Editorial Diagnostic and Interventional Radiology for

EditorialDiagnostic and Interventional Radiology for Liver Diseases

Satoru Murata,1 Pascal Niggemann,2 Edward W. Lee,3 and Per Kristian Hol4

1Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, 1-1-5 Sendagi, Bunkyou-ku,Tokyo 113-8602, Japan2Department of Radiology, Diakoniekrankenhaus Mannheim, Speyererstr. 91, 68163 Mannheim, Germany3Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA757, Westwood Plaza,Suite 2125B, Los Angeles, CA 90095, USA4The Intervention Centre, Oslo University Hospital Rikshospitalet, Pb 4950 Nydalen, 0424 Oslo, Norway

Correspondence should be addressed to Satoru Murata; [email protected]

Received 28 January 2015; Accepted 28 January 2015

Copyright © 2015 Satoru Murata et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Diseases of the liver are common and often chronic. More-over, the mortality rate associated with chronic liver diseasesremains high, despite the constant development of noveldiagnostic and therapeutic modalities; therefore, numerousefforts are being made to improve imaging techniques,especially in this decade. Currently available imaging pro-cedures allow us to ascertain the morphology, circulation,metabolism, parenchymal texture, fibrosis, and/or tumorviability in the liver. New modalities and protocols, such asmagnetic resonance (MR) perfusion, MR elastography, anddual-energy computed tomography (CT), enable the poten-tial evaluation of liver function via imaging studies. Thus,the utilization of advanced imaging techniques and con-temporary interventional radiology (IR) devices has realizednovel multimodality treatments for liver diseases, resultingin promising outcomes in many patients who cannot besurgically treated.

This special issue of BioMed Research Internationalreviews recent diagnostic and interventional radiologicalaspects of various liver diseases such as liver cancer, fibrosis,chronic hepatitis, liver steatosis, and portal hypertension. Inparticular, new advances in imaging devices and protocolsto evaluate fibrosis or hepatitis are described, as well asfunctional magnetic resonance imaging (MRI) techniquesfor the liver. On the other hand, various interventionalradiological techniques to provide more efficient therapy topatients with advanced liver cancer are also introduced.

MRI is often performed to assess the liver in patients withchronic liver diseases. In this special issue, B. S. Kim et al.present a well-written review on a range of most utilizedliver MR sequences to image patients with poor breath-holdcapabilities. Recent updates on robust liver imaging as well asthe advantages and disadvantages of these new methods arediscussed in detail.

Liver fibrosis is a life-threatening condition with highmorbidity and mortality owing to its diverse causes. Liverbiopsy is the gold-standard method for diagnosing andstaging liver fibrosis in chronic liver diseases, but it has severallimitations, including sample variability and its invasivenature with potential complications. To resolve these prob-lems, different noninvasive imaging-based methods havebeen developed for the accurate diagnosis of liver fibrosis.However, these techniques can only evaluate morphologicalor perfusion-related alterations of the liver, and thus, they areuseful for the diagnosis of only late-stage liver fibrosis, whichis characterized by “irreversible” anatomic and hemodynamicchanges. Therefore, the early identification of hepatic fibrosisis of clinical significance to timely initiate therapy and toeffectively achieve disease regression. In this special issue,S. Palmucci et al. and Z. Li et al. review liver fibrosisevaluated by diffusion-weighted MRI and molecular MRItechniques, respectively, to offer valuable perspectives on thedevelopment and limitations of diagnosing early-stage liverfibrosis.

Hindawi Publishing CorporationBioMed Research InternationalVolume 2015, Article ID 147583, 2 pageshttp://dx.doi.org/10.1155/2015/147583

2 BioMed Research International

The two MRI-related original research reports in thisissue are authored by J. M. Alustiza et al. and F. Paparo et al.who describe MRI liver iron quantification by using theliver-to-muscle ratio and report the reproducibility of sucha method on different MRI machines. Their results confirmits practicality and suggest the possibly wider acceptance ofthis elegant noninvasive technique. F. Paparo et al. reportthat MRI proton density fat fraction is a useful technique forthe noninvasive assessment of liver steatosis in patients withchronic viral C hepatitis.

Diagnostic imaging is increasingly being performed toenable the treatment of liver diseases, and this trend isexpected to persist. Hepatectomy is considered the firstchoice of treatment for early hepatocellular carcinoma(HCC) and resectable cholangiocellular carcinoma.Althoughextended resection is sometimes required for a cure, a suffi-cient volume of the remnant liver should be preserved, unlesshepatic failure ensues after surgery. Portal vein embolization(PVE) is an established and effective method to increasethe volume of the future liver remnant and allows moreextensive resections. In this issue, A. Akiba et al. describe theusefulness of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) MRI for the predictionof liver volume change after PVE. They evaluated signalintensity (SI) contrast between nonembolized and embolizedareas after PVE as well as the change in SI contrast beforeand after PVE (SI ratio) to conclude that either parameterhad a negative correlation with the percentage of the futureliver remnant. Such a result indicated that EOB-MRI mightbe useful for the prediction of hepatic hypertrophy after PVE.

Many IR techniques have been introduced for the treat-ment of liver cancers in the last few decades. Transarterialchemoembolization (TACE) is a major IR method to treatunresectable HCC. However, there is an ongoing controversyregarding which chemoembolization materials should beused to achieve good tumor control and reduce side effects.D. Yasui et al. reported the superior efficacy of TACEwith warmedmiriplatin compared to nonwarmedmiriplatin.Because miriplatin, a recently developed anticancer drugwith few toxic side effects on the vessel wall during arterialinjection, is highly viscous, it yielded suboptimal tumorresponse. Thus, the study by D. Yasui et al. is significant indemonstrating how to increase the efficiency of TACE withmiriplatin. Maximizing TACE visualization of the hepatictumor and identification of tumor feeding vessels is veryimportant and may require repeated injection of contrastmedia, possibly leading to renal failure. J. Paul et al. describean ultrafast cone-beam CT imaging protocol during image-guided hepatic TACE, which reduces the required volumeof contrast media and radiation dose, thus allowing moreextensive treatment.

TACE results in both tumor hypoxia and longer activityperiods of anticancer drugs trapped in the tumor tissue.However, it also induces a posttreatment surge of angiogenicfactors, such as vascular endothelial growth factor (VEGF),as early as a few hours after the procedure. Such a processmay contribute to tumor revascularization, thus reducing theefficacy of TACE. Therefore, several researchers have com-bined sorafenib, an antiangiogenic drug that blocks tumor

cell proliferation and angiogenesis by inhibiting the activity ofVEGF receptors, with TACE to potentially improve treatmentoutcomes. However, sorafenib cannot be used in patientswith severe thrombocytopenia, one of the complications ofhypersplenism, owing to its platelet-decreasing effect. Y.Ooka et al. evaluated the long-termoutcome of partial splenicembolization (PSE) with selective TACE in patients withadvanced HCC accompanied by severe thrombocytopeniaand reported that the procedure allowed these patients toreceive additional sorafenib chemotherapy.

Radiofrequency ablation (RFA) is known to be an effec-tive minimally invasive treatment for small HCC. However,its efficacy is equivocal for HCC larger than 3 cm, and RFA-related complications might depend heavily on the lesionlocation. A. Orlacchio et al. demonstrated that RFA withcareful preprocedural planning could be safely performedeven for lesions larger than 3 cm located in close proximity tothe gallbladder. They report a complete necrosis rate of 87%without major complications in a small patient cohort.

In conclusion, the present special issue summarizesrecent advances in both diagnostic radiology and interven-tional radiology, providing us with valuable perspectives inthis ever-progressing field.

Satoru MurataPascal NiggemannEdward W. LeePer Kristian Hol

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