Search Results (86)

Background/Objectives: Differentiating focal nodular hyperplasia (FNH) from hepatic adenoma (HA) remains challenging, as FNH is benign whereas HA carries risks of hemorrhage and malignant transformation. This prospective single-center pilot study evaluated the diagnostic performance of three-dimensional magnetic resonance elastography (3D-MRE) using a gravitational transducer for non-invasive differentiation of FNH and HA. Methods: Thirty-three participants (23 FNH, 10 HA) underwent 3D-MRE using the gravitational transducer. Viscoelastic parameters—stiffness, shear wave speed (Cs), wave attenuation, and phase angle—were quantified for lesions and background parenchyma. $\Delta$-values were calculated by subtracting background liver measurements from lesion values. Results: FNH demonstrated significantly higher stiffness than HA (median 3.16 vs. 2.58 kPa; p = 0.02) and higher Cs (median 1.81 vs. 1.64 m/s; p = 0.001). Normalized stiffness differences ($\Delta$ stiffness) were significantly greater in FNH than HA (median 0.83 vs. 0.10 kPa; p = 0.001). Generalized additive models revealed divergent volume-dependent stiffening behaviors. In ROC analysis, $\Delta$ stiffness and $\Delta$ Cs each achieved an AUC of 0.87, indicating that single background-normalized viscoelastic parameters carry the principal diagnostic signal. An exploratory multivariable combination of $\Delta$ stiffness with patient age produced an apparent AUC of 0.93 with wide odds-ratio confidence intervals, and is presented as hypothesis-generating rather than as a clinical prediction model. Conclusions: In this pilot cohort, 3D-MRE using the gravitational transducer showed encouraging parameter-level separation between FNH and HA, with background normalization enhancing discrimination. Wave attenuation and phase angle did not differ significantly between lesion types. Given the small sample size (particularly the HA subgroup of ten patients), the mixed reference standard (histological confirmation in only 14 of 33 lesions; definitive hepatobiliary-phase MRI criteria in 19 of 33), the single-slice ROI used for lesion measurement, and the incomplete characterization of background liver parenchyma, these findings should be regarded as hypothesis-generating and require external validation in larger, multicenter cohorts before any clinical application. Full article

Background: Neuroendocrine neoplasms are frequently diagnosed after the detection of liver metastases, often when the primary tumor remains occult. Accurate non-invasive differentiation of neuroendocrine liver metastases (NELMs) from other focal hepatic lesions is therefore crucial. This study aimed to characterize the magnetic resonance imaging (MRI) features of NELMs using hepatocyte-specific contrast agents and to identify a potential radiologic “signature” that may suggest a neuroendocrine origin. Methods: This retrospective study included three cohorts: patients with histologically confirmed NELMs (n = 51; 146 lesions), patients with colorectal cancer liver metastases (n = 18; 46 lesions), and patients with benign hepatic hemangiomas (n = 28; 51 lesions). All subjects underwent standardized liver MRI with Gd-EOB-DTPA. Lesions were evaluated for size, diffusion-weighted imaging characteristics, apparent diffusion coefficient values, arterial-phase enhancement, T2-weighted signal, hepatobiliary-phase appearance, and hemorrhagic components. Statistical analyses included univariate and multivariate testing and receiver operating characteristic curve analysis. Results: NELMs commonly demonstrated arterial hyperenhancement, diffusion restriction, and variable T2 and hepatobiliary-phase signal heterogeneity. Compared with colorectal metastases and hemangiomas, NELMs showed distinctive patterns, particularly higher rates of hepatobiliary-phase heterogeneity and arterial enhancement. Lesion size, ADC metrics, T2 heterogeneity, and hemorrhage were significant discriminators. Conclusions: Hepatocyte-specific MRI enables identification of characteristic imaging features of NELMs. An integrated assessment of morphologic, diffusion, and hepatobiliary-phase findings may facilitate early recognition of neuroendocrine metastases, even when the primary tumor is unknown, improving diagnostic confidence and clinical management. Full article

Hepatic hemangiomas are the most common benign liver tumors and are typically small and asymptomatic; however, pedunculated and exophytic variants are extremely rare and may mimic extrahepatic lesions on imaging, posing a potential diagnostic challenge. The aim of this study was to describe the multimodal imaging features of a pedunculated hepatic hemangioma arising from the left triangular ligament and to review the available literature with particular attention to MRI findings and diagnostic considerations. A 52-year-old man underwent contrast-enhanced thoracoabdominal CT for unrelated symptoms, which incidentally revealed a pedunculated hepatic lesion. Further evaluation was performed with multiparametric MRI at 1.5T, including diffusion-weighted imaging and dynamic contrast-enhanced sequences. A review of the English-language literature published up to 2025 focusing on pedunculated and exophytic hepatic hemangiomas was also conducted. CT and MRI demonstrated imaging features consistent with hepatic hemangioma, including peripheral nodular enhancement with progressive centripetal fill-in and marked T2 hyperintensity. Multiplanar MRI depicted a thin vascular pedicle connecting the lesion to the hepatic capsule, supporting its hepatic origin. Fewer than approximately 30 well-documented cases have been reported in the English literature. Recognition of these imaging findings may facilitate correct diagnosis and help avoid unnecessary invasive procedures. Full article

Solitary fibrous tumour is an uncommon, predominantly benign tumour of mesenchymal origin, developing mainly in the thoracic cavity and on the pleural surface, although it has been reported in a wide variety of extrapleural sites. Its occurrence in the liver is particularly rare. We present the case of a 57-year-old woman in whom a large mass was identified in the left lobe of the liver, demonstrating inhomogeneous contrast enhancement without significant compression of the abdominal vessels. The lesion measured 170 mm in its greatest diameter and severely destroyed the surrounding liver parenchyma. SFT is characterised by haphazardly arranged ovoid and spindle-shaped cells with numerous mildly staghorn-like vessels lined by flattened endothelium. It typically shows NAB2–STAT6 gene rearrangement with CD34 and/or STAT6 positivity on immunohistochemistry. Since imaging methods are not specific regarding the nature of the lesion, pathological and immunohistochemical analyses are essential for establishing an accurate diagnosis and assessing differential diagnostic possibilities. Full article

Background: Fluorescence-guided surgery based on near-infrared imaging, most often using indocyanine green (ICG), is increasingly used in colorectal cancer (CRC) surgery. This narrative review integrates current evidence across four clinically relevant domains-anastomotic perfusion, lymphatic mapping, tumor localization, and metastasis detection and emphasizes the technical and translational factors that will determine broader implementation. Methods: We performed a structured narrative review of clinical and translational studies identified through PubMed and citation tracking, with emphasis on ICG-based workflows and emerging targeted tracers. Because the literature spans heterogeneous interventions, imaging platforms, and endpoints, no de novo meta-analysis or formal risk-of-bias assessment was undertaken. Results: ICG fluorescence angiography is the most mature application and can refine transection-line selection, although its effect on anastomotic leak appears protocol dependent. In lymphatic mapping, ICG improves visualization of drainage pathways and nodal basins but does not reliably distinguish benign from metastatic nodes. For tumor localization, ICG supports lesion marking and dynamic tissue characterization, while targeted probes and contrast-free adjuncts may improve oncologic specificity. For metastatic disease, ICG is most useful for liver margin guidance and for excluding residual disease, whereas CEA-targeted and multimodal approaches appear particularly promising for peritoneal metastases. Conclusions: The added value of this review lies in linking current clinical maturity to the translational steps still required for routine adoption. In CRC surgery, fluorescence imaging is already useful in selected settings, but broader implementation will depend on standardized protocols, objective real-time quantification, and multicenter validation of targeted tracers against clinically meaningful outcomes. Full article

Background: Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are benign hepatic tumors that predominantly affect women of reproductive age and are associated with hormonal and metabolic factors. While FNH is a non-progressive lesion without malignant potential, HA carries a relevant risk of hemorrhage and malignant transformation. Differentiation between these entities remains challenging due to overlapping imaging features. Although contrast-enhanced magnetic resonance imaging (MRI) is considered the diagnostic reference standard, its cost, limited availability, and contraindications restrict routine long-term use. Therefore, contrast-enhanced ultrasound (CEUS) has emerged as an alternative modality for follow-up. This study evaluated the effectiveness of CEUS in long-term monitoring of FNH and HA compared with MRI. Methods: Patients with imaging-confirmed FNH or HA underwent paired CEUS and MRI examinations within 48 h at baseline and follow-up. Lesion size was assessed using maximal and minimal diameters, and longitudinal changes were classified according to RECIST-like criteria. Paired non-parametric statistical tests were applied. Results: 41 benign liver lesions (28 FNH and 13 HA) were analyzed across 92 paired examinations. Baseline lesion measurements were comparable between CEUS and MRI. A statistically significant difference was observed in the assessment of the largest lesion diameter, while no significant differences were detected for the shortest diameter. Longitudinal evaluation showed no significant differences between modalities in detecting lesion size changes. Response classification was concordant in 42 of 51 follow-up assessments, with stable disease as the most frequent outcome. Conclusions: After definitive diagnosis, CEUS may serve as a reliable standalone modality for routine long-term surveillance of FNH and HA in clinically stable patients. Its performance in lesion measurement and response assessment is comparable to MRI, while offering advantages in cost, accessibility, and patient tolerability. MRI may be reserved for cases with suspicious changes on CEUS. Full article

Background and Clinical Significance: CEUS enhances the visualization of vascular patterns within liver lesions, enabling differentiation between benign and malignant lesions, including hemangiomas, focal nodular hyperplasia, and hepatocellular carcinoma, with high accuracy. Lymphangiomas are rare benign lymphatic-system tumors, with intra-abdominal lymphangiomas accounting for approximately 5% of cases, most of which occur in the pediatric population. Intra-abdominal lymphangiomas commonly occur in multiple localizations due to lymphangiomatosis, but solitary lymphangiomas in adults are rare and easy to be misdiagnosed due to asymptomatic cases or non-specific symptoms. Case Presentation: A 65-year-old male with a history of left nephroadrenalectomy due to clear renal-cell carcinoma and paraaortic lymphadenectomy (staging pT3bN0M0V1R0) presented for a routine contrast-enhanced abdominal computer tomography examination. The scan showed several hypervascular structures that accumulate contrast in the arterial phase in the right liver lobe. Three years later, the patient developed complaints of abdominal pain and night sweats. Multiple MRI and CT examinations were performed, followed by a CEUS and a liver-core biopsy, which supported the diagnosis of hepatic lymphangioma. Conclusions: CEUS may be a more valuable evaluation method for follow-up examination than repeating CT and MRI scans. The real-time diagnostic possibility and tissue-perfusion data provide more profound information about the lesion of interest. Thus, it can be used as a primary diagnostic tool when a biopsy is performed. Although this method is relatively new, it can be applied in clinical settings with great value, and it saves time and resources. Full article

Background/Objectives: Postoperative intracerebral hematomas (POHs) are a common complication following brain tumor surgery and are typically associated with unfavorable outcomes. While extensive hemorrhages have been studied extensively, smaller, Non-Space-Occupying hemorrhages are frequently detected, yet their clinical relevance and associated risk factors remain insufficiently understood. This study aimed to identify predictive factors for the occurrence of Non-Space-Occupying postoperative cerebral hemorrhages in patients undergoing brain tumor resection. Methods: A total of 1481 patients without a history of anticoagulant or antiplatelet therapy underwent brain tumor surgery at our neurosurgical institute over a ten-year period. Non-Space-Occupying postoperative hemorrhages were diagnosed in 84 patients using cranial computed tomography (cCT) or magnetic resonance imaging (cMRI) performed after the tumor resection. Demographic data, pre-existing comorbidities, and tumor characteristics were collected and analyzed. Results: Non-Space-Occupying POHs occurred in 5.6% of patients. The most frequent tumor type associated with POHs was glioblastoma multiforme (N = 33; 39.3%), followed by metastatic lesions (N = 9; 10.7%) and benign primary intracranial neoplasms (N = 31; 38%). None of the affected patients exhibited new neurological deficits or signs of increased intracranial pressure. A multivariate analysis identified the tumor size as an independent risk factor for Non-Space-Occupying POHs (p = 0.002), with patient age emerging as the strongest predictor (p = 0.001). Conclusions: Non-Space-Occupying POHs after a brain tumor resection are significantly associated with the tumor size, an advanced patient age, and the presence of pre-existing liver disease. The recognition of these risk factors may facilitate targeted perioperative monitoring and guide postoperative management strategies. Full article

Intrahepatic cholangiocarcinomas (iCCAs) are histologically subdivided into small duct-type (SD-iCCA) and large duct-type (LD-iCCA). LD-iCCA versus SD-iCCA may differ in the molecular/genetic profiles and oncogenesis, including precursor lesions. While several precursors, such as high-grade biliary intraepithelial neoplasm (BilIN) and intraductal papillary neoplasm of bile duct (IPNB), have been proposed for LD-iCCA, the potential SD-iCCA precursors remain to be identified. Amid growing interests in the precursors of SD-iCCA, benign “biliary lesions/neoplasms developing in the hepatic parenchyma (BLNP)” such as von Meyenburg complexes (VMCs), bile duct adenomas (BDAs), and biliary adenofibroma (BAF), have been noted to determine whether they have the potential for precursor of SD-iCCA. Herein, these BLNPs were reviewed. BLNP can be classified into three categories. First, traditional VMC and BDA in normal livers which lack atypical features are categorized as “traditional BLNP”. Second, a constellation of several lesions such as VMC and BDA detectable in the background livers of SD-iCCA and in chronic liver disease (unusual VMC and BDA), VMC with dysplastic features, BDA located in the deep hepatic parenchyma, multiple BDA, BDA presenting the BRAF V600E mutation, and BAF harboring variable dysplasia or in situ carcinomas, which may include neoplastic lesions but do not show invasive growth, are categorized as “unusual/dysplastic BLNP”. Third, tubulocystic carcinoma with BAF-like features (AI-TCC) and SD-iCCA with ductal plate malformation (DPMP) which share overlapping features and show relatively good post-operative outcomes and retained features of VMC or DPM, and BDA and BAF, are categorized as “low-grade malignant BLNP”. While the first category is benign and may not be related to SD-iCCA, some of the second category may be related to SD-iCCA, and the third category is malignant and shows invasive growth. The latter two categories may form a common biliary tumorigenic spectrum involving BLNP. Precursors of SD-iCCA, if they exist, may be included in the second category, and the third category may represent unique carcinomas possibly associated with or followed by conventional SD-iCCA. In conclusion, this novel approach to categorize BLNPs into three categories guarantees further studies of precursors of and their progression to conventional SD-iCCA. Full article

Background and Clinical Significance: Hepatic sarcoidosis is a benign lesion of unknown etiology. The gold standard for diagnosing hepatic sarcoidosis is histopathological examination. The symptoms and imaging findings of patients with hepatic sarcoidosis are often atypical, leading to misdiagnosis as hepatocellular carcinoma (HCC). Ultrasound resolution microscopy (URM) can overcome the diffraction limit, enabling fine visualization and quantitative analysis of the microvascular networks. This study aimed to provide new evidence for the differential diagnosis of these two diseases by comparing the URM parameters of hepatic sarcoidosis initially misdiagnosed as HCC with those of HCC. Case Presentation: A 67-year-old woman was admitted to the hospital due to upper abdominal pain for two weeks. Ultrasonography revealed a liver mass. The lesion was located in segment IV of the left hepatic lobe, was approximately 18 × 10 mm in size, and appeared hypoechoic. Contrast-enhanced ultrasound and enhanced magnetic resonance imaging both showed a “fast-in, fast-out” pattern, strongly suggesting HCC. The tumor markers were within the normal range. The patient underwent a laparoscopic left hepatic lobectomy. The histopathological diagnosis of the resected specimen was “hepatic sarcoidosis”. URM examination was performed during the preoperative diagnostic process. Subsequently, the URM parameters of the patient’s lesion were analyzed and compared with those of HCC. The results showed differences in multiple URM parameters, including microvascular flow velocity, diameter, microvascular density ratio, and vascular distribution, between this case of hepatic sarcoidosis and HCC. Conclusions: URM can quantitatively and multidimensionally evaluate the microvasculature of liver lesions, providing new reference data for the diagnosis and differential diagnosis of hepatic sarcoidosis. Full article

Background: Germ cell tumors are benign or malignant tumors that originate from the human embryo’s primordial germ cells. This study aims to conduct a retrospective analysis of germ cell tumors followed up at our institution, including their epidemiological data, treatment, and prognosis. Patients and Methods: Ninety-three cases were included and retrospectively evaluated for socio-demographic features, clinical data, presenting symptoms, histopathological findings, localization, staging, treatment protocol, and survival analysis. Results: Patients were diagnosed between 10 days and 17 years 10 months (median 27.2 months); 37 (40.7%) were male, 54 (59.3%) female. The tumors were located in the sacrococcygeal region (33.3%), ovaries (26.8%), testes (25.8%), abdomen (7.5%), CNS (2.1%), liver, adrenal gland, anterior mediastinum, and spine. Thirty-nine lesions were benign, and 54 were malignant. Mature cystic teratomas (40.8%), endodermal sinus tumors (28.0%), mixed germ cell tumors (12.9%), immature teratomas (9.7%), germinoma (6.5%), gonadoblastoma (1.1%), and choriocarcinoma (1.1%) were the different types of histology. We observed metastases in 17 malignant cases, with the lungs being the most commonly affected (10.7%). Stages I, II, III, and IV included 16, 17, 11, and 10 cases, respectively. Survival rates for all cases were 95.8%, and for malignant tumors, they were 92.7%. For malignant cases, the event-free survival rate was 84.2%. Conclusions: The findings provide comprehensive epidemiological and clinical data on germ cell tumors, enhancing understanding of their distribution, treatment outcomes, and prognosis. The high survival rates observed highlight the effectiveness of current treatment protocols, as well as the importance of early diagnosis and appropriate management. Full article

FDG PET/CT often underperforms in characterizing hyper-enhancing, FDG-non-avid renal masses. We present two cases illustrating the potential of ⁶⁸Ga-NY104, a novel small-molecule tracer targeting carbonic anhydrase IX (CAIX), for this differential diagnosis. Both patients presented with a hyper-enhancing right renal mass suspicious for clear cell renal carcinoma (ccRCC) and subsequently underwent both ¹⁸F-FDG and ⁶⁸Ga-NY104 PET/CT, with histopathology and CAIX immunohistochemistry (IHC) as the reference standard. On ¹⁸F-FDG, both lesions were non-avid (SUVmax 2.6 and 2.2, Tumor-to-Liver Ratio [TLR] 0.87 and 0.69, respectively). However, on ⁶⁸Ga-NY104 PET/CT, Patient 1 (a 65-year-old man) showed intense, homogeneous uptake (SUVmax 26.0, TLR 4.64), while Patient 2 (a 67-year-old woman) showed negligible uptake (SUVmax 2.5, TLR 0.68). It was consistent with histopathology and IHC results that Patient 1 was CAIX-positive ccRCC, while Patient 2 was CAIX-negative hemangioma. Our preliminary cases suggest the potential utility of CAIX-targeted PET/CT imaging with ⁶⁸Ga-NY104 in differentiating ccRCC from benign mimickers like renal hemangioma, which warrants further prospective evaluation. Full article

Objective: To evaluate the safety, diagnostic yield, and ablation efficacy of a single-session workflow combining stereotactic percutaneous core-needle biopsy (CNB) immediately followed by microwave ablation (MWA) for liver tumors. Methods: We retrospectively reviewed consecutive patients (December 2021–May 2025) who underwent stereotactic CNB followed by MWA in the same procedure. Primary endpoints were primary technique efficacy (PTE) and complications. Secondary endpoints were 6-month local tumor progression (LTP) and diagnostic yield. Six-month LTP was summarized using a Kaplan–Meier (KM) point estimate with Greenwood 95% CIs. Results: Thirty-three patients underwent single-session biopsy and ablation (33 biopsied; 41 lesions ablated). PTE was 95.1% (39/41); two residual tumors were successfully re-ablated. Six-month LTP was 3.6% (patient level; KM 95% CI 0.0–10.5%) and 2.8% (lesion level; KM 95% CI 0.0–8.2%). There was one major complication (3%, post-ablation abscess) and no minor complications. Adequate tissue was obtained in all biopsies; a definitive diagnosis was established in 88% (29/33): malignancy in 73% (24/33) and benignity in 15% (5/33); 12% (4/33) were nondiagnostic. In the hepatocellular carcinoma (HCC)-suspected subgroup (LI-RADS LR-3 to LR-5; n = 24), all LR-5 lesions were HCC (11/11). Among LR-4 lesions (n = 7), histology showed HCC in 1/7 (14%) and cholangiocarcinoma in 2/7 (29%); 4/7 (57%) were benign or nondiagnostic. Among LR-3 lesions (n = 6), 2/6 (33%) were HCC and 4/6 (67%) were benign or nondiagnostic. In the metastasis-suspected subgroup (n = 9), malignancy was confirmed in 8/9 (89%); 1/9 (11%) was nondiagnostic. Conclusions: Single-session stereotactic CNB followed by MWA is feasible and safe, yields diagnostically useful tissue, and achieves high ablation efficacy. Full article

Background and Clinical Significance: Schwannoma is a benign, encapsulated neurogenic neoplasm that originates from Schwann cells of the peripheral nerve sheath. While these tumors may develop in virtually any anatomical location, gallbladder schwannomas are exceptionally rare. Case Presentation: A 56-year-old female patient underwent hepatic tumor resection and cholecystectomy following imaging findings suggestive of possible small hepatocellular carcinoma in the right hepatic lobe and biliary cystadenoma. Postoperative pathological examination confirmed that the liver lesion was a lymphoproliferative disorder and that the gallbladder lesion was a classic schwannoma. The patient recovered well with no evidence of disease recurrence during the two-month follow-up. Conclusions: Current literature indicates that the pathogenesis of gallbladder schwannomas remains unclear, with no apparent age or gender predilection. These lesions lack distinctive clinical or radiological features, necessitating histopathological confirmation. However, they demonstrate excellent prognosis, with no reported recurrence after complete surgical excision. Full article

Background and Objectives: What led to the development of elastography was the emerging need for a method that could objectively and accurately assess the stiffness of internal structures. As a result, a distinction between normal from pathological tissues becomes possible. Objective: To evaluate non-invasive elastographic techniques, point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE), as methods for differentiating simple liver cysts from liver hemangiomas. Materials and Methods—a total of 63 patients—32 with simple liver cysts and 31 with liver hemangiomas were analyzed. The purpose was to determine the values of the average trend (arithmetic mean or median according to the data distribution) as well as the reference intervals of SWV for both methods in the above-mentioned patients. Final diagnoses were confirmed by contrast-enhanced computed tomography (CECT). Results: The pSWE SWV values (median) for simple hepatic cysts showed an average trend of 1.14 m/s, with an upper limit of 3.33 m/s and a lower limit of 0.35 m/s. For 2D-SWE, the average trend for simple hepatic cysts was 1.00 m/s, with an upper limit of 1.54 m/s and a lower limit of 0.65 m/s. For liver hemangiomas, the average trend in pSWE was 1.36 m/s, with an upper limit of 3.22 m/s and a lower limit of 0.57 m/s. For 2D-SWE, the average trend was 1.34 m/s, with an upper limit of 2.27 m/s and a lower limit of 0.80 m/s. Findings in our work mainly serve as reference values. Conclusions: The accurate diagnosis of liver diseases is of paramount importance when it comes to the approach and treatment of individual benign liver lesions. Early diagnosis of focal liver lesions remains a challenging task. Full article