consecutive patients referred to our hospital with suspicious gallbladder lesions with histopathological diagnosis confirmation and available contrast-enhanced portal venous phase CT scans were retrospectively selected. A CT-based CNN was trained once on gallbladder only and once on gallbladder including a 2 cm adjacent liver parenchyma. The best-performing classifier was combined with the diagnostic results based on radiological visual analysis. Results: A total of 127 patients were included in the study: 83 patients with benign gallbladder lesions and 44 with gallbladder cancer. The CNN trained on the gallbladder including adjacent liver parenchyma achieved the best performance with an AUC of 0.81 (95% CI 0.71–0.92), being >10% better than the CNN trained on only the gallbladder (p = 0.09). Combining the CNN with radiological visual interpretation did not improve the differentiation between GBC and benign gallbladder diseases. Conclusions: The CT-based CNN shows promising ability to differentiate gallbladder cancer from benign gallbladder lesions. In addition, the liver parenchyma adjacent to the gallbladder seems to provide additional information, thereby improving the CNN’s performance for gallbladder lesion characterization. However, these findings should be confirmed in larger multicenter studies. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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6 pages, 871 KiB

Open AccessCase Report

Hyperammonemic Encephalopathy in a Patient with Pancreatic Neuroendocrine Tumor and Portosystemic Shunt

by Marcel Zorgdrager, Frans J. C. Cuperus and Robbert J. de Haas

Diagnostics 2023, 13(3), 572; https://doi.org/10.3390/diagnostics13030572 - 03 Feb 2023

Viewed by 1427

Abstract

Hyperammonemia can lead to encephalopathy and may be accompanied by a diagnostic dilemma. Imaging as well as biochemical analyses are the cornerstone for identifying possible underlying causes such as severe liver disease or urea cycle defect. We report a case of a patient that presented with neurological deficits based on hyperammonemia in the presence of a large pancreatic neuroendocrine tumor (PNET) and portosystemic shunts in the liver. Prior cases are rather scarce, and the exact mechanism is not fully understood. The case illustrates the added value of a multimodality imaging approach in patients presenting with hyperammonemia-induced encephalopathy. Full article

(This article belongs to the Special Issue Advances and Novelties in Hepatobiliary and Pancreatic Imaging 2.0)

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