Karaciğer Hastalıklarında Radyolojik Değerlendirmenin Önemi
Özet
Karaciğer hastalıklarının tanısında radyolojik değerlendirme; benign ve malign fokal lezyonlar ile diffüz parankimal hastalıkların ayırt edilmesinde kritik bir öneme sahiptir. İlk başvurulacak noninvaziv yöntem ultrasonografi (US) iken, lezyon karakterizasyonu ve problem çözümü için dinamik kontrastlı bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) tercih edilir. Son teknolojik gelişmeler sayesinde, kimyasal şift MRG ile karaciğer yağlanması (hepatosteatoz) yüzdesi ölçülebilmekte, MR elastografi ve shear wave elastografi (SWE) ile fibrozis/siroz derecesi noninvaziv olarak saptanabilmektedir. Ayrıca, multifokal lezyonların ayrımı, demir birikimi (hemakromatozis) tespiti ve LI-RADS standardizasyonu ile hepatoselüler karsinom (HSK) gibi malignitelerin erken teşhisi mümkün kılınmaktadır. Kesin tanı konulamayan durumlarda ise US veya BT kılavuzluğunda perkütan biyopsi uygulanır.
Radiological evaluation plays a critical role in the diagnosis of liver diseases, enabling the differentiation between benign and malignant focal lesions and diffuse parenchymal disorders. While ultrasonography (US) is the initial noninvasive method, dynamic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are utilized as problem-solving tools for lesion characterization. Advanced technologies, such as chemical shift MRI, allow quantitative assessment of hepatic steatosis, while MR elastography and shear wave elastography (SWE) offer noninvasive staging of liver fibrosis and cirrhosis. Furthermore, radiological imaging facilitates the distinction of multifocal lesions, identification of iron overload (hemochromatosis), and early detection of malignancies like hepatocellular carcinoma (HCC) through LI-RADS categorization. In cases where a definitive diagnosis remains challenging, US or CT-guided percutaneous biopsy is performed.
Referanslar
Federle M P., Jeffrey R.B, Woodward PJ. et al., Çeviri editörü: İbrahim Tanzer Sancak Diagnostic Imaging Abdomen,2. Baskı (2013), Kısım III Bölüm 1, Güneş Tıp Kitapevi
O'Neill EK, Cogley JR, Miller FH. The ins and outs of liver imaging. Clin Liver Dis. 2015 Feb;19(1):99-121.
McNaughton DA, Abu-Yousef MM. Doppler US of the liver made simple. Radiographics. 2011 Jan-Feb;31(1):161-88.
Gamage, P., Glick, Y. Ultrasound elastography. Reference article, Radiopaedia.org. (accessed on 04 Oct 2021)
Saraireh, Hamzeh A, Shailendra Singh. “Role of endoscopic ultrasound in liver disease: Where do we stand in 2017. World journal of hepatology vol. 9,24 (2017): 1013-1021.
Vijayaraghavan GR, David S, Bermudez-Allende M, et al. Imaging-guided Parenchymal Liver Biopsy: How We Do It. J Clin Imaging Sci. 2011;1:30.
Walker TG. Interventional Procedures. Lippincott Williams & Wilkins. (2012) ISBN:1931884862.
Silas, A. M., Kruskal, J. B., & Kane, R. A. (2001). Intraoperative ultrasound. Radiologic Clinics of North America, 39(3), 429-448.
Neal C. Dalrymple, CHAPTER 2 - Multidetector Computed Tomography, Editor(s): Neal C. Dalrymple, John R. Leyendecker, Michael Oliphant, Problem Solving in Abdominal Imaging,Mosby,2009, Pages 39-55
John R. Leyendecker,CHAPTER 3 - Magnetic Resonance Imaging,editor(s): Neal C. Dalrymple, John R. Leyendecker, Michael Oliphant,Problem Solving in Abdominal Imaging,Mosby,2009,Pages 56-79,
Gaillard, F., Murphy, A. Liver protocol (MRI). Reference article, Radiopaedia.org. (accessed on 04 Oct 2021)
12.Kalra N, Duseja A, Das A et al. Chemical shift magnetic resonance imaging is helpful in detecting hepatic steatosis but not fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Ann Hepatol. 2009 Jan-Mar;8(1):21-5.
Metin NO, Karaosmanoğlu AD, Metin Y, Karçaaltıncaba M. Focal hypersteatosis: a pseudolesion in patients with liver steatosis. Diagn Interv Radiol. 2019;25(1):14-20.
Qayyum A. MR spectroscopy of the liver: principles and clinical applications. Radiographics. 2009 Oct;29(6):1653-64.
Bharwani N, Koh DM. Diffusion-weighted imaging of the liver: an update. Cancer Imaging. 2013 Apr 15;13(2):171-85.
Venkatesh SK, Yin M, Ehman RL. Magnetic resonance elastography of liver: technique, analysis, and clinical applications. J Magn Reson Imaging. 2013 Mar;37(3):544-55.
Soyer P, Bluemke DA, Bliss DF, et al. Surgical segmental anatomy of the liver: demonstration with spiral CT during arterial portography and multiplanar reconstruction. AJR Am J Roentgenol. 1994 Jul;163(1):99-103.
Türk karaciğer araştırmaları derneği, Alkol dışı yağlı karaciğer hastalığı klinik rehberi, Ankara 2021. S(17-18)
Hamer OW, Aguirre DA, Casola G, et al. Fatty liver: imaging patterns and pitfalls. Radiographics. 2006 Nov-Dec;26(6):1637-53.
Kani KK, Moshiri M, Cuevas Cet al. Imaging patterns of hepatic steatosis on multidetector CT: pearls and pitfalls. Clin Radiol. 2012 Apr;67(4):366-71.
20.Reeder SB, Sirlin CB. Quantification of liver fat with magnetic resonance imaging. Magn Reson Imaging Clin N Am. 2010 Aug;18(3):337-57,
Pasanta D, Htun KT, Pan J, et al. Magnetic Resonance Spectroscopy of Hepatic Fat from Fundamental to Clinical Applications. Diagnostics (Basel). 2021 May 7;11(5):842.
Labranche R, Gilbert G, Cerny M, et al. Liver Iron Quantification with MR Imaging: A Primer for Radiologists. Radiographics. 2018 Mar-Apr;38(2):392-412.
Golfeyz S, Lewis S, Weisberg IS. Hemochromatosis: pathophysiology, evaluation, and management of hepatic iron overload with a focus on MRI. Expert Rev Gastroenterol Hepatol. 2018 Aug;12(8):767-778.
Joshi G, Crawford K, Hanna T,et al. US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing Beyond Gallbladder and Biliary Disease. Radiographics. 2018;38(3):766-93.
Sangster GP, Previgliano CH, Nader M, et al. MDCT Imaging Findings of Liver Cirrhosis: Spectrum of Hepatic and Extrahepatic Abdominal Complications. HPB Surg. 2013;2013:129396.
Hanna RF, Aguirre DA, Kased N, Emery SC, Peterson MR, Sirlin CB. Cirrhosis-associated hepatocellular nodules: correlation of histopathologic and MR imaging features. Radiographics. 2008 May-Jun;28(3):747-69.
Cura M, Haskal Z, Lopera J. Diagnostic and interventional radiology for Budd-Chiari syndrome. Radiographics. 2009 May-Jun;29(3):669-81.
Wells ML, Fenstad ER, Poterucha JT, et al. Imaging Findings of Congestive Hepatopathy. Radiographics. 2016 Jul-Aug;36(4):1024-37.
Borhani AA, Wiant A, Heller MT. Cystic hepatic lesions: a review and an algorithmic approach. AJR Am J Roentgenol. 2014 Dec;203(6):1192-204.
Rawla P, Sunkara T, Muralidharan P, et al. An updated review of cystic hepatic lesions. Clin Exp Hepatol. 2019;5(1):22-29.
Soares KC, Arnaoutakis DJ, Kamel I, et al. Cystic neoplasms of the liver: biliary cystadenoma and cystadenocarcinoma. J Am Coll Surg. 2014;218(1):119-128.
Marrone G, Crino' F, Caruso S, et al. Multidisciplinary imaging of liver hydatidosis. World J Gastroenterol. 2012;18(13):1438-1447.
Mamone G, Di Piazza A, Carollo V, et al. Imaging of hepatic hemangioma: from A to Z. Abdom Radiol (NY). 2020 Mar;45(3):672-691.
Sheeza Imtiaz MBBS, F. C. P. S. (2017). Imaging focal nodular hyperplasia. Applied Radiology, 46(2), 26.
Katabathina VS, Menias CO, Shanbhogue AK, et al. Genetics and imaging of hepatocellular adenomas: 2011 update. Radiographics. 2011 Oct;31(6):1529-43.
Iannaccone R, Federle MP, Brancatelli G, et al. Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol. 2006 Jul;187(1):W43-52.
Torabi M, Hosseinzadeh K, Federle MP. CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 2008 Nov-Dec;28(7):1967-82.
Dawes, L. Pyogenic liver abscess. Case study, Radiopaedia.org. (2021)
Bächler P, Baladron MJ, Menias C, Beddings I. et al. Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls. Radiographics. 2016 Jul-Aug;36(4):1001-23.
Chouhan MD, Wiley E, Chiodini PL, et al. Hepatic alveolar hydatid disease (Echinococcus multilocularis), a mimic of liver malignancy: a review for the radiologist in non-endemic areas. Clin Radiol. 2019 Apr;74(4):247-256.
Fábrega-Foster K, Ghasabeh MA, Pawlik TM, et al. Multimodality imaging of intrahepatic cholangiocarcinoma. Hepatobiliary Surg Nutr. 2017 Apr;6(2):67-78.
Kumar V, Abbas AK, Fausto N et-al. Robbins and Cotran pathologic basis of disease. W B Saunders Co. (2005)
Funda obuz, Türk radyoloji derneği seminerleri, 2015;3: 437-60.
Ganeshan D, Szklaruk J, Kundra V, et al. Imaging features of fibrolamellar hepatocellular carcinoma. AJR Am J Roentgenol. 2014 Mar;202(3):544-52.
Choi J. Imaging of hepatic metastases. Cancer Control. 2006 Jan;13(1):6-12.
Lyburn ID, Torreggiani WC, Harris AC, et al. Hepatic epithelioid hemangioendothelioma: sonographic, CT, and MR imaging appearances. AJR Am J Roentgenol. 2003 May;180(5):1359-64.
Koyama T, Fletcher JG, Johnson CD, et al. Primary hepatic angiosarcoma: findings at CT and MR imaging. Radiology. 2002 Mar;222(3):667-73.
Caiado, Angela Hissae Motoyama, et al. "Complications of liver transplantation: multimodality imaging approach." Radiographics 27.5 (2007): 1401-1417.
