Contrast-Enhanced T1-Weighted Magnetic Resonance Cholangiography Using Gadoxetate Disodium in Potential Living Liver Donors: Qualitative and Quantitative Improvement with 3-hour Delayed Imaging.

BACKGROUND: Contrast-enhanced T1-weighted magnetic resonance cholangiography (CE-T1-MRC) after gadoxetate disodium administration can be used for preoperative evaluation of the bile ducts in live liver donors. This study aimed to determine whether CE-T1-MRC with 3-hour delayed imaging improves bile duct visualization both qualitatively and quantitatively compared with 20-minute delayed imaging in potential living liver donors. METHODS: We retrospectively identified 33 potential living liver donors (mean age, 30.1 years; 18 men and 15 women) who underwent preoperative CE-T1-MRC with both 20-minute delayed and 3-hour delayed imaging in a single session. The radiologist scored biliary visualization for right and left hepatic ducts (RHD and LHD), their secondary confluences and segmental bile ducts, common hepatic duct (CHD), and cystic duct (CD), and measured relative contrast ratio (rC) and relative signal intensity (rS) for RHD, LHD, and CHD. The data were analyzed using Wilcoxon's signed-rank test and paired t-test. RESULTS: In qualitative analysis, duct visualization scores for RHD and LHD, their secondary confluences and segmental bile ducts, CHD, and CD were significantly higher on CE-T1-MRC with 3-hour delayed imaging than with 20-minute delayed imaging (all, P ≤ .046). In quantitative analysis, both rC and rS of RHD, LHD, and CHD were significantly higher on CE-T1-MRC with 3-hour delayed imaging than with 20-minute delayed imaging (all, P < .001). CONCLUSIONS: CE-T1-MRC with 3-hour delay imaging improves bile duct visualization both qualitatively and quantitatively in potential living liver donors.

Cutoff Values for Diagnosing Hepatic Steatosis Using Contemporary MRI-Proton Density Fat Fraction Measuring Methods.

OBJECTIVE: To propose standardized MRI-proton density fat fraction (PDFF) cutoff values for diagnosing hepatic steatosis, evaluated using contemporary PDFF measuring methods in a large population of healthy adults, using histologic fat fraction (HFF) as the reference standard. MATERIALS AND METHODS: A retrospective search of electronic medical records between 2015 and 2018 identified 1063 adult donor candidates for liver transplantation who had undergone liver MRI and liver biopsy within a 7-day interval. Patients with a history of liver disease or significant alcohol consumption were excluded. Chemical shift imaging-based MRI (CS-MRI) PDFF and high-speed T2-corrected multi-echo MR spectroscopy (HISTO-MRS) PDFF data were obtained. By temporal splitting, the total population was divided into development and validation sets. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of the MRI-PDFF method. Two cutoff values with sensitivity > 90% and specificity > 90% were selected to rule-out and rule-in, respectively, hepatic steatosis with reference to HFF ≥ 5% in the development set. The diagnostic performance was assessed using the validation set. RESULTS: Of 921 final participants (624 male; mean age ± standard deviation, 31.5 ± 9.0 years), the development and validation sets comprised 497 and 424 patients, respectively. In the development set, the areas under the ROC curve for diagnosing hepatic steatosis were 0.920 for CS-MRI-PDFF and 0.915 for HISTO-MRS-PDFF. For ruling-out hepatic steatosis, the CS-MRI-PDFF cutoff was 2.3% (sensitivity, 92.4%; specificity, 63.0%) and the HISTO-MRI-PDFF cutoff was 2.6% (sensitivity, 88.8%; specificity, 70.1%). For ruling-in hepatic steatosis, the CS-MRI-PDFF cutoff was 3.5% (sensitivity, 73.5%; specificity, 88.6%) and the HISTO-MRI-PDFF cutoff was 4.0% (sensitivity, 74.7%; specificity, 90.6%). CONCLUSION: In a large population of healthy adults, our study suggests diagnostic thresholds for ruling-out and ruling-in hepatic steatosis defined as HFF ≥ 5% by contemporary PDFF measurement methods.

Oral effervescent agent improving magnetic resonance cholangiopancreatography.

Background: The purpose of our study was to validate the oral effervescent agent improving magnetic resonance cholangiopancreatography (MRCP) in patients with suspicious pancreatobiliary disease. Methods: One hundred and eleven consecutive patients with alleged or suspected pancreatobiliary tree problems who had undergone two-dimensional (2D) MRCP imaging both before and after oral effervescent enhancement (conventional-MRCP and enhanced-MRCP) were included. Two radiologists independently scored overall image quality, visualization of ten ductal segments, and gastroduodenal fluid signal intensity score. In consensus, they assessed the presence of gastroduodenal fluids and pancreatobiliary tree overlapping. The data were analyzed using Wilcoxon's signed-rank test, McNemar test, and paired t-test. Results: The grades of overall image quality and individual biliary duct visualization for ten targeted ductal segments, and gastroduodenal fluid signal intensity scores increased significantly on enhanced-MRCP by both readers (P≤0.02), but there was no significant increase for pancreatic duct (PD) at head and tail. On enhanced-MRCP, gastroduodenal fluids except for gastric fundus were less detected rather than those on conventional-MRCP. Anatomic structures of gastroduodenal fluids overlapping extrahepatic bile duct were mainly gastric antrum, duodenal bulb, and 2nd portion on conventional-MRCP. However, these fluids were less overlapped on enhanced-MRCP (P<0.001). Gastric body and antrum were main anatomic structures of gastroduodenal fluids overlapping PD on conventional-MRCP, and fluid in these locations significantly less overlapped PD on enhanced-MRCP (P≤0.02). Conclusions: Oral administration of effervescent agent provided effective elimination of gastroduodenal fluid overlapping pancreatobiliary ductal system at MRCP and can improve the quality of the examination in the patients with known or suspected pancreatobiliary disease.

Sex-specific Cutoff Values of Visceral Fat Area for Lean vs. Overweight/Obese Nonalcoholic Fatty Liver Disease in Asians.

Background and Aims: Visceral obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD). We investigated sex-specific optimal cutoff values for visceral fat area (VFA) associated with lean and overweight/obese NAFLD in an Asian population. Methods: This retrospective study included 678 potential living liver donors (mean age, 30.8±9.4 years; 434 men and 244 women) who had undergone abdominal computed tomography (CT) imaging and liver biopsy between November 2016 and October 2017. VFA was measured using single-slice abdominal CT. NAFLD was evaluated by liver biopsy (≥5% hepatic steatosis). Receiver operating characteristic curve analysis was used to determine cutoff values for VFA associated with lean (body mass index [BMI] <23 kg/m2) and overweight/obese (BMI ≥23 kg/m2) NAFLD. Results: Area under the curve (AUC) values with 95% confidence intervals (CI) for VFA were 0.82 (95% CI, 0.75-0.88) for lean and 0.74 (95% CI, 0.69-0.79) for overweight/obese men with NAFLD. The AUC values were 0.67 (95% CI, 0.58-0.75) for lean and 0.71 (95% CI, 0.62-0.80) for overweight/obese women with NAFLD. The cutoff values for VFA associated with lean NAFLD were 50.2 cm2 in men and 40.5 cm2 in women. The optimal cutoff values for VFA associated with overweight/obese NAFLD were 100.6 cm2 in men and 68.0 cm2 in women. Conclusions: Sex-specific cutoff values for VFA may be useful for identifying subjects at risk of lean and overweight/obese NAFLD.

Progression of Portal Hypertension in Acute Cellular Rejection After Liver Transplantation.

OBJECTIVES: This study was designed to investigate the frequency of computed tomography features indicating progression of portal hypertension and their clinical relevance in patients who experienced acute cellular rejection after liver transplantation. MATERIALS AND METHODS: This retrospective study included 141 patients with pathologically diagnosed acute cellular rejection following liver transplant. Patients were divided into early and late rejection groups according to the time of diagnosis. Two radiologists analyzed the interval changes in spleen size and variceal engorgement on computed tomography images obtained at the times of surgery and biopsy. Aggravation of splenomegaly and variceal engorgement were considered computed tomography features associated with the progression of portal hypertension. Clinical outcomes, including responses to treatment and graft survival, were compared between patients with and without these features. RESULTS: The frequency of progression of portal hypertension was 31.9% and did not differ significantly in patients who experienced early (30.8% [28/91]) and late (34.0% [17/50]) rejection (P = .694). In the late rejection group, computed tomography features indicating progression of portal hypertension were significantly associated with poor response to treatment (P = .033). Graft survival in both the early and late rejection groups did not differ significantly in patients with and without progression of portal hypertension. CONCLUSIONS: Computed tomography features suggesting the progression of portal hypertension were encountered in about one-third of patients who experienced acute cellular rejection after liver transplant. Progression of portal hypertension was significantly related to poor response to treatment in the late rejection group.

Relationship of body mass index and abdominal fat with radiation dose received during preoperative liver CT in potential living liver donors: a cross-sectional study.

Background: Although contrast-enhanced computed tomography (CT) is currently the most widely-used imaging modality for the preoperative evaluation of potential living liver donors, radiation exposure remains a major concern. The present study aimed to determine the relationship of body mass index (BMI) and abdominal fat with the effective radiation dose received during liver CT scans as part of a pre-donation work-up in potential living donors. Methods: This retrospective cross-sectional study included 695 potential living donors (mean age, 30.5±9.7 years; 445 men and 250 women) who had undergone preoperative liver CT scans between 2017 and 2018. The following measures were evaluated: BMI, abdominal fat as measured at the level of the third lumbar vertebra, and effective dose based on the dose length product (DLP). Correlations between the effective dose and other variables were evaluated using Pearson's correlation coefficient. Results: The mean BMI, total fat area (TFA), and effective dose were 23.6±3.3 kg/m2, 218.7±110.0 cm2, and 9.4±3.3 mSv, respectively. The effective dose during liver CT scans had a strong positive correlation with both BMI (r=0.715; P<0.001) and TFA (r=0.792; P<0.001). As BMI and TFA increased, so did the effective dose. Conclusions: Higher BMI and TFA significantly increased the radiation dose received during liver CT scans in potential living donors.

Visceral Fat Area Is an Independent Risk Factor for Overweight or Obese Nonalcoholic Fatty Liver Disease in Potential Living Liver Donors.

BACKGROUND: The present study aimed to evaluate the correlation between hepatic steatosis (HS), determined by biopsy, and visceral adiposity, measured by computed tomography (CT), in overweight or obese potential living liver donors, and to investigate the risk factors for overweight or obese nonalcoholic fatty liver disease (NAFLD). METHODS: This retrospective study included 375 overweight or obese (body mass index ≥23 kg/m2) potential living liver donors (mean age, 30.4 ± 9.5 years; 273 men) who underwent liver biopsies and abdominal CT examinations in 2017 and 2018. Anthropometry, laboratory parameters, body composition, and HS were assessed. Correlations were analyzed using Pearson's correlation coefficient, and logistic regression was used to identify independent predictors of overweight or obese NAFLD. RESULTS: Visceral fat area (VFA) was positively correlated with the degree of HS in men (r = 0.307; P < .001) and women (r = 0.387; P < .001). Multivariable logistic regression analysis showed that alanine aminotransferase (odds ratio [OR], 1.017; 95% confidence interval [CI], 1.001-1.033; P = .033) and VFA (OR, 1.015; 95% CI, 1.008-1.022; P < .001) were independent risk factors for overweight or obese NAFLD in men, and VFA (OR, 1.029; 95% CI, 1.011-1.047; P = .002) was an independent risk factor for overweight or obese NAFLD in women. CONCLUSION: Visceral adiposity was positively correlated with the degree of HS in overweight or obese potential living liver donors. Additionally, visceral adiposity may be an independent risk factor for overweight or obese NAFLD in potential living liver donors.

Comparison of gadoxetate disodium-enhanced MRI sequences for measuring hepatic observation size and its implication of LI-RADS classification.

PURPOSE: We aimed to determine the optimal image sequence for measurement of hepatic observations on gadoxetate disodium-enhanced MRI in comparison with pathologic measurement, and to evaluate its clinical impact on the Liver Imaging Reporting and Data System (LI-RADS) v2018 classification. METHODS: Two hundred and fifty-three patients (279 hepatic observations) who underwent gadoxetate disodium-enhanced MRI and subsequent hepatectomy were retrospectively included. Two radiologists independently evaluated the visualization score (five-point scale) and size of each observation on six MRI sequences (T1-weighted, T2-weighted, arterial-phase, portal venous-phase, transitional-phase [TP], and hepatobiliary-phase [HBP] images) and assigned a LI-RADS category. Correlations between MRI and pathologic measurements were evaluated using Pearson correlation coefficients. A repeated measures analysis of variance with Bonferroni post hoc comparison tests was used to compare the visualization scores and absolute differences between MRI sequences and pathologic measurements. The LI-RADS classification according the size measurement of each MRI sequence was compared using Cochran's Q test with a post hoc McNemar's test. RESULTS: Of the MRI sequences, HBP had the highest visualization score (4.1 ± 0.6) and correlation coefficient (r = 0.965). The absolute difference between MRI and pathologic measurement was lowest on TP (2.3 mm ± 2.2), followed by HBP (2.4 mm ± 2.1). In the LI-RADS classifications, HBP did not have any non-visible observations. Regarding LR-3, LR-4, and LR-5, there was no significantly different LI-RADS classification among the six MRI sequences (p ≥ 0.122). CONCLUSION: Hepatobiliary-phase images are clinically useful for measuring hepatic observations on gadoxetate disodium-enhanced MRI, especially regarding visibility and correlation with pathologic findings.

Impact of the preoperative skeletal muscle index on early remnant liver regeneration in living donors after liver transplantation.

Background: We investigated the correlation between the preoperative skeletal muscle index (SMI) and remnant liver regeneration after right hemihepatectomy for living-donor liver transplantation and aimed to identify preoperative predictors of greater early remnant liver regeneration in living donors. Methods: This retrospective study included 525 right hemiliver donors (mean age, 28.9±8.3 years; 345 male patients) between 2017 and 2018, who underwent computed tomography before surgery and on postoperative day (POD) 7. Preoperative anthropometry, laboratory parameters, skeletal muscle area at the third lumbar vertebral level, and liver volume before and after surgery were evaluated. Correlations were analyzed using Pearson correlation coefficients, and stepwise multiple regression analysis was performed to identify independent predictors of greater remnant liver regeneration. Results: Remnant liver regeneration volume on POD 7 was positively correlated with body mass index (BMI; r=0.280, P<0.001) and SMI (r=0.322, P<0.001), and negatively correlated with age (r=-0.154, P<0.001) and the ratio of future remnant liver volume (FRLV) to total liver volume (TLV; r=-0.261, P<0.001). Stepwise multiple regression analysis showed that high BMI (ß=0.146; P=0.001) and SMI (ß=0.228, P<0.001), young age (ß=-0.091, P=0.025), and a low FRLV/TLV ratio (ß=-0.225, P<0.001) were predictors of greater remnant liver regeneration. Conclusions: High SMI and BMI, young age, and a low FRLV/TLV ratio may predict greater early remnant liver regeneration in living donors after LDLT.

Nanoparticle delivery of recombinant IL-2 (BALLkine-2) achieves durable tumor control with less systemic adverse effects in cancer immunotherapy.

Recent strategies in cancer immunotherapy based on interleukin-2 (IL-2) are generally focused on reducing regulatory T cell (Treg) development by modifying IL-2 receptor alpha (IL-2Rα) domain. However, the clinical utility of high-dose IL-2 treatment is mainly limited by severe systemic toxicity. We find that peritumorally injectable 'BALLkine-2', recombinant human IL-2 (rIL-2) loaded porous nanoparticle, dramatically reduces systemic side effects of rIL-2 by minimizing systemic IL-2 exposure. Notably, in cynomolgus monkeys, subcutaneous (SC)-injection of BALLkine-2 not only dramatically reduces systemic circulation of rIL-2 in the blood, but also increases half-life of IL-2 compared to IV- or SC-injection of free rIL-2. Peritumorally-injected BALLkine-2 enhances intratumoral lymphocyte infiltration without inducing Treg development and more effectively synergizes with PD-1 blockade than high-dose rIL-2 administration in B16F10 melanoma model. BALLkine-2 could be a highly potent therapeutic option due to higher anti-tumor efficacy with lower and fewer doses and reduced systemic toxicity compared to systemic rIL-2.

Controlled attenuation parameter measured using transient elastography for the noninvasive assessment of macrovesicular steatosis in potential living liver donors.

PURPOSE: This study aimed to determine the diagnostic performance of the controlled attenuation parameter (CAP) measured using transient elastography (TE) for assessing macrovesicular steatosis (MaS) in potential living liver donors using same-day biopsy as a reference standard. METHODS: This retrospective study included 204 living liver donor candidates who underwent TE and liver biopsy on the same day between July 2013 and June 2014. The histologic degree of MaS was determined. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of CAP for diagnosing MaS of >10%, and the optimal cutoff value was identified using the maximal Youden index. RESULTS: Based on liver biopsy, 185 subjects had MaS of ≤10% and 19 had MaS of >10%. The CAP value was significantly correlated with the percentage of MaS on liver biopsy (r=0.635, P<0.001), and the median CAP value was significantly higher in subjects with MaS of >10% than in those with MaS of ≤10% (300 dB/m vs. 209 dB/m, P<0.001). The AUROC for diagnosing MaS of >10% by CAP was 0.938 (95% confidence interval, 0.896 to 0.967), and a CAP of >259 dB/m yielded a sensitivity of 84.2% and a specificity of 92.4%. CONCLUSION: The CAP measured using TE was significantly correlated with MaS and accurately detected substantial MaS in potential living liver donors. The CAP is a promising tool for the noninvasive diagnosis of MaS and may be used to screen unsuitable living liver donor candidates.

Visceral adiposity as a risk factor for lean non-alcoholic fatty liver disease in potential living liver donors.

BACKGROUND AND AIM: This study aimed to investigate the relationship between hepatic steatosis (HS) evaluated by biopsy and visceral adiposity assessed by computed tomography in lean living liver donor candidates and to determine the risk factors for lean non-alcoholic fatty liver disease (NAFLD). METHODS: This retrospective study included 250 lean (body mass index, < 23 kg/m2 ) potential living liver donors (mean age, 31.1 ± 8.6 years; 141 men) who had undergone liver biopsy and abdominal computed tomography between 2017 and 2018. Anthropometry, laboratory parameters, body composition, and the degree of HS were evaluated. Logistic regression was used to identify independent predictors of lean NAFLD. RESULTS: The visceral fat area (VFA) was significantly correlated with the degree of HS in men (r = 0.408; P < 0.001) and women (r = 0.360; P < 0.001). The subcutaneous fat area was significantly correlated with the degree of HS in men (r = 0.398; P < 0.001), but not in women. The skeletal muscle area did not correlate with the degree of HS in either men or women. In the multivariable logistic regression analysis, the VFA (odds ratio [OR], 1.028; 95% confidence interval [CI], 1.013-1.044; P < 0.001) and subcutaneous fat area (OR, 1.016; 95% CI, 1.004-1.028; P = 0.009) were independent risk factors for lean NAFLD in men, and the VFA (OR, 1.036; 95% CI, 1.013-1.059; P = 0.002) was an independent risk factor for lean NAFLD in women. CONCLUSIONS: The severity of non-alcoholic fatty liver was positively correlated with visceral fat accumulation in a lean Asian population. Visceral adiposity may be a risk factor for lean NAFLD in potential living liver donors.

Change in hepatic volume profile in potential live liver donors after lifestyle modification for reduction of hepatic steatosis.

PURPOSE: We aimed to evaluate changes in hepatic volume and hemiliver volume percentage in potential liver donors after hepatic steatosis (HS) reduction through lifestyle modification. METHODS: Fifty liver donor candidates with HS (macrovesicular fat [MaF] ≥ 20%) underwent abdominal computed tomography (CT) and liver biopsy before (baseline) and after (follow-up) lifestyle modification. According to the change in MaF, subjects were classified as group A (MaF reduction ≥ 20%, n = 25), and group B (MaF reduction < 20%, n = 25). The hepatic volume and hemiliver volume percentage were measured using CT volumetric analysis. RESULTS: Volume percentage of the left hemiliver + S1 (over the whole liver) significantly increased at follow-up in group A (P < 0.001) but not in group B (P = 0.598). The absolute volume change of the right hemiliver and its percentage change from the baseline were significantly greater than those of the left hemiliver + S1 in group A (P < 0.007). There were no significant differences in these values in group B (P = 0.064 and 0.507, respectively). The percentage of subjects that earned the benefit of becoming suitable donors from the change in hepatic volume distribution caused by HS improvement was 52.0% (13/25) and 40.0% (10/25) in group A and group B, respectively. Regarding posthepatectomy liver failure, none was identified in group A after donation, whereas 12% (3/25) was identified in group B. CONCLUSION: Hepatic volume profile may change considerably in potential liver donors with HS (MaF ≥ 20%) after HS reduction through lifestyle modification. Reevaluation of the hepatic volume is required before liver procurement after lifestyle modification in these subjects.

Liver Imaging Reporting and Data System Category on Magnetic Resonance Imaging Predicts Recurrence of Hepatocellular Carcinoma After Liver Transplantation Within the Milan Criteria: A Multicenter Study.

BACKGROUND: This study was designed to investigate the association between Liver Imaging Reporting and Data System (LI-RADS) category and recurrence of hepatocellular carcinoma (HCC) after primary liver transplantation (LT) within the Milan criteria. METHODS: This multicenter, retrospective study included 140 recipients who underwent living donor LT (LDLT) for treatment-naïve HCC and pretransplant contrast-enhanced magnetic resonance imaging (MRI) between 2009 and 2013. LI-RADS categories were assigned using LI-RADS version 2018. Recurrence-free survival (RFS) and associated factors were evaluated using Cox proportional hazards regression analysis, Kaplan-Meier analysis, and log-rank test. Histological grading and microvascular invasion (MVI) were analyzed on the pathologic examinations of explanted livers. RESULTS: The overall 1-, 3-, 5-, and 7-year RFS rates were 95.6%, 92.6%, 90.2%, and 89.3%, respectively. In the multivariable analysis, independent predictors of recurrence included HCCs categorized as LR-M (hazard ratio [HR], 18.68; 95% confidence interval [CI], 5.79-60.23; P < 0.001) and the largest tumor size of ≥ 3 cm on MRI (HR, 4.18; 95% CI, 1.42-12.37; P = 0.010). The 5-year RFS rate was significantly lower in patients with HCCs categorized as LR-M than in those with HCCs categorized as LR-5 or 4 (LR-5/4) (36.9% vs. 95.8%, respectively; P < 0.001). HCCs categorized as LR-M exhibited significantly more MVI than HCCs categorized as LR-5/4 (57.1% vs. 17.5%, respectively; P = 0.002). CONCLUSIONS: Patients with HCCs categorized as LR-M using LI-RADS version 2018 may have a worse prognosis after primary LT within the Milan criteria than those with HCCs categorized as LR-5/4.

Reappraisal of the prognostic value of Epstein-Barr virus status in monomorphic post-transplantation lymphoproliferative disorders-diffuse large B-cell lymphoma.

The role of the Epstein-Barr virus (EBV) status in the blood for predicting survival in post-transplantation lymphoproliferative disorders-diffuse large B-cell lymphoma (PTLD-DLBCL) is unknown. We evaluated the prognostic values of pre-treatment EBV-encoded small RNA (EBER) detected with in situ hybridization in tissues and EBV DNA in the whole blood (WB) and plasma in 58 patients with monomorphic PTLD-DLBCL after solid organ transplantation. There were no significant differences in the rates of overall response, complete response, and survival according to EBER EBV and WB EBV status. In contrast, patients with positive plasma EBV DNA had significantly lower rates of overall response (60.0% vs. 94.4%, P = 0.043) and complete response (40.0% vs. 88.9%, P = 0.019) as well as worse progression-free survival (PFS) (P = 0.035) and overall survival (OS) (P = 0.039) compared with patients with negative plasma EBV DNA. In multivariate analysis, plasma EBV DNA positivity was a significantly unfavorable prognostic factor for PFS [hazard ratio (HR) 4.92, 95% confidence interval (CI) 1.22-19.86, P = 0.025] and OS (HR 4.48, 95% CI 1.14-17.63, P = 0.032). Despite small number of 6 patients with plasma EBV positivity, plasma EBV DNA positivity might be more prognostic for survival than EBER or WB EBV DNA positivity in patients with monomorphic PTLD-DLBCL.

Porto-sinusoidal vascular disease with portal hypertension versus liver cirrhosis: differences in imaging features on CT and hepatobiliary contrast-enhanced MRI.

PURPOSE: To differentiate the computed tomography (CT) and magnetic resonance imaging (MRI) features of porto-sinusoidal vascular disease (PSVD) and liver cirrhosis (LC). METHODS: In this retrospective case-control study of patients with PSVD matched in a 1:3 ratio with LC patients according to liver function, initial diagnosis and time to final diagnosis were analyzed. Imaging features on CT and the parenchymal enhancement on hepatobiliary phase of hepatobiliary agent-enhanced MRI (HBA-MRI) were compared using a generalized linear mixed model. Focal hepatic lesions in the PSVD group were analyzed. RESULTS: In total, 43 PSVD patients and 129 LC patients were included. Among PSVD patients, 72.1% were initially misdiagnosed with LC. PSVD patients had a longer diagnostic delay than LC patients (32 months vs. 4 months; p < 0.001). Liver surface nodularity was less common in the PSVD group than in the LC group (16.3% vs. 89.2%, p < 0.001). Increased caudate-to-right lobe ratio, heterogeneous parenchymal enhancement, and portal vein abnormalities were more frequently noted in the PSVD group than in the LC group (all p < 0.001). The grade of portal hypertension was significantly higher in the PSVD group than in the LC group (p < 0.001), and they also had brighter parenchymal enhancement during the hepatobiliary phase of HBA-MRI (p < 0.001). In the PSVD group, 14% patients had at least one focal hepatic lesion, primarily a focal nodular hyperplasia (FNH)-like nodule. CONCLUSIONS: Some imaging features on CT and HBA-MRI can distinguish PSVD from LC. Benign focal lesions, most commonly FNH-like nodules, can develop in PSVD.

Living Donor Liver Transplantation Versus Deceased Donor Liver Transplantation for Hepatocellular Carcinoma Within or Beyond the Milan Criteria: Comparable Long-Term Outcomes.

BACKGROUND: The long-term outcomes after living donor liver transplantation (LDLT) vs deceased donor liver transplantation (DDLT) for hepatocellular carcinoma (HCC) remain controversial. We compared the long-term outcomes between LDLT and DDLT in patients with HCCs within or beyond the Milan criteria. METHODS: This retrospective study included 896 patients who underwent liver transplantation (829 LDLTs and 67 DDLTs) for HCC from June 2005 to May 2015. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method with log-rank test. RESULTS: RFS at 1, 3, 5, and 10 years after LDLT was 89.6%, 84.6%, 82.4%, and 79.6%, respectively, and, after DDLT, was 92.4%, 86.2%, 82.4%, and 82.4%, respectively, and OS at 1, 3, 5, and 10 years after LDLT was 96.1%, 88.1%, 85.6%, and 82.7%, respectively, and, after DDLT, was 97.0%, 83.6%, 82.1%, and 77.3%, respectively, with no significant differences in RFS (P = .838) or OS (P = .293) between groups. No statistically significant differences after LDLT or DDLT were identified in RFS (89.8% vs 98.1%, respectively, at 5 years; P = .053) or OS (90.4% vs 90.6% , respectively, at 5 years; P = .583) for HCCs meeting the Milan criteria as well as for those beyond the Milan criteria (RFS, 37.8% vs 28.6%, respectively, at 5 years; P = .560 and OS, 57.3% vs 50.0%, respectively, at 5 years; P = .743). CONCLUSIONS: Patients who underwent LDLT for HCCs showed comparable long-term outcomes to patients who underwent DDLT. Patients with HCCs within the Milan criteria demonstrated acceptable long-term outcomes after both LDLT and DDLT.

Lifestyle Modification Leads to Spatially Variable Reduction in Hepatic Steatosis in Potential Living Liver Donors.

The spatial variability of hepatic fat reduction in potential living liver donors with hepatic steatosis (HS) who undergo lifestyle modification has not been investigated. Here, we aimed to examine the intrasegmental and intersegmental variability of changes in liver attenuation on computed tomography (CT) in potential living liver donors with HS after diet modification and exercise. A total of 87 living liver donor candidates (30.5 ± 7.0 years; 74 males) with biopsy-proven macrovesicular fat (MaF) ≥10% were included. All underwent diet modification and exercise to improve HS, baseline and follow-up unenhanced CT scans, and liver biopsies. Attenuation and its variability (mean and standard deviation, respectively, in Hounsfield units) in segmental, lobar, superficial, deep, and whole areas of the liver were measured across 32 different regions of interest on both baseline and follow-up CT. At baseline, the right lobe and superficial areas of liver showed significantly lower and more variable attenuation than left lobe and deep areas. Greater variability was noted in patients with more severe HS. Mean interval changes in liver attenuation and variability before and after diet modification and exercise were 13.7 (range, -10.6 to 46.2) and 4.7 (1.6-10.6), respectively. The mean interval change in liver attenuation was significantly higher in the right lobe than in the left (14.7 versus 12.7; P < 0.001), and in superficial areas than in deep areas (14.0 versus 13.4; P = 0.02). Greater variability and larger interval changes in liver attenuation were noted in those who responded (≥20% decrease in MaF) to diet modification and exercise than in those who did not. In conclusion, potential living liver donors with HS show significant intrasegmental and intersegmental variability in hepatic fat reduction on CT before and after diet modification and exercise.

The role of multiphase CT in patients with acute postoperative bleeding after liver transplantation.

PURPOSE: The aim of this study was to investigate the role of multiphase computed tomography (CT) in patients with acute postoperative bleeding after liver transplantation(LT). METHODS: We retrospectively analyzed multiphase CT images in 270 post-LT bleeding patients between November 2013 and December 2017, with special attention to contrast extravasation (type I, focal or stipple; type II, jet). Patients were classified into conservative management trial and primary therapeutic intervention groups by initial treatment strategy, and then conservative management trial group was subdivided into successful conservative management and conservative management failure groups. On multiphase CT, we evaluated contrast extravasation volume, rate, and patterns (focal or stipple vs. jet). The concordances of the bleeding source determined by multiphase CT to the actual bleeding source were analyzed. RESULTS: Of 270 patients, 134 contrast extravasation sites were identified in 116 (43.0%) patients. Most (94.8%, 146/154) of patients without contrast extravasation was successfully managed by conservative management. The mean volume and rate of contrast extravasation significantly increased in order of successful conservative management, conservative management failure, and primary therapeutic intervention groups (all p < 0.01). In subgroup analysis, jet pattern contrast extravasation was more commonly observed with conservative management failure group (p = 0.01). In addition, the change in pattern of contrast extravasation from type I to II was significantly related to the conservative management failure (OR 10.3; 95% CI 1.8-60.4; p = 0.01). There was substantial agreement in localization of bleeding source between multiphase CT and surgery or angiography (Cohen Kappa = 0.78). CONCLUSION: Multiphase CT is helpful in the assessment for need of therapeutic intervention and to determine the treatment of choice in recipient with post-LT bleeding.