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2.
Chinese Medical Journal ; (24): 1181-1190, 2021.
Article in English | WPRIM | ID: wpr-878169

ABSTRACT

BACKGROUND@#Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC.@*METHODS@#Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade.@*RESULTS@#The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HFtumor - HFliver) and relative flow (rHF = ΔHF/HFliver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781.@*CONCLUSION@#Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEFvariance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.


Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Contrast Media , Humans , Liver Neoplasms/diagnostic imaging , Perfusion , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed
3.
Article in Chinese | WPRIM | ID: wpr-921565

ABSTRACT

Liver metastasis is not rare during the course of neuroendocrine neoplasms.The methods for treating neuroendocrine neoplasm with liver metastasis(NENLM)are diversifying,which exposes the limitations of the early therapeutic response assessment based on only morphological changes.The emerging imaging biomarkers can sensitively describe changes in response to treatment from the functional level,providing new ideas for the therapeutic response evaluation of NENLM.In this paper,we reviewed the status quo and the latest research progress of imaging assessment for early therapeutic response of NENLM,aiming to provide reference for assessing the response and further exploring the treatment-related biomarkers.


Subject(s)
Diagnostic Imaging , Humans , Liver Neoplasms/diagnostic imaging , Neoplasm Metastasis , Neuroendocrine Tumors/diagnostic imaging
4.
Article in Chinese | WPRIM | ID: wpr-879252

ABSTRACT

The three-dimensional (3D) liver and tumor segmentation of liver computed tomography (CT) has very important clinical value for assisting doctors in diagnosis and prognosis. This paper proposes a tumor 3D conditional generation confrontation segmentation network (T3scGAN) based on conditional generation confrontation network (cGAN), and at the same time, a coarse-to-fine 3D automatic segmentation framework is used to accurately segment liver and tumor area. This paper uses 130 cases in the 2017 Liver and Tumor Segmentation Challenge (LiTS) public data set to train, verify and test the T3scGAN model. Finally, the average Dice coefficients of the validation set and test set segmented in the 3D liver regions were 0.963 and 0.961, respectively, while the average Dice coefficients of the validation set and test set segmented in the 3D tumor regions were 0.819 and 0.796, respectively. Experimental results show that the proposed T3scGAN model can effectively segment the 3D liver and its tumor regions, so it can better assist doctors in the accurate diagnosis and treatment of liver cancer.


Subject(s)
Humans , Image Processing, Computer-Assisted , Liver Neoplasms/diagnostic imaging , Tomography, X-Ray Computed
6.
Rev. cir. (Impr.) ; 72(4): 342-346, ago. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1138720

ABSTRACT

Resumen Introducción: Los Schwannomas de la vía biliar corresponden a una entidad extremadamente infrecuente, habiéndose reportado solo escasos casos en la literatura. Caso Clínico: El presente paciente corresponde a un hombre de 45 años, a quien durante examen rutinario se le pesquisa una lesión quística hepática. La resonancia magnética confirmó la lesión, y la biopsia de la pieza resecada diagnosticó la existencia de un Schwannoma benigno con marcadores positivos para vimentina y proteína S-100.


Introduction: Bile duct schwannoma is an extremely rare condition. We report a 45 years old male patient in whom during a rutinary ultrasound exam a liver cyst was detected. Magnetic resonance confirmed lesión and the histopathology of the resected specimen was a benign schwannoma proven by positive inmunoreaction to vimentina.


Subject(s)
Humans , Male , Middle Aged , Liver Neoplasms/diagnostic imaging , Neurilemmoma/diagnostic imaging , Biopsy , Ultrasonography , Liver Neoplasms/pathology , Neurilemmoma/pathology
7.
Rev Assoc Med Bras (1992) ; 66(7): 908-912, 2020. graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136324

ABSTRACT

SUMMARY Hepatocellular carcinoma in patients with hepatitis C in the absence of cirrhosis is uncommon. We demonstrate the importance of morphofunctional magnetic resonance imaging (MRI) with a hepatospecific contrast agent by describing an asymptomatic female patient with HCV, who presented with a nodule detected on ultrasound. She underwent inconclusive computed tomography, presenting no signs of chronic liver disease. MRI with hepatospecific contrast providing functional information combined with the superior tissue contrast inherent to this method stands out for its greater accuracy with the possibility of not resorting to invasive diagnostic methods. With increasing experience and the dissemination of this new diagnostic modality in the medical field, its use and other potential benefits of morphofunctional MRI with hepatospecific contrast agents may be established, benefiting patients with challenging focal liver lesions.


RESUMO O surgimento de carcinoma hepatocelular em pacientes portadores de hepatite C na ausência de cirrose é de ocorrência pouco comum. Demonstramos a importância da ressonância magnética (RM) morfofuncional com contraste hepatoespecífico por meio da descrição de uma paciente do sexo feminino, assintomática, portadora do vírus da hepatite C (VHC), que se apresentou com nódulo detectado na ultrassonografia. Realizou tomografia computadorizada inconclusiva, sem sinais de hepatopatia crônica. A RM com contraste hepatoespecífico, ao proporcionar informações funcionais, somado ao superior contraste tecidual inerente ao método, destaca-se pela maior acurácia, com a possiblidade de não se recorrer a métodos diagnósticos invasivos. Com o acúmulo de experiência e divulgação dessa nova modalidade diagnóstica no meio médico, sua utilização e outros potenciais benefícios da RM morfofuncional com contraste hepatoespecífico podem vir a se estabelecer, beneficiando pacientes com lesões hepáticas focais desafiadoras.


Subject(s)
Humans , Female , Hepatitis C/complications , Carcinoma, Hepatocellular/virology , Carcinoma, Hepatocellular/diagnostic imaging , Liver Neoplasms/virology , Liver Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Contrast Media , Liver Cirrhosis
8.
Rev. cir. (Impr.) ; 71(6): 562-565, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1058319

ABSTRACT

Resumen Introducción: El colangiocarcinoma intrahepático (CIH) corresponde al segundo tumor hepático primario y la resección quirúrgica es la única alternativa válida para el tratamiento curativo de esta enfermedad. Reporte de casos: Describimos 2 paciente portadores de CIH con compromiso de vena cava inferior (VCI) que fueron sometidos a resección en Clínica Alemana de Santiago (CAS). Ambas pacientes son de género femenino de 39 y 47 años de edad. Ambas fueron sometidas a resección mayor hepática izquierda, asociada a resección del segmento I y extendida a VCI. La reconstrucción de la VCI fue realizada con parche pericárdico bovino y cierre primario respectivamente. El período desde el posoperatorio hasta el alta, fue de 13 y 23 días respectivamente. Discusión: Aunque la reseccion quirúrgica es la única vía para la curación en el CIH, el compromiso de estructuras vasculares hacen que esto no sea posible. El manejo multidisciplinario asociado a una técnica meticulosa realizada por un equipo quirúrgico experimentado, hacen posible lograr buenos resultados.


Introduction: Intrahepatic cholangiocarcinoma is the second most common primary liver tumor and surgical resection the only valid curative treatment. Case reports: We describe two patients harboring an intrahepatic cholangiocarcinoma with cava vein involvement who underwent resection at Clinica Alemana of Santiago. Both patients were females with ages of 39 and 47 years old. Both patients underwent left liver resection, associated to resection of segment I and of a portion of cava vein. Reconstruction of resected portion of the cava vein was performed by using a pericardium bovine patch and primary closure respectively. Postoperative period was uneventfully being discharged at 13 and 23 days respectively. Discussion: Although surgical resection is the only way to get curativeness, frequent involvement of large vascular structures make treatment unfeasible. A multidisciplinary approach associated with a meticulous technique performed by an experienced surgical team make possible to accomplish the above objective.


Subject(s)
Humans , Female , Adult , Middle Aged , Vena Cava, Inferior/physiopathology , Cholangiocarcinoma/physiopathology , Liver Neoplasms/surgery , Cholangiocarcinoma/surgery , Cholangiocarcinoma/complications , Cholangiocarcinoma/diagnostic imaging , Laparotomy/methods , Liver Neoplasms/diagnostic imaging
9.
Rev. méd. Chile ; 147(6): 808-812, jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1020731

ABSTRACT

Eighty percent of hepatocarcinomas are inoperable at the moment of diagnosis. Liver transplantation is the treatment of choice in these cases, but local therapies are another alternative. Among these, Image-Guided BrachyAblation is a safe choice. We report a 76-year-old male with a hepatocarcinoma, who was considered inoperable due to the high surgical risk of the patient. A local treatment with Image-Guided BrachyAblation was decided. A brachytherapy needle was placed in the tumor under computed tomography guidance and a 15 Gy single dose was delivered from an Iridium-192 source. The patient had no immediate complications and at one month of follow up he continued without incidents.


Subject(s)
Humans , Male , Aged , Brachytherapy/methods , Carcinoma, Hepatocellular/radiotherapy , Ablation Techniques/methods , Radiotherapy, Image-Guided/methods , Liver Neoplasms/radiotherapy , Radiation Dosage , Iridium Radioisotopes , Tomography, X-Ray Computed , Treatment Outcome , Carcinoma, Hepatocellular/diagnostic imaging , Liver Neoplasms/diagnostic imaging
10.
Rev. chil. pediatr ; 90(3): 316-320, jun. 2019. graf
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1013839

ABSTRACT

INTRODUCCIÓN: El hemangioendotelioma hepático (HEH) es un tumor benigno, raro en niños, que se presenta frecuentemente en el primer año de vida. La presentación clínica es variable y su diagnóstico se realiza en base a la sospecha clínica, estudios de laboratorio y de imagen. El objetivo fue describir un caso de hemangioendotelioma hepático multifocal. CASO CLÍNICO: Niña de 3 meses que presentó hepatomegalia sin elementos de falla hepática ni cardiaca. Se realizó ecografía y tomografía de ab domen que orientaron al diagnóstico de HEH que se confirmó con la angioresonancia de abdomen. Recibió glucocorticoides a altas dosis en forma prolongada. Al año y medio de iniciado el tratamiento se evidenció remisión del tumor. Presentó efectos secundarios por el tratamiento instaurado. CONCLUSIONES: La presencia de una hepatomegalia aislada en un lactante asintomático debe hacer pensar en una probable patología tumoral, orientándonos por la clínica e imagenología al diagnóstico nosológico de la misma. Siempre se debe sospesar las posibles complicaciones con los riesgos de los tratamientos a realizar. En este caso la extensión del tumor y sus probables complicaciones justificó el uso de corticoterapia prologada a altas dosis a pesar de sus efectos adversos.


INTRODUCTION: Hepatic hemangioendothelioma is a rare benign tumor in children, which frequently occurs in the first year of life. The clinical presentation is variable and the diagnosis is based on clinical suspicion, and laboratory and imaging studies. The objective was to describe a case of multifocal hepa tic hemangioendothelioma. CLINICAL REPORT: 3-month-old girl who presented hepatomegaly without elements of hepatic or heart failure. Abdominal ultrasound and CT scan were used to diagnose hepatic hemangioendothelioma, which was confirmed by CT abdominal angiography. The patient received glucocorticoid treatment at high doses for a prolonged period. A year and a half after treatment, there was evidence of tumor remission. She had side effects from the established treatment. CONCLUSIONS: In asymptomatic patients with isolated hepatomegaly, it should be considered a probable tumor patho logy, considering the clinic and imaging studies. Possible complications and treatments risks must always be assessed. In this case, the tumor extension and its probable complications justified the use of prolonged corticosteroid therapy at high doses despite its adverse effects.


Subject(s)
Humans , Female , Infant , Hemangioendothelioma/diagnostic imaging , Hepatomegaly/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Treatment Outcome , Computed Tomography Angiography , Glucocorticoids/administration & dosage , Hemangioendothelioma/drug therapy , Hepatomegaly/etiology , Hepatomegaly/drug therapy , Liver Neoplasms/drug therapy
11.
Arq. gastroenterol ; 55(3): 208-211, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973889

ABSTRACT

ABSTRACT BACKGROUND: Though strongly suggestive of metastasis, focal lesions on liver scans of oncological patients require histological confirmation for the prescription of adequate treatment. OBJECTIVE: To evaluate the safety and efficacy of US-guided percutaneous core liver biopsy. METHODS: Descriptive, cross-sectional study based on secondary data from 171 patients submitted to US-guided percutaneous core liver biopsy at the diagnostic radiology service of the Ceará Cancer Institute (ICC, Brazil) between February 2010 and March 2015. Quantitative data were expressed in absolute numbers or percentages, with emphasis on the rate of complications observed within six hours after the procedure. RESULTS: The overall accuracy was 96.4%. The overall rate of complications was 2.3%, three quarters of which was due to hemorrhage. Age over 50 years was positively associated with accuracy. No deaths occurred within the period of observation. CONCLUSION: Our findings support the claim that the use of thick biopsy needles improves diagnostic accuracy. The few complications observed were non-lethal and predominantly hemorrhagic.


RESUMO CONTEXTO: Lesões focais nos exames de imagem do fígado em pacientes oncológicos, embora sejam achados fortemente sugestivos de envolvimento metastático, permanece a necessidade de confirmação histológica, a fim de que se institua uma terapia apropriada. OBJETIVO: Verificar a segurança e a eficácia do procedimento de biópsia hepática percutânea guiada por ultrassom, realizado pelo serviço de Radiologia e Diagnóstico por Imagem do Instituto do Câncer do Ceará (ICC). MÉTODOS: Estudo transversal, descritivo, baseado em dados secundários de 171 pacientes, submetidos a biópsias hepáticas percutâneas, guiadas por ultrassonografia, realizadas no ICC, de fevereiro de 2010 a março de 2015. Os dados quantitativos obtidos foram apresentados em forma de números absolutos ou percentuais, com ênfase nas taxas de complicações, ocorridas nas primeiras seis horas de observação hospitalar. RESULTADOS: A acurácia geral foi de 96,4%. Encontramos uma taxa global de complicações de 2,3%, sendo que 75% delas foram de natureza hemorrágica. Não verificamos a ocorrência de óbitos dentro do período de observação pós-biópsia. CONCLUSÃO: A utilização de agulhas calibrosas, parece, de fato, estar relacionada à melhoria na acurácia diagnóstica, com baixas taxas de complicações, sobretudo as hemorrágicas, contudo não letais. No presente trabalho, a idade mostrou-se um fator modificador da acurácia.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Ultrasonography, Interventional/methods , Image-Guided Biopsy/methods , Liver/pathology , Liver Neoplasms/pathology , Postoperative Complications , Cross-Sectional Studies , Reproducibility of Results , Ultrasonography, Interventional/adverse effects , Biopsy, Large-Core Needle , Image-Guided Biopsy/adverse effects , Liver/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Middle Aged , Neoplasm Metastasis
13.
Gastroenterol. latinoam ; 29(1): 27-32, 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-1116764

ABSTRACT

Hepatocellular carcinoma (HCC) is the main primary liver malignancy. Its prevalence is increasing and is associated in 90% to cirrhotic patients. Hemoperitoneum secondary to spontaneous rupture of the tumor is an uncommon complication in Latin America and the Western world, being more prevalent in Asian races. However, it is associated to hemodynamic repercussion with high mortality, therefore high level of suspicion and early treatment are required. Regarding the management of the condition, in addition to hemodynamic stabilization, active hemostatic control is recommended over conservative management, transarterial chemoembolization being currently the chosen alternative. We present a series of three clinical cases of patients who debuted with clinical manifestation of hemoperitoneum during the diagnostic process of a HCC.


El carcinoma hepatocelular (CHC) corresponde a la principal neoplasia maligna primaria hepática. Su prevalencia va en aumento y se asocia en 90% a pacientes cirróticos. El hemoperitoneo secundario a rotura espontánea del tumor constituye una complicación infrecuente en Latinoamérica y Occidente, siendo más prevalente en razas asiáticas. Sin embargo, se asocia a repercusión hemodinámica con alta mortalidad, por lo que requiere un alto índice de sospecha y tratamiento oportuno precoz. En cuanto al manejo del cuadro, junto a la estabilización hemodinámica se recomienda un control hemostático activo por sobre manejo conservador, siendo la embolización transarterial la alternativa de elección actualmente. Describimos a continuación una serie de tres casos clínicos de pacientes que debutan con manifestación clínica de hemoperitoneo durante el proceso diagnóstico de un CHC.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/complications , Hemoperitoneum/etiology , Hemoperitoneum/therapy , Liver Neoplasms/complications , Rupture, Spontaneous , Tomography, X-Ray Computed , Treatment Outcome , Carcinoma, Hepatocellular/diagnostic imaging , Embolization, Therapeutic , Liver Neoplasms/diagnostic imaging
14.
ABCD arq. bras. cir. dig ; 31(1): e1360, 2018. tab
Article in English | LILACS | ID: biblio-949206

ABSTRACT

ABSTRACT Background: Liver elastography have been reported in hepatocellular carcinoma (HCC) with higher values; however, it is unclear to identify morbimortality risk on liver transplantation waiting list. Aim: To assess liver stiffness, ultrasound and clinical findings in cirrhotic patients with and without HCC on screening for liver transplant and compare the morbimortality risk with elastography and MELD score. Method: Patients with cirrhosis and HCC on screening for liver transplant were enrolled with clinical, radiological and laboratory assessments, and transient elastography. Results: 103 patients were included (without HCC n=58 (66%); HCC n=45 (44%). The mean MELD score was 14.7±6.4, the portal hypertension present on 83.9% and the mean transient elastography value was 32.73±22.5 kPa. The median acoustic radiation force impulse value of liver parenchyma was 1.98 (0.65-3.2) m/s and 2.16 (0.59-2.8) m/s in HCC group. The HCC group was significantly associated with HCV infection (OR 26.84; p<0.0001), higher levels of serum alpha-fetoprotein (OR 5.51; p=0.015), clinical portal hypertension (OR 0.25; p=0.032) and similar MELD score (p=0.693). The area under the receiver operating characteristics (AUROC) showed sensitivity and specificity for serum alpha-fetoprotein (cutoff 9.1 ng/ml), transient elastography value (cutoff value 9 kPa), and acoustic radiation force impulse value (cutoff value 2.56 m/s) of 50% and 86%, 92% and 17% and 21% and 92%, respectively. The survival group had a mean transient elastography value of 31.65±22.2 kPa vs. 50.87±20.9 kPa (p=0.098) and higher MELD scores (p=0.035). Conclusion: Elastography, ultrasound and clinical findings are important non-invasive tools for cirrhosis and HCC on screening for liver transplant. Higher values in liver elastography and MELD scores predict mortality.


RESUMO Racional: A elastografia hepática tem sido relatada nos carcinomas hepatocelulares (CHC); porém, não é claro identificar o risco de morbimortalidade na lista de transplante hepático. Objetivo: Avaliar a morbimortalidade com elastografia transitória e escore MELD. Método: Pacientes adultos com cirrose na triagem para transplante de fígado foram incluídos no estudo. Resultados: Foram incluídos 103 pacientes (sem CHC n=58 (66%), CHC n=45 (44%). O escore MELD médio foi de 14,7±6,4, a hipertensão portal foi de 83,9% e o valor médio de elastografia transitória foi de 32,73±22,5 kPa. O valor médio de ARFI (Impulsão de Força de Radiação Acústica) do parênquima hepático foi de 1,98 (0,65-3,2) m/s e 2,16 (0,59-2,8) m/s no grupo CHC. O grupo CHC foi significativamente associado à infecção por vírus da hepatite C (OR 26,84, p<0,0001), níveis mais altos de alfa-feto proteína sérica (OR 5,51; p=0,015), hipertensão portal clínica (OR 0,25; p=0,032) e pontuação MELD semelhante (p=0,693). Os valores de AUROCs (Area Under the Receiver Operating Characteristics) mostraram sensibilidade e especificidade para a alfa-feto proteína sérica (limite de 9,1 ng/ml), valor elastografia transitória (valor de corte 9 kPa) e valor ARFI (valor de corte 2,56 m/s) de 50% e 86%, 92% e 17% e 21% e 92%, respectivamente. O grupo de sobrevivência apresentou valor elastografia transitória médio de 31,65±22,2 kPa vs. 50,87±20,9 kPa (p=0,098) e valores mais elevados de MELD (p=0,035). Conclusão: Valores mais elevados na elastografia do fígado e nos escores MELD predizem a mortalidade.


Subject(s)
Humans , Male , Female , Adult , Aged , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/diagnostic imaging , Elasticity Imaging Techniques , Liver Cirrhosis/mortality , Liver Cirrhosis/diagnostic imaging , Liver Neoplasms/mortality , Liver Neoplasms/diagnostic imaging , Prognosis , Predictive Value of Tests , Waiting Lists , Liver Transplantation , Carcinoma, Hepatocellular/surgery , Carcinoma, Hepatocellular/complications , Liver Cirrhosis/surgery , Liver Cirrhosis/complications , Liver Neoplasms/surgery , Liver Neoplasms/complications
15.
Einstein (Säo Paulo) ; 16(1): eRC4015, 2018. graf
Article in English | LILACS | ID: biblio-891460

ABSTRACT

ABSTRACT Transarterial selective internal radiation therapy with yttrium-90, also known as radioembolization, is a therapy based on the administration of resin or glass microspheres loaded with the radioisotope yttrium-90, via selective arterial catheterization of tumor-feeding vessels. It is classified as a type of locoregional therapy and its main goal is to treat patients with primary or secondary hepatic lesions that are unresectable and not responsive to other therapies. Since it is a new technology still restricted to very few hospitals in Brazil, but used in patients throughout the country, it is necessary to demonstrate the main aspects of hepatic lesions treated with selective internal radiation therapy found in magnetic resonance imaging, and to make specific considerations on interpretation of these images. The objective of this report is to demonstrate the main aspects of magnetic resonance imaging of unresectable primary or secondary hepatic lesions, in patients submitted to transarterial selective internal radiation therapy.


RESUMO A radioterapia interna seletiva transarterial com ítrio-90, também conhecida como radioembolização, é uma terapia baseada na administração de microesferas de resina ou vidro carregadas com o radioisótopo ítrio-90, via cateterismo arterial seletivo dos vasos nutridores do tumor. É classificada como um tipo de terapia locorregional e seu principal objetivo é tratar pacientes portadores de lesões hepáticas primárias ou secundárias irressecáveis e não responsivas a outras terapias. Por se tratar de uma nova tecnologia, portanto ainda restrita a pouquíssimos hospitais no Brasil (ainda que utilizada em todo país), é necessário demonstrar os principais aspectos de imagem das lesões hepáticas tratadas com radioterapia interna seletiva transarterial encontrados em exame de ressonância magnética, além de delinear considerações específicas de interpretação destas imagens. O objetivo deste relato é demonstrar os principais aspectos encontrados em ressonância magnética de lesões hepáticas irressecáveis, primárias ou secundárias, de pacientes submetidos à radioterapia interna seletiva transarterial.


Subject(s)
Humans , Male , Female , Aged , Yttrium Radioisotopes/therapeutic use , Radiosurgery/methods , Embolization, Therapeutic/methods , Liver Neoplasms/therapy , Magnetic Resonance Imaging , Treatment Outcome , Liver Neoplasms/diagnostic imaging , Middle Aged
18.
Ann. hepatol ; 16(3): 421-429, May.-Jun. 2017. tab, graf
Article in English | LILACS | ID: biblio-887254

ABSTRACT

ABSTRACT Background. Evidence supporting benefit of hepatocellular carcinoma (HCC) surveillance in reducing mortality is not well-established. The effect of HCC surveillance in reducing mortality was assessed by an inverse probability of treatment weighting (IPTW)- based analysis controlled for inherent bias and confounders in observational studies. Material and methods. This retrospective cohort study was conducted on 446 patients diagnosed with HCC between 2007 and 2013 at a major referral center. Surveillance was defined as having at least 1 ultrasound test within a year before HCC diagnosis. Primary outcome was survival estimated using the Kaplan-Meier method with lead-time bias adjustment and compared using the log-rank test. Hazard ratio (HR) and 95% confidence interval (Cl) were computed using conventional Cox and weighted Cox proportional hazards analysis with IPTW adjustment. Results. Of the 446 patients, 103 (23.1%) were diagnosed with HCC through surveillance. The surveillance group had more patients with the Barcelona-Clinic Liver Cancer stage A (80.6% vs. 33.8%, P < 0.0001), more patients eligible for potentially curative treatment (73.8% vs. 44.9%, P < 0.0001), and longer median survival (49.6 vs. 15.9 months, P < 0.0001). By conventional multivariate Cox analysis, HR (95% Cl) of surveillance was 0.63 (0.45-0.87), P = 0.005. The estimated effect of surveillance remained similar in the IPTW-adjusted Cox analysis (HR: 0.57; 95% Cl: 0.43-0.76, P < 0.001). Conclusions. HCC surveillance by ultrasound is associated with a 37% reduction in mortality. Even though surveillance is recommended in all guidelines, but in practice, it is underutilized. Interventions are needed to increase surveillance rate for improving HCC outcome.


Subject(s)
Humans , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/diagnostic imaging , Thailand , Time Factors , Cohort Effect , Proportional Hazards Models , Predictive Value of Tests , Retrospective Studies , Ultrasonography/standards , Practice Guidelines as Topic , Risk Assessment , Kaplan-Meier Estimate , Early Detection of Cancer/methods , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Liver Neoplasms/diagnostic imaging , Neoplasm Staging
20.
Ann. hepatol ; 16(1): 107-114, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-838092

ABSTRACT

Abstract: Background. Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim. To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material and methods. Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively. Results. Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027). Conclusions. This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/mortality , Sarcopenia/mortality , Liver Cirrhosis/mortality , Liver Neoplasms/mortality , Prognosis , Rome/epidemiology , Time Factors , Tomography, X-Ray Computed , Prevalence , Multivariate Analysis , Retrospective Studies , Risk Factors , Carcinoma, Hepatocellular/secondary , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/diagnostic imaging , Risk Assessment , Kaplan-Meier Estimate , Sarcopenia/diagnostic imaging , Tertiary Care Centers , Liver Cirrhosis/diagnostic imaging , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Liver Neoplasms/diagnostic imaging
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