ABSTRACT
Purpose@#Nivolumab and regorafenib are second-line therapies for patients with advanced hepatocellular carcinoma (HCC). We aimed to compare the effectiveness of nivolumab and regorafenib. @*Materials and Methods@#We retrospectively reviewed patients with HCC treated with nivolumab or regorafenib after sorafenib failure. Progression-free survival (PFS) and overall survival (OS) were analyzed. An inverse probability of treatment weighting using the propensity score (PS) was performed to reduce treatment selection bias. @*Results@#Among the 189 patients recruited, 137 and 52 patients received regorafenib and nivolumab after sorafenib failure, respectively. Nivolumab users showed higher Child-Pugh B patients (42.3% vs. 24.1%) and shorter median sorafenib maintenance (2.2 months vs. 3.5 months) compared to regorafenib users. Nivolumab users showed shorter median OS (4.2 months vs. 7.4 months, p=0.045) than regorafenib users and similar median PFS (1.8 months vs. 2.7 months, p=0.070). However, the median overall and PFS did not differ between the two treatment groups after the 1:1 PS matching (log-rank p=0.810 and 0.810, respectively) and after the stabilized inverse probability of treatment weighting (log-rank p=0.445 and 0.878, respectively). In addition, covariate-adjusted Cox regression analyses showed that overall and PFS did not significantly differ between nivolumab and regorafenib users after 1:1 PS matching and stabilized inverse probability of treatment weighting (all p>0.05). @*Conclusion@#Clinical outcomes of patients treated with nivolumab and regorafenib after sorafenib treatment failure did not differ significantly.
ABSTRACT
Purpose@#This study aimed to evaluate the feasibility of measuring liver fat using the volumetric measurement method (Fatvol) by comparing it with the conventional 27-regions of interest drawing method (Fatroi). @*Materials and Methods@#This retrospective study included 67 patients who underwent liver magnetic resonance imaging with fat quantification in August or September 2020.Two experienced abdominal radiologists measured the proton density fat fraction (PDFF) of the liver using the mDIXON-Quant sequence for each of two methods. The PDFF was measured twice with each method at intervals of at least 4 weeks to avoid recall bias. Measurement times were recorded. The intra-class correlation coefficient (ICC) was calculated for intra-exam repeatability, inter-reviewer reproducibility, and inter-exam agreement. @*Results@#Measurement times for Fatvol were significantly shorter than for Fatroi. Measurement times for Fatroi and Fatvol, respectively, for reviewer A were 209.4 ± 55.1 s and 137.2 ± 51.5 s in session 1, and 180.9 ± 37.3 s and 127.0 ± 46.1 s in session 2. For reviewer B, the times were 190.7 ± 30.1 s and 74.8 ± 27.4 s in session 1, and 174.6 ± 21.8 s and 64.1 ± 17.5 s in session 2. In all cases, p < 0.001. The mean PDFF values were 7.2% ± 6.4% and 7.2% ± 6.5% (sessions 1 and 2, respectively) for Fatroi and 7.4% ± 6.0% and 7.3% ± 6.1% for Fatvol for reviewer A. For reviewer B, they were 7.1% ± 6.6% and 7.1% ± 6.6% for Fatroi and 7.4% ± 5.8% and 7.4% ± 5.8% for Fatvol. The ICCs between measurement methods (0.998 and 0.995 for reviewers A and B, respectively), for Fatvol within each reviewer (0.999 and 1.000 in sessions 1 and 2, respectively), and between reviewers (0.999) were excellent. @*Conclusion@#The measurement time could be significantly reduced using Fatvol compared to Fatroi while maintaining the consistency of the liver fat measurement values.
ABSTRACT
Purpose@#Acquisition time reduction in diffusion-weighted imaging (DWI) can be achieved by the combining multiband and variable-rate selective excitation (MB-VERSE). This study attempted to evaluate and compare the image quality (IQ) and focal lesion detectability of the respiratory-triggered MB-VERSE DWI with conventional DWI for liver magnetic resonance imaging. @*Materials and Methods@#The acquisition time, IQ, and focal lesion detectability of MBVERSE DWI and conventional DWI were compared in 144 patients. Qualitative (overall IQ, IQ at the liver dome, sharpness of the liver margin, and degree of artifacts) and quantitative (signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR], and apparent diffusion co efficient) IQ parameters were compared with the Wilcoxon signed-rank test. The diagnostic accuracy for focal lesion detectability was estimated with the mean figure of merit (FOM) from the area under the jackknife alternative free-response receiver operating characteristic curve. @*Results@#The MB-VERSE DWI exhibited significantly shorter scan time (153.1 ± 34.5 s vs.225.1 ± 33.0 s, p 0.050) and similar diagnostic accuracy (FOM, 0.958 vs.0.957, p = 0.583) compared to those of the conventional DWI. @*Conclusion@#MB-VERSE DWI exhibited a significantly shorter acquisition time than conventional DWI, with compromised overall IQ and lower SNR but preserved CNR and focal liver lesion detectability. MB-VERSE DWI may be a useful alternative for patients requiring a short acquisition time.
ABSTRACT
Background@#/Aim: This study aimed to determine the diagnostic performance of 2022 Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) imaging criteria compared with the 2018 KLCA-NCC for hepatocellular carcinoma (HCC) in high-risk patients using magnetic resonance imaging (MRI). @*Methods@#This retrospective study included 415 treatment-naïve patients (152 patients who underwent extracellular contrast agent [ECA]-MRI and 263 who underwent hepatobiliary agent [HBA]-MRI; 535 lesions, including 412 HCCs) with a high risk of HCC who underwent contrast-enhanced MRI. Two readers evaluated all lesions according to the 2018 and 2022 KLCA-NCC imaging diagnostic criteria, and the per-lesion diagnostic performances were compared. @*Results@#In “definite” HCC category of both 2018 and 2022 KLCA-NCC, HBA-MRI showed a significantly higher sensitivity for the diagnosis of HCC than ECA-MRI (77.0% vs. 64.3%, P=0.006) without a significant difference in specificity (94.7% vs. 95.7%, P=0.801). On ECAMRI, “definite” or “probable” HCC categories of the 2022 KLCA-NCC had significantly higher sensitivity than those of the 2018 KLCA-NCC (85.3% vs. 78.3%, P=0.002) with identical specificity (93.6%). On HBA-MRI, the sensitivity and specificity of “definite” or “probable” HCC categories of both 2018 and 2022 KLCA-NCC were not significantly different (83.3% vs. 83.6%, P>0.999 and 92.1% vs. 90.8%, P>0.999, respectively). @*Conclusions@#In “definite” HCC category of both 2018 and 2022 KLCA-NCC, HBA-MRI provides better sensitivity than ECA-MRI without compromising specificity. On ECA-MRI, “definite” or “probable” HCC categories of the 2022 KLCA-NCC may improve sensitivity in the diagnosis of HCC compared with the 2018 KLCA-NCC.
ABSTRACT
Purpose@#The aim of the present study was to evaluate the per-lesion sensitivity and specificity of the Korean Liver Cancer Association–National Cancer Center (KLCA-NCC) 2022 criteria for the noninvasive diagnosis of hepatocellular carcinoma (HCC), with intraindividual comparison of the diagnostic performance of magnetic resonance imaging with extracellular agents (ECA-MRI) and hepatobiliary agents (HBA-MRI). @*Materials and Methods@#Patients at high risk for HCC who were referred to a tertiary academic institution for hepatic lesions with size ≥ 10 mm between July 2019 and June 2022 were enrolled. A total of 91 patients (mean age, 58.1 years; 76 men and 15 women) with 118 lesions who underwent both ECA-MRI and HBA-MRI were eligible for final analysis. The per-lesion sensitivities and specificities of the KLCA-NCC 2022 criteria using ECA-MRI and HBA-MRI were compared using McNemar’s test. @*Results@#The 118 lesions were 93 HCCs, 4 non-HCC malignancies, and 21 benign lesions. On HBA-MRI, the “definite” HCC category showed significantly higher sensitivity than ECA-MRI (78.5% vs. 58.1%, p 0.999). For “probable” or “definite” HCC categories, there were no differences in the sensitivity (84.9% vs. 84.9%, p > 0.999) and specificity (84.0% vs. 84.0%, p > 0.999) between ECA-MRI and HBA-MRI. @*Conclusion@#The “definite” HCC category of the KLCA-NCC 2022 criteria showed higher sensitivity in diagnosing HCC on HBA-MRI compared with ECA-MRI, without compromising specificity. There were no significant differences in the sensitivity and specificity of “probable” or “definite” HCC categories according to ECA-MRI and HBA-MRI.
ABSTRACT
Background/Aims@#To compare the performance of the Liver Imaging Reporting and Data System (LI-RADS) v2018 and Korean Liver Cancer Association-National Cancer Center (KLCANCC) 2018 criteria for diagnosing hepatocellular carcinoma (HCC) using magnetic resonance imaging (MRI) with hepatobiliary agent (HBA). @*Methods@#We searched the MEDLINE and EMBASE for studies from January 1, 2018, to October 20, 2021, that compared the diagnostic performance of two imaging criteria on HBA-MRI. A bivariate random-effects model was fitted to calculate the per-observation sensitivity and specificity, and the estimates of paired data were compared. Subgroup analysis was performed based on the observation size. Meta-regression analysis was also performed for study heterogeneity. @*Results@#Of the six studies included, the pooled sensitivity of the definite HCC category of the KLCA-NCC criteria (82%; 95% confidence interval [CI], 74% to 90%; I 2 =84%) was higher than that of LR-5 of LI-RADS v2018 (65%; 95% CI, 52% to 77%; I 2 =96%) for diagnosing HCC (p<0.001), while the specificity was lower for KLCA-NCC criteria (87%; 95% CI, 84% to 91%; I 2 =0%) than LI-RADS v2018 (93%; 95% CI, 91% to 96%; I 2 =0%) (p=0.017). For observations sized ≥20 mm, the sensitivity was higher for KLCA-NCC 2018 than for LI-RADS v2018 (84% vs 74%, p=0.012), with no significant difference in specificity (81% vs 85%, p=0.451). The reference standard was a significant factor contributing to the heterogeneity of sensitivities. @*Conclusions@#The definite HCC category of KLCA-NCC 2018 provided a higher sensitivity and lower specificity than the LR-5 of LI-RADS v2018 for diagnosing HCC using MRI with HBA.
ABSTRACT
Purpose@#Although chronotropic incompetence (CI) is common in patients with complex congenital heart disease (CHD) and is associated with adverse cardiovascular outcomes, few data are available regarding modifiable predictors of CI in this escalating patient population. We tested the hypothesis that higher levels of physical activity (PA) are associated with a lower prevalence of CI in patients with complex CHD and evaluated the receiver operating characteristic curve to identify the PA level that best predicted CI. @*Methods@#We evaluated 111 adolescents with complex CHD. CI was defined as the failure to achieve 80% of the chronotropic response index during peak cardiopulmonary exercise test. Self-reported habitual activity was obtained using a global PA questionnaire. @*Results@#CI was identified in 45 of the 111 cases (40.5%). After adjusting for potential confounding variables, the high PA group demonstrated a lower odds ratio for having CI (odds ratios, 0.25; 95% confidence interval, 0.06‒0.99) compared with the low PA group. The most accurate cut-point for PA to predict the prevalence of CI was 15 metabolic equivalents (METs)-hours/week (areas under the curve, 0.71; 95% confidence interval, 0.61‒0.81; sensitivity, 71%; specificity, 69%). @*Conclusion@#Our findings demonstrate that higher levels of PA are associated with a lower prevalence of CI, independent of potential confounders, and that 15 METs-hours/week of PA provides a cut-point for accurately predicting the presence of CI in adolescents with complex CHD.
ABSTRACT
Background@#Sarcopenia is defined as the loss of skeletal muscle mass and is associated with negative clinical outcomes. This study aimed to establish sex-specific cutoff values for the skeletal muscle area (SMA) and skeletal muscle index (SMI) at the third lumbar vertebral (L3) level using computed tomography (CT) imaging to identify sarcopenia in healthy Korean liver donors. @*Methods@#This retrospective study included 659 healthy liver donors (408 men and 251 women) aged 20 to 60 years who had undergone abdominal CT examinations between January 2017 and December 2018. Assessment of body composition was performed with an automated segmentation technique using a deep-learning system. Sex-specific SMA and SMI distributions were assessed, and cutoff values for determining sarcopenia were defined as values at either two standard deviations (SDs) below the mean reference value or below the fifth percentile. @*Results@#Using the SD definition, cutoff values for SMA and SMI were 117.04 cm2 and 39.33 cm2/m2, respectively, in men and 71.39 cm2 and 27.77 cm2/m2, respectively, in women. Using the fifth percentile definition, cutoff values for SMA and SMI were 126.88 cm2 and 40.96 cm2/m2, respectively, in men and 78.85 cm2 and 30.60 cm2/m2, respectively, in women. @*Conclusion@#Our data provide sex-specific cutoff values for the SMA and SMI at the L3 level measured by CT imaging in a healthy Korean population, which may be applicable for identifying sarcopenia in this population.
ABSTRACT
Background@#Sarcopenia is defined as the loss of skeletal muscle mass and is associated with negative clinical outcomes. This study aimed to establish sex-specific cutoff values for the skeletal muscle area (SMA) and skeletal muscle index (SMI) at the third lumbar vertebral (L3) level using computed tomography (CT) imaging to identify sarcopenia in healthy Korean liver donors. @*Methods@#This retrospective study included 659 healthy liver donors (408 men and 251 women) aged 20 to 60 years who had undergone abdominal CT examinations between January 2017 and December 2018. Assessment of body composition was performed with an automated segmentation technique using a deep-learning system. Sex-specific SMA and SMI distributions were assessed, and cutoff values for determining sarcopenia were defined as values at either two standard deviations (SDs) below the mean reference value or below the fifth percentile. @*Results@#Using the SD definition, cutoff values for SMA and SMI were 117.04 cm2 and 39.33 cm2/m2, respectively, in men and 71.39 cm2 and 27.77 cm2/m2, respectively, in women. Using the fifth percentile definition, cutoff values for SMA and SMI were 126.88 cm2 and 40.96 cm2/m2, respectively, in men and 78.85 cm2 and 30.60 cm2/m2, respectively, in women. @*Conclusion@#Our data provide sex-specific cutoff values for the SMA and SMI at the L3 level measured by CT imaging in a healthy Korean population, which may be applicable for identifying sarcopenia in this population.
ABSTRACT
The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.