Advertisement

The expanding potential of functional liver imaging: From research tools to clinical practice in oncology and internal medicine

      In this issue of the European Journal of Internal Medicine, M.N. Cruz and colleagues present a review of current liver imaging techniques [
      • Cruz M.
      • Aguiar Ferreira A.
      • Papanikolaou N.
      • Banerjee R.
      • Caseiro Alves F.
      New boundaries of liver imaging: from morphology to function.
      ], the potential of which has expanded from mere imaging, with regard to viewing inside the body, as if it were a macroscopic autoptic sectorial exam; but, in living bodies, to the exploration of organ and cellular functions. This evolution has taken place, thanks to the digital revolution, and has boosted in the last ten to fifteen years, in keeping with the rapidly increasing speed of computing machines. Functional imaging means that radiological techniques, based on X-rays or magnetic resonance (MR) or ultrasound (US) are utilized to provide information about the function of whole organs, or of specific cell types or of liver circulation, or even about the expression of molecular biomarkers at a microscopic level. The review focuses primarily in depth on the advancement of MR techniques [
      • Cruz M.
      • Aguiar Ferreira A.
      • Papanikolaou N.
      • Banerjee R.
      • Caseiro Alves F.
      New boundaries of liver imaging: from morphology to function.
      ]. Indeed, the techniques that have advanced most are MR and US. This is in keeping with the fact that CT implies X-rays, the utilization of which and particularly repeated utilization over time (to monitor functional changes over time) must be limited due to radiation hazards. Moreover, X-rays are less affected by changes in living structures than MR and US and were felt less apt to provide functional information, at least as of today. There have been no dramatic general advances in Positron Emission Tomography for the liver in recent years for the standard clinical practice, but this technique is to be listed as a fully functional imaging, because it assesses metabolic processes in the body, like cellular activity in terms of glucidic metabolism (18-Fludeoxyglucose PET) or of choline uptake (choline-11 carbon) just to make a few examples of most commonly utilized tracers, which are standard clinical practice. Several other biomarkers for different metabolic processes have been introduced or are tested in recent times, to assess different diseases, not limited to the oncological field [
      • Filippi L.
      • Schillaci O.
      • Bagni O.
      Recent advances in PET probes for hepatocellular carcinoma characterization.
      ], as some promising tracers are apparently able to assess specific hepatocellular and biliary functions [
      • Keiding S.
      • Sørensen M.
      • Frisch K.
      • Gormsen L.C.
      • Munk O.L.
      Quantitative PET of liver functions.
      ].

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cruz M.
        • Aguiar Ferreira A.
        • Papanikolaou N.
        • Banerjee R.
        • Caseiro Alves F.
        New boundaries of liver imaging: from morphology to function.
        Eur J Internal Med. 2020; https://doi.org/10.1016/j.ejim.2020.06.004
        • Filippi L.
        • Schillaci O.
        • Bagni O.
        Recent advances in PET probes for hepatocellular carcinoma characterization.
        Expert Rev Med Dev. 2019; 16: 341-350
        • Keiding S.
        • Sørensen M.
        • Frisch K.
        • Gormsen L.C.
        • Munk O.L.
        Quantitative PET of liver functions.
        Am J Nucl Med Mol Imaging. 2018; 25: 73-85
        • İdilman İ.S.
        • Akata D.
        • Özmen M.N.
        • Karçaaltıncaba M.
        Different forms of iron accumulation in the lier on MRI.
        Diagn Interv Radiol. 2016; 22: 22-28
        • Drakonaki E.E.
        • Maris T.G.
        • Maragaki S.
        • Klironomos V.
        • Papadakis A.
        • Karantanas A.H.
        Deferoxamine versus combined therapy for chelating liver, spleen and bone marrow iron in beta-thalassemic patients: a quantitative magnetic resonance imaging study.
        Hemoglobin. 2010; 34: 95-106
        • European Association for the Study of the Liver (EASL)
        European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease..
        J Hepatol. 2016; 64: 1388-1402
        • Renzulli M.
        • Biselli M.
        • Brocchi S.
        • Granito A.
        • Vasuri F.
        • Tovoli F.
        • et al.
        New hallmark ofhepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm.
        Gut. 2018; 67: 1674-1682
        • Dietrich C.F.
        • Bamber J.
        • Berzigotti A.
        • Bota S.
        • Cantisani V.
        • Castera L.
        • et al.
        EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version).
        Ultraschall Med. 2017; 38: e16-e47
        • Dietrich C.F.
        • Nolsoe C.
        • Barr R.
        • Berzigott A.
        • Burns P.
        • Cantisani V.
        • et al.
        Guidelines and good clnical practice recommendations for contrast-enhanced ultrasound in the liver – update 2020.
        Ultrasound Med Biol. 2020; (e-pub)
        • Lee Y.J.
        • Kim S.H.
        • Kang B.J.
        • Kim Y.J.
        Contrast-enhanced ultrasound for early prediction of response of breast cancer to neoadjuvant chemotherapy.
        Ultraschall Med. 2019; 40: 194-204
        • Piscaglia F.
        • Berzigotti A.
        • Amat-Roldan I.
        • Vukotic R.
        • Bosch J.
        • CLEVER Study investigators
        Non-invasive measurement of HVPG using graph analysis based on dynamic contrast-enhanced ultrasound with ESAOTE MyLab: the CLEVER study.
        Dig Liver Dis. 2018; 50: 33
        • Eisenbrey J.R.
        • Dave J.K.
        • Halldorsdottir V.G.
        • Merton D.A.
        • Miller C.
        • Gonzalez J.M.
        • et al.
        Chronic liver disease: noninvasive subharmonic aided pressure estimation of hepatic venous pressure gradient.
        Radiology. 2013; 268: 581-588
        • Willmann J.K.
        • Bonomo L.
        • Testa A.C.
        • Rinaldi P.
        • Rindi G.
        • Valluru K.S.
        • et al.
        Ultrasound molecular imaging with BR55 in patients with breast and ovarian lesions: first-in-human results.
        J Clin Oncol. 2017; 35: 2133-2140
        • Baron Toaldo M.
        • Salvatore V.
        • Marinelli S.
        • Palamà C.
        • Milazzo M.
        • Croci L.
        • et al.
        Use of VEGFR-2 targeted ultrasound contrast agent for the early evaluation of response to sorafenib in a mouse model of hepatocellular carcinoma.
        Mol Imaging Biol. 2015; 17: 29-37
        • Lassau N.
        • Estienne T.
        • de Vomecourt P.
        • Azoulay M.
        • Cagnol J.
        • Garcia G.
        • et al.
        Five simultaneous artificial intelligence data challenges on ultrasound, CT, and MRI.
        Diagn Interv Imaging. 2019; 100: 199-209